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The aim of this study was to characterize the newly released different upland rice varieties grown at two representative locations in Ethiopia. This experiment was conducted in factorial design arranged in completely randomized design with three replications. The factors considered were variety (Hidassie, Kokit, NERICA-3, NERICA-4, NERICA-12 and NERICA-13), and growing location (Fogera and Pawe). Collected samples were processed to brown rice and analyzed for selective physical, proximate, cooking, functional, mineral, and color properties. The results showed that the growing location and variety had a significant effect (P ≤ 0.05) on rice quality attributes. The variety Kokit was the most consistent in terms of hectoliter weight, alkali-spreading value, grain weight, amylose, and grain thickness. The mean minimum cooking time of the varieties had ranged from 6.67 to 28.0 min. The gelatinization temperature of upland brown rice varieties varied from 59 to 78.33°C. NERICA-4 grown at Pawe had significantly higher gelatinization temperature (78.33°C) compared to others. The protein content was higher in all the studied varieties grown at Pawe (9.82 to 10.29%) than the varieties grown at Fogera (6.34 to 8.44%). The maximum values for manganese (23.52 mg/kg), magnesium (1091.31 mg/kg) and zinc (25.95 mg/kg) were found in Hidassie grown at Fogera. Similarly, the highest Fe content (70.6 mg/kg) was found in NERICA-3 at Pawe. The current findings will be highly useful for the researchers and processers in the field of rice research and development.

The objective of this study was to compare the effects of two types of active triple-layer films containing curcumin on the shelf-life of salmon fillets. One film (Film A) contained pure curcumin dissolved in lemongrass essential oil, while the other (Film B) incorporated curcumin from Curcuma longa extract dissolved in citral. The impact of these active films on the preservation of salmon fillets quality and safety was studied by analyzing factors such as color parameters, sensory evaluation, lipid oxidation, and biogenic amines. Despite good active properties measured in vitro, both films harmed the sensory quality and color of salmon. However, the incorporation of active ingredients in biopolymer films has shown the potential to inhibit biogenic amine formation. The findings pave the way for future research to explore the synergistic effects of combining various natural extracts with active packaging films.

In Ethiopia, the cultivation of lowland rice varieties is recently introduced. However, the physicochemical and functional characteristics of these varieties are not reported. Therefore, this study was conducted to determine the physicochemical properties, proximate and mineral compositions, and cooking and functional properties of the six rice varieties (Demozie, Ediget, FOFIFA, Gumara, Hiber, and X-jigna) cultivated in two locations (Fogera and Pawe). Grain length, length-breadth (L/B) ratio, and thousand kernel weights (TKW) were within the ranges 5.16-7.19 mm, 1.81-2.6 mm, and 22.13-29.43 g, respectively. FOFIFA from Pawe was characterized by the highest values for grain length (7.19 mm) and TKW (29.43 g). The crude protein, ash, and fiber contents were within the rages of 5.56-1.02, 0.47-1.58, and 2.16-3.66%, respectively. Varieties from Pawe contained significantly higher protein compared with Fogera. X-jigna from Pawe had the highest amylose content (26.57%) and alkaline spread value (ASV, 7.1), as well as the lowest for gelatinization temperature (64.33 °C) compared to others. The minimum cooking time ranged from 7.67 min for Hiber to 48.0 min for Gumara - both from Pawe. Gruel solid loss, water uptake ratio, and kernel elongation varied at 1.16-2.55, 1.34-1.46, and 1.04-1.17%. The calcium, zinc, iron, magnesium, and manganese contents were within the ranges of 0.60-19.60, 1.49-3.56, 1.21-9.26, 63.18-120.88, and 1.42-4.02 mg/ 100 g, respectively. Water absorption (WAI) and water solubility (WSI) indices were within the ranges of 6.03-6.20 g/g and 2.49-3.61 g/g, respectively. Gumara and Fogera had the highest (13.91) a* (redness) color value compared to others. All of the quality characteristics considered in this investigation were markedly influenced (p < 0.01) by the variety and growing location. It could be concluded that the use of different rice varieties cultivated at different locations yielded products with significantly different rice quality attributes. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize the newly released different upland rice varieties grown at two representative locations in Ethiopia. This experiment was conducted in factorial design arranged in completely randomized design with three replications. The factors considered were variety (Hidassie, Kokit, NERICA-3, NERICA-4, NERICA-12 and NERICA-13), and growing location (Fogera and Pawe). Collected samples were processed to brown rice and analyzed for selective physical, proximate, cooking, functional, mineral, and color properties. The results showed that the growing location and variety had a significant effect (P ≤ 0.05) on rice quality attributes. The variety Kokit was the most consistent in terms of hectoliter weight, alkali-spreading value, grain weight, amylose, and grain thickness. The mean minimum cooking time of the varieties had ranged from 6.67 to 28.0 min. The gelatinization temperature of upland brown rice varieties varied from 59 to 78.33°C. NERICA-4 grown at Pawe had significantly higher gelatinization temperature (78.33°C) compared to others. The protein content was higher in all the studied varieties grown at Pawe (9.82 to 10.29%) than the varieties grown at Fogera (6.34 to 8.44%). The maximum values for manganese (23.52 mg/kg), magnesium (1091.31 mg/kg) and zinc (25.95 mg/kg) were found in Hidassie grown at Fogera. Similarly, the highest Fe content (70.6 mg/kg) was found in NERICA-3 at Pawe. The current findings will be highly useful for the researchers and processers in the field of rice research and development. [ABSTRACT FROM AUTHOR]

Objective: There are limited data in Ethiopia on common childhood illnesses. We aimed to measure the incidence and risk factors of common childhood illnesses in rural parts of southern Ethiopia., Design: A community-based cohort study., Participants and Study Setting: A total of 903 children of 5 years or younger were included between July 2017 and January 2018. We randomly selected households from three administrative units (kebeles) in Wonago district in Ethiopia., Outcomes: Data on incidence of illnesses were collected by interviewing the mothers of the children every second week, in 6 months. Incidence densities per child-week of observation were calculated, and predictors or recurrent illnesses were evaluated in multilevel Poisson regression models., Results: Out of 903 children, 882 were included (97.6%). At least one illness was experienced among 87.3% of the children. Overall illness incidence rate was 19.7 episodes per 100 child-weeks, 95% CI 18.4 to 20.7. The incidence rate of fever symptoms was 5.5 episodes per 100 child-weeks; of acute respiratory infections (ARIs) 4.2 episodes per 100 child-weeks; of diarrhoea, 3.4 episodes per 100 child-weeks. In the multilevel analysis, household wealth status, child age, child nutritional status, source of drinking water, place for cooking and number of children below 5 years of age in the household were main risk factors for illnesses., Conclusions: Children below 5 years of age in Ethiopia often experience fever, ARIs and diarrhoea. The identified risk factors were related to poverty and highlighted the importance of preventive measures to reduce the incidence of these diseases., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Traffic crashes are significant public health concern in Nigeria, particularly among young drivers. The study aims to explore the underlying pattern of risky driving behaviors and the associations with demographic factors among young drivers in Nigeria. A combined approach of Latent Class Analysis (LCA) and Association Rule Mining is applied to the dataset comprising responses from 684 young drivers who complete the "Behavior of Young Novice Drivers Scale" (BYND) questionnaires. The LCA identifies four distinct classes of drivers based on the risky behavior profiles: Reckless-Speedsters, Cautious Drivers, Distracted Multitaskers, and Emotion-impacted Drivers. Association rule mining further connects these driver classes to demographic and driving history variables, uncovering intriguing insights. Reckless-Speedsters predominantly consist of young males who engage in riskier driving behaviors, including exceeding speed limits and disregarding traffic rules. Conversely, Cautious Drivers, also predominantly young males, exhibit a safer driving profile marked by rule adherence and a notably lower crash rate. Distracted Multitaskers, sharing a demographic profile with Cautious Drivers, diverge significantly due to their higher crash involvement, hinting at a propensity for distracted driving practices. Lastly, Emotion-Impacted Drivers, primarily comprising young employed males, display behaviors influenced by emotions, shorter driving distances, and prior unsupervised driving experience. Most of the behaviors are attributed to inadequate traffic control, absence of traffic signs in most of the roads, preferential treatment, and lack of strict law enforcement in the country. The findings hold substantial implications for road safety interventions in Nigeria, urging targeted approaches to address the unique challenges presented by each driver class. With acknowledging the study limitations and advocating for future research in objective measures and emotion-behavior interactions, the comprehensive approach provides a robust foundation for enhancing road safety in the Nigerian context., 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 Ltd. All rights reserved.)

Background: Nurses turnover intention, representing the extent to which nurses express a desire to leave their current positions, is a critical global public health challenge. This issue significantly affects the healthcare workforce, contributing to disruptions in healthcare delivery and organizational stability. In Ethiopia, a country facing its own unique set of healthcare challenges, understanding and mitigating nursing turnover are of paramount importance. Hence, the objectives of this systematic review and meta-analysis were to determine the pooled proportion ofturnover intention among nurses and to identify factors associated to it in Ethiopia., Methods: A comprehensive search carried out for studies with full document and written in English language through an electronic web-based search strategy from databases including PubMed, CINAHL, Cochrane Library, Embase, Google Scholar and Ethiopian University Repository online. Checklist from the Joanna Briggs Institute (JBI) was used to assess the studies' quality. STATA version 17 software was used for statistical analyses. Meta-analysis was done using a random-effects method. Heterogeneity between the primary studies was assessed by Cochran Q and I-square tests. Subgroup and sensitivity analyses were carried out to clarify the source of heterogeneity., Result: This systematic review and meta-analysis incorporated 8 articles, involving 3033 nurses in the analysis. The pooled proportion of turnover intention among nurses in Ethiopia was 53.35% (95% CI (41.64, 65.05%)), with significant heterogeneity between studies (I 2  = 97.9, P = 0.001). Significant association of turnover intention among nurses was found with autonomous decision-making (OR: 0.28, CI: 0.14, 0.70) and promotion/development (OR: 0.67, C.I: 0.46, 0.89)., Conclusion and Recommendation: Our meta-analysis on turnover intention among Ethiopian nurses highlights a significant challenge, with a pooled proportion of 53.35%. Regional variations, such as the highest turnover in Addis Ababa and the lowest in Sidama, underscore the need for tailored interventions. The findings reveal a strong link between turnover intention and factors like autonomous decision-making and promotion/development. Recommendations for stakeholders and concerned bodies involve formulating targeted retention strategies, addressing regional variations, collaborating for nurse welfare advocacy, prioritizing career advancement, reviewing policies for nurse retention improvement., (© 2024. The Author(s).)

Background: Despite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People's Region (SNNPR) of Ethiopia., Methods: A community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI., Results: From a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness., Conclusion: Low LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country's malaria elimination goal., (© 2024. The Author(s).)

Motorcyclist hazardous actions (e.g., particularly speed too fast or failing to stop in assured clear distance (ACD)) are commonly identified as risk factors that significantly impact the motorcyclist injury severity. However, endogenous effects resulting from motorcyclist hazardous actions have seldom been considered, which may cause the biased estimates. Specifically, two important sources of endogeneities (i.e., endogeneity arising from observed confounding factors and endogeneity caused by unobserved confounders) tend to yield a biased relationship between hazardous actions and motorcyclist injury severity. To jointly account for two sources of endogeneities and provide more robust estimates, the study tries to assess the effects of speed-too-fast and failing to stop in ACD on motorcyclist injury severity via a hybrid method by integrating the generalized propensity score approach with instrumental variable model. Specifically, we adopt a generalized propensity score matching method to reduce the endogeneity bias arising from observed confounders. Furthermore, the matched data are used to develop an instrumental variable model with random parameters to handle the endogeneity resulting from unobserved confounders and unobserved heterogeneity, which consists of random parameters binary logit models modelling the motorcyclist hazardous actions in the first stage and a random parameters logit model with heterogeneity in means modelling the motorcyclist injury severity in the second stage. The proposed approach is estimated based on Michigan motorcycle crash data from 2015 to 2018. Results suggest that alcohol use leads motorcyclists to engage in speed-too-fast, while alcohol use and signal control cause motorcyclists to be involved in failing to stop in ACD. Middle-aged and elderly motorcyclists, alcohol use, speed too fast, speed limit ≥50 mph, wet surface, and head-on/angle crashes significantly increase the injury severity of motorcyclists. Moreover, failing to stop in ACD produces a random parameter with heterogeneity in means, while intersection increases the mean effects of failing to stop in ACD on motorcyclist minor injury. These findings further provide insights for a better understanding of hazardous actions and motorcyclist injury severity via the impact analysis of various explanatory variables., 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 Ltd. All rights reserved.)

Around half of adolescent pregnancies in low- and middle-income countries are unintended, contributing to millions of unsafe abortions per year. Adolescents 360 (A360), a girl-centred initiative, aimed to increase voluntary uptake of modern contraceptives among adolescents in Nigeria, Ethiopia and Tanzania. We evaluated the effectiveness and cost-effectiveness of A360 in increasing modern contraceptive use in selected geographies. We used before-and-after cross-sectional studies of adolescent girls in four settings. Two Nigerian settings had purposefully selected comparison areas. Baseline and endline household surveys were conducted. The primary study outcome was modern contraceptive prevalence rate (mCPR). Secondary outcomes mapped onto the A360 Theory of Change. Interpretation was aided by a process evaluation along with secular mCPR trends and self-reported A360 exposure data. Incremental design and implementation costs were calculated from implementer systems, site visits, surveys, and interviews. mCPR change was modelled into maternal disability-adjusted life years (DALY) averted to calculate incremental cost-effectiveness ratios. In Oromia, Ethiopia, mCPR increased by 5% points (95% CI 1-10; n = 1,697). In Nigeria, there was no evidence of an effect of A360 on mCPR in Nasarawa (risk ratio: 0·96, 95% CI: 0·76-1·21; n = 5,414) or in Ogun (risk ratio: 1·08, 95% CI: 0·92-1·26; n = 3,230). In Mwanza, Tanzania, mCPR decreased by 9% points (-17 to -0.3; n = 1,973). Incremental cost per DALY averted were $30,855 in Oromia, $111,416 in Nasarawa, $30,114 in Ogun, and $25,579 in Mwanza. Costs per DALY averted were 14-53 times gross domestic product per capita. A360 did not lead to increased adolescent use of modern contraceptives at a population level, except in Oromia, and was not cost-effective. This novel adolescent-centred design approach showed some promise in addressing the reproductive health needs of adolescents, but must be accompanied by efforts to address the contextual drivers of low modern contraceptive use., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Krug 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 and Objective: An important indicator of the quality of antenatal care (ANC) is the satisfaction of the client. Despite this, women in Ethiopia are very dissatisfied with the quality of their ANC. In Ethiopia, a systematic review was conducted to estimate the pooled prevalence of client satisfaction (CS) with ANC services., Methods: Only articles published in English were included in this review. Medline/PubMed, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion requirements. Using a random effects model, the overall rate of CS with prenatal care was calculated. Additionally, Egger's test and funnel plots were used to examine publication bias. STATA version 14 was used to perform all statistical analyses., Results: This review included 20 studies involving 8447 women attending prenatal care services. In Ethiopia, the overall customer satisfaction rate with prenatal care services was 60.42% (95% CI [51.33.99, 69.51]; I2 = 98.9%, P < 0.001). Previous ANC follow-up, iron and folic acid supplementation, and the last planned pregnancy were statistically associated with CS., Conclusion and Global Health Implications: In Ethiopia, 60% of women are satisfied with their ANC. This shows that 40% of women are dissatisfied with the prenatal care provided by healthcare professionals. This will lead to a low utilization of ANC services throughout the country. Therefore, the Ethiopian government, especially the Ministry of Health and nongovernmental organizations (NGOs), must take measures to address this severity and improve identified factors., Competing Interests: The authors declare that they have no competing interests., (© 2024 The Authors. Published by Global Health and Education Projects, Inc., USA.)

Background: Annually, around half a million new cases of cervical cancer and 250,000 deaths occur worldwide. It is the second-leading cancerous cause of death after breast cancer among women. Repeated infection and prolonged persistence with human papilloma virus is common among HIV-positive women due to their immune status. A one-visit screen and treat strategy for cervical cancer prevention was instituted in 2010 nationwide in 14 selected hospitals. So, assessing service uptake and associated factors among ART clients is mandatory., Method: From December 2015 to March 2016 G.C., a cross-sectional study was conducted. An interviewer-administered, semi-structured questionnaire was used to collect data. The data were entered, cleaned, and analyzed using IBM SPSS version 20 software. A statistically significant association of variables was determined based on an adjusted odds ratio with a 95 % confidence interval and a p value of 0.05., Result: Cervical cancer screening service uptake among the 647 interviewed participants was 59 %. Study participants accounting for 19 % (N = 123) were 18-29 age group, 56.6 % (N = 366) were 30-39 %, and 24.4 % (N = 158) were in 40-64 age group. Of 647 participants, 43.7 % (N = 283) were illiterate and educated less than secondary level of education, 36.0 % (N = 233) had a secondary level of education, and 20.2 % (N = 131) had an education above secondary. Being encouraged by others to get screened for cervical cancer (AOR = 1.88, 95 % CI: 1.25, 2.82), knowing another woman who got screened, and getting information from the media (AOR = 0.4, 95 % CI: 0.27, 0.60) were associated with the uptake of cervical cancer screening., Conclusion: The uptake of cervical cancer screening among ART clients attending the clinic was not satisfactory. Encouragement to get screened, knowing other screened women, and getting information from the media were important predictors of CCS service uptake. Exploring more information on the attitudes of clients to improve service uptake is mandatory., Competing Interests: Declaration of Competing Interest The authors declare that they do not have competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Zooprophylaxis is one of the possible environmental vector control strategies for malaria prevention. However, its effect on reducing malaria transmission has been questionable, requiring a detailed understanding of contextual factors. This study aims to evaluate the effect of keeping livestock on malaria incidence in south-central Ethiopia. A cohort of 34,548 people in a total of 6,071 households was followed for 121 weeks from October 2014 to January 2017. Baseline data were collected, including livestock ownership. Weekly home visits were done to actively search for malaria cases, and passive case detection was also carried out. Malaria was diagnosed with rapid diagnostic tests. Log binomial and parametric regression survival-time models were used to estimate effect measures. A total of 27,471 residents had complete follow-ups, and the majority (87.5%) lived in households owning livestock, including cattle, sheep, goats, and chickens. The overall incidence risk of malaria was 3.7%, and there was a 24% reduction in the risk of malaria among livestock owners. The total cohort contributed to 71,861.62 person-years of observation. The incidence rate of malaria was 14.7 cases per 1,000 person-years. There was a 17% reduction in the rate of malaria among livestock owners. Meanwhile, the protective effect of livestock ownership increased as the number of livestock or the livestock-to-human ratio increased. In conclusion, livestock owners had less malaria. In a setup where domestication of livestock is a common practice and the predominant malaria vector tends to feed more on livestock than humans, zooprophylaxis remains a promising strategy for malaria prevention.

Purpose: To identify the dietary patterns and their association with cardiovascular risk factors among adult people in urban and rural areas of Wolaita, southern Ethiopia., Methods: A total of 2,483 participants aged 25-64 years were selected using a three-stage random sampling. Data for this study were collected using structured questionnaires, the previous 24-h dietary intake assessment, anthropometric, blood pressure, and biochemical measurements. We used factor analysis to identify dietary patterns. Factors associated with dietary patterns were analyzed using multiple linear regression models. The adjusted regression coefficients with their 95% CI were used to ascertain the association., Result: We identified three major dietary patterns that explained 51% of the variance in food consumption. The western dietary pattern was characterized by the consumption of meat/organ meat, biscuits/sweets, chicken stew, pasta-macaroni recipes, butter, white wheat bread, egg recipe, and Ethiopian dish shiro-wet , and was positively associated with urban residence, obesity, hypertension, blood glucose, and total cholesterol levels. Adherence to the consumption of tubers, whole-grain maize products, coffee leaves-and-herbs beverage, legumes, and sweet potatoes featured the traditional dietary pattern . The traditional dietary pattern showed a positive relationship with rural residence, physical activity, and obesity, and it had a negative relationship with hypertension. The healthy dietary pattern was characterized by the intake of green leafy vegetables, green pepper, and whole-grain maize products, and negatively related to obesity, and hypertension, while positively related to urban residence., Conclusion: The coexistence of western, traditional, and healthy dietary patterns in the present study indicates the transition to a new dietary pattern in the study area. All dietary patterns were associated with one or more cardiovascular risk factors, but the western dietary pattern was associated with most of these, while the traditional diet showed fewer such associations. Therefore, it might be useful to promote healthy and traditional dietary patterns along with physical activity. Interventions related to the current findings, if initiated early in life, may benefit the public in preventing cardiovascular risk factors such as obesity, hypertension, and type 2-diabetes., 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 Kumma and Loha.)

Pneumonia is a major killer of children younger than five years old. In resource constrained health facilities, the capacity to diagnose severe pneumonia is low. Therefore, it is important to identify technologies that improve the diagnosis of severe pneumonia at the lowest incremental cost. The objective of this study was to conduct a health economic evaluation of standard integrated management of childhood illnesses (IMCI) guideline alone and combined use of standard IMCI guideline and pulse oximetry in diagnosing childhood pneumonia. This is a cluster-randomized controlled trial conducted in health centres in southern Ethiopia. Two methods of diagnosing pneumonia in children younger than five years old at 24 health centres are analysed. In the intervention arm, combined use of the pulse oximetry and standard IMCI guideline was used. In the control arm, the standard IMCI guideline alone was used. The primary outcome was cases of diagnosed severe pneumonia. Provider and patient costs were collected. A probabilistic decision tree was used in analysis of primary trial data to get incremental cost per case of diagnosed severe pneumonia. The proportion of children diagnosed with severe pneumonia was 148/928 (16.0%) in the intervention arm and 34/876 (4.0%) in the control arm. The average cost per diagnosed severe pneumonia case was USD 25.74 for combined use of pulse oximetry and standard IMCI guideline and USD 17.98 for standard IMCI guideline alone. The incremental cost of combined use of IMCI and pulse oximetry was USD 29 per extra diagnosed severe pneumonia case compared to standard IMCI guideline alone. Adding pulse oximetry to the diagnostic toolkit in the standard IMCI guideline could detect and treat one more child with severe pneumonia for an additional investment of USD 29. Better diagnostic tools for lower respiratory infections are important in resource-constrained settings, especially now during the COVID-19 pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Tesfaye 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: Large-scale deworming programs have been successful in reducing the burden of disease due to soil-transmitted helminth (STH; Ascaris lumbricloides, Trichuris trichiura and hookworm) infections, but re-infection in absence of other measures is unavoidable. We assessed the role of nail contamination as a source of infection with the goal to evaluate the potential of nail clipping as a simple measure to further reduce STH-attributable morbidity., Methods: A cross-sectional study was conducted in Jimma Town (Ethiopia). Both stool samples and clipped nails were collected from 600 schoolchildren and microscopically screened for the presence of STHs. We also interviewed the children to gain insights into their hygiene practices. Subsequently, we explored any associations between infection, nail contamination and personal hygiene., Results: Any STH infections were observed in 24.3% of the children (A. lumbricoides: 18.5%; T. trichiura: 9.8%; hookworm: 0.5%). The intensity of the infections was mainly low, only in a few cases a moderate-to-heavy intensity infection was observed (A. lumbricoides: 4.3%; T. trichiura: 0.2%). Other helminth species observed were Schistosoma mansoni (5.0%), Hymenolepis nana (2.7%), Taenia spp. and Enterobius vermicularis (<1.0%). The analysis of the nail material revealed the presence of A. lumbricoides (1.7%), Taenia spp. (1.0%), T. trichiura (0.5%), E. vermicularis (0.5%) and H. nana (0.2%). The odds of infection with any STH increased as the frequency of trimming decreased. The odds of nail contamination with any STH and A. lumbricoides were higher for younger children., Conclusions: The presence of helminth eggs under the nails of children highlights a poor personal hygiene. The association between any STH infection and frequency of nail trimming needs to be explored in an intervention study. The recent prevalence of any STH infections indicated that scaling down of the frequency of deworming is justified but that STH is still a public health problem., Competing Interests: The authors have declared that no competing interests exist.

Objective: To assess the prevalence, magnitude and factors associated with the number of major modifiable cardiovascular disease (CVD) risk factors., Design: Community-based cross-sectional study., Setting: General population in urban and rural Wolaita, southern Ethiopia., Participants: A total of 2483 adults aged 25-64 years were selected using the three-stage random sampling., Outcome Measures: Prevalence of major modifiable CVD risk factors, co-occurrences and the number of modifiable CVD risk factors., Results: The major modifiable CVD risk factors documented in the Wolaita area were smoking with a weighted prevalence of 0.8%, hypercholesterolaemia 5.0%, hypertriglyceridaemia 15.5%, low high-density lipoprotein cholesterol (HDL-C) 31.3%, high systolic blood pressure 22.2%, high diastolic blood pressure 22.4%, physical inactivity 44.1%, obesity 2.8% and hyperglycaemia 3.7%. The numbers of participants having ≥1, ≥2 and ≥3 major modifiable CVD risk factors in the study area were 2013, 1201 and 576 with a weighted prevalence of 75.8%, 42.3% and 19.4%, respectively. In general, there were 28 different combinations of major modifiable CVD risk factor co-occurrences. The combination of physical inactivity with low HDL-C was found in 19.7% of the study participants, followed by physical inactivity with hypertension of 17.8%. Urban residence, male gender, sugar-sweetened food consumption and older age had a positive association with the number of major modifiable CVD risk factors, while being a farmer had a negative association., Conclusions: The prevalence and magnitude of major modifiable CVD risk factors in the study area were high. The components of the most prevalent combinations of major modifiable CVD risk factors should be targeted. Therefore, public health measures against major modifiable CVD risk factors such as promotion of physical exercise and reduction of sugar-sweetened food consumption have to be taken, targeting the vulnerable groups such as urban residents and older age., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: It remains largely unknown where and how infections with soil-transmitted helminths (STHs; Ascaris, Trichuris, Necator and Ancylostoma) occur. We therefore aimed to identify possible sources of infection by assessing the environmental contamination in an STH-endemic area., Methods: We first performed a series of laboratory experiments designed to optimize a soil straining-flotation method to detect and quantify Ascaris and Trichuris eggs in soil, and to validate the diagnostic performance of the optimized method when followed by microscopy and qPCR. In a second phase, we applied this method to assess the level of STH contamination in 399 environmental samples collected from 10 school compounds, 50 households and 9 open markets in Jimma Town (Ethiopia). Subsequently, we explored associations between the environmental contamination and both the corresponding STH epidemiology at the level of the schools and the household characteristics. Finally, we assessed the knowledge, attitude and practice (KAP) towards STHs in school children., Principal Findings: Our soil straining-flotation method has an analytical sensitivity of 50 eggs per 100 grams of soil and egg recovery rate of 36.0% (Ascaris) and 8.0% (Trichuris). The analysis of field samples with both microscopy and qPCR revealed the presence of 8 different helminth species of medical importance, including but not limited to the human STHs. There was a significant association between the environmental contamination and prevalence of any STH infections at the school level only. The KAP indicated a lack of knowledge and awareness of STHs., Conclusions/significance: Our optimized straining-flotation method has a moderate diagnostic performance and revealed that life stages of helminths are ubiquitous in the environment, which might be due to the poor sanitary facilities at both the schools and the households, and a poor level of KAP towards STHs. Further research is required to gain more insights into the contribution of these life stages to transmission., Competing Interests: The authors have declared that no competing interests exist.

Understanding the financial context of the lives of female sex workers (FSWs) is essential to address structural drivers of HIV risk. We used a financial diary methodology to record daily financial transactions over six weeks from a stratified purposive sample ( n  = 34) of FSWs in Addis Ababa, Ethiopia. FSWs also provided information on their experience with gender-based violence and condom use. FSWs generated 90.1% of total cash from sex work, with a median weekly income of USD 60.53. They engaged mostly in protected vaginal sex, earning approximately USD 4.57 per act. Food, housing, and clothing represented the largest areas of expenditure. Around 17% of expenses were recorded as costs of sex work (e.g., alcohol). Median weekly expenditures accounted for 62% of median weekly income. Nearly all participants reported depositing money into savings at least once over six weeks, while 71% reported a loan transaction during the six-week period, most as borrowers. Findings suggest that financial literacy and formalized savings activities, with life skills and empowerment training, have potential to build FSW's economic resilience, mitigating a structural driver of sex work and HIV risk.

Introduction: Congenital cytomegalovirus (cCMV) is a common cause of neurodevelopmental delays and sensorineural hearing loss of infants, yet the prevalence of cCMV and the associated factors in Ethiopia are not studied. Hence, this study was to assess the prevalence and associated factors of cCMV in Southern Ethiopia. Methodology . A mother-newborn pair cross-sectional study was conducted at Hawassa University Comprehensive and Specialized Hospital, Ethiopia. Newborn's saliva sample was tested for cCMV using Alethia CMV molecular assay. Mothers' serum was tested serologically for anti-CMV IgM and IgG by EUROIMMUN ELISA. Pregnant women responded to a questionnaire about their previous and current obstetric history and sociodemographic characteristics. The chi-square ( χ 2 ) test and independent-sample t -test were used to determine the associations between infections and possible risk factors; then, potential variables were screened for multivariable analysis., Results: A total of 593 mother-newborn pairs were assessed. CMV was detected in 14 of 593 newborn saliva swabs (2.4%; 95% CI 1.2-3.7). As assessed by CMV IgM-positive results, maternal CMV seropositivity was 8.3% (49/593); thus, the rate of mother-to-child transmission of CMV was 28% (14/49) among CMV IgM-positive women. Congenital CMV infection was significantly associated with maternal exposure through nursery school children in the household, women sharing a feeding cup with children, and any of the detected curable STIs during pregnancy. Birth weight was negatively associated with CMV infection. Maternal age, gravidity, level of education, and sharing of children feeding utensils were not associated with cCMV infection., Conclusion: A high rate of cCMV infection in the absence of awareness demands further in-depth investigation in Ethiopia. Thus, policymakers must take appropriate action through the antenatal care system for prevention strategies and put in place a constant health education and awareness creation of pregnant women about the causes of infection and hygienic measures., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Mengistu Hailemariam Zenebe et al.)

Introduction: Hypertension is a global public health challenge. There is a lack of evidence on the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia., Aim: To assess the prevalence of hypertension, prehypertension, and related factors among adult populations of Wolaita, southern Ethiopia., Methods: A community-based cross-sectional study was conducted on 2483 adult residents, selected using a two-stage random sampling technique. The quantitative data collected from structured questionnaires; anthropometric and biochemical measurements were entered into EpiData version 3.1 using double-entry systems. We determined the weighted prevalence of hypertension and pre-hypertension for the two-stage survey. The multivariate logistic regression analysis was used to assess factors associated with hypertension and carried out after declaring the data set as survey data to account for the effect of clustering. An adjusted coefficient with 95% CI was used to ascertain the significance of the association., Results: The weighted prevalence of hypertension and prehypertension in the Wolaita area was 31.3% (27.7%-35.1%) and 46.4% (42.9%-50.0%) respectively. The weighted prevalence of hypertension of those who were not aware of their hypertension until the time of the survey was 29.8%% (26.5%-33.3%). Where the weighted prevalence of self-reported cases of hypertension was 2.2% (1.2%-3.8%). Obesity, sugar-sweetened food consumption, male sex, elevated total cholesterol, raised fasting blood sugar, and advancing age were positively associated with hypertension., Conclusion: The prevalence of hypertension among adults in Wolaita was high. A small proportion of the affected people are aware of their high blood pressure. This study reported a high prevalence of pre-hypertension; which indicates a high percentage of people at risk of hypertension. It is essential to develop periodic screening programs, and primary intervention strategies such as the prevention of obesity, and reduction of sugar-sweetened food consumption., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The aim of this study was to assess the seroprevalence and associated factors of cytomegalovirus (CMV) among pregnant women in Southern Ethiopia., Design: Cross-sectional study., Setting: The study was conducted in Hawassa University comprehensive and specialised hospital. Hawassa, Southern Ethiopia., Participants: A total of 600 consecutive pregnant women attending the delivery ward were recruited for the study from August to October 2020., Outcome Measures: The study assessed the rate of maternal anti-CMV IgG and IgM antibodies. The association of obstetric history, sociodemographic and behavioural characteristics with seropositivity of CMV was also evaluated based on the collected data using structured questioners., Results: Seropositivity for CMV IgM antibodies was 8.2% (49/600) (95% CI 6% to 10.5%), whereas the CMV IgG was 88.7% (532/600), (95% CI 89.5% to 94.0%). Seroprevalence of CMV IgM was higher in women of older age, currently unmarried, having nursery schooled children and with any of the detected curable sexually transmitted infections, while seroprevalence of CMV IgG was significantly associated only with women having nursery schooled children. Seroprevalence was not significantly associated with previous adverse pregnancy outcome, gravidity, being a child daycare occupant mother and newborn birth weight., Conclusion: In the present study, we identified a high rate of CMV IgM and CMV IgG seroprevalence among pregnant women in Southern Ethiopia. Given that there is no existing CMV diagnosis, special attention should be designed to pregnant women in parallel to the existing antenatal care facility. Besides, training healthcare professionals will support awareness conception among pregnant women concerning the sequels of CMV infection during pregnancy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms' resolution and explore its predictors among symptomatic COVID-19 patients in Ethiopia., Methods: A hospital-based prospective cohort study involving 124 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from 18 March to 20 August 2020. Physicians at the centre recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P  < 0.05., Results: A total of 124 symptomatic COVID-19 patients with a mean age of 42 years (±17) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of sixty-eight days. Sex and body mass index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females ( P  = 0.039; CI: 0.22-0.96) and the hazard of delayed sign or symptom resolution in those with BMI ≥ 25 kg/m 2 was 35% higher than in those with BMI < 25 kg/m 2 ( P  = 0.041; CI: 0.44-0.98])., Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male and/or having a BMI ≥ 25 kg/m 2 were predictors of a delayed sign or symptom resolution time. Therefore, it is important to consider proportion of males and those with BMI ≥ 25 kg/m 2 when preparing isolation and treatment centres. Males and individuals with BMI ≥ 25 kg/m 2 shall also be given priority when shielding from the COVID-19., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Lifestyle Medicine published by John Wiley & Sons Ltd.)

Background: Globally, understanding spatial analysis of malnutrition is increasingly recognized. However, our knowledge on spatial clustering of malnutrition after controlling for known risk factors of malnutrition such as wealth status, food insecurity, altitude and maternal characteristics is limited from Ethiopia. Previous studies from southern Ethiopia have shown seasonal patterns of malnutrition, yet they did not evaluate spatial clustering of malnutrition., Objective: The aim of this study was to assess whether child stunting and maternal malnutrition were spatially clustered in drought-prone areas after controlling for previously known risk factors of malnutrition., Methods: We used a community-based cohort study design for a one-year study period. We used SaTScan software to identify high rates of child stunting and maternal malnutrition clustering. The outcome based was the presence or absence of stunting and maternal malnutrition ([BMI] <18.5 kg/m 2 ). We controlled for previously known predictors of child stunting and maternal malnutrition to evaluate the presence of clustering. We did a logistic regression model with declaring data to be time-series using Stata version 15 for further evaluation of the predictors of spatial clustering., Results: The crude analysis of SaTScan showed that there were areas (clusters) with a higher risk of stunting and maternal malnutrition than in the underlying at risk populations. Stunted children within an identified spatial cluster were more likely to be from poor households, had younger and illiterate mothers, and often the mothers were farmers and housewives. Children identified within the most likely clusters were 1.6 times more at risk of stunting in the unadjusted analysis. Similarly, mothers within the clusters were 2.4 times more at risk of malnutrition in the unadjusted analysis. However, after adjusting for known risk factors such as wealth status, household food insecurity, altitude, maternal age, maternal education, and maternal occupation with SaTScan analysis, we show that child stunting and maternal malnutrition were not spatially clustered., Conclusion: The observed spatial clustering of child stunting and maternal malnutrition before controlling for known risk factors for child stunting and maternal malnutrition could be due to non-random distribution of risk factors such as poverty and maternal characteristics. Moreover, our results indicated the need for geographically targeted nutritional interventions in a drought-prone area., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2021 The Author(s).)

Background: Iron-deficiency anemia (IDA) is a common type of nutritional anemia in low-income countries, including Ethiopia. However, there is limited data on iron deficiency anemia prevalence and associated factors in Ethiopia, particularly for children aged 2 to 5 years., Objectives: To establish the prevalence of iron deficiency anemia and associated risk factors, focusing on iron-rich food consumption among children aged 2 to 5 years in southern Ethiopia., Methods: A community-based cross-sectional study was conducted in southern Ethiopia in 2017, involving 331 randomly selected children aged 2 to 5 years old. A structured questionnaire was used to collect information about the children and the households. Venous blood was collected from each child in a test tube to measure hemoglobin, ferritin, and C-reactive protein (CRP). Hemoglobin levels were determined using Hemocue ® 301 and adjusted for altitude. Anemia was defined as hemoglobin levels <11 g/dl. Ferritin was adjusted for inflammation based on CRP concentration and low ferritin concentration defined as adjusted ferritin concentration <12 µg/L. IDA was considered when a child had both hemoglobin level <11g/dl and low ferritin concentration. Bi-variable and multivariable logistic regression models were performed to identify factors associated with IDA and iron-rich food consumption., Results: The prevalence of iron deficiency anemia was 25%, and the total anemia prevalence was 32%. Only 15% of children consumed iron-rich foods in the preceding 24 h, and 30% of children consumed iron-rich foods at least once in the preceding week. IDA decreased as the height for age z-score increased (Adjusted Odds Ratio 0.7; 95% CI [0.5-0.9]). Mothers with increased educational level (AOR 1.1; 1.0-1.2) and households with increased dietary diversity (AOR 1.4; 1.2-1.6) consumed more iron-rich foods., Conclusions: Iron deficiency anaemia was a moderate public health problem in southern Ethiopia, and the iron-rich food consumption was low. Interventions should focus on food supplementation and fortification, food diversification and nutritional education, and promoting women's education., Competing Interests: The authors declare that they have no competing interests., (© 2021 Orsango et al.)

Background: In Ethiopia, 38% of children less than 5 years of age are stunted and 57% are anaemic. Both have a negative impact later in life on physical growth and cognitive development and often coexist. There are few studies in Ethiopia that assessed co-morbid anaemia and stunting (CAS) and context-specific factors associated with it., Objective: The objective of this study was to assess the prevalence of CAS, and factors associated with CAS among children aged 2 to 5 years, in southern Ethiopia., Methods: A community-based cross-sectional survey was conducted among 331 randomly selected children in 2017. Mothers were interviewed using a structured questionnaire to obtain child and household information. Anthropometric measurements and blood samples for haemoglobin were collected. Stunting was defined as height-for-age Z-scores (HAZ) less than -2 SDs and anaemia was defined as altitude-adjusted haemoglobin levels less than 11.0 g/dL. CAS was defined when a child was both stunted and anaemic. Crude and adjusted multinomial logistic regression analyses were used to identify factors associated with CAS., Results: Out of 331 children studied, 17.8% (95% CI 13.87% to 22.4%) had CAS. Factors found significantly linked with higher odds of CAS were increased child age (adjusted OR (AOR) 1.0 (1.0 to 1.1)) and no iron supplementation during the last pregnancy (AOR (95% CI) 2.9 (1.3 to 6.2)). One factor found significantly linked to lower odds of CAS was food secured households (AOR (95% CI) 0.3 (0.1 to 0.9))., Conclusions: Co-morbid anaemia and stunting among children in the study area is of concern; it is associated with household food security, iron supplementation during pregnancy and child age. Therefore, comprehensive interventions focusing on improving household food security and promoting iron supplementation for pregnant women are suggested., Competing Interests: Authors declared that there is no computing interest.: Authors declared that there is no computing interest., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Curable sexually transmitted infections (STIs) such as infection with Chlamydia trachomatis (C. trachomatis), Neisseria gonorrhoeae (N. gonorrhoeae), and Trichomonas vaginalis (T. vaginalis) can lead to adverse pregnancy and birth outcome. There are limited data on the prevalence and correlate of STI in Ethiopia, yet pregnant women are not screened for curable STI. Hence in this study, the prevalence of STIs and associated risk factors were assessed., Methodology: A cross- sectional study was conducted on consecutive women attending the delivery ward at the Hawassa comprehensive and specialized hospital. Vaginal swabs collected at the time of labor and delivery were tested for C. trachomatis, N. gonorrhoeae and T. vaginalis using GeneXpert. Study participants responded to a questionnaire about their previous and current obstetric history and socio-demographic characteristics. Possible independent factors for curable STIs were assessed by chi-square, bivariable, and multivariable, logistic regression., Results: Of the 350 vaginal swabs tested, 51 (14.6%, 95% CI: 10.9-18.3) were positive for one or more curable STIs. The prevalence of C. trachomatis, N. gonorrhoeae and T. vaginalis were 8.3%, 4.3%, and 3.1%, respectively. STIs was associated (p<0.005) with the delivery outcomes birth weight and gestational age. A 3-fold increase in odds of acquisition STIs was found in currently unmarried women (AOR, 3.5; 95% CI: 1.1-10.4; p = 0.028), in women <25 years (AOR, 2.7; 95% CI 1.1-6.6; p = 0.031). Women reporting presence of vaginal discharge (AOR, 7.7; 95% CI: 3.2-18.6; p < 0.001) and reporting pain during urination (AOR, 6.5; 95% CI: 2.6-16.2; p <0.001) found to associate with curable STIs., Conclusion: The higher magnitude of STIs found in this population, and the absence of symptoms in many illustrate the need for systematic follow-up during routine antenatal care primarily history taking and asking for signs and symptoms to provide early management and avoid long term sequelae., Competing Interests: the Authors has no conflict of interests.

Introduction: road traffic injuries represent accounts for significant cause of morbidity and mortality around the globe, particularly in developing countries like Ethiopia. Poor pre-hospital care system and delays in hospitals before getting aids added to the woes of mortality. However, there are no study that determine the types of injury, management and outcome of road traffic accidents and associated factors in this study area., Methods: a hospital based retrospective cross sectional study was conducted among patients attending to Adama Hospital Medical College with accidental injuries from January to December 2015. Data were retrieved from 556 patients registry selected by systematic random sampling from 11,120 injuries visiting the hospital. Data were coded, cleaned and entered to SPSS version 20 for analysis. Factors associated with the management outcome of injury related to road traffic accident were analyzed and statistical significance was declared with p < 0.05 with CI of 95%., Results: out of 556 trauma victims, 304 (54.7%) were due to road traffic accidents followed by personal violence (24%) and falling accident (10.3%). The majorities (74.8%) of patients were male and urban residents (55%). Soft tissue injury was the most frequent type of injury (51%) followed by extremity fracture and dislocation (26%). Delay to come to hospital (over 24 hours), severity of injuries and management types were factors influencing management outcome of injuries related to traffic accidents. About 90.1%, 4.6% and 5.3% of the patients were discharged without any prominent disability, permanent disability and died respectively., Conclusion: road traffic accidents are preventable causes of morbidity and mortality. Practices of strict road safety measures and appropriate use of roadways by pedestrians should be in place, while establishing and strengthening early access to hospital and pre-hospital care to save life of injuries., Competing Interests: The authors declare no competing interests., (Copyright: Eskindir Deresse et al.)

The persistence and pervasiveness of growth stunting in low- and middle-income countries spur reexamination of disease transmission pathways related to water, sanitation, and hygiene. Animal feces constitute a more important reservoir of enteric pathogens in homes in low-income countries than previously recognized, and exploratory object mouthing and direct ingestion of soil and animal feces represent underexplored exposure pathways. The effectiveness, adoption, constraints, and scale-up potential of measures for reducing infant and young children's exposure to fecal pathogens are recently beginning to be systematically explored. This mixed methods study tested the feasibility and appeal of using playpens to establish a hygienic "safe zone" for infants in rural Ethiopia. We conducted home trials of three playpen designs, including two models made from locally available materials through user-centered design. After using playpens for several weeks, caregivers reported extensive benefits, ranging from perceived safety to developmental and hygiene benefits for infants and relief from physical stress and worry for caregivers. We observed many playpens contaminated with Escherichia coli after weeks of use, though at concentrations below those of the common room floor on which infants might otherwise have played. Caregivers reported daily playpen use, but for intervals likely insufficient to protect infants from pathogen exposure affecting growth. We determine that playpens alone cannot plausibly protect infants from environmental contamination, but our results support further exploration of the potential benefits and commercial viability of scaling up use of playpens in rural, agricultural households as part of a comprehensive approach to child development and women's empowerment.

This study was conducted to evaluate seasonal patterns of household food insecurity, dietary diversity, and household characteristics on wasting and stunting among children in households followed for 1 year in the drought-prone areas of Sidama, Ethiopia. A cohort study design was employed. Data were collected on the pre-harvest season (March and June) and post-harvest season (September and December) of 2017. We studied 935 children aged 6 to 47 months. At four seasons over a year, we had 3,449 observations from 897 households and 82% (2,816) (95% CI: 80.3-82.9) were food in-secured households. Severe food insecurity was higher in the pre-harvest (March; food scarcity season) which was 69% as compared to 50% of September ( P < .001). From 3,488 observations, 44% (1,533) (95% CI: 42.3-45.6) of children were stunted. Stunting showed seasonal variations with 38% (95% CI: 34.7-41.0) in March and 49% (95% CI: 45.8-52.5) in December. Six percent (95% CI: 5.0-6.6) of children were wasted, with higher prevalence in March (8%) as compared to 3% of September ( P < .001). Moreover, household characteristics such as poverty level, education, occupation and the household food insecurity and dietary diversity were associated with subsequent wasting and stunting.

Background: In 2009, the Government of Ethiopia initiated the implant scale-up initiative, which expanded contraceptive access by training health extension workers (HEWs) to insert single-rod etonogestrel contraceptive implants (Implanon) at rural health posts. Removals were provided by referrals to higher levels of the health system. However, little was known about whether women were getting their implants removed at the recommended 3-year postinsertion date or what barriers they faced to removal., Methods: Between June and July 2016, 1,860 Ethiopian women, who had a 1-rod etonogestrel implant inserted by either an HEW or another health care provider between 3 and 6 years prior, were surveyed. We describe the characteristics of the sample and use multivariable logistic regression to predict factors associated with keeping implants inserted beyond 3 years., Results: Women who had received their implants from HEWs were significantly more likely to report keeping them inserted for more than 3 years (adjusted odds ratio=2.50; 95% confidence interval=1.19, 5.24), compared with those who got their implant from another health care provider. Women who reported distance to the facility or transportation as a barrier were also significantly more likely to keep their implant for more than 3 years. Married and educated women were less likely to keep their implants for an extended duration. Among women who had their implant for 3 years or less, women who had had it inserted by an HEW were significantly more likely to report that the provider was unable or refused to provide removal as a barrier., Discussion: Efforts to expand lower level and community-based access to contraceptive implants that do not ensure reliable access to removals at the same level as insertions may lead to women using implants beyond the recommended duration., (© Costenbader et al.)

Background: Few studies have evaluated iron-rich plant-based foods, such as amaranth grain, to reduce anemia and iron deficiency anemia. Amaranth is rich in nutrients, but with high level of phytate. The objective of this trial was to evaluate the efficacy of home processed amaranth grain containing bread in the treatment of anemia, hemoglobin concentration and iron deficiency anemia among two-to-five year-old children in Southern Ethiopia., Method: Children with anemia (hemoglobin concentration <110.0g/L) (N = 100) were identified by random sampling and enrolled in a 1:1 cluster randomized controlled trial for six months in 2017. The amaranth group (N = 50), received 150g bread containing 70% amaranth and 30% chickpea, the amaranth grain was processed at home (soaking, germinating, and fermenting) to decrease the phytate level. The maize group (N = 50), received 150g bread, containing processed maize (roasted and fermented) to give a similar color and structure with amaranth bread. Hemoglobin, ferritin, and CRP were measured at baseline and at the end of intervention. Hemoglobin and ferritin values were adjusted for altitude and infection, respectively. Generalized estimating equation and generalized linear model were used to analyze the data., Result: In the last follow-up measure anemia prevalence was significantly lower in the amaranth group (32%) as compared with the maize group (56%) [adjusted risk ratios, aRR: 0.39 (95%CI: 0.16-0.77)]. Hemoglobin concentration estimate of beta coefficient was significantly higher in the amaranth group compared with the maize group [aβ 8.9g/L (95%CI: 3.5-14.3)], p-value <0.01. The risk of iron deficiency anemia is significantly lower in the amaranth group [aRR: 0.44 (95%CI: 0.23-0.83)] in the intention to treat analysis but not significant in the complete case analysis. There was no significant difference between groups in iron deficiency [aRR: 0.81 (95%CI: 0.55-1.19)]., Conclusion: Processed amaranth bread had favorable effects on hemoglobin concentration and has the potential to minimize anemia prevalence., Clinical Trial Registration: Trial registry number: PACTR201705002283263 https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=2283., Competing Interests: The authors have declared that no competing interests exist.

Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson's total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level., Competing Interests: The authors have declared that no competing interests exist.

Objective: To assess the magnitude of premenstrual dysphoric disorder (PMDD) and associated factors among female students of the College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia, 2019., Design: Institution-based cross-sectional study design., Setting: College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia., Participants: 386 participants were recruited for self-administered interview using the stratified followed by simple random sampling technique., Measurement: Data were collected by self-administered interview. Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PMDD. The Perceived Stress Scale (PSS) and the Oslo-3 social support are used to assess the factors. The data were checked, cleaned and entered into EpiData V.3.1 and exported to Statistical Package for Social Science (SPSS) V.21.0 for analysis. Bivariate and multivariable binary logistic regressions were used. OR with 95% CI was employed to see the strength of associations between dependent and independent variables. Variables with a p value <0.05 in multivariable logistic regression were declared as significantly associated., Result: 386 participants were involved in the study, with a response rate of 84.6%. The overall magnitude of PMDD in this study was 34.7% (30.3 to 39.1). Severe menstrual pain (adjusted OR (AOR)=2.82, 95% CI: 1.83 to 4.23), perception of an impact on academic performance due to menstrual pain (AOR=2.31, 95% CI: 1.23 to 4.32), and high perceived stress (AOR=3.52, 95% CI: 2.58 to 5.60) were significantly associated with PMDD disorder among female medical and health sciences students., Conclusion: PMDD is high among female medical and health sciences students. Thus, it needs early screening and intervention especially for those who have severe menstrual pain, perceived to have an impact on academic performance and high perceived stress., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To assess whether pulse oximetry improves health workers' performance in diagnosing severe childhood pneumonia at health centres in Southern Ethiopia., Design: Parallel cluster-randomised trial., Setting: Government primary health centres., Participants: Twenty-four health centres that treat at least one pneumonia case per day in Southern Ethiopia. Children aged between 2 months and 59 months who present at health facilities with cough or difficulty breathing were recruited in the study from September 2018 to April 2019., Intervention Arm: Use of the Integrated Management of Childhood Illness (IMCI) algorithm and pulse oximeter., Control Arm: Use of the IMCI algorithm only., Primary and Secondary Outcome Measures: The primary outcome was the proportion of children diagnosed with severe pneumonia. Secondary outcomes included referred cases of severe pneumonia and treatment failure on day 14 after enrolment., Result: Twenty-four health centres were randomised into intervention (928 children) and control arms (876 children). The proportion of children with severe pneumonia was 15.9% (148 of 928 children) in the intervention arm and 3.9% (34 of 876 children) in the control arm. After adjusting for differences in baseline variables children in the intervention arm were more likely to be diagnosed as severe pneumonia cases as compared with those in the control arm (adjusted OR: 5.4, 95% CI 2.0 to 14.3, p=0.001)., Conclusion: The combined use of IMCI and pulse oximetry in health centres increased the number of diagnosed severe childhood pneumonia., Trial Registration Number: PACTR201807164196402., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Ethiopian households' out-of-pocket healthcare payments constitute one-third of the national healthcare budget and are higher than the global and low-income countries average, and even the global target. Such out-of-pocket payments pose severe financial risks, can be catastrophic, impoverishing, and one of the causal barriers for low utilisation of healthcare services in Ethiopia. This study aimed to assess the financial risk of seeking maternal and neonatal healthcare in southern Ethiopia., Methods: A population-based cohort study was conducted among 794 pregnant women, 784 postpartum women, and their 772 neonates from 794 households in rural kebeles of the Wonago district, southern Ethiopia. The financial risk was estimated using the incidence of catastrophic healthcare expenditure, impoverishment, and depth of poverty. Annual catastrophic healthcare expenditure was determined if out-of-pocket payments exceeding 10% of total household or 40% of non-food expenditure. Impoverishment was analysed based on total household expenditure and the international poverty line of ≈ $1.9 per capita per day., Results: Approximately 93% (735) of pregnant women, 31% (244) of postpartum women, and 48% (369) of their neonates experienced illness. However, only 56 households utilised healthcare services. The median total household expenditure was $527 per year (IQR = 390: 370,760). The median out-of-pocket healthcare payment was $46 per year (IQR = 46: 46, 92) with two episodes per household, and shared 19% of the household's budget. The poorer households paid more than did the richer for healthcare, during pregnancy-related and neonatal illness. However, the richer paid more than did the poorer during postpartum illness. Forty-six percent of households faced catastrophic healthcare expenditure at the threshold of 10% of total household expenditure, or 74% at a 40% non-food expenditure, and associated with neonatal illness (aRR: 2.56, 95%CI: 1.02, 6.44). Moreover, 92% of households were pushed further into extreme poverty and the poverty gap among households was 45 Ethiopian Birr per day. The average household size among study households was 4.7 persons per household., Conclusions: This study demonstrated that health inequity in the household's budget share of total OOP healthcare payments in southern Ethiopia was high. Besides, utilisation of maternal and neonatal healthcare services is very low and seeking such healthcare poses a substantial financial risk during illness among rural households. Therefore, the issue of health inequity should be considered when setting priorities to address the lack of fairness in maternal and neonatal health.

Although maternal survival has improved in the last decades, evidence on illnesses and the use of health services during pregnancy remains scarce. Therefore, we aimed to assess the incidence and risk factors for illnesses among pregnant women and measure the use of health services. A prospective cohort study was conducted in three kebeles in rural southern Ethiopia among 794 pregnant women from May 2017 to July 2018. Each woman was followed every two weeks at home. Poisson and survival regression models were used for analysis. The incidence rate of episodes of illnesses was 93 per 100 pregnant-woman-weeks (95%CI: 90.6, 94.2), with an average of eight episodes of illnesses per woman. Anaemia accounted for 22% (177 of 794 women), and hypertension 3% (21 women of 794 women). However, utilization of health services for any illness episodes was only 8% (95%CI: 7.6%, 8.9%). The main reasons for not using health services were that the women thought the illness would heal by itself, women thought the illness was not serious, women could not afford to visit the health institutions, or women lacked confidence in the health institutions. The risk factors for illnesses are having many previous pregnancies in life time (ARR = 1.42; 95%CI = 1.02, 1.96), having history of stillbirth (ARR = 1.30; 95%CI = 1.03, 1.64), having history of abortion (AHR = 1.06; 95%CI = 1.02, 1.11), and walking more than 60 minutes to access the nearest hospital (AHR = 1.08; 95%CI = 1.03, 1.14). The risk factors for low use of health services are also having history of abortion (AHR = 2.50; 95%CI = 1.00, 6.01) and walking more than 60 minutes to access the nearest hospital (AHR = 1.91; 95%CI = 1.00, 3.63). Rural Ethiopian pregnant women experience a high burden of illness during pregnancy. Unfortunately, very few of these women utilize health services., Competing Interests: The authors have declared that no competing interests exist.

Background: Seasonality poses a considerable food security challenge in Ethiopia. Yet, measuring seasonal variations in food insecurity, particularly the dimension of food access, lacks an adequately validated tool. We therefore evaluated the performance of an adapted Household Food Insecurity Access Scale (HFIAS) to estimate seasonal variations in food insecurity (FI) among subsistence villagers in Ethiopia., Methods: We employed a cohort study design using a panel of four repeated measurements taken in June, September, and December in the year 2017, and in March 2018. The study recruited 473 villagers from the drought-affected Wolaita area in southwest Ethiopia. The performance of the HFIAS was evaluated via internal consistency (Chronbach's alpha values) and criterion validation techniques. The set of criteria include: parallelism between affirmative responses to FI questions and wealth strata; dose-response relationship between FI and dietary intake; and also FI severity and household wealth status., Results: This study revealed that the HFIAS had satisfactory performance in four repeated measurements. The likelihood of affirmative responses to questions about FI decreased with ascending wealth quintiles. We observed an inverse dose-response relationship between FI and wealth status, and between FI and household dietary diversity., Conclusions: The HFIAS showed an acceptable potential for measuring seasonal variations in FI in the study area. Our findings complement efforts to evaluate the scale's applicability in various settings, in order to promote cross-culture monitoring and comparisons. However, it required a careful adaption for contextual and cultural sensitivities., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s). 2019.)

Introduction: Understanding the spatiotemporal clustering of malaria transmission would help target interventions in settings of low malaria transmission. The aim of this study was to assess whether malaria infections were clustered in areas with long-lasting insecticidal nets (LLINs) alone, indoor residual spraying (IRS) alone, or a combination of LLINs and IRS interventions, and to determine the risk factors for the observed malaria clustering in southern-central Ethiopia., Methods: A cohort of 34,548 individuals residing in 6,071 households was followed for 121 weeks, from October 2014 to January 2017. Both active and passive case detection mechanisms were used to identify clinical malaria episodes, and there were no geographic heterogeneity in data collection methods. Using SaTScan software v 9.4.4, a discrete Poisson model was used to identify high rates of spatial, temporal, and spatiotemporal malaria clustering. A multilevel logistic regression model was fitted to identify predictors of spatial malaria clustering., Results: The overall incidence of malaria was 16.5 per 1,000 person-year observations. Spatial, temporal, and spatiotemporal clustering of malaria was detected in all types of malaria infection (P. falciparum, P. vivax, or mixed). Spatial clustering was identified in all study arms: for LLIN + IRS arm, a most likely cluster size of 169 cases in 305 households [relative risk (RR) = 4.54, P<0.001]; for LLIN alone arm a cluster size of 88 cases in 103 households (RR = 5.58, P<0.001); for IRS alone arm a cluster size of 58 cases in 50 households (RR = 7.15, P<0.001), and for control arm a cluster size of 147 cases in 377 households (RR = 2.78, P<0.001). Living 1 km closer to potential vector breeding sites increased the odds of being in spatial clusters by 41.32 fold (adjusted OR = 41.32, 95% CI = 3.79-138.89)., Conclusions: The risk of malaria infection varied significantly between kebeles, within kebeles, and even among households in areas targeted for different types of malaria control interventions in low malaria transmission setting. The results of this study can be used in planning and implementation of malaria control strategies at micro-geographic scale., Trial Registration: PACT R2014 11000 882128 (8 September 2014)., Competing Interests: The authors have declared that no competing interests exist.

Background: Prevention and control of hypertension has not been given due attention though previous studies indicated that hypertension is growing public health problem., Objective: This study aimed to determine the prevalence of hypertension and associated factors in Bona district, southern Ethiopia., Methods: A community based cross-sectional study was conducted on 1952 participants aged ≥25 years in Bona District, southern Ethiopia. Data were collected from consented participants recruited using multistage sampling technique. Data were entered, checked for quality and analyzed by SPSS for Windows version 20.0. Since the outcome variables were ordered categorical, we used multinomial logistic regression model to identify associated factors. Among the independent variables included in the model no multicolinearity was observed. The level of significance was set at P value ≤ 0.05., Results: The observed prevalence of hypertension (21.8%) was remarkable in rural setting. Out of hypertensive participants, 195 (45.9%) were newly diagnosed. About one third of the participants (31.4%) had central obesity measured by waist-to-height ratio ≥0.50. Being male, age advancement, high BMI (≥25.0 kg/m2) and central obesity (waist-to-height ratio ≥0.50) were positively associated with both systolic and diastolic hypertension. Systolic hypertension was negatively associated with high family income. The likely hood of developing diastolic hypertension increased in participants with family history of hypertension., Conclusion: The overall prevalence of hypertension, 21.8%, is alarmingly high that it can be said that hypertension is becoming a silent epidemic in Ethiopia. Nationwide survey is needed to get the clear magnitude of hypertension so that early detection and management strategies can be enforced., Competing Interests: The authors have declared that no competing interests exist.

Background: Health system support is crucial for quality child healthcare. Therefore, this baseline survey, which is part of the community-based management study of severe pneumonia, was conducted to assess the state of health system support of IMNCI and iCCM, and health workers' knowledge in managing childhood pneumonia at health facilities., Methods: A survey was conducted in 99 government health institutions in South Ethiopia from 07 to 14 January, 2018. A questionnaire for health system support and case scenario for the management of severe pneumonia was adapted from the WHO health facility survey tool. The questionnaire's interview, facility observation, case scenario and retrospective record review were all used as data collection methods. Indicators of health system support in the context of an integrated management of childhood illness were used. Proportions for categorical variables and means for continuous variables were also computed for each indicator. Mean score was analysed for assessing the knowledge of health workers in managing the case scenario., Results: In the study area, only 12 (34%) of health centres and 18 (29%) of health posts received supervision, which included the observation of case management. The mean number of essential oral antibiotics for the home treatment of pneumonia available at the facility was 1.1 (95% CI 0.9 to 1.3), whereas the mean number of pre-referral drugs for the treatment of severe pneumonia was 1.3 (95% CI 1.0 to 1.6). Approximately 47 (48%; 95% CI 37.7 to 57.3) of the surveyed health facilities had materials and equipment to support vaccination services, and 71 (72%; 95% CI 62.8 to 80.6) of them had the vaccines on the day of the survey. Only four (4%; 95% CI 0.3 to 8.3) of the health facilities had all the essential job aids and supplies for providing services for pneumonia. The providers' mean knowledge score for the management of severe childhood pneumonia was 14.9 out of 22 correct answers., Conclusion: There is a room to improve the health system support to integrated management of neonatal and childhood illness through supply chain management and knowledge of health workers in the management of severe pneumonia by providing training.

Background: Indoor residual house spraying (IRS) and long-lasting insecticidal nets (LLINs) are the key front-line malaria vector interventions against Anopheles arabiensis, the sole primary malaria vector in Ethiopia. Universal coverage of both interventions has been promoted and there is a growing demand in combinations of interventions for malaria control and elimination. This study compared the impact on entomological outcomes of combining IRS and LLINs with either intervention alone in Adami Tullu district, south-central Ethiopia. The epidemiological outcomes were recently published on a separate paper., Methods: This factorial, cluster-randomized, controlled trial randomized villages to four study arms: IRS + LLIN, IRS, LLIN, and control. LLINs (PermaNet 2.0) were provided free of charge. IRS with propoxur was applied before the main malaria transmission season in 2014, 2015 and 2016. Adult mosquitoes were collected in randomly selected villages in each arm using CDC light trap catch (LTC) set close to a sleeping person, pyrethrum spray catch (PSC), and artificial pit shelter (PIT), for measuring mosquito host-seeking density (HSD), indoor resting density (IRD), and outdoor resting density (ORD), respectively. Human landing catch (HLC) was performed in a sub-set of villages to monitor An. arabiensis human biting rates (HBR). Mean vector densities and HBR were compared among study arms using incidence rate ratio (IRR) calculated by negative binomial regression., Results: There were no significant differences in mean densities (HSD, IRD, ORD) and HBR of An. arabiensis between the IRS + LLIN arm and the IRS arm (p > 0.05). However, mean HSD, IRD, ORD, and HBR were significantly lower in the IRS + LLIN arm than in the LLIN alone arm (p < 0.05). All An. arabiensis tested for malaria infection were negative for Plasmodium species. For this reason, the entomological inoculation rate could not be determined., Conclusions: The IRS + LLIN were as effective as IRS alone in reducing densities and HBR of An. arabiensis. However, the effectiveness of the two interventions combined was higher than LLINs alone in reducing densities and HBR of the vector. Added impact of the combination intervention against malaria infectivity rates of An. arabiensis compared to either intervention alone remains unknown and warrants further research. Trial registration PACTR201411000882128. Registered 8 September 2014, https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1154-2.