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Abay Atnafu,1 Liya Wassie,1 Melaku Tilahun,1,&ast; Selfu Girma,1 Yohannes Zenebe,2 Muluye Abebe Beyene,1 Ashenafi Alemu,1 Emnet Fisseha,1 Haymanot Agze,1 Tigist Desta,1 Kassu Desta,3,&ast; Kidist Bobosha1,&ast; 1Armauer Hansen Research Institute, Addis Ababa, Ethiopia; 2Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 3Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia&ast;These authors contributed equally to this workCorrespondence: Abay Atnafu, Tel +251912205822, Email ayatab.ayele7@gmail.comBackground: Extrapulmonary tuberculosis (EPTB), particularly tubercular lymphadenitis (TBLN), remains to pose a huge public health problem in Ethiopia. A significant number of TBLN patients who completed a full course anti-TB treatment regimen were reported to have enlarged lymph nodes and other TB-like clinical presentations. This could either be from a paradoxical reaction or microbiological relapse, possibly due to mono/multi-drug resistance.Objective: To investigate the rate of mono and multidrug resistance patterns of Mycobacterium tuberculosis as a cause of the observed treatment failures in clinically diagnosed and anti-TB treatment (newly or previously)-initiated LN patients.Methods: A cross-sectional study was conducted on 126 TBLN-suspected and previously treated patients between March and September 2022. Data were analyzed using SPSS (Version 26.0). Descriptive statistics were used to determine the frequency, percentage, sensitivity, specificity, and positive and negative predictive values. The level of agreement was determined using Cohen’s kappa and a Chi-square test was used to measure the association between risk factors and laboratory test outcomes. A P-value < 0.05 was considered statistically significant.Results: Mycobacterium tuberculosis was confirmed in 28.6% (N=36) of the 126 cases using BACTEC MGIT 960 culture detection method. Approximately, 13% (N=16) of the samples were collected from previously treated TBLN patients, of which 5/16 (31.3%) were multi-drug resistant, 7/16 were drug-sensitive and 4/16 were culture negative. To rule out other non-tuberculous agents, all samples were grown on blood and Mycosel agar plates, and no growth was detected.Conclusion: The emergence of drug resistant (DR) TB seems to not just be limited to pulmonary form but also to TBLN. In this study we observed a considerable number of microbiologically confirmed relapses among previously treated cases, possibly indicating the need for confirmation of drug resistance using rapid molecular methods or phenotypical methods during treatment follow up.Keywords: tubercular lymphadenitis, relapse, drug sensitivity testing, DST, FNA

Yosef Zenebe,1 Baye Akele,2 Mulugeta W/Selassie,3 Mogesie Necho1 1Department of Psychiatry, Wollo University, Dessie, Ethiopia; 2Department of Pharmacy, Wollo University, Dessie, Ethiopia; 3Department of Pediatrics and Child Health Nursing, Wollo University, Dessie, EthiopiaCorrespondence: Yosef Zenebe, Email yosef.zenebe79@gmail.com; yosef.zenebe@wu.edu.etBackground: Neurocognitive impairment (NCI) is one of the most common neurological complications in HIV-positive individuals, particularly in resource-limited countries. Neurocognitive impairments can occur at any stage of HIV infection, although the risk increases as the infection progresses. However, in Africa, there are few studies with highly variable and inconsistent results. Therefore, this study aimed to determine the prevalence and factors associated with NCI among HIV-positive people in Africa.Methods: For this systematic review and meta-analysis, we used PubMed/Medline, Scopus, Web of Science, the Cochrane Library, Embase, and PsycINFO to comprehensively search a number of papers. Studies reporting the prevalence of NCI and its factors were included in the estimation of the pooled prevalence. A consistent data extraction format was created in Microsoft Excel to extract the data, which was then imported into STATA 11 statistical software for analysis. The heterogeneity was evaluated using the I2 test, and a random effect meta-analysis model was employed to calculate the pooled prevalence of NCI because the included studies showed significant heterogeneity.Results: In all, Africa had a pooled prevalence of NCI of 45.15% (95% CI: 36.86, 53.43). According to the subgroup analysis of this study, West Africa had the lowest frequency, at 42.40% (95% CI: 22.03, 62.77), whereas Central and South Africa had the highest prevalence, at 49.33% (95% CI: 10.72– 87.95).Conclusion: In Africa, the cumulative prevalence of NCI was high. Being a woman, not having a formal education, those with only an elementary education, being older, having late-stage HIV, and abusing drugs were all often associated with NCI. The average burden of NCI in Africa is high and that would be a significant figure for interventional actions in the area.Keywords: Africa, meta-analysis, NCI, HIV

Yimer Endris,1 Mulugeta W/Selassie,2 Afework Edmealem,3 Sewunet Ademe,3 Wondwossen Yimam,3 Yosef Zenebe4 1Department of Adult Health Nursing, Tropical College of Medicine, Dessie, Ethiopia; 2Department of Pediatrics and Child Health Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia; 3Department of Comprehensive Nursing, Wollo University, College of Medicine and Health Sciences, Dessie, Ethiopia; 4Department of Psychiatry, Wollo University, College of Medicine and Health Sciences, Dessie, EthiopiaCorrespondence: Mulugeta W/Selassie, Email alzunfa@yahoo.comIntroduction: Nurse–physician collaboration is an integral part of quality improvement in health care. Collaboration enables individuals to work together to achieve defined and common health purposes. There is limited evidence related to nurse–physician inter-professional collaboration and its associated factors in Ethiopia, particularly in Dessie city public hospitals.Objective: To assess nurse–physician inter-professional collaboration and associated factors at public hospitals in Dessie city, Ethiopia, 2021.Methods: An institutional-based cross-sectional study was conducted among nurses and physicians at public hospitals in Dessie city. A self-administered questionnaire was used for data collection. Stratified simple random sampling techniques were used to select study participants proportional to the sample size allocation. The final sample size was 260 and allocated proportionally to Dessie Comprehensive Specialized Hospital and Boru Meda General Hospital. The data were entered and analyzed using EPI-data version 4.6 and SPSS version 26 software respectively. During analysis, p-values less than 0.25 in binary logistic regression were entered into multivariable logistic regression. Finally, p-values less than 0.05 in multi-variable logistic regression were considered statically significant.Results: The mean score for inter-professional collaboration was 97.40 ± 19.6SD. In this study, inter-professional collaboration among nurses and physicians was 44.2%. This study showed that favorable attitude [AOR=3.205; CI: 1.781– 5.766], respondents working in the gynecological department [AOR=0.210; CI: 0.052– 0.849], satisfied organizational support [AOR=2.062; CI: 1.140– 3.729] and urban residents [AOR=3.996; CI: 1.069– 14.931] were factors associated with nurse–physician inter-professional collaboration.Conclusion: In this study, nurse–physician inter-professional collaboration was low. Training on the importance of health teamwork, timely monitoring and evaluation of organizational support, and professional empowerment towards a favorable attitude of nurse–physician inter-professional collaboration shall be provided at hospital levels. Routine assessment and timely intervention of the gynecological department for nurse–physician inter-professional collaboration shall be done at hospital levels. Moreover, both quantitative and qualitative research shall be performed for future research.Keywords: inter-professional, collaboration, nurse, physician, associated factors

Hussien Kebede,1 Tessema Tsehay,2 Mogesie Necho,3 Yosef Zenebe3 1Department of Adult Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 2Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia; 3Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaCorrespondence: Mogesie NechoDepartment of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaEmail nechomoges2014@gmail.comBackground: Satisfaction of patients is a key measure of quality pharmacy service delivery. However, the traditional way of drug inventory and dispensing practice by professionals negatively affects the satisfaction of patients. Hence, assessment of satisfaction level is an important tool to identify gaps in pharmacy service delivery and works for its improvement.Objective: To determine the level of patients’ satisfaction towards outpatient pharmacy service and contributing factors at Dessie Town Public Hospitals, South Wollo, North-east Ethiopia, 2020.Methods: We implement a facility-based cross-sectional survey on 414 patients over the age of 18 years from the outpatient pharmacy service of Dessie town public hospitals. The study was done from February to June 2020 through a systematic random sampling method and face-to-face pharmacy exit interview using the Self Reporting Questionnaire-17. We used Epi-data version 3.1 for data entry and SPSS-21 software for analysis. We assessed the strength of association in the binary logistic regression with odds ratio and declare statistical significance with p-value < 0.05.Results: Among the total patients participated, 246 (59.4%) were satisfied towards outpatient pharmacy services. In this finding, comfortability of waiting area [AOR=1.87; 95% CI, (1.13, 4.18)], frequency of visit [AOR=2.4; 95% CI, (1.19, 4.80)], and payment status [AOR=2.90; 95% CI, (1.21, 6.95)] showed a positive association towards satisfaction. On the other hand, age (28– 37 years) [AOR=0.16; 95% CI, (0.08– 0.34)], number of drug dispensed [AOR=0.3; 95% CI, 0.13– 0.41] and medication availability [AOR=0.44; 95% CI, (0.26, 0.71)] showed a negative association with patient satisfaction.Conclusion and Recommendations: The findings of the current study revealed that patients’ satisfaction towards outpatient pharmacy services provided by public Hospitals at Dessie town was low. Hence, hospitals need to take attention to and consider the identified gaps like improving the availability of drugs, comfortability of waiting area, payment status, and the number of drugs dispensed, and the frequency of visits.Keywords: patients’ satisfaction, pharmacy service, Dessie

Abstract Background Multi-month dispensing (MMD) of antiretroviral therapy (ART) is an integral component of differentiated HIV service delivery for people living with HIV (PLHIV). Although many countries have scaled up ART dispensing to 3-month intervals, Ethiopia was the first African country to implement six-month dispensing (6-MMD) at scale, introducing its Appointment Spacing Model (ASM) for people doing well on ART in 2017. As of June 2021, 51.4% (n = 215,101) of PLHIV on ART aged ≥ 15 years had enrolled in ASM. Since little is known about the benefits and challenges of ASM perceived by Ethiopian clients and their healthcare workers (HCWs), we explored how the ASM was being implemented in Ethiopia’s Oromia region in September 2019. Methods Using a parallel convergent mixed-methods study design, we conducted 6 focus groups with ASM-eligible enrolled clients, 6 with ASM-eligible non-enrolled clients, and 22 in-depth interviews with HCWs. Data were audio-recorded, transcribed and translated into English. We used thematic analysis, initially coding deductively, followed by inductive coding of themes that emerged from the data, and compared the perspectives of ASM-enrolled and non-enrolled clients and their HCWs. Results Participants enrolled in ASM and HCWs perceived client-level ASM benefits to include time and cost-savings, fewer work disruptions, reduced stigma due to fewer clinic visits, better medication adherence and improved overall health. Perceived health system-level benefits included improved quality of care, decongested facilities, reduced provider workloads, and improved record-keeping. Although non-enrolled participants anticipated many of the same benefits, their reasons for non-enrollment included medication storage challenges, concerns over less frequent health monitoring, and increased stress due to the large quantities of medicines dispensed. Enrolled participants and HCWs identified similar challenges, including client misunderstandings about ASM and initial ART stock-outs. Conclusions ASM with 6-MMD was perceived to have marked benefits for clients and health systems. Clients enrolled in the ASM and their HCWs had positive experiences with the model, including perceived improvements in efficiency, quality and convenience of HIV treatment services. The concerns of non-ASM enrolled participants suggest the need for enhanced client education about the model and more discreet and efficiently packaged ART and highlight that ASM is not ideal for all clients.

Abstract Background The combination of nutrient removal using microalgae from wastewater with carbohydrate production has been considered as a promising approach for sustainable wastewater treatment and production of valuable products such as biofuels. In Ethiopia, urbanization and industrial development are not in tandem with wastewater treatment system The objective of this study was to evaluate nutrient removal and carbohydrate production potential of the indigenous microalgae Scenedesmus sp. grown in anaerobically digested brewery wastewater. The indigenous Scenedesmus sp. was grown in an anaerobically digested brewery effluent in different seasons of the year. The biomass was converted into carbohydrate using microwave, autoclave, and oven as pretreatment, followed by optimization for acid concentrations and hydrolysis time. Result The overall removal efficiencies for the indigenous Scenedesmus sp. based wastewater treatment system were over 99%, 92%, 63%, 65% and 75% for NH4 +-N, TN, PO4 3− -P, TP and COD, respectively. The concentrations of final effluent quality of these parameters except for phosphorus nutrient were below the permissible discharge limit for brewery effluent standard set by Ethiopian Environmental Protection Authority. With regard to carbohydrate production, microwave-assisted acid hydrolysis with HCl produced a higher total sugar than that of autoclave and oven pretreatments. Among acid concentrations, HCl with 3 N produced a higher total sugar, which is significantly different (P

The use of wastewater as a nutrient source for microalgae cultivation is considered as a cost-effective approach for algal biomass and biofuel production. The microalgal biomass contains carbohydrates that can be processed into bioethanol through different extraction methods. The objective of this study is to optimize the microwave-assisted extraction (MAE) of carbohydrates from the indigenous Scenedesmus sp. grown on brewery effluent. Optimization of independent variables, such as acid concentration (0.1–5 N), microwave power (800–1200 W), temperature (80–180 °C) and extraction time (5–30 min) performed by response surface methodology. It was found that all independent variables had a significant and positive effect on microwave-assisted carbohydrate extraction. The quadratic model developed on the basis of carbohydrate yield had F value of 112.05 with P < 0.05, indicating that the model was significant to predict the carbohydrate yield. The model had a high value of R2 (0.9899) and adjusted R2 (0.9811), indicating that the fitted model displayed a good agreement between the predicted and actual carbohydrate yield. An optimum carbohydrate yield obtained was 260.54 mg g−1 under the optimum conditions of acid concentration (2.8 N), microwave power (1075 W), temperature (151 °C) and extraction time (22 min). The validation test showed that the model has adequately described the microwave-assisted extraction (MAE) of carbohydrates from microalgal biomass. This study demonstrated that the indigenous Scenedesmus sp. grown on brewery effluent provides a promising result in carbohydrate production for bioethanol feedstock.

Abstract Background While pulmonary tuberculosis is the most common presentation, extra pulmonary tuberculosis is also an important clinical problem. However, no adequate information had been made available on the prevalence of smear positive extra pulmonary tuberculosis in Gondar. The aim of this study was to assess the prevalence and possible risk factors of smear positive extra pulmonary tuberculosis among suspected patients at University of Gondar Hospital. Methods A cross-sectional study on extra pulmonary tuberculosis suspected patients was conducted at University of Gondar Hospital from January 2012 to April, 2012. Specimens of patients suspected of extra pulmonary tuberculosis were obtained from fine needle aspiration and body fluid samples collected by pathologist. Demographic characteristics and other variables were collected using a pretested semi-structured questionnaire. Smears were prepared from each sample and stained by Ziehel Neelson and Wright stain. The result of the study was analyzed with bivariate and multivariate logistic regression. Result A total of 344 extra pulmonary tuberculosis suspected clients were included in the study and specimens were taken from lymph node aspirates and body fluids. The overall prevalence of smear positive extra pulmonary tuberculosis was 34 (9.9%). Of these cases of extra pulmonary tuberculosis, lymph node tuberculosis constituted the largest proportion (82.4%). Among the 34 extra pulmonary tuberculosis patients, over half of them (52.9%) were positive for human immunodeficiency virus. The largest proportion of tuberculosis and human immunodeficiency virus cases occurred among persons with in the age group of 31–40 years. Previous history of tuberculosis (OR = 4.77, 95% CI 1.86-12.24), contact to a known tuberculosis cases (OR = 6.67 95% CI 2.78-16.90), history of underlying diseases (OR = 2.79 95% CI 1.15-6.78) and income (OR = 12.9 95% CI 2.25-68.02) were significantly associated with extra pulmonary tuberculosis infection. Conclusion The prevalence of smear positive extra pulmonary tuberculosis infection in Gondar is high. Screening of lymph node and other body fluid specimens for extra pulmonary tuberculosis could help for treatment, control and prevention of the disease.