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Zelalem Tadesse,1 Abdi Bekele Bayissa,2 Tolesa Diriba,3 Nahom Chernet,4 Seniat Tsegaye,5 Molla Tsega6 1Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia; 2Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 3School of Public Health, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; 4Department of Pediatrics and Child Health, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia; 5Amanuel Specialized Mental Health Hospital, Addis Ababa, Ethiopia; 6Department of Internal Medicine, School of Medicine, College of Medicine and Health Science, Debre Markos University, Debre Markos, EthiopiaCorrespondence: Zelalem Tadesse, Tel +251970377161, Email zelemanwon@gmail.comBackground: Early identification of patients at high risk of poor clinical outcomes is the key to success in saving the lives of patients with coronavirus disease 2019 (COVID-19). Neutrophil to Lymphocyte Ratio (NLR) is an easily available and cheap surrogate inflammatory marker, its baseline NLR role in African COVID-19 patients remains to be investigated. The objective of the study aimed to evaluate the role of NLR as a predictor of severity and mortality of COVID-19 patients admitted at the Millennium COVID 19 care center in Addis Ababa, Ethiopia.Methods: A cross-sectional study was conducted on patients with COVID-19 admitted to the Millennium COVID-19 care center from August 1 to October 30, 2021. Receiver Operating Characteristic curve analysis was used to calculate the area under the curve to assess the predictive capacity of NLR on mortality and severity. Multivariable logistic regression analysis was done to identify the association between independent variables and disease outcomes with an Adjusted Odds Ratio (AOR), P-value, and 95% CI for AOR were used for testing significance.Results: The NLR of 9.47 was identified as the optimal cut-off value for predicting mortality with a sensitivity of 88.7% and a specificity of 95.4% (Area Under the Curve (AUC):0.95, 95% CI 0.92– 98; P< 0.001) and the NLR of 5.86 was an effective threshold value in predicting the severity of disease with a sensitivity of 92.2% and a specificity of 75% (AUC:0.85, 95% CI 0.800– 0.905; P< 0.001). In multivariable logistic regression analysis, after adjusting for confounding factors, NLR of more than 9.47 and 5.86 was significantly associated with all‐cause of in‐hospital mortality (AOR=4.73, 95% CI, 1.19– 33.68; P< 0.02), and severity of disease (AOR=12.98, 95% CI 3.85– 43.80; P=0.001), respectively.Conclusion: NLR greater than 9.47 and 5.86 effectively predict mortality and severity of the disease, respectively. It provides an objective input for early decision-making in inpatient management especially in resources limited area.Keywords: COVID 19, neutrophil-to-lymphocyte ratio

Tadesse Waktola Gamessa,1 Samuel Tadesse Abebe,1 Lemlem Degafu Abate,1 Megersa Kebede Abo,1 Alemu Abibi Mekonnen,1 Zerihun Ketema Tadesse,1 Addisu Fayera Woyesa,1 Regasa Bayisa Obse,1 Mahdi Abdella Ibrahim,1 Gizeaddis Lamesgin Simegn2 1Pharmaceticals and Medical Equipment Directorate, Ministry of Health, Addis Ababa, Ethiopia; 2School of Biomedical Engineering, Jimma Institute of Technology, Jimma University, Jimma, EthiopiaCorrespondence: Tadesse Waktola Gamessa, Pharmaceuticals and Medical Equipment Directorate, Ministry of Health, Addis Ababa, Ethiopia, Tel +251910201915, Email tadessewatola@gmail.comBackground: Planning and budgeting of medical devices allow a healthcare institution to properly use funds, acquire quality and efficient medical devices, and improve healthcare service delivery. The lack of proper policy in the procurement and management of medical devices causes inappropriate usage of funds and impedes the quality of a product. This study aimed to identify the current practices and gaps in the planning and budgeting of medical devices in Ethiopian public hospitals. In this study, an assessment was conducted in all regional public hospitals to assess the current status of medical device management, identify the gaps, and provide suggestions for areas of improvement.Methods: A descriptive cross-sectional design was used for the study assessment where a structured data collection tool was utilized to collect data. A multi-stage stratified random sampling proportionate to size technique was employed for the sampling of public hospitals in all regions of Ethiopia. The collected data was analyzed using SPSS version 26 software.Results: The availability of medical equipment development plans, budgeting, and spare parts procurement plans were found to be below 50% in public hospitals. It was also noted that 40.3% of hospitals do not prepare medical device technical specifications during procurement orders. Moreover, the engagement of biomedical engineers/technicians in the planning and procurement of medical devices was found to be below 50%.Conclusion: This assessment showed that there is a need for improvement in the development of procurement plans and preparation of technical specifications for medical devices in Ethiopian public hospitals. Developing policies and strategies for the proper use of funds in the procurement of medical devices, involving biomedical engineering professionals in the planning, procurement and use of medical devices could help to improve the quality, optimized utilization and efficiency of medical devices and ultimately enhance healthcare service delivery.Keywords: biomedical engineering professionals, budgeting, medical device, planning, public hospitals

Inefficiency in barley production is among the challenges to agricultural transformation in Ethiopia. North Shewa zone of Amhara regional state is not exception in this regard. As such addressing inefficiency is among the crucial efforts for agricultural transformation. The objective of the current study was to analyze the technical efficiency of barley production in north Shewa zone of Amhara regional state, Ethiopia. For this purpose 385 farm households were randomly selected from four purposively selected districts in the zone. The one-step maximum likelihood estimation result of the Cobb-Douglas production function result reveals that seed application, DAP fertilizer application, UREA fertilizer application, land under barley production, labor and oxen ownership have a positive and significant effect on barley production. The predicted average technical efficiency score is found to be 85.06 percent implying that given existing input mix and technology it is possible to increase the production of barley on average by 14.94%. The study found that education, non/off farm income, access to market information, access to extension service and tropical livestock unit are found to have a positive and significant effect on the technical efficiency of barley production while distance from the market and marital status (divorced) have a negative significant effect on technical efficiency of barley production. The result suggests that the government should encourage farmers vocational trainings and participation in off/non-farm activities, improve access to market information, access to extension services, livestock ownership and access to market to improve barley production efficiency.

The main objective of the study is to identify the determinants of wheat value chain in case of North Shewa Zone of Amhara region, Ethiopia. The researchers used multistage purposive random sampling technique to select representative households in the study area. The ordinary least square output revealed that production of wheat, price of wheat and secondary and tertiary education of the household positively and significantly affect supply of wheat to the market. On the other hand, distance from the market and distance from the main road have negative and significant effect on supply of wheat. Moreover, the multinomial logit regression result showed that household family size and market information have positive and significant effect while distance from the market and ownership of livestock have negative and significant effect on smallholder farmers’ market participation. The binary logit model also indicates that land holding, access to market information, total livestock and primary education affected positively and significantly. Therefore, policies aiming at increasing farmer’s awareness of producing value added wheat produce to enhance value creations are recommended to strengthen chain development.

Abstract Exclusive breastfeeding (EBF) during the first 6 months of life is crucial for optimizing child growth, development and survival, as well as the mother's wellbeing. Mother's employment may hinder optimal breastfeeding, especially in the first 6 months. We assessed the effectiveness of a baby‐friendly workplace support intervention on EBF in Kenya. This pre‐post intervention study was conducted between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of workplace support policies and programme interventions including providing breastfeeding flexi‐time and breaks for breastfeeding mothers; day‐care centres (crèches) for babies near the workplace and lactation centres with facilities for breast milk expression and storage at the crèches; creating awareness on available workplace support for breastfeeding policies; and home‐based nutritional counselling for pregnant and breastfeeding women. EBF was measured through 24‐h recall. The effect of the intervention on EBF was estimated using propensity score weighting. The study included 270 and 146 mother–child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. The prevalence of EBF was higher in the treated group (80.8%) than in the nontreated group (20.2%); corresponding to a fourfold increased probability of EBF [risk ratio (RR) 3.90; 95% confidence interval (CI) 2.95–5.15]. The effect of the intervention was stronger among children aged 3–5 months (RR 8.13; 95% CI 4.23–15.64) than among those aged

Laying the ground for the agricultural sector to derive development is critical and urgent in relieving majority of the poor out of poverty trap. This in turn calls the modernization of the agriculture sector through agricultural technology adoption. The major objective of the study is to assess the perception and determinants of agricultural technology adoption in North Shoa zone, Amhara regional state, Ethiopia. Data were collected from 796 farming households from four districts namely, Angolela Tera, Menz Gera, Minijar Shenkora and Moretna Jiru. For analysis purpose, t-test and binomial logistic model was employed. The result indicates that the likelihood of adopting improved seed, chemical fertilizer and irrigation is higher among households with higher age, greater years of schooling, large farm size, large livestock ownership and many extension contacts. Additionally, the likelihood of adopting these agricultural technologies is higher for household participating in non-farm income generating activities, having membership status in various social group and having access to credit. The likelihood of adopting the prevailing agricultural technologies also found higher for male- headed households as compared to female-headed ones. Distance to the nearest market also negatively and significantly affects the decision to adopt various agricultural technologies. The study suggested that the awareness of farmers concerning the available agricultural technologies should be raised through membership of different social group and frequent extension contact. On the other, promoting farmers to participate in off-farm income generation activities and creating access to credit service can reduce the financial constraint in purchasing and possessing new agricultural technologies.

The main objective of this study is to examine the determinants of the technical efficiency of commercial banks in Ethiopia over the period from 2011 to 2014. For this purpose, the study used secondary data from the annual reports of the commercial banks in Ethiopia under study. To estimate the technical efficiency score DEA was employed on input variables (interest expense, operating expense and deposit) and output variables (interest income, non-interest income and loan). The estimated technical efficiency score indicated that, Under the constant returns to scale assumption Abay bank, Construction and Business bank and Cooperative bank of Oromia are found to be less efficient, while Nib international bank and Oromia international bank are found to be more efficient. Under the variables returns to scale assumption Construction and Business bank, Abay bank and Cooperative bank of Oromia are found to be less efficient while Oromia international bank, Awash international bank and Wegagen bank are found to be more efficient. It is also confirmed that Oromia international bank and Nib international bank are the most scale efficient commercial banks in Ethiopia compared to the commercial banks incorporated in the study while Berhan international bank and Awash international bank are the least scale efficient banks. A Tobit model is used to examine the determinants of technical efficiency. Accordingly, it is found that level of capitalization, liquidity risk, return on asset and market share are found to have positive and significant effect on the technical efficiency score.

Objective:To assess the prevalence and practice of fertility regulation methods among remote Ethiopian communities of the Hamer District, Southern Ethiopia. Materials and methods: Community-based cross sectional study was conducted in Hamer District of South Regional State of Ethiopia. The study populations were women of reproductive age group residing in the District and purposively identified key informants. Stratified Simple random sampling procedure was carried out to reach at the 382 women included in the survey. The Data was collected using structured questionnaire and analyzed using SPSS computer software. Results: The study revealed that there exist various traditional as well as modern fertility regulation methods in the area (particularly the former). Traditional Methods including the use of herbs called ‘Ditha' and ‘Dohe'; the application of different materials on the uterus; infanticide & Abortion were among the risky methods that are widely practiced in the area currently. On the other hand; methods like Post Partum Abstinence and natural methods were among the methods with unknown efficacy despite extensive practice. For women who are deep to the District (rural) and are illiterate; the awareness, knowledge and practice of these methods is by far less than many figures in the country; on the other hand, the same was high for the urban women even when compared with some regional and national figures. Conclusion:it was possible to conclude that various types of traditionally known useful and harmful (risky) fertility regulation methods exist in the area. These findings imply the importance of strengthening the IEC/BCC and introduction of reliable modern family planning methods as well as establishing reproductive health services, and possibly establishment of abortion care in the area is a timely activity to end with the problems.

Abstract Background Routine malaria surveillance data is useful for assessing incidence and trends over time, and in stratification for targeting of malaria control. The reporting completeness and potential bias of such data needs assessment. Methods Data on 17 malaria indicators were extracted from the Integrated Disease Surveillance and Response System database for July 2004 to June 2009 (Ethiopian calendar reporting years 1997 to 2001). Reporting units were standardized over time with 2007 census populations. The data were analysed to show reporting completeness, variation in risk by reporting unit, and incidence trends for malaria indicators. Results Reporting completeness, estimated as product of unit-month and health facility reporting, was over 80% until 2009, when it fell to 56% during a period of reorganization in the Ministry of Health. Nationally the average estimated annual incidence of reported total malaria for the calendar years 2005 to 2008 was 23.4 per 1000 persons, and of confirmed malaria was 7.6 per 1,000, with no clear decline in out-patient cases over the time period. Reported malaria in-patient admissions and deaths (averaging 6.4 per 10,000 and 2.3 per 100,000 per year respectively) declined threefold between 2005 and 2009, as did admissions and deaths reported as malaria with severe anaemia. Only 8 of 86 reporting units had average annual estimated incidence of confirmed malaria above 20 per 1,000 persons, while 26 units were consistently below five reported cases per 1,000 persons per year. Conclusion The Integrated Disease Surveillance and Response System functioned well over the time period mid 2004 to the end of 2008. The data suggest that the scale up of interventions has had considerable impact on malaria in-patient cases and mortality, as reported from health centres and hospitals. These trends must be regarded as relative (over space and time) rather than absolute. The data can be used to stratify areas for improved targeting of control efforts to steadily reduce incidence. They also provide a baseline of incidence estimates against which to gauge future progress towards elimination. Inclusion of climate information over this time period and extension of the dataset to more years is needed to clarify the impact of control measures compared to natural cycles on malaria.

Abstract Background Ownership of insecticidal mosquito nets has dramatically increased in Ethiopia since 2006, but the proportion of persons with access to such nets who use them has declined. It is important to understand individual level net use factors in the context of the home to modify programmes so as to maximize net use. Methods Generalized linear latent and mixed models (GLLAMM) were used to investigate net use using individual level data from people living in net-owning households from two surveys in Ethiopia: baseline 2006 included 12,678 individuals from 2,468 households and a sub-sample of the Malaria Indicator Survey (MIS) in 2007 included 14,663 individuals from 3,353 households. Individual factors (age, sex, pregnancy); net factors (condition, age, net density); household factors (number of rooms [2006] or sleeping spaces [2007], IRS, women's knowledge and school attendance [2007 only], wealth, altitude); and cluster level factors (rural or urban) were investigated in univariate and multi-variable models for each survey. Results In 2006, increased net use was associated with: age 25-49 years (adjusted (a) OR = 1.4, 95% confidence interval (CI) 1.2-1.7) compared to children U5; female gender (aOR = 1.4; 95% CI 1.2-1.5); fewer nets with holes (Ptrend = 0.002); and increasing net density (Ptrend < 0.001). Reduced net use was associated with: age 5-24 years (aOR = 0.2; 95% CI 0.2-0.3). In 2007, increased net use was associated with: female gender (aOR = 1.3; 95% CI 1.1-1.6); fewer nets with holes (aOR [all nets in HH good] = 1.6; 95% CI 1.2-2.1); increasing net density (Ptrend < 0.001); increased women's malaria knowledge (Ptrend < 0.001); and urban clusters (aOR = 2.5; 95% CI 1.5-4.1). Reduced net use was associated with: age 5-24 years (aOR = 0.3; 95% CI 0.2-0.4); number of sleeping spaces (aOR [per additional space] = 0.6, 95% CI 0.5-0.7); more old nets (aOR [all nets in HH older than 12 months] = 0.5; 95% CI 0.3-0.7); and increasing household altitude (Ptrend < 0.001). Conclusion In both surveys, net use was more likely by women, if nets had fewer holes and were at higher net per person density within households. School-age children and young adults were much less likely to use a net. Increasing availability of nets within households (i.e. increasing net density), and improving net condition while focusing on education and promotion of net use, especially in school-age children and young adults in rural areas, are crucial areas for intervention to ensure maximum net use and consequent reduction of malaria transmission.

Abstract Background The emergence of drug resistance is a major problem in malaria control. Combination of molecular genotyping and characterization of mutations or single nucleotide polymorphisms (SNPs) correlated with drug resistance can provide information for subsequent surveillance of existing and developing drug resistance patterns. The introduction of artemether/lumefantrine (AL) as first-line treatment, never used before in Ethiopia, allowed the collection of baseline data of molecular polymorphisms before a selection due to AL could occur. Method 97 patients with uncomplicated falciparum malaria were recruited from April to June 2006 and treated with either AL, quinine (Q) or atovaquone/proguanil (AP) in Jimma University Hospital, Ethiopia. Mutations or SNPs associated with resistance to these drugs were analysed by RFLP (pfdhfr, pfmdr1) and sequencing of the target genes (pfcytb, pfserca ). Results SNPs previously reported to be associated with resistance to the study drugs were identified in recrudescent and treatment sensitive isolates. A total of seven recrudescences were obtained. The pfmdr1 N86Y mutation was found in 84.5% of isolates. The triple mutation 51I,59R,108N of the pfdhfr gene occured in high frequency (83.3%) but no pfcytb mutation was detected. Sequencing showed a variety of previously described and new mutations in the pfserca gene. Conclusion The prevalence of mutations was in accordance with the expected patterns considering recent drug regimens. The broad introduction of AL and the cessation of former drug regimens might probably change the current distribution of polymorphisms, possibly leading to decreased sensitivity to AL in future. Continuous surveillance of molecular patterns in this region is, therefore, recommended.

Abstract Background Malaria transmission in Ethiopia is unstable and seasonal, with the majority of the country's population living in malaria-prone areas. Results from DHS 2005 indicate that the coverage of key malaria interventions was low. The government of Ethiopia has set the national goal of full population coverage with a mean of 2 long-lasting insecticidal nets (LLINs) per household through distribution of about 20 million LLIN by the end of 2007. The aim of this study was to generate baseline information on malaria parasite prevalence and coverage of key malaria control interventions in Oromia and SNNPR and to relate the prevalence survey findings to routine surveillance data just before further mass distribution of LLINs. Methods A 64 cluster malaria survey was conducted in January 2007 using a multi-stage cluster random sampling design. Using Malaria Indicator Survey Household Questionnaire modified for the local conditions as well as peripheral blood microscopy and rapid diagnostic tests, the survey assessed net ownership and use and malaria parasite prevalence in Oromia and SNNPR regions of Ethiopia. Routine surveillance data on malaria for the survey time period was obtained for comparison with prevalence survey results. Results Overall, 47.5% (95% confidence interval (CI) 33.5–61.9%) of households had at least one net, and 35.1% (95% CI 23.1–49.4%) had at least one LLIN. There was no difference in net ownership or net utilization between the regions. Malaria parasite prevalence was 2.4% (95% CI 1.6–3.5%) overall, but differed markedly between the two regions: Oromia, 0.9% (95% CI 0.5–1.6); SNNPR, 5.4% (95% CI 3.4–8.5), p < 0.001. This difference between the two regions was also reflected in the routine surveillance data. Conclusion Household net ownership exhibited nearly ten-fold increase compared to the results of Demographic and Health Survey 2005 when fewer than 5% of households in these two regions owned any nets. The results of the survey as well as the routine surveillance data demonstrated that malaria continues to be a significant public health challenge in these regions–and more prevalent in SNNPR than in Oromia.

Background: Malaria transmission in Ethiopia is unstable and seasonal, with the majority of the country's population living in malaria-prone areas. Results from DHS 2005 indicate that the coverage of key malaria interventions was low. The government of Ethiopia has set the national goal of full population coverage with a mean of 2 long-lasting insecticidal nets (LLINs) per household through distribution of about 20 million LLIN by the end of 2007. The aim of this study was to generate baseline information on malaria parasite prevalence and coverage of key malaria control interventions in Oromia and SNNPR and to relate the prevalence survey findings to routine surveillance data just before further mass distribution of LLINs.Methods: A 64 cluster malaria survey was conducted in January 2007 using a multi-stage cluster random sampling design. Using Malaria Indicator Survey Household Questionnaire modified for the local conditions as well as peripheral blood microscopy and rapid diagnostic tests, the survey assessed net ownership and use and malaria parasite prevalence in Oromia and SNNPR regions of Ethiopia. Routine surveillance data on malaria for the survey time period was obtained for comparison with prevalence survey results.Results: Overall, 47.5% (95% confidence interval (CI) 33.5-61.9%) of households had at least one net, and 35.1% (95% CI 23.1-49.4%) had at least one LLIN. There was no difference in net ownership or net utilization between the regions. Malaria parasite prevalence was 2.4% (95% CI 1.6-3.5%) overall, but differed markedly between the two regions: Oromia, 0.9% (95% CI 0.5-1.6); SNNPR, 5.4% (95% CI 3.4-8.5), p < 0.001. This difference between the two regions was also reflected in the routine surveillance data.Conclusion: Household net ownership exhibited nearly ten-fold increase compared to the results of Demographic and Health Survey 2005 when fewer than 5% of households in these two regions owned any nets. The results of the survey as well as the routine surveillance data demonstrated that malaria continues to be a significant public health challenge in these regions-and more prevalent in SNNPR than in Oromia. [ABSTRACT FROM AUTHOR]

Trachoma recrudescence is a serious concern for trachoma control programs. Programs define recrudescence as the return of trachomatous inflammation-follicular (TF) prevalence above elimination threshold (≥5%) on district-level trachoma surveillance surveys (TSSs). This study aimed to determine potential correlates of trachoma recrudescence within a historically highly endemic region. Between 2015 and 2021, population-based TSSs were conducted in 51 districts of Amhara, Ethiopia. District estimates were calculated accounting for multistage design; logistic regression was used to estimate the association of key correlates with recrudescence at the district level. Among the 51 districts, 17 (33%) were recrudescent. Correlates of recrudescence included indicators of historic trachoma burden, such as higher trachomatous inflammation-intense (TI) prevalence (odds ratio [OR]: 2.6, CI: 1.4-5.3) and higher Chlamydia trachomatis ( Ct ) infection prevalence (OR: 2.9, CI: 1.1-9.9) at the first recorded impact survey. The increased prevalence of children with clean faces (OR: 0.4, CI: 0.21-1.0) and the increased prevalence of travel time to a water source ≤ 30 min (OR: 0.5, CI: 0.2-1.1) at the TSS were associated with a protective effect from recrudescence. Data on historical trachoma burden as well as current water and sanitation conditions may help programs predict where recrudescence is more likely to occur and thus help programs sustain elimination as a public health problem.

Stigma is common in people affected with Neglected Tropical Diseases (NTDs). However, no validated tools are available to assess and monitor stigma in trachoma-affected communities. We tested the cross-cultural equivalence of the 5-question stigma indicator-affected persons (5-QSI-AP) scale in persons with trachomatous trichiasis (TT), the blinding stage of trachoma, and the 5-question stigma indicator-community stigma (5-QSI-CS) scale in person without TT, in Amhara region, Ethiopia. Conceptual, item, semantic, and operational equivalence were assessed through exploratory qualitative methods; measurement equivalence was assessed quantitatively through internal consistency, construct validity, and reproducibility. A total of 390 people participated: 181 were persons with TT, 182 persons without TT, 19 mental health, trachoma, social science, and linguistics experts, and eight interviewers. Items included in both scales were adequately relevant and important to explore stigma in the target culture. Concern about others knowing that they have TT, shame, avoidance by others, and problems getting married or in their marriage were among the issues persons with TT faced in this study community. The 5-QSI-AP had a Cronbach's α of 0.57 for internal consistency and showed adequate discriminant validity where persons with central corneal opacity from TT had higher mean stigma scores than their counterparts. The 5-QSI-CS had a Cronbach's α of 0.70 for internal consistency and a correlation of r = 0.23 with the Social Distance Scale (SDS) for convergent validity. The test-retest reliability analysis between the initial and repeat measures produced an intraclass correlation coefficient of 0.60 and 0.53 for the 5-QSI-AP and 5-QSI-CS respectively, and no evidence of systematic bias in mean stigma scores. The 5-QSI scales have satisfactory cultural validity to assess and monitor stigma in this trachoma-affected Amharic-speaking study population. With further cross-cultural validation, these brief and easy to administer scales would offer the possibility to rapidly measure and monitor stigma associated with NTDs., Competing Interests: Competing interests The authors have declared that no competing interests exist.

Background: The world faces great difficulty in continuing to provide essential maternity health care after the onset of COVID-19 pandemic Many women have trouble accessing maternity healthcare due to fear of infection. A decline in the utilization of maternity health services is suggested to worsen adequate antenatal care service utilization. Thus, this study aimed to determine the pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 in Ethiopia., Methods: The searching of articles was carried out on Web of Science, Scopus, PubMed, CINHAL, Google Scholar, African journals online, and the institutional repository of Ethiopian universities. Using a Microsoft Excel standardized spreadsheet, the data were extracted. A random effect model was used to determine a pooled estimate of adequate antenatal care utilization. I 2 statistics were used to quantify the amount of heterogeneity. The evidence of publication bias was examined using Egger's regression test and a visual inspection of the funnel plot. Subgroup and sensitivity analyses were also carried out., Results: Finally, this systematic review and meta-analysis included 11 eligible articles. The overall pooled estimate of adequate antenatal care service utilization after the onset of COVID-19 pandemic in Ethiopia was 46.28% (95% CI: 35.32%-57.26%). There is a substantial amount of heterogeneity between studies ( I 2 = 99.07%, p < 0.001). Pregnant women who visited antenatal care early were 10.9 times more likely to have adequate antenatal care utilization than those without early visits (AOR = 10.93, 95% CI: 7.2-14.66)., Conclusion: In this review, the percentage of women who utilized adequate antenatal care after the onset of COVID-19 pandemic in Ethiopia was less than half. Early antenatal care visit is an important factor to achieve adequate antenatal care service utilizations., Systematic Review Registration: : CRD42023495279., 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 Wondmeneh and Solomon Tadesse.)

Many effective health system innovations fail to reach those who need them most, falling short of the goal of universal health coverage. In the 5 years since the Federal Ministry of Health in Ethiopia localised the Practical Approach to Care Kit (PACK) programme to support primary care reforms, PACK has been scaled-up to over 90% of the country's primary care health centres. Known as the Ethiopian Primary Healthcare Clinical Guideline (EPHCG), the programme comprises a comprehensive, policy-aligned clinical decision support tool (EPHCG guide) and an implementation strategy to embed comprehensive, integrated care into every primary care consultation for individuals over 5 years of age, while addressing barriers to streamlined primary healthcare delivery. We describe the components of the EPHCG programme and the work done to establish it in Ethiopia. Yamey's framework for successful scale-up is used to examine the programme and health system factors that enabled its scale-up within a 5-year period. These included high-level ministry leadership and support, a cascade model of implementation embedded in all levels of the health system, regular EPHCG guide and training material updates and strategies to generate stakeholder buy-in from managers, health workers, patients and communities. Challenges, including stakeholder resistance, training fidelity and quality and procurement of medicines and diagnostic tests, are described, along with efforts to resolve them. Insights and learnings will be of interest to those implementing PACK programmes elsewhere, and managers and researchers responsible for design and delivery of health systems strengthening innovations at scale in low-income and middle-income countries., Competing Interests: Competing interests: RVC, LRF, DG-P and C-JR developed the PACK programme and mentored its localisation and implementation in Ethiopia. CH and AB led evaluations of EPHCG implementation. The rest of the co-authors led the EPHCG implementation., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: The development of modern agriculture has significantly contributed to improving global food security and safety, alleviating poverty, and enhancing human health and livelihoods. However, the rapid advancement of modern agriculture has also brought about various challenges that limit its sustainable development. This commentary aims to discuss these issues through the One Health lens, and provide valuable insights for balancing modern agricultural activities with the need to protect and promote the health of all the sectors., Main Text: This commentary explores the multifaceted impacts of modern agriculture on social development, as well as the associated various health challenges and environmental impacts within the One Health framework. Key issues include ecosystem degradation, increased risk of interspecies disease transmission like zoonoses, reverse zoonoses, and vector-borne diseases, and the escalated threat of antimicrobial resistance due to intensified agricultural production and increased antimicrobial use. To address these challenges, this commentary outlines potential solutions anchored in the development and implementation of modern technologies and good agricultural practices, such as precision farming, integrated pest management, biosecurity measures, vaccination programs, as well as surveillance and early detection of health risks., Conclusions: Good agricultural practices supported by scientific and technological advancements are essential for aligning productivity with the One Health vision, ensuring the health and resilience of all the sectors. Enhancing stakeholder education, strengthening regulatory frameworks, and providing supportive policies and infrastructure for farmers to adopt sustainable practices are crucial for the long-term viability of agrifood systems. The Food and Agriculture Organization of the United Nations plays a pivotal role in guiding this sustainable transformation through the One Health approach., (© 2024. The Author(s).)

The purpose of this study was to investigate the correlation between bacterial load of Chlamydia trachomatis as measured from quantitative polymerase chain reaction (qPCR) and the relative clinical severity of trachomatous inflammation. Individuals with trachoma from rural communities in Ethiopia had photographs taken as well as swabs obtained of the upper tarsal conjunctivas. Conjunctival swabs were processed with PCR assay, which provided quantitative results of ocular chlamydial load. A series of 125 conjunctival photographs were ranked from least to most severe according to clinical severity for follicular and papillary conjunctivitis. Higher intensity rankings of trachomatous inflammation were associated with higher chlamydial load for both follicular inflammation (Spearman's ρ = 0.43; P <0.001) and papillary inflammation (Spearman's ρ = 0.50; P <0.001). Rankings of trachomatous inflammation may be a clinically meaningful indicator of trachoma.

Objectives: A 6-week course of tetracycline eye ointment is an alternative to single -dose oral azithromycin in annual mass drug administration for trachoma control. Compliance with the recommended tetracycline eye ointment regimen has not been well characterised when administered as part of a trachoma control program., Methods: A routine mass drug administration for trachoma was carried out in 40 communities in the Amhara region of Ethiopia. Two tubes of tetracycline eye ointment, to be administered twice daily for 6 weeks, was offered to all children under 6 months of age, to pregnant women who declined to take azithromycin, and to all individuals with a macrolide allergy. Seven weeks following the mass drug administration, a treatment compliance survey was performed for all community members documented to have received tetracycline eye ointment during the mass drug administration., Results: Of the 491 individuals documented as having received tetracycline eye ointment from the treatment records, 367 completed the survey, of which 214 recalled being offered tetracycline eye ointment. A total of 105 (49%) respondents reported taking ≥1 daily dose of tetracycline eye ointment on most days of the week for at least the first week. Only 20 (9%) respondents reported taking at least 1 tetracycline eye ointment dose per week for 6 weeks. The most common reasons for low compliance included 'saving it for a future infection' and 'stopped because I (or my child) seemed healthy'. The odds of low compliance were greater for those who reported not having adequate counselling (e.g., odds ratio [OR] 5.3, 95% CI 2.5-28.9 when low compliance was defined as not taking a tetracycline eye ointment dose for most days of at least the first week)., Conclusions: Compliance with tetracycline eye ointment was low when administered by a trachoma program during a routine mass drug administration, especially for those reporting inadequate counselling. Further research with a larger sample size and varied settings is warranted to better understand and improve compliance., (© 2024 The Authors Tropical Medicine & International Health published by John Wiley & Sons Ltd.)

Trachoma is targeted for global elimination as a public health problem by 2030. Measurement of IgG antibodies in children is being considered for surveillance and programmatic decision-making. There are currently no guidelines for applications of serology, which represents a generalizable problem in seroepidemiology and disease elimination. We collated Chlamydia trachomatis Pgp3 and CT694 IgG measurements (63,911 children ages 1-9 years) from 48 serosurveys, including surveys across Africa, Latin America, and the Pacific Islands to estimate population-level seroconversion rates (SCR) along a gradient of trachoma endemicity. We propose a novel, generalizable approach to estimate the probability that population C. trachomatis transmission is below levels requiring ongoing programmatic action, or conversely is above levels that indicate ongoing interventions are needed. We provide possible thresholds for SCR at a specified level of certainty and illustrate how the approach could be used to inform trachoma program decision-making using serology., Competing Interests: KR, PJH, and PME are employees of, and EMHE receives salary support from, the International Trachoma Initiative, which receives an operating budget and research funds from Pfizer Inc., the manufacturers of Zithromax® (azithromycin). The other authors declare no competing interests. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

Purpose: Trachoma surveys are used to estimate the prevalence of trachomatous inflammation-follicular (TF) to guide mass antibiotic distribution. These surveys currently rely on human graders, introducing a significant resource burden and potential for human error. This study describes the development and evaluation of machine learning models intended to reduce cost and improve reliability of these surveys., Methods: Fifty-six thousand seven hundred twenty-five everted eyelid photographs were obtained from 11,358 children of age 0 to 9 years in a single trachoma-endemic region of Ethiopia over a 3-year period. Expert graders reviewed all images from each examination to determine the estimated number of tarsal conjunctival follicles and the degree of trachomatous inflammation-intense. The median estimate of the 3 grader groups was used as the ground truth to train a MobileNetV3 large deep convolutional neural network to detect cases with TF., Results: The classification model predicted a TF prevalence of 32%, which was not significantly different from the human consensus estimate (30%; 95% confidence interval of difference, -2 to +4%). The model had an area under the receiver operating characteristic curve of 0.943, F1 score of 0.923, 88% accuracy, 83% sensitivity, and 91% specificity. The area under the receiver operating characteristic curve increased to 0.995 when interpreting nonborderline cases of TF., Conclusions: Deep convolutional neural network models performed well at classifying TF and detecting the number of follicles evident in conjunctival photographs. Implementation of similar models may enable accurate, efficient, large-scale trachoma screening. Further validation in diverse populations with varying TF prevalence is needed before implementation at scale., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)