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Abstract Objective Dandruff, a condition caused by lipophilic Malassezia fungi, is an excessive shed of dead skin cells from the scalp. Effective preventive and curative measures of the condition depend on knowledge and understanding of the prevalence of the condition, the common etiologic species, and the associated factors. This study aimed to investigate the prevalence, common etiologic species, and associated factors of Malassezia infection in Mekelle City, Ethiopia. Method A facility-based cross-sectional study was conducted from February 2019 to June 2020 involving 217 participants who were visiting dermatology clinics to seek treatment for dandruff conditions. Information on the socio-demographic characteristics and hair care behaviors of the participants was obtained. Isolation and identification of Malassezia species from scalp scrapings using cultural and biochemical tests were carried out. Results Out of the 217 participants with dandruff, 111 (51.15%) were positive for Malassezia fungi. One hundred forty (140) Malassezia isolates were collected from the 111 positive participants. Further study of the isolates yielded three etiologic species: Malassezia globosa (67.15%), M. furfur (21.70%), and M. restricta (12.15%). Demographic characteristics, namely gender (AOR = 2.605; 95%CI: 1.427 − 4.757) and age (AOR = 2.667; 95%CI: 1.046 − 6.795), as well as hair care behaviors, namely use of hair oil (AOR = 2.964; 95%CI: 1.288 − 6.820), were associated with the presence of Malassezia species. However, the use of anti-dandruff shampoo (AOR = 2.782; 95%CI: 1.301 − 10.993) was negatively associated with the presence of Malassezia species among the participants with dandruff conditions. These findings open opportunities to devise effective prevention, management, and control measures for Malassezia-based dandruff conditions.

Abstract Background Tuberculosis (TB) is Ethiopia’s leading infectious killer disease. The war in the Tigray region of Ethiopia has resulted in the disruption of TB care services. Prediction models are recommended to aid the diagnosis of TB in resource-limited settings. However, the development of such decision-support tools without the participation of end users may not be successful. To inform the tool development, we described barriers to diagnosing TB and identified applicable and desirable parameters for the proposed tool. Methods We conducted a qualitative study between February and June 2023 in two cities in Tigray, Northern Ethiopia. We conducted 12 in-depth interviews and four focus group discussions with healthcare workers (HCWs). Interviews were translated, coded, and analyzed to identify predefined and emergent themes during the thematic analysis. Results Healthcare workers used symptoms, risk factors, signs, and investigations to diagnose TB. However, failure to ask about antibiotic use, the absence and non-affordability of investigations, and patient load were barriers affecting the diagnosis of TB. Most of the classic TB symptoms and their duration were sorted as very important, simple, reliable, generalizable, and desirable indices. In addition, a trial of antibiotics, being chronically sick-looking, having HIV, having a contact history with a TB patient, and an erythrocyte sedimentation rate fulfilled the above criteria. Conclusions In the TB diagnostic process, HCWs account for a variety of data, but they prefer the classic symptoms of TB to heighten their clinical suspicion. Antibiotic trials and some risk factors were also considered reasonable. However, when HCWs have a heavy workload and a shortage of investigations, they experience a suboptimal TB diagnostic process. Hence, appropriate context consideration and care providers’ preferences for parameters will inform tool development.

Abstract Background One in three women experienced intimate partner violence (IPV) worldwide which has remained major public health challenge. Women’s reproductive health service utilization has been seriously impacted by IPV. There is a paucity of evidence on the magnitude of IPV among contraceptive users in southern Ethiopia. Hence, the main aim of this study was to determine the level of IPV and its associated factors among married women who were contraceptive users in primary health care settings in Adilo Zuria district in southern Ethiopia. Methods A facility-based cross-sectional study was conducted among systematically recruited 405 married women who were contraceptive users in a primary health care setting in Adilo Zuria district in southern Ethiopia. Data were collected through face-to-face interviews using an adapted tool from existing literature including the World Health Organization IPV survey. Collected data were entered into EpiData 4.6 and exported to SPSS version 26 for cleaning and analysis. Descriptive and logistic regression analyses were performed to determine the level of IPV and identify factors associated with IPV. An adjusted odds ratio (AOR) from multiple logistic regression at a 95% confidence interval (CI) was used to declare a significant association. Results The prevalence of current IPV among contraceptive users was 72.6% (95% CI; 68.1-76.8%). Current psychological, physical, and sexual violence were 39.3%, 38.5%, and 31.9%, respectively. In multivariable analysis, women’s being rural resident (AOR: 3.19, 95%CI: 1.69–6.02), women’s formal education (AOR: 0.37, 95%CI: 0.19–0.70), partners alcohol consumption (AOR: 3.32, 95%CI: 1.89–5.84), partners Khat chewing (AOR: 7.22, 95%CI: 4.12–12.65) and poor social support (AOR: 2.47, 95%CI: 1.43–4.27) were significantly associated with current IPV against women. Conclusions Women’s experience of IPV on contraceptive users was found to be unacceptably high in the study area. Women’s being rural residents, having poor social support and partners who drank alcohol and Khat chewing were predictors of women’s experience of IPV. Thus, interventions in improving women’s educational status, strengthen the social support systems, and the behavior of partners who use stimulant substances are highly relevant to tackle IPV among contraceptive users in the primary healthcare setting.

Abstract Background Despite being a widely used generic measure of health-related quality of life worldwide, there is limited evidence on the psychometric properties of the EuroQoL Five-dimensions five level (EQ-5D) among cervical cancer patients in Ethiopia. Objective To evaluate psychometric properties of the Amharic version of EQ-5D among Ethiopian cervical cancer patients. Methods A longitudinal survey of cervical cancer patients receiving treatment at two Ethiopian tertiary care facilities was conducted from March 2022 to July 2023. Participants completed the EQ-5D and the European Organization for Research and Therapy of Cancer (EORTC QLQ-C30) at baseline and after three months on treatment. Effect size and standardized response mean were used to assess responsiveness. Anchor-based and distribution-based methods were used to calculate the minimal clinically important difference (MCID). Minimal detectable change (MDC) ratios were computed at the individual and group levels. Statistical significance was determined at p 0.6) and the instrument showed good discriminate validity between patients with different health states. The effect size ranged between − 0.12 and 0.60 for the EQ-5D index value and − 0.12 to 1.16 for the EQ VAS, indicating small to large responsiveness. The average (range) MCID value of the EQ-5D index was 0.10–0.15. The findings showed that MCID to MDC ratios at the group level were more clinically meaningful than the individual level. Conclusion The EQ-5D effectively detected changes and discriminate patients with different levels of health. While group-level MCIDs were established in this study, further studies are recommended to prove its usefulness at the individual-level.

Abstract The armed conflict in Tigray, which spanned from November 2020 to November 2022, along with the accompanying siege, led to the near-total collapse of Tigray’s healthcare system. Type 1 Diabetes Mellitus, the most common chronic condition in children, requires significant lifestyle adjustments, including daily insulin injections, regular glucose monitoring, and dietary modifications; all of which are severely impacted by war and siege. This study compared Type 1 diabetes care for children at the Ayder Comprehensive Specialized Hospital, Tigray, during the conflict and siege period with that of the pre-war period. We conducted a retrospective cross-sectional survey, analyzing data from September 2019 to August 2020 (pre-war period) and comparing it with data from September 2021 to August 2022 (war and siege period). Descriptive statistics, including frequencies and percentages, were employed, and Pearson’s or Spearman’s correlation analyses were used to evaluate correlations where appropriate. We identified 143 pediatric patients admitted (56 during the pre-war period and 87 during the war and siege period), with a mean age of 109 months in both periods. During the war and siege, a higher proportion of diabetes admissions were due to diabetic ketoacidosis (DKA) (90%) compared to the pre-war period (75%). In the pre-war period, the most common trigger for DKA was infections (35%), while in the war and siege period, it shifted to malnutrition (47%), infections (46%), lack of access to healthcare facilities (31%), and running out of medicines (24%). Complications such as death, renal failure, cerebral edema, and shock were more prevalent during the war and siege periods. The case fatality rate was significantly higher during the war and siege (9%) compared to the pre-war period (0%), correlating strongly with the severity of DKA, the degree of hypokalemia, the presence of complications, and admission during the war and siege. Our study showed the negative impact of war and siege on diabetes care in children demonstrating a high rate of DKA admissions with increased severity, complications, malnutrition, and case fatality rates. People with diabetes especially type 1 deserve great attention during such a crisis as the lack of insulin could lead to severe complications including death.

Abstract Background Unmet need for birth spacing can significantly impact maternal and child health outcomes, leading to unintended or mistimed births, neonatal mortality, pregnancy loss, induced abortions, small-sized births, and malnutrition. Considering the role of women empowerment in women’s sexual and reproductive health, we examined the association between the survey-based women's empowerment index (SWPER) and unmet need for spacing in sub-Saharan Africa (SSA). Methods We used data from the Demographic and Health Surveys of 21 in SSA conducted between 2015 and 2021. In this study, the unit of analysis was women of reproductive age (15 to 49 years) who were married or living together and required family planning during the survey period. Multilevel logistic regression was fitted to examine the association between SWPER and the unmet need for spacing. The results were presented using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results The hotspot countries for unmet need for birth spacing were Angola, Benin, Liberia, Mauritania, and Sierra Leone. The findings showed that with the empowerment indicators, women with high attitude to violence (disagreement or rejection of violence) (AOR = 0.95; 95% CI 0.91, 0.99), and women with high decision-making (AOR = 0.90; 95% CI 0.85, 0.95) exhibited lower odds of unmet spacing need relative to women with low attitude to violence and those with low decision making. Women with high autonomy (AOR = 1.32; 95% CI 1.25, 1.39) were more likely to experience unmet need for spacing compared to those with low autonomy. Conclusion Unmet need for spacing has been linked to indices of women's empowerment such as attitudes toward violence, independence, and decision-making. Organizations such as UNICEF, UNFPA, and the Bill & Melinda Gates Foundation should consider incorporating SWPER indicators when planning interventions to address the high unmet need for spacing among women in SSA. Additionally, various governments and aid organizations must give women's empowerment a high priority as a tactical intervention strategy to increase access to contraception in the countries considered in this study. These programmes would contribute to attaining SDGs 3.1 and 3.7.

Abstract Background Sweet syndrome (acute febrile neutrophilic dermatosis) is an uncommon inflammatory disorder characterized by the abrupt appearance of painful, edematous, and erythematous papules, plaques, or nodules on the skin. There are various subtypes, such as classical, drug-induced, malignancy-associated, and the less common variant giant cellulitis-like Sweet syndrome. This case is unique due to its presentation of the giant cellulitis-like variant of Sweet syndrome in a patient from Ethiopia. The unusual distribution of the skin lesions and the initial lack of response to antibiotics make this case particularly noteworthy. It underscores the importance of considering Sweet syndrome in differential diagnoses when faced with atypical skin manifestations and ineffective antibiotic treatment. This contribution adds valuable insights to the scientific literature by highlighting the need for heightened awareness of this rare variant and improving diagnostic accuracy in similar clinical scenarios. Case presentation A 60-year-old Ethiopian male patient who presented to the accident and emergency department with a 5-day history of fever, chills, sweating, and rigor accompanied by a reddish skin color change around the anterolateral region of the right chest wall. On physical examination, there were erythematous, indurated tender plaques with ill-defined borders over the right antero- and posterolateral chest wall with extension to the lateral part of the right neck and medial aspect of the right arm. Subsequently, the patient was started on antibiotics, but there was a suboptimal response. Skin biopsy revealed features suggestive of giant cellulitis-like Sweet syndrome. He was then started on steroids, which significantly improved his symptoms. Conclusion A cautious stance is essential when identifying Sweet syndrome in individuals displaying erythematous plaque-like skin lesions in atypical areas of the body with uneven distribution. Such presentation may signal Sweet syndrome rather than a common infection. If conventional treatments, such as antibiotics, fail to resolve symptoms, consider Sweet syndrome as a potential diagnosis. This approach ensures timely and appropriate treatment, preventing treatment delay and misdiagnosis.

Optimizing agricultural crop production involves utilizing proper irrigation and fertilization techniques. A two-year experiment conducted in the Tselemty district during the off seasons of 2019 and 2020 aimed to assess the impact of varying irrigation levels and nitrogen fertilizer application rates on the growth, yield, and crop water productivity of pepper. The study included three irrigation levels (75%, 100%, and 125% of the required irrigation) and three nitrogen fertilizer application rates (75%, 100%, and 125% of the recommended amount). Analysis of the results using Gen-Stat software revealed that most pepper yield attributes were not significantly affected by the different irrigation and fertilizer levels. However, the marketable yield showed significant variation based on the combined application rates. The research indicates that, under ideal circumstances, the optimal approach for pepper growers is a combination of meeting 100% of the irrigation requirement and applying 100% of the recommended nitrogen fertilizer rate. Nevertheless, in scenarios where water resources are limited and fertilizer expenses are high, a reduced irrigation level of 75% of the requirement coupled with 75% of the recommended nitrogen fertilizer rate could be a viable alternative that does not lead to a substantial decrease in yield.

Abstract Background Worldwide, 10% of postpartum women experience postpartum depression, which can lead to diverse sequalae at individual, family, and societal levels. In sub-Saharan Africa, it is estimated that 17% of women experience depression in the postpartum period, which could be an underestimate as 48% of women in the region do not receive postnatal care (81% in Ethiopia and 51% in Guinea) and a large share of postpartum depression remains undiagnosed and untreated as a result. Globally, despite a critical evidence gap, there are growing reports of postpartum depression among women mistreated (disrespected and abused) during childbirth in health facilities, making a strong case to examine the association between mistreatment and postpartum depression. This study in Addis Ababa (Ethiopia) and Conakry (Guinea) uses a mixed methods design to 1) examine the link between mistreatment and postpartum depression, 2) explore the health system capacity to provide respectful maternity care and maternal mental health services, and 3) explore the experiences of women in accessing care and support for postpartum depression. Methods We will conduct a prospective longitudinal survey of women (434 in Addis Ababa and 408 in Conakry) from the third trimester of pregnancy to eight weeks postpartum and carry out in-depth interviews with key health system informants (20–25 in each city) and women who recovered from a clinically confirmed episode of postpartum depression (15–25 in each city). Quantitative data from the women’s survey will be analysed using a multilevel mixed-effects model; qualitative data from key-informants will be analysed by using a hybrid thematic analysis approach, whereas data from women’s in-depth interviews will be analysed using the phenomenological approach. The inclusion of two different settings in our study (Addis Ababa and Conakry) will enable us to apply a comparative health systems lens to explore the dynamics of respectful maternity care and maternal mental health services within the broader health systems of the two countries (Ethiopia and Guinea). Discussion The findings from this study will inform actions aimed at mitigating the mistreatment of women in maternity settings and improving promotive, preventive, and treatment interventions for postpartum depression in Ethiopia and Guinea. The findings can also be extrapolated to other low-resource settings.

Abstract Background Although vaginal stenosis following pelvic or vaginal radiotherapy for cancer treatment is a common complication, postpartum vaginal stenosis is a very rare obstetric complication. We report two cases of postpartum vaginal stenosis. Case presentation The first was case was a 30-year-old para-I Ethiopian woman who presented with a history of foul-smelling vaginal discharge on her 11th postpartum day. Pelvic magnetic resonance imaging (MRI) demonstrated a 1.4 cm distal vaginal stenosis. The second case was a 39-years-old para-II Ethiopian woman who presented with history of amenorrhea and dysparunia of 20 months duration. Abdominopelvic ultrasound examination revealed hematometrocolpos secondary to postinflammatory vaginal stenosis, and 3300 ml of hematocolpometra was drained. In both cases, adhesion excision with successful vaginal reconstruction was performed. Conclusion Postpartum vaginal stenosis is a rare obstetric complication and vaginal adhesions excision with regular vaginal dilation is the recommended management for it.

The pharmaceutical research sector’s inability to develop new drugs has made it challenging to combat microbial resistance. Secondary metabolites from plant extracts have been identified as potential protective agents against multi-drug-resistant bacteria. This study aimed to analyze hydro-ethanol extracts’ antioxidant and antimicrobial activities from various parts of the Zahidi date (whole fruit, pit powder, and flesh). Phytochemical screening of phenolic and flavonoid compounds was performed using high-performance liquid chromatography (HPLC). Total phenolic and flavonoid compounds were extracted at their maximum levels, 71.89 mg/100 g and 843.06 mg/100 g, respectively, using EoH 60%. The whole fruit had the highest concentration of flavonoid quercetin (0.83 μg/g) and phenolic compoundsinapic acid (20.03 μg/g) at the same concentration. The findings from the broth micro-dilution method showed that the whole fruit had the strongest antimicrobial effects at 60% EoHagainst Salmonella typhi (30 mg/ml), Helicobacter pylori (27 mg/ml), Escherichia coli (22 mg/ml), and Staphylococcus aureus (44 mg/ml). Zahidi whole fruit extracts showed higher antioxidant potential at EoH 60% using 2, 2-diphenyl-1-picrylhydrazyl (DPPH) scavenging potential (78%) and ferric-reducing antioxidant power. Principal component analysis (PCA) revealed a significant negative correlation between antioxidant activity and the minimum inhibitory concentration (MIC). Evidence from this study highlights the considerable antioxidant and antimicrobial properties of Zahidi date fruit, suggesting its potential use in producing natural drugs and value-added foods to counteract contagious diseases.

ABSTRACT Starch is a prevalent functional component in food processing because due to its thickening capabilities. The aim of this study was to assess the potential stabilization effects of native, heat-moisture treated, and hydroxypropylated anchote starches in tomato sauce. Tomato sauce was made with different percentages (0%, 0.5%, 1%, and 1.5%) of native and modified anchote starch. A maximum 3.97% decrease in moisture content was observed in tomato sauce concentrated with 1.5% heat-moisture treated anchote starch. Significance differences were observed among tomato sauce samples in their proximate composition. The maximum lightness (L*) value was 29.23% in tomato sauce concentrated with 1.5% hydroxypropylated anchote starch, while the lowest was 26.2% for tomato sauce without starch. With increasing levels of starch used for thickening, b* increased, while the a* value decreased insignificantly. Sauce samples with 1.5% native anchote starch had the highest titratable acidity (0.64%) and total soluble solids (8.97%). Increased storage time resulted in a decrease in vitamin C content of all sauce samples. The addition of starch to tomato sauce resulted in a significant change in pasting qualities, with the highest peak viscosity (11287.69 cP) achieved at 1.5% native anchote starch. The highest (6.2 cm) and lowest (3.7 cm) Bostwick consistency was recorded for the control sauce and for the sauce concentrated with 1.5% native anchote starch. In general, although few undesirable characteristics resulted, especially the addition of modified anchote starch resulted in considerable quality attributes, and can be used as an alternative thickening agent in food processing.