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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 Introduction Opportunistic infections (OIs) are more common and severe among people with suppressed immunity like those living with HIV/AIDS (PLWH). This study aimed to assess the prevalence of OIs and associated factors among PLWH attending antiretroviral therapy (ART) clinics in the Gedeo zone, Southern Ethiopia. Methods A facility based retrospective cohort study was conducted from April to June 2018 among PLWH attending ART clinics in Gedeo zone, Ethiopia from November 2016 – November 2017. A simple random sampling method was used to select the both paper based and electronic study participants’ charts. Adjusted odds ratios were calculated using multivariable logistic regression analysis for variables statistically significant at 95% confidence interval under bivariable logistic regression analysis, and significance was declared at P

Abstract Background The injectable shorter multi-drug resistant tuberculosis (MDR-TB) regimen, has been reported to be less costly and more effective in the treatment of MDR-TB compared to the longer regimen. Ethiopia introduced the injectable shorter regimen (SR) in April 2018 following official recommendation by the World Health Organization (WHO) in 2016. While the WHO recommendation was based on evidence coming from extensive programmatic studies in some Asian and African countries, there is paucity of information on patient outcomes in the Ethiopian context. Thus, we aimed to assess the treatment outcomes and identify factors associated with the outcomes of MDR-TB patients on injectable SR. Methods A multi-center facility-based retrospective cohort study was conducted in Ethiopia on 245 MDR-TB patients who were treated between April 2018 and March 2020. Data were collected from patients’ medical records and analyzed using SPSS version 25. Descriptive statistics was used to summarize the results while inferential analysis was employed to investigate predictors of treatment outcomes and survival status. Results A total of 245 patients were included in the study, with 129 (52.7%) of them being female. Median age of the patients was 27 (IQR: 21–33). The overall treatment success rate was 87.8%, with 156 (63.7%) cured and 59 (24.1%) patients who completed treatment. The unfavorable outcomes accounted for 12.2%, with 16 (6.5%) treatment failure, 8 (3.3%) death and 6 (2.4%) lost to follow up. Majority of the unfavorable outcomes occurred during the early phase of therapy, with median time to event of 1.8 months (95% CI: 0.99—2.69). The use of khat (a green leafy shrub abused for its stimulant like effect) and being diagnosed with MDR-TB than rifampicin resistant only, were identified as independent factors associated with unfavorable outcomes. Conclusion The injectable SR for MDR-TB was found to have positive treatment outcomes in the context of programmatic management in Ethiopia.

Abstract Background Economic relief programs are strategies designed to sustain societal welfare and population health during a regional or global scale infectious disease outbreak. While economic relief programmes are considered essential during a regional or global health crisis, there is no clear consensus in the literature about their health and non-health benefits and their impact on promoting equity. Methods We conducted a scoping review, searching eight electronic databases from January 01, 2001, to April 3, 2023, using text words and subject headings for recent pathogens (coronavirus (COVID-19), Ebola, Influenza, Middle East Respiratory Syndrome (MERS), severe acute respiratory syndrome (SARS), HIV, West Nile, and Zika), and economic relief programs; but restricted eligibility to high-income countries and selected diseases due to volume. Title and abstract screening were conducted by trained reviewers and Distiller AI software. Data were extracted in duplicates by two trained reviewers using a pretested form, and key findings were charted using a narrative approach. Results We identified 27,263 de-duplicated records, of which 50 were eligible. Included studies were on COVID-19 and Influenza, published between 2014 and 2023. Zero eligible studies were on MERS, SARS, Zika, Ebola, or West Nile Virus. We identified seven program types of which cash transfer (n = 12) and vaccination or testing incentive (n = 9) were most common. Individual-level economic relief programs were reported to have varying degrees of impact on public health measures, and sometimes affected population health outcomes. Expanding paid sick leave programs had the highest number of studies reporting health-related outcomes and positively impacted public health measures (isolation, vaccination uptake) and health outcomes (case counts and the utilization of healthcare services). Equity impact was most often reported for cash transfer programs and incentive for vaccination programs. Positive effects on general well-being and non-health outcomes included improved mental well-being and quality of life, food security, financial resilience, and job security. Conclusions Our findings suggest that individual-level economic relief programs can have significant impacts on public health measures, population health outcomes and equity. As countries prepare for future pandemics, our findings provide evidence to stakeholders to recognize health equity as a fundamental public health goal when designing pandemic preparedness policies.

Abstract Introduction Hypoglycemia is a common occurrence in diabetic patients. But unlike non diabetic patients, its causes are frequently related to drugs they are receiving to control blood glucose. But this may not always be the case. Here we report a type 2 diabetic patient with severe hypoglycemia owing to acute hypopituitarism secondary to pituitary apoplexy. Case presentation A 45 year old male diabetic patient from Ethiopia taking 2 mg of oral glimepiride daily who presented with change in mentation of 30 minutes and blood glucose recording of 38 mg/dl upon arrival to the emergency room. Brain magnetic resonance imaging showed pituitary macroadenoma with hemorrhage suggestive of pituitary apoplexy. Blood work up showed low adrenocorticotropic hormone, cortisol, and serum sodium levels. Subsequently transsphenoidal hypophysectomy was done. Conclusion The occurrence of hypoglycemia in a diabetic patient taking sulphonylurea monotherapy is common. But when it is severe enough to cause altered mentation, patients should be approached differently. In the presence of clinical clues suggesting cortisol deficiency, hypopituitarism can be a possible cause.

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.

This study presents an engineering geological investigation aimed at assessing the bearing capacity of the proposed site for the Meli gold processing plant (GPP) located in the northwestern region of Tigray, Ethiopia. The geological composition of the site predominantly comprises low-grade metamorphic rocks, with intermediate metavolcanic rocks being the most prevalent. This research utilized an innovative combination of empirical methodologies, including the Hoek–Brown and Mohr–Coulomb criteria, to evaluate the strength and elasticity characteristics of the rock mass. Additionally, the rock mass foundation for the GPP was rigorously classified using renowned systems such as the rock mass rating (RMR), quality index (Q), and geological strength index (GSI). Employing five different empirical equations to estimate bearing capacity, this study significantly advances our understanding by comparing these diverse methodologies, which is a novel approach in this geological context where engineering property data are scarce or non-existent. The bearing capacities determined using the Hoek–Brown and Mohr–Coulomb criteria ranged from 11.6 to 46.2 MPa and 7.9 to 10.5 MPa, respectively. These findings not only offer valuable insights into the assessment of bearing capacity in metamorphic rock formations but also underscore the effectiveness of combining multiple empirical approaches to enhance the reliability of geological assessments. This research contributes to the advancement of construction practices and enhances project planning strategies in comparable geological environments, particularly highlighting the utility of robust empirical data in the absence of extensive drilling data. By integrating comprehensive empirical analyses, the study provides a methodological framework that significantly aids in informed decision-making for future projects located in similar geological settings.

Abstract The urgency to restore landscapes to counteract deforestation, soil degradation, and biodiversity loss has resulted in a global commitment to landscape restoration. Many frameworks and tools have emerged for the design and implementation of restoration activities. The frameworks tend to focus on selected dimensions of sustainability, with the majority focusing on the ecological. Current frameworks miss a balanced assessment of (planned) interventions taking into account also the social dimension relating to participation and ownership as well as improvement of livelihoods. The objective of this review is to assess current frameworks for identification of strength and weaknesses and to derive an integrated Forest Landscape Restoration (FLR) assessment framework model that shall help overcome current limitations. Applying systematic literature review, a total of 22 frameworks are selected and analyzed in-depth applying qualitative content analysis. Our review finds that frameworks vary with respect to their focus and restoration objectives. They also differ in relation to spatial and temporal scale, degree of stakeholder participation, consideration of ecological and social dimensions, monitoring and evaluation approaches, as well as provisions for exit strategies. Findings are summarized in form of an integrated FLR assessment framework, comprising six interlinked components: stakeholder participation, customization, time and scale of application, social-ecological balance, monitoring, evaluation and learning, and exit strategy. The proposed framework facilitates design and implementation of context specific interventions, balancing the nexus of social and ecological dimensions of FLR and acknowledges the need to also include reflection on learnings and planning of an exit strategy for long-term success. Graphical Abstract

Abstract Background Foot and mouth disease is a contagious, transboundary, and economically devastating viral disease of cloven-hoofed animals. The disease can cause many consequences, including decreased productivity, limited market access, and elimination of flocks or herds. This study aimed to assess farmers’ willingness to pay (WTP) for foot and mouth disease (FMD) vaccines and identify factors influencing their WTP. A cross-sectional questionnaire survey was conducted on 396 randomly selected livestock-owning farmers from three districts in the central Oromia region (Ambo, Dendi, and Holeta districts. The study utilized the contingent valuation method, specifically employing dichotomous choice bids with double bounds, to evaluate the willingness to pay (WTP) for the FMD vaccine. Mean WTP was assessed using interval regression, and influential factors were identified. Results The study revealed that the farmer’s mean willingness to pay for a hypothetical foot and mouth disease vaccine was 37.5 Ethiopian Birr (ETB) [95% confidence interval [CI]: 34.5 40.58] in all data, while it was 23.84 (95% CI: 21.47–26.28) in the mixed farming system and 64.87 Ethiopian Birr (95% CI: 58.68 71.15) in the market-oriented farming system. We identified main livelihood, management system, sales income, breed, keeping animals for profit, and foot and mouth disease impact perception score as significant variables (p ≤ 0.05) determining the farmers’ WTP for the FMD vaccine. Conclusion Farmers demonstrated a high computed willingness to pay, which can be considered an advantage in the foot and mouth disease vaccination program in central Oromia. Therefore, it is necessary to ensure sufficient vaccine supply services to meet the high demand revealed.

Abstract Climate change significantly affects the diversity, growth, and survival of indigenous plant species thereby influencing the nutrition, health and productivity of honey bees (Apis mellifera). Hypoestes forskaolii (Vahl) is one of the major honey bee plant species in Ethiopia’s Tigray region. It is rich in pollen and nectar that typically provides white honey, which fetches a premium price in both local and inter-national markets. Despite its socio-economic and apicultural significance, the distribution of H. forskaolii has been declining, raising concerns regarding its conservation efforts. However, there is limited knowledge on how environmental and climatic factors affect its current distribution and response to future climate change. The study investigates the current and projected (the 2030s, 2050s, 2070s, and 2090s) habitat distributions of H. forskaolii under three future climate change scenarios (ssp126, ssp245, and ssp585) using the Maximum Entropy Model (MaxEnt). The results show that land use (50.1%), agro-ecology (28%), precipitation during the Driest Quarter (11.2%) and soil texture (6.1%) predominantly influence the distribution of H. forskaolii, collectively explaining 95.4% of the model's predictive power. Habitats rich in evergreen trees and mosaic herbaceous with good vegetation cover are identified as the most suitable for H. forskaolii. The spatial distribution of H. forskaolii is concentrated in the highlands and mid-highlands of the eastern and southern parts of Tigray, characterized by a colder temperature. Across the three climate change scenarios, the size of suitable habitat for H. forskaolii is projected to decrease over the four time periods studied. Predictions under the ssp585 scenario reveal alarming results, indicating a substantial decrease in the suitable habitat for H. forskaolii from 4.26% in the 2030s to 19.09% in the 2090s. Therefore, given the challenges posed by climate change, research efforts should focus on identifying and evaluating new technologies that can help the H. forskaolii species in adapting and mitigating the effects of climate change.

Abstract Background We aimed to compare anticoagulation control and outcomes between usual medical care (UMC) and pharmacist-led anticoagulation services (PLAS) in patients receiving warfarin at the Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Methods A quasi-experimental study was conducted, including 350 (66.7%) and 175 (33.3%) patients from the UMC and PLAS groups, respectively, from 525 patients. The time in therapeutic range (TTR) was determined using the Rosendaal method, with a TTR ≥ 65% set as the cut-off for optimal anticoagulation. The two-sample Wilcoxon rank-sum (Mann–Whitney U) test was used to compare continuous variables between groups. Categorical variables were compared between groups using Pearson’s chi-square test or Fisher’s exact test. Logistic regression and negative binomial regression analyses were conducted to identify the factors associated with suboptimal TTR and secondary outcomes, respectively, at the p values

Abstract Background Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. Methods A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1–30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. Result In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). Conclusion The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.

Abstract Nutrition-sensitive agriculture is an approach that aims to ensure the production of affordable, safe, culturally appropriate, and nutritious foods in sufficient quantity and quality to meet dietary needs. This study aims to examine the production pathway by which smallholder farmers adopt nutrition-sensitive agriculture in northwest Ethiopia. Data were collected from 478 randomly sampled households through a structured questionnaire-based survey, observations, and group discussions. Descriptive and inferential statistics were employed for analysis. Binary logistic regression analysis was used to estimate the influences of demographic, socioeconomic, and institutional explanatory variables on the production of various food groups in households. Arable land owned by households, the use of irrigation, access to the nearest markets, contacts with agricultural extension workers, and management practices affect plant-sourced food production. On the other hand, the number of livestock owned, the total crop produced, and contacts with extension workers affected animal-sourced food production. However, different factors, such as technological, institutional, and managerial challenges, that include dependency on rain-fed and free-grazing-based traditional herding systems adversely affect the production pathway to nutrition-sensitive agriculture. The study concludes that improving agricultural extension services, promoting small-scale irrigation schemes, and introducing improved animal feeding with improved crop and livestock management techniques could significantly contribute to increased household availability of diversified foods.

Universities around the world have faced challenges in maintaining face-to-face knowledge sharing. Knowledge sharing through web technology is an essential solution for all universities. However, web technology-based knowledge-sharing practices in developing countries such as Ethiopia face many challenges. This study examines the factors that challenge the use of web technologies for knowledge-sharing practices by academic staff and presents recommendations to improve the current environment in Ethiopian public universities. The study employed semi-structured interviews with 30 respondents and analyzed the data using Nvivo qualitative data analysis software. The results revealed that lack of technical skill, lack of systems integrated into teaching-learning practice, lack of awareness, lack of an appropriate reward system, lack of commitment from top management, lack of a knowledge-sharing policy, and a lack of knowledge mapping are among the identified challenges hindering the knowledge-sharing practice of academic staff. These findings provide evidence of knowledge-sharing practices and give insights regarding enhancing knowledge-sharing practices within higher education. In addition, this study also contributes to the body of knowledge about the challenges of knowledge sharing. The findings will benefit academic staff, university administrations, and higher education institutions. Future studies could consider replicating this study from a quantitative method perspective with a larger sample size focused on Ethiopian public higher education. This study could also be considered for replication from the perspective of private higher education.