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Background: Rapid, integrated information exchange between stakeholders is critical for effective emergency preparedness and response. However, many low- and middle-income countries face barriers to seamless data sharing. While information accessibility is recognized as important for evidence-based decision-making and resource allocation in Ethiopia, factors influencing current health information sharing practices among stakeholders involved in public health emergency management programs are unclear. This study aims to examine multi-sectoral stakeholders' perspectives and experiences with health data sharing during emergencies in Ethiopia, to identify opportunities and challenges influencing practices to strengthen the national public health emergency response system., Methods: A mixed-methods study was conducted between June and August 2023, involving a survey of 169 stakeholders actively involved in PHEM programs in Ethiopia as well as 23 in-depth interviews with key informants in senior leadership or advisory roles. The data was analyzed using descriptive statistics in SPSS and thematic analysis of qualitative transcripts., Results: During emergencies, it was observed that data sharing between different entities occurred. Quantitative findings showed the predominant types of health data shared between stakeholders during emergencies included hospital data (109, 64.5 %), clinical case information, and laboratory results. Challenges limiting effective coordination included issues like limited functionality of digital health systems (75, 44 %), incompatible data formats (13, 34 %), and financial constraints (83, 49 %) and and socio-cultural barriers constrain current practices in Ethiopia. Qualitative interviews identified five themes around risk communication and inclusive alert systems. Experts emphasized tailored, multichannel outreach but noted infrastructure gaps and digital divides currently limit poorer communities' engagement., Conclusion: While collaborative health information exchange during emergencies is recognized as important, systemic, financial, and socio-cultural barriers constrain current practices in Ethiopia. Targeted strategies including capacity building, investment in integrated data infrastructure, economic optimization through innovative financing models, trust-based relationship development, and locally relevant communication channels informed by stakeholder perspectives can optimize information accessibility, coordination, quality, and equity of healthcare services during public health emergencies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In Ethiopia, the utilization of sexual and reproductive health services (SRH) is alarmingly inadequate, leading to higher rates of maternal and newborn mortality. Disparities in accessing sexual and reproductive health (SRH) services exist among different population groups, with construction worker women at a higher risk of experiencing such issues. We investigated the utilization of sexual and reproductive health services and associated factors among construction worker women in Southern Ethiopia., Method: We conducted a cross-sectional study among construction worker women (15-49) in Southern Ethiopia from July 1st to July 30th, 2021. The participants were selected randomly using venue-day-time sampling (VDTS). The data were collected by a pretested structured questionnaire using an open data kit (ODK) and exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis. Binary logistic regression analysis was conducted to identify factors associated with sexual and reproductive health service utilization. An adjusted odds ratio with 95% CI was used and statistical significance was declared at p-value < 0.05., Results: The study revealed that 54.4% of women of reproductive age had used at least one sexual and reproductive health service in the past year. About 66.7% of women experienced sexual harassment at work, with sex discrimination (86.9%) and sexist hostility (57.9%) being the most common. Aged over 20 years, married women, living with husbands, friends, and boyfriends, within 30 min of health facilities, and having a favorable attitude were significantly associated with SRH service utilization., Conclusion: Nearly half of construction workers in southern Ethiopia are not using sexual and reproductive health services, indicating a concerning lack of access to such services. Over two-thirds of women experience sexual harassment in construction site. Therefore, to ensure universal access to SRH services, it is essential to design a new approach including outreach programs specifically tailored to reach such vulnerable groups., (© 2024. The Author(s).)

Background: Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia., Methods: An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities., Result: In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m 2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity., Conclusion: The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs., (© 2023. BioMed Central Ltd., part of Springer Nature.)

In Ethiopia, undernutrition is a quite common health problem among people living with HIV. Unlike in developed countries, nutritional counseling for people living with HIV has not received much attention. This study aimed to explore the perception of people living with HIV on their dietary practice and the existing health care service in Ethiopia. A phenomenological qualitative study was conducted in two hospitals in southern Ethiopia from March to June 2018. A pre-tested interview guide was prepared in English and translated into the Amharic language. The data were collected using key informant interviews, focus group discussions and observations in the ART clinics by six trained nurses. The data were analyzed thematically. Almost all focus group discussion participants mentioned that a healthy diet for ART patients is very important. The majority of the participants mentioned that they were not satisfied with the counseling service given at the ART clinics. Lack of training for health care professionals on nutritional counseling was also reported as a challenge by the nurses themselves. Nutritional counseling given by health care professionals at the ART clinic was poor. Emphasis should be given to the training of healthcare professionals working in ART clinics on nutritional counseling.

Background: Maternal undernutrition is one of the commonest public health problems in many low- and middle-income countries where generally more than 20% of women are undernourished. It is more common in rural areas due to unclear factors. Therefore, the aim of this study was to investigate the prevalence of undernutrition in general and in subgroups and determine risk factors among pregnant women in rural Ethiopia., Methods: A community-based cross-sectional survey was conducted from April 30 to May 30, 2019 on 550 pregnant women who were randomly selected from six districts in southern Ethiopia. Trained and experienced nurses measured undernutrition using mid-upper arm circumference and collected other data. We used multilevel mixed-effect logistic regression to identify factors associated with undernutrition among pregnant women., Results: The prevalence of undernutrition among pregnant women was 38% (95% CI: (34.2-42.3). The odds of undernutrition was higher among women who got pregnant previously (adjusted odds ratio [AOR]: 1.66; 95% CI: 1.02-2.71), who had a history of miscarriage (AOR: 3.18; 95% CI: 1.77-5.70), who practiced food taboos (AOR: 2.23; 95% CI: 1.47-3.39), and who did not get any nutritional counseling during pregnancy (AOR: 2.97; 95% CI: 1.79- 4.95). The prevalence of undernutrition was higher among pregnant women who had multiple risk factors and the difference was statistically significant (p < 0.001)., Conclusion: Undernutrition is a highly prevalent problem among rural Ethiopian pregnant women, especially with those who avoid food, do not get counseled, and had two or more pregnancies and a history of miscarriage. Improving the integration of nutrition programs with routine healthcare services and encouraging a multi-sectorial intervention strategy would help to reduce maternal undernutrition in the country., (© 2023. The Author(s).)

Accumulating evidence clearly shows poor implementation of nutrition interventions, in Ethiopia and other African countries, with many missed opportunities in the first 1000 days of life. Even though there are high-impact interventions in this critical period, little is known about the barriers and facilitators influencing their implementation. This paper aims to explore barriers and facilitators for the implementation of nutrition services for small children with a focus on growth monitoring and promotion, iron-folic acid supplementation and nutrition counselling. We conducted a qualitative study in four districts of Ethiopia. The data collection and analysis were guided by the consolidated framework for implementation research (CFIR). A total of 42 key informant interviews were conducted with key stakeholders and service providers. Interviews were transcribed verbatim and coded using CIFR constructs. We found that from 39 constructs of CFIR, 14 constructs influenced the implementation of nutrition interventions. Major barriers included lack of functional anthropometric equipment and high caseload (complexity), poor staff commitment and motivation (organisational incentive and reward), closed health posts (patient need and resource), false reporting (culture), lack of priority for nutrition service (relative priority), poor knowledge among service providers (knowledge and belief about the intervention) and lack of active involvement and support from leaders (leadership engagement). Adaptability and tension for change were the facilitators for the implementation of nutrition interventions. Effective implementation of nutrition interventions at primary health care units requires several actions such as improving the healthcare providers' motivation, improving leadership engagement, and creating a strong system for monitoring, supportive supervision and accountability., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Visceral leishmaniasis (VL) is the leading cause of health concerns among Ethiopian migrant workers. Understanding risk perception and health-protective behavior are significant challenges in the prevention and eradication of the disease. As a result, studies are required to assess these important epidemiological factors, which will provide guidance on how to assist migrant workers in taking preventive measures against VL., Method: We conducted qualitative research among migrant workers on seasonal agricultural farms in Northwest Ethiopia between June and November 2019 to assess their perception of the risk of contracting VL and their willingness to use protective measures against the disease. Seventeen focus group discussions and 16 key informant interviews were conducted to study migrant workers' risk perception in relation to sandfly bite exposure and use of sandfly control measures. For analysis, all interviews were recorded, transcribed, and translated. ATLASti was used to perform qualitative content analysis on the data., Result: Migrant workers are fearful of VL because of previous exposure and the disease's prevalence in the area. They believe, however, that VL is a minor illness that is easily treated. While Insecticide Treated Nets (ITNs) are widely accepted as a protective measure, there are still reservations about using them due to the seasonality of the transmission, difficulties in hanging them on farm areas, and a preference for alternative traditional practices. Regardless of perceived self-efficacy, the central cues were the message delivered by the health workers and an increase in sandfly bite irritation. Based on the findings, three levels of intervention modalities are suggested: 1) increasing pre-arrival awareness through outdoor media (posters, stickers, billboards), 2) encouraging proper use of protective measures upon arrival at farm camps, and 3) informing departing workers on disease recognition and best practices for health-seeking continuous use of protective measures at home., Conclusion: This finding suggests that VL prevention interventions should focus on individuals' perceptions in order to promote consistent use of protective measures. The findings are highly useful in planning effective interventions against VL., (© 2022. The Author(s).)

Background: People living with HIV, who take antiretroviral therapy (ART), often enjoy long and healthy lives, but this therapy has well known metabolic adverse effects. Physical activity is found to be an important factor in improving these physiological parameters. This study aimed to determine physical activity level and associated factors among HIV patients in Ethiopia., Methods: An institutional based cross sectional study was conducted from May to June 2019. We selected a total of 422 adult HIV patients, attending antiretroviral therapy clinics in three selected hospitals in Southern Ethiopia. Data were collected at routine care consultations by nine trained nurses using a pre-tested structured questionnaire. The level of physical activity was measured by the international physical activity questionnaire (IPAQ)., Result: The mean age of participants was 38.7 ± 9.13 years. Of the participants, 68% were physically inactive, with a higher proportion of inactive women (74%) than men (61%) [(AOR = 1.64, 95% CI (1.07, 2.53)]. In addition, urban vs. rural residents [(AOR = 2.57, 95% CI (1.16, 5.72)] and patients who were on ART for ≥ 24 months [(AOR = 1.88, 95% CI (1.15, 3.08)] had higher odds of having a low physical activity level., Conclusion: Most people living with HIV and receiving ART have low physical activity levels. Especially female and urban living patients and those with longer treatment duration have low levels of physical activity. More insight is needed on the reasons for physical inactivity among HIV patients and physical activity programs for HIV patients in low-income countries need to be developed., (© 2022. The Author(s).)

Anaemia remains a severe public health problem among children in Ethiopia and targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. An analysis was performed using Ethiopia Demographic and Health Survey 2016 data. Blood specimens for anaemia testing were collected from 9268 children aged 6-59 months. A child was considered as anaemic if the bloodhaemoglobin count was less than 11.0 g/dL. We applied Kulldorf's spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran the local indicator of spatial association and the Getis-Ord Gi* statistics to detect and locate hotspots and multilevel multivariable analysis to identify risk factors for anaemia clustering. More than half of children aged 6-59 months (57%) were found to be anaemic in Ethiopia. We found significant geospatial inequality of anaemia among children and identified clusters (hotspots) in the eastern part of Ethiopia. The odds of anaemia among children found within the identified cluster was 1.5 times higher than children found outside the cluster. Women anaemia, stunting and high fertility were associated with anaemia clustering.

Anaemia in children remains a significant public health threat. Recent numbers from Ethiopia showed that more than two-thirds of children under the age of 2 years were anaemic. This study aimed to investigate the determinants of anaemia throughout Ethiopia over 11 years, making use of the Ethiopian Demographic and Health Survey (EDHS) rounds 2005, 2011 and 2016. The EDHS made it possible to use data on blood tests and detailed questionnaires among infants and young children. Multivariable logistic regression was applied to assess the association of anaemia and different immediate and underlying determinants. A total of 7,324 children aged 6-23 months were included in the analysis, with prevalences of anaemia being 71% in 2005, 61% in 2011 and 72% in 2016. The following determinants were significantly associated with childhood anaemia throughout the entire period: children younger than 1 year, anaemic mothers and those growing up in pastoralist regions. Risk factors such as diet and infections were consistently not significantly associated with anaemia. Given the tremendous adverse health effects of anaemia in young children, urgent action is needed. Hence, this study recommends nationwide multisectoral interventions targeting pastoralist regions, maternal and child health, screening and treatment of risk groups that could reduce the prevalence of anaemia., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Objectives: To evaluate the performance of the predictors in estimating the probability of pulmonary tuberculosis (PTB) when all versus only significant variables are combined into a decision model (1) among all clinical suspects and (2) among smear-negative cases based on the results of culture tests., Design: A cross-sectional study., Setting: Two public referral hospitals in Tigray, Ethiopia., Participants: A total of 426 consecutive adult patients admitted to the hospitals with clinical suspicion of PTB were screened by sputum smear microscopy and chest radiograph (chest X-ray (CXR)) in accordance with the Ethiopian guidelines of the National Tuberculosis and Leprosy Program. Discontinuation of antituberculosis therapy in the past 3 months, unproductive cough, HIV positivity and unwillingness to give written informed consent were the basis of exclusion from the study., Primary and Secondary Outcome Measures: A total of 354 patients were included in the final analysis, while 72 patients were excluded because culture tests were not done., Results: The strongest predictive variables of culture-positive PTB among patients with clinical suspicion were a positive smear test (OR 172; 95% CI 23.23 to 1273.54) and having CXR lesions compatible with PTB (OR 10.401; 95% CI 5.862 to 18.454). The regression model had a good predictive performance for identifying culture-positive PTB among patients with clinical suspicion (area under the curve (AUC) 0.84), but it was rather poor in patients with a negative smear result (AUC 0.64). Combining all the predictors in the model compared with only the independent significant variables did not really improve its performance to identify culture-positive (AUC 0.84-0.87) and culture-negative (AUC 0.64-0.69) PTB., Conclusions: Our finding suggests that predictive models based on clinical variables will not be useful to discriminate patients with culture-negative PTB from patients with culture-positive PTB among patients with smear-negative cases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Family planning counseling is critical for women to make informed reproductive and sexual health decisions. Despite Ethiopia's success in expanding access to family planning services, information on the quality of family planning counseling is limited. The objectives of this study were to assess whether the quality of counseling from the female client´s perspective has changed over time (2014 to 2018) and to investigate determinants associated with the quality of counseling to provide a more nuanced understanding of disparities in sexual and reproductive health outcomes in Ethiopia., Methods: Data were obtained from five rounds of the Ethiopian Performance Monitoring and Accountability 2020 female survey questionnaire. Quality of counseling was categorized into four levels based on the responses of the questions that compose the Method Information Index, a core Family Planning 2020 indicator that serves as a proxy for quality of counseling and reflects the extent to which women are informed about side effects and alternate methods. The proportion of female contraceptive users that received good counseling were examined over time by each region, demographic characteristics, and contraception method type and source. Ordinal logistic regression was applied to the last survey round (2018) to investigate determinants associated with counseling quality., Results: The proportion of female contraception users that reported receiving information on all three questions did not significantly change over the period 2014 to 2018. Overall quality of counseling on family planning was low, with only 30% of women reporting receiving sufficient information during counseling. The likelihood of good quality counseling was the least among those who had no formal schooling when compared to those who had higher educational attainment (OR = 0.70, 95% CI: 0.50, 0.97). Women from the wealthiest quintile were 1.72 times more likely (95% CI: 1.10, 2.69) to receive good quality counseling when compared to women in the lower wealth quintile. Women from rural areas were 1.51 times more likely to have received good counseling when compared to those in urban areas (95% CI: 1.04, 2.18). Amhara residents were less likely to receive good counseling when compared to the SNNPR (OR: 0.51, 95% CI: 0.32, 0.81). Women who acquired their method from the private sector had worse counseling (OR: 0.31, 95% CI: 0.23, 0.41) when compared to the public sector. Those using short-acting methods were more at risk of receiving lesser quality counseling when compared to users of long-acting methods (OR: 0.58, 95% CI: 0.46, 0.72)., Conclusion: The results of this analysis indicated that Ethiopia's overall progress in modern contraceptive use has not been accompanied by a corresponding increase in the quality of family planning counseling. Improving the quality of contraception counseling for women across all demographics, including wealth quintiles and education, is a crucial strategy to support positive reproductive health outcomes with a rights-based focus. Based on the findings of this study, it is essential to emphasize the need to do proper counseling for all methods including short-acting methods especially for those working the private sector and some of the regions which have lower prevalence of good counseling. Further community-based participatory and qualitative research should focus on understanding the root causes and barriers to the delivery of high-quality counseling in Ethiopia., Competing Interests: The authors have declared that no competing interests exist.

Objective: Evidence on treatment outcomes and their trend analysis through a register based retrospective study have significant contributions in the improvement of a national tuberculosis program. This study was aimed at determining tuberculosis treatment outcomes and their trend analysis., Results: A total of 3445 patient records were included. More than half (58%) were males and the mean age was 33.88 ± 16.91 years (range 0-90). From the total TB patients, 18.8% were HIV co infected. The treatment outcome of TB patients were 371 (10.8%) cured, 2234 (64.8) treatment completed, 119 (3.5%) died, 9 (0.3%) failed, 178 (5.1%) defaulted and 534 (15.5%) were transferred out. The overall treatment success rate was 89.5%. When assessed on yearly basis, treatment success rate was 87% in year 2009-2010 to 92.8% in 2013-2014 with 6.67% change in the outcome indicator over the 5 years period. Among pulmonary TB, pulmonary negative TB and extra pulmonary TB, the rate of successful treatment outcome was 83.1% to 89%, 85.1% to 89.4%, and 87.4% to 92%, respectively in the year 2009-2010 to 2013-2014. The percentage of the overall successful treatment outcomes were significantly associated with the year of treatment (p = 0.014).

Background: To improve tuberculosis case detection, interventions that are feasible with available resources are needed. We investigated whether involving trained prison inmates in a tuberculosis control programme improved tuberculosis case detection, shortened pre-treatment symptom duration, and increased treatment success in a resource-limited prison setting in Ethiopia., Methods: In this cluster-randomised trial we randomly assigned prisons in the regions Amhara and Tigray of Ethiopia to an intervention group or a control group, after matching them into pairs based on their geographical proximity and size. Larger prisons were considered eligible whereas smaller prisons were excluded. We selected three to six prison inmates in each intervention prison. The recruited prison inmates who received a 3-day training course and were capable of identifying presumptive tuberculosis cases then provided health education to all other prison inmates about tuberculosis prevention and control every 2 weeks for 1 year. They also actively searched for symptomatic prison inmates and undertook routine symptom-based tuberculosis screening. The control prisons followed the existing passive case finding system. The primary outcome was the mean case detection rate at the end of the year, measured at cluster (prison) level. This trial is registered at ClinicalTrials.gov, number NCT02744521., Findings: We randomly assigned 16 prisons with a total population of 18 032 inmates to either the intervention group (n=8) or the control group (n=8) from April 1, 2016, to March 31, 2017. During the 1-year study period, 75 new tuberculosis cases (1% of 8874 total inmates) were detected in the intervention prisons and 25 new cases (<1% of 9158 total inmates) were detected in the control prisons. The mean case detection rate was significantly higher in the intervention group than in the control group (mean difference 52·9 percentage points, 95% CI 17·5-88·3, p=0·010)., Interpretation: Involving trained inmate peer educators in the tuberculosis control programme in Ethiopian prisons significantly improved the tuberculosis case detection rate. The findings have important implications for clinical and public health policy, particularly in prisons of low-income countries where tuberculosis burden is high and the recommended tuberculosis diagnostic and treatment algorithms have generally not been implemented., Funding: Nuffic, Mekelle University., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The causes of acute malnutrition-or "wasting"-are complex, and a better understanding of the underlying drivers is necessary in order to design effective interventions. Water, sanitation, and hygiene (WASH) practices may play a fundamental role in acute malnutrition, but more research is needed to confirm this relationship. We investigated the association between WASH practices and acute malnutrition among children 6 to 59 months of age in rural Ethiopia, making use of the Ethiopian Demographic and Health Survey. Descriptive statistics were used to assess the WASH status of all rural children. Bivariate logistic regression analyses were performed to assess associations between nutritional status and WASH. Multivariate logistic regression analyses were used to adjust for confounders. A total of 7,209 children were included in the analysis, of which 867 (12.0%) were acutely malnourished. Proper toilet facilities (AOR = 0.63, 95% CI [0.46, 0.86]) and a water source close to home (AOR = 0.71, 95% CI [0.61, 0.83]) were associated with a lower prevalence of wasting. A safe water source for drinking (COR = 1.03, 95% CI [0.89, 1.19]) and a safe disposal of the child's stool (AOR = 0.97, 95% CI [0.84, 1.13]) were not significantly associated with acute malnutrition. These results suggest that WASH practices are related to acute malnutrition. Future studies-in particular intervention studies-should investigate whether improving WASH practices is effective in reducing malnutrition in infants and young children., (© 2018 John Wiley & Sons Ltd.)

Background: Increasing mobile phone ownership, functionality and access to mobile-broad band internet services has triggered growing interest to harness the potential of mobile phone technology to improve health services in low-income settings. The present project aimed at designing an mHealth system that assists midlevel health workers to provide better maternal health care services by automating the data collection and decision-making process. This paper describes the development process and technical aspects of the system considered critical for possible replication. It also highlights key lessons learned and challenges during implementation., Methods: The mHealth system had front-end and back-end components. The front-end component was implemented as a mobile based application while the back-end component was implemented as a web-based application that ran on a central server for data aggregation and report generation. The current mHealth system had four applications; namely, data collection/reporting, electronic health records, decision support, and provider education along the continuum of care including antenatal, delivery and postnatal care. The system was pilot-tested and deployed in selected health centers of North Shewa Zone, Amhara region, Ethiopia., Results: The system was used in 5 health centers since Jan 2014 and later expanded to additional 10 health centers in June 2016 with a total of 5927 electronic forms submitted to the back-end system. The submissions through the mHealth system were slightly lower compared to the actual number of clients who visited those facilities as verified by record reviews. Regarding timeliness, only 11% of the electronic forms were submitted on the day of the client visit, while an additional 17% of the forms were submitted within 10 days of clients' visit. On average forms were submitted 39 days after the day of clients visit with a range of 0 to 150 days., Conclusions: In conclusion, the study illustrated that an effective mHealth intervention can be developed using an open source platform and local resources. The system impacted key health outcomes and contributed to timely and complete data submission. Lessons learned through the process including success factors and challenges are discussed.

Background: The prison situations are notorious for causing interruptions of tuberculosis (TB) treatment and occurrence of unfavorable outcomes. In Ethiopian prisons, though TB treatment programs exist, treatment outcome results and factors contributing to unsuccessful outcome are not well documented. In this study, we assessed the treatment outcome of TB cases and identified risk factors for unsuccessful outcome in northern Ethiopian prisons., Methods: A retrospective record review was conducted for all prisoners diagnosed with TB between September 2011 and August 2015. Outcome variables were defined following WHO guidelines., Results: Out of the 496 patients, 11.5% were cured, 68% completed treatment, 2.5% were lost to follow-up, 1.6% were with a treatment failure, 1.4% died, and 15% were transferred out. All transferred out or released prisoners were not appropriately linked to health facilities and might be lost to treatment follow-up. The overall treatment success rate (TSR) of the 5 years was 94% among the patients who were not transferred out. The odds of unsuccessful outcome were 4.68 times greater among re-treatment cases compared to the newly treated cases. The year of treatment was also associated with variations in TSR; those treated during the earlier year were more likely to have unsuccessful outcome. Sputum non-conversion at the second-month check-up was strongly associated with unsuccessful outcome among the smear-positive cases., Conclusions: The mean TSR of the prisoners in the study prisons was quite satisfactory when gauged against the target level set by the End TB Strategy. However, the lack of appropriate linkage and tracking systems for those prisoners transferred or released before their treatment completion would have a negative implication for the national TB control program as such patients might interrupt their treatment and develop drug-resistant TB. Being in a re-treatment regimen and sputum non-conversion at the second-month check-up were significantly associated with unsuccessful treatment outcome among the all forms of and smear-positive TB cases, respectively.

Introduction: Prison settings have been often identified as important but neglected reservoirs for TB. This study was designed to determine the prevalence of undiagnosed pulmonary TB and assess the potential risk factors for such TB cases in prisons of the Tigray region., Method: A cross-sectional study was conducted between August 2013 and February 2014 in nine prisons. A standardized symptom-based questionnaire was initially used to identify presumptive TB cases. From each, three consecutive sputum samples were collected for acid-fast bacilli (AFB) microscopy and culture. Blood samples were collected from consented participants for HIV testing., Result: Out of 809 presumptive TB cases with culture result, 4.0% (95% CI: 2.65-5.35) were confirmed to have undiagnosed TB. The overall estimated point prevalence of undiagnosed TB was found to be 505/100,000 prisoners (95% CI: 360-640). Together with the 27 patients who were already on treatment, the overall estimated point prevalence of TB would be 793/100,000 prisoners (95% CI: 610-970), about four times higher than in the general population. The ratio of active to passive case detection was 1.18:1. The prevalence of HIV was 4.4% (36/809) among presumptive TB cases and 6.3% (2/32) among undiagnosed TB cases. In a multivariate logistic regression analysis, chewing Khat (adjusted OR = 2.81; 95% CI: 1.02-7.75) and having had a close contact with a TB patient (adjusted OR = 2.18; 95% CI: 1.05-4.51) were found to be predictors of undiagnosed TB among presumptive TB cases., Conclusions: This study revealed that at least half of symptomatic pulmonary TB cases in Northern Ethiopian prisons remain undiagnosed and hence untreated. The prevalence of undiagnosed TB in the study prisons was more than two folds higher than in the general population of Tigray. This may indicate the need for more investment and commitment to improving TB case detection in the study prisons.

Background: Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections., Methods and Findings: In this trial, 367 parasite-negative school-aged children (aged 6-15 y) were randomly assigned to receive both, one or the other, or neither of the interventions in a 2 × 2 factorial design. Assignment sequence was concealed. After 6 mo of follow-up, stool samples were examined using direct, concentration, and Kato-Katz methods. Hemoglobin levels were determined using a HemoCue spectrometer. The primary study outcomes were prevalence of intestinal parasite reinfection and infection intensity. The secondary outcome was anemia prevalence. Analysis was by intention to treat. Main effects were adjusted for sex, age, drinking water source, latrine use, pre-treatment parasites, handwashing with soap and nail clipping at baseline, and the other factor in the additive model. Fourteen percent (95% CI: 9% to 19%) of the children in the handwashing with soap intervention group were reinfected versus 29% (95% CI: 22% to 36%) in the groups with no handwashing with soap (adjusted odds ratio [AOR] 0.32, 95% CI: 0.17 to 0.62). Similarly, 17% (95% CI: 12% to 22%) of the children in the nail clipping intervention group were reinfected versus 26% (95% CI: 20% to 32%) in the groups with no nail clipping (AOR 0.51, 95% CI: 0.27 to 0.95). Likewise, following the intervention, 13% (95% CI: 8% to 18%) of the children in the handwashing group were anemic versus 23% (95% CI: 17% to 29%) in the groups with no handwashing with soap (AOR 0.39, 95% CI: 0.20 to 0.78). The prevalence of anemia did not differ significantly between children in the nail clipping group and those in the groups with no nail clipping (AOR 0.53, 95% CI: 0.27 to 1.04). The intensive follow-up and monitoring during this study made it such that the assessment of the observed intervention benefits was under rather ideal circumstances, and hence the study could possibly overestimate the effects when compared to usual conditions., Conclusions: Handwashing with soap at key times and weekly nail clipping significantly decreased intestinal parasite reinfection rates. Furthermore, the handwashing intervention significantly reduced anemia prevalence in children. The next essential step should be implementing pragmatic studies and developing more effective approaches to promote and implement handwashing with soap and nail clipping at larger scales.

Background: In Ethiopia, most deaths take place at home and routine certification of cause of death by physicians is lacking. As a result, reliable cause of death (CoD) data are often not available. Recently, a computerized method for interpretation of verbal autopsy (VA) data, called InterVA, has been developed and used. It calculates the probability of a set of CoD given the presence of circumstances, signs, and symptoms reported during VA interviews. We applied the InterVA model to describe CoD in a rural population of Ethiopia., Objective: VA data for 436/599 (72.7%) deaths that occurred during 2010-2011 were included. InterVA-4 was used to interpret the VA data into probable cause of death. Cause-specific mortality fraction was used to describe frequency of occurrence of death from specific causes., Results: InterVA-4 was able to give likely cause(s) of death for 401/436 of the cases (92.0%). Overall, 35.0% of the total deaths were attributed to communicable diseases, and 30.7% to chronic non-communicable diseases. Tuberculosis (12.5%) and acute respiratory tract infections (10.4%) were the most frequent causes followed by neoplasms (9.6%) and diseases of circulatory system (7.2%)., Conclusion: InterVA-4 can produce plausible estimates of the major public health problems that can guide public health interventions. We encourage further validation studies, in local settings, so that InterVA can be integrated into national health surveys.

Background: Over the last fifty years the world has seen enormous decline in mortality rates. However, in low-income countries, where vital registration systems are absent, mortality statistics are not easily available. The recent economic growth of Ethiopia and the parallel large scale healthcare investments make investigating mortality figures worthwhile., Methods: Longitudinal health and demographic surveillance data collected from September 11, 2009 to September 10, 2012 were analysed. We computed incidence of mortality, overall and stratified by background variables. Poisson regression was used to test for a linear trend in the standardized mortality rates. Cox-regression analysis was used to identify predictors of mortality. Households located at <2300 meter and ≥ 2300 meter altitude were defined to be midland and highland, respectively., Results: An open cohort, with a baseline population of 66,438 individuals, was followed for three years to generate 194,083 person-years of observation. The crude mortality rate was 4.04 (95% CI: 3.77, 4.34) per 1,000 person-years. During the follow-up period, incidence of mortality significantly declined among under five (P<0.001) and 5-14 years old (P<0.001), whereas it increased among 65 years and above (P<0.001). Adjusted for other covariates, mortality was higher in males (hazard ratio (HR) = 1.42, 95% CI: 1.22, 1.66), rural population (HR = 1.74, 95% CI: 1.32, 2.31), highland (HR = 1.20, 95% CI: 1.03, 1.40) and among those widowed (HR = 2.25, 95% CI: 1.81, 2.80) and divorced (HR = 1.80, 95% CI: 1.30, 2.48)., Conclusions: Overall mortality rate was low. The level and patterns of mortality indicate changes in the epidemiology of major causes of death. Certain population groups had significantly higher mortality rates and further research is warranted to identify causes of higher mortality in those groups.

Aim: Little is known about the reasons why tuberculosis (TB) service providers do not follow TB treatment guidelines. A better understanding of their real-world experiences associated with non-compliance with guideline may highlight opportunities for enhanced TB care. Whether the problem is actual or perceived may also affect the type of intervention needed to overcome the barrier. This study aimed to explore TB service providers' reasons for not complying with TB treatment guidelines., Method: A descriptive qualitative design was used. Focus group discussions were held with 39 service providers involved in TB care. The study was carried out in the Tigray region of Ethiopia, in four of the six zonal hospitals. Data were analysed using content analysis., Results: The main reasons for non-compliance with TB treatment guidelines were: (1) insufficient diagnostic modalities, limiting the capacity to correctly diagnose TB and provide the right regimen; (2) ambiguity in guideline recommendations especially for specific subgroups of patients, making it difficult to prioritize them to the right regimen; and (3) poor documentation concerning referred patients, with no appropriate examination and difficulty obtaining information from previously treated patients., Conclusion: Non-compliance may reflect valid questions about the applicability of guideline recommendations in the local context of health care. Special consideration should be given to previously treated patients, as an important factor influencing guideline compliance. Guideline compliance may also be improved by a better strategy to retest those patients whose initial tests are negative in health care contexts where TB is frequently missed., (© 2013 John Wiley & Sons, Ltd.)

Research on associated risk factors for intestinal parasitic infections and malnutrition in various geographic regions is needed for the development of appropriate control strategies. The aim of this study was to determine the risk factors associated with intestinal parasitic infections, anaemia, and malnutrition in school children, living in urban and rural areas of northern Ethiopia. Six hundred school children, aged 6-15 years, were randomly selected in a cross-sectional survey from 12 primary schools. Sociodemographic and anthropometric data were collected. Faecal samples were examined using direct, concentration, and the Kato-Katz methods. Urine specimens were analysed for Schistosoma haematobium ova. Haemoglobin was measured using a HemoCue spectrometer. The overall prevalence of intestinal parasitosis was 72% (95% confidence interval (CI): 66-76%). The prevalence of anaemia, stunting, and thinness were 11% (95% CI: 8-13%), 35% (95% CI: 31-38%), and 34% (95% CI: 30-38%), respectively. Poor personal hygiene habits were generally associated with anaemia and nutritional deficiency (low body mass index). Multivariate logistic regression models related Schistosoma mansoni infection with boys. Boys were also more likely to be malnourished. Hookworm infection was associated with anaemia and unhygienic finger nails. Access to clean water and latrines, with some hygiene and sanitation communication activities, could improve health of children in Ethiopia. The use of smartphone technology in demographic data collection proved to be successful. The potential advantage offered by this technology for parasitological field surveys merits further investigation.