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Background: Although tuberculosis is highly prevalent in low- and middle-income countries, millions of cases remain undetected using current diagnostic methods. To address this problem, researchers have proposed prediction rules. Objective: We analyzed existing prediction rules for the diagnosis of pulmonary tuberculosis and identified factors with a moderate to high strength of association with the disease. Methods: We conducted a comprehensive search of relevant databases (MEDLINE/PubMed, Cochrane Library, Science Direct, Global Health for Reports, and Google Scholar) up to 14 November 2022. Studies that developed diagnostic algorithms for pulmonary tuberculosis in adults from low and middle-income countries were included. Two reviewers performed study screening, data extraction, and quality assessment. The study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. We performed a narrative synthesis. Results: Of the 26 articles selected, only half included human immune deficiency virus-positive patients. In symptomatic human immune deficiency virus patients, radiographic findings and body mass index were strong predictors of pulmonary tuberculosis, with an odds ratio of >4. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. In symptomatic human immune deficiency virus patients, a C-reactive protein level ⩾10 mg/L had a sensitivity and specificity of 93% and 40%, respectively, whereas a trial of antibiotics had a specificity of 86% and a sensitivity of 43%. In smear-negative patients, anti-tuberculosis treatment showed a sensitivity of 52% and a specificity of 63%. Conclusions: The performance of predictors and diagnostic algorithms differs among patient subgroups, such as in human immune deficiency virus-positive patients, radiographic findings, and body mass index were strong predictors of pulmonary tuberculosis. However, in human immune deficiency virus-negative individuals, the biomarkers showed a moderate association with the disease. A few models have reached the World Health Organization’s recommendation. Therefore, more work should be done to strengthen the predictive models for tuberculosis screening in the future, and they should be developed rigorously, considering the heterogeneity of the population in clinical work.

Sunflower is the most important oil crop ranked as fourth edible oil in the world. The study was conducted in Northern Ethiopia during 2017–2019 cropping seasons using randomized completely block design with three replications. The objective was to decipher the genotype by environment interaction (GEI) in multi-environment trials (MET) and identify adaptable sunflower genotypes. Combined ANOVA, AMMI ANOVA and Eberhart and Rusell regression were analyzed, and GGE bi-plots, AMMI1 and AMMI2 bi-plots, Principal component Analysis (PCA), multi-trait genotype–ideotype distance index (MGIDI), correlation network plot for sunflower traits were sketched. AMMI stability measures, Best Linear Unbiased Prediction (BLUP) based indexes; parametric and non-parametric statistics were computed using R-statistical software. In the AMMI ANOVA the main effects of the environment (E) (54.18 % SS), genotype (G) (16.9 % SS) and GEI (23.50 % SS) were significant (p

Abstract Background Human Immunodeficiency Virus (HIV) is a major public health problem that continues to pose an enormous challenge to mankind’s survival worldwide. In urban Ethiopia, the HIV prevalence among adults aged 15–49 years is 2.9%, while in Addis Ababa, it is 3.4%. To take the edge off, the Ethiopian government has been implementing the 90-90-90 strategy also known as the surge project, in urban cities. However, the implementation of the program has not been evaluated. Thus, we evaluated the process of the 90-90-90 targets of the surge project in Addis Ababa, Ethiopia. Methods We conducted a case study with concurrent mixed-methods evaluation. We used indicator-driven evaluation dimensions –availability and accommodation dimensions from the health services access and compliance and fidelity from implementation fidelity frameworks to test the program process theory with a total of 52 indicators. We interviewed a total of 419 clients and 210 healthcare providers and reviewed 417 clients’ cards and 17 registries. We also conducted 30 key informant interviews and resource inventory. A binary logistic regression analysis was done to identify factors associated with clients’ satisfaction. We transcribed and translated the qualitative data and analysed thematically. Finally, we judged the overall process of the surge project based on the pre-seated judgmental criteria as; needs urgent improvement, needs improvement and well implemented. Results We found that 90% of the project process was as per the program process theory measured by the availability of resources (95.8%), compliance (88.0%), fidelity (84.7%), and accommodation of services (89.3%). We found a shortage of human power, test kits, and viral load testing machines. The commitment of health care providers, provider-client interaction, and clients’ satisfaction with the service at card rooms were found to be poor. Moreover, being aged 15–24, being married and government government-employed were negatively associated with clients’ satisfaction with antiretroviral therapy services. Conclusion The process of the surge project needs improvement. Moreover, the achievements of the first two 90–90 targets were poor. Therefore, implementers need to take intensified action for the availability of resources and to improve the commitment of healthcare providers through refreshment training.

Abstract Background Hemophilia is a rare genetic condition that is often overlooked and underdiagnosed, particularly in low-income countries. Long-term spontaneous joint bleeding and soft tissues can have a significant negative impact on a patient’s health-related quality of life (HRQoL). The objective of this study was to assess HRQoL and its associated factors in Ethiopian patients with hemophilia. Methods A cross-sectional survey was conducted among patients with hemophilia at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. Patients were recruited consecutively during follow-up visits. The European Quality of Life Group’s 5-Domain Questionnaires at five levels (EQ-5D-5L) and Euro Quality of Life Group’s Visual Analog Scale (EQ-VAS) instruments were used to assess HRQoL. The EQ-5D-5L utility score was computed using the disutility coefficients. We applied the Krukal-Wallis and Mann–Whitney U tests to determine the differences in EQ-5D-5L and EQ-VAS utility scores between patient groups. A multivariate Tobit regression model was used to identify factors associated with HRQoL. Statistical analyses were performed using STATA version 14 and statistical significance was determined at p

Abstract Background Displacement is a psychologically stressful event. Since the war began, the people of Tigray were subjected to stressful events such as torture, rape, the killing of a family member, forced displacement, and even ethnic cleansing in their home countries. Especially displaced individuals are faced mental health problems. This study aimed to assess the prevalence of depression and associated factors among community internally displaced people due to the war on Tigray, in 2021. Methods The community-based cross-sectional study design was applied from August 06 to 30, 2021 in all Weredas of Tigray. A total of 1,990 cIDP were recruited through a two-stage sampling technique. A structured and standardized questionnaire was used to collect data. Both bivariate and multivariable logistic regression was applied to identify associated risk factors and AOR with 95% confidence interval was used to select statistically significant variables. Results The prevalence of depression among internally displaced people was 81.2% (95% CI: 79.4–83%), with more than 60% categorized as moderate and severe depression. The married and divorced marital status, being government employee, having family size > = 4, destruction of household fixed assets, looting of cereals, and having disabled family members due to the war were the significantly associated risk factors of depression. Conclusions The prevalence of depression among community internally displaced people during the war on Tigray is very high compared to other studies conducted elsewhere. Almost 8 of 10 IDPs are developed depression and this is a very series health issue that needs immediate intervention by local, international organizations and communities around the world.

Abstract Background Measuring socioeconomic inequalities in healthcare usage represents a critical step towards promoting health equity, in alignment with the principles of universal health coverage and the United Nations’ Sustainable Development Goals. In this study, we assessed the socioeconomic inequalities in HIV testing during antenatal care (ANC) in sub-Saharan Africa. Methods Sub-Saharan Africa was the focus of this study. Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Mauritania, Mozambique, Rwanda, Sierra Leone, Uganda, Zambia, and Zimbabwe were the countries included in the study. This study used current Demographic and Health Surveys data spanning from 2015 to 2022. A total of 70,028 women who tested for HIV as part of antenatal contacts formed the sample for analysis. We utilized the standard concentration index and curve to understand the socioeconomic inequalities in HIV testing during antenatal care among women. Additionally, a decomposition analysis of the concentration index was ran to ascertain the contributions of each factor to the inequality. Results Overall, 73.9% of women in sub-Saharan Africa tested for HIV during ANC. The countries with the highest proportions were Malawi, Rwanda, Zambia, and Zimbabwe. Mali Benin, Guinea, Mali, and Mauritania were the countries with the lowest proportions of HIV testing. Being among the richer [AOR 1.10, 95% CI: 1.02,1.18] and richest [AOR 1.41, 95% CI:1.30, 1.54] wealth quintiles increased the odds of HIV testing during ANC. The concentration value of 0.03 and the curve show that HIV testing is more concentrated among women in the highest wealth quintile. Hence, wealthy women are advantaged in terms of HIV testing. As the model’s residual value is negative (-0.057), the model overestimates the level of inequality in the outcome variable (HIV during ANC), which means that the model’s explanatory factors can account for higher concentration than is the case. Conclusion We found that there is substantial wealth index-related inequalities in HIV testing, with women of the poorest wealth index disadvantaged in relation to the HIV testing. This emphasizes the necessity for sub-Saharan Africa public health programs to think about concentrating their limited resources on focused initiatives to grasp women from these socioeconomic circumstances. To increase women’s access to HIV testing, maternal and child health programs in sub-Saharan Africa should attempt to minimize female illiteracy and poverty. Consequently, health education may be required to provide women with comprehensive HIV knowledge and decrease the number of lost opportunities for women to get tested for HIV. Given the link between knowledge of HIV and HIV testing, it is important to focus on community education and sensitization about HIV and the need to know one’s status.

Abstract Background Ensuring regular supervision, capacity building and motivation are crucial for the successful retention of health extension workers (HEWs). Failure in these aspects could increase the attrition rate of HEWs. To date, there has not been a comprehensive nationwide study on HEW attrition that could act as a source of evidence for policy makers. This study explored HEW attrition, including leaving the health sector entirely and its regional variation, trends and predictors of attrition out of the health system. Methods This study explored the attrition of HEWs from the beginning of the program until the end of 2018. A district-based mixed method study was conducted to review the personnel files of HEWs. A multistage sampling technique was employed to select 3,476 HEWs, and a probability weight was assigned for each observation. Descriptive statistics were calculated for the outcome and predictor variables. A logistic regression model was used to model attrition out of the health system. A qualitative study was conducted to understand the reasons why HEWs leave their jobs. Thematic analysis was performed using Nvivo version 12. Results The magnitude of attrition of HEWs was found to be 21.1% during the fifteen years of HEP implementation. Of the total 704 who left their job as an HEW, 530 (73%) left the health system altogether. Number of biological children [AOR = 0.61, 95% CI; 0.42–0.89], having an additional education [AOR = 8.34, 95% CI; 3.67–18.98], obtaining official recognition [AOR = 0.29, 95% CI; 0.10–0.83], administrative reprimand [AOR = 1.66, 95% CI; 1.07 -2. 56), distance between district health office and health post [AOR = 1.75, 95%CI; 1.18–2.59) and COC status [AOR = 2.06, 95%CI 1.39–3.06) were independent predictors of leaving the health sector. High regional variation in attrition was observed, ranging from 38.5% in Addis Ababa to just 6.1% in the Harari region. The trend of attrition has steadily increased over time, with a high of 1,999 attritions per 10,000 HEW in 2018. Psychosocial factors, administrative issues, career advancement incentives, and workplace-related problems were the themes that emerged from the qualitative study as reasons for attrition of HEWs. Conclusion Even though the magnitude of attrition was relatively low, there was high regional variation and incremental trends. Moreover, the out-of-health sector attrition is also high. Critically examining the HEP policy environment to increase the number of HEWs deployed per health post to reduce workload and improving HEW incentives, including career development, may assist in increasing HEW job satisfaction, which in turn could help to reduce attrition, including leaving the health sector.

Abstract The relationship between normal-weight obesity (NWO)—high percent body fat (%BF) in individuals with normal body mass index (BMI)—and cardiometabolic abnormalities has not been explored in Africa. We determined the prevalence of the NWO and evaluated its association with hypertension, elevated blood sugar and dyslipidaemia among adults in Addis Ababa, Ethiopia. A cross-sectional study was conducted among adults 18–64 years (n = 600). Blood pressure, blood glucose, lipid profile, and anthropometric measurements were completed. As a function of skinfold thickness, body density and %BF were estimated using Durnin & Womersley and Siri Equations, respectively. The relationship between the NWO and the outcomes of interest, assessed using adjusted linear and logit models. The age- and sex-standardised prevalence of NWO was 18.9% (95% confidence interval (CI) 15.8, 22.2%). Comparison between normal-weight lean (normal %BF and BMI) and normal-weight obese individuals suggested no difference in systolic blood pressure (β = 2.55; 95% CI − 0.82, 5.92); however, diastolic blood pressure (β = 3.77: 95% CI 1.37, 6.18) and odds of hypertension (adjusted odds ratio (AOR) = 2.46: 95% CI 1.18, 5.13) were significantly raised in the latter. Similarly, adults with NWO had elevated blood glucose (β = 2.30; 95% CI 1.23, 15.66) and increased odds of high blood sugar level (AOR = 1.68; 95% CI 1.05, 2.67). LDL (β = 8.73: 1.56, 15.90), triglyceride (β = 20.99: 0.78, 41.22), total cholesterol (β = 10.47: 1.44, 19.50), and Cholesterol to HDL ratio (β = 0.65: 0.27, 1.04) were also raised among adults with NWO. NWO is common among adults in Addis Ababa and is associated with cardiometabolic derangements.

Abstract Background Maternal and neonatal health services are life-saving interventions for neonatal health outcomes. As Rwanda endeavors to accomplish sustainable development goals, adequate ANC is essential to lessen of neonatal mortality. The utilization of ANC continues to be inadequate and high neonatal mortality rate persevere in Rwanda. Understanding the direct and indirect factors that affect newborn health outcomes is necessary for well-targeted interventions. However, few studies had been conducted in Rwanda to evaluate the importance of ANC in improving neonatal health. This study therefore assessed the association between ANC and neonatal outcomes. Methods The Demographic and Health Surveys (DHS) are household surveys that are cross-sectional, nationally representative, and used to collect data on population, health, and nutrition. Data from the 2010,2015 and 2020 Rwanda Demographic and Health Surveys (RDHS) were used. The study involved 17,747 women between the ages of 15 and 49 who had a single live birth and at least one ANC visit in five years prior to each survey. Bivariate and multivariable logistic regression, a survey adjusted for clusters at multiple level, and the estimation of adjusted odds ratios (aOR) and 95% confidence intervals were used to evaluate the relationship between the outcome and independent variables. Results Out of 17,747 women ;7638(42.91%) of the mothers had adequate ANC visits and low birth weight (LBW) was found among 833(4.63%) neonates. The birth of a LBW baby (aOR:4.64;95%CI:3.19,6.74) was directly related to increased odds of neonatal death. Mothers aged 20–34 years (aOR:0.40; 95%CI:0.20,0.81), a preceding birth interval of 24months or greater (aOR:0.41:95%CI:0.28,0.60), baby being female (aOR:0.72; 95%CI:0.54,0.96), having adequate ANC visits (aOR:0.64;95% CI:0.46,0.89) and the birth order of the newborn being ranked second or third (aOR:0.60; 95%CI:0.38,0.95) were negatively associated with neonatal death. Conclusion Health education programs targeting teen and primigravida mothers should be encouraged. Among the newborn survival interventions, addressing short birth intervals and the effective management of LBW cases should be explored. The findings confirm the fundamental importance of adequate ANC in the neonatal survival.

Background: One emergency that occurs frequently and has high morbidity is carbon monoxide poisoning. After a time of lucidity, some victims who recover from the incident of acute carbon monoxide exposure may later suffer delayed neuropsychiatric sequelae (DNS), which can include cognitive impairments, a wide range of neurological abnormalities, and affective disorders. Below, we report the first documented incident of DNS after carbon monoxide poisoning in Ethiopia. Case presentation: A 40-year-old male patient who developed a coma after he was exposed to burning charcoal in a closed room was admitted to Debre Tabor Comprehensive Specialized Hospital in the northwest region of Ethiopia. He stayed for 12 days during his first admission and was discharged with improvement. One month after discharge, he developed delayed neuropsychiatric sequelae, which manifested as bizarre behavior, being unable to walk unsupported, loss of concentration, and failure to control urine and feces. Brain MRI showed bilateral periventricular and frontoparietal deep white matter subcortical abnormal T1 and T2 prolongation with no restriction of diffusivity, possibly due to demyelinating disorders. He was managed with fluid therapy, benzhexol, risperidone, and rehabilitation therapy. He stayed for two weeks in our hospital and was discharged with improvement. Conclusion: Despite the paucity of delayed neuropsychiatric sequelae from carbon monoxide poisoning, physicians should be highly suspicious in the right situations. The precise mechanisms of delayed toxic effects, prevention measures, and treatment modalities have not yet been determined; therefore, more research and attention are required.

Abstract Canine visceral leishmaniasis (CVL) is a significant vector-borne Meta zoonotic disease caused by agents of the L. donovani complex. The disease is transmitted by the bite of phlebotomine female sandflies of the genera Phlebotomus and Lutzomyia in the old and new worlds, respectively. This study was conducted to assess the knowledge, attitude, and practices of the residents about CVL based on the One Health concept in two towns of the Oromia Region, Ethiopia. A community-based cross-sectional study was conducted between October 2019 and September 2020, using an interview questionnaire as the study instrument. The study participants were selected through a simple random sampling method. Pearson’s Chi-square and logistic regression tests were used to evaluate the association between the study participants’ knowledge, attitude, and practices toward CVL and possible risk factors. The study included a total of 400 participants, and the results indicated that 77.25% had good knowledge, 60.5% had a favorable attitude, and 59.25% had good practices toward CVL. The town of Ejaji and dog ownership were significantly associated with good knowledge (p = 0.001), and attitude (p = 0.001) towards CVL, while having a dog (p = 0.001), having a diploma (p = 0.019) or degree and above (0.018), being divorced or widowed (0.012), and being Oromo (p = 0.013) were all significantly associated with good CVL practice. Most participants in both study areas had good knowledge but moderate attitudes and practices toward CVL. Therefore, it is crucial to undertake comprehensive community health education and awareness programs of zoonotic visceral leishmaniasis and its vectors based on the One Health concept through various means.

Kibrom Berhanu Gebresilassie, Mengistu Hagazi Tequare, Micheal Berhe Gebremedhin, Wegen Beyene Tesfamariam, Tesfay Hailu Tekle, Teame Tekleab Gebremedhin, Kidanemariam Alem Berhie, Hailemariam Berhe, Hiluf Ebuy Abraha Mekelle University, College of Health Sciences, Mekelle, EthiopiaCorrespondence: Wegen Beyene Tesfamariam, Department of Medical Biochemistry & Molecular Biology, School of Medicine, College of Health Sciences, Mekelle University, P.o.box 1871, Mekelle, Ethiopia, Fax +251 0 344416681, Email wegeneyb@gmail.comObjective: To determine the effect of armed conflict and COVID-19 pandemic on the level and trend of surgical volume at Ayder Comprehensive Specialized Hospital, Tigray, Northern Ethiopia.Methods: All major surgeries carried out over four consecutive years were included and subjected to an interrupted time-series analysis called segmented regression analysis to examine the effect of war and COVID-19 on level of and trend changes in major surgeries. The outcome was measured and estimated that there was a significant change in the number of major surgeries as a result of the conflict and COVID-19 pandemic compared to the baseline status.Results: We analyzed 29,877 major surgeries conducted during the study period. The results indicate that, before the beginning of the intervention period, on average 632 surgeries per month were performed [632.1 (95% CI: 575.8, 688.41)]. Right after COVID-19, however, this number dropped by 359 patients per month [− 359.3 (95% CI: − 486.4, − 232.2)]. During the war period, the number of surgeries decreased by 232 patients per month [− 232.7 (95% CI: − 408.5, − 56.9)].Conclusion: This study revealed that both COVID-19 and the war in Tigray have significantly reduced the number of major surgeries that could have been carried out in their absence at a large tertiary hospital in Northern Ethiopia.Keywords: surgery, trend, armed conflict, COVID-19, Tigray, war

Reduced graphene oxide (rGO) is the demanded material for large-scale graphene applications due to the relative ease of preparing sufficient quantities with the desired properties. Herein, optimized preparation conditions for water-dispersible rGO using the one-step chemical exfoliation method are reported. The rGO samples were obtained from graphite under different controlled reaction conditions, i.e., temperature (120, 140, and 160 °C) and time (16, 20, and 24 hrs). The microstructural, chemical, wetting, and electrical properties of samples were characterized using Raman spectroscopy, X-ray diffraction (XRD), Fourier transform infrared (FT-IR) spectroscopy, contact angle measurement, current-voltage (I–V) characteristic, and electrochemical impedance spectroscopy (EIS), respectively. The Raman parameter (i.e., the ID/IG values) was used to assess the quality of rGO materials. Accordingly, rGO160@20 showed the smallest ID/IG value (0.57) compared to the rest of the samples, followed by rGO160@16 and rGO120@24 with 0.75 and 0.77 values, respectively. The observed broad and diffused peaks centered at 2θ = 25° from XRD are the finger-print characteristics of rGO samples. FT-IR (mainly due to -OH) and lower contact angle values (≤ 33 °C) analysis confirmed the hydrophilic nature of these samples. The samples' non-linear I-V characteristics were attributed to disordered dielectric barriers. The charge transfer resistances (Rct) at the electrode/electrolyte interface were 21.65 for rGO160@20 and 25.65 for rGO160@16 and rGO120@24. EIS analysis also confirmed the rGO samples have supercapacitor behavior. Experimental parameters' synergistic effects influenced sample microstructure. Optimal processing conditions of rGO samples were also achieved for energy storage and applications that need graphene water dispersion.