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Esayas Kebede Gudina,1 Zeleke Mekonnen,2 Daniel Yilma1 1Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Jimma University Institute of Health, Jimma, EthiopiaCorrespondence: Esayas Kebede Gudina, Department of Internal Medicine, Jimma University Institute of Health, P. O.Box 5058, Jimma, Ethiopia, Email esayas.gudina@ju.edu.etAbstract: The world has come a long way in the fight against the COVID-19 pandemic by averting the initially feared humanitarian crisis and by producing effective vaccines in a record time. Paradoxically, more new daily cases are being reported today than when there was not any effective vaccine around. The success against the pandemic so far is dented by inadequate vaccine supply in most low-income countries and widespread vaccine hesitancy. By the end of 2021, only half of WHO Member States have reached the target of immunizing 40% of their populations, while only less than 10% of the population in low-income countries have received at least one dose of the vaccine. This happened while more than nine billion doses of the vaccines were administered globally, predominantly in rich countries. On the backdrop of these man-made factors, the evolution of highly mutated variants of the virus is causing more uncertainties than the pre-vaccine time. If the vaccine inequities and hesitancy are not properly addressed, we are likely to enter into the vicious cycle of inequitable vaccine distribution leading to low vaccination rates in most low-income countries where the majority of the world population resides. This will ultimately enhance sustained transmission of the virus, leading to evolution of new variants of concern. As the highly mutated variants are likely to infect both vaccinated and unvaccinated individuals, it will inevitably lead to major doubts in the effectiveness and acceptance of the vaccines. In this review, we present how this vicious cycle may prolong the pandemic and discuss the importance of concerted global action to tackle it.Keywords: COVID-19, SARS-CoV-2, variants of concern, vaccine hesitancy, vaccine scepticism, vaccine inequity

Shiferaw Woyesa,1 Aklilu Mamo,1 Zeleke Mekonnen,1 Gemeda Abebe,1 Esayas Kebede Gudina,2 Tesfaye Milkesa3 1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia; 2Department of Internal Medicine, Jimma University, Jimma, Ethiopia; 3Ambo University Hospital, Ambo, EthiopiaCorrespondence: Shiferaw Woyesa Email bekeleshiferaw@yahoo.comBackground: Lipoproteins are complexes of lipids and proteins that are essential for the transport of cholesterol, triglycerides, and fat-soluble vitamins. The linkage between chronic diseases like diabetes mellitus and HIV infection increases the complication of the diseases and worsens the clinical outcome of the patients.Purpose: To assess and compare lipid and lipoprotein profiles among HIV-infected and non-infected diabetic patients, and to identify independent predictor variables for abnormal lipid and lipoprotein profiles.Patients and Methods: A comparative cross-sectional study design was used to carry out the research, and a convenient sampling technique was used to include 96 adult diabetic patients (48 HIV-infected and 48 non-infected diabetics). Socio-demographic and clinical data were collected by interviewer-administered questionnaire. Five milliliter blood sample was collected and processed for lipid and lipoprotein profile measurement. Multivariate and bivariate logistic regressions were used to identify independent predictor variables for abnormal lipid and lipoprotein profiles.Results: The prevalence of diabetic dyslipidemia was 41.7% and 37.5% in HIV-infected and non-infected diabetic patients, respectively. Hypercholesterolemia was more commonly detected among HIV-infected diabetic patients than non-HIV-infected, 25.0% versus 18.8%, respectively. Similarly, hypertriglyceridemia was more commonly observed in HIV-infected (31.3%) than non-infected diabetic patients (20.8%). About 25.0% HIV-infected diabetic patients had combined hyperlipidemia (hypercholesterolemia plus hypertriglyceridemia); and about 4.2% had hypoalphalipoproteinemia or isolated low HDL-C. Being female and long duration of diabetes mellitus were independent predictor variables for abnormal lipid and lipoprotein profiles in HIV-infected patients. Similarly, being female and high blood pressure were independent predictor variables in non-HIV-infected diabetic patients.Conclusion: High prevalence lipid and lipoprotein abnormalities were detected in HIV-infected diabetic patients even though the abnormalities were also common in non-HIV co-morbid diabetic patients. Hence, proactive screening and treatment of blood glucose, lipid, and lipoprotein abnormalities are critically important and should be part of comprehensive HIV care.Keywords: diabetes mellitus, hypertriglyceridemia, lipoproteins, hypercholesterolemia, HIV-infection

Tsegaye Melaku,1 Mulatu Gashaw,2 Legese Chelkeba,3 Melkamu Berhane,4 Sisay Bekele,5 Gemechu Lemi,6 Tekle Wakjira,7 Getnet Tesfaw,2 Zeleke Mekonnen,2 Solomon Ali,8 Arne Kroidl,9,10 Andreas Wieser,9,10 Guenter Froeschl,9,10 Esayas Kebede Gudina11 1School of Pharmacy, Jimma University, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia; 3Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia; 5Department of Ophthalmology, Jimma University, Jimma, Ethiopia; 6Department of Surgery, Jimma University, Jimma, Ethiopia; 7Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia; 8Department of Microbiology, Immunology and Parasitology, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 9Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany; 10German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany; 11Department of Internal Medicine, Jimma University, Jimma, EthiopiaCorrespondence: Tsegaye MelakuSchool of Pharmacy, Jimma University, Jimma, EthiopiaTel +251 913765609Email tsegayemlk@yahoo.comIntroduction: Inappropriate antibiotic use is a major public health concern and driver of antibiotic resistance. Excessive exposure to antibiotics results in the emergence and spread of drug-resistant microorganisms. This study aimed to measure the volume of antibiotic consumption at the outpatient settings in a tertiary-care teaching hospital in Ethiopia.Methods: A cross-sectional study was undertaken from February 01, 2019 to March 31, 2019 at Jimma Medical Center in southwest Ethiopia. Antibiotics use was analyzed using Anatomical Therapeutic Chemical Classification and Defined Daily Dose (DDD) system. Antibiotic use was calculated as DDD per 100 outpatients per day. Antibiotics were classified based on World Health Organization “AWaRe” classification scheme as “Access”, “Watch” and “Reserve” group antibiotics and measured their consumption intensity.Results: A total of 496 adult patients were included in the study. The mean (SD) age of participants was 33.07 (14.05) years. The total amount of antibiotics consumed was 5.31 DDD/100 outpatients per day. Ciprofloxacin was the most commonly [122 (21.12%)] prescribed antibiotics with DDD/100 outpatients per day value of 1.13, followed by amoxicillin [68 (11.76%)] with DDD/100 outpatients per day value of 0.44, and azithromycin [61 (10.55%)] with DDD/100 outpatients per day value of 0.51. On antibiotic consumption index, antibiotics in the “Watch” group had 2.10 DDD/100 outpatients per day.Conclusion: There was high consumption of antibiotics in the study setting. Based on the use control criteria, half of the antibiotics used were in the “Watch” group. The high level of consumptions of antibiotics, such as ciprofloxacin, norfloxacin, and azithromycin, in particular, requires further scrutiny and calls for an urgent implementation of an antibiotic stewardship program at the hospital.Keywords: antibiotics, antibiotics consumption, antibiotic resistance, defined daily dose, Ethiopia

Tsegaye Melaku,1 Legese Chelkeba,1 Zeleke Mekonnen,2 Kabaye Kumela1 1Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia; 2School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, EthiopiaCorrespondence: Tsegaye MelakuJimma University, Jimma, EthiopiaTel +251 913765609Email tsegayemlk@yahoo.comBackground: Antiretroviral therapy has decreased human immunodeficiency virus related mortality. However, the incidence of diabetes mellitus is increasing among people living with human immunodeficiency virus and adds complexity to the standards of care.Objective: The study was aimed to determine the glycemic control and delivery of clinical care among people living with diabetes and human immunodeficincy virus in Ethiopia.Methods: A comparative prospective cohort study was conducted among patients living with diabetes at follow-up clinics of Jimma Medical Center in two study arms. The first arm was people living with diabetes and human immunodeficiency virus. The second arm was human immunodeficiency virus negative patients living with diabetes. The expanded English version of the summary of diabetes self-care activities scale was used to measure self-care behaviors. In order to identify the predictors of glycemic control, multivariable Cox regression analysis was used. Statistical significance at p-value ≤ 0.05 was considered.Results: A total of 297 eligible participants were followed for one year, with a mean age of 44.35± 12.55 years. Males accounted for 55.9%. After one year of follow-up, 61.9% of diabetes people living with human immunodeficiency virus, and 49% of human immunodeficiency virus-negative patients with diabetes poorly met blood glucose target (p=0.037). Female gender [AHR: 2.72; 95% CI (1.21– 5.72)], age > 31 years [AHR: 2.48; 95% CI (1.34– 11.01)], increased waist circumference [AHR: 3.64; 95% CI (2.57– 16.12)], overweight [AHR: 3.63; 95% CI (1.65– 22.42)], chronic disease comorbidity [AHR: 2.02; 95% CI (1.44– 2.84)], human immunodeficiency virus infection [AHR: 3.47; 95% CI (2.03– 23.75)], living longer with diabetes (> 5 years) [AHR: 3.67; 95% CI (3.26– 4.14)] showed a higher risk of blood sugar control failure and were independent predictors of uncontrolled glycemia. Tuberculosis infection increased the risk of uncontrolled blood sugar among people living with diabetes and human immunodeficency virus[AHR:3.82;95% CI(2.86-5.84].Conclusion: Significant gaps were observed in achieving the recommended glycemic target and involvement of patients on self-care care behavior in the study area. The co-occurrence of tuberculosis, human immunodeficiency virus, and diabetes is triple trouble needing special attention in their management. It is high time to leverage the clinical care of the looming co-epidemics through chronic comprehensive care clinic.Keywords: human immunodeficiency virus, glycemic control, treatment outcome, self-care behavior

Binyam Gintamo,1 Mohammed Azhar Khan,1 Henok Gulilat,1 Zeleke Mekonnen,2 Rakesh Kumar Shukla,1 Tabarak Malik3 1Department of Biotechnology, Faculty of Applied Sciences and Biotechnology, Shoolini University, Bajhol, HP, India; 2School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia; 3Department of Biochemistry, College of Medicine & Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Tabarak Malik Email malikitrc@gmail.comBackground: Integrated Management of Neonatal and Childhood Illnesses (IMNCI) is one of the child health programs and it provides an integrated approach and focuses on the well-being of the whole child. Globally, nearly nine million children pass away every year with preventable and treatable conditions. IMNCI program is provided by the health facilities to aid children under five years of age from illness. This study is aimed at assessing the implementation of the IMNCI program in public health centers of Soro District, Hadiya Zone, Southern Ethiopia.Methods: The implementation of the IMNCI program was studied using a facility-based cross-sectional study design integrating both qualitative and quantitative data collected from 9 public health centers in Soro district, Hadiya Zone, Southern Ethiopia. A total of 390 (92%) caregivers were included in the study by the proportion of under-five outpatient coverage from each public health center. Data were collected through face to face interviewer-administered questionnaires, document review checklist, observation checklist, and in-depth interview guide.Results: Based on agreed criteria resources’ availability was 80.11% and judged as fair. Less than 50% of health centers (HCs) had cotrimoxazole and gentamycin. The compliance of health workers was 85.5% and judged as good. Below 85% of prescribed drugs were given correctly for the classified disease. Counseling on medication and follow updates were given for less than 80% of caretakers. The overall satisfaction of clients on IMNCI was 79.5% according to the judging criteria. The caretakers who took less than 30 minutes to reach the health center on foot (AOR=7.7, 95% CI [3.787– 15.593]), caretakers who waited for less than 30 minutes to see the health care provider (AOR=2, 95% CI [1.00– 3.77]), the caretakers who found prescribed drugs in HCs pharmacy (AOR = 3.7,95% CI [1.91– 7.34]), the caretakers who have less than four family size (AOR=2, 95% [1.109– 4.061]) were more satisfied in IMNCI services, whereas, caregivers who measured the weight of child were negatively associated with satisfaction (AOR= 0.24, 95% CI [0.13– 0.45]).Conclusion: This study found that the overall implementation of the Integrated Management of Neonatal and Childhood Illnesses was good. All health centers had trained health workers, ORS, paracetamol, vitamin A, chart booklet, and IMNCI guidelines were available; however, cotrimoxazole, gentamycin, ampicillin, and mebendazole were less abundant drugs in health centers. Further, a large-scale study is required to be conducted in future in other districts to ensure proper implementation of the IMNCI program in Ethiopia.Keywords: IMNCI, healthcare provider, practice, Hadiya zone, southern Ethiopia

In this paper we have investigated the effects of geomagnetic storm on the variation of interplanetary magnetic field (IMF Bz), disturbance storm time (Dst), solar wind speed and total electron content (TEC) over Ethiopian ionosphere. A total of 17 geomagnetic storms have analysed by using ground based Global Positioning System (GPS) stations at Bahir Dar (11° N, 38° E), Debark(4.32° N, 109.48° E), Armi (3.03° N, 109.29° E), Nazret (8.57° N, 39.29° E), Robe(7.60° N, 40°E), Assosa (1.14° N, 106.16° E), and Ambo(8.59° N, 37.51° E) from the years 2010 to 2013. The results have revealed that there is a mixed effect of geomagnetic storm on the variation of interplanetary magnetic field (IMF Bz), disturbance storm time (Dst), solar wind speed and total electron content (TEC), however, most of the effects were positive and might be attributed to the prompt penetration electric fields (PPEFs) and disturbed dynamo fields. [ABSTRACT FROM AUTHOR]

Model projections of future CO2 and CH4 exchange in Arctic tundra diverge widely. Here we used ecosys to examine how climate change will affect CO2 and CH4 exchange in troughs, rims, and centers of a coastal polygonal tundra landscape at Barrow, AK. The model was shown to simulate diurnal and seasonal variation in CO2 and CH4 fluxes associated with those in air and soil temperatures (Ta and Ts) and soil water contents (θ) under current climate in 2014 and 2015. During RCP 8.5 climate change from 2015 to 2085, rising Ta, atmospheric CO2 concentrations (Ca), and precipitation (P) increased net primary productivity (NPP) from 50-150 g C m-2 y-1, consistent with current biometric estimates, to 200--250 g C m-2 y-1. Concurrent increases in heterotrophic respiration (Rh) were slightly smaller, so that net CO2 exchange rose from values of -25 (net emission) to +50 (net uptake) g C m-2 y-1 to ones of -10 to +65 g C m-2 y-1. Increases in net CO2 uptake were largely offset by increases in CH4 emissions from 0-6 to 1-20 g C m-2 y-1, reducing gains in net ecosystem productivity. These increases in net CO2 uptake and CH4 emissions were modeled with hydrological boundary conditions that were assumed not to change with climate. Both these increases were smaller if boundary conditions were gradually altered to increase landscape drainage during model runs with climate change. [ABSTRACT FROM AUTHOR]

Abstract: Microtopographic variation that develops among features (troughs, rims, and centers) within polygonal landforms of coastal arctic tundra strongly affects movement of surface water and snow and thereby affects soil water contents (θ) and active layer depth (ALD). Spatial variation in ALD among these features may exceed interannual variation in ALD caused by changes in climate and so needs to be represented in projections of changes in arctic ALD. In this study, increases in near‐surface θ with decreasing surface elevation among polygon features at the Barrow Experimental Observatory (BEO) were modeled from topographic effects on redistribution of surface water and snow and from lateral water exchange with a subsurface water table during a model run from 1981 to 2015. These increases in θ caused increases in thermal conductivity that in turn caused increases in soil heat fluxes and hence in ALD of up to 15 cm with lower versus higher surface elevation which were consistent with increases measured at BEO. The modeled effects of θ caused interannual variation in maximum ALD that compared well with measurements from 1985 to 2015 at the Barrow Circumpolar Active Layer Monitoring (CALM) site (R2 = 0.61, RMSE = 0.03 m). For higher polygon features, interannual variation in ALD was more closely associated with annual precipitation than mean annual temperature, indicating that soil wetting from increases in precipitation may hasten permafrost degradation beyond that caused by soil warming from increases in air temperature. This degradation may be more rapid if increases in precipitation cause sustained wetting in higher features. [ABSTRACT FROM AUTHOR]

Abstract: Differences of surface elevation in arctic polygonal landforms cause spatial variation in soil water contents (θ), active layer depths (ALD), and thereby in CO2 and CH4 exchange. Here we test hypotheses in ecosys for topographic controls on CO2 and CH4 exchange in trough, rim, and center features of low‐ and flat‐centered polygons (LCP and FCP) against chamber and eddy covariance (EC) measurements during 2013 at Barrow, Alaska. Larger CO2 influxes and CH4 effluxes were measured with chambers and modeled with ecosys in LCPs than in FCPs and in lower features (troughs) than in higher (rims) within LCPs and FCPs. Spatially aggregated CO2 and CH4 fluxes from ecosys were significantly correlated with EC flux measurements. Lower features were modeled as C sinks (52–56 g C m−2 yr−1) and CH4 sources (4–6 g C m−2 yr−1), and higher features as near C neutral (−2–15 g C m−2 yr−1) and CH4 neutral (0.0–0.1 g C m−2 yr−1). Much of the spatial and temporal variations in CO2 and CH4 fluxes were modeled from topographic effects on water and snow movement and thereby on θ, ALD, and soil O2 concentrations. Model results forced with meteorological data from 1981 to 2015 indicated increasing net primary productivity in higher features and CH4 emissions in some lower and higher features since 2008, attributed mostly to recent rises in precipitation. Small‐scale variation in surface elevation causes large spatial variation of greenhouse gas (GHG) exchanges and therefore should be considered in estimates of GHG exchange in polygonal landscapes. [ABSTRACT FROM AUTHOR]

Diarrhea claims >500,000 lives annually among children under five years of age in low- and middle-income countries. Mortality due to acute diarrhea (<7 days' duration) is decreasing, but prolonged (7-13 days) and persistent (≥14 days of duration) diarrhea remains a massive challenge. Here, we use a case-control study to decipher if fecal gut microbiota compositional differences between Ethiopian children with acute (n=554) or prolonged/persistent (n=95) diarrhea and frequency-matched non-diarrheal controls (n=663) are linked to diarrheal etiology. We show that diarrhea cases are associated with lower bacterial diversity and enriched in Escherichia spp., Campylobacter spp., and Streptococcus spp. Further, diarrhea cases are depleted in gut commensals such as Prevotella copri, Faecalibacterium prausnitzii, and Dialister succinatiphilus, with depletion being most pronounced in prolonged/persistent cases, suggesting that prolonged duration of diarrhea is accompanied by depletion of gut commensals and that re-establishing these via e.g., microbiota-directed food supplements offer a potential treatment strategy., (© 2024. The Author(s).)

This study aimed to retrospectively assess the cost-effectiveness of various COVID-19 vaccination strategies in Ethiopia. It involved healthcare workers (HCWs) and community participants; and was conducted through interviews and serological tests. Local SARS-CoV-2 variants and seroprevalence rates, as well as national COVID-19 reports and vaccination status were also analyzed. A cost-effectiveness analysis was performed to determine the most economical vaccination strategies in settings with limited vaccine access and high SARS-CoV-2 seroprevalence. Before the arrival of the vaccines, 65% of HCWs had antibodies against SARS-CoV-2, indicating prior exposure to the virus. Individuals with prior infection exhibited a greater antibody response to COVID-19 vaccines and experienced fewer new infections compared to those without prior infection, regardless of vaccination status (5% vs. 24%, p < 0.001 for vaccinated; 3% vs. 48%, p < 0.001 for unvaccinated). The cost-effectiveness analysis indicated that a single-dose vaccination strategy is optimal in settings with high underlying seroprevalence and limited vaccine availability. This study underscores the need for pragmatic vaccination strategies tailored to local contexts, particularly in high-seroprevalence regions, to maximize vaccine impact and minimize the spread of COVID-19. Implementing a targeted approach based on local seroprevalence information could have helped Ethiopia achieve higher vaccination rates and prevent subsequent outbreaks.

Introduction: Postoperative delirium in paediatric patients is a recognised issue. Nevertheless, in low- and middle-income nations, researchers have had luck in determining its extent and predictors. Identifying predictors of postoperative delirium in paediatric patients having general anaesthesia at Tertiary Hospitals in Ethiopia was the aim of this study., Methods: A multicenter, prospective follow up study was conducted from April 15 to June 15, 2023 at the study settings. During the study period a total of 424 paediatric surgical patients treated under general anaesthesia in all study locations, ranging in age from birth to sixteen were candidates for this study. Charts and direct observation of patient's with assessment tool [Cornell Assessment of Pediatric Delirium (CAPD)] were used from each available patient. Binary logistic regression analysis was performed to determine predictors of postoperative delirium in paediatric patients undergoing surgery under general anaesthesia., Results: Postoperative delirium occurred in 160 of the 404 paediatric patients who underwent surgery under general anaesthesia. Ophthalmic surgery, corticosteroid use, anticholinergic use, severe postoperative pain, and preoperative anxiety were found to be predictors of postoperative delirium; whereas, sedative medication premedication and paracetamol used for analgesia were found to be protective against postoperative delirium., Inference and Recommendation: The postoperative delirium in paediatric patients undergoing surgery under general anaesthesia was higher compared to developed countries. Ophthalmic surgery, corticosteroids, anticholinergic medications, postoperative pain, and preoperative anxiety were found to be predictors. The impact of postoperative delirium might be lessened by concentrating on its screening and factor control., 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., (© 2024 Yaregal Melesse, Teshale Tesema, Ayinie Mekonnen, Chekol, Admass and Mengie Workie.)

Objectives: Lockdowns and border closures impacted medicine availability during the COVID-19 pandemic. This study aimed to assess the availability of essential, generic medicines for chronic diseases at public pharmaceutical supply agencies in Ethiopia., Design: Comparative cross-sectional study., Setting: The availability of essential, generic medicines for chronic diseases was assessed at two public pharmaceutical supply agency hubs., Participants: The current study included public supply agency hub managers, warehouse managers and forecasting officers at the study setting., Outcomes: The assessment encompassed the availability of chronic medicines on the day of data collection, as well as records spanning 8 months before the outbreak and 1 year during the pandemic. A total of 22 medicines were selected based on their inclusion in the national essential drug list for public health facilities, including 17 medicines for cardiovascular disease and 5 for diabetes mellitus., Results: The results of the study indicate that the mean availability of the selected basket medicines was 43.3% (95% CI: 37.1 to 49.5) during COVID-19, which was significantly lower than the availability of 67.4% (95% CI: 62.2 to 72.6) before the outbreak (p<0.001). Prior to COVID-19, the overall average line-item fill rate for the selected products was 78%, but it dropped to 49% during the pandemic. Furthermore, the mean number of days out of stock per month was 11.7 (95% CI: 9.9 to 13.5) before the outbreak of COVID-19, which significantly increased to 15.7 (95% CI: 13.2 to 18.2) during the pandemic, indicating a statistically significant difference (p<0.001). Although the prices for some drugs remained relatively stable, there were significant price hikes for some products. For example, the unit price of insulin increased by more than 130%., Conclusion: The COVID-19 pandemic worsened the availability of essential chronic medicines, including higher rates of stockouts and unit price hikes for some products in the study setting. The study's findings imply that the COVID-19 pandemic has aggravated already-existing medicine availability issues. Efforts should be made to develop contingency plans and establish mechanisms to monitor medicine availability and pricing during such crises., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Modern medicine is not the choice of patients with "shimetere" in the Gurage community owing to their perception of 'parenteral medication use severely aggravates the disease'. For this reason, the root part of Polygala sadebeckiana Gürke is commonly utilized as traditional medicine in the management of the disease. The aim of this study was to evaluate the antimicrobial activity of Polygala sadebeckiana Gürke extract on bacterial isolates from wound samples of patients with "Shimetere"., Methods: The agar well diffusion method was used to evaluate antibacterial activity, and the agar dilution method was utilized to determine minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MICs). The crude extract was tested against isolated bacteria at concentrations of 25, 50, 75 and 100 mg/mL in triplicate (3x). The positive controls were azithromycin (15 µg) and cloxacillin disk (5 µg), and the negative control was dimethylsulfoxide (5%). The group mean comparisons were made using one-way ANOVA at a significance level of p < 0.05, and the results are presented as the mean ± standard deviation. The presence of secondary metabolites from crude extract was checked by standard testing procedures., Results: S. aureus and S. pyrogen were the two identified bacteria from 9 (60%) and 3 (20%) wound samples, respectively. All identified bacterial strains were susceptible to the reference antibiotics. Tannins and saponins were the most abundant secondary metabolites found in the crude extracts. The average inhibition zones of the plant extracts with 100, 75, 50 and 25 mg/mL concentrations were 27, 20.33, 15.25, and 11.96 mm (p < 0.000) for S. aureus and 30.02, 24.50, 19.07, and 15.77 mm (p < 0.000) for S. pyrogen bacteria, respectively. The MIC and MBC of the crude extract were 1.67 and 10 mg/mL for S. aureus and 0.98 and 4 mg/mL for S. pyrogen., Conclusion: Polygala sadebeckiana Gürke contained significant tannins and saponins as secondary metabolites and had antibacterial activities against isolated bacteria (S. aureus and S. pyrogen) from "Shimetere". The potential mechanism of antibacterial action of the plant extract was cell wall synthesis inhibition., (© 2024. The Author(s).)

Introduction: There is an unmet need for One Health (OH) surveillance and reporting systems for antimicrobial resistance (AMR) in resource poor settings. District health information system, version 2 (DHIS2), is a globally recognized digital surveillance platform which has not been widely utilized for AMR data yet. Our study aimed to understand the local stakeholders' viewpoints on DHIS2 as OH-AMR surveillance platform in Jimma, Ethiopia which will aid its further context specific establishment., Methods: We performed an exploratory qualitative study using semi-structured key informant interviews (KIIs) in Jimma Zone at Southwest Ethiopia. We interviewed 42 OH professionals between November 2020 and February 2021. Following verbatim transcription of the audio recordings of KIIs, we conducted thematic analysis., Results: We identified five major themes which are important for understanding the trajectory of OH-AMR surveillance in DHIS2 platform. The themes were: (1) Stakeholders' current knowledge on digital surveillance platforms including DHIS2. (2) Stakeholders' perception on digital surveillance platform including DHIS2. (3) Features suggested by stakeholders to be included in the surveillance platform. (4) Comments from stakeholders on system implementation challenges. (5) Stakeholders' perceived role in the process of implementation. Despite several barriers and challenges, most of the participants perceived and suggested DHIS2 as a suitable OH-AMR surveillance platform and were willing to contribute at their current professional roles., Conclusions: Our study demonstrates the potential of the DHIS2 as a user friendly and acceptable interoperable platform for OH-AMR surveillance if the technology designers accommodate the stakeholders' concerns. Piloting at local level and using performance appraisal tool in all OH disciplines should be the next step before proceeding to workable format., 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 The Author(s). Published by Elsevier B.V. All rights reserved.)

Giardia duodenalis is a common pathogenic intestinal protozoan parasite with high prevalence in developing countries, especially among children. The distribution of giardia assemblages among humans and their clinical relevance remains controversial. This study aimed to determine the prevalence and assemblage of Giardia among children under 5 years of age in Jimma, Southwest Ethiopia. Employing a case-control design, 606 children presenting with diarrhea at Jimma university medical center and Serbo Health Center were enrolled from December 2016 to July 2018 along with 617 matched controls without diarrhea. Giardia was detected and typed using real-time PCR. Univariate and multivariate regression analysis was performed. The total prevalence of Giardia was 41% (501/1223) and did not differ significantly between cases and controls (40% vs 42%). Prevalence increased by age, with the highest prevalence seen in children aged ≥ 25 months. Children without diarrhea with a history of diarrhea during the last month were more likely to be Giardia positive compared to children with no history diarrhea (OR 1.8 and 95%CI; 1.1-2.9). Regardless of current diarrhea symptoms, assemblage B predominated with 89%, followed by assemblage A (8%) and mixed infection assemblage A and B (3%). We report a high prevalence of Giardia by PCR detection in Jimma, Ethiopia, with assemblage B being predominant. There was a similar distribution of Giardia assemblages between children with and without diarrhea. Increasing age was a risk factor for Giardia infection. Community-based prevention and control strategies need to be employed to decrease the risk of giardia infection., (© 2023. The Author(s).)

School-based mass deworming programs are implemented to reduce soil-transmitted helminth (STH) infection prevalence and intensity among school-aged children. However, previous studies debate the impact of deworming beyond the removal of worms. Hence, this study aimed to examine the effect of mass deworming on nutritional indicators in young Ethiopian schoolchildren. A school-based cross-sectional study was conducted among 1,036 participants from April to May 2020 in Jimma Town, Ethiopia. An interviewer-based questionnaire was administered to the children to gather data on sociodemographic, lifestyle variables, and deworming status. Anthropometric measurements were taken for the height and weight of the children. Stool samples were collected and analyzed for STH infection using direct wet mount microscopy and the Kato-Katz technique. In multivariate logistic regression analysis, deworming within the past 6 months or 1 year was not significantly associated with underweight, stunting, and thinning. However, deworming within the past year was significantly associated with decreased weight-for-age z-score (adjusted mean difference = -0.245; 95% CI: -0.413 to -0.076; P = 0.004). Deworming in the past 6 months demonstrated a nonsignificant trend toward increased stunting (adjusted odds ratio = 1.258; 95% CI: 0.923-1.714; P = 0.145). This study provides evidence that deworming in the past 6 months or 1 year was not significantly associated with underweight, stunting, and thinning. However, deworming within the past year was associated with a significantly decreased weight-for-age z-score in young Ethiopian schoolchildren of Jimma Town after adjustment for confounding variables.

Objective: This study aimed to determine the diagnostic accuracy of the antigen rapid diagnostic test (Ag-RDT) as a screening tool for SARS-CoV-2 infection compared to Quantitative reverse transcription polymerase chain reaction (qRT-PCR)., Methods: This study was conducted at six referral hospitals in Oromia Region, Ethiopia. One thousand seven hundred twenty-one patients who visited the hospitals for various medical conditions were tested with qRT-PCR and/or Ag-RDTs. Qualitative detection of SARS-CoV-2 antigen was performed using the Panbio™ COVID-19 Ag rapid test device., Results: Compared with qRT-PCR, Ag-RDTs had a sensitivity of 33.3 % (95%CI: 30.9%-35.9 %) and a specificity of 99.3 % (95%CI: 98.8%-99.7 %) to detect active SARS-CoV-2 infection. The area under the receiver operator curve was 0.67 (95%CI: 0.63-0.69). The sensitivity of Ag-RDTs appeared high in patients with shortness of breath (73.3 %) and those presenting with all three symptoms - fever, cough, and dyspnea (71.4 %). In all instances, specificity was more than 98 %. The Ag-RDT positivity rate also correlated well with viral load: 51.7 % in cases with cycle threshold (Ct) < 25 (high viral load) and only 3.4 % when Ct > 25 (low viral load)., Conclusion: Although Ag-RDT for diagnosing SARS-CoV-2 is a good option as a point-of-care screening tool, it has a low sensitivity to detect active infections. Using Panbio™ COVID-19 Ag Rapid test for diagnostic and treatment decisions may lead to a false negative, resulting in patient misdiagnosis, ultimately contributing to disease spread and poor patient outcome., Competing Interests: 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., (© 2023 Published by Elsevier Ltd.)

Background: Shigellosis is the most common cause of epidemic dysentery found worldwide, particularly in developing countries, where it causes infant diarrhea and mortality. The prevalence of Shigella species resistant to commonly used antimicrobial drugs has steadily increased. The purpose of this review is to describe the prevalence and antimicrobial resistance (AMR) characteristics of Shigella species in East Africa between 2015 and 2022., Methods: Studies were identified using a computerized search of Medline/PubMed, Google Scholar, and Web of Science databases, with a detailed search strategy and cross-checking of reference lists for studies published between 2015 and 2022. Articles presenting data on prevalence and AMR, accessibility of the full-length article, and publication dates between 2015 and 2022 were the eligibility criteria for inclusion in the review. Original research reports written in English were considered. The heterogeneities of the studies were examined, and a meta-analysis was performed to estimate the pooled prevalence and AMR using a random effects model., Results: The pooled prevalence of Shigella species in East Africa was 6.2% (95% CI -0.20-12.60), according to an analysis of 22 studies. Shigella species prevalence was 4.0% in Ethiopia, 14.6% in Kenya, 0.7% in Sudan, 5.2% in South Sudan, and 20.6% in Somalia. The association of Shigella infection significantly varied among the countries ( p = 0.01). Among the antibiotics tested, most Shigella isolates were susceptible to ciprofloxacin, norfloxacin, nalidixic acid, and ceftriaxone. Despite the fact that the reports varied in study sites and time, Shigella species were resistant to tetracycline, ampicillin, amoxicillin, chloramphenicol, and co-trimoxazole., Conclusion: The pooled estimate indicates high burden of Shigella infection in East Africa, as well as a high proportion of drug resistance pattern to tetracycline, ampicillin, chloramphenicol, and amoxicillin. Therefore, initiating and scale-up of performing drug susceptibility test for each shigellosis case need to be considered and strengthened., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Basha Ayele et al.)

Background: Shigella and parasitic infections are common public health problems throughout the world. Shigellosis is an acute gastroenteritis infection and one of Ethiopia's most common causes of morbidity and mortality, especially in children under five. High resistance rates to commonly used antibiotic agents have been documented in different locations in Ethiopia., Objective: This study aimed to characterize the antimicrobial features of the Shigella species isolated from children under five years of age with acute diarrhea in Addis Ababa, Ethiopia., Methods: Using a cross-sectional study, freshly passed fecal specimens were collected for intestinal parasite and bacterial isolation. Fecal samples for bacterial identification were placed immediately in Cary-Blair media and transported to the Ethiopian Public Health Institution (EPHI) laboratory. Antimicrobial susceptibility testing (AMST) was conducted using the disk diffusion method. Data were described using descriptive statistical tools. The association of independent and dependent variables was evaluated with logistic regression. A P value ≤0.05 was considered statistically significant., Results: The prevalence of intestinal parasites was 8.2% with seven different species. Among the 534 stool-cultured specimens, 47 (8.8%) were positive for Shigella species. Antimicrobial susceptibility testing (AMST) showed that 100%, 93.6%, 80.9%, 72.3%, and 57.5% were susceptible to norfloxacin, nalidixic acid, ciprofloxacin, gentamicin, and cefoxitin, respectively. However, 100% of the isolates were resistant to amoxicillin and erythromycin. More than 50% of the isolates were resistant to three and above antibiotics, while none of them were susceptible to all the antibiotics tested. All risk factors assessed did not show a statistically significant association with Shigella infection., Conclusion: The high levels of antibiotic resistance observed among the commonly prescribed antibiotics are alarming. The emerging resistance to ciprofloxacin and nalidixic acid signals a severe public health threat in the management of shigellosis. Raising awareness about resistance and educating health professionals, policymakers, and the public can help improve the quality of patient care and rational antibiotic use., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Basha Ayele et al.)

Introduction: Previous studies have sought to identify risk factors for malnutrition in populations of schoolchildren, depending on traditional logistic regression methods. However, holistic machine learning (ML) approaches are emerging that may provide a more comprehensive analysis of risk factors., Methods: This study employed feature selection and association rule learning ML methods in conjunction with logistic regression on epidemiological survey data from 1,036 Ethiopian school children. Our first analysis used the entire dataset and then we reran this analysis on age, residence, and sex population subsets., Results: Both logistic regression and ML methods identified older childhood age as a significant risk factor, while females and vaccinated individuals showed reduced odds of stunting. Our machine learning analyses provided additional insights into the data, as feature selection identified that age, school latrine cleanliness, large family size, and nail trimming habits were significant risk factors for stunting, underweight, and thinness. Association rule learning revealed an association between co-occurring hygiene and socio-economical variables with malnutrition that was otherwise missed using traditional statistical methods., Discussion: Our analysis supports the benefit of integrating feature selection methods, association rules learning techniques, and logistic regression to identify comprehensive risk factors associated with malnutrition in young children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Russel, Perry, Bonzani, Dontino, Mekonnen, Ay and Taye.)

Background: COVID-19 pandemic posed a major impact on the availability and affordability of essential medicines. This study aimed to assess the knock-on effects of the COVID-19 pandemic on the supply availability of non-communicable chronic disease (NCD) medicines and paracetamol products in Ethiopia., Methods: A mixed methods study was conducted to assess the supply and availability of twenty-four NCD drugs and four paracetamol products listed on the national essential medicines list for hospitals. Data were collected from twenty-six hospitals located in seven zones of Oromia region in the southwestern part of Ethiopia. We extracted data on drug availability, cost and stock out for these drugs between May 2019 and December 2020. The quantitative data were entered into Microsoft Excel and exported to statistical package software for social science (SPSS) version 22 (IBM Corporation, Armonk, NY, USA) software for analysis., Results: The overall mean availability of selected basket medicines was 63.4% (range 16.7% to 80.3%) during the pre-COVID-19 time. It was 46.3% (range 2.8% to 88.7) during the pandemic. There was a relative increase in the availability of two paracetamol products [paracetamol 500 mg tablet (67.5% versus 88.7%) and suppository (74.5% versus 88%)] during the pandemic. The average monthly orders fill rates for the selected products range from 43 to 85%. Pre-COVID-19, the average order fill rate was greater or equal to 70%. However, immediately after the COVID-19 case notification, the percentage of order(s) filled correctly in items and quantities began decreasing. Political instability, shortage of trained human resources, currency inflation, and limited drug financing were considered as the major challenges to medicine supply., Conclusion: The overall stock out situation in the study area has worsened during COVID-19 compared to pre-COVID-19 time. None of the surveyed chronic disease basket medicines met the ideal availability benchmark of 80% in health facilities. However, availability of paracetamol 500 mg tablet surprisingly improved during the pandemic. A range of policy frameworks and options targeting inevitable outbreaks should exist to enable governments to ensure that medicines for chronic diseases are consistently available and affordable., (© 2023. The Author(s).)

Background: Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool., Methods: We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAKG2). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species (Ascaris lumbricoides, Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select (SS); screen, select and retest (SSR) and no selection (NS)) and number of subjects enrolled (100-5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design., Principal Findings: Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAKG2 required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAKG2) or ≥80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity., Conclusions/significance: We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO (SS) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs., Trial Registration: ClinicalTrials.gov NCT03465488., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: the FECPAKG2 technology was produced and distributed by Techion Group Ltd, of which ET is an employee and GM is managing director. Both hold stocks in Techion Group Ltd. The Mini-FLOTAC device is a commercial product distributed by GC, LR and MPM through the University of Napoli Federico II. All other authors declared that they have no competing interests., (Copyright: © 2023 Coffeng 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.)

Fasciolosis is regarded as a major challenge to livestock productivity worldwide, but the burden of disease in humans has only started to receive some attention in the past three decades. The aim of this study was to determine the prevalence of human and animal fasciolosis and its determinant factors in the Gilgel Gibe and Butajira Health and Demographic Surveillance System (HDSS) sites in Ethiopia. A study was undertaken among 389 households across the two sites. Face-to-face interviews were conducted to investigate the knowledge, attitudes and practices of households with regard to fasciolosis. Stools from 377 children aged 7-15 years, and 775 animals (cattle, goats and sheep) were analyzed using a proprietary Fasciola hepatica ( F. hepatica ) coproantigen ELISA kit. The prevalence of fasciolosis in children was 0.5% and 1% in Butajira and Gilgel Gibe HDSS sites, respectively. The overall prevalence of animal fasciolosis was 29%, 29.2%, and 6% among cattle, sheep, and goats, respectively. More than half of the respondents from Gilgel Gibe (59%, n = 115) did not know that humans can be infected with F. hepatica . The majority of respondents in Gilgel Gibe (n = 124, 64%) and Butajira (n = 95, 50%) did not know the transmission route for fasciolosis. Grazing animals were 7 times more likely to be infected with fasciolosis than animals in cut-and-carry production systems (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI]: 3.91-13.17). The findings indicated a lack of knowledge amongst local populations about fasciolosis. Thus, there is a need for public health awareness campaigns about fasciolosis in the study areas.