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Abstract Heavy metals in food can pose significant health risks, necessitating regular monitoring and assessment of their concentrations in commonly consumed foods. This study aims to assess the levels of essential and heavy metals and conduct health risk assessments in peanuts and date palms. Using wet acid digestion, the concentrations of heavy metals: iron (Fe), zinc (Zn), copper (Cu), arsenic (As), lead (Pb), and chromium (Cr) were measured in six each sample of peanuts and date palms, via Flame Atomic Absorption Spectroscopy (FAAS). To assess the health risks for adult males and females, the study calculated the estimated daily intake (EDI), target hazard quotient (THQ), hazard index (HI), and incremental lifetime cancer risk (ILCR) based on Maximum Recommended Daily Intake (MRDI) of each metal. The average concentrations of heavy metals in peanuts were: Fe 12.6 ± 0.54, Zn 5.3 ± 0.1, Cu 3.53 ± 0.33, As 0.001 ± 0.0, Pb 0.01 ± 0.0, and Cr 0.02 ± 0.0 in mg/kg. For date palms, the average concentrations were: Fe 40.23 ± 2.5, Zn 48.31 ± 0.8, Cu 10.65 ± 0.05, As 0.05 ± 0.002, Pb 0.2 ± 0.01, and Cr 0.5 ± 0.03 in mg/kg. All measured concentrations were below WHO standards. The estimated daily intake of metals from both food was found to be below the Maximum Recommended Daily Intake (MRDI). The hazard index for peanuts was within safe limits, indicating no significant non-carcinogenic health risks. In contrast, the hazard index for date palms exceeded 1, suggesting potential non-carcinogenic health risks. Incremental lifetime cancer risks were within allowable limits. In conclusion, the concentrations of heavy metals in peanuts and date palms from the Jigjiga market are within safe limits set by the WHO.

Abstract Background The emergence and rapid spread of gram-negative bacteria resistant to carbapenems among newborns is concerning on a global scale. Nonetheless, the pooled estimate of gram-negative bacteria resistant to carbapenem that cause neonatal sepsis in developing nations remains unknown. Thus, this study aimed to determine the combined prevalence of gram-negative bacteria resistant to carbapenem in African newborns who were suspected of having sepsis. Methods All studies published from January 1, 2010, up to December 30, 2023, from PubMed, Science Direct, Scopus electronic databases, and the Google Scholar search engine were researched. Isolates tested for carbapenem from neonates with sepsis, English language papers conducted in Africa, and cross-sectional and cohort studies papers were included. Using PRISMA guidelines, we systematically reviewed and meta-analyzed studies that assessed the prevalence of carbapenem-resistant gram-negative bacteria. The “Joanna Briggs Institute” was used critically to evaluate the quality of the included studies. The data analysis was carried out using STATA™ version 17. Heterogeneity across the studies was evaluated using Q and I 2 tests. The subgroup analysis was done and, funnel plot and Egger’s regression test were used to detect publication bias. A sensitivity analysis was conducted. Results All 36 studies were included in the meta-analysis and systematic review. The pooled prevalence of carbapenem resistance in Africa was 30.34% (95% CI 22.03–38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, and meropenem was 35.57% (95% CI 0.67–70.54%) and 34.35% (95% CI 20.04% – 48.67%), respectively. A. baumannii and Pseudomonas spp. had pooled prevalence of 45.9% (95% CI 33.1–58.7%) and 43.0% (95% CI 23.0–62.4%), respectively. Similarly, Pseudomonas spp. and A. baumannii also exhibited strong meropenem resistance, with a pooled prevalence of 29.2% (95% CI 4.8–53.5%) and 36.7% (95% CI 20.1–53.3%), respectively. E. coli and K. pneumoniae were the two most common isolates. Conclusion There should be urgent antimicrobial stewardship practices, strengthened surveillance systems and effective treatment for neonates with sepsis. There was remarkable variation in resistance across the continent.

Many medicinal plants and their essential oils are used to treat or prevent diseases without the risk of mutagenicity, carcinogenicity, or teratogenicity. Eucalyptus essential oils are commonly used as preservatives, flavoring agents, and various consumer goods. Eucalyptus leaves are being widely studied due to their volatile essential oils, including 1,8-cineole, p-cymene, α- and β-pinene, limonene, citronellal, citral, eudesmol, terpinen-4-ol, terpineol, α–phellanderene, and 9β-sitosterol. Among these compounds, 1,8-cineole is the most abundant. Eucalyptus leaves are rich in flavonoids and phenolic compounds and are thus a great source of antioxidants. 2,2-Diphenyl-1-picrylhydrazyl (DPPH), ferric reducing antioxidant power (FRAP), and 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assays were used to measure antioxidant capacity. The antioxidant activity of Eucalyptus essential oil is stronger than that of standard antibiotics such as erythromycin, cefixime, and gentamicin due to the presence of significant terpenoids in addition to phenolic chemicals and flavonoids. A lower IC50 indicates greater antioxidant potential. Phenolic compounds and flavonoids are often associated with beneficial health outcomes, including anti-inflammatory and antioxidant effects, anticancer properties, reduced risk of cardiovascular diseases, prevention of age-related neurodegenerative diseases, and prevention of Alzheimer’s disease. Flavonoids also play essential roles in plants, including protecting against reduction, fertility, reproduction, and infection. Due to their anti-inflammatory, antioxidative, and immunomodulatory properties, flavonoids are crucial for pharmacological, medical, and nutraceutical applications.

Background: The genetic diversity of Mycobacterium tuberculosis complex (MTBC) strains was characterized among isolates from individuals with pulmonary tuberculosis (PTB) symptoms attended holy water sites (HWSs) in the Amhara region, Ethiopia. Methods: A cross-sectional study was done from June 2019 to March 2020 to describe the genetic diversity and drug-resistance profiles of MTBC isolates. Sputum specimens were collected and cultured in the Löwenstein-Jensen culture medium. Line Probe Assay, MTBDRplus VER 2.0, and MTBDRsl VER 2.0 were used to detect first-and second-line anti-TB drug-resistance patterns. A spoligotyping technique was utilized to characterize the genetic diversity. Statistical analysis was performed using STATA 15. Results: Of 560 PTB-symptomatic participants, 122 (21.8%) were culture-positive cases. Spoligotyping of 116 isolates revealed diverse MTBC sublineages, with four major lineages: Euro-American (EA) (Lineage 4), East-African-Indian (EAI) (Lineage 3), Ethiopian (ETH) (Lineage 7), East Asian (EA) (Lineage 2). The majority (96.6%) of the isolates were EA (lineage 4) and EAI, with proportions of 54.3% and 42.2%, respectively. A total of 31 spoligotype patterns were identified, 26 of which were documented in the SITVIT2 database. Of these, there were 15 unique spoligotypes, while eleven were grouped with 2-17 isolates. SIT149/T3-ETH (n = 17), SIT26/CAS1-DELHI (n = 16), SIT25/CAS1-DELHI (n = 12), and SIT52/T2 (n = 11) spoligotypes were predominant. A rare spoligotype pattern: SIT41/Turkey and SIT1/Beijing, has also been identified in North Shewa. The overall clustering rate of sub-lineages with known SIT was 76.4%.Of the 122 culture-positive isolates tested, 16.4% were resistant to rifampicin (RIF) and/or isoniazid (INH). Multidrug-resistant TB (MDR-TB) was detected in 12.3% of isolates, five of which were fluoroquinolones (FLQs) resistant. SIT149/T3-ETH and SIT21/CAS1-KILI sublineages showed a higher proportion of drug resistance. Conclusions: Diverse MTBC spoligotypes were identified, with the T and CAS families and EA (lineage 4) predominating. A high prevalence of drug-resistant TB, with SIT149/T3-ETH and CAS1-KILI sublineages comprising a greater share, was observed. A study with large sample size and a sequencing method with stronger discriminatory power is warranted to understand better the genetic diversity of circulating MTBC in this cohort of study, which would help to adopt targeted interventions.

PurposeThis study examined the patterns and frequency of genetic changes responsible for resistance to first-line (rifampicin and isoniazid), fluoroquinolones, and second-line injectable drugs in drug-resistant Mycobacterium tuberculosis (MTB) isolated from culture-positive pulmonary tuberculosis (PTB) symptomatic attendees of spiritual holy water sites (HWSs) in the Amhara region.Patients and methodsFrom June 2019 to March 2020, a cross-sectional study was carried out. A total of 122 culture-positive MTB isolates from PTB-suspected attendees of HWSs in the Amhara region were evaluated for their drug resistance profiles, and characterized gene mutations conferring resistance to rifampicin (RIF), isoniazid (INH), fluoroquinolones (FLQs), and second-line injectable drugs (SLIDs) using GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0. Drug-resistant MTB isolates were Spoligotyped following the manufacturer’s protocol.ResultsGenetic changes (mutations) responsible for resistance to RIF, INH, and FLQs were identified in 15/122 (12.3%), 20/122 (16.4%), and 5/20 (25%) of MTB isolates, respectively. In RIF-resistant, rpoB/Ser531Lue (n = 12, 80%) was most frequent followed by His526Tyr (6.7%). Amongst INH-resistant isolates, katG/Ser315Thr1 (n = 19, 95%) was the most frequent. Of 15 MDR-TB, the majority (n = 12, 80%) isolates had mutations at both rpoB/Ser531Leu and katG/Ser315Thr1. All 20 INH and/or RIF-resistant isolates were tested with the MTBDRsl VER 2.0, yielding 5 FLQs-resistant isolates with gene mutations at rpoB/Ser531Lue, katG/Ser315Thr1, and gyrA/Asp94Ala genes. Of 20 Spoligotyped drug-resistant MTB isolates, the majority (n = 11, 55%) and 6 (30%) were SIT149/T3-ETH and SIT21/CAS1-Kili sublineages, respectively; and they were any INH-resistant (mono-hetero/multi-). Of 15 RIF-resistant (RR/MDR-TB) isolates, 7 were SIT149/T3-ETH, while 6 were SIT21/CAS1-Kili sublineages. FLQ resistance was detected in four SIT21/CAS1-Kili lineages.ConclusionIn the current study, the most common gene mutations responsible for resistance to INH, RIF, and FLQs were identified. SIT149/T3-ETH and SIT21/CAS1-Kili constitute the majority of drug-resistant TB (DR-TB) isolates. To further understand the complete spectrum of genetic changes/mutations and related genotypes, a sequencing technology is warranted.

BackgroundProfessional licensing bodies are valuable sources for tracking the health workforce, as many skilled health-care providers require formal training, registration, and licensure. Regulatory activities in Ethiopia were not effectively implemented due to poor follow-up and gaps in skilled human resources, budget, and information technology infrastructure.ObjectiveThe aim of this study was to explore and describe the lived experiences and challenges faced by health care managers in health professionals' licensure practices in Ethiopia.MethodsA cross-sectional study design with a phenomenological approach was employed between March 26 and April 30, 2021, to collect qualitative data. We conducted in-depth interviews with a total of 32 purposively selected health system managers. An interview guide was prepared in English, translated into Amharic, and then pretested. Audio recorded data was transcribed verbatim, translated, and analysed manually by themes and sub-themes. A member check was done to check the credibility of the result.ResultsThe data revealed four major themes: awareness of licensing practices, enforcement of licensing practices, systems for assuring the quality of licensing practices, and challenges to licensing practices. Lack of awareness among managers about health workforce licensing was reported, especially at lower-level employers. Regulators were clear on the requirements to issue a licence to the health workforce if they are competent in the licensing exam, while human resource managers do not emphasise whether the employees have a licence or not during employment. As a result of this, non-licenced health workers were employed. Health care managers mentioned that they did not know any monitoring tools to solve the issue of working without a licence. Fraudulent academic credentials, shortage of resources (human resources, finance, equipment, and supplies), and weak follow-up and coordination systems were identified as main practice challenges.ConclusionsThis study reported a suboptimal health professionals' licensing practice in Ethiopia, which is against the laws and proclamations of the country that state to employ all health workers only with professional licenses. Challenges for health professionals' licensing practice were identified as fraudulent academic credentials, a shortage of resources (HR, finance, equipment, and supplies), and a weak follow-up and coordination system. Further awareness of licensing practices should be created, especially for lower-level employers. Regulators shall establish a reliable digital system to consistently assure the quality of licensing practices. Health care managers must implement mechanisms to regularly monitor the licensing status of their employees and ensure that government requirements are met. Collaboration and regular communication between regulators and employers can improve quality practices.

BackgroundDespite the decline in tuberculosis (TB) incidence across many regions worldwide, including Ethiopia, the disease remains highly concentrated among vulnerable or socially marginalized populations and in high-risk settings. This systematic review and meta-analysis aims to estimate the pooled prevalence of pulmonary tuberculosis (PTB) among key and vulnerable populations (KVPs) residing in hotspot settings in Ethiopia.MethodsPotential papers were searched systematically in PubMed, Scopus, ScienceDirect databases, Google Scholar search engine, and institutional electronic repositories/registrars. A total of 34 potential articles that provide necessary information on the prevalence of PTB were reviewed and data were analyzed to determine the pooled prevalence of PTB among KVPs. The relevant data were recorded and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled prevalence of PTB, subgroup analysis was computed by types of hotspot settings and year of publication.ResultsThis meta-analysis demonstrates that the pooled prevalence of PTB among populations residing in hotspot settings in Ethiopia was 11.7% (95% confidence interval (95CI): 7.97-15.43) with an I2 of 99.91% and a p< 0.001. Furthermore, the subgroup analysis unveiled the pooled prevalence of PTB among KVPs residing in different hotspot settings as follows: Prison inmates 8.8% (95CI: 5.00-12.55%), University students 23.1% (95CI: 15.81-30.37%), Refugees 28.4% (95CI: -1.27-58.15%), Homeless peoples 5.8% (95CI: -0.67-12.35%), Healthcare settings 11.1% (95CI: 0.58-21.63%), Spiritual holy water sites attendees 12.3% (95CI: -6.26-30.80%), and other high-risk settings 4.3% (95CI: 0.47-8.09%). Besides, the subgroup analysis revealed that the pooled prevalence of PTB post-2015 was 10.79% (95CI: 5.94-15.64%), whereas it stood at 14.04% (95CI: 10.27-17.82%) before 2015.ConclusionThe prevalence of PTB among KVPs residing in the hotspot settings in Ethiopia remains significant, with a weighted pooled prevalence of 11.7%. Thus, the national TB control programs should give due attention and appropriate control measures should be instituted that include regular systematic TB screening, compulsory TB testing for presumptive TB cases among KVPs, and tightened infection control at hotspot settings.

BackgroundAntimicrobial-resistant (AMR) bacterial infection is a significant global threat to the healthcare systems. Pseudomonas aeruginosa, the leading infectious agent in the healthcare setting is now one of the major threats due to AMR. A comprehensive understanding of the magnitude of AMR, particularly highly public health important pathogens such as P. aeruginosa, is necessary for the management of infections based on local information.ObjectiveThis systematic review and meta-analysis aimed to determine the country-wide AMR of P. aeruginosa.MethodsSystematic searches were performed to retrieve articles from PubMed, Scopus, Web of Science, ScienceDirect electronic databases, Google Scholar search engine, and repository registrars from 2015 to 31st December 2023. Twenty-three studies that provided important data on AMR in P. aeruginosa were systematically reviewed and analyzed to determine the country-wide magnitude of P. aeruginosa AMR profile from healthcare-associated infections. AMR of P. aeruginosa to 10 different antibiotics were extracted separately into Microsoft Excel and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) was used to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled resistance to each antibiotic. Subgroup analysis was performed by infection type and year of publication.ResultsThis systematic review and meta-analysis revealed that the pooled prevalence of P. aeruginosa in clinical specimens associated with HAI was 4.38%(95%CI: 3.00-5.76). The pooled prevalence of AMR in P. aeruginosa for different antibiotics varies, ranging from 20.9% (95%CI: 6.2-35.8) for amikacin to 98.72% (95%CI: 96.39-101.4) for ceftriaxone. The pooled resistance was higher for ceftriaxone (98.72%), Trimethoprim-sulfamethoxazole (75.41), and amoxicillin-clavulanic acid (91.2). In contrast relatively lower AMR were observed for amikacin (20.9%) and meropenem (28.64%). The pooled multi-drug resistance (MDR) in P. aeruginosa was 80.5% (95%CI: 66.25-93.84). Upon subgroup analysis by infection types and year of publication, P. aeruginosa isolated from healthcare-associated infections exhibited higher resistance to ceftazidime (94.72%) compared to isolates from mixed types of healthcare-associated infections (70.84%) and surgical site infections (57.84%). Antimicrobial resistance in gentamicin was higher during the periods of 2018-2020 (73.96%), while comparatively lower during 2021-2023 (42.69%) and 2015-2017 (29.82%).ConclusionsSignificantly high AMR and MDR were observed from this systematic review and meta-analysis. AMR obtained from this systematic review and meta-analysis urges the need for improved infection control, antimicrobial stewardship practices, and strengthened surveillance systems to control the spread of AMR and ensure effective treatment of P. aeruginosa infections.Protocol registrationThis systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024518145).

Ethiopia is a high-tuberculosis (TB) burden country with 157 new cases per 100,000 people, with 23,800 TB-related deaths in 2020. In Ethiopia, TB patients have different healthcare-seeking behaviors. They frequently visit spiritual places, such as holy water sites (HWSs), to seek treatment for their illness spiritually. This study examined the prevalence of pulmonary TB (PTB) and drug susceptibility profiles of Mycobacterium tuberculosis (MTB) isolates among spiritual HWS attendees in Northwest Ethiopia. A cross-sectional study was conducted from June 2019 to March 2020. Sputum samples were collected, processed, and cultured using Löwenstein–Jensen (LJ) culture medium. Second-generation line probe assays (LPAs), GenoType®MTBDRplus VER2.0 and GenoType®MTBDRsl VER2.0, were used to detect anti-TB drug-resistant isolates. STATA 17 was utilized to perform descriptive statistics, bivariate, and multivariate regression analyses. Of 560 PTB-symptomatic participants, 21.8% ((95% confidence interval (95 CI): 18.4–25.2%)) were culture-positive, resulting in a point prevalence of 1,183/100,000 attendees. Amongst HWS attendees, culture-positive TB occurred most commonly in persons 18–33 years of age (28.5% (95 CI 23.4–34.3%)). Other participant characteristics significantly associated with culture-positive PTB were as follows: rural residents (adjusted odds ratio (aOR) 2.65; 95 CI 1.38–5.10), married participants (aOR 2.43; 95 CI 1.28–4.63), family members >5 per household (aOR 1.84; 95 CI 1.04–3.24), and sharing living space (aOR 10.57; 95 CI 3.60–31.13). Also, among 438 participants followed for 12 months after showing negative TB culture results while at the HWS, 6.8% (95 CI 4.4–9.4%) developed or contracted culture-positive TB post-residency at the HWSs. Of the 122 tested isolates, 20 (16.4%) were isoniazid (INH) and/or rifampicin (RIF) resistant. Multidrug-resistant (MDR) TB was detected in 15 cases (12.3%), five of which were fluoroquinolones (FLQs) resistant. The findings from this study should raise a concern about HWSs as potential high-risk settings for TB transmission. It is recommended that appropriate control measures be instituted that include compulsory TB testing and tightened infection control at HWSs, where an increased risk exists for transmission of TB.

Introduction: The population structure of Mycobacterium tuberculosis complex (MTBC) in Ethiopia is diverse but dominated by Euro-American (Lineage 4) and East-African-Indian (Lineage 3) lineages. The objective of this study was to describe the genetic diversity of MTBC isolates in Central, Eastern and Southeastern Ethiopia. Methods: A total of 223 MTBC culture isolates obtained from patients referred to Adama and Harar TB reference laboratories were spoligotyped. Demographic and clinical characteristics were collected. Results: Six major lineages: Euro-American (Lineage 4), East-African-Indian (Lineage 3), East Asian (Lineage 2), Indo-Oceanic (Lineage 1), Mycobacterium africanum (Lineage 5 and Lineage 6) and Ethiopian (Lineage 7) were identified. The majority (94.6 %) of the isolates were Euro-American and East-African-Indian, with proportions of 75.3 % and 19.3 %, respectively. Overall, 77 different spoligotype patterns were identified of which 42 were registered in the SITVIT2 database. Of these, 27 spoligotypes were unique, while 15 were clustered with 2–49 isolates. SIT149/T3_ETH (n = 49), SIT53/T1 (n = 33), SIT21/CAS1_Kili (n = 24) and SIT41/Turkey (n = 11) were the dominant spoligotypes. A rare Beijing spoligotype pattern, SIT541, has also been identified in Eastern Ethiopia. The overall clustering rate of sub-lineages with known SIT was 71.3 %. Age group (25–34) was significantly associated with clustering. Conclusion: We found a heterogeneous population structure of MTBC dominated by T and CAS families, and the Euro-American lineage. The identification of the Beijing strain, particularly the rare SIT541 spoligotype in Eastern Ethiopia, warrants a heightened surveillance plan, as little is known about this genotype. A large-scale investigation utilizing a tool with superior discriminatory power, such as whole genome sequencing, is necessary to gain a thorough understanding of the genetic diversity of MTBC in the nation, which would help direct the overall control efforts.

AbstractConventional rice milling produces a high percentage (40%) of rice breakage. The parboiling process is, therefore, considered the best solution for reducing the susceptibility of the rice grain to breakage in addition to varietal characteristics and quality of milling machine. The parboiling process hardens the rice kernel enabling it to withstand the machine’s impact and reduce breakage during the milling process. The objective of this study was determining of the milling quality of a short-grain Ethiopian rice variety (Selam). A full factorial design was used to study the effects of the parboiling factors in CRD arrangement. The factors were soaking temperatures (40, 60, and 80°C), soaking times (6, 12, and 24 hours), and steaming times (15, 25, and 35 minutes) compared with the non-parboiled rice as a control using controlled randomized design. The result showed that combinations of treatments had significant (P ≤ 0.05) differences in the quality parameters, such as percentage of broken rice, head rice yield, and total milling recovery during milling, compared to the control. The minimum and maximum percentages of breakage for parboiled rice were 0.95 and 9.30%, which were recorded at soaking temperatures, soaking time, and steaming time of 80°C, 24 hours and 35 minutes, and 40°C, 6 hours, and 15 minutes, respectively, in contrast to the non-parboiled rice (41.73% breakage). The result showed that the highest milling recovery (90.40%) was obtained at 40°C soaking temperature, 6 hours of soaking time, and 15 minutes of steaming time compared to the control (79.30%).

Introduction: Paternal postnatal depression is a type of depression that occurs among male partners after childbirth. Although the problem has a multidimensional impact, there is limited data in low-income countries, including Ethiopia. Therefore, this study aimed to uncover this problem in the study setting. Objective: To assess paternal postnatal depression and associated factors. Method and study period: A community-based cross-sectional study was employed from April 1 to 30, 2023, among 423 fathers in Mattu Town, Southwest Ethiopia. A face-to-face interviewer administered a structured questionnaire prepared by the Open Data Kit tool. The study participants were selected by simple random sampling techniques. A binary and multivariable logistic regression analysis was used. Both crude and adjusted odds ratios with a 95% confidence interval were calculated, and a p -value of less than 0.05 was used. Result: Among 423 fathers, 412 participated, making the response rate 97.40%. The prevalence of paternal postnatal depression was 29.37% (95% confidence interval: 24.95%, 31.25). The poor wealth index (adjusted odds ratio (AOR): 1.67; 95% confidence interval: 1.88, 3.14), loneliness (AOR: 1.81; 95% confidence interval: 1.20, 3.20), poor social support (AOR: 6.08; 95% confidence interval: 2.55, 14.48), feeling of family income stress (AOR: 3.22; 95% confidence interval: 1.89, 5.50), and history of adverse pregnancy outcome (AOR: 3.00; 95% confidence interval: 1.62, 0.59) were significant associated factors at p -value less than 0.05. Conclusions: The study identified nearly 3 in 10 fathers suffering from paternal postnatal depression. Therefore, the Ministry of Health and other concerned bodies should focus on this population group to alleviate it. In addition, health professionals and extension workers should provide evidence-based care plans based on the identified factors.

Abstract Introduction Hand hygiene compliance is the problem of developing nations particularly in Sub-Saharan Africa including Ethiopia. Despite a lot of efforts have been employed, healthcare-associated infections are the existing health care problems, leading to impaired quality of life, prolonged hospital stays, increased healthcare costs, morbidity and mortality. This study aimed to assess the magnitude and factors associated with hand hygiene compliance among health care providers working at the primary hospitals of Waghimira Zone, Northeast Ethiopia. Methods Facility-based cross-sectional study design supplemented with qualitative research method was employed at the primary hospitals of Waghimira Zone from March 02–15, 2020. Simple random sampling using lottery method was applied to select 253 study participants. The data were coded on pre-arranged coding sheet and entered into Epi-Data version 3.1 and exported to SPSS version 25 for analysis. Descriptive statistics were displayed using tables and figures. Binary logistic regression analysis was used to test associations between the independent and the outcome variable. Multivariable logistic regression analysis was fitted to identify the independent predictors of hand-hygiene compliance at p-value

In this article we report on an exploration of leadership and context for the improvement of quality education in South African socioeconomic-deprived school contexts viewed through Hellinger's contextual theory, open systems theory, Bronfenbrenner's ecology of human development, and Bourdieu's theory of field, habitus and power. A post positivistic approach allowed for a quantitative research design which employed an interpretivist lens to use the theory and the context to interpret the numbers. A self-designed questionnaire was used for the data collection. We analysed the data by means of the Statistical Package for the Social Sciences (SPSS) analysis program and evaluated using a Likert scale. In the study reported on here, the mean scores -- sorted from the highest, which means the most important factor, to the lowest -- are presented. The findings reveal that low teacher professionalism and non-compliance to the regulations, contextual factors outside the schools (teenage pregnancy, vandalism), learners' circumstantial challenges, high accountability by the department without considering schools' contextual factors, and a lack of parental involvement in the teaching-learning process were among the biggest challenges for principals to influence quality education.

Ermias Solomon Yalew, Ashenafi Zemed Melese, Yisak Girma Guadie, Moges Gashaw Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, EthiopiaCorrespondence: Ermias Solomon Yalew, Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia, Tel +251928991466, Email sermias131@gmail.comBackground: Adherence to prescribed exercise is linked to improved treatment results for physical performance and function. Failure to adhere to the home-exercise program will adversely affect the outcome of the treatment, decrease the treatment’s efficacy, and be a cause for physiotherapists to alter treatment unnecessarily. The effectiveness of physical exercise can be determined when the patient complies with exercise therapy. Hence, this study aimed to assess patient adherence to home-based exercise programs and identify the predictors that affect the adherence of patients to home-based exercise programs.Methods: From April 1st to May 30th, 2021, a prospective multi-institution cross-sectional study was conducted at the comprehensive specialized hospitals of Gondar University, Felege Hiwot, and Tibebe Ghion. Data from 300 participants were collected through face-to-face interviews and patient medical file reviews. Binary logistic regression was done to identify predictors of patient adherence to home exercise programs with SPSS version 20. The strength of the association was represented by the adjusted odds ratio.Results: A 95.84% (n=300) response rate with 18– 80 years age range participated in this study. Among the study participants, 35.3% (n=106) (95% CI: 29.7– 40.3) of them were found adherent to home-based exercise programs. Age (adjusted OR 3.13 (1.031– 9.507)), gender (AOR 2.67 (1.322– 6.923)), education level (AOR 4.34 (1.101– 17.070)), occupation (adjusted OR 4.89 (1.184– 20.228)), remembering exercise (adjusted OR 2.62 (1.116– 6.161)), and patient interest in exercise (adjusted OR 3.08 (1.103– 8.574)) were independent predictors of exercise adherence.Conclusion: The proportion of adherence to home exercise programs was relatively poor. Older age, being female, uneducated, employed, and busy work status patients had a high tendency of non-adherence. Forgetfulness, perceived exercise is boring, or no interest had negative affect on their adherence.Keywords: adherence, home-based exercise, physiotherapy, exercise, Ethiopia

ABSTRACT: Objectives: Globally, the incidence and mortality of tuberculosis (TB) are declining; however, low detection of drug-resistant disease threatens to reverse current progress toward global TB control. Multiple rapid molecular diagnostic tests have recently been developed to detect genetic mutations in Mycobacterium tuberculosis (Mtb) known to confer drug resistance. However, their utility depends on the frequency and distribution of resistance-associated mutations in the pathogen population. This review aimed to assess the prevalence of gene mutations associated with rifampicin (RIF)- and isoniazid (INH)-resistant Mtb in Ethiopia.Methods: We searched the literature in PubMed/MEDLINE, Web of Science, Scopus and Cochrane Library. Data analysis was conducted in Stata 11.Results: Totally, 909 (95.8%) of 949 INH-resistant Mtb isolates had detectable gene mutations: 95.8% in katG315 and 5.9% in the inhA promoter region. Meta-analysis resulted in an estimated pooled prevalence of katGMUT1(S315T1) of 89.2% (95% CI 81.94–96.43%) and a pooled prevalence of inhAMUT1(C15T) of 77.5% (95% CI 57.84–97.13%). Moreover, 769 (90.8%) of 847 RIF-resistant strains had detectable rpoB gene mutations. Meta-analysis resulted in a pooled prevalence of rpoBMUT3(S531L) of 74.2% (95% CI 66.39–82.00%).Conclusion: RIF-resistant Mtb were widespread, particularly those harbouring rpoB(S531L) mutation. Similarly, INH-resistant Mtb with katG(S315T1) and inhA(C15T) mutations were common. Tracking S531L, S315T1 and C15T mutations among RIF- and INH-resistant isolates, respectively, would be diagnostically and epidemiologically valuable. Rapid diagnosis of RIF- and INH-resistant Mtb would expedite modification of TB treatment regimens, and proper timely infection control interventions could reduce the risk of development and transmission of multidrug-resistant TB.

Objectives: Although neonatal near miss is an emerging concept and a tool for improving neonatal care, its magnitude and associated factors are less researched in Ethiopia. Thus, this study was aimed to uncover the magnitude of neonatal near miss and its associated factors in public hospitals in Eastern Ethiopia. Methods: A facility-based cross-sectional study was employed on a randomly selected 405 mother–neonate pairs. An interview using a structured questionnaire accompanied by review of medical records was used to collect data from the mothers and records of the neonates. Neonatal near miss was defined as having any of the pragmatic (gestational age

Wolde Melese Ayele Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaCorrespondence: Wolde Melese Ayele Email wolde400@gmail.comPurpose: Appendicitis is surgical emergency that might need removal of the inflamed appendix. Unless treated, appendicular abscess, perforation, and even death might be the unfavorable outcomes. Hence, this study was aimed to investigate the unfavorable outcomes and associated factors among appendicitis operated patients.Patients and Methods: A total of 300 patients who operated for appendicitis from September 1 2019 to August 30 2020 were studied using a retrospective cross-sectional study. Data were collected by using a checklist. Epi-data and SPSS version 25 were used for data entry and analysis, respectively. Binary logistic regression model was used to identify independent factors. A p< 0.05 was used to set the statistical significance of factors.Results: Among 300 patients who were operated for acute appendicitis, 36 (12%) developed unfavorable outcomes. Though one death because of sepsis was recorded, wound infection was the main postoperative disorder. Female (AOR=0.49; 95% CI: 0.13– 0.074), living outside the hospital setting (AOR= 0.49; 95% CI: 0.13– 0.074), duration of illness before arrival at the hospital (1– 3 days (AOR= 1.67; 95% CI: 1.34– 8.37) and ≥ 4 days (AOR=5.38; 95% CI: 1.63– 7.69)), more than 3 days hospital stay (AOR= 3.21; 95% CI: 2.06– 8.10), and mass in the right lower quadrant (AOR= 6.01; 95% CI: 2.11– 14.50) were the independent predictors of unfavorable outcomes of appendicitis treatment.Conclusion: In this study, unfavorable outcome of acute appendicitis was high. More than one-tenth of appendicitis cases developed unfavorable outcomes. Living outside the hospital setting area, long duration of illness before arrival at the Hospital, more than 3 days hospital stay, and mass in the right lower quadrant were the risk factors, while females were less likely to have unfavorable outcomes of appendicitis. Therefore, closely working with patients who have abdominal pain and increasing their awareness about acute appendicitis will improve the operation outcome.Keywords: acute appendicitis, associated factors, treatment outcome

Wolde Melese Ayele Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Wollo University, Dessie, EthiopiaCorrespondence: Wolde Melese Ayele Email wolde400@gmail.comPurpose: Coronavirus disease-2019 is an emerging disease that threatens the world. With the absence of successful treatment precipitated by the lack of health infrastructures in developing countries including Ethiopia, efforts to enhance the attitudes and practice of people are critical for managing the pandemic. Hence, this study aimed to assess the practice, attitude towards COVID-19, and divine belief among residents in Ethiopia.Patients and Methods: A community-based cross-sectional study combining qualitative design was conducted in August 2020. The qualitative design was employed to explore the respondents’ divine belief towards the COVID-19 pandemic. Chi-square analysis was computed to identify factors associated with practice against COVID-19 prevention measures. The calculated chi-square greater than the tabulated value at a degree of freedom ((row total-1) * (column total)) and P-value < 0.05 were considered statistically significant.Results: In this study, a total of 508 respondents participated. The mean age of the participants was 38.4 ± 11.2 (SD) years. The overall practice of prevention measures and attitude towards COVID-19 was 53.3% (95% CI: 49.0– 57.6%) and 49.6% (95% CI: 45.3– 53.9%), respectively. Age, residency, educational status, monthly income of the household, having a child, and attitude towards COVID-19 were statistically significant predictors of COVID-19 prevention measures (P< 0.05).Conclusion: As the global threat of COVID-19 continues, it is critical to improving the respondents’ practice and attitude towards the precautionary measures, especially some religious followers.Keywords: COVID-19, practice, attitudes, divine belief, Ethiopia

Ukba Asefa,1 Wolde Melese Ayele2 1Department of Gynecology and Obstetrics, Dessie Specialized Referral Hospital, Dessie, Amhara Regional State, Ethiopia; 2Department of Epidemiology and Biostatistics, Wollo University, Dessie, Amhara Regional State, EthiopiaCorrespondence: Wolde Melese AyeleDepartment of Epidemiology and Biostatistics, Wollo University, Dessie 1145, EthiopiaTel +251921885231Email wolde400@gmail.comPurpose: It is known that being pregnant at any reproductive age is not risk-free. Aside from this, older gravidity usually ends up with adverse outcomes both to the mother and newborn. Hence, the aim of this study was to investigate the association of adverse maternal and perinatal outcomes with advanced maternal age pregnancy in Northeastern Ethiopia.Methods: A hospital-based comparative cross-sectional study was employed among pregnant mothers. The study was conducted among advanced age (≥ 35 years, n= 398) mothers and adult age (20– 34 years, n=398) mothers. Socio-demographic, obstetrics, and pregnancy outcomes were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records and comparing the two groups. Bivariable and multivariable logistic regressions were done to determine factors associated with maternal and perinatal outcomes. The magnitude of the association was measured using odds ratio at 95% confidence level and statistical significance was declared at a P-value of < 0.05.Results: Advanced age mothers had significantly higher adverse pregnancy outcomes (64.6% vs 37.8%) compared with adult age mothers. This study shows that advanced maternal age is statistically associated with pregnancy-induced hypertension (AOR=3.14, 95% CI: 1.931– 5.089), antepartum hemorrhage (AOR=2.22, 95% CI: 1.245– 3.942), a cesarean delivery (AOR=2.59, 95% CI: 1.775– 3.790), and postpartum hemorrhage (AOR=2.01, 95% CI: 1.445– 2.819). Moreover, advanced maternal age pregnancy was also a risk factor for preterm delivery (AOR=3.01, 95% CI: 1.441– 6.297), low birth weight (AOR=3.08, 95% CI: 1.735– 5.492), low fifth minute Apgar score (AOR=3.99, 95% CI: 2.099– 7.618), and perinatal death (AOR= 2.46, 95% CI: 1.360– 4.42).Conclusion: In this study, adverse pregnancy and perinatal outcomes among advanced aged mothers were high in a specialized hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. Therefore, healthcare providers, the specialized hospital, and policymakers should give due emphasis to the effective intervention of advanced age pregnant mothers.Keywords: advanced maternal age, pregnancy, adverse obstetric outcome, adverse perinatal outcomes, Ethiopia

Abstract Background Human immunodeficiency virus (HIV) infection is a global health problem. The epidemic is very serious in sub-Saharan Africa with approximately 70% of the global cases. The disease particularly affects youth, accounting for half of the new HIV infections yearly. Inadequate knowledge may contribute to the high rates among youth. Hence, the main aim of this study was to examine the association between residence and comprehensive HIV knowledge among women aged 15–24 years in Ethiopia. Methods This cross-sectional study used nationally representative data from the 2016 Ethiopian demographic health survey (n = 5926). Chi-square tests and multivariable logistic regression modeling were performed. Results Approximately 23.9% of the study participants had a comprehensive HIV knowledge and 74.7% were rural residents. In the multivariable-adjusted model, we found a significant interaction between place of residence and HIV testing on comprehensive HIV knowledge (P for interaction = 0.005). In the subgroup analysis, a statistically significant associations between place of residence and comprehensive HIV knowledge was found only in women who have never been tested for HIV. In this subgroup, rural women had lower odds of having a comprehensive HIV knowledge compared to their urban counterparts (OR 0.42, 95% CI: 0.23–0.74; P = 0.003). Furthermore, in the subgroup of women who have never been tested for HIV, education and region were significantly associated with comprehensive HIV knowledge. Compared to women with no education, the odds of having a comprehensive HIV knowledge were higher in women who had primary (OR 2.86, 95% CI: 1.63–5.02; P

Abstract Background Neonatal hypothermia is a global health problem and a major factor for neonatal morbidity and mortality, especially in low and middle-income countries. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of neonatal hypothermia and its associated factors in Eastern Africa. Methods We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search electronic databases (PubMed, Cochrane Library and Google Scholar; date of last search: 15 October 2019) for studies reporting the prevalence and associated factors of neonatal hypothermia. The data was extracted in the excel sheet considering prevalence, and categories of associated factors reported. A weighted inverse variance random-effects model was used to estimate the magnitude and the effect size of factors associated with hypothermia. The subgroup analysis was done by country, year of publication, and study design. Results A total of 12 potential studies with 20,911 participants were used for the analysis. The pooled prevalence of neonatal hypothermia in East Africa was found to be 57.2% (95%CI; 39.5–75.0). Delay in initiation of breastfeeding (adjusted Odds Ratio(aOR) = 2.83; 95% CI: 1.40–4.26), having neonatal health problem (aOR = 2.68; 95% CI: 1.21–4.15), being low birth weight (aOR =2.16; 95%CI: 1.03–3.29), being preterm(aOR = 4.01; 95%CI: 3.02–5.00), and nighttime delivery (aOR = 4.01; 95% CI:3.02–5.00) were identified associated factors which significantly raises the risk of neonatal hypothermia. Conclusions The prevalence of neonatal hypothermia in Eastern Africa remains high. Delay in initiation of breastfeeding, having a neonatal health problem, being low birth weight, preterm, and nighttime delivery were identified associated factors that significantly raises the risk of neonatal hypothermia.

BackgroundThe rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated.AimThe aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries.MethodsEnglish published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird's random Effects model. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis.ResultsOut of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa.ConclusionThe review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.

The current study was conducted on workers in the printing industry in Addis Ababa, the capital and largest city of Ethiopia, which has grown significantly in recent years, providing work for a large number of people whose health motivates us to carry out this work. Because these workers handle substances that appear innocuous but are toxic to human health, such as paint products like VOCs, inhaling these volatile and organic solvents is involuntary. If chronic, it manifests in various symptomatic forms in humans, such as changes in psychomotor function or organ damage, highlighting the need to investigate and evaluate their toxicity depending on the degree of aversion and repercussions experienced by those exposed to this type of solvent. The study was conducted on 40 workers who work in randomly selected locations in Addis Ababa, Ethiopia. For the quantification of total hippuric acid and phenols in urine, two different methods were used. Finally, a survey was carried out to obtain information on the level of knowledge of the toxicity of the chemical substances that use the degree of protection; once the results of the quantitative analyses were obtained and supplemented with the data made by the personal interview, it allowed us to obtain the necessary information to carry out the statistical evaluation and thus to interpret the real substance of the occupational exposure of contamination to which these workers are exposed. The total phenols found averaged 226.61±3.62 mg/L, and hippuric acid is 2.126±0.83 g/L. These values indicate benzene and toluene exposure because they exceed WHO reference values in urine.

Autonomous driving vehicles (ADVs) are sleeping giant intelligent machines that perceive their environment and make driving decisions. Most existing ADSs are built as hand-engineered perception-planning-control pipelines. However, designing generalized handcrafted rules for autonomous driving in an urban environment is complex. An alternative approach is imitation learning (IL) from human driving demonstrations. However, most previous studies on IL for autonomous driving face several critical challenges: (1) poor generalization ability toward the unseen environment due to distribution shift problems such as changes in driving views and weather conditions; (2) lack of interpretability; and (3) mostly trained to learn the single driving task. To address these challenges, we propose a view-invariant spatiotemporal attentive planning and control network for autonomous vehicles. The proposed method first extracts spatiotemporal representations from images of a front and top driving view sequence through attentive Siamese 3DResNet. Then, the maximum mean discrepancy loss (MMD) is employed to minimize spatiotemporal discrepancies between these driving views and produce an invariant spatiotemporal representation, which reduces domain shift due to view change. Finally, the multitasking learning (MTL) method is employed to jointly train trajectory planning and high-level control tasks based on learned representations and previous motions. Results of extensive experimental evaluations on a large autonomous driving dataset with various weather/lighting conditions verified that the proposed method is effective for feasible motion planning and control in autonomous vehicles.

Background: Tuberculosis (TB) remains a significant global public health issue, despite advances in diagnostic technologies, substantial global efforts, and the availability of effective chemotherapies. Mycobacterium tuberculosis, a species of pathogenic bacteria resistant to currently available anti-TB drugs, is on the rise, threatening national and international TB-control efforts. This systematic review and meta-analysis aims to estimate the pooled prevalence of drug-resistant TB (DR-TB) in Ethiopia. Materialsand Methods: A systematic literature search was undertaken using PubMed/MEDLINE, HINARI, the Web of Science, ScienceDirect electronic databases, and Google Scholar (1 January 2011 to 30 November 2020). After cleaning and sorting the records, the data were analyzed using STATA 11. The study outcomes revealed the weighted pooled prevalence of any anti-tuberculosis drug resistance, any isoniazid (INH) and rifampicin (RIF) resistance, monoresistance to INH and RIF, and multidrug-resistant TB (MDR-TB) in newly diagnosed and previously treated patients with TB. Results: A total of 24 studies with 18,908 patients with TB were included in the final analysis. The weighted pooled prevalence of any anti-TB drug resistance was 14.25% (95% confidence interval (CI): 7.05–21.44%)), whereas the pooled prevalence of any INH and RIF resistance was found in 15.62% (95%CI: 6.77–24.47%) and 9.75% (95%CI: 4.69–14.82%) of patients with TB, respectively. The pooled prevalence for INH and RIF-monoresistance was 6.23% (95%CI: 4.44–8.02%) and 2.33% (95%CI: 1.00–3.66%), respectively. MDR-TB was detected in 2.64% (95%CI: 1.46–3.82%) of newly diagnosed cases and 11.54% (95%CI: 2.12–20.96%) of retreated patients with TB, while the overall pooled prevalence of MDR-TB was 10.78% (95%CI: 4.74–16.83%). Conclusions: In Ethiopia, anti-tuberculosis drug resistance is widespread. The estimated pooled prevalence of INH and RIF-monoresistance rates were significantly higher in this review than in previous reports. Moreover, MDR-TB in newly diagnosed cases remained strong. Thus, early detection of TB cases, drug-resistance testing, proper and timely treatment, and diligent follow-up of TB patients all contribute to the improvement of DR-TB management and prevention. Besides this, we urge that a robust, routine laboratory-based drug-resistance surveillance system be implemented in the country.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

ABSTRACT Antibiotic resistance (AR) remains a major threat to public and animal health globally. However, AR ramifications in developing countries are worsened by limited molecular diagnostics, expensive therapeutics, inadequate numbers of skilled clinicians and scientists, and unsanitary environments. The epidemiology of Gram-negative bacteria, their AR genes, and geographical distribution in Africa are described here. Data were extracted and analyzed from English-language articles published between 2015 and December 2019. The genomes and AR genes of the various species, obtained from the Pathosystems Resource Integration Center (PATRIC) and NCBI were analyzed phylogenetically using Randomized Axelerated Maximum Likelihood (RAxML) and annotated with Figtree. The geographic location of resistant clones/clades was mapped manually. Thirty species from 31 countries and 24 genera from 41 countries were analyzed from 146 articles and 3,028 genomes, respectively. Genes mediating resistance to β-lactams (including blaTEM-1, blaCTX-M, blaNDM, blaIMP, blaVIM, and blaOXA-48/181), fluoroquinolones (oqxAB, qnrA/B/D/S, gyrA/B, and parCE mutations, etc.), aminoglycosides (including armA and rmtC/F), sulfonamides (sul1/2/3), trimethoprim (dfrA), tetracycline [tet(A/B/C/D/G/O/M/39)], colistin (mcr-1), phenicols (catA/B, cmlA), and fosfomycin (fosA) were mostly found in Enterobacter spp. and Klebsiella pneumoniae, and also in Serratia marcescens, Escherichia coli, Salmonella enterica, Pseudomonas, Acinetobacter baumannii, etc., on mostly IncF-type, IncX3/4, ColRNAI, and IncR plasmids, within IntI1 gene cassettes, insertion sequences, and transposons. Clonal and multiclonal outbreaks and dissemination of resistance genes across species and countries and between humans, animals, plants, and the environment were observed; Escherichia coli ST103, K. pneumoniae ST101, S. enterica ST1/2, and Vibrio cholerae ST69/515 were common strains. Most pathogens were of human origin, and zoonotic transmissions were relatively limited. IMPORTANCE Antibiotic resistance (AR) is one of the major public health threats and challenges to effective containment and treatment of infectious bacterial diseases worldwide. Here, we used different methods to map out the geographical hot spots, sources, and evolutionary epidemiology of AR. Escherichia coli, Klebsiella pneumoniae, Salmonella enterica, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., Neisseria meningitis/gonorrhoeae, Vibrio cholerae, Campylobacter jejuni, etc., were common pathogens shuttling AR genes in Africa. Transmission of the same clones/strains across countries and between animals, humans, plants, and the environment was observed. We recommend Enterobacter spp. or K. pneumoniae as better sentinel species for AR surveillance.

Summary: Background: Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods: We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000–17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2·5th and 97·5th percentiles of those 250 draws. Findings: While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62·6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000–7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910–68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation: To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Funding: Bill & Melinda Gates Foundation.

Introduction. The burden of bloodstream infections (BSIs) has been warranted in Ethiopia. Globally, the emergency and raised resistance rate of bacterial antimicrobial resistance is becoming a prominent problem, and it is difficult to treat patients having sepsis. In this review, we aimed to determine the pooled prevalence of bacterial isolates among presumptive patients with bloodstream infections in Ethiopia. Methods. A systematic search was performed from PubMed/MEDLINE, Scopus, HINARI, ScienceDirect, and Google Scholar electronic databases using PRISMA guidelines. The data analysis was carried out using STATATM version 14 after the records were cleaned and sorted out. Results. A total of 26 studies with 8,958 blood specimens and 2,382 culture-positive bacterial isolates were included for systematic review and meta-analysis. The meta-analysis derived a pooled culture-positive bacterial prevalence which was 25.78% (95% CI: 21.55–30.01%). The estimated pooled prevalence of Gram-positive and Gram-negative bacterial isolates was 15.50% (95% CI: 12.84–18.15%) and 10.48 % (95% CI: 8.32–12.63%), respectively. The two common Gram-positive bacteria isolated from patients suspected of BSIs were coagulase-negative Staphylococcus with a pooled prevalence of 5.75% (95% CI: 4.58–6.92%) and S. aureus 7.04 % (95% CI: 5.37–8.72%). Similarly, the common Gram-negative bacterial isolates and their estimated pooled prevalence were E. coli 1.69% (95% CI: 1.21–2.16%), Klebsiella species 7.04 % (95% CI: 5.37–8.72%), Pseudomonas species 0.39% (95% CI: 0.08–0.70%), Salmonella species 1.09% (95% CI: 0.79–1.38%), and Streptococcus pyogenes 0.88% (95% CI: 0.54–1.22%). Conclusion. The prevalence of bacterial isolates among presumptive patients suspected to BSIs in Ethiopia remains high. Furthermore, we found a remarkable variation in the pathogen distribution across the study setting.

Abstract Background Neonatal mortality has persisted high in Ethiopia in spite of many efforts being applied to decrease this adverse trend. Early detection of neonatal illness is an important step towards improving newborn survival. Toward this end, there is a need for the mothers to be able to identify signs in neonates that signify severe illnesses. The aim of this study was to assess knowledge about neonatal danger signs and its associated factors among postnatal mothers attending at Woldia general hospital, Ethiopian. Methods Institutional based cross-sectional study design was conducted from January–May, 2017. The hospital that provides antenatal care (ANC), delivery, and postnatal services was purposively sampled. Structured interviewer managed questionnaire was administered to postnatal mothers attending Woldia general hospital. Frequencies, bivariate and multivariate logistic regression were determined using the SPSS software (Version 20). Results During the study period 197 mothers attending postnatal care (PNC) service at Woldia general hospital were interviewed. Information on different neonatal danger signs was not provided to 92(46.7%) postnatal mothers during their antenatal clinic attendance by the healthcare providers. The majority of mothers, 174(88.3%) identified less than six neonatal danger signs. The hotness of the body of neonates was the commonly recognized danger sign by 106(53.8%) postnatal mothers. Of the total mothers, 67(34%), 60(30.5%), 56(28.4%), 44(22.3%) recognized unable to breastfeeding, convulsion, lethargy, difficulty in breathing as newly born danger signs, respectively. Out of 197 mothers, 32(16.2%) were giving birth at home. Mother’s age(AOR = 1.33, 95% CI: 1.99–3.08), marital status(AOR = 2.50, 95% CI: 0.29–4.31), mother’s education status(AOR = 3.48, 95% CI:1.57–8.72), husband’s education(AOR = 4.92, 95% CI: 1.29–12.81), attending ANC (AOR = 2.88, 95% CI: 1.15, 4.85), mother’s residence(AOR = 0.78, 95% CI: 0.47–1.65), information about neonatal danger signs(AOR = 3.48, 95% CI 1.40–9.49) had positive association with maternal level of knowledge to identify different neonatal danger signs. Conclusion Maternal knowledge level about neonatal danger signs was very low. Therefore, intervention modalities that focus on increasing level of parental education, access to ANC and PNC service are needed.

The main purpose of the study was examining the correlations of emotional intelligence, academic help-seeking behaviour, and psychological help-seeking behaviour on students’ academic achievement in Woldia College of Teacher Education (WCTE), Woldia, Ethiopia. The participants were 283 first‑year regular diploma students (179 males and 104 females) of the college in the academic year of 2015/2016. The study employed a quantitative approach which followed correlation design involving four instruments to collect data for the study: Emotional Intelligence Questionnaire, Academic Help-Seeking Behaviour Questionnaire, Psychological Help-Seeking Behaviour Questionnaire, and Cumulative Grade Point Average (CGPA). The reliability statistics for Emotional Intelligence, Academic Help-Seeking Behaviour and Psychological Help-Seeking Behaviour Questionnaires showed Cronbach Coefficient Alpha of 0.856, 0.882, and 0.873 respectively. To answer the research questions raised in the study, descriptive statistics such as mean and standard deviation and Pearson product-moment analysis, as well as inferential statistics such as independent sample t‑test, multiple regression tests, and beta coefficients were conducted. The Pearson correlation analysis reported the following findings: (1) emotional intelligence, academic help-seeking behaviour and, psychological help-seeking behaviour had a significant positive correlation with students’ academic achievement; (2) emotional intelligence and academic help-seeking behaviour had a positive but not significant correlation with each other; (3) however, emotional intelligence was negatively but not significantly correlated with psychological help-seeking behaviour. The multiple regression analysis showed that there was a significant contribution of emotional intelligence, academic help-seeking behaviour and psychological help-seeking behaviour to the total variance of academic achievement (R2 = 0.383, F = 24.789, P 0.05). The beta coefficients revealed that the independent contributions of independent variables of the study to the total variance of academic achievement were found to be emotional intelligence (22.0248%, which is 57.4634% of the total R2, which was 0.383), academic help-seeking behaviour (11.861%, which is 30.9457% of the total R2, which was 0.383, and psychological help-seeking behaviour (4.4426%, which is 11.5908% of the total R2, which was 0.383) respectively. The independent sample t‑test reported that there were significant gender differences in students’ emotional intelligence and psychological help-seeking behaviour. The gender differences in academic help-seeking behaviour and academic achievement were not statistically significant. Finally, it was recommended that parents, instructors, counsellors, and administrative bodies should work on promoting students’ emotional intelligence and developing students’ help-seeking behaviours (academic and psychological help-seeking behaviours) to enhance academic achievement of students in WCTE.

Abstract Background Breast cancer is the most common cancer among females. Assessing self-screening practices for breast cancer patients is vital for developing targeted interventions. The current study aimed to assess self-screening practices for breast cancer and associated factors via the theory of planned behavior constructs among female students in Ethiopian universities. Methods A cross-sectional study design was conducted using the theory of planned behavior constructs. The data were collected from January 30, 2022, to February 30, 2022, in Ethiopia. A structured, self-administered questionnaire was used. The validity and reliability tests were checked to use the questionnaire in the main study through a pilot test. The data were collected through online Google Forms by distributing them to university students via Telegram groups, Imo, emails, and Facebook. The collected data were exported to SPSS version 26 for analysis. Bivariate analysis was used to identify the candidate variables for multiple logistic regression (P value

In this article we report on an investigation into developing people and serving the community at faith-based schools through a servant leadership theory lens. Relevant literature was reviewed, and data were collected from school leaders by means of individual semi-structured interviews. Twelve participants were purposively selected from schools classified as top-performing schools in Gauteng, a province in South Africa. The interviews with these participants were audiotaped and transcribed, and the data analysed by using a process of abductive data analysis. The following measures were employed to review the servant leadership practices of faith-based leaders: being a serving leader, fostering people growth, and enhancing community relationships. Overall, principals were found to be effective leaders involved in a hands-on manner in both task-orientated and person-orientated activities. The servant leadership conception whereby "other" interests are regarded as more important than own interests serves as the basis for people development and there is a clear awareness that the enhancement of community relationships is a key facet in the communication that takes place between school principals and community members. The participants also showed concern for school-led development activities. It was evident that participating school staff were personally involved in facilitating learning activities such as collaborative workgroups and workshops and in creating a supporting structure for staff development. Apart from recommending that principals' leadership behaviour in the abovementioned areas is consolidated, we strongly support their involvement in related matters such as coping with contextual realities and enhancing community relationships. The improvement of community relationships is eventually a challenging task to be exercised by principals within the social, political and demographic contexts of faith-based schools.

INTRODUCTION: Sexual and reproductive health (SRH) communication is most likely to promote healthy sexual practices and to reduce risky sexual behavior among adolescents. Communication is the principal means for parents to transmit sexual values and knowledge to their children. This study aimed to assess adolescent-parent communication on SRH issues among high school students in Woldia town. METHODS: A cross-sectional study was conducted from December 15-31, 2016. Systematic random sampling technique was used to select 693 students from Grades 9 and 10. Data were entered into Epi-info version 3.5.1 and analyzed by usingSPSS version 20. Logistic regression with OddsRatios(OR) and 95% Confidence intervals (CI) was used to identify the independent predictors of adolescent-parent communication. RESULTS: 674 students accepted to participate in this study giving a response rate of 97.3%.Only 205(30.4%) had discussed on two or more SRH topics with their parents. In logistic regression analyses, mothers who could read and write [AOR=2.0; 95% CI=1.3-3.1] and had diploma certificate [AOR=2.0; 95% CI=1.4-2.9] were more likely to discuss on SRH issues with their children. Adolescents who agreed on the importance of discussion on SRH issues [AOR=2.5; 95% CI=1.3-4.5], whoever gotSRH information [AOR=2.0; 95% CI=1.4-2.9] and those whoever had sexual intercourse [AOR=1.7; 95% CI=1.1-2.6] were more likely to discuss on different SRH issues with their parents. CONCLUSION: This study revealed that parent-adolescent communication on SRH issues was inadequate.Therefore, there is a need to equip and educate parents on different adolescents' SRH issues.