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Birds are vital bioindicators of biodiversity and ecosystem health, but their persistence and ecological roles are under severe threat from human activities in the Lake Tana Basin, Ethiopia. Rapid land and forest degradation driven by agricultural expansion, urbanization, and the rising demand for fuelwood imperil avian community structure and ecosystem functions in this region. However, amidst this ecological challenge, church forests have emerged as crucial sanctuaries. Despite their small size and isolation from each other by mainly agricultural land-use, these church forests provide indispensable ecosystem services and play a pivotal role in preserving biodiversity. Understanding the significance of church forests for avian biodiversity and the factors influencing bird species richness and community composition is paramount. To this end, a comprehensive survey was conducted in 24 church forests between November and December 2018. Data collection involved both point counts utilizing Audiomoth acoustic loggers and transect surveys. The study revealed a total of 131 bird species in the surveyed church forests, including endemic and threatened species. These birds exhibited diverse foraging habits and functional traits. Notably, church forest size and canopy cover were positively associated with species richness, highlighting the importance of preserving and potentially expanding these forested areas. Furthermore, the research identified key factors driving the similarity of bird communities in church forests, notably forest surface area, canopy cover, and altitude. Importantly, resilience metrics demonstrated significant positive relationships with species richness, emphasizing the conservation value of these unique ecosystems. Our study underscores the critical role of church forests in safeguarding avian biodiversity in the Lake Tana Basin, and our findings advocate for conservation efforts aimed at preserving and enhancing the region's church forests, as their continued degradation could jeopardize both ecological and socio-economic potential in this network of remnant forests.

Ecosystem services (ES) are the connection between nature and society, and are essential for the well-being of local communities that depend on them. In Ethiopia, church forests and the surrounding agricultural matrix supply numerous ES. However, the ES delivered by both land use types have not yet been assessed simultaneously. Here we surveyed both church forests and their agricultural matrices, aiming to quantify, compare and unravel the drivers underlying tree-based ES supply, density and multifunctionality. We found that almost all church forests and half of the agricultural matrices provided high ES densities. ES multifunctionality was higher in the agricultural matrices, suggesting that people deliberately conserve or plant multifunctional tree species. Furthermore, the supply of all categories of ES was positively correlated with church forest age (p-value < 0.001) in the agricultural matrix, while the extent of church forest was positively correlated with the density of all categories ecosystem services score in the church forests (p-value < 0.001). Our results can be used to prioritize conservation efforts at sites that provide high levels of ES supply, ES density and ES multifunctionality, and to prioritize restoration efforts at sites with low levels thereof.

Ethiopia imports all fuel and crude oils from abroad at high cost, and transportation of these fluids has been carried out by using various capacity of road transportation heavy-duty truck vehicle. Most tanker truck accidents happen during turning because of the fluid splashing in partially loaded tanks and of the uniqueness of the carrying liquids. This is a result of the fact that current baffle configurations are effective at reducing sloshing when braking or accelerating but ineffective at doing so when turning. Consequently, the primary goal of this thesis work is to investigate how different baffle systems affect lateral sloshing reduction. In this work, the optimal baffle configuration and its arrangements for modified oval tanks at 50% and 80% fill levels were tried, and the dynamic analysis of tanker trucks was researched. The tanker truck and baffle system are designed in CATIA V5 for the numerical analysis, and the CFD study is completed in ANSYS Fluent 2021. R2 and the dynamic analysis are carried out in ANSYS LS-DYNA to study the stability of truck. The computational simulation is carried out as a tank with eight types of baffle systems such as existing baffles (TB), TB with BMLB, UMLB, CLB, 2HLB, 2VHLB, 4HLB, and 4VHLB with similar meshing resolution, similar turbulence modeling, similar boundary conditions, and also similar solution strategies. Transverse baffles with bottom-mounted four holes longitudinal baffle with hole-varying position (4VHLB) are discovered to be the best baffle type after evaluating all baffle designs. This suggests that the quantity of sloshing is reduced as the number of holes with small diameters increases. Maximum lateral force and roll moment are reduced by the most, by 47.76% and 58.66%, respectively, at 50% fill level and by 58.08% and 22.52%, at 80% fill level. Consequently, the case tanker truck’s use of this revised design baffle will be crucial for enhancing rollover stability while cornering.

The tomato (Lycopersicon esculentum Mill) is an important vegetable crop in Ethiopia and is produced and eaten in large quantities throughout the nation. However, the tomato production is quite low (10 tons·ha−1) compared to the global average yield of 34 tons·ha−1 due to the repetitive use of chemical fertilizers alone, growing intensive crops that are absorbing significant amounts of the soil nutrients, and the lack of application of organic fertilizers. Therefore, it is crucial to take accurate measurements when using fertilizers in order to solve issues and boost crop yield. The study’s objective was to find out how NPSB and vermicompost fertilizers together influenced tomato growth, yield characteristics, and yield at the Wallaga University Research Site for two consecutive years (2021 and 2022). The experiment used a factorial randomized block design with two components: four levels of NPSB and four levels of vermicompost. The tomato fruit production and all of its components were strongly impacted by the primary and interaction effects of NPSB and vermicompost treatment rates. The highest fruit length was 6.26 cm, the largest fruit diameter was 5.94 cm, the shoot fresh weight was 48.25 g·plant−1, the shoot dry weight was 4.50 g·plant−1, the marketable fresh fruit per plant was 5.54 kg, and the fruit yield was 24.36 ton·ha−1 after the application of 125 kg·ha−1 NPSB plus 8 ton·ha−1 vermicompost. Application of 125 kg·ha−1 of NPSB fertilizer along with 8 tons·ha−1 of vermicompost increases net benefits by 115922.5 ETB·ha−1 as compared to a control. Therefore, in order to enhance tomato yield, it may be suggested that farmers utilize the combination of 125 kg·ha−1 of NPSB and 8 tons·ha−1 of vermicompost rather than applying any inorganic fertilizers alone.

Study Region: We investigate the event runoff response in six sub-catchments in the Lake Tana sub-basin, headwater of the Blue Nile basin, northwest Ethiopia. Steep and mountainous terrains surround floodplains, imposing runoff and soil erosion in the upper catchments and flooding and sedimentation at floodplains. This study was conducted in the upland runoff source catchments. Study Focus: The focus is to investigate catchment characteristics that control the event runoff response in upland catchments, and how recent land management practices may have contributed to improved hydrological conditions. Event rainfall and runoff data were obtained at five-minute time steps through automated divers and tipping bucket rain gauges and related to catchment characteristics. New Hydrological Insights for the Region: Our results show that the catchment event quickflow response was controlled by different factors of both natural and anthropogenic nature of which forest and shrubs, bund density and soil organic matter content were found to be the most important to reduce event quickflow. On the contrary, increase in cropland area caused an increase in quickflow. Through least square fitting procedure of the Natural Resources Conservation Service Curve Number method (NRCS-CN), a site specific abstraction ratio (λ) value of 0.01, rather than the commonly used 0.2 or 0.05, was found to be most appropriate for the sub-humid highlands of Ethiopia.

Forest fragmentation is globally pervasive but especially severe in tropical forests, as exemplified by the state of Afrotropical montane forests in Ethiopia, where remnant forests almost exclusively exists as small, isolated fragments centered around churches, forming networks of partially intact ‘habitat islands.’ Church forests deliver ecosystem services such as forest products and erosion control, and are considered a benchmark for assessing forest biodiversity quality. However, safeguarding church forest integrity necessitates a better understanding of the factors determining their biodiversity and community structure. Therefore, we surveyed a network of church forests southeast of Lake Tana to assess factors explaining their tree species richness and composition. We found that the 24 church forests studied here represent about 20% of the ca. 270 tree species that occur in tropical northeast Africa. All surveyed forests however face strong extinction debts, with five tree species at risk of completely disappearing from the region and many more species only regenerating in a limited number of church forests. Church forest integrity partially reflected the anthropogenic pressure on the area, as forest regeneration tended to be stronger in fenced church forests. Seedling abundance depended on the local presence of large, mature conspecific trees and on the geographic distance to potential source populations of seeds, strongly suggest that metapopulation dynamics likely are important. We conclude that church forest conservation and minimizing further degradation of the landscape matrix are needed to help sustaining the ecological and socioeconomic potential of this unique network of remnant forests.

Some of the only Afromontane forest in northern Ethiopia today is on lands managed by followers of the Ethiopian Orthodox Church, where for centuries priests and communities have conserved forest groves around church buildings. The ecological value of the thousands of church forests in Ethiopia has been widely acknowledged, but little is known about the diverse local institutions that govern these resources, or how such institutions might be changing in response to Ethiopia’s rapid recent economic development. This study uses a unique panel survey to explore changes in community perspectives on the social and ecological roles of church forests, and rules governing church forest use, in four Orthodox communities over time. Our sample consists of 122 household surveys conducted in 2002 and a further 122 surveys from 2014, with 71 households interviewed in both periods. We find that reported uses of church forests vary across forests and over time, with larger forests more likely to be used for extractive purposes such as firewood and construction timber, while smaller forests have become more restricted to renewable or non-extractive uses such as natural medicines, honey, and prayer. Results of logistic regression suggest church followers’ support for preserving church forests increases with age and access to alternative sources of firewood – including exotic Eucalyptus spp. plantations which are increasingly widespread in northern Ethiopia. We also observe a shift since 2002 away from an expectation that church followers themselves hold responsibility for rule enforcement in church forests to a perceived sharing of responsibility by church authorities (i.e. priests) and government (i.e. police) in 2014. Together the progressive introduction of exotic tree species in church forests combined with the erosion of religious norms surrounding local forest governance may threaten the integrity and diversity of these unique social-ecological systems.

Species of the genus Eucalyptus (common name eucalyptus) are widely planted all across Ethiopia—including on large areas of land previously allocated to food production. In recent decades eucalyptus has also increasingly been planted on lands around and within “church forests,” sacred groves of old-aged Afromontane trees surrounding Ethiopian Orthodox Tewahido churches. These revered holy sites have long been recognized for their cultural values and also for their ecosystem services—including their potential to support species conservation and restoration, as church forests are some of the only remaining sanctuaries for many of Ethiopia’s indigenous and endemic plant and animal populations. Ethiopian Orthodox church communities have a long history of planting and nurturing indigenous tree seedlings to sustain church forest groves. However, due to the fast-growing nature of eucalyptuscombined with its widely recognized socio-economic benefits (as fuelwood, charcoal, construction wood, etc.), this introduced species has been widely plantedaround church forests—in some cases even replacing native tree species within church forests themselves. In many developing country contexts the introduction of exotic eucalyptus has been shown to have ecological impacts ranging from soil nutrient depletion, to lowering water tables, to allelopathic effects. In this study, we collected soil samples from indigenous forest fragments (church forests), adjacent eucalyptus plantations, and surrounding agricultural land to examine how eucalyptus plantations in Ethiopian Orthodox church communitiesmight impact soil quality relative to alternative land uses. Soil properties, including organic matter, pH, total nitrogen, and total phosphorus were measured in samples across 20 church forest sites in South Gondar, East Gojjam, West Gojjam, Awi, and Bahir Dar Liyu zones in the Amhara Region of the northern Ethiopian Highlands. Findings indicate that although soil in eucalyptus stands is more acidic and has lower organic matter and nutrient levels than nearby church forests, eucalyptusplantations also exhibit consistently higher organic matter and nutrient levels when compared to adjacent agricultural land. These findings suggest that eucalyptus planting could potentially benefit soil fertility on land that has been degraded by subsistence agriculture.

Despite increments in immunization coverage over the past decades, substantial inequality due to wealth status has persisted in Ethiopia. This study aimed to decompose the concentration index into the contributions of individual factors to socioeconomic inequalities of childhood vaccination dropout in remote and underserved settings in Ethiopia by using a decomposition approach. A wealth index was developed by reducing 41 variables related to women's household living standards into nine factors by using principal component analysis. The components were further totaled into a composite score and divided into five quintiles (poorest, poorer, middle, richer, and richest). Vaccination dropout was calculated as the proportion of children who did not get the pentavalent-3 vaccine among those who received the pentavalent-1 vaccine. The concentration index was used to estimate socioeconomic inequalities in childhood vaccination dropout, which was then decomposed to examine the factors contributing to socioeconomic inequalities in vaccination dropout. The overall concentration index was -0.179 (P <0.01), confirming the concentration of vaccination dropout among the lowest wealth strata. The decomposition analyses showed that wealth index significantly contributed to inequalities in vaccination dropout (49.7%). Place of residence also explained -16.2% of the inequality. Skilled birth attendance and availability of a health facility in the kebele (the lowest administrative government structure) also significantly contributed (33.6% and 12.6%, respectively) to inequalities in vaccination dropout. Wealth index, place of residence, skilled birth attendance, and availability of a health facility in the kebele largely contributed to the concentration of vaccination dropout among the lowest wealth strata. Policymakers should address vaccination inequality by designing more effective strategies.

Uninterrupted availability of vaccines requires a robust vaccine supply chain and logistics system (VSCLS). With special focus on remote and underserved settings, we assessed the reach and bottlenecks of the Ethiopian VSCLS after the initiation of the last mile transition. We explored the perspectives of key stakeholders using a qualitative phenomenological study. More than 300 in-depth interviews and 22 focus group discussions were conducted. The study was sequentially implemented over two phases to understand the bottlenecks at national and regional (Phase I) and lower (Phase II) levels. After the transition, the Ethiopian Pharmaceutical Supply Service started supplying vaccines directly to health facilities, bypassing intermediaries. The transition reduced supply hiccups and enabled the health sector to focus on its core activities. However, in remote areas, achievements were modest, and health facilities have been receiving supplies indirectly through district health offices. By design, health posts collect vaccines from health centers, causing demotivation of health extension workers and frequent closure of health posts. Challenges of the VSCLS include artificial shortage due to ill forecasting and failure to request needs on time, lack of functional refrigerators secondary to scarcity of skilled technicians and spare parts, and absence of dependable backup power at health centers. Vaccine wastages owing to poor forecasts, negligence, and cold chain problems are common. The VSCLS has not yet sustainably embraced digital logistics solutions. The system is overstrained by frequent outbreak responses and introduction of new vaccines. We concluded that the transition has improved the VSCLS, but the reach remains suboptimal in remote areas.

(1) Background: Measles remains a major cause of disease and death worldwide, especially in the World Health Organization African Region. This study aimed to estimate the coverage of measles vaccinations and map the spatial distribution of measles vaccination dropout in Ethiopia; (2) Methods: A cross-sectional survey was conducted in Ethiopia's underprivileged areas. The study included 3646 mothers/caregivers of children. ArcGIS for the spatial analysis, Global Moran's I statistic for spatial autocorrelation, and Getis-Ord Gi* statistics for hot spot analysis were applied; (3) Results: Overall, coverages of measles-containing-vaccine first- and second-doses were 67% and 35%, respectively. Developing regions had the lowest coverages of measles-containing-vaccine first- and second-doses, 46.4% and 21.2%, respectively. On average, the measles vaccination dropout estimate was 48.3%. Refugees had the highest measles vaccination dropout estimate (56.4%). The hot spot analysis detected the highest burden of measles vaccination dropout mainly in the northeastern parts of Ethiopia, such as the Afar Region's zones 1 and 5, the Amhara Region's North Gondar Zone, and peripheral areas in the Benishangul Gumuz Region's Assosa Zone; (4) Conclusions: The overall measles vaccination coverages were relatively low, and measles vaccination dropout estimates were high. Measles vaccination dropout hot spot areas were detected in the northeastern parts of Ethiopia.

Background: Vaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12-35 months in remote and underserved areas of Ethiopia., Methods: This study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12-35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout., Results: A total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24-10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15-2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21-2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87-40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24-2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38-2.52)]., Conclusion: Vaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout., 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 Shiferie, Gebremedhin, Andargie, Tsegaye, Alemayehu, Mekuria, Wondie and Fenta.)

Combining oral (OPV) and inactivated (IPV) poliovirus vaccines prevents importation of poliovirus and emergence of circulating vaccine-derived poliovirus. We measured the coverage with IPV and third dose of OPV (OPV-3) and identified determinants of coverage inequality in the most at-risk populations in Ethiopia. A national survey representing 10 partly overlapping underserved populations-pastoralists, conflict-affected areas, urban slums, hard-to-reach settings, developing regions, newly formed regions, internally displaced people (IDPs), refugees, and districts neighboring international and interregional boundaries-was conducted among children 12 to 35 months old (N = 3,646). Socioeconomic inequality was measured using the concentration index (CIX) and decomposed using a regression-based approach. One-third (95% CI: 31.5-34.0%) of the children received OPV-3 and IPV. The dual coverage was below 50% in developing regions (19.2%), pastoralists (22.0%), IDPs (22.3%), districts neighboring international (24.1%) and interregional (33.3%) boundaries, refugees (27.0%), conflict-affected areas (29.3%), newly formed regions (33.5%), and hard-to-reach areas (38.9%). Conversely, coverage was better in urban slums (78%). Children from poorest households, living in villages that do not have health posts, and having limited health facility access had increased odds of not receiving the vaccines. Low paternal education, dissatisfaction with vaccination service, fear of vaccine side effects, living in female-headed households, having employed and less empowered mothers were also risk factors. IPV-OPV3 coverage favored the rich (CIX = -0.161, P < 0.001), and causes of inequality were: inaccessibility of health facilities (13.3%), dissatisfaction with vaccination service (12.8%), and maternal (4.9%) and paternal (4.9%) illiteracy. Polio vaccination coverage in the most at-risk populations in Ethiopia is suboptimal, threatening the polio eradication initiative.

Background: In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia., Method: At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs., Result: At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed., Conclusion: The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses., (© 2022. The Author(s).)

Ethiopia has adopted the Integrated Community Case Management of Newborn and Child Illness (iCMNCI) strategy to expand access to neonatal and child health services. This study assessed compliance with the iCMNCI case management protocol at the primary care settings. A descriptive cross-sectional assessment was conducted in eight districts of Benishangul-Gumuz Region from April to December 2019, and 1,217 sick children aged 2 to 59 months and 43 sick young infants aged 0 to 2 months who sought clinical consultation at the 236 health posts were selected purposively. Trained supervisors reviewed the medical records of two most recent cases from each illness category to quantify the extent to which health workers correctly assessed, classified, treated, and followed up cases per the iCMNCI guidelines. A total of 32,981 children sought clinical consultation of whom 31,830 (96.5%) were aged 2 to 59 months, and 1,151 (3.5%) were young infants aged 0 to 2 months. Of the 1,217 selected children, 426 (35%) had pneumonia, 287 (23.6%) malaria, 501 (41.2%) diarrhea, and 3 (0.2%) had malnutrition. Nearly two-thirds 306 (72%) of pneumonia cases were correctly classified as having had the disease and 297 (70%) were correctly treated for pneumonia; 213 (74%) were correctly classified as having had malaria and 210 (73%) were correctly treated for malaria; and 393 (78%) were correctly classified as having had diarrhea and 297 (59%) were correctly treated for diarrhea. Generally, the current practices of child illness assessment, classification, and treatment have deviated from iCMNCI guidelines. Future interventions should support frontline health workers to comply strictly with case management protocols through training, mentorship, and supervision.

Background: Sexually Transmitted Infections (STIs) increase the risk of contracting Human Immunodeficiency Virus (HIV). Hence, early screening and treatment of STIs as a behavioral practice will reduce the odds of HIV infection among at risk and vulnerable sub-populations. To that end, HIV prevention strategies need to design evidence-based interventions using behavioral models or theories to help at-risk individuals adopt early screening and treatment of STI as preventive health behavior. In this study, commercial sex workers were considered as HIV at-risk sub-populations., Objective: Measuring to what extent that Integrated Behavioral Model constructs explain individuals' intention to practice early screening and treatment of sexually transmitted infections as healthy behavior of interest in HIV prevention., Design: Integrated Behavioral Model (IBM) measurement survey was conducted using Respondent Driven Sampling (RDS) in six towns located in the main transport corridors of Ethiopia. Respondents' answers to model construct-based questions and intention to practice the health behavior of interest were measured using Likert Scale. Analysis was done to assess the correlation and level of association of model construct-based questions with intention to practice the preventive health behavior., Results: Respondents' attitude explained 32%, perceived control 2%, normative influence 21%, and self-efficacy 53 % of their intention to get early screening and treatment of sexually transmitted infections., Conclusion: Self-efficacy explained the variability of respondents' intention to get early screening and treatment of STIs most, while perceived control was the least. Hence, HIV prevention behavioral interventions targeting early screening and treatment of STIs should give high emphasis to self-efficacy., (© 2021 Alemayehu WA et al.)

Background: The study was conducted in a remote sputum sample collection sites and GeneXpert® MTB/RIF testing centers to detect Mycobacterium tuberculosis in Malawi. The main purpose of the study was to evaluate whether sputum samples stored and transported with OMNIgene®•SPUTUM (OM-S) medium perform comparably to the routine cold-chain stored and transported samples for GeneXpert testing to detect Mycobacterium tuberculosis., Methods: Two sputum samples from each of 362 tuberculosis suspects were randomly assigned to the OMNIgene treated (OM-S group) or the standard-of-care group (SOC; transported via cold chain). All specimens were tested at regional GeneXpert testing sites using the expectorated (raw) sputum protocol. Demographic, clinical, transport/storage and Xpert data were recorded for each specimen pair. Agreement between the SOC and OM-S groups' Xpert results was evaluated using Cohen's kappa analysis., Results: Mean patient age was 42.3 years (range 2-79 years), 77% of patients were female, and 80% were HIV-positive. Mean transport/storage time was 6.7 days (range, 0-29 days). The rates of MTB positivity for the OM-S and SOC groups were comparable (11.8 and 11.2%, respectively), inter-test agreement was "very good" (κ = 0.97), and overall percent agreement was 99%. Two specimen pairs (both mucoid, one 13 days transport, one 1 day transport) had discordant Xpert results., Conclusion: OM-S-treated sputum specimens can undergo multi-day ambient-temperature storage as well as transport and yield Xpert results comparable to those of cold-chain-transported samples in Malawi.