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Ethiopia has made significant progress in the last two decades in improving the availability and coverage of essential maternal and child health services including childhood immunizations. As Ethiopia keeps momentum towards achieving national immunization goals, methods must be developed to analyze routinely collected health facility data and generate localized coverage estimates. This study leverages the District Health Information Software (DHIS2) platform to estimate immunization coverage for the first dose of measles vaccine (MCV1) and the third dose of diphtheria-pertussis-tetanus-Hib-HepB vaccine (Penta3) across Ethiopian districts ("woredas"). Monthly reported numbers of administered MCV1 and Penta3 immunizations were extracted from public facilities from DHIS2 for 2017/2018-2021/2022 and corrected for quality based on completeness and consistency across time and districts. We then utilized three sources for the target population (infants) to compute administrative coverage estimates: Central Statistical Agency, DHIS2, and WorldPop. The Ethiopian Demographic and Health Surveys were used as benchmarks to which administrative estimates were adjusted at the regional level. Administrative vaccine coverage was estimated for all woredas, and, after adjustments, was bounded within 0-100%. In regions with the highest immunization coverage, MCV1 coverage would range from 83 to 100% and Penta3 coverage from 88 to 100% (Addis Ababa, 2021/2022); MCV1 from 8 to 100% and Penta3 from 4 to 100% (Tigray, 2019/2020). Nationally, the Gini index for MCV1 was 0.37, from 0.13 (Harari) to 0.37 (Somali); for Penta3, it was 0.36, from 0.16 (Harari) to 0.36 (Somali). The use of routine health information systems, such as DHIS2, combined with household surveys permits the generation of local health services coverage estimates. This enables the design of tailored health policies with the capacity to measure progress towards achieving national targets, especially in terms of inequality reductions.

Abstract Background Beekeeping activity is carried out in most parts of Ethiopia. However, despite the favorable agro-ecology for beekeeping practices and the high number of bee colonies the country is endowed with, the level of beekeeping adoption is low. Methods This study was conducted to identify determinants of the decision to adopt beekeeping, and the intensity of adoption by using a cross-sectional data collected from 772 rural households in Northwest Ethiopia. Stratified random sampling method was used to select the households, and the data were collected using a questionnaire. To achieve the objectives, Heckman two-stage sample selection model was used. Results The result of the first step Heckman model revealed that age and educational level of the household head, household size, extension visits, training, incentive, home consumption of honey, major economic activities of the household, perception towards better hives, distance to the nearest marketplace, the number of years the household stayed in the village, and location were the significant variables influencing rural households’ beekeeping adoption decision. The second step Heckman model revealed that livestock holding of a household head, number of extension visits, credit use, presence of honey bee pests, whether a household is engaged in swarm catching practices, and major economic activities of a household head were the variables that influence the intensity of beekeeping adoption significantly. Conclusions The findings of the study can be used to make evidence-based policy interventions to improve beekeeping adoption and the intensity of beekeeping adoption by rural households, which could also help to improve their livelihoods.

Abstract Background Sustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track milestones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in the epidemiology of HIV/AIDS in Ethiopia across ages compared to neighboring countries. Methods The National Data Management Center for health’s research team at the Ethiopian Public Health Institute has analyzed the Global Burden of Disease (GBD) 2017 secondary data for the year 2010 to 2017 for Ethiopia and its neighbors. GBD 2017 data sources were census, demographic and a health survey, prevention of mother-to-child HIV transmission, antiretroviral treatment programs, sentinel surveillance, and UNAIDS reports. Age-standardized and age-specific HIV/AIDS incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence intervals. Results Ethiopia and neighboring countries recorded slow progress in reducing new HIV infection since 2010. Only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania, and Uganda already achieved the 75% mortality reduction target set for 2020. The incidence: prevalence ratio for Ethiopia, Rwanda, and Uganda were 1 due to high incidence. The HIV incidence rate in Ethiopia was dropped by 76% among under 5 children in 2017 compared to 2010 and the country would likely to attain the 2020 national target, but far behind achieving the target among the 15–49 age group. Conclusions Ethiopia and neighboring countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020, although they progressed poorly in reducing HIV incidence. By recording an incidence:prevalence ratio benchmark of less than 0.03, Ethiopia, Rwanda, and Uganda are well heading towards epidemic control. Nonetheless, the high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to reach out undiagnosed cases and to build institutional capacity for generating strong evidence to ensure sustainable epidemic control.

Abstract Background Mortality caused by injuries is increasing and becoming a significant global public health concern. Limited evidence from Ethiopia on road traffic, unintentional and intentional injuries indicate the potential public health impact of problems resulting from such injuries. However, there is a significant evidence gap about the actual national burden of all injuries in Ethiopia. This data base study aimed to reveal the national burden of different injuries in Ethiopia. Methodology Data for this study were extracted from the estimates of the Global Burden of Diseases (GBD) 2017 study. Estimates of metrics such as Disability-Adjusted Life Years (DALYs), death rates, incidence, and prevalence were extracted. The metrics were then examined at different injury types, socio-demographic categories such as age groups and sex. Trends of the metrics were also explored for these categories across years from 2007 to 2017. The DALYs and deaths due to injuries in Ethiopia were also compared with other East African countries (specifically Kenya, Tanzania, Uganda, and Zambia) in order to evaluate regional differences across years, by sex and by different injury types such as transport injuries, unintentional injuries, self-harm and interpersonal violence. Results The age-standardized injury death rate has decreased to 69.4; 95% UI: (63.0–76.9) from 90.11; 95% UI: (82.41–97.73) in 2017 as compared with 2007. Road injury, falls, self-harm and interpersonal violence were the leading causes of mortality from injuries occurring in 2017. The age-standardized injury DALYs rate has decreased to 3328.2; 95% UI: (2981.7-3707.8) from 4265.55; 95% UI: (3898.11–4673.64) in 2017 as compared with 2007. The number of deaths resulting from injuries in 2017 was highest for males, children under 5 years, people aged 15–24. Conclusion The current age-standardized death rate and DALYs from injuries is high and the observed annual reduction is not satisfactory. There is a difference in gender and age regarding the number of deaths resulting from injuries. The data indicates that the current national efforts to address the public health impact of injuries in Ethiopia are not sufficient enough to bring a marked reduction. As a result, a more holistic approach to address all injuries is recommended in Ethiopia.

Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a “greenfield” site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. Results: Despite considerable challenge, with financial support, personal commitment, and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. Conclusions: The most valuable data for global health policy are from high-mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong, sustained, local research leadership, and to broaden the scientific remit. To support this, we have set up a new collaboration, the “Hararghe Health Research Partnership”.

The most common procedure for analyzing multi-environmental trials is based on the assumption that the residual error variance is homogenous across all locations considered. However, this may often be unrealistic, and therefore limit the accuracy of variety evaluation or the reliability of variety recommendations. The objectives of this study were to show the advantages of mixed models with spatial variance–covariance structures, and direct implications of model choice on the inference of varietal performance, ranking and testing based on two multi-environmental data sets from realistic national trials. A model comparison with a chi-square test for the trials in the two data sets (wheat data set BW00RVTI and barley data set BW01RVII) suggested that selected spatial variance-covariance structures fitted the data significantly better than the ANOVA model. The forms of optimally-fitted spatial variance-covariance, ranking and consistency ratio test were not the same from one trial (location) to the other. Linear mixed models with single stage analysis including spatial variance-covariance structure with a group factor of location on the random model also improved the real estimation of genotype effect and their ranking. The model also improved varietal performance estimation because of its capacity to handle additional sources of variation, location and genotype by location (environment) interaction variation and accommodating of local stationary trend.

Background Food insecurity is a state in which people do not have both physical and economic access to sufficient food to meet their dietary needs. Food insecurity affects all nations despite that it is high in Africa, particularly in Ethiopia. There is limited information on the magnitude of food insecurity and its associated factors among lactating mothers in Ethiopia. Therefore, the purpose of this study was to determine the magnitude of food insecurity and associated factors among lactating mothers in Yirgalem Town, South Ethiopia. Methods A community-based cross-sectional study design was conducted on five randomly selected Kebeles and 557 lactating mothers who were selected using a simple random sampling technique from January 10 to April 30, 2022. The data were collected using interviewer administered questionnaires. Bi-variable and multivariable logistic regression analysis was used in the analysis. Family folder documentation was used to know the number of lactating mothers found in each Kebeles. Food insecurity was measured by household food insecurity access scale (version 3). Dietary diversity was assessed by the 24-hour dietary recall method. Results The magnitude of food insecurity among lactating mothers was 58.2%. Low minimum dietary diversity score, mothers with two and below antenatal care, mothers who had more than two children under 5 years, no home gardening practice, and having meals two and below were significantly associated with food insecurity. Conclusion The magnitude of food insecurity was 58.2% in the study area. Therefore, the agricultural and health sectors should work collaboratively to improve home gardening practices, dietary diversity practices and maternal health services are highly recommended to reduce food insecurity.

Background: Ethiopia, with about 10% of Africa's population, has little direct information on causes of death, particularly in rural areas where 80% of Ethiopians live. In 2019-2020, we conducted electronic verbal autopsies (e-VA) to examine causes of death and quantify cause-specific mortality rates in rural Ethiopia., Methods: We examined deaths under 70 years in the three years prior to the survey dates (November 25, 2019-February 29, 2020) among 2% of East Gojjam Zone (Amhara Region) using registered deaths and adding random sampling in this cross-sectional study. Trained surveyors interviewed relatives of the deceased with central dual-physician assignment of causes as the main outcome. We documented details on age, sex and location of death, and derived overall rural death rates using 2007 Census data and the United Nations national estimates for 2019. To these, we applied our sample-weighted causes to derive cause-specific mortality rates. We calculated death risks for the leading causes for major age groups., Findings: We studied 3516 deaths: 55% male, 97% rural, and 68% occurring at home. At ages 5 and older, injuries were notable, accounting for over a third of deaths at 5-14 years, half of the deaths at ages 15-29 years, and a quarter of deaths at ages 30-69 years. Neonatal mortality was high, mostly from prematurity/low birthweight and infections. Among children under 5 (excluding neonates), infections caused nearly two-thirds of deaths. Most maternal deaths (84%) arose from direct causes. After injuries, especially suicide, assaults, and road traffic accidents, vascular disease (15%) and cancer (13%) were the leading causes among adults at 30-69 years. HIV/AIDS and tuberculosis deaths were also important causes among adults., Interpretation: Rural Ethiopia has a high burden of avoidable mortality, particularly injury, including suicide, assaults, and road traffic accidents., Funding: International Development Research Centre, and the Canadian Institutes of Health Research., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Background: Adult vitamin D deficiency, which is a public health problem in low-income countries, is correlated with increased mortality. Although health care workers (HCWs) in Ethiopia are educated on important minerals their counseling on the uses of vitamin D and its possible sources was not witnessed since their knowledge and practice is low. The main aim of this study is to explore barriers to good knowledge, positive attitude, and practice of health care providers on adult vitamin D., Methods: An exploratory qualitative study is done in three ecologies covering highland, midland, and lowland. The size of 27 participants was fixed by saturation of ideas. In-depth interviews were conducted among leaders and HCWs of different professional groups in health centers and hospitals. Moderators were Ph.D. holders. An interview guide was developed after reviewing research that was translated into the local language. Interviews were audio-taped, transcribed and, translated. Open Code software was used to code and categorize the data. Themes were developed using thematic analysis which is presented using themes and sub-themes., Result: The main barriers are related to health systems, HCWs' understandings, and the educational system. Lack of attention by the health systems' leadership, missing adult vitamin D as a priority in health programs, lack of capacity building scheme and the absence of adult vitamin D management and treatment guidelines are barriers related to the health system. On the other hand, health care professionals believed that the prevalence of adult vitamin D deficiency is insignificant and vitamin D deficiency is only an issue related to children. Besides, the absence of studies,the focus of the medical curriculum on child vitamin D and the inadequacy of laboratory investigation are barriers related to the education system and research., Conclusion: Adult vitamin D deficiency is a neglected public health problem with many barriers related to diagnosis and treatment. Barriers are related to the professionals themselves, their leadership, health facilities, and the education system. The government should give attention to adult vitamin D management and treatment, continuous on the job training, development of guidelines, purchase of laboratory equipment, the inclusion of adult vitamin D in pre-service and, in-service training curriculums., (© 2021. The Author(s).)

Improved breeding practices and participatory health services have been designed and implemented by a partnership between national and international institutions in various parts of Ethiopia since 2014. Based on a panel data of two waves, we have estimated the impact of these interventions on small ruminant fertility, offtake, return per head of animal, and gross income per adult equivalent. Different specifications of the difference-in-differences model revealed that access to small ruminant health services has increased offtake, return per head of sheep/goat, and gross income per adult equivalent. Participants in community-based small ruminant breeding have also higher offtake and gross income per capita than those who are not taking part. The findings of this study are expected to help understand the economic benefits that accrue to rural areas when livestock development interventions are made based on the right diagnosis. The results of this study will also be useful in informing the ongoing discussion in Ethiopia on the transformation of the livestock sector., 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. The reviewer SS declared a shared affiliation with one of the authors, SG, to the handling editor at time of review., (Copyright © 2021 Kassie, Asnake, Haile, Mengistu, Gizaw and Rischkowsky.)

Background: Maize is the most important cereal and most widely cultivated staple that plays a key role in the food security of sub-Saharan Africa (SSA). Although some countries have achieved significant gains in maize productivity, the SSA average yields are far below what could be obtained with improved cultivars under good crop management. Low cultivar turnover is one among many contributing factors to low maize yields in SSA. At present, there is a critical knowledge gap on the identity, number, and age of maize cultivars currently grown by smallholder farmers on the continent., Results: This study revealed that nearly 500 maize cultivars were grown in 13 African countries surveyed in the 2013/2014 main crop season. Sixty-nine percent of the cultivars each occupied <1% of the total maize area; only two cultivars occupied >40% and four occupied >30% area. Approximately 32% of all the cultivars were hybrids, 23% were improved open-pollinated varieties (OPVs), and 46% were locals. Eastern Africa (EA) and southern Africa (SA) accounted for about 43 and 38%, respectively, of all the cultivars reported, whereas West Africa's (WA) share was 19%. The average area planted to modern cultivars in the surveyed areas was estimated at 57%-with EA, SA, and WA estimates of 82, 55, and 36%, respectively; however, increased adoption was not necessarily always related to improved productivity, as the latter depends on many additional factors. Each household planted an average of 1.781 cultivars (range 1-8). The overall weighted average age of the cultivars was 15 years, with hybrids and OPVs being 13 and 18 years, respectively., Conclusions: Maize variety turnover in SSA is slower than what is practiced in the USA and other world regions such as Latin America and Asia. The substantial variations among regions and countries in all parameters measured suggest a tailored approach to mitigation interventions. Findings of this current study pave the way for replacing the old cultivars with more recent releases that are tolerant or resistant to multiple stresses and are more resilient., (© 2017 Sellgren KL et al.)