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Abstract An estimated 2.5 million people have been internally and externally displaced in the Tigray region of northern Ethiopia in conflict and post-conflict settings. This induced a loss of access to basic and essential healthcare services. The situation was overwhelming, causing service inaccessibility, inadequate health facilities, unstable security to access the services, shortage of supplies and drugs, and medical equipment’s in the region. The regional public health emergency management is one service delivery set up for the critically ill. It is characterized by weak emergency management capacities, poor coordination and integration. In addition, the system falls in to two independent sectors in the Tigray Health Bureau (THB), Tigray Health Research Institute (THRI). This leads to a fragmented system, an unclear leadership and governance role and a poor service delivery setup and tracking mechanism. The situation leads to resource duplication and poor business practice. Indeed, this type of service delivery setup secures personal and professional interest more than community interest. The situation exacerbated the occurrence of recurrent outbreaks in the region, with, for instance, zoonotic diseases (anthrax and rabies), acute watery diarrhoea, measles, malaria, yellow fever, and coronavirus disease 2019 (COVID-19) approaching to their level of epidemic. Moreover, they will spike as an epidemic in the future. All these circumstances made it evident that the system need reform to adhere with legal global, national, and regional frameworks, guidelines and proclamations. The system should have one service delivery set up at regional level. It must fall into regional public health institutes (PHIs) to adhere its service packages to the current advancements. Furthermore, integrated effort need from program implementers, relevant stakeholders and policy-makers should be committed and work together in the review and reform process.

Abstract Tick-borne encephalitis virus (TBEV) vaccine breakthrough (VBT) infections are not uncommon in endemic areas. The clinical and immunological outcomes have been poorly investigated. We assessed the magnitude and specificity of virus-specific antibody and T cell responses after TBE in previously vaccinated subjects and compared the results with those of unvaccinated TBE patients and study subjects that received vaccination without VBT infection. Symptomatic TBEV infection of unvaccinated study subjects induced virus-specific antibody responses to the E protein and non-structural protein 1 (NS1) as well as T cell responses to structural and other non-structural (NS) proteins. After VBT infections, significantly impaired NS1-specific antibody responses were observed, while the virus-specific T cell responses to the NS proteins were relatively strong. VBT infection caused predominantly moderate to severe disease during hospitalization. The level of TBEV EDIII- and NS1-specific antibodies in unvaccinated convalescent patients inversely correlated with TBE severity and neurological symptoms early after infection.

Abstract Accurate estimation of infiltration rates is crucial for effective irrigation system design and evaluation by optimizing irrigation scheduling, preventing soil erosion, and enhancing water use efficiency. This study evaluates and compares selected infiltration models for estimating water infiltration rates in the Shillanat-iv irrigation scheme in northern Ethiopia. Soil samples were collected to determine textural classes using hydrometer soil texture analysis and the United States Department of Agriculture (USDA) textural triangle. The soil textural map of the study was created using the inverse distance weight interpolation technique in ArcGIS version 10.4. Infiltration rates were measured using the double-ring infiltrometer for five soil textures: clay loam, loam, sandy clay loam, clay, and sandy loam. Six infiltration models (Kostiakov, Modified Kostiakov, Revised Modified Kostiakov, Philip, Horton, and Novel) were employed and evaluated using statistical parameters. Model calibration and validation were conducted using data from 38 points within the study area. The parameter values of the infiltration models were optimized using SPSS statistical software using least-squares errors. The results showed that, Revised Modified Kostiakov, Modified Kostiakov, and Novel infiltration models demonstrated superior capability in estimating infiltration rates for clay loam, loam, and sandy loam soil textures, respectively. Horton's model outperformed other models in estimating infiltration rates for both sandy clay loam and clay soil textures. The appropriately fitted infiltration models can be utilized in designing the irrigation system to estimate the infiltration rate of soil textures within the selected irrigation scheme and at similar sites with comparable soil textures.

Abstract Background A variety of bioactive compounds isolated from various botanical sources have been found to have therapeutic and immunotherapeutic effects on chicken coccidiosis. Aim This study aimed to evaluate the anti‐coccidial potential of Enteromorpha prolifera polysaccharide (EP) in indigenous chickens in Northwest Ethiopia. Materials and Methods A total of 78 male indigenous chickens were used for this study. The study had two treatment groups: (1) the EP non‐supplemented group (those fed on diets without EP and Eimeria oocyst inoculated) and (2) the EP group (those receiving diets supplemented with 400 mg EP/kg diet and Eimeria oocyst inoculated). Each treatment group had five replications. Following fourteen days of EP supplementation, 1.5 × 104 oocysts of mixed Eimeria species were inoculated into individual birds. Results EP‐supplemented chicken showed significantly lower (p

Abstract Background Food insecurity is a state or condition in which people have limited or uncertain physical, social, and economic access to safe, sufficient, and nutritious food to meet their dietary needs. Since no thorough evaluation was carried out to determine the degree of household food insecurity in Tigrayan communities in the aftermath of the conflict. This study aims to describe household-level food insecurity status among pregnant and lactating women during the post-armed conflict in Tigray, Ethiopia. Method Descriptive research was designed to assess household food insecurity. A multi-stage sampling technique was used for this study. One thousand two hundred forty-nine households were selected systematically following a list of food insecure households. Descriptive statistical values, including frequency counts, percentages, minimum values, maximum values, and averages, were calculated to quantify the indicators under study. Household food insecurity and hunger Scale measurement using the standardized Food and Agriculture Organization standard. Results The mean age (± SD) of the mothers was 28.35 ± 5.91 years. More than three fourth of the participants 1010(80.93%) were rural residents. The survey result showed that 88.8% of the pregnant and lactating were food insecure. Half (50.1%) of the households were hungry,one month before the study, 78.5% of the families expressed concern about running out of food and 6.4% had severe hunger. Conclusions The food insecurity levels and hunger prestige of the study communities were excessively high. This is in the context of a region affected by intense armed conflict. It is commended that the study communities need to be safeguarded from the direct and long-term consequences of armed conflict-caused household food insecurity.

Abstract Background More than 70% of the health facilities in Tigray, northern Ethiopia, have been totally or partially destroyed by the recent war in the region. Diagnosis and management of tuberculosis were among many health services that suffered. In this study we assess the status of tuberculosis care in health facilities of Tigray during the recent war and compare it with the immediate pre-war state. Methods Using sequential mixed method, we analyzed and compared the availability of diagnostic services in 69 health facilities and the utilization of tuberculosis care in 50 of them immediately before the war (September-October 2020) and during the war (November-July 2021). TB focal persons in each selected health facility were interviewed to evaluate the status of diagnostic services. Patient service utilization was assessed using health facility registrations. We also compared the average monthly case detection rate of multidrug resistant tuberculosis in the region before and during the war. We computed summary statistics and performed comparisons using t-tests. Finally, existing challenges related to tuberculosis care in the region were explored via in-depth interviews. Two investigators openly coded and analyzed the qualitative data independently via thematic analysis. Results Among the 69 health facilities randomly selected, the registers of 19 facilities were destroyed by the war; data from the remaining 50 facilities were included in the TB service utilization analysis. In the first month of the war (November 2021) the number of tuberculosis patients visiting health facilities fell 34%. Subsequently the visitation rate improved steadily, but not to pre-war rates. This reduction was significant in northwest, central and eastern zones. Tuberculosis care in rural areas was hit hardest. Prior to the war 60% of tuberculosis patients were served in rural clinics; this number dropped to an average of 17% during the war. Health facilities were systematically looted. Of the 69 institutions assessed, over 69% of the microscopes in health centers, 87.5% of the microscopes in primary hospitals, and 68% of the microscopes in general hospitals were stolen or damaged. Two GeneXpert nucleic acid amplification machines were also taken from general hospitals. Regarding drug resistant TB, the average number of multidrug resistant tuberculosis (MDR TB) cases detected per month was reduced by 41% during the war with p-value

ABSTRACTTick-borne encephalitis virus (TBEV) infection may cause acute central nervous system inflammation varying in clinical manifestations and severity. A possible correlation of TBEV-specific antibody and cell-mediated immune responses, shortly after infection, with clinical manifestations, severity and long-term outcome has been poorly investigated. In a cohort of thirty early tick-borne encephalitis (TBE) patients, we assessed the magnitude, specificity and functional properties of TBEV-specific T-cell and antibody responses. These responses early during disease were assessed in view of clinical manifestations, severity and long-term outcome. TBEV-specific T-cell responses to C, E, NS1, and NS5 proteins were significantly lower in patients with severe acute illness than in patients with mild TBE. Lower T-cell responses to E, NS1, and NS5 proteins also correlated with the development of meningoencephalomyelitis. Virus-specific antibody titres early after infection did not correlate with disease severity, clinical manifestations, or long-term outcome in this study, possibly due to the small number of patients of which matching serum and peripheral blood mononuclear cells were available. The findings suggest that virus-specific T cells afford a certain degree of protection against the development of severe TBEV-induced disease.

Abstract Vaccination uptake is essential to controlling the ongoing COVID-19 pandemic. Healthcare workers (HCWs) play a critical role in receiving, recommending and delivering COVID-19 vaccination. Understanding the specific influences on each behaviour enables the development of targeted and tailored interventions to improve vaccination uptake. This paper presents a qualitative synthesis of HCWs’ individual and context barriers and drivers to these three vaccination behaviours across 10 countries in Europe and Central Asia. Qualitative data from interviews and focus group discussions with 378 HCWs between December 2020 and March 2022 were synthesised and organised by four COM (capability, physical and social opportunity, motivation) factors. Differences by stage of COVID-19 vaccine roll-out (in preparation, early and late delivery) were explored. Receiving vaccination related to all four factors. Recommending vaccination mostly related to capability and motivation. HCWs were generally well-informed by official sources and viewed vaccination as the way to end the pandemic, acknowledging their important role in this. Colleagues, family and friends were positive influences on personal vaccination decisions. However, knowledge gaps were evident, particularly amongst nurses who relied on (social) media. Concerns about safety and effectiveness, often connected to knowledge gaps, were heightened by the accelerated timeline for COVID-19 vaccine development and approval. This impeded some HCWs’ motivation to receive and recommend vaccination even in the later roll-out countries. Delivering vaccination was facilitated by support from public health organisations, teamwork and service re-organisation, more evident amongst later roll-out countries. Ongoing high workloads, stress and burnout hindered delivery. Complex and inter-related factors affecting HCWs’ vaccination behaviours were identified. These insights should inform the design of multifaceted interventions (e.g., communication skills training, management support for HCWs’ mental health, and engaging them in decision-making for service redesign); not only for COVID-19 vaccination as it is integrated into routine services but for routine immunization as a whole.

Abstract Background Palliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia’s rural and regional health care settings. Methods A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders. Results Participants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers. Conclusions Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models.

Abstract Background Obstetric fistula is a major public health concerns in Ethiopia. It is the most devastating cause of all maternal morbidities. Method Data from the 2016 Ethiopian Demographic Health Survey (EDHS) was analyzed. A community-based unmatched case control study was conducted. Seventy cases and 210 non cases were selected using random number table. Data were analyzed by using STATA statistical software version 14. Multivariable logistic regression model was applied to determine the factors associated with fistula. Results The majority of fistula cases were from rural residences. The multivariable statistical model showed that rural residence (Adjusted OR (AOR) = 5, 95% CI 4.26, 7.52), age at first marriage (AOR = 3.3, 95% CI 2.83, 4.60), poorest wealth index (AOR = 3.3, 95% CI 2.24, 5.01) and decision making for contraceptive use by husband alone (AOR = 1.3, 95% CI 1.124, 1.67) were factors significantly associated with obstetric fistula. Conclusion Age at first marriage, rural residence, poorest wealth index and decision making for contraceptive use by husband alone were significantly associated factors for obstetric fistula. Intervening on these factors will reduce the magnitude of obstetrics fistula. In this context there is in-need to improve on avoiding early marriage through awareness creation to the community and developing legal framework by the policymakers. Furthermore, information about the joint decision making to use contraceptives should be disseminated though mass-media and interpersonal channels.

Background: Availability and accessibility of opioids are a worldwide problem. In low-resource settings, such as Ethiopia, access to opioids is either limited or nonexistent and legally restricted in health care settings. This study aimed to identify barriers for the availability and accessibility of opioids in Ethiopian rural and regional health care settings. Methods: A mixed-method case study design was used. A total of 220 nurses from primary, secondary, and tertiary health care settings were invited to participate in a survey of knowledge and practice. For the qualitative interview, 38 participants were recruited from educational facilities, health services, and the community across a region. Results: Barriers in availability and accessibility of opioid analgesics were expressing pain considered as a sign of weakness, lack of knowledge, side effect concerns about prescribing morphine, only doctors being authorized to prescribe morphine, lack of foreign currency to import morphine ingredients, and inequity in accessing morphine in hospitals and none in rural health care settings. Conclusion: The findings of this study indicate that opioids, particularly morphine, were not consistently available and accessible to all patients in need. Health professionals lacked knowledge about opioids. Strengthening the existing pain-free initiatives and improving the type, dose, and supply of morphine could help reduce needless suffering and enhance access to essential pain medicines for those in need.

Abstract Background The livelihood of rural households in Ethiopia, like in most developing countries, largely depends on land resource. However, nowadays most rural households are denied access to arable land in the highland of Ethiopia due to high population growth and shortage of arable land. Landlessness is, therefore, becoming a serious social and economic problem in the rural highland areas of Ethiopia in general and Tigrai region in particular. This study, therefore, intends to explore the choice of livelihood strategies of landless rural households and assess the challenges and opportunities of the livelihoods of landless rural households in selected districts of Tigrai region. Methods This study is conducted in three randomly selected districts of Tigrai region, namely, Kilte-Awlaelo, Degua-Tembien, and Hintalo-Wajerat districts. For the purpose of this study, two Tabias were randomly chosen from each districts. Then, afterward, both primary and secondary data sources were consulted to address the specific objectives of this study. The primary data were collected from 258 randomly selected households and six focus group discussions. This study used Multivariate Probit and Negative Binomial Regression to analyze factors influencing the choice of livelihood strategies and the number of livelihood options adopted by the landless rural households, respectively. Results This study finds that the livelihood sources of the landless rural households in the study area include farm (90%), non-farm (72%), and off-farm (41%) economic activities. The result of the Multivariate Probit regression indicates that household head characteristics, human capital, social capital, physical capital, financial capital, and institution-related factors were significantly influencing the choice of livelihood strategies of the landless rural households. The results of the negative binomial regression model, on the other hand, assert that household head-related factors, social capital, and institution-related factors were significantly influencing the number of livelihood options adopted by the landless rural households. This study affirms that stone or sand selling, dairy farming, poultry production, animal fattening, and bee keeping are the major opportunities to improve the livelihood of the landless rural households. Moreover, this study also identifies that shortage of arable land, youth unemployment, lack of access to infrastructure, poor land administration, and lack of access to financial capital were the major challenges facing the landless rural households. Concluding remarks This study concludes that all stakeholders efforts to address the problem of landlessness need to be geared to enhance access of landless rural households to different livelihood capitals, such as human, social, financial, physical, and natural capitals. Moreover, rural township and village enterprises could enhance the access of landless rural households to market and job opportunities.

Background: Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country’s healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units. Objective: This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve. Design: Face-to-face interviews were conducted in a rural region of Ethiopia. Methods: Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis. Results: Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals’ awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable. Conclusions: Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.

This music score was submitted for the Kaleidoscope 2020 Call for Scores, an open access collaboration with the UCLA Music Library.

Abstract Background Pneumonia is an acute respiratory infection of the lungs. A child dies of pneumonia every 39 s globally. Even though pneumonia affects children worldwide, the risk and repercussions of the disease are more prevalent in poor and middle-income nations. Despite the initiatives by the Ethiopian government, there are still numerous instances and deaths caused by childhood pneumonia. Therefore, this study aimed to identify the risk factors for pneumonia among 2–59 months-old children visiting Adama Hospital Medical College, Adama, Ethiopia. Methods An institution-based unmatched case-control study was conducted among 124 cases and 124 controls from January 1, 2021, to March 15, 2021. Cases were selected using a consecutive sampling technique. For each case, the next patient from the same pediatric outpatient room who met the inclusion criteria was taken as a control. Data were collected using a pretested, structured interviewer-administered questionnaire containing sociodemographic, environmental, and nutritional factors, comorbid illnesses, and related care practices. A multiple logistic regression model was fitted. Results Family size of ≥ 5 compared to 5000 birr (AOR: 3.94, 95% CI: 1.06, 14.6), use of charcoal as the main fuel for cooking (AOR: 7.03, 95% CI: 2.38, 20.78), and wood or dung as the main fuel for cooking compared to electricity (AOR: 6.58, 95% CI: 2.07, 20.9), malnutrition compared to no malnutrition (AOR: 4.77, 95% CI: 1.89, 12.06), diarrhea compared to no diarrhea in the past 2 weeks (AOR: 3.3, 95% CI: 1.52, 7.14) and upper respiratory tract infection (URTI) compared to no infection in the past 2 weeks (AOR: 3.29, 95% CI: 1.31, 8.23) were found to be risk factors for pneumonia. Conclusion In this study, risk factors for pneumonia were family size, monthly income, type of energy used for cooking, malnutrition, and diarrhea or URTI in the past 2 weeks. Relatively simple interventions such as cooking with electricity, and other interventions like prevention, early detection and treatment of malnutrition, diarrhea, and URTI, and promotion of family planning are important.

Abstract Surface irrigation type is one of the most widely used in the world due to its low cost investment. However it is complex method of applying water to soil, because of extreme difficult to achieve good control over the highly variable nature of the movement of water across a soil surface and its infiltration into the soil over a season. This study is attempted to optimize furrow irrigation decision variables at Wonji Shoa sugar estate using field experiment and two simulation models. The field data of experimental site was measured as input for models and simulated using the SIRMOD software and WinSRFR software package. Furrow lengths of 32 m, 48 m and 64 m, slopes of 0.05%, 0.075% and 0.1%and flow rates of 3 l/sec, 4 l/sec and 5 l/sec were analyzed with three replication using volume balance method and two simulation models. The study found optimum decision variables that gave maximum application efficiency and distribution uniformity were slope of 0.1%, furrow length of 32 m and inflow rate of 4 l/sec at cut-off time of 15.79 min. Thus, to improve the performance of furrow irrigation practice, optimal furrow length, inflow rates and cut-off time found by this study should be adopted. Findings from the study would serve as a source of information for use by policy makers and planners during the design and Operation of irrigation development programs. It does not focus on yield related optimization. So, it is open for the future research to conduct yield related optimization of the decision variables.

Tick-borne encephalitis (TBE) is a serious neurological disease caused by TBE virus (TBEV). Because antiviral treatment options are not available, vaccination is the key prophylactic measure against TBEV infections. Despite the availability of effective vaccines, cases of vaccination breakthrough infections have been reported. The multienzymatic non-structural protein 3 (NS3) of orthoflaviviruses plays an important role in polyprotein processing and virus replication. In the present study, we evaluated NS3 of TBEV as a potential vaccine target for the induction of protective immunity. To this end, a recombinant modified vaccinia virus Ankara that drives the expression of the TBEV NS3 gene (MVA-NS3) was constructed. MVA-NS3 was used to immunize C57BL/6 mice. It induced NS3-specific immune responses, in particular T cell responses, especially against the helicase domain of NS3. However, MVA-NS3-immunized mice were not protected from subsequent challenge infection with a lethal dose of the TBEV strain Neudoerfl, indicating that in contrast to immunity to prME and NS1, NS3-specific immunity is not an independent correlate of protection against TBEV in this mouse model.

Background: A variety of bioactive compounds isolated from various botanical sources have been found to have therapeutic and immunotherapeutic effects on chicken coccidiosis. Aim: This study aimed to evaluate the anti‐coccidial potential of Enteromorpha prolifera polysaccharide (EP) in indigenous chickens in Northwest Ethiopia. Materials and Methods: A total of 78 male indigenous chickens were used for this study. The study had two treatment groups: (1) the EP non‐supplemented group (those fed on diets without EP and Eimeria oocyst inoculated) and (2) the EP group (those receiving diets supplemented with 400 mg EP/kg diet and Eimeria oocyst inoculated). Each treatment group had five replications. Following fourteen days of EP supplementation, 1.5 × 104 oocysts of mixed Eimeria species were inoculated into individual birds. Results: EP‐supplemented chicken showed significantly lower (p < 0.05) oocyst counts compared to non‐supplemented ones on 9 and 11 days post‐challenge. In addition, chickens in the EP‐supplemented group showed less severe lesion scores, with an average score of 1.33. Chickens that received EP showed a maximum of 27.27% protection against lesions. In contrast, the non‐supplemented chickens had a lower percentage of protection (19.83%). The maximum anti‐coccidial index value (146.98) was obtained from EP‐supplemented chickens. Chickens in the EP‐supplemented group exhibited a significantly higher (p < 0.05) weight gain. Conclusion: Overall, the inclusion of EP in chickens' diets shows promise as a potential anti‐coccidial strategy. However, additional research is required to explore the mechanisms by which EP in chickens' diet could involve in increasing the protection ability of chickens against coccidiosis. [ABSTRACT FROM AUTHOR]

Rootstocks have a significant influence on adaptation to biotic and abiotic stress conditions and quality of fruit. So, choice of rootstock for a specific growing region is an important decision for a grower to make when establishing a commercial citrus orchard. This study was undertaken to assess effects of rootstock and location on quality of orange fruit. The study was conducted over two consecutive years (2017/18 and 2018/19). Scions from the Gunda Gundo orange grove were grafted on rough lemon and sour orange rootstocks and planted in Tigray and Afar, Ethiopia at four sites (Abala, Agulae, Adiha and Rama). The experiment was laid out in Randomized Complete Block Design (RCBD) with four replications. Data on different physico-chemical and bioactive compounds were collected and analyzed using R software (version 4). Compared to sour orange, rough lemon rootstock revealed higher fruit mass (151.96 g, 195.38 g), fruit length (62.27 mm, 68.88 mm) and fruit diameter (65.58 mm, 71.3 mm), in 2017/18, 2018/19, respectively. Among the four locations (Abala, Agulae, Adiha and Rama), higher juice percentage was found in Adiha (43.47% in 2017/18) and Abala (49.87%, in 2018/19). In 2017/18 higher total soluble solid (TSS, 13.87%), TSS/acid ratio (19.18) and fruit rag (32.77%), were obtained at the Rama site. On the one hand, higher vitamin C (826.6 mg·kg−1) and total phenolic content (208 mg·kg−1 GAE) were recorded at Agulae than Abala, Adiha and Rama sites from sour orange rootstock. High TSS, TSS/acid ratio and antioxidant were recorded from orange fruits at Rama site. This was expected to have resulted from hot climate conditions at the site. Besides, at a relatively cooler condition of the Agulae site, high phenolic, reduced ferric power and high vitamin C were recorded. Rough lemon rootstock improved fruit size, while rootstock did not affect the contents of TSS, TSS/acid ratio across the sites in both harvesting years.

Abstract Background Despite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia. Methods A retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression. Results A total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of