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Background: Camelpox is a common viral disease of camelids caused by camelpox virus, which is endemic in most camelid-breeding countries including Ethiopia, and causes major economic losses. This study aimed to quantify the seroprevalence of camelpox and identify associated risk factors to put into practice efficient control strategies for the disease in the study area. Methods: A cross-sectional study was carried out between January and July of 2023. Blood samples were collected from 374 camels of 75 households residing in two districts in six peasant associations. A sandwich enzyme-linked immunosorbent assay was employed to detect camelpox-specific antibodies from sera samples. To identify potential risk factors, camel owners were asked in face-to-face interviews. Results: The overall seroprevalence of camelpox in the study areas was 16.0% (95% confidence interval: 12.0%-20.0%). A multivariable logistic regression analysis revealed risk factors season, age, and sex had an association with seroprevalence of camelpox (p < 0.05). Sex was strongly associated with camelpox seropositivity, with female camels having a 3.2-fold higher risk of infection than male camels. Likewise, age-related vulnerability to infection was observed in young dromedaries, as they were 2.3 times more likely to become infected than adults. Conclusion: This study revealed moderate seroprevalence of camelpox in the study area. Thus, effective preventative strategies, such as vaccination programs to stop the spread of camelpox and reduce the financial losses caused by the disease, should be encouraged. [ABSTRACT FROM AUTHOR]

BackgroundCamelpox is a common viral disease of camelids caused by camelpox virus, which is endemic in most camelid-breeding countries including Ethiopia, and causes major economic losses. This study aimed to quantify the seroprevalence of camelpox and identify associated risk factors to put into practice efficient control strategies for the disease in the study area.MethodsA cross-sectional study was carried out between January and July of 2023. Blood samples were collected from 374 camels of 75 households residing in two districts in six peasant associations. A sandwich enzyme-linked immunosorbent assay was employed to detect camelpox-specific antibodies from sera samples. To identify potential risk factors, camel owners were asked in face-to-face interviews.ResultsThe overall seroprevalence of camelpox in the study areas was 16.0% (95% confidence interval: 12.0%–20.0%). A multivariable logistic regression analysis revealed risk factors season, age, and sex had an association with seroprevalence of camelpox (p < 0.05). Sex was strongly associated with camelpox seropositivity, with female camels having a 3.2-fold higher risk of infection than male camels. Likewise, age-related vulnerability to infection was observed in young dromedaries, as they were 2.3 times more likely to become infected than adults.ConclusionThis study revealed moderate seroprevalence of camelpox in the study area. Thus, effective preventative strategies, such as vaccination programs to stop the spread of camelpox and reduce the financial losses caused by the disease, should be encouraged.

Brucellosis is a neglected bacterial zoonotic disease with economic and public health importance in pastoral communities of sub-Saharan Africa. A cross)sectional study was conducted from December 2021 to April 2022, to estimate the prevalence and identify the associated risk factors causing brucellosis in animals and associated with occupational diseases in humans from three selected districts of “the Somali Pastoral region,” Eastern Ethiopia. In this study, 1,000 serum samples were screened for anti-Brucella spp. antibodies using Rose Bengal Plate Test (RBPT) and further confirmed using a competitive enzyme-linked immunosorbent assay (cELISA). A structured questionnaire was used to collect the biodata of tested animals and animal attendants to test the association between explanatory and outcome variables. The overall animal level prevalence was 5% (95% CI, 6.1–7.2.0) in small ruminants, 2.9% (95% CI, 1.5–4.9) in camels, and 2.0% (95% CI, 0.2–3.7) in occupationally linked humans. Herd size and herd history of retained fetal membranes were risk factors associated with Brucella spp. seropositivity in animals (p  <  0.05). Disposing of retained fetal membranes was significantly associated (p  <  0.05) with Brucella spp. seropositivity in humans. Evidence of brucellosis in various livestock species and associated seropositivity in humans indicates the need for a coordinated One Health approach, considering sociocultural dynamics of pastoral communities in controlling brucellosis to safe guard public health and increase livestock productivity. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 19 (COVID‐19) is life‐threatening infectious disease caused by SARS‐CoV‐2 virus that caused a global pandemic. SARS‐CoV‐2 has been widely transmitted throughout Ethiopia, with over 501,060 cases confirmed and 7574 deaths until November 2023. This study assessed for the first time the seroprevalence SARS‐CoV‐2 in the general population of the Somali Region during the COVID‐19 pandemic. Methods: A cross‐sectional study design was conducted from May to June 2021 in 14 districts of Somali Region. Blood samples were collected in 820 participants in addition to administering a questionnaire that included sociodemographic characteristics and history of clinical symptoms of COVID‐19. Blood samples were tested for the presence or absence of anti‐SARS‐CoV‐2 using a commercial Enzyme‐Linked Immunosorbent Assay (ELISA) kit (Euroimmun). Results: Overall, 477 (58.2%) were male and 343 (41.8%) were female. The majority of the participants (N = 581; 70.9%) were between 18 and 34 years old and not vaccinated against COVID‐19 (N = 793; 96.7%). The overall seroprevalence of SARS‐CoV‐2 antibodies was 41.7% (95% CI: 33.3%–47.6%). The highest prevalence was found in Goljano district (70%) and the lowest in Gunagado district (22.5%). Only age was found to be associated with COVID‐19 seropositivity. Conclusion: Prevalence of SARS‐CoV‐2 antibodies was the highest ever reported in Ethiopia, indicating that a large proportion of the population had been infected 14 months after the start of the outbreak in the country. Such studies are important to swiftly reassess and improve specific COVID‐19 preventive and control measures to reduce transmissions within the community in a given setting. [ABSTRACT FROM AUTHOR]

Background Following interventions to eliminate trachoma in Somali region, Ethiopia, we aimed to re-estimate the prevalence of trachomatous trichiasis (TT) and trachomatous inflammation—follicular (TF) at woreda level and identify the factors associated with the disease. Methods We implemented cross-sectional community-based surveys in 50 trachoma-endemic woredas, using a standardized survey. Households were the secondary sampling unit. Surveys were undertaken through a combination of interviews of household heads and direct inspection of water, sanitation and hygiene (WASH) access, plus clinical evaluation of eligible household members for TT and TF. Results Overall, 41 (82%) of the 50 woredas had met the WHO-recommended active trachoma elimination threshold (prevalence of TF <5% in 1–9-y-olds) and 42 (84%) had met the TT threshold (prevalence of TT unknown to the health system <0.2% in ≥15-y-olds). Only 18% of households had access to an improved drinking water source within a 30-min trip and only 25% had an improved latrine. Conclusions Additional rounds of antibiotic mass drug administration, plus interventions to enhance facial cleanliness and improve the environment, are required in nine woredas. TT surgical campaigns are needed in eight woredas. Greater access to WASH is required across all the woredas that were surveyed. [ABSTRACT FROM AUTHOR]

BackgroundOpen defecation contributes to the spread of different feco-oral diseases. Therefore, access to a latrine is strongly recommended, as it considerably reduces the risks. Even though provision of latrine facilities alone does not guarantee the desired health benefits, they should be integrated with behavior change. In Ethiopia, efforts have been made to increase the coverage of latrine facilities. However, evidence on how consistently households use it is limited. Most prior studies focused on latrine utilization among households, and limited evidence is available about open defecation practices among households with latrines and associated factors. Thus, this study is critical for developing effective intervention approaches to prevent open defecation among households with latrines.ObjectiveThe aim of this study was to assess the open defecation practice and associated factors among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia, 2023.MethodA community-based, cross-sectional study design was employed among households with latrines in the district. A total of 632 households latrines were selected using a systematic sampling technique. Data were collected using a structured questionnaire and an observational checklist. The questionnaire was designed in KoboTool box, Humanitarian Response software, and the data were collected using the Kobo Collect version 2023.2.4 mobile application. The data were downloaded from the server in the Microsoft Excel format for data cleaning before being exported to STATA version 14 for analysis. Bivariate and multivariable analyses were employed to investigate the relationship between outcome and independent variables. Odd ratios with 95% confidence intervals were utilized to assess the association between the outcome and the predictor variables. A P-value of

Brucellosis is a neglected bacterial zoonotic disease with economic and public health importance in pastoral communities of sub-Saharan Africa. A cross-sectional study was conducted from December 2021 to April 2022, to estimate the prevalence and identify the associated risk factors causing brucellosis in animals and associated with occupational diseases in humans from three selected districts of “the Somali Pastoral region,” Eastern Ethiopia. In this study, 1,000 serum samples were screened for anti-Brucella spp. antibodies using Rose Bengal Plate Test (RBPT) and further confirmed using a competitive enzyme-linked immunosorbent assay (cELISA). A structured questionnaire was used to collect the biodata of tested animals and animal attendants to test the association between explanatory and outcome variables. The overall animal level prevalence was 5% (95% CI, 6.1–7.2.0) in small ruminants, 2.9% (95% CI, 1.5–4.9) in camels, and 2.0% (95% CI, 0.2–3.7) in occupationally linked humans. Herd size and herd history of retained fetal membranes were risk factors associated with Brucella spp. seropositivity in animals (p

BackgroundNeonates admitted to neonatal intensive care units experience an average of 8–17 moderate to severe painful procedures per day. Because neonates lack the cognitive capacity to express their pain's location or severity, they are very dependent on healthcare providers to recognize, assess, and manage their pain. The health and development of newborns are negatively impacted by persistent or untreated pain experienced early in life. Therefore, studying neonatal pain management practices and associated factors in healthcare is critical to tackling workforce problems, enhancing neonatal care, and lowering the long-term health impacts of neonates.MethodFrom January 1 to 30, 2023, a facility-based cross-sectional study design was used at six public hospitals in the Somali region of Ethiopia. A total of 336 healthcare providers enrolled using a simple random sample technique. A self-administered, structured questionnaire was utilized to collect the data. The analyses used bivariate and multivariate logistic regression. To find the association between the outcome and predictor factors, the odd ratio and the 95% CI were computed.ResultThe study revealed that 35.4% [95% CI 30.4%–40.5%] of respondents reported that they had good neonatal pain management practices. Ever having undergone training in neonatal pain assessment and management [AOR = 2.26 (95% CI 1.259, 4.07)], availability of pain assessment tools [AOR = 3.05 (95% CI 1.249, 7.469)], and having a favorable attitude toward neonatal pain management practice [AOR = 3.71 (95% CI 1.525, 9.035)] were found to be factors with a significant association with neonatal pain management practice.ConclusionBased on the study's findings, there is a low level of neonatal pain management practice among healthcare providers in the Somali region. The study emphasizes the significance of having access to pain assessment tools and the requirement for healthcare professionals to get training on neonatal pain assessment and management.

Abstract Background Coronavirus disease 19 (COVID‐19) is life‐threatening infectious disease caused by SARS‐CoV‐2 virus that caused a global pandemic. SARS‐CoV‐2 has been widely transmitted throughout Ethiopia, with over 501,060 cases confirmed and 7574 deaths until November 2023. This study assessed for the first time the seroprevalence SARS‐CoV‐2 in the general population of the Somali Region during the COVID‐19 pandemic. Methods A cross‐sectional study design was conducted from May to June 2021 in 14 districts of Somali Region. Blood samples were collected in 820 participants in addition to administering a questionnaire that included sociodemographic characteristics and history of clinical symptoms of COVID‐19. Blood samples were tested for the presence or absence of anti‐SARS‐CoV‐2 using a commercial Enzyme‐Linked Immunosorbent Assay (ELISA) kit (Euroimmun). Results Overall, 477 (58.2%) were male and 343 (41.8%) were female. The majority of the participants (N = 581; 70.9%) were between 18 and 34 years old and not vaccinated against COVID‐19 (N = 793; 96.7%). The overall seroprevalence of SARS‐CoV‐2 antibodies was 41.7% (95% CI: 33.3%–47.6%). The highest prevalence was found in Goljano district (70%) and the lowest in Gunagado district (22.5%). Only age was found to be associated with COVID‐19 seropositivity. Conclusion Prevalence of SARS‐CoV‐2 antibodies was the highest ever reported in Ethiopia, indicating that a large proportion of the population had been infected 14 months after the start of the outbreak in the country. Such studies are important to swiftly reassess and improve specific COVID‐19 preventive and control measures to reduce transmissions within the community in a given setting.

Cross-sectional study was conducted from October 2021 to August 2022 to investigate the prevalence and associated risk factors of bovine tuberculosis in cattle in selected districts of the pastoral settings of Fafan zone, Somali region, eastern Ethiopia. A comparative intradermal tuberculin test was performed using purified protein derivatives. Animal-related characteristics, and the owner's knowledge on the importance of BTB were collected using a structured questionnaire. The prevalence was 11.24 % (95 % CI, 8.61–14.35) and 43.3 % (95 % CI, 33.27–53.75) at the individual and herd levels, respectively. There were statistically significant differences in the proportions of positive reactor animals according to body condition score (P = 0.000), age (P = 0.048), seasonal migration (P = 0.038), parity number (P = 0.005), and reproductive status (P = 0.037). Animals with poor body condition scores had a significantly higher likelihood of testing positive, with their odds being 11.4 times greater (COR = 11.408, CI = 3.43–37.94, P

BackgroundTuberculosis is a major public health problem worldwide, particularly in resource-limited countries. Loss of follow-up during treatment is one of the major obstacles in the fight against tuberculosis, which has serious implications for patients, their families, communities, and health service providers.PurposeTo assess the magnitude of the loss to follow-up tuberculosis treatment and associated factors among adults attending public health facilities in Warder District, Somali Regional State, eastern Ethiopia from November 02–17, 2021.MethodsA 5-year (from 1 January 2016 to 31 December 2020) retrospective study was conducted on 589 adult tuberculosis treatment records. Data were collected using a structured data extraction format. Data were analyzed using STATA version 14.0 statistical package. Variables with P < 0.05 in the multivariate logistic regression analysis were considered statistically significant.ResultsA total of 98 (16.6%) TB patients failed to follow up with their treatment. Age between 55 and 64 years (AOR = 4.4, 95% CI: 1.9–9.9), being male (AOR = 1.8, 95% CI: 1.1–2.9), living more than 10 km away from a public health facility (AOR = 4.9, 95% CI:2.5–9.4), and having a history of tuberculosis treatment (AOR = 2.3, 95% CI: 1.2–4.4) were associated with a higher likelihood of not following up, while having a positive initial smear result (AOR = 0.48, 95% CI: 0.24–0.96) was associated with a lower probability of not following up.ConclusionOne out of six patients was lost to follow-up after initiating their tuberculosis treatment. Hence, improving the accessibility of public health facilities with a special focus on older adults, male patients, smear-negative patients, and retreatment cases is highly warranted among TB patients.

Pastoralists and wildlife co‐exist in the Somali Regional State competing for habitat, food and water resources. A questionnaire survey conducted among 198 pastoralists, captured information on their perception of wildlife against the backdrop of wildlife population decrease, illegal wildlife trade and lack of quantitative and qualitative data in the area. The top perceived threats to livestock were drought (46%), wildlife attacks (33.8%) and diseases (20.2%). Daily encounters between wildlife and livestock were reported by 61.1% of respondents. Herbivores, including warthogs, accounted for the majority of these encounters (88.4%), whereas carnivores were rarely observed with livestock, except for jackals. The majority (92.9%) of the respondents did not think that wildlife could transmit diseases to livestock. Jackals were reported by 7.1% to transmit rabies. A strong dislike for wildlife was recorded in 99% of all respondents. All stated that wildlife should not be protected. Half of the respondents did not see any benefits in wildlife. Wildlife populations have decreased over the last 10 years, particularly lions and cheetahs. Pastoralist's attitudes and perceptions towards wildlife in the study area were negative, potentially affecting conservation efforts. There is an urgent need to improve awareness of the benefits of wildlife and to include wildlife in integrated human‐livestock‐environment surveillance systems. [ABSTRACT FROM AUTHOR]

Epilepsy in low- and middle-income countries is linked to lower quality of life and premature death. Limited healthcare access and stigma in regions like Somali hinder effective management and lead to social isolation, affecting family relationships, education, and employment opportunities. Even though determining the status and factors affecting epileptic patients' quality of life is an initial step toward enhancing treatment outcomes, there is a scarcity of evidence-based information on epileptic patients' quality of life in the study area. To assess the quality of life and its associated factors among patients with epilepsy at selected public hospitals of the Somali region, Eastern Ethiopia, from June 30 to July 30, 2023. An institution-based cross-sectional study was undertaken on 422 epileptic patients in five public hospitals in the Somali region. A simple random sampling procedure was utilized to choose study participants. Face-to-face interviews were conducted with a pretested structured questionnaire, and data was analyzed using SPSS version 26. A multivariable logistic regression analysis with 95% confidence intervals was used to investigate the relationships between the dependent and independent variables. A P-value of less than 0.05 was used to declare the statistical significance of the observed relationships. Overall, 56.4 % of epileptic patients had good quality of life (95 % CI = 51.5–59.2 %) with 98.8 % response rate. Age in year ≥ 35 (AOR = 0.28; 95 %CI: 0.11, 0.71), family size (four to six, and greater than or equal to seven) (AOR = 0.12; 95 %CI: 0.04,0.33) and (AOR = 0.23; 95 %CI: 0.08, 0.68), poor drug adherence (AOR = 14.42; 95 %CI: 3.93, 52.95), lack physical activities (AOR = 0.33; 95 %CI: 0.17, 0.66), smoking (AOR = 0.41; 95 %CI: 0.18, 0.91), alcohol Consumption (AOR = 0.06; 95 %CI: 0.02), and absence of depression (AOR = 3.32;95 %CI: 1.35, 8.17) were significant association with quality of life among epileptic patients. The magnitude of good quality of life among epileptic patients is lower, implying that poor quality of life among epileptic patients remains a public health concern in the study area. Drug adherence, physical activity, smoking, alcohol consumption, anxiety, and depression status were all modifiable factors that influenced quality of life. As a result, it would be ideal if all health practitioners prioritized health education and counseling on treatment adherence, comorbidity, and drug abuse prevention. Furthermore, screening for, identifying, and treating psychological illnesses on a regular basis would greatly benefit epilepsy sufferers' quality of life. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral adherence is defined as an individual's behaviors such as taking medications, following a diet, and/or making lifestyle changes that are consistent with agreed-upon recommendations from a health care provider. For antiretroviral therapy (ART), a high level of consistent adherence is required to suppress viral replication, improve immunological and medical outcomes, reduce the threat of emerging antiretroviral drug resistance, and reduce the risk of HIV transmission. Objective: To assess non-adherence to antiretroviral therapy and associated factors among adult HIV patients in Somali region public hospitals, eastern Ethiopia. Methods and materials: Research participants of 405 were studied in Jigjiga and Godey public hospitals at ART clinics from January 1st to June 30th, 2022, and interviewed consecutively until the set proportion was met in each hospital, using a facility-based cross-sectional study design. A pretested, semi-structured English questionnaire was used to collect data on socio-demographic variables, while a card review of the patient's medications, clinical stage, viral load, and CD4 count was performed. The information was coded and entered into Epidata version 3.1, then exported and analyzed with SPSS v20. To determine the relationship between the outcome variable and the independent factors, bivariate logistic regression was used, with a value of

IntroductionThe rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of supporting of the Ethiopian Government's Citizen Score Card at primary healthcare facilities and hospitals in future. Many health facilities in Somali Region struggle with budget shortages related to ineffective budget planning and budget execution at woreda health office levels. In this context, an intervention to first improve budget accountability, through the implementation of citizen audits, was proposed.MethodologyThe rapid study focused on five woredas (districts) within Somali Region, where interviews were conducted with the heads of woreda health offices. In the same five woredas, directors of healthcare facilities were interviewed and offices and healthcare facilities were observed. The framework of assessment and analysis was based on health systems literature on fragile and conflict affected states guided the questions for the health authorities and health facility management.FindingsThe research yielded five distinct mini case studies covering woreda health office planning and budgeting capacity and support (or lack thereof), and related impressions of challenges regarding healthcare delivery at health facilities in the same five woredas.ResultsThe findings demonstrated that the capacity for healthcare planning and budgeting Somali Region at woreda level varied significantly and that little guidance was available from regional level health authorities. Frontline health services clearly suffered from budget shortages as a result.ConclusionThe research provided an evidence base for the delay of the roll-out of the Community Scorecard implementation across Somali Region. In a context whereby health facilities remain under-resourced due to budgeting constraints, a citizen-service provider-focused accountability intervention would have been of limited utility. The rapid case study research, conducted by condensing the usual case study research process, allowed for the production of evidence that was “robust enough” to demonstrate heterogeneity and challenges regarding budgeting quality across the five research sites. This evidence clearly transcended the hitherto anecdotal evidence that woreda-level health budget planning remains an area that faces significant shortcomings.

During the summer monsoon, the Somali region undergoes a significant upwelling phenomenon that enhances plankton productivity, thereby benefiting fisheries. Wind and coastal dynamics initially drive this upwelling, but eventually, eddy flows influence it. Our study explores the interplay between ocean currents, eddies, and chlorophyll-a concentrations using the backward Finite-Size Lyapunov Exponents (bFSLEs) technique. We also delve into the specific role of Ekman transport in distributing chlorophyll-a across the region. The Great Whirl (GW), an anticyclonic eddy, predominantly causes strong downwelling, interrupting the summer monsoon upwelling along the Somali coast longitudinally. Despite the GW's significant impact on moving upwelled water offshore, the influence of downwelling diminishes northward. As a result, the northern Somali coast, especially around 9°N and 10°N, showcases the most extensive offshore upwelling, reaching as far as 55°E. Our findings highlight a robust connection between chlorophyll-a levels and oceanic dynamics, influenced by both currents and eddies, as evidenced by bFSLEs, and by cross-shore Ekman transport, particularly within chlorophyll-a concentrations ranging from 0.2 to 0.6 mg m−3. The data suggests that Ekman transport-induced upwelling primarily drives coastal phytoplankton biomass. Furthermore, bFSLEs analysis underlines the supportive role of ocean currents and eddies in the offshore distribution of chlorophyll-a, especially near the coast. Further examination of lagged correlations reveals a temporal lag between peak concentrations of chlorophyll-a and Ekman transport; the lag increases offshore and is at least 9 days near the coast. [ABSTRACT FROM AUTHOR]

Abstract Background The movement of malaria vectors into new areas is a growing concern in the efforts to control malaria. The recent report of Anopheles stephensi in eastern Ethiopia has raised the necessity to understand the insecticide resistance status of the vector in the region to better inform vector-based interventions. The aim of this study was to evaluate insecticide resistance in An. stephensi in eastern Ethiopia using two approaches: (1) World Health Organization (WHO) bioassay tests in An. stephensi; and (2) genetic analysis of insecticide resistance genes in An. stephensi in eastern Ethiopia. Methods Mosquito larvae and pupae were collected from Kebri Dehar. Insecticide susceptibility of An. stephensi was tested with malathion 5%, bendiocarb 0.1%, propoxur 0.1%, deltamethrin 0.05%, permethrin 0.75%, pirimiphos-methyl 0.25% and DDT 4%, according to WHO standard protocols. In this study, the knockdown resistance locus (kdr) in the voltage gated sodium channel (vgsc) and ace1R locus in the acetylcholinesterase gene (ace-1) were analysed in An. stephensi. Results All An. stephensi samples were resistant to carbamates, with mortality rates of 23% and 21% for bendiocarb and propoxur, respectively. Adult An. stephensi was also resistant to pyrethroid insecticides with mortality rates 67% for deltamethrin and 53% for permethrin. Resistance to DDT and malathion was detected in An. stephensi with mortality rates of 32% as well as An. stephensi was resistance to pirimiphos-methyl with mortality rates 14%. Analysis of the insecticide resistance loci revealed the absence of kdr L1014F and L1014S mutations and the ace1R G119S mutation. Conclusion Overall, these findings support that An. stephensi is resistant to several classes of insecticides, most notably pyrethroids. However, the absence of the kdr L1014 gene may suggest non-target site resistance mechanisms. Continuous insecticide resistance monitoring should be carried out in the region to confirm the documented resistance and exploring mechanisms conferring resistance in An. stephensi in Ethiopia.

Introduction: neonatal death is a global issue in both developed and developing countries. Evidence on determinants of neonatal mortality is scarce, particularly in the pastoralist and agro-pastoralist areas of Ethiopia, including the Somali region. This study aimed to identify the determinants of mortality among neonates admitted to neonatal intensive care units at selected public hospitals, in the Somali region, eastern Ethiopia., Methods: an unmatched case-control study design was employed from January 1 st -30 th , 2020. The total sample size was 312 neonates (156 cases and 156 controls) who were admitted to the neonatal intensive care unit from January 2018 to December 30 th , 2019. A simple random sampling technique was used to select neonates. The data were collected by a structured checklist. Data entry and analysis were done by EpiData version 4.6 and SPSS version 23, respectively. Binary logistic regression using bivariate and multivariable analysis was done to identify determinants. Odds ratios were computed at 95% CI and a P value <0.05 was considered statistically significant., Results: a total of 310 neonates with complete medical charts (155 cases and 155 control) were included in the study. Lack of antenatal care (AOR 4.71; 95%CI: 1.41-15.75), rural residence (AOR=8.38; 95%CI: 2.22-31.69), premature rupture of membrane (AOR=4.29; 95%CI: 1.21-15.19), five-minutes APGAR score below-seven (AOR=9.87; 95%CI: 2.30-42.33), prenatal asphyxia (AOR=14.71; 95%CI: 2.79-77.33) and length of hospital stay ≤3 days (AOR=15.09; 95%CI: 2.89-78.62) were significantly associated with neonatal mortality., Conclusion: this study identifies rural residence, lack of antenatal care, premature rupture of membranes, low APGAR scores, prenatal asphyxia, and short hospital stays as determinants. Hence, improving access to basic health services such as antenatal care and early screening for pregnant mothers and newborns is critical. By prioritizing these interventions, healthcare systems can effectively work towards reducing neonatal mortality rates, ultimately improving the health outcomes of infants and their mothers., Competing Interests: The authors declare no competing interests., (Copyright: Zemenu Shiferaw Yadita et al.)

Abstract Background Visceral leishmaniasis (VL), a vector-borne disease caused by species of the L. donovani complex, has (re)-emerged in Ethiopia during the last two decades and is currently of increasing public health concern. However, very little is known about VL epidemiology in the Somali Region of Ethiopia. The aim of this study was to provide detailed epidemiological information on seroprevalence, associated factors and incriminated vectors of VL in Shebelle Zone and Ethiopian Somali Region in general. Methods A cross-sectional epidemiological study was conducted between March and May 2016 in Gode and Adadle districts of Shebelle Zone, Ethiopian Somali Region. Two-stage semi-random sampling was applied for selecting study participants for the field survey. The study included structured questionnaire interviews, serological assays (rK39-immunochromatographic test), ELISA and entomological surveys. Results From a total of 361 participants, 57 (15.8%) were seropositive for VL including 46 (12.7%) rK39 positive and 11 (3.0%) positive by both rK39 and ELISA. VL seroprevalence was higher (P

Ethiopia is gifted with various heritage resources, and it has registered its different types of heritage as a world heritage site. The megalithic culture in Ethiopia comprises dolmens, tumuli, and steles which are widely dispersed across the country. Though, the Somali Regional State is rich in natural, cultural, and historical heritage sites scholars have not yet given the attention it deserves. In this regard, the Derbi Belanbel Stele site is among them. Accordingly, this study proposed to explore the steles of the Derbi Belanbel site of Duhun woreda Somali region, Ethiopia. The study employed an exploratory research design and a qualitative research approach to investigating the historical value of the steles of Derbi Belanbel, to assess the shape, style, and height of Derbi Belanbel steles and challenge and prospects of sustaining the steles in the study area. Purposive and snowball sampling techniques were used to choose key informants who have beneficial knowledge, experience, and link with the heritage site. Data were gathered via personal observation, focus group discussion, semi-structured interviews, and document analysis. Concerning data analysis, a thematic data analysis technique was employed. The results of this study revealed that the steles of the Derbi Belanbel site have a historical value having different shapes and heights that could inspire further archaeological and historical research. However, due to poor preservation and conservation practice, some of the steles are on the verge of deterioration or change of their original nature.

Background: Open defecation contributes to the spread of different feco-oral diseases. Therefore, access to a latrine is strongly recommended, as it considerably reduces the risks. Even though provision of latrine facilities alone does not guarantee the desired health benefits, they should be integrated with behavior change. In Ethiopia, efforts have been made to increase the coverage of latrine facilities. However, evidence on how consistently households use it is limited. Most prior studies focused on latrine utilization among households, and limited evidence is available about open defecation practices among households with latrines and associated factors. Thus, this study is critical for developing effective intervention approaches to prevent open defecation among households with latrines., Objective: The aim of this study was to assess the open defecation practice and associated factors among households with latrines in rural communities of Ararso District, Somali Region, Eastern Ethiopia, 2023., Method: A community-based, cross-sectional study design was employed among households with latrines in the district. A total of 632 households latrines were selected using a systematic sampling technique. Data were collected using a structured questionnaire and an observational checklist. The questionnaire was designed in KoboTool box, Humanitarian Response software, and the data were collected using the Kobo Collect version 2023.2.4 mobile application. The data were downloaded from the server in the Microsoft Excel format for data cleaning before being exported to STATA version 14 for analysis. Bivariate and multivariable analyses were employed to investigate the relationship between outcome and independent variables. Odd ratios with 95% confidence intervals were utilized to assess the association between the outcome and the predictor variables. A P-value of <0.05 was used as the threshold point for statistical significance., Result: In this study, the prevalence of open defecation practice among households with latrines was 32.4% (95% CI: 28.1, 35.9). Sex of the household (AOR = 1.60, 95% CI: 1.06, 2.4), educational status (AOR = 2.40, 95% CI: 1.08, 5.53), family size (AOR = 1.62, 95% CI: 1.22, 2.78), the presence of under-5-year-old children in the house (AOR = 1.84, 95% CI: 1.19, 2.75), the need for latrine maintenance (AOR = 2.37.95% CI: 1.62, 3.48), current status of the latrine (AOR = 2.37, 95% CI: 1.62, 3.48), and latrine cleanness status (being unclean) (AOR = 1.91, 95% CI: 1.29, 2.81) were significantly associated with open defecation practice among households with latrine., Conclusion: The study concluded that open defecation was significantly practiced by households with latrines. This revealed that the presence of a latrine alone was insufficient to considerably reduce open defecation. To alleviate this problem, the government and health workers, in collaboration with the health bureau, should promote frequent sanitation and hygiene education in the communities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ismail, Ibrahim, Abdi, Geremew, Mulugeta, Ayele and Cheru.)

Background: Worldwide, tuberculosis (TB) is a serious public health issue, especially in low-income countries, including Ethiopia. For those who are HIV-positive, TB poses a major risk to their health. The development of chemotherapy and the effectiveness of treatment have resulted in notable increases in patient survival. The evaluation of TB treatment outcomes is an essential metric for determining the success of TB and HIV co-morbidity control strategies., Purpose: This study aims to identify TB treatment outcomes and associated factors among TB/HIV co-infected patients in public health facilities in Jigjiga, Somali Region, Ethiopia, in 2021., Patients and Methods: A hospital-based cross-sectional study design was done on three facilities (Karamara, Hasan Yabare Referral Hospital, and Jigjiga Health Center) with a total of 194 study participants. Data were extracted using a checklist, entered into EpiData version 3 (The EpiData Association, Odense, Denmark), and analyzed using SPSS Statistics version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) for descriptive and inferential analysis of the study objectives. Variables in the bivariate logistic regression analysis with p-values less than 0.25 were entered into a multivariate logistic regression to identify the independent factors of TB treatment outcome. Associations were computed using an adjusted odds ratio with a 95% CI. P-values less than 0.05 were finally considered statistically significant., Results: The following TB treatment outcomes were observed among all TB/HIV co-infected patients enrolled in this study: 126 (67.4%) completed treatment, three (1.8%) died, 42 (22.5%) were cured, and 16 (8.6%) were transferred out; 168 (89.8%) had a successful treatment outcome. Category of the patient (AOR = 0.194, 95% CI: 0.041, 0.923), sex of the patient (AOR = 1.490, 95% CI: 1.449, 4.951), and cotrimoxazole preventive therapy (CPT) initiation (AOR = 0.073, 95% CI: 0.021, 0.254) were found to be significant predictors for successful TB treatment outcome at a p-value less than 0.05 with a 95% CI., Conclusion: Overall, 89.8% of TB treatments were successful among TB/HIV co-infected patients. This study has found sex, socioeconomic status, and CPT initiation were significant factors for a successful TB treatment outcome. Based on these findings, governmental and non-governmental organizations should facilitate the implementation and enforce the availability of all TB/HIV co-infected patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Abdilahi et al.)

Introduction: In order to enhance rational drug use, it is very important to assess the prescribing pattern of the facilities using standard prescribing checklists. Hence, the aim of this study was to assess drug use pattern using WHO prescribing indicators at Sheikh Hassan Sultan Yabere Referral Hospital, Eastern Ethiopia. Objective: the objective of this study is to assess drug use pattern using WHO prescribing indicators at Sheikh Hassan Sultan Yabere Referral Hospital, Eastern Ethiopia 2019 Method: Retrospective study design was employed to assess the current drug prescribing pattern of Sheikh Hassan Sultan Yabere Referral Hospital.Six Month prescription papers from December 1, 2018 to May 31, 2019 were surveyed. A total of 600 prescriptions that were selected using systematic random sampling were reviewed. Data was collected from prescriptions at outpatient pharmacy. The data was entered to excel and analyzed and presented with tables and charts. Results: The average number of drugs prescribed per encounter or mean was 1.98 with a range between one and six drugs. The percentage of encounters in which an antibiotic or injection prescribed were 60 % (n=600) and 2.5 % (n=600) respectively. The percentage of drugs prescribed by generic name and from an essential drug list were 89.5 % (n=600) and 98.99% (n=600). The commonly prescribed forms of antibiotics were Amoxicillin (19.15%), Amoxicillin/Clavulunate (17.41) and Azithromycin (16.83%).The most commonly prescribed injection was Ceftriaxone (52.14%). Conclusion: This study revealed major deviation from standard WHO recommended rational prescribing practice with regard to antibiotic use. The study also showed deviation from WHO standard with regard to use of generic name and prescribing from national formulary/Essential drug list [ABSTRACT FROM AUTHOR]

Background: The movement of malaria vectors into new areas is a growing concern in the efforts to control malaria. The recent report of Anopheles stephensi in eastern Ethiopia has raised the necessity to understand the insecticide resistance status of the vector in the region to better inform vector-based interventions. The aim of this study was to evaluate insecticide resistance in An. stephensi in eastern Ethiopia using two approaches: (1) World Health Organization (WHO) bioassay tests in An. stephensi; and (2) genetic analysis of insecticide resistance genes in An. stephensi in eastern Ethiopia. Methods: Mosquito larvae and pupae were collected from Kebri Dehar. Insecticide susceptibility of An. stephensi was tested with malathion 5%, bendiocarb 0.1%, propoxur 0.1%, deltamethrin 0.05%, permethrin 0.75%, pirimiphos-methyl 0.25% and DDT 4%, according to WHO standard protocols. In this study, the knockdown resistance locus (kdr) in the voltage gated sodium channel (vgsc) and ace1R locus in the acetylcholinesterase gene (ace-1) were analysed in An. stephensi. Results: All An. stephensi samples were resistant to carbamates, with mortality rates of 23% and 21% for bendiocarb and propoxur, respectively. Adult An. stephensi was also resistant to pyrethroid insecticides with mortality rates 67% for deltamethrin and 53% for permethrin. Resistance to DDT and malathion was detected in An. stephensi with mortality rates of 32% as well as An. stephensi was resistance to pirimiphos-methyl with mortality rates 14%. Analysis of the insecticide resistance loci revealed the absence of kdr L1014F and L1014S mutations and the ace1R G119S mutation. Conclusion: Overall, these findings support that An. stephensi is resistant to several classes of insecticides, most notably pyrethroids. However, the absence of the kdr L1014 gene may suggest non-target site resistance mechanisms. Continuous insecticide resistance monitoring should be carried out in the region to confirm the documented resistance and exploring mechanisms conferring resistance in An. stephensi in Ethiopia. [ABSTRACT FROM AUTHOR]

Despite the tremendous achievement in reducing child mortality and morbidity in the last two decades, diarrhoea is still a major cause of morbidity and mortality among children in many developing countries, including Ethiopia. Hand washing with soap promotion, water quality improvements and improvements in excreta disposal significantly reduces diarrhoeal diseases. The objective of this study was to evaluate the effect of hand washing with soap and water, sanitation and hygiene (WASH) educational Intervention on the incidence of under-five children diarrhoea. A community-based cluster randomized controlled trial was conducted in 24 clusters (sub-Kebelles) in Jigjiga district, Somali region, Eastern Ethiopia from February 1 to July 30, 2015. The trial compared incidence of diarrhoea among under-five children whose primary caretakers receive hand washing with soap and water, sanitation, hygiene educational messages with control households. Generalized estimating equation with a log link function Poisson distribution family was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval. The results of this study show that the longitudinal adjusted incidence rate ratio (IRR) of diarrhoeal diseases comparing interventional and control households was 0.65 (95% CI 0.57, 0.73) suggesting an overall diarrhoeal diseases reduction of 35%. The results are similar to other trials of WASH educational interventions and hand washing with soap. In conclusion, hand washing with soap practice during critical times and WASH educational messages reduces childhood diarrhoea in the rural pastoralist area.

Nejimu Biza Zepro,1 Ahmed Tahir Ahmed2 1College of Health Sciences, Samara University, Samara, Afar, Ethiopia; 2College of Health Science, Jigjiga University, Jigjiga, Somali, Ethiopia Abstract: Maternal health service utilizations are poorly equipped, inaccessible, negligible, and not well documented in the pastoral society. This research describes a quantitative and qualitative study on the determinants of institutional delivery among pastoralists of Liben Zone with special emphasis on Filtu and Deka Suftu woredas of Somali Region, Ethiopia. The study was funded by the project “Fostering health care for refugees and pastoral communities in Somali Region, Ethiopia”. This community-based cross-sectional study was conducted during November 2015. Interviews through a questionnaire and focus group discussions were used to collect the data. Proportional to size allocation followed by systematic sampling technique was used to identify the study units. The major determinants of institutional delivery in the study area were as follows: being apparently healthy, lack of knowledge, long waiting time, poor quality services, cultural beliefs, religious misconception, partner decision, and long travel. Around one-third (133, 34.5%) of the women had visited at least once for their pregnancy. More than half (78, 58.6%) of the women had visited health facilities due to health problems and only 27 (19.9%) women had attended the recommended four antenatal care visits. Majority (268, 69.6%) of the pregnant women preferred to give birth at home. Women who attended antenatal care were two times more likely to deliver at health facilities (AOR, 95% confidence interval [CI] =2.38, 1.065–4.96). Women whose family members preferred health facilities had 14 times more probability to give birth in health institutions (AOR, 95% CI =13.79, 5.28–35.8). Women living in proximity to a health facility were 13 times more likely to give birth at health facilities than women living far away (AOR, 95% CI =13.37, 5.9–29.85). Nomadic way of life, service inaccessibility, and sociodemographic and cultural obstacles have an effect on the utilization of delivery services. Increasing access, information, education, and communication need to reach pastoral women in need. Keywords: pastoralism, delivery service utilization, Liben Zone, Somali Region, Ethiopia

Background: Neonates admitted to neonatal intensive care units experience an average of 8-17 moderate to severe painful procedures per day. Because neonates lack the cognitive capacity to express their pain's location or severity, they are very dependent on healthcare providers to recognize, assess, and manage their pain. The health and development of newborns are negatively impacted by persistent or untreated pain experienced early in life. Therefore, studying neonatal pain management practices and associated factors in healthcare is critical to tackling workforce problems, enhancing neonatal care, and lowering the long-term health impacts of neonates., Method: From January 1 to 30, 2023, a facility-based cross-sectional study design was used at six public hospitals in the Somali region of Ethiopia. A total of 336 healthcare providers enrolled using a simple random sample technique. A self-administered, structured questionnaire was utilized to collect the data. The analyses used bivariate and multivariate logistic regression. To find the association between the outcome and predictor factors, the odd ratio and the 95% CI were computed., Result: The study revealed that 35.4% [95% CI 30.4%-40.5%] of respondents reported that they had good neonatal pain management practices. Ever having undergone training in neonatal pain assessment and management [AOR = 2.26 (95% CI 1.259, 4.07)], availability of pain assessment tools [AOR = 3.05 (95% CI 1.249, 7.469)], and having a favorable attitude toward neonatal pain management practice [AOR = 3.71 (95% CI 1.525, 9.035)] were found to be factors with a significant association with neonatal pain management practice., Conclusion: Based on the study's findings, there is a low level of neonatal pain management practice among healthcare providers in the Somali region. The study emphasizes the significance of having access to pain assessment tools and the requirement for healthcare professionals to get training on neonatal pain assessment and management., 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 Abebe, Orcho, Chane, Mesfin and Seifu.)

Cross-sectional study was conducted from October 2021 to August 2022 to investigate the prevalence and associated risk factors of bovine tuberculosis in cattle in selected districts of the pastoral settings of Fafan zone, Somali region, eastern Ethiopia. A comparative intradermal tuberculin test was performed using purified protein derivatives. Animal-related characteristics, and the owner's knowledge on the importance of BTB were collected using a structured questionnaire. The prevalence was 11.24 % (95 % CI, 8.61-14.35) and 43.3 % (95 % CI, 33.27-53.75) at the individual and herd levels, respectively. There were statistically significant differences in the proportions of positive reactor animals according to body condition score ( P  = 0.000), age ( P = 0.048), seasonal migration ( P = 0.038), parity number ( P  = 0.005), and reproductive status ( P  = 0.037). Animals with poor body condition scores had a significantly higher likelihood of testing positive, with their odds being 11.4 times greater (COR = 11.408, CI = 3.43-37.94, P  < 0.001). In multivariate logistic regression, poor body condition score remained significantly associated with the odds of a positive reaction to tuberculosis (AOR = 0.137, CI = 0.053-0.356, P  < 0.001). Similarly, the analysis showed that seasonal migration (AOR = 2.882, CI = 1.155-7.191, P  = 0.023) and parity number (AOR = 11.64, CI = 1.818-74.464, P  = 0.010) were significant predictors of bovine tuberculosis infection in cattle. According to the questionnaire, 14.2 % (17 of 120) and 13.3 % (16 of 120) of the respondents were knowledgeable about bovine tuberculosis and its transmission from animals to humans, and vice versa, respectively. The general judgment of herders' understanding of bovine tuberculosis transmission methods to humans was very low. The study findings showed a high prevalence of bovine tuberculosis in the study area, emphasizing the need for an effective control and prevention strategy., 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., (© 2024 The Authors.)

Background: To accelerate the expansion of primary healthcare coverage, the Ethiopian government started deploying specially trained community health workers named Health Extension Workers (HEWs) in 2003. HEWs work on sixteen health service packages; one being tuberculosis (TB) control and prevention. However, their contribution to TB care and prevention services among pastoralist communities has not been evaluated. Thus, this study has assessed their contribution in identification of persons with presumptive pulmonary TB in Ethiopian Somali Pastoralist Region.Method: A cross sectional study with mixed approach of quantitative and qualitative methods was applied. A randomly selected cross-sectional sample of 380 pulmonary TB cases from 20 health facilities was selected to obtain information on the role of HEWs in the identification of persons with presumptive TB, and their referral. Purposively selected HEWs were also interviewed individually to obtain in-depth information on their in-service training and experiences with referring TB cases. SPSS version20 was used to summarize the quantitative data and test statistical significance using chi-square test and logistic regression model. The qualitative data was analyzed under the principles of thematic analysis.Result: Overall, 20.3% [95% CI = 16.6-24.5] of pulmonary TB patients were referred by HEWs; while the majority were referred by healthcare workers (52.6%), family members (13.4%), neighbours/friends (2.4%) and self-referred (11.3%). Out of all, 66.1% and 53.4% had neither received community TB health education nor home visit from HEW respectively. Multivariate analysis indicated that provision of community health education [AOR = 14.0, 95% CI = 6.6-29.5], being model household [AOR = 21.2, 95% CI = 9.5-47.3], home visit from HEW [AOR = 2.8, 95% CI = 1.2-9.6] and rural residence [AOR = 3.0, 95% CI = 1.2-7.7] were significantly associated with referral by HEW. The qualitative findings supported that HEWs' involvement in referral of persons with presumptive TB was limited. Communities' low confidence in HEWs, inaccessibility of TB services at nearest health centers and lack of in-service trainings for HEWs were identified by the interviewee HEWs as underlying factors for their limited involvement.Conclusion: The contribution of health extension workers in identifying and referring presumptive TB cases is limited in Ethiopian Somali pastoralist region. Increased community health education and home visits by HEWs could contribute to increased identification and referral of persons with presumed TB. HEW should be properly trained on TB through in-service refreshment trainings and supported by routine supervision. Further expansion of TB diagnostic services would benefit to increasing case detection. [ABSTRACT FROM AUTHOR]

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Background: Tuberculosis is a major public health problem worldwide, particularly in resource-limited countries. Loss of follow-up during treatment is one of the major obstacles in the fight against tuberculosis, which has serious implications for patients, their families, communities, and health service providers., Purpose: To assess the magnitude of the loss to follow-up tuberculosis treatment and associated factors among adults attending public health facilities in Warder District, Somali Regional State, eastern Ethiopia from November 02-17, 2021., Methods: A 5-year (from 1 January 2016 to 31 December 2020) retrospective study was conducted on 589 adult tuberculosis treatment records. Data were collected using a structured data extraction format. Data were analyzed using STATA version 14.0 statistical package. Variables with P < 0.05 in the multivariate logistic regression analysis were considered statistically significant., Results: A total of 98 (16.6%) TB patients failed to follow up with their treatment. Age between 55 and 64 years (AOR = 4.4, 95% CI: 1.9-9.9), being male (AOR = 1.8, 95% CI: 1.1-2.9), living more than 10 km away from a public health facility (AOR = 4.9, 95% CI:2.5-9.4), and having a history of tuberculosis treatment (AOR = 2.3, 95% CI: 1.2-4.4) were associated with a higher likelihood of not following up, while having a positive initial smear result (AOR = 0.48, 95% CI: 0.24-0.96) was associated with a lower probability of not following up., Conclusion: One out of six patients was lost to follow-up after initiating their tuberculosis treatment. Hence, improving the accessibility of public health facilities with a special focus on older adults, male patients, smear-negative patients, and retreatment cases is highly warranted among TB patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Birhane, Mekonnen, Dingeta and Teklemariam.)

Background: A third of the world population is infected with tuberculosis (TB) bacilli. TB accounts for 25 % of all avoidable deaths in developing countries. The objective of the study was to assess impact of directly observed treatment short-course (DOTS) strategy on new tuberculosis case finding and treatment outcomes in Somali Regional State, Ethiopia from 2003 up to 2012 and from 2004 up to 2013, respectively. Methods: A health facility based retrospective study was employed. Quarterly reports were collected using World Health Organization (WHO) reporting format for TB case finding and treatment outcome from all zones in the region to the Federal Ministry of Health. Results: A total of 31, 198 all types of new TB cases were registered and reported during the period from 2003 up to 2012, in the region. Out of these, smear positive pulmonary TB cases were 12,466 (40 %), and 10,537 (33.8 %) and 8195 (26.2 %) for smear negative pulmonary TB and extra-pulmonary TB cases, respectively. An average case detection rate (CDR) of 19.1 % (SD 3.6) and treatment success rate (TSR) of 85.5 % (SD 5.0) for smear positive pulmonary TB were reported for the specified years period. For the overall study period, trend chi-squire analysis for CDR was X² = 2.1; P > 0.05 and X² = 5.64; P < 0.05 for TSR. Conclusions: The recommended TSR set by WHO was achieved (85.5 %) and the CDR reported was far below (19.1 %) from the recommended target. Extensive efforts should be established to maintain the achieved TSR and to increase the low CDR for the smear positive pulmonary TB cases through implementing alternative case finding strategies. [ABSTRACT FROM AUTHOR]

Introduction: The rapid research described in this chapter was conducted as an assignment for a UN agency in Ethiopia's Somali Region. The agency's aim was support the implementation of an interim citizen engagement intervention, with a view of supporting of the Ethiopian Government's Citizen Score Card at primary healthcare facilities and hospitals in future. Many health facilities in Somali Region struggle with budget shortages related to ineffective budget planning and budget execution at woreda health office levels. In this context, an intervention to first improve budget accountability, through the implementation of citizen audits, was proposed., Methodology: The rapid study focused on five woredas (districts) within Somali Region, where interviews were conducted with the heads of woreda health offices. In the same five woredas, directors of healthcare facilities were interviewed and offices and healthcare facilities were observed. The framework of assessment and analysis was based on health systems literature on fragile and conflict affected states guided the questions for the health authorities and health facility management., Findings: The research yielded five distinct mini case studies covering woreda health office planning and budgeting capacity and support (or lack thereof), and related impressions of challenges regarding healthcare delivery at health facilities in the same five woredas., Results: The findings demonstrated that the capacity for healthcare planning and budgeting Somali Region at woreda level varied significantly and that little guidance was available from regional level health authorities. Frontline health services clearly suffered from budget shortages as a result., Conclusion: The research provided an evidence base for the delay of the roll-out of the Community Scorecard implementation across Somali Region. In a context whereby health facilities remain under-resourced due to budgeting constraints, a citizen-service provider-focused accountability intervention would have been of limited utility. The rapid case study research, conducted by condensing the usual case study research process, allowed for the production of evidence that was "robust enough" to demonstrate heterogeneity and challenges regarding budgeting quality across the five research sites. This evidence clearly transcended the hitherto anecdotal evidence that woreda-level health budget planning remains an area that faces significant shortcomings., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pieterse.)

A cross-sectional study of bovine tuberculosis (BTB) detected by the comparative intradermal tuberculin test (CIDT) was conducted in livestock of the Somali region in southeast Ethiopia-in four pastoral associations from January to August 2009. In 94 herds, each of 15 cattle, camels, and goats was tested per herd leading to a total of 1,418 CIDT tested animals, with 421 cattle, 479 camels, and 518 goats. A herd was considered positive if it had at least one reactor. Prevalence per animal species was calculated using a xtgee model for each species. The individual animal prevalence was 2.0% [95% confidence interval (CI), 0.5-8.4], 0.4% (95% CI, 0.1-3%), and 0.2% (95% CI, 0.03-1.3) in cattle, camels, and goats, respectively. Prevalence of avian mycobacterium purified protein derivative (PPD) reactors in cattle, camels, and goats was 0.7% (95% CI, 0.2-2.0%), 10.0% (95% CI, 7.0-14.0%), and 1.9 (95% CI, 0.9-4.0%), respectively, whereby camels had an odds ratio of 16.5 (95% CI, 5.0-55.0) when compared to cattle. There was no significant difference between livestock species in BTB positivity. In the present study, the prevalence of bovine tuberculosis was low in Somali pastoral livestock in general and in camels and goats in particular. The high proportion of camel reactors to avian PPD needs further investigation of its impact on camel production. [ABSTRACT FROM AUTHOR]

Between May 2006 and January 2007, blood samples and ticks were randomly collected from 220 nomadic animals from Filtu and Dollo Odo districts, Libaan zone, in the Somali Region of Ethiopia. Overall, 81.5% cattle, 98.2% camels, 53.4% goats and 61.1% sheep were infested by ixodid ticks. Collected ticks (n = 1,036) were identified as Rhipicephalus pulchellus (40.1%), R. pravus (25.8%), Amblyomma gemma (9.4%), Hyalomma rufipes (13.3%), H. truncatum (2.8%), H. impeltatum (1.2%) and H. dromedarii (0.5%); immature stages (6.1%) belonged to the genera Rhipicephalus and Amblyomma. Tick infestation burden was evaluated by the Tick Abundance Score method on 57 animals from Dollo Odo in August 2006, and it was significantly higher in cattle and camels than in small ruminants ( p < 0.001). Reverse Line Blot Hybridisation was applied to detect Theileria, Babesia, Ehrlichia and Anaplasma spp. Five out of 50 blood samples from Filtu, four from cattle and, surprisingly, one from a camel, were positive for Theileria mutans and two from cattle for T. velifera. Adult ticks (n = 104) from both districts were tested and A. gemma from cattle were positive to T. velifera (1) and Ehrlichia ruminantium (5 samples). Positive E. ruminantium samples were also tested by PCR targeting pCS20 and 16S rRNA genes and submitted to DNA sequencing. The phylogenetic reconstruction of pCS20 fragment showed the presence of the Somali region sequences in the East-South African group. Our results are the first available on ticks and selected tick-borne diseases from the Somali region of Ethiopia and could be used as preliminary information for planning sustainable control strategies for tick and tick-borne pathogens in the study area and in neighbouring areas with similar socio-ecological features. [ABSTRACT FROM AUTHOR]