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The experiences of parents raising children with developmental disabilities have been widely researched, although most of this research comes from Western, high-income countries. In comparison, little is known about the lived experiences of parents of children with developmental disabilities in low- and middle-income countries and in Africa in particular. Parents’ lived experiences can provide insights into local conceptualizations of developmental disabilities, challenges children and their families face and their needs. This study explores the experiences of parents (14 mothers and 4 fathers) raising children with developmental disabilities in urban and rural Ethiopia using in-depth interviews. Cultural and religious beliefs played a role in the types of delays or differences in their child’s development that parents noticed early and the kinds of support they sought. Parents experienced stigma and lack of understanding from others. Their experiences regarding some of the challenges they faced such as lack of appropriate services varied based on where they lived (urban or rural). Single mothers especially were faced with multiple and intersecting struggles including poverty, stigma, and lack of social support. Implications for future research and interventions that aim to increase knowledge about developmental disabilities, tackle stigma and improve the lives of children and their families are discussed. Lay abstract The experiences of parents raising children with developmental disabilities have been widely researched, although most of this research comes from Western, high-income countries. In comparison, little is known about the lived experiences of parents of children with developmental disabilities in low- and middle-income countries and in Africa in particular. We interviewed 14 mothers and 4 fathers in Addis Ababa and the rural town of Butajira to explore what life is like for parents caring for children with developmental disabilities in Ethiopia. Cultural and religious beliefs played a role in the types of delays or differences in their child’s development that parents noticed early and the kinds of support they sought. Parents experienced stigma and lack of understanding from others. Their experiences regarding some of the challenges they faced such as lack of appropriate services varied based on where they lived (urban or rural). Single mothers especially were faced with multiple struggles including poverty, stigma, and lack of social support. Implications for future research and interventions that aim to increase knowledge about developmental disabilities, tackle stigma and improve the lives of children and their families are discussed.

Although most children with autism and other neurodevelopmental disorders live in low- and middle-income countries, assessment tools are lacking in these settings. This study aims to culturally adapt and validate two questionnaires for use in Ethiopia: the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires were adapted to be suitable for administration in low-literate caregivers and translated using the backward translation procedure. The factor structure, reliability and validity were investigated using caregiver-reports on 300 children with neurodevelopmental disorders or physical health conditions. Confirmatory factor analysis of the Pediatric Quality of Life Inventory™ Family Impact Module data indicated an acceptable fit of the hypothesised eight-factor structure. Internal consistency was high for both measures. Test–retest reliability was excellent for the Autism Treatment Evaluation Checklist and moderate to excellent for the Pediatric Quality of Life Inventory™ Family Impact Module. Both questionnaires demonstrated adequate known-group validity, with moderate to very large effect size group differences between case and control groups. The questionnaires correlated moderately with each other. In conclusion, the Ethiopian adaptations of the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module are valid and reliable tools for use in parents of children with neurodevelopmental disorders including autism. These adapted measures may also be valuable for use in other low-income settings. Lay abstract Although most children with autism and other neurodevelopmental disorders live in low- and middle-income countries, reliable tools to assess these conditions are often not available in these settings. In this study, we adapted two questionnaires developed in Western high-income contexts for use in Ethiopia – the Autism Treatment Evaluation Checklist and the Pediatric Quality of Life Inventory™ Family Impact Module. Both measures are completed by a child’s caregiver and both are relatively short and easy to complete. The Autism Treatment Evaluation Checklist is used to monitor the developmental issues of the child, while the Pediatric Quality of Life Inventory™ Family Impact Module measures the impact of the child’s condition on the caregiver. We translated both tools into the Ethiopian language Amharic, and adapted them to the local cultural context. Three hundred caregivers, half of whom were parents of children with neurodevelopmental disorders, and half were parents of children with physical health problems, completed the questionnaires through a face-to face interview, so that non-literate caregivers could also take part. Both tools performed adequately, measured what we aimed to measure and were reliable. Both the Autism Treatment Evaluation Checklist and Pediatric Quality of Life Inventory™ are suitable tools to assess children with developmental and other health problems in Ethiopia and their caregivers. We believe that more similar tools should be developed or adapted for use in low-income countries like Ethiopia, to gain a better understanding of developmental problems in those settings, and allowing clinicians and service providers to use these tools in their practice. Moreover, these tools can be used in future studies to evaluate interventions to improve support for families.

Background Globally, the Tuberculosis treatment success rate was worse for HIV-positive TB patients compared with HIV- negative TB patients. This study aimed at determining the impact of HIV-AIDS and factors associated with TB treatment outcomes. Methods This study was a retrospective cohort study of five years of tuberculosis data from four public health facilities in Hosanna Town. A total of 604 study participants were included using a systematic random sampling technique. Descriptive analysis of ratios, rates, and proportions was done and binary logistic regression, bivariable and multivariable, analysis was also done. Result A total of 604 TB patients were enrolled in this study. 302 (50%) were HIV co-infected. The overall treatment success rate was 90.1% (544/604). Treatment success rates are 86.4% (261/302) for TB-HIV co-infected patients and 93.7% (283/302) for non-co-infected patients. TB-HIV co-infected patients had a higher risk of an unsuccessful treatment outcome (Adjusted Relative Risk [ARR]: 2.7; 95% Confidence Interval [CI]: 1.4 – 5.2). The risk of unsuccessful treatment outcome is also higher among rural residents (ARR: 3.3; CI: 1.4 – 5.0), patients on the re-treatment category (ARR: 2.7; CI: 1.4 – 5.1), and with chronic disease (ARR: 3.3; CI: 1.3 – 8.1). Conclusion TB treatment success rate is good as compared to the WHO minimum requirement. Successful treatment outcome is lower among patients with HIV infection, rural residents, patients on re-treatment, and patients with chronic disease. Therefore, due emphasis should be given to these high-risk groups.

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Background Major Depressive Disorder is a leading cause of disease burden for women of childbearing age. The prevalence of perinatal depression is significantly higher in women from low and middle income countries than from high income countries. Antenatal depression is associated with low birth weight and preterm delivery. There is also evidence that depression during pregnancy can alter the development of a woman's fetus and her child, with an increased risk for child emotional and behavioral problems. Detection of perinatal depression in primary health care (PHC) is very low. This research gathered evidence on the current practice of detection of pregnant women with moderate-severe depression in the Sodo district and explored potential solutions to the identified challenges. Methods A qualitative study was conducted in four health centres and a primary hospital, located in the Sodo district, Ethiopia. In-depth interviews were carried out with pregnant women diagnosed to have depression. Focus group discussions (FGDs) were conducted with antenatal care (ANC) PHC workers. A framework approach to qualitative data analysis was used. OpenCode computer software was used for data handling during the analysis. Results Nine pregnant women were interviewed in-depth and twelve ANC PHC workers participated in two FGDs. Identified themes were categorized under client, provider and system level barriers, and illness related influences. Women's reluctance to disclose symptoms and seek help and not thinking what they had was an illness and/or not thinking they would get help from ANC clinic were client-side barriers to identifying depression. ANC PHC workers not asking about depressive symptoms, their reluctance to disclose a diagnosis of depression to the affected women and not thinking women with mental health problems are in their clinics were the main provider level barriers. The setting not being conducive for depression assessment, inadequate mental health training and ANC assessment format not having a place for recording mental health assessment were system level barriers raised. Difficulty in differentiating clinical depression from normal emotional reaction emerged as the main illness related influence. ANC PHC workers proposed community awareness-raising, improving communication between women and PHC workers and making mental health assessment part of the routine ANC service, among others, as possible solutions to improve detection of antenatal depression in ANC clinics. Conclusion Multiple client, provider and system level barriers to detection of depression in pregnant women in ANC clinics were identified in the current study. The identified barriers call for interventions at different levels; awareness raising at a community level, training on communicating about emotional concerns and mental health care at a provider level and enabling the health care system to support integration of mental health care into maternal health services at a higher level. Follow-up studies are required to better understand the experiences of women and providers, to quantify the magnitude of the problem and to develop and evaluate contextually appropriate interventions to improve detection of depression in pregnant women.

Although stigma related to developmental disorders (DD) has been associated with poor mental health among caregivers, an in-depth understanding of factors that influence internalisation of stigma by caregivers is missing. The aim of our study was to explore perceptions and experiences of stigma among parents of children with DD in Ethiopia and examine the contributing and protective factors for internalised stigma based on the perspectives of the parents themselves. We conducted in-depth interviews with eighteen parents (fourteen mothers, four fathers) in Addis Ababa (between December 25, 2017 and January 8, 2018) and the rural town of Butajira (between August 08, 2018 and August 16, 2018). We analysed the data using thematic analysis. Parents perceived and experienced different forms of stigma that were directed towards their child (public stigma) and themselves (courtesy stigma). Some parents also described how they isolated themselves and their child from social life (affiliate stigma). Parents perceived the negative consequence of stigma on the lives of their child with DD, siblings and themselves. Most parents also described examples of positive reactions and support from their own family and the community. Participants’ accounts suggested supportive contributions and positive responses from the general public came primarily from those who had better awareness of DD. Not all parents in our study internalised the stigma that was directed at them. Whilst perceived family support and acceptance and increased awareness about DD appeared to help some parents not to internalise stigma, the perceived lack of social support and acceptance made some parents vulnerable to internalised stigma. These findings can inform anti-stigma intervention priorities. Awareness-raising activities targeting the community as a whole as well as interventions targeting parents themselves are likely to be beneficial. Interventions should consider the wellbeing of the whole family unit rather than focus on individuals alone., Highlights • Parents of children with developmental disorders in Ethiopia report severe stigma. • Not all parents in this qualitative study internalised the stigma directed at them. • Parents also discussed positive reactions and support from others. • Perceived family support and acceptance helped parents not to internalise stigma. • Perceived lack of social support made parents vulnerable to internalised stigma.

Background Although depression is highly prevalent among cancer patients, it is often underdiagnosed and poorly managed particularly in developing nations. These shortcomings can have substantial adverse effects not only on the disease prognosis but also on patients’ quality of life. The Patient Health Questionnaire-9 is a widely used depression screening tool but it has not been validated among patients with chronic illnesses such as cancer in Ethiopia. We aim to validate the PHQ-9 among Ethiopian cancer patients in an outpatient setting. Methods A cross-sectional study was conducted among cancer patients attending the oncology clinic at Tikur Anbessa Specialized Hospital (TASH). We assessed criterion validity and performance of the PHQ-9 test against the gold standard Mini-International Neuropsychiatric Interview (MINI) diagnostic tool among patients with cancer. The MINI was administered by psychiatric nurses who were blind to the initial PHQ-9 screening tool. Results A total of 163 patients completed the 2 stages of a diagnostic interview in the study. The majority (64%) of the participants were women, the mean age was 46 (13.5) years. Using the gold standard MINI test the prevalence of Major Depressive Episode (MDE) was 15%. The internal consistency (Cronbach’s α) for PHQ-9 was 0.78 suggesting good (acceptable) internal consistency for the reliability of the test scores. When the total PHQ-9 score was used to identify cases of MDE, the Area under the Curve (AUC) was 0.93 (95% confidence interval [CI], 0.88–0.97) on Receiver Operating Characteristic (ROC) analysis. This shows evidence for the excellent discriminating power of the PHQ-9 between cases and non-cases of MDE. At cutoff point ≥4, the PHQ-9 had a sensitivity of 88% and specificity of 78.1% on the ROC curve to detect MDE. Conclusion PHQ-9 is a reliable and valid instrument to detect MDE among individuals with chronic conditions such as cancer patients in outpatient settings and it can be used in resource-limited settings for early diagnosis and proper therapy of such patients.

The World Health Organization’s Caregiver Skills Training programme for children with developmental disorders or delays teaches caregivers strategies to help them support their child’s development. Ethiopia has a severe lack of services for children with developmental disorders or delays. This study explored the perspectives of Ethiopian caregivers, professionals and other stakeholders to inform adaptation and implementation of the World Health Organization’s Caregiver Skills Training in Ethiopia. Data collection included (1) a consultation and review, comprising stakeholder meetings, review of draft Caregiver Skills Training materials and feedback from Ethiopian Master Trainees and (2) a pre-pilot including quantitative feasibility and acceptability measures and qualitative interviews with caregivers (n = 9) and programme facilitators/observers (n = 5). The consultation participants indicated that the Caregiver Skills Training addresses an urgent need and is relevant to the Ethiopian context. Several adaptations were proposed, including more emphasis on psycho-education, stigma, parental feelings of guilt and expectations of a cure. The adapted Caregiver Skills Training was pre-piloted with excellent participation (100%) and retention (90%) rates. Four themes were developed from the qualitative data: (1) Programme acceptability and relevance, (2) Perceived programme benefits, (3) Challenges and barriers and (4) Suggestions for improvement. The World Health Organization’s Caregiver Skills Training addresses a local need and, with careful adaptations, is feasible and acceptable to be implemented in Ethiopia. These findings may have relevance to low-resource settings worldwide.

Objective: Using a social ecological framework, this study aimed to establish emerging mental health clinicians and researchers' perspectives about child and adolescent mental health (CAMH) in Africa. Method: Perspectives of 17 participants from Ethiopia, Kenya, South Africa, Tunisia, Uganda and Zambia, whose professional backgrounds ranged from psychiatry to speech-language therapy, were collected at an African CAMH conference. Data were gathered using open-ended questions, using an online survey. Data were analysed using theoretical thematic analysis. Results: An adapted social ecological framework highlighted: An increased need for commitment from governments to improve CAMH in Africa; and addressing mental health stigma and discrimination through community awareness. The need for specialised CAMH facilities were identified, particularly in the public health sector. The need for multi-sectoral, multi-disciplinary partnerships for advocacy, service delivery, and continuity of care were also identified. Participants emphasised the importance of CAMH awareness, and the role of governments in recognising CAMH needs and using policies to improve CAMH in Africa. Participants were hopeful about the transformation of CAMH on the continent. Conclusion: The participants prioritised government- and community-level awareness to increase the resources and support offered by CAMH services in Africa.

Diabetes mellitus is fourth most high mortality rate diseases in the world and it is also a cause of kidney disease, blindness, and heart diseases. Data mining techniques support a medical decision for a correct diagnosis, treatment of disease in such way it minimizes the workload of specialists. This study proposed to predict diabetes using data mining techniques. Back propagation algorithm is used to predict whether the person has diabetic or not. And also J48, naive bayes and support vector machine were used to predict diabetes. These neural networks were having an input layer with having 8 parameters, one hidden layer having 6 neurons and produce one output layer.5 fold cross-validation technique and large value learning rate was used to improve the performance of the model. PIMA Indian dataset used to conduct this study. The study implemented in RStudio using R programming language. The performance of Back propagation algorithm is used to predict diabetes diseases gave 83.11 % accuracy, 86.53% sensitivity and 76% specificity, the result shows improvement from previous work. The obtained result is also compared with J48, naive bayes and support vector machine algorithm.

Our current understanding of autism and other developmental disorders is primarily based on research conducted in high-income countries, predominantly in North America and Europe. Even within high-income countries, White participants are overrepresented in autism research. There is now increased recognition that a more global and diverse research representation is warranted. This paper argues that in order for global and diverse research efforts to be effective, it is essential to collaborate and engage with local experts and stakeholders, including local researchers, clinicians and representatives from governmental and non-governmental organisations. Such collaborations ensure that studies use culturally appropriate methods and materials, and that research findings are interpreted taking local context into account. Ultimately, these collaborations build local capacity and foster the development of culturally and contextually appropriate interventions that address locally perceived needs. The adage ‘nothing about us without us’ is vital to global autism research.

Supplemental material, AUT848532_Supplemental_material for Adapting and pre-testing the World Health Organization’s Caregiver Skills Training programme for autism and other developmental disorders in a very low-resource setting: Findings from Ethiopia by Bethlehem Tekola, Fikirte Girma, Mersha Kinfe, Rehana Abdurahman, Markos Tesfaye, Zemi Yenus, Erica Salomone, Laura Pacione, Abebaw Fekadu, Chiara Servili, Charlotte Hanlon and Rosa A Hoekstra in Autism

Supplemental material, AUT848532_Lay_Abstract for Adapting and pre-testing the World Health Organization’s Caregiver Skills Training programme for autism and other developmental disorders in a very low-resource setting: Findings from Ethiopia by Bethlehem Tekola, Fikirte Girma, Mersha Kinfe, Rehana Abdurahman, Markos Tesfaye, Zemi Yenus, Erica Salomone, Laura Pacione, Abebaw Fekadu, Chiara Servili, Charlotte Hanlon and Rosa A Hoekstra in Autism

Supplemental material, AUT848532_Lay_Abstract for Adapting and pre-testing the World Health Organization’s Caregiver Skills Training programme for autism and other developmental disorders in a very low-resource setting: Findings from Ethiopia by Bethlehem Tekola, Fikirte Girma, Mersha Kinfe, Rehana Abdurahman, Markos Tesfaye, Zemi Yenus, Erica Salomone, Laura Pacione, Abebaw Fekadu, Chiara Servili, Charlotte Hanlon and Rosa A Hoekstra in Autism

Supplemental material, AUT848532_Supplemental_material for Adapting and pre-testing the World Health Organization’s Caregiver Skills Training programme for autism and other developmental disorders in a very low-resource setting: Findings from Ethiopia by Bethlehem Tekola, Fikirte Girma, Mersha Kinfe, Rehana Abdurahman, Markos Tesfaye, Zemi Yenus, Erica Salomone, Laura Pacione, Abebaw Fekadu, Chiara Servili, Charlotte Hanlon and Rosa A Hoekstra in Autism