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Introduction: the obesity epidemic is growing faster in developing countries with no exception of Ethiopia. Currently, abdominal obesity is identified as a major risk factor for chronic diseases due to the accumulation of liable fat. However, despite the evidence of certain documented data, abdominal obesity has been on the rise in Ethiopia, especially in urban areas. Therefore, this study aimed to assess the prevalence and factors associated with abdominal obesity among adults in Jimma town, Southwest Ethiopia., Methods: a community-based cross-sectional study was employed on 845 adults selected using a multi-stage sampling technique. Data were collected using a pretested interviewer-administered questionnaire. Data were entered using Epi-data version 3.1 and exported to STATA version 14 for analysis. Simple linear regression was conducted to identify candidate variables. A multivariable linear regression model was fitted to identify factors associated with abdominal obesity. P-value<0.05 was used to declare statistical significance., Results: a total of 806 respondents participated in this study, making a response rate of 95.4%. The magnitude of abdominal obesity was found to be 24.6% (95% CI: 21.5, 27.5). Physical activity (β= -2.053; 95%CI: -3.353, -0.454), alcohol consumption (β=1.631; 95%CI: 0.176, 3.087), and age (β=0.319; 95%CI: 0.250, 0.389) were significantly associated with abdominal obesity., Conclusion: the magnitude of abdominal obesity among adults in the study area was high compared to previous studies. Alcohol drinking, being physically inactive, and age were predictors of abdominal obesity. There is a need for intervention for adults with physical inactivity and alcohol consumption to reduce abdominal obesity., Competing Interests: The authors declare no competing interests., (Copyright: Fitsum Endale et al.)

High salinity mobilization and movement from salt-laden deposits in semi-arid landscapes impair soils and water resources worldwide. Semi-arid regions worldwide are expected to experience rising temperatures and lower precipitation, impacting water supply and spatio-temporal patterns of salinity loads and affecting downstream water quality. This study quantifies the impact of future climate on hydrologic fluxes and salt loads in the Gunnison River Watershed (GRW) (14,608 km 2 ), Colorado, using the APEX-MODFLOW-Salt hydro-chemical watershed model and three different CMIP5 climate models projection downscaled by Multivariate Adaptive Constructed Analogs (MACA) for the period 2020-2099. The APEX-MODFLOW-Salt model accounts for the reactive transport of major salt ions (SO 4 2- , Cl - , CO 3 2- , HCO 3 - , Ca 2+ , Na + , Mg 2+ , and K + ) to streams via surface runoff, rainfall erosional runoff, soil lateral flow, quick return flow and groundwater-stream exchange. Model results are analyzed for spatial and temporal trends in water yield and salt loading pathways. Although streamflow is primarily derived from surface runoff (65%), the predominant source of salt loads is the aquifer (73%) due to elevated concentrations of groundwater salt. Annual salt loading from the watershed is 582 Mkg, approximately 10% of the salt load in the Colorado River measured at Lee's Ferry, AZ. For future climate scenarios, annual salt loads from the watershed increased between 4.1% and 9.6% from the historical period due to increased salt loading from groundwater and quick return flow. From the results, applying the APEX-MODFLOW-Salt model with downscaled future climate forcings can be a helpful modeling framework for investigating hydrology and salt mobilization, transport, and export in historical and predictive settings for salt-affected watersheds., 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.)

The CRISPR-Cas (Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR)) and the associated protein (Cas9) system, a young but well-studied genome-editing tool, holds plausible solutions to a wide range of genetic disorders. The single-guide RNA (sgRNA) with a 20-base user-defined spacer sequence and the Cas9 endonuclease form the core of the CRISPR-Cas9 system. This sgRNA can direct the Cas9 nuclease to any genomic region that includes a protospacer adjacent motif (PAM) just downstream and matches the spacer sequence. The current challenge in the clinical applications of CRISPR-Cas9 genome-editing technology is the potential off-target effects that can cause DNA cleavage at the incorrect sites. Off-target genome editing confuses and diminishes the therapeutic potential of CRISPR-Cas9 in addition to potentially casting doubt on scientific findings regarding the activities of genes. In this review, we summarize the recent technological advancements in reducing the off-target effect of CRISPR-Cas9 genome editing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Asmamaw Mengstie et al.)

Antimicrobial resistance of Escherichia coli is a growing problem in both developed and developing countries. This study aimed to investigate the phenotypic antimicrobial resistance of E. coli isolates ( n = 260) isolated from the stool specimen of patients attending public health facilities in Addis Ababa and Hossana. This study also aimed to characterize phenotypically confirmed extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates ( n = 22) using whole-genome sequencing. Resistance to 18 different antimicrobials was assessed using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The highest resistance rate among the E. coli isolates was found for ampicillin (52.7%), followed by trimethoprim-sulfamethoxazole (29.6%). Of all isolates, 50 (19.2%) were multidrug-resistant and 22 (8.5%) were ESBL producers. ESBL genes were detected in 94.7% of the sequenced E. coli isolates, and multiple β-lactamase genes were detected in 57.9% of the isolates. The predominant ESBL gene identified was bla CTX-M-15 (78.9%). The bla TEM-1B gene was detected in combination with other ESBL genes in 57.9% of the isolates, while only one of the sequenced isolates contained the bla TEM-1B gene alone. The bla CTX-M-3 gene was detected in three isolates. The genes bla CTX-M-15 and bla TEM-1B as well as bla CTX-M-15 and bla TEM-169 were confirmed to coexist in 52.6% and 10.5% of the sequenced E. coli isolates, respectively. In addition, bla OXA-1 was identified together with bla CTX-M-15 and bla TEM-1B in one isolate, and in one isolate, bla TEM-169 together with bla CTX-M-15 and bla TEM-1B was found. The results obtained show that measures need to be taken to reduce the spread of drug resistance and ensure the long-term use of available antimicrobials.

Introduction: Meningoencephalocele is a rare congenital neural tube defect that results in herniation of brain tissue, necessitating surgical treatment. However, anaesthetic management of meningoencephalocele is challenging because of the giant occipital mass in airway management, particularly for anaesthetists working in resource-limited settings. Therefore, this case report aimed to share the challenges encountered during the perioperative anaesthesia management of a giant occipital meningoencephalocele in Ethiopia., Case Presentation: A 16-day-old female neonate was referred from a health centre in Ethiopia for surgical excision and repair of a giant occipital meningoencephalocele (GOM). The main challenges were hemodynamic instability and airway management due to the giant mass on neck movement and inability to achieve the optimal position for intubation., Methods: A single clinical case report discussed challenges encountered during perioperative anaesthesia management of GOM in a resource-limited setting in Ethiopia, and this work has been reported in line with the SCARE 2023 criteria., Conclusion: Anaesthesia management in neonates with GOM is challenging for anaesthetists in resource-limited settings because of the scarcity of different airway equipment and large masses. Another concern was to avoid pressure on the GOM due to rupture, which may result in hemodynamic instability and hypothermia. Therefore, attention should be paid to proper handling of the airway, hypothermia, and fluid loss. Generally, managing an occipital meningoencephalocele poses challenges for anaesthetists, particularly in terms of securing the airway. Despite these challenges, the authors managed with locally available resources., Competing Interests: The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article, (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Gynecological cancers pose a significant threat to women worldwide, especially those in resource-limited settings. Human analysis of images remains the primary method of diagnosis, but it can be inconsistent and inaccurate. Deep learning (DL) can potentially enhance image-based diagnosis by providing objective and accurate results. This systematic review and meta-analysis aimed to summarize the recent advances of deep learning (DL) techniques for gynecological cancer diagnosis using various images and explore their future implications., Methods: The study followed the PRISMA-2 guidelines, and the protocol was registered in PROSPERO. Five databases were searched for articles published from January 2018 to December 2022. Articles that focused on five types of gynecological cancer and used DL for diagnosis were selected. Two reviewers assessed the articles for eligibility and quality using the QUADAS-2 tool. Data was extracted from each study, and the performance of DL techniques for gynecological cancer classification was estimated by pooling and transforming sensitivity and specificity values using a random-effects model., Results: The review included 48 studies, and the meta-analysis included 24 studies. The studies used different images and models to diagnose different gynecological cancers. The most popular models were ResNet, VGGNet, and UNet. DL algorithms showed more sensitivity but less specificity compared to machine learning (ML) methods. The AUC of the summary receiver operating characteristic plot was higher for DL algorithms than for ML methods. Of the 48 studies included, 41 were at low risk of bias., Conclusion: This review highlights the potential of DL in improving the screening and diagnosis of gynecological cancer, particularly in resource-limited settings. However, the high heterogeneity and quality of the studies could affect the validity of the results. Further research is necessary to validate the findings of this study and to explore the potential of DL in improving gynecological cancer diagnosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could., (Copyright © 2024 Taddese, Tilahun, Awoke, Atnafu, Mamuye and Mengiste.)

The World Health Organization [WHO] recommends a genotype-specific human papillomavirus [HPV] vaccination as a primary prevention strategy to control the burden of cervical cancer globally. In Ethiopia, where the non-vaccine-targeted HPV genotypes have not been adequately studied, a vaccination initiative was launched in 2018 targeting HPV-6,-11, -16, and -18 for girls aged 14-18 years. The co-existence of both vaccine-targeted and non-targeted genotypes is a serious concern, as it can accelerate cancer progression. Therefore, this study was conducted to determine the prevalence of non-vaccine-targeted HPV genotypes and assess the level of multiple infections with other genotypes in eastern Ethiopia. A health facility-based cross-sectional study including 110 women with positive HPV DNA results was conducted from April to August 2021. A structured questionnaire to collect demographic and clinical data was used. Cervical swabs were collected using L-shaped FLOQSwabs. Women's cytological profile was determined based on Pap smear test results. An automated nucleic acid extraction system using STARMag 96 ProPrep Universal Extraction Kit was utilized following the manufacturer's protocol. An amplification assay in real-time was employed to amplify and identify the HPV Late 1 [L1] gene, which is utilized for genotyping purposes. Following this, the collected data was entered into Epi data version 3.1 software, and the analysis was performed using STATA version 14. A total of 110 women [age range 30-60 years, mean age = 36.5 years and SD ± 6.9] had positive HPV DNA results and were included in the study. Among these, 108 women had valid co-testing [Pap test and HPV DNA test] results for further analysis, and the results of the remaining 2 women were rejected. Overall, the prevalence of non-vaccine-targeted HPV was 56 (51.8%, 95%CI [0.42, 0.61]), of which 28 women (25.4%, 95%CI [0.18, 0.34]) had a single non-vaccine HPV genotype infection. The remaining 29 women (26.4%, 95% CI: 0.190-0.355) experienced multiple infections. The non-vaccine-targeted genotypes of HPV-35 accounted for 11 cases (10%, 95%CI [0.06, 0.17]), HPV-68 was detected in 9 women (8.2%, 95%CI [0.04, 0.15]), HPV-56 and HPV-66 were both found in 8 cases each (7.3%, 95%CI [0.04, 0.14]) of the total. In addition, out of these 108 women, 93 (86.1%, 95%CI [0.78, 0.91]) had low-grade squamous intraepithelial lesions, 13 (12%, 95%CI [0.07, 0.20]) no intraepithelial lesion or malignancy, and two (1.9%, 95%CI [0.01, 0.07]) high-grade squamous intraepithelial lesions. Furthermore, there was no statistical difference [p = 0.755] between vaccine-targeted and non-vaccine-targeted genotypes as the primary cause of cervical lesions. In conclusion, the findings of the present study highlight the existence of a notable prevalence of multiple infections caused by non-vaccine-targeted HPV genotypes. Therefore, it is recommended that both the Federal and regional health bureaus to evaluate the range of hr HPV genotypes protected by the current HPV vaccine and explore the option of transitioning from the quadrivalent HPV vaccine to a novavalent vaccine that includes seven high-risk HPV genotypes., (© 2024. The Author(s).)

Background: Depressive disorder is one of the severe and common mental illnesses in the general population. Bipolar disorder is a severe, persistent mental illness associated with significant morbidity and mortality. However, there is a paucity of data on the prevalence of depressive disorder, and bipolar disorder in our study area., Objective: This study aimed to assess the prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar Health and Demographic Surveillance Sites in Eastern Ethiopia., Methods: A community-based cross-sectional study was conducted among 1,416 participants. A multi-stage sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final model were considered statistically significant., Results: The overall prevalence of depressive and bipolar disorders among our study participants was 6.7% (95% CI: 5.40, 8.20) and 2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder included a family history of mental illness, chronic medical illnesses, unemployment, low educational status, divorced or widowed, poor social support, and current alcohol use or khat chewing. Single, males, divorced or widowed, and current consumers of alcohol were independent predictors for bipolar disorder., Conclusions and Recommendation: The results of our investigation showed that bipolar illness and depression were significant public health issues. It was shown that although bipolar disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is imperative that the relevant body grow and enhance the provision of mental health services. Furthermore, research on the effects and burdens of bipolar disorder in the community is required., (© 2023. The Author(s).)

Background: The carcinogenic properties of arsenic make it one of the most hazardous chemicals globally. Nevertheless, the exact level of human exposure to arsenic and the associated risks of cancer and non-cancer effects through different pathways in Ethiopia are still uncertain., Objective: The primary aim of this study was to evaluate the risk of both cancer and non-cancer outcomes among children and adults who have been exposed to arsenic through drinking water in the Adami Tulu Jido Kombolcha district of Ethiopia., Methods: For this study, a longitudinal study design was employed. A total of 45 groundwater sources were sampled using the census sampling method. The concentrations of total arsenic were measured using Agilent 7900 series inductively coupled plasma mass spectrometry. Carcinogenic and noncarcinogenic risk assessments were conducted by calculating lifetime cancer risk and hazard quotients. Microsoft Office Excel was utilized to calculate human health risk indices, and descriptive statistical analysis were performed using SPSS software., Results: Our findings revealed that during the dry season, the mean arsenic concentration in the groundwater samples was 11.15 ± 9.38 µg/L, while during the rainy season, it was 10.67 ± 8.16 µg/L. The total cancer risk for children, resulting from oral ingestion and skin contact, was 1.15 × 10 -2 and 1.07 × 10 -2 during the dry and rainy seasons, respectively. For adults, the total cancer risk from oral ingestion and skin contact during the dry and rainy seasons was 4.95 × 10 -3 and 4.59 × 10 -3 , respectively. Furthermore, the total hazard quotients for children via oral ingestion and skin absorption were 25.9 and 24.0 during the dry and rainy seasons, respectively. For adults, the total hazard quotients from ingestion and dermal contact during the dry and rainy seasons were 11 and 10, respectively., Conclusions: The findings indicate that the risks of cancer and non-cancer effects resulting from arsenic exposure through ingestion and dermal exposure were found to exceed the acceptable thresholds in both seasons. These results emphasize the urgent need for focused attention on the study population in the study area due to the high likelihood of experiencing adverse health outcomes., Competing Interests: 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., (© 2024 The Authors.)

Fall-planted cover crop (CC) within a continuous corn (Zea mays L.) system offers potential agroecosystem benefits, including mitigating the impacts of increased temperature and variability in precipitation patterns. A long-term simulation using the Decision Support System for Agrotechnology Transfer model was made to assess the effects of cereal rye (Secale cereale L.) on no-till continuous corn yield and soil properties under historical (1991-2020) and projected climate (2041-2070) in eastern Nebraska. Local weather data during the historical period were used, while climate change projections were based on the Canadian Earth System Model 2 dynamically downscaled using the Canadian Centre for Climate Modelling and Analysis Regional Climate Model 4 under two representative concentration pathways (RCP), namely, RCP4.5 and RCP8.5. Simulations results indicated that CC impacts on corn yield were nonsignificant under historical and climate change conditions. Climate change created favorable conditions for CC growth, resulting in an increase in biomass. CC reduced N leaching under climate change scenarios compared to an average reduction of 60% (7 kg ha - 1 ) during the historical period. CC resulted in a 6% (27 mm) reduction in total water in soil profile (140 cm) and 22% (27 mm) reduction in plant available water compared to no cover crop during historical period. CC reduced cumulative seasonal surface runoff/soil evaporation and increased the rate of soil organic carbon buildup. This research provides valuable information on how changes in climate can impact the performance of cereal rye CC in continuous corn production and should be scaled to wider locations and CC species., (© 2023 The Authors. Journal of Environmental Quality published by Wiley Periodicals LLC on behalf of American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

The biggest threat to the effectiveness of vaccination initiatives is a lack of information about and trust in immunization. This study aimed to determine the prevalence of knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. PubMed, Web of Science, Google Scholar, EMBASE, and the Ethiopian University online library were searched. To look for heterogeneity, I 2 values were computed and an overall estimated analysis was carried out. Although 2108 research articles were retrieved, only 12 studies with a total of 5,472 participants met the inclusion criteria for this systematic review and meta-analysis. The pooled estimates of participants with good knowledge of and positive attitudes toward the COVID-19 vaccine were found to be 65.06% (95% CI: 56.69-73.44%; I 2  = 82.3%) and 60.15% (95% CI: 45.56-74.74%; I 2  = 89.4%), respectively, revealing that there is a gap in knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. A holistic and multi-sectoral partnership is necessary for a successful COVID-19 vaccination campaign.

Introduction: Antiretroviral Treatment (ART) has great importance in reducing viral load. Though a global effort was made to suppress viral load, the level of viral load suppression among ART patients is still high in Ethiopia., Objective: This study aims to assess the magnitude and contributing factors for viral load suppression among patients attending ART clinics in Ethiopia., Methods: The articles were searched using different databases using the guideline of reporting systematic review and meta-analysis (PRISMA). A random effect model was used to ascertain the pooled prevalence of viral load suppression in Ethiopia using STATA 14 software., Results: The pooled prevalence of suppressed viral load was 75.25% (95% CI: 68.61-81.89). Having good adherence (OR: 2.71, 95% CI 2.27, 3.15), baseline CD4 count (OR: 1.74, 95% CI 1.53, 1.96), and being female (OR: 1.41, 95% CI 1.04, 1.79) were determinants of pooled estimates of suppressed viral load., Conclusion: The pooled prevalence of suppressed viral load was 75% which is lower than the targeted level by the sustainable development goal (SDG) 2020, which was 90%. Therefore, the stakeholders should be focused on the existing strategies to decrease viral load among ART patients. They should work to adhere to patients for ART treatment., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Objective: This research aimed to assess COVID-19 vaccine acceptance and the factors influencing it among the population of the Somali region in Ethiopia through a cross-sectional COVID-19 survey., Design: Community-based cross-sectional study., Setting: The survey was conducted in eight selected districts of the Somali region in Ethiopia from 20 October 2021 to 30 October 2021., Participants: Participants were chosen using simple random sampling and data analysis used Stata V.14. Both bivariable and multivariable binary logistic regression methods were applied, with variables having a p value below 0.2 considered for inclusion in the final model, where statistically significant factors were identified at p<0.5., Primary Outcome Measure: Willingness to take the vaccine., Results: A total of 1010 respondents participated in this study. The proportion of people's willingness to take the vaccine was 65% (95% CI 62 to 68). When you believe moderately or highly that getting a COVID-19 vaccine will protect others (AOR=6.2, 95% CI 1.43 to 26.6) and (AOR=7.2, 95% CI 1.7 to 29.7), then you will protect others as well. Whereas, a desire to get vaccinated little, moderately and highly (AOR=4.3, 95% CI 1.77 to 10.4), (AOR=20, 95% CI 8.5 to 47) and (AOR=147, 95% CI 55 to 392), respectively, was significantly associated with willingness to take the vaccine. Moreover having close family and friends who want them to get a COVID-19 vaccine (AOR=2, 95% CI 1.2 to 3.57) and religious leaders or community leaders (AOR=1.8, 95% CI 1 to 3.1) were significant factors in the multivariable logistic regression model., Conclusion: This study found that COVID-19 vaccine acceptance was low in the Somali region. Factors positively linked to one's willingness to get vaccinated included the belief that it protects others, personal desire for vaccination and support from family, friends, community and religious leaders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Research on the Awash River focused on the upper section, while the middle and lower regions received little attention. Thus, the goal of this study was to evaluate the impact of anthropogenic activities on the upper and middle Awash River. The study took place in nine sampling locations in dry and wet seasons from September 2021 to April 2022 using a multi-habitat sampling approach. We used macroinvertebrate metrics, environmental variables, and multivariate analysis to evaluate ecological health. The highest concentrations of NO 3 , soluble reactive phosphorus, and total phosphorus (0.50-0.93 mg L -1 ) were recorded at the river-mouth of the upper Awash, while the locations below Metehara had the lowest levels of dissolved oxygen (1.81-2.33 mg L -1 ). Redundancy analysis indicated that dissolved oxygen, NH 3 , temperature, NO 2 , pH, TSS, NO 3 , and TDS influenced macroinvertebrate distribution. The presence of the sensitive groups Caenidae, Hydropsychidae, Heptageniidae, and Aeshnidae at upstream sites indicated better ecological conditions. The middle and downstream sites supported moderately tolerant and tolerant taxa demonstrating water quality impairment. The lowest Ethiopian biotic score was recorded at the river-mouth of the upper Awash. The study sites below Metehara demonstrated severe ecological impairment since highly tolerant taxa were abundant and had strong correlations with temperature, TSS, and TDS levels. Pollutants from agricultural farms and domestic and industrial wastes from Addis Ababa, Metehara, and Merti towns most likely affect the impaired sites. This study demonstrated that the middle Awash experienced substantial ecological deterioration, indicating the need for restoration works to fit the water for socio-economic development., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021., Methods: A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model., Results: A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption., Conclusion: A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Getachew, Tolossa, Teklemariam, Ayele and Roba.)

Background: Malaria is a major cause of morbidity and mortality in children under the age of five worldwide. Although various malaria elimination measures have been implemented over the past decades, malaria remains a serious threat to public health, especially in tropical and subtropical areas. Ethiopia has set targets for eliminating malaria by 2030. No research has been conducted in the study area concerning malaria among children, who are the most malaria-prone segment of a community. The purpose of this study was to assess malaria prevalence and the factors associated with it among children under five years of age who attended the Sheko Health Center, Southwest Ethiopia, from June 1 to October 30, 2022., Materials and Methods: An institutional-based cross-sectional study was employed from June 1 to October 30, 2022, at the Sheko Health Center. Capillary blood samples were collected from 286 randomly selected symptomatic children. Data on socio-demographics and associated factors were collected using a pre-tested structured questionnaire, and data on parents' and guardians' knowledge about malaria was recorded on Excel 2016 Spreadsheets after interviewing them, and their responses were presented by a frequency table. Data were entered into Epi Data Manager (v4.0.2.101) and analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Associated factors of malaria were analyzed using bivariate and multivariable logistic regression, and statistical significance was set at P < 0.05., Result: Overall, 23.4% (95% CI = 18.6-28.8%) malaria infection was recorded among the children whose blood samples were examined, with Plasmodium falciparum, Plasmodium vivax, and mixed infections (both species) representing 52.2%, 34.3%, and 13.4% of the cases, respectively. The majority of the parents or guardians believed that malaria is transmissible but could be prevented, and 80% of them considered mosquito bites to be the main mode of malaria transmission. Insecticide-treated net (ITN) was mentioned as a malaria prevention strategy by more than half of the respondents, while indoor residual spraying (IRS) was considered only by 19.6%. Based on multivariable logistic regression analysis, a significant association was found in children between the ages of 12 and 36 months (adjusted odds ratio = 5.050; 95% CI: 1.964-12.982), children who lived in rural areas (adjusted odds ratio = 2.901; 95% CI: 1.439-5.845), and children who did not use ITN the past two weeks before sample collection (adjusted odds ratio = 3.341; 95% CI: 1.646-6.781)., Conclusion: This study revealed a high malaria prevalence among children aged under five years. Attention must be paid to improving the coverage of the ITN and its use in the study area, which could help reduce the risk of mosquito bites. Health education for the guardians of the children could also help to raise awareness about the prevention and control strategies for malaria transmission and further reduce the impact of the disease., Competing Interests: The authors have no conflicts of interest to declare in this work., (Copyright: © 2023 Duguma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Trachoma is endemic in Southern Nations, Nationalities and Peoples' (SNNP) and Sidama regions of Ethiopia. We aimed to measure the prevalence of trachomatous inflammation-follicular (TF) among children aged 1 - 9 years and the prevalence of trachomatous trichiasis (TT) unknown to the health system among people aged ≥15 years following interventions for trachoma in 52 woredas of SNNP and Sidama regions., Methods: From 2017 - 2019, 66 two-stage cluster sampling cross-sectional population-based surveys were carried out in 52 woredas (third-level administrative divisions) using a standardized World Health Organization-recommended survey methodology. This included one impact survey in 40 woredas, two consecutive impact surveys in 10 woredas and three consecutive impact surveys in two woredas. Water, sanitation and Hygiene (WASH) access was assessed using a modified version of the United Nations Children's Fund/WHO Joint Monitoring Programme questionnaire., Results: By the end of this survey series, 15 (23%) of the woredas had met the active trachoma elimination threshold (TF prevalence <5%) and 12 (18%) had met the TT threshold (TT ≤ 0.2%). Regarding WASH coverage, 20% of households had access to an improved drinking water source within a 30-min journey and 3% had an improved latrine. There was strong evidence that TF was less common in 4 - 6-year-olds and 7 - 9-year-olds than 1 - 3-year-olds., Conclusion: Based on the findings, further antibiotic mass drug administration is required in 37 woredas and active TT case finding is needed in 40 woredas. In these surveys, access to WASH facilities was very low; WASH improvements are required.

In the present study, the diversity of medicinal plants and associated traditional medicinal knowledge of the rural community in the Ameya district in Ethiopia was assessed and documented. A survey was conducted through semistructured interviews, guided field walks, focus group discussions, and field observations. The snowball and purposeful sampling techniques were employed to select general and knowledgeable informants, respectively. Accordingly, a total of 210 respondents, 156 (74.3%) males and 54 (25.7%) females, were participated in this study. The informants were selected from seven kebeles (the lowest administrative units) following the recommendations of the local community for the availability of traditional medicinal plant use practice. Descriptive statistics, preference ranking, fidelity level, informant consensus factor, and direct matrix ranking were used to analyze and present the data. A total of 78 medicinal plants represented in 70 genera and 40 families were identified. Croton macrostachyus and Dodonaea viscosa were the most preferred species used to treat wounds, whereas Cucumis ficifolius and Phragmanthera macrosolen were the most popular species applied to treat stomachache. Leaves (38%) and roots (20%) were the most predominantly used plant parts for remedial preparation to treat 42 human ailments. The informant consensus factor (ICF) value ranged between 0.45 and 0.81, with the respiratory diseases category scoring the highest ICF value. The fidelity level (FL) value for the medicinal plants ranged from 24 to 95%. Considerable proportions (55.5%) of the medicinal plants were collected from wild habitats. Higher ICF (0.81) and FL (>90%) scores indicate the presence of rich traditional knowledge in the community. This knowledge can be used to select medicinal plants (such as Croton macrostachyus , Cucumis ficifolius , Dodonaea viscosa , and Phragmanthera macrosolen ) for further pharmacological and phytochemical studies., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Temesgen Tadesse and Alemtshay Teka.)

Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of low birth weight (LBW). As a result, the goal of this study is to fill those gaps in the previous studies. An institution-based cross-sectional study was employed. Binary logistic regression was used to identify the associated factors. In this study, the magnitude of LBW was 13.06%. History of chronic medical illness (AOR = 3; 95% CI: (1.02, 9.17)), haemoglobin level during pregnancy (AOR = 0.23; 95% CI: (0.10, 0.50)), iron/folic acid supplementation (AOR = 0.27; 95% CI: (0.10, 0.72)) and extra meal during pregnancy (AOR = 3.2; 95% CI: (1.52, 7.00)) were significantly associated with LBW. The magnitude of LBW in this study was comparable to the Ethiopian Demographic and Health Survey (EDHS) report from 2016. It is better to intervene in those identified factors in order to reduce LBW.Impact Statement What is already known on this subject? Low birth weight (LBW) accounts for 60-80% of all neonatal deaths each year. In developing countries like Ethiopia, LBW is a major public health concern. Almost half of the world's infants are not weighed at birth, a figure that is especially high in sub-Saharan Africa including Ethiopia. What do the results of this study add? Only 14% of births had information on birth weight available at the time of birth in Ethiopia. Hence, previous studies underestimate the magnitude and associated factors of LBW. To meet the Sustainable Development Goals (SDGs)-2030 targets for neonatal and child mortality, sufficient evidence on the magnitude of LBW and associated factors must be important in order to contribute to the development of timely interventions. A history of chronic medical illness, haemoglobin level, iron/folic acid supplementation and extra meal during pregnancy was associated with LBW. What are the implications of these findings for clinical practice and/or further research? The findings of this study will be useful in developing better health policies to prevent LBW as well as interventions that can target the identified factors.

Study Objective: The aim of this study was to examine the epidemiology of alcohol-associated fall injuries among older adults aged ≥65 years in the United States., Methods: We included emergency department (ED) visits for unintentional fall injuries by adults from the National Electronic Injury Surveillance System-All Injury Program during 2011 to 2020. We estimated the annual national rate of ED visits for alcohol-associated falls and the proportion of these falls among older adults' fall-related ED visits using demographic and clinical characteristics. Joinpoint regression was performed to examine trends in alcohol-associated ED fall visits between 2011 and 2019 among older adult age subgroups and to compare these trends with those of younger adults., Results: There were 9,657 (weighted national estimate: 618,099) ED visits for alcohol-associated falls, representing 2.2% of ED fall visits during 2011 to 2020 among older adults. The proportion of fall-related ED visits that were alcohol-associated was higher among men than among women (adjusted prevalence ratio [aPR]=3.6, 95% confidence interval [CI] 2.9 to 4.5). The head and face were the most commonly injured body parts, and internal injury was the most common diagnosis for alcohol-associated falls. From 2011 to 2019, the annual rate of ED visits for alcohol-associated falls increased (annual percent change 7.5, 95% CI 6.1 to 8.9) among older adults. Adults aged 55 to 64 years had a similar increase; a sustained increase was not detected in younger age groups., Conclusion: Our findings highlight the rising rates of ED visits for alcohol-associated falls among older adults during the study period. Health care providers in the ED can screen older adults for fall risk and assess for modifiable risk factors such as alcohol use to help identify those who could benefit from interventions to reduce their risk., (Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the predictors of adverse maternal and perinatal outcomes among parturients with prolonged second stage of labor., Methods: This study is a cross-sectional study of women with prolonged second stage of labor from January 1 to June 30, 2021, in four tertiary hospitals in Ethiopia. Data were collected prospectively using a structured questionnaire. Descriptive statistics were used to analyze baseline characteristics. Bivariate and multivariate logistic regression analyses were applied to determine predictors of adverse maternal and perinatal outcomes., Results: A total of 406 women were included in the study. More than half (25/46, 54%) of the women with a prolonged second stage of 4 h or longer had vaginal delivery, which was lower than the 73% (140/190) of women who had a second stage of 2-3 h and the 63.4% (64/101) of women with a second stage duration of 3-4 h. Duration of second stage of labor was not a predictor of composite adverse maternal outcomes nor was it a predictor of adverse perinatal outcome. Operative vaginal delivery (adjusted odds ratio [aOR] 6.0, 95% confidence interval [CI] 2.41-14.9) and nulliparity (aOR 4.1, 95% CI 1.58-10.41) were predictors of adverse maternal outcome, but nulliparity (aOR 1.8, 95% CI 1.05-3.04) and duration of rupture of membranes greater than 18 h (aOR 2.4, 95% CI 1.21-4.93) were predictors of adverse perinatal outcomes., Conclusion: Under strict fetal and maternal well-being monitoring, women with a prolonged second stage of labor can labor for an additional 2 h (up to a total of 4 h) without increasing adverse maternal and neonatal outcomes., (© 2023 International Federation of Gynecology and Obstetrics.)

Background: The cost of maternal complications is considered as an important factor hindering the utilization of maternal health care services. However, information of estimate of spending on maternal complication was lacking. This study was aimed to estimate the cost of maternal complications and associated factors among mother's attending Hawassa public hospitals, Sidama Regional state, Ethiopia., Methods: A cross-sectional study design was conducted among 348 randomly selected mothers attending public hospitals in Hawassa from November 15 to December 15, 2021. Data was coded and entered into Epi Data version 3.1 and exported to STATA version 16.0 for analysis. Simple and multiple linear regression analysis was done. Correlation coefficient along with 95% CI was used to present the finding and p  < 0.05 was used to declare statistical significance., Results: This study found that total median cost of maternal complications was 4895.5 (IQR = 3779) ETB. The total median direct medical cost was 1765.5 (IQR = 1649.5) ETB. Number of days absent [( R  = 0.028; 95% CI: (0.023, 0.033)], distance from facility [( R  = 0.001; 95% CI: (0.000, 0.002)], site of laboratory diagnosis [( R  = 0.230; 95% CI: (0.140, 0.320)], number of laboratory test conducted [( R  = 0.045; 95% CI: (0.021, 0.069)] were found to be significance predictors of maternal complications costs., Conclusions: Total median cost of maternal complications in current study was high. Respondents' site of diagnosis, number of days missed from work, number of laboratory tests, and distance from hospitals were independent predictors of maternal complications cost. Thus, we will recommend governments to introduce strategies that specifically help mothers with maternal complications., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Adansonia digitata (baobab), a multipurpose and highly valued tree species, is facing threats due to anthropogenic factors like shifting cultivation practices and fire. The aim of this study was to examine the population structure and phenological attributes of baobab in three districts (i.e. Kafta Humera, Tselemt, and Quara district) in Northwestern Ethiopia. The study was carried out by establishing 17 plots 1 km long and 100 m wide covering a total area of 170 ha in the Quara district and five plots covering 50 ha each in the Kafta Humera and Tselemt districts. Further, plots were subdivided into 25 × 25 m and 5 × 5 m sub-plots for recording other woody species and their regeneration status, respectively. Thirty reproductively matured trees with easily visible crowns were selected to record phenological characteristics and fruit yield. The findings revealed that baobab population was significantly higher in the Tselemt district (3.15 ± 0.15) as compared to Quara (1.43 ± 0.43) and Kafta Humera (1.30 ± 0.23) sites. A bell-shaped diameter distribution was observed in the Quara district and irregular-shaped distributions were observed in Kafta Humera and Tselemt districts. Phenological periodicity and fruit production of baobab did not vary significantly among the three study sites. On average, 404 fruits per tree were recorded with a maximum of 559 fruits in mid-diameter size class trees. Due to livestock browsing, shifting cultivation practices, and uncontrolled fire, the recruitments are limited in the study areas. An in-situ conservation strategy through the plantation and proper management practices are needed to sustain baobab tree species., Competing Interests: 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., (© 2023 The Authors. Published by Elsevier Ltd.)

In several regions across the globe, snow has a significant impact on hydrology. The amounts of water that infiltrate the ground and flow as runoff are driven by the melting of snow. Therefore, it is crucial to study the magnitude and effect of snowmelt. Snow droughts, resulting from reduced snow storage, can drastically impact the water supplies in basins where snow predominates, such as in the western United States. Hence, it is important to detect the time and severity of snow droughts efficiently. We propose the Snow Drought Response Index or SnoDRI, a novel indicator that could be used to identify and quantify snow drought occurrences. Our index is calculated using cutting-edge ML algorithms from various snow-related variables. The self-supervised learning of an autoencoder is combined with mutual information in the model. In this study, we use Random Forests for feature extraction for SnoDRI and assess the importance of each variable. We use reanalysis data (NLDAS-2) from 1981 to 2021 for the Pacific United States to study the efficacy of the new snow drought index. We evaluate the index by confirming the coincidence of its interpretation and the actual snow drought incidents., (© 2023. The Author(s).)

Background: The utilization of an immediate postpartum intrauterine device (IPPIUD) during the postpartum period helps women to realize their desire for birth spacing and prevent unplanned pregnancies. However, many postpartum mothers do not undergo immediate postpartum family planning in developing countries, including Ethiopia, which consequently increases the risk of unplanned pregnancies and pregnancy-related complications., Objective: To assess the utilization of an IPPIUD and its associated factors among women who gave birth in public hospitals in the West Wollega Zone in 2022., Methods: An institutional-based cross-sectional study was conducted among 605 postpartum mothers who delivered their baby between 15 April and 15 May 2022 at public hospitals in the West Wollega Zone, Ethiopia. A systematic random sampling technique was used to select study subjects, and the data were collected using an interviewer-administered structured questionnaire, which was then entered into EpiData Entry version 4.6 and exported to the Statistical Package for Social Science version 26 for analysis. The variable with a p -value of ≤ 0.05 with an adjusted odds ratio and 95% confidence intervals was used to declare statistically significant association., Result: The prevalence of the utilization of the IPPIUD among respondents who gave birth in West Wollega public hospitals within 48 h was 27.2% (95% CI, 23.7-30.9). Age ranging between 25 and 34 years (AOR = 4.27, 95%CI:1.68-10.85), early initiation of antenatal care (ANC; AOR = 1.91, 95%CI: 2.8-10.01), adequate knowledge of IPPIUD (AOR = 4.71, 95%CI: 2.63-6.63), favorable attitude toward family planning (AOR = 3.35, 95%CI: 2.07-5.44), planning of pregnancy (AOR = 2.21, 95%CI: 1.37-4.11), and counseling (AOR = 4.14, 95%CI: 2.60-6.68) were factors that were significantly associated with the utilization of IPPIUD., Conclusion: According to the 2019 Ethiopia Mini Demographic and Health Survey (mini EDHS 2019), the utilization of an immediate postpartum intrauterine device was low, that is, 35%. Age of respondents, early initiation of antenatal care, favorable attitude toward, planning of pregnancy, adequate knowledge of, and counseling on IPPIUD utilization were significantly associated with the mother's utilization of immediate postpartum intrauterine device. Thus, the zonal health office and health professionals should work toward encouraging all the women who gave birth at public hospitals to the utilization of immediate postpartum intrauterine devices by improving awareness among the women in that specific zone through counseling to increase the uptake of IPPIUD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Guye, Kanea, Nigussie, Girma and Shambi.)

Background: Antimicrobial resistance is one of the common global public health problems. The emergence of antimicrobial resistance is multifactorial, and tackling its development is challenging. Consequently, infections caused by resistant bacteria are unresponsive to conventional drugs, resulting in prolonged and severe illnesses, higher mortality rates, and considerable healthcare costs. Therefore, understanding the antimicrobial resistance profiles of bacterial pathogens is essential to optimize treatments and reduce the risks associated with infections. This study aimed to determine the antimicrobial resistance patterns of bacterial isolates from different clinical specimens at the Ethiopian Public Health Institute (EPHI)., Materials and Methods: The retrospective cross-sectional study was conducted on the bacterial culture and antibiotic susceptibility reports of different clinical specimens referred to the Bacteriology Laboratory of EPHI from September 2015 to August 2019. Standard bacteriological techniques were used for the isolation and identification of the bacteria. Data were extracted from 840 patients' records, which included the type of clinical sample cultured, the name of the bacteria, the representations of the antibiotics used for susceptibility testing, and the susceptibility results. Descriptive statistics were used to describe the bacterial isolates and the antimicrobial resistance profiles., Results: Eight types of clinical specimens were analyzed for bacterial isolates and urine specimens were the most analyzed. Ten different genera of bacteria were identified by culture. Almost all the isolates were gram-negative bacteria, while only one species of gram-positive (Staphylococcus aureus) was reported. Antibiotic sensitivity patterns were tested on 840 culture isolates. Escherichia coli strains revealed more than 57% resistance to seventeen antibiotics. Klebsiella pneumoniae showed nearly 70% or greater resistance rates for 17 of the antibiotics used. The overall detected multidrug resistance (MDR) was 64.29%. The highest MDR was reported in Acinetobacter strains (84%) followed by K. pneumoniae (80%)., Conclusions: The multidrug resistance rates found in this study were alarming. Strengthening antimicrobial resistance surveillance at the national level is mandatory, and antimicrobial sensitivity testing should be accessible at local diagnostic centers., (© 2023. The Author(s).)

Background: Community-acquired pneumonia among adults remains an important cause of morbidity and mortality in both industrialized and developing countries, including Ethiopia. Moreover, despite the availability of the best clinical standards, morbidity and mortality from community-acquired pneumonia have not improved over the last few decades. Therefore, prompt assessment and correction of modifiable risk factors are crucial to reduce morbidity and mortality. However, there are limited data on the determinants of community-acquired pneumonia among adults in the current study area., Purpose: This study aimed to identify the determinants of community-acquired pneumonia among adult patients visiting Debre Berhan University Hospital, Ethiopia, May 2023., Methods: A hospital-based unmatched case-control study design was conducted to select 113 cases and 113 controls using a consecutive sampling technique. Using the SPSS version 25 software bi-variable and multivariable logistic regression analyses were performed to identify the determinants of community-acquired pneumonia. Adjusted odds ratios with 95% confidence intervals and p-values < 0.05 were used to assess the level of significance., Results: In this study, recent history of common cold [AOR: 4.35, 95% CI: (2.22, 8.51)], recent history of toothache [AOR: 2.51, 95% CI: (1.18, 5.33)], and not brushing teeth regularly [AOR, 2.79; 95% CI: (1.32, 5.88)] were significantly associated with community-acquired pneumonia., Conclusion: In this study, common cold, recent history of toothache, and lack of regular oral hygiene were significantly associated with community acquired pneumonia in adults. Therefore, health promotion of oral hygiene and the common cold is recommended to decrease the risk of pneumonia., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Mulugeta et al.)

Drought is a common and costly natural disaster with broad social, economic, and environmental impacts. Machine learning (ML) has been widely applied in scientific research because of its outstanding performance on predictive tasks. However, for practical applications like disaster monitoring and assessment, the cost of the models failure, especially false negative predictions, might significantly affect society. Stakeholders are not satisfied with or do not "trust" the predictions from a so-called black box. The explainability of ML models becomes progressively crucial in studying drought and its impacts. In this work, we propose an explainable ML pipeline using the XGBoost model and SHAP model based on a comprehensive database of drought impacts in the U.S. The XGBoost models significantly outperformed the baseline models in predicting the occurrence of multi-dimensional drought impacts derived from the text-based Drought Impact Reporter, attaining an average F 2 score of 0.883 at the national level and 0.942 at the state level. The interpretation of the models at the state scale indicates that the Standardized Precipitation Index (SPI) and Standardized Temperature Index (STI) contribute significantly to predicting multi-dimensional drought impacts. The time scalar, importance, and relationships of the SPI and STI vary depending on the types of drought impacts and locations. The patterns between the SPI variables and drought impacts indicated by the SHAP values reveal an expected relationship in which negative SPI values positively contribute to complex drought impacts. The explainability based on the SPI variables improves the trustworthiness of the XGBoost models. Overall, this study reveals promising results in accurately predicting complex drought impacts and rendering the relationships between the impacts and indicators more interpretable. This study also reveals the potential of utilizing explainable ML for the general social good to help stakeholders better understand the multi-dimensional drought impacts at the regional level and motivate appropriate responses., 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 © 2023 Elsevier B.V. All rights reserved.)

Background: Several studies have been conducted on structural congenital anomalies (CA). However, there is a paucity of studies that provide a comprehensive review of structural anomalies. We aimed to verify the available research articles to pool the possible risk factors of structural CA in resource-limited settings., Setting: The research articles were genuinely searched using PubMed, Scopus, Cochrane Library, Web of Science, free Google database search engines, Google Scholar, and ScienceDirect databases. Published studies were searched and screened for inclusion in the final analysis, and studies without sound methodologies and review and meta-analysis were not included in the analysis., Participants: This review analyzed data from 95,755 women who gave birth as reported by primary studies. Ten articles were included in this systematic review and meta-analysis. The articles that had incomplete information and case reports were excluded from the study., Results: The overall pooled effect estimate (EI) of structural CA was 5.50 (4.88-6.12) per 100 births. In this systematic review and meta-analysis, maternal illness EI with odds ratio (OR) = 4.93 (95% CI: 1.02-8.85), unidentified drug use with OR = 2.83 (95% CI: 1.19-4.46), birth weight with OR = 4.20 (95% CI: 2.12-6.28), chewing chat with OR = 3.73 (95% CI: 1.20-6.30), chemical exposure with OR = 4.27 (95% CI: 1.19-8.44), and taking folic acid tablet during pregnancy with OR = 6.01 (95% CI: 2.87-14.89) were statistically significant in this meta-regression., Conclusions: The overall pooled effect estimate of structural CA in a resource-limited setting was high compared to that in countries with better resources. Maternal illness, unidentified drug use, birth weight, chewing chat, chemical exposure, and never using folic acid were found to be statistically significant variables in the meta-regression. Preconception care and adequate intake of folic acid before and during early pregnancy should be advised., Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022384838., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Geda, Lamiso, Berhe, Chibsa, Sahle, Assefa, Mohammed, Abeje and Gesese.)

Purpose: Escherichia coli strains that produce extended-spectrum ß-lactamase (ESBL) and carbapenemase are among the major threats to global health. The objective of the present study was to determine the distribution of ß-lactamase genes among multidrug-resistant (MDR) and ESBL-producing Diarrheagenic E. coli (DEC) pathotypes isolated from under-five children in Ethiopia., Patients and Methods: A cross-sectional study was conducted in Addis Ababa and Debre Berhan, Ethiopia. It was a health-facility-based study and conducted between December 2020 and August 2021. A total of 476 under-five children participated in the study. DEC pathotypes were detected by conventional Polymerase Chain Reaction (PCR) assay. After evaluating the antimicrobial susceptibility profile of the DEC strains by disk diffusion method, confirmation test was done for ESBL and carbapenemase production. ß-lactamase encoding genes were identified from phenotypically ESBLs and carbapenemase positive DEC strains using PCR assay., Results: In total, 183 DEC pathotypes were isolated from the 476 under-five children. Seventy-nine (43%, 79/183) MDR-DEC pathotypes were identified. MDR was common among enteroaggregative E. coli (EAEC) (58%, 44/76), followed by enterotoxigenic E. coli (ETEC) (44%, 17/39)) and enteroinvasive E. coli (EIEC) (30%, 7/23). Phenotypically, a total of 30 MDR-DEC pathotypes (16.4%, 30/183) were tested positive for ESBLs. Few ETEC (5.1%, 2/39) and EAEC (2.6%, 2/76) were carbapenemase producers. The predominant β-lactamase genes identified was bla TEM (80%, 24/30) followed by bla CTX -M (73%, 22/30), bla SHV (60%, 18/30), bla NDM (13%, 4/30), and bla OXA -48 (13%, 4/30). Majority of the ß-lactamase encoding genes were detected in EAEC (50%) and ETEC (20%). Co-existence of different β-lactamase genes was found in the present study., Conclusion: The bla TEM , bla CTX-M , bla SHV , bla NDM , and bla OXA-48 , that are associated with serious and urgent threats globally, were detected in diarrheagenic E. coli isolates from under-five children in Ethiopia. This study also revealed the coexistence of the β-lactamase genes., Competing Interests: The authors declare that they have no competing interests in this work., (© 2023 Zenebe et al.)

Public concerns about cyanotoxins production in water and its detrimental impacts on human and animal health are growing primarily due to the widespread eutrophication observed in aquatic ecosystems. A review of relevant literature was done to determine the degree of cyanotoxin occurrence and its harmful effects in African waterbodies. Data were extracted from 64 published studies from 1990 to 2022 that quantified the concentration of cyanotoxins in African aquatic ecosystems. Cyanotoxins have been reported in 95 waterbodies (29 lakes, 41 reservoirs, 10 ponds, 9 rivers, 5 coastal waters, and 1 irrigation canal) from 15 African countries. Cyanotoxins were documented in all the regions of Africa except the central region. Microcystins have been reported in nearly all waterbodies (98.9%), but anatoxin-a (5.3%), cylindrospermopsin (2.1%), nodularins (2.1%), homoanatoxin-a (1.1%), and β-N-methylamino-L-alanine (1.1%) were encountered in a small number of water ecosystems, homoanatoxin-a and β-N-methylamino-L-alanine each occurred in one waterbody. The largest concentrations of microcystins and nodularins were reported in South African Lakes Nhlanganzwani (49,410 μg L -1 ) and Zeekoevlei (347,000 μg g -1 ). Microcystin concentrations exceeding the WHO guideline for lifetime drinking water (1 μg L -1 ) were reported in 63% of the aquatic ecosystems surveyed. The most frequently reported toxin-producing cyanobacteria genus is Microcystis spp. (73.7%), followed by Oscillatoria spp. (35.8%) and Dolichospermum spp. (33.7%). Cyanotoxin-related animal mortality and human illness were reported in the continent. Consequently, it is necessary to regularly monitor the level of nutrients, cyanobacteria, and cyanotoxins in African waterbodies in an integrated manner to devise a sustainable water resources management., (© 2023. The Author(s), under exclusive licence to Springer Nature B.V.)

There is limited empirical evidence on whether Coronavirus disease 2019 (COVID-19) related lockdown restrictions precipitate or perpetuate musculoskeletal (MSK) disorders. This study was aimed to synthesis literature that assessed the impact of COVID-19 related lockdown restrictions on MSK health. A literature search was conducted using MEDLINE, CINAHL, PsycINFO, Allied and Complementary Medicine Database (AMED), Web of Science, and Scopus databases. Studies meeting the following criteria were included in the review: the condition being considered was MSK health, the intervention was COVID-19 related lockdown restrictions, cross sectional studies, cohort studies, case controlled, prospective studies and retrospective studies. Data were extracted by 2 independent researchers. Risk of bias was assessed by the Newcastle-Ottawa quality assessment scale. Evidence from included studies was summarised using narrative synthesis. Fourteen studies comprising 22,471 participants of the general population from Turkey (n = 5), Italy (n = 1), Poland (n = 1), Australia (n = 2), Jordan (n = 1), Bangladesh (n = 1), Estonia (n = 1), the Netherlands (n = 1) and Saudi Arabia (n = 1) have met the inclusion criteria. The sample size of populations studied ranged from 91 to 1054. The included studies used questionnaire, visual analogic scale, or growth mixture modelling. Except for one study, all the included studies reported increased prevalence and incidence of MSK disorders due to COVID-19 related lockdown restrictions. The findings suggest that COVID-19 related lockdown restriction led to increased MSK disorders. Home-based strategies such as physical activity programmes and ergonomic workspace could potentially guide public health authorities to avoid MSK health problem., (© 2023. The Author(s).)

Diarrhea is one of the important public health problems in developing countries. Salmonella and Shigella species are the major bacterial causal agents of diarrhea. The increasing burden of antimicrobial resistance is posing difficulty in the treatment of these pathogens. This study aimed to assess the occurrence of Salmonella and Shigella in the feces of diarrheic patients receiving health services in Addis Ababa, Ethiopia, and to determine their antimicrobial susceptibility profile. A cross-sectional study involving 13 health centers was conducted where 428 diarrheic patients were recruited. Standard microbiology techniques were used to isolate Salmonella and Shigella from stool samples. In addition, Salmonella isolates were confirmed by polymerase chain reaction (PCR). The Kirby-Bauer disc diffusion method was employed to assess susceptibility to 11 antimicrobials for each of the Salmonella and Shigella isolates. The prevalence of Salmonella and Shigella spp. among diarrheic patients was 8.4%; n  = 36 and 5.6%; n  = 24, respectively. Thirty (83.3%) of Salmonella isolates were susceptible to all antimicrobials tested, whereas 4 (10.8%) of isolates were resistant to 2 or more antimicrobials and 2 (5.6%) were multidrug resistant. Resistance to ampicillin was recorded in only one (2.7%) of Salmonella isolates; however, resistance to ampicillin was recorded in 12 (50%) of the Shigella isolates. Half of the Shigella isolates ( n  = 12) were resistant to 2 or more antimicrobials while 5 (20.8%) of them were resistant to 3 or more antimicrobials. The overall rate of resistance to antimicrobials was more common in Shigella compared to Salmonella isolates. In conclusion, Salmonella and Shigella were isolated from the feces of diarrheic patients, with a higher rate of antimicrobial resistance in Shigella isolates, which could make the treatment of shigellosis challenging. Therefore, increasing hygienic practices during food preparation to reduce the burden of Salmonella and Shigella infection and prudent use of antimicrobials are recommended to limit the spread of antimicrobial resistant strains., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Tiruneh Ararsa et al.)

The proactive identification of asymptomatic patients and the mitigation of associated problems are essential to the elimination of malaria. For asymptomatic malaria and related variables among pregnant women in Ethiopia, there are no national pooled estimates. As a result, the goal of this study is to compile thorough and compelling data from several Ethiopian investigations. Google Scholar, PubMed, Scopes, the Web of Science, the Cochrane Library, and African Journals Online were a few of the electronic resources that were accessed. The investigation included all observational studies. STATA version 15 was used to extract the data from the Microsoft Excel file and conduct the analysis. The estimated pooled prevalence of asymptomatic malaria among pregnant women was calculated using a random-effects model. An inverse variance index (I 2 ) analysis was utilized to find heterogeneity. To assess the publication bias, funnel plots, and Egger's statistical tests were used. The study determined that the combined prevalence of asymptomatic malaria among pregnant women was 7.20 (95% confidence interval = 4.22, 10.18) and 4.69 (95% confidence interval = 2.77, 6.62) by microscopy and rapid diagnostic test, respectively. The presence of stagnant water near their home (odds ratio = 4.31; 95% confidence interval = 1.66, 11.20); not using insecticide-treated nets (odds ratio = 6.93; 95% confidence interval = 3.27, 14.71); the lack of indoor residual spray service (odds ratio = 2.68; 95% confidence interval = 1.63, 4.40); and the presence of pregnant women in their neighborhood (odds ratio = 3.14; 95% confidence interval = 1.4). This study showed that pregnant women have a high pooled prevalence of asymptomatic malaria. Women living in rural areas near stagnant water and those who never used insecticide-treated nets had a two-, four-, or six-fold higher prevalence of asymptomatic malaria, respectively. The use of advanced diagnostic techniques could produce a higher magnitude of the disease. For effective intervention toward elimination, active case detection at the community level is also advised., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42023411385; identifier, CRD42023411385., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Duguma, Tekalign, Kebede and Bambo.)

Background: Maternal morbidity and mortality remain critical public health challenges in Ethiopia with limited evidence on the effectiveness of interventions and health promotion strategies. A scoping review of the existing literature on maternal morbidity and mortality interventions and health promotion in Ethiopia can provide a comprehensive overview of the current evidence, identify research gaps and establish a framework for successful maternal morbidity and mortality interventions., Objective: The systematic review seeks to assess the existing literature on maternal morbidity and mortality interventions in Ethiopia to develop an evidence-based framework for effective interventions., Method: The methodology for this study adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines for systematic review protocol. A comprehensive search strategy will be devised, in compliance with the highly sensitive search guidelines of Cochrane, which will involve using both snowball methods to identify relevant articles and searching electronic databases using specific key search terms. The following databases will be searched for studies to be included in the systematic review: MEDLINE (via PubMed), Embase, Scopus, Google Scholar, Web of Science, Science Direct and African Journals Online (AJOL).The search will be restricted to English language publications starting from January 2010 to May 2023. In a comprehensive review process, independent reviewers will meticulously assess titles, abstracts and full texts of studies, ensuring alignment with predetermined inclusion and exclusion criteria at each stage of selection.Quality evaluation instruments appropriate for each research design will be used to assess the quality of the selected studies. The findings from the included studies will be analysed and summarised using a narrative synthesis approach., Ethics and Dissemination: Since this systematic review is based on the reviewing of existing literature and will not involve the collection of primary data, ethical approval is not required. The results will be disseminated through peer-reviewed publication and conference presentations., Prospero Registration Number: CRD42023420990., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Very high (spatial and temporal) resolution satellite (VHRS) and high-resolution unmanned aerial vehicle (UAV) imagery provides the opportunity to develop new crop disease detection methods at early growth stages with utility for early warning systems. The capability of multispectral UAV, SkySat and Pleiades imagery as a high throughput phenotyping (HTP) and rapid disease detection tool for wheat rusts is assessed. In a randomized trial with and without fungicide control, six bread wheat varieties with differing rust resistance were monitored using UAV and VHRS. In total, 18 spectral features served as predictors for stem and yellow rust disease progression and associated yield loss. Several spectral features demonstrated strong predictive power for the detection of combined wheat rust diseases and the estimation of varieties' response to disease stress and grain yield. Visible spectral (VIS) bands (Green, Red) were more useful at booting, shifting to VIS-NIR (near-infrared) vegetation indices (e.g., NDVI, RVI) at heading. The top-performing spectral features for disease progression and grain yield were the Red band and UAV-derived RVI and NDVI. Our findings provide valuable insight into the upscaling capability of multispectral sensors for disease detection, demonstrating the possibility of upscaling disease detection from plot to regional scales at early growth stages., (© 2023. Springer Nature Limited.)

Objective: This study aimed to investigate the prevalence and associated factors of poor sleep quality among Bole Lemi Industrial Park workers in Addis Ababa, the capital of Ethiopia., Design: An institution-based cross-sectional study was conducted from July to August 2022. The data were collected using a validated and standardised Pittsburgh Sleep Quality Index Questionnaire. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14. A multivariable binary logistic regression analysis was conducted to identify factors associated with poor sleep quality. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05., Setting: The study was conducted in Bole Lemi Industrial Park in Addis Ababa., Participants: A total of 370 workers participated in this study., Outcome Measures: The primary outcome of the study was the prevalence of poor sleep quality., Results: The total response rate was 87.7%. The majority (260, 70.3%) of the participants were female. The mean (±SD) age of the participants was 30.5 (±10.6) years. The prevalence of poor sleep quality during the last months was found to be 75.4% (n=279) (95% CI: 70.7% to 79.7%). Undiversified dietary intake (AOR: 1.63; 95% CI (1.09 to 2.78)), caffeine consumption more than 250 mg per day (AOR: 2.57; 95% CI (1.12 to 6.05)) and night shift work (AOR: 2.36; 95% CI (1.27 to 4.41)) were risk factors for poor sleep quality among sampled workers., Conclusion: This study detected that poor sleep quality is highly prevalent among garment and textile industry workers, indicating that it is a significant public health issue that requires immediate attention. Therefore, modifications of the work environment involving night shift work and the improvement of workers' personal lifestyles involving dietary diversification and caffeine consumption are needed to minimise the burden of poor sleep quality among workers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%-46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%-77%). Women involved in home gardening significantly increased (73%-93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children., (© 2023 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: COVID-19 is a rapidly emerging global health threat and economic disaster. The epidemiology and outcomes of COVID-19 patients in Ethiopia are scarce. Thus, the present study aimed to assess clinical profiles, epidemiological characteristics, and treatment outcomes of patients with COVID-19 and to identify determinants of the disease outcome among COVID-19 patients in North-eastern Ethiopia., Methods: A retrospective observational cohort study was conducted in North-eastern Ethiopia, from May 2020 to Jan 2022 on a total of 364 SARS-COV-2 infected patients. Demographic and clinical data were abstracted from the medical records of patients. Bivariable and multivariable analyses were conducted to determine the factors associated with the mortality of COVID-19 patients and variables with a P-value < 0.05 were considered statistically significant., Result: Among 364 COVID-19 patients included in this study, two-thirds (68.1%) were males with a median age of 34 years. The majority; 42.9% & 33.0% respectively cases were detected at the health facility and community level surveillance. Furthermore, 6.6% of patients had pre-existing comorbidities of which diabetes mellitus (23.1%) and hypertension (15.3%) had the highest frequency. The symptomatic rate of COVID-19 patients was 30.5%. The most common clinical presentations were cough (26.9%), fever (26.1%), and shortness of breath (15.2%). Moreover, the mortality rate of COVID-19 patients was 4.1% which was independently predicted by a history of underlining co-morbidity (AHR:6.09; 95%CI:1.299-28.56; P = 0.022) and a history of severe or critical conditions (AHR 11.8; 95%CI:4.89-28.83; P = 0.003)., Conclusion: Severe or critical acute COVID-19 and underlining comorbidities are associated with higher mortality. Therefore, critical follow-up and management should be given to patients with underlying diseases is required., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Gedefie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: In 2020, scabies were integrated into the WHO roadmap for neglected tropical diseases, aimed at ending the negligence to realize the SDGs. Ethiopia has also introduced scabies as a notifiable disease in drought-prone localities since 2015. Many of the previous studies employed study designs that might be subject to bias. Moreover, there is no scientific evidence about scabies in this area. Hence, this study aimed to determine the prevalence and associated factors of scabies among children aged below 15 years in rural Ethiopia., Methods: A community-based cross-sectional study was carried out among 942 children in rural kebeles of Lay Gayent District from March through May 15, 2021. A two-stage sampling technique was applied. Data on sociodemographics, housing, water supply and sanitation, children's personal hygiene, and caregivers' knowledge about scabies were collected by a structured questionnaire. Data quality was maintained through pretesting, training of data collectors and supervisors, and supervision. An adjusted binary logistic regression was modelled to identify factors associated with scabies. The Hosmer-Lemeshow goodness-of-fit test was run to check the model fitness., Results: The prevalence of scabies was 21.5% (95% CI 19.0-24.3). Maternal illiteracy (adjusted odds ratio (AOR) = 1.61; 95% CI 1.07-2.43); low household wealth (AOR = 2.04; 95% CI 1.25-3.33); unimproved water source (AOR = 1.58; 95% CI 1.05-2.40); not cleaning a house daily (AOR = 2.43; 95% CI 1.63-3.62); not trimming nails (AOR = 2.21; 95% CI 1.50-3.25); cloth sharing with a scabies case (AOR = 11.77; 95% CI 6.94-19.97); and low caregiver knowledge about scabies (AOR = 2.44; 95% CI 1.64-3.63) were factors associated with scabies., Conclusions: Scabies remains a significant public health issue among children aged below 15 years in the district. Maternal illiteracy, low household wealth, unimproved water source, not cleaning a house daily, not trimming nails, cloth sharing with a scabies case, and low caregiver knowledge about scabies were factors associated with scabies. Community-wide interventions with prime emphasis on improving maternal education and caregivers' knowledge about scabies, upgrading household wealth, ensuring a safe water supply, providing healthy housing, and ensuring adequate personal hygiene are warranted., (© 2023. Japanese Society of Tropical Medicine.)

Background: According to current estimates, there are 665,723 people in Ethiopia who have human immunodeficiency syndrome. As Ethiopia inches closer to attaining the 95/95/95 targets for treatment coverage and reaching epidemic control, however, attrition from anti-retroviral treatment is still one of the key programmatic challenges., Objective: To assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District., Method: A 6-year (June 28, 2015 to June 27, 2021) institution-based retrospective cohort study was used to recruit 540 study participants by using simple random sampling. Data were obtained from chart review, coded, entered into Epi Data, and exported to Stata 14.2 software for analysis. At least 1 month missed appointment is considered as attrition and the predictors of attrition were identified using bivariable and multivariable Cox proportional hazard models and an adjusted hazard ratio (AHR). Bivariate and multivariate analyses were conducted to find predictors of attrition, p -value < 0.05 was considered statistically significant., Results: From the total 540 study participant, 158 (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years .Being WHO clinical stage III or IV (AHR = 1.96,), non-practice of Appointment spacing model (AHR = 3.98), poor or fair ART adherence level (AHR = 6.47), age groups (15-24) years (AHR = 1.73) and Others ART linkage points[index case testing, tuberculosis clinic and referral from private/public health institutions] (AHR = 1.76) were significantly associated., Conclusions: The study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient sociodemographic, clinical, and treatment-related factors were significantly associated with patients on ART., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Introduction: Antenatal exercise can reduce gestational weight gain, backache; pregnancy induced medical disorders, caesarean section rates, and improves pregnancy outcomes. American College of Obstetrics and Gynecology (ACOG) recommends prenatal exercise, which is associated with minimal risk and has been shown to be beneficial for pregnancy outcomes, although some exercise routines may need to be modified. Consequently, this meta-analysis is intended to verify the pooled practice of antenatal exercise in Africa using available primary articles., Methods: Genuine search of the research articles was done via PubMed, Scopes, Cochrane library, the Web of Science; free Google databases search engines, Google Scholar, and Science Direct databases. Published and unpublished articles were searched and screened for inclusion in the final analysis and Studies without sound methodologies, and review and meta-analysis were not included in this analysis. The Newcastle-Ottawa scale was used to assess the risk of bias. If heterogeneity exceeded 40%, the random effect method was used; otherwise, the fixed-effect method was used. Meta-analysis was conducted using STATA version 14.0 software. Publication bias was checked by funnel plot and Egger test., Results: This review analyzed data from 2880 women on antenatal care contact from different primary studies. The overall pooled effect estimate of antenatal exercise in Africa was 34.50(32.63-36.37). In the subgroup analysis for pooled antenatal exercise practice by country, it was 34.24 (31.41-37.08) in Ethiopia and 37.64(34.63-40.65) in Nigeria., Conclusion: The overall pooled effect estimate of antenatal exercise in Africa was low compared to other continent. As it was recommended by ACOG antenatal exercise to every patient in the absence of contraindications, it should be encouraged by professionals providing antenatal care service., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Geda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Maternal malnutrition remains a major public health problem, particularly in low and middle-income countries and war-affected areas like Ethiopia. Malnourished pregnant and lactating women with low nutrient stores have babies with poor mental and physical development, increasing the risk of poor birth outcomes. Despite the fact that the majority of Ethiopian mothers are malnourished, there is little evidence in war-affected areas. Therefore, the objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant and lactating mothers in the war affected area of North Gondar Zone, northwest Ethiopia., Methods: A community-based cross-sectional study was conducted from April 10 to May 25, 2022. A multistage random sampling technique was used to select 1560 pregnant and lactating mothers. MUAC was to ascertain the outcome variable. Data was entered and analyzed by using EPI INFO version 3.5.3 and SPSS version 24, respectively. A multivariable logistic regression analysis was employed to identify the factors associated with acute malnutrition. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association., Results: The prevalence of acute malnutrition among pregnant and lactating women was 34.3% at the 95% CI (31.9-36.8). The age of the mothers (AOR = 0.73; 95% CI: 0.54, 0.99), family size 6-8 (AOR = 1.21; 95% CI: 1.03, 1.82), and greater than or equal to 9 family sizes (AOR = 0.44; 95% CI: 0.19, 0.97), were significantly associated with acute malnutrition., Conclusions: In the current study, the prevalence of acute malnutrition among pregnant and lactating mothers is high in the study area. Mother's age and family size were factors associated with acute malnutrition in war-affected areas. As a result, mothers with large families will require special assistance to reduce the impact of malnutrition., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Risk of bias tools is important in identifying inherent methodical flaws and for generating evidence in studies involving systematic reviews (SRs) and meta-analyses (MAs), hence the need for sensitive and study-specific tools. This study aimed to review quality assessment (QA) tools used in SRs and MAs involving real-world data. Electronic databases involving PubMed, Allied and Complementary Medicine Database, Cumulated Index to Nursing and Allied Health Literature, and MEDLINE were searched for SRs and MAs involving real-world data. Search was delimited to articles published in English, and between inception to 20 of November 2022 following the SRs and MAs extension for scoping checklist. Sixteen articles on real-world data published between 2016 and 2021 that reported their methodological quality met the inclusion criteria. Seven of these articles were observational studies, while the others were of interventional type. Overall, 16 QA tools were identified. Except one, all the QA tools employed in SRs and MAs involving real-world data are generic, and only three of these were validated. Generic QA tools are mostly used for real-world data SRs and MAs, while no validated and reliable specific tool currently exist. Thus, there is need for a standardized and specific QA tool of SRs and MAs for real-world data., (© 2023. Crown.)

Background: Different vaccines have been approved for use against coronavirus disease and distributed globally in different regions. Efforts should be made on the vaccination to control the spread and impacts of the coronavirus pandemic. However, the general population's attitudes and intention to uptake coronavirus disease 2019 (COVID-19) vaccinations were poor., Objective: This study aimed to assess the barriers to and intention to be vaccinated against COVID-19 and the associated factors among adults in the Jimma zone, Ethiopia., Methods: A community-based cross-sectional study with multistage sampling was conducted with 621 participants from 16 April to 17 May 2022. Multivariable logistic regression was used to identify factors associated with the outcome of interest. Statistical p-value ≤0.05 was set at p ≤ 0.05. Qualitative data were supplemented with quantitative results., Results: The majority of the study participants (382 [61.5%]) intended to uptake the COVID-19 vaccine. In this study, travel history (Adjusted Odds Ratio (AOR) = 2.18, 95% CI 1.23-3.87), vaccination history (AOR = 2.64, 95% CI 1.69-4.12), perceptions of infection prevention for COVID-19 (AOR = 1.97, 95% CI 1.28-3.03), subjective norm (AOR = 2.27, 95% CI 1.52-3.39), and perceived behavioral control (PBC) (AOR = 2.30, 95% CI 1.55-3.41) were significantly associated with the intention to be vaccinated against COVID-19., Conclusion: More than half of the adult participants intended to be vaccinated against COVID-19. The study participant's traveling history, vaccination history, perception of infection prevention for COVID-19, subjective norms, and Perceived Behavioral Control were significantly associated with the intention to be vaccinated., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Sisay et al.)

Introduction: globally, an estimated two billion cases of diarrhea occur every year, and an estimated 1.7 million children under the age of five years, mostly in developing countries die due to diarrheal cases. It is caused by different enteropathogens such as bacteria, viruses, and parasites. Diarrhea caused by parasitic etiology is common in under-five-year children in sub-Saharan Africa. The objective was to investigate the parasitic etiology of diarrhea among under-five-year children in Mizan-Tepi University Teaching Hospital, Southwest Ethiopia., Methods: institution-based cross-sectional study was conducted from September to November 2021. A total of 300 under-five-year children presenting with diarrhea in Mizan-Tepi University Teaching Hospital were included in the study. Data used to assess associated factors for intestinal parasitic infections (IPIs) was collected using a structured questionnaire. Stool specimens were collected from the study participants for investigations of the parasitic etiology of diarrhea. The specimens were processed microscopically using direct wet mount and formol ether concentration techniques. Modified Ziehl-Neelsen staining of formol-ether concentrated specimens was also performed. Data was entered using Epi-Data version 4.6.0 and analyzed using Stata/SE version 14.0. Crude odds ratio and adjusted odds ratio were used to determine the association., Results: from a total of 300 children who participated in this study, 68 (22.67%) were positive for at least one intestinal parasite. E. histolytica23(7.67%) and G. lamblia17(5.67%) were the predominant parasitic etiologies and 28(9.33%) were positive for intestinal helminthic parasites; 11(3.67%) Ascaris lumbricoides, 10(3.33%) Trichuris trichiura, 4(1.33%) Hymenolepsis nana, and 3(1%) were double infection with Trichuris trichuria and Ascaris lumbricoides. Multivariable analysis revealed the age group category 2-3 years of age children was more attributable to intestinal parasitic infections (AOR= 0.466, 95% CI: 0.204-0.976)., Conclusion: the overall prevalence of intestinal parasitic infections (IPIs) in this study was 22.67%. Diarrheal etiology of intestinal parasites among under five years of children identified in this study were significantly associated with maternal/ guardians´ educational status, (AOR=94.900, 95% CI: 24.664-365.155) use of unprotected water for drinking, (AOR =25.189, 95% CI: 4.671-135.847)., Competing Interests: The authors declare no competing interests., (Copyright: Teshale Worku et al.)

Background: Cultural practices are any experiences or beliefs that are socially shared views and behaviors practiced in a certain society at a certain time. Cultural malpractices are defined as socially shared views and traditionally accepted behaviors experienced in a certain society that harm maternal health. Worldwide, the period of pregnancy, labor, and delivery is embedded with different beliefs, customs, and rituals in different societies that contribute a lot to maternal death. They are responsible for the annual deaths of 303,000 mothers and 2.7 million newborns globally. In developing countries, it accounts for approximately 5%-15% of maternal deaths. In Ethiopia, approximately 18% of infant deaths occur due to cultural malpractice, and 52% of pregnant mothers give birth at home following cultural customs in Dire Dawa city. The objective of this study was to assess cultural malpractices during pregnancy, childbirth, and the postnatal period and its associated factors among women who gave birth once in Dire Dawa City in 2021., Methods: Community-based mixed study was conducted. A total of 624 study participants were selected through a systematic random sampling technique, and a purposive sampling method was used for qualitative data. The study was conducted in the randomly selected Kebeles of Dire Dawa City, Eastern Ethiopia, from November 1 to December 30, 2021. Data were entered into Epi Data version 4.1 and exported to SPSS version 24 for analysis. Bivariate and multivariate analyses were done, and the degree of association was measured by using the odds ratio with 95% CI and significance was declared at a p -value of <0.05. The qualitative data were analyzed thematically using ATLAS-ti version 7., Results: The overall prevalence of cultural malpractice during pregnancy, childbirth, and the postnatal period was 74.6% [95% CI: 70.59%, 77.49%]. Women over the age of 35 were two times more likely [AOR 2.61, 95% CI, 1.45-4.72] to commit cultural malpractice than women aged 15-24 and 25-34. Those with no antenatal care (ANC) follow-up were three times more likely to commit cultural malpractice [AOR 3.57, 95% CI, 1.72-7.40], those who were absent from health education were nearly two times more likely to commit cultural malpractice [AOR 1.83, 95%CI, 1.25-2.67], and women whose culture allows harmful traditional practices were nearly two times more likely to commit cultural malpractices than their counterparts [AOR 1.69, 95%CI, 1.29-2.54]., Conclusion: In this study, nearly three-fourths of participants were involved in cultural malpractices. Therefore, strengthening community education and behavioral change messages on the importance of ANC and avoiding unhealthy care during pregnancy, childbirth, postnatal and neonatal periods, especially with pregnancy at old age (age > 35), may help to reduce cultural malpractices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Hailu, Mohammed, Sintayehu, Tadesse, Abera, Abdurashid, Solomon, Ali, Mellese, Weldeamaniel, Mengesha, Hailemariyam, Amsalu, Dejene and Girma.)

Soil-transmitted helminths (STHs) and Schistosoma mansoni infections are common parasitic infections in sub-Saharan Africa. Their distributions vary across altitudes in Ethiopia. Hence, ongoing updates of infection risk factors and prevalence data are necessary for successful intervention. A school-based, cross-sectional study was conducted from October to December 2019 involving 530 schoolchildren who were recruited by systematic random sampling from Amhara Regional State. A structured questionnaire was used to collect data on sociodemographic, geographical and environmental factors. Stool samples were collected and processed by Ritchie's and Kato Katz techniques. Data were entered into EpiData and analyzed using SPSS. Descriptive statistics were used to compute prevalence, and logistic regression was used to assess factors associated with STHs and S. mansoni infections. Variables with P < 0.05 were considered statistically significant. Among 530 schoolchildren, 169 (31.9%) and 78 (14.7%) were infected with STHs and S. mansoni, respectively. The prevalence of STHs (40.2%) in the semi-highlands and S. mansoni (30.4%) in the lowlands was high. Infrequent shoes wearing, exposure to soil, not washing vegetables before eating, and living outside in lowland areas were significantly associated with STHs infections (P < 0.05). Schoolchildren who fetched water to irrigate fields, swam in rivers, and lived in lowland areas were significantly associated with S. mansoni infection (P < 0.05). In conclusion, prevalence rates of STHs and S. mansoni infections differed across altitudes in Amhara Regional State. Therefore, current control strategies including deworming and provision of clean water and education on sanitation and hygiene should be intensified and adapted to the local context.