Ethiopian National Research Articles

Data management practice of health extension workers and associated factors in Central Gondar Zone, northwest Ethiopia.

Generating quality data for decision-making at all levels of a health system is a global imperative. The assessment of the Ethiopian National Health Information System revealed that health information system resources, data management, dissemination, and their use were rated as "not adequate" among the six major components of the health system. Health extension workers are the frontline health workforce where baseline health data are generated in theEthiopian health system. However, the data collected, compiled, and reported by health extension workers are unreliable and of low quality. Despite huge problems in data management practices, there is a lack of sound evidence on how to overcome these health data management challenges, particularly among health extension workers. Thus, this study aimed to assess data management practices and their associated factors among health extension workers in theCentral Gondar Zone. An institution-based cross-sectional study was conducted among 383 health extension workers. A simple random sampling method was used to select districts, all health extension workers were surveyed in the selected districts, and a structured self-administered questionnaire was used for data collection. The data was entered using EpiData version 4.6 and analyzed using STATA, version 16. Bivariable and multivariable binary logistic regression analyses were executed. An odds ratio with a 95% confidence interval and a p-value of <0.05 was calculated to determine the strength of theassociation and to evaluate statistical significance, respectively. Of the 383 health extension workers enrolled, all responded to the questionnaire with a response rate of 100%. Furthermore, 54.7% ofthe respondents had good data management practices. In the multivariable logistic regression analysis, being a married woman, having good data management knowledge, having agood attitude toward data management, having 1-5 years of working experience, and havingasalary ranging from 5,358 to 8,013 Ethiopian Birr were the factors significantly associated with good data management practices among health extension workers. The overall data management practice was poor with only five health extension workers out of ten having good data management practices.

A qualitative study of the barriers and facilitators for women with a disability seeking sexual and reproductive health services in Addis Ababa, Ethiopia

BackgroundThe need to advance the sexual and reproductive health (SRH) and rights of women with a disability is becoming more widely recognized. Regrettably, in low- and middle-income settings like Ethiopia, several barriers impede women with a disability (WWDs) from receiving SRH services and care.ObjectivesThis study aims to explore barriers and enablers for women with a disability to access sexual and reproductive health services in Addis Ababa, Ethiopia.MethodsA qualitative phenomenological study was conducted among the purposively selected reproductive age (18–49) group of WWDs living in Addis Ababa who were members of the Ethiopian National Association of Persons with physical disabilities and the Ethiopian National Association for Blind. Ten in-depth interviews, and 2 focus group discussions, were conducted using an interview guide. The analysis involved the use of both a priori codes (from the theory) and emergent inductive codes (from the question guide).ResultsIn this study, several barriers were identified as keeping participants from accessing SRH services, such as unfavorable community views, organizational barriers in health facilities [HFs], financial limitations, transportation problems, and a lack of knowledge about the SRH programs that are available. The enabling factors that made WWDs access SRH services include social support and networking, access to education, positive providers' attitudes, and women's self-confidence/Assertiveness.ConclusionThe study reveals that financial problems brought on by inadequate health insurance coverage, economic hardship, the expense of transportation to the health facility, and the lack of preferential treatment at the health facility are some of the hurdles that WWDs face while accessing SRH services and care. To address these problems and promote SRH access, measures should be taken to decrease financial barriers, improve physical access, and build strong relationships with the community, the church, and healthcare providers.

Revolutionising multi-sectoral nutrition policy: Insights from the Ethiopian National Information Platform for Nutrition (NiPN) approach.

Revolutionising multi-sectoral nutrition policy: Insights from the Ethiopian National Information Platform for Nutrition (NiPN) approach.

Prevalence of Anemia and its associated factors among 6–59 months age children visiting public hospitals at Afar Region, Northeast Ethiopia: a hospital-based cross-sectional study

BackgroundAnemia is a significant global public health issue among children aged 6 to 59 months, particularly in low-income countries like Ethiopia. Studies focusing on pastoral communities, especially in the Afar Region, often underestimate the prevalence of anemia in these children. To address this information gap, this study aimed to determine the prevalence of anemia and its associated factors among children aged 6 to 59 months in public hospitals in the Afar Region of northeastern Ethiopia.MethodA hospital-based cross-sectional study was conducted among children aged 6 to 59 months, using systematic random sampling, at public hospitals in the Afar Region from February 28 to April 30, 2023.The data collection tool was adapted from the Ethiopian National Food Consumption Survey and the World Health Organization Infant and Young Child Feeding guidelines. Data entry was performed using EpiData version 4.2 and Anthroplus software for anthropometric measurements. Data analysis was conducted using SPSS version 26. Binary logistic regression models were applied to identify predictors of anemia, with a p-value of ≤ 0.05 considered statistically significant.ResultAmong the 306 children aged 6 to 59 months, the overall prevalence of anemia was 46.41 (95 CI: 43.8–48.9 ). Of the 142 anemic children aged 6 to 59 months, 62 (43.66 ) had mild anemia, 60 (42.25 ) had moderate anemia, and 20 (14.08 ) had severe anemia. Key factors associated with anemia included mothers with no formal education, the lowest family monthly income, a family size greater than five, and rural residence. Additionally, a previous diagnosis of parasitic infection, children aged 24–35 months, early weaning, a malaria diagnosis within the past three months, and diarrhea in the last two weeks were significant predictors of anemia in children aged 6 to 59 months.ConclusionIn the current study, anemia in children aged 6 to 59 months was classified as severe and is regarded as a critical public health issue. This suggests that more efforts should be made to significantly decrease anemia by actively involving rural mothers with no formal education and low income who have children aged 6–59 months, focusing on the prevention and management of malaria, diarrhea, and parasitic infections.

Alcohol use and its associated factors among Ethiopian military personnel

BackgroundStudies indicate that alcohol use is more prevalent in the military and that such use is related to coping mechanisms for stress. Alcohol use could result in health and social...

Coverage of Two-Dose Preemptive Cholera Mass Vaccination Campaign in High-Priority Hotspots in Shashemene, Oromia Region, Ethiopia.

Cholera is a public health priority in Ethiopia. The Ethiopian National Cholera Plan elaborates a multi-year scheme of oral cholera vaccine (OCV) use. Aligned with this, a preemptive OCV campaign was conducted under our Ethiopia Cholera Control and Prevention project. Here, we present the OCV vaccination outcomes. Cholera high-priority hotspots in the Oromia Region, Shashemene Town (ST) and Shashemene Woreda (SW), were selected. Four kebelles (Abosto, Alelu, Arada, and Awasho) in ST and 4 clusters (Faji Gole, Harabate, Toga, and Chabi) in SW were study sites with OCV areas nested within. A total of 40 000 and 60 000 people in ST and SW, respectively, were targeted for a 2-dose OCV (Euvichol-Plus) campaign in 11-15 May (first round [R1]) and 27-31 May (second round [R2]) 2022. Daily administrative OCV coverage and a coverage survey in 277 randomly selected households were conducted. The administrative OCV coverage was high: 102.0% for R1 and 100.5% for R2 in ST and 99.1% (R1) and 100.0% (R1) in SW. The coverage survey showed 78.0% (95% confidence interval [CI]: 73.1-82.9) of household members with 2-dose OCV and 16.8% (95% CI: 12.4-21.3) with no OCV in ST; and 83.1% (95% CI: 79.6-86.5) with 2-dose OCV and 11.8% (95% CI: 8.8-14.8) with no OCV in SW. The 2-dose coverages in 1-4-, 5-14-, and ≥15-year age groups were 88.3% (95% CI: 70.6-96.1), 88.9% (95% CI: 82.1-95.7), and 71.3% (95% CI: 64.2-78.3), respectively, in ST and 78.2% (95% CI: 68.8-87.7), 91.0% (95% CI: 86.6-95.3), and 78.7% (95% CI: 73.2-84.1) in SW. High 2-dose OCV coverage was achieved. Cholera surveillance is needed to assess the vaccine impact and effectiveness.

The Facade of Justice: Transitionless Transitional Justice of Ethiopia

The Ethiopian government has committed to a transitional justice process to address gross human rights violations through investigation, prosecution, truth-finding and revelation, reconciliation, conditional amnesty, reparation, and institutional reforms. Despite these efforts and international support, this mechanism will unlikely resolve Ethiopia's political and security issues. The government's lack of intent to cease ongoing conflicts and its continued human rights violations hinder effective participation in implementing the transitional justice process. Furthermore, the involvement of non-state and foreign actors, which are beyond the state’s authority, in gross human rights violations undermines accountability. Victims and witnesses in conflict zones face significant barriers to participation due to the government's limited reach and fear of retribution. Gross human rights violations by the government and the Ethiopian National Defense Force raise doubts about the accountability of civil and military leaders through a government-controlled transitional justice mechanism. To address these challenges, the current government should relinquish power to a transitional government to mitigate undue influence on the justice process, cease hostilities, and hold officials accountable. If the government resists establishing a transitional government, a hybrid court with foreign judges and prosecutors should handle high-profile cases, while domestic courts, with strict measures to ensure impartiality and independence, should address other cases.

Modeling the Contribution of Multiple Micronutrient Fortification of Salt to Daily Nutrient Intake Among the Ethiopian Population

BackgroundSalt is an affordable commodity and has wide coverage regardless of economic and social status and, hence, could be suitable vehicle for multiple micronutrient fortification. ObjectivesThis study aimed to simulate the contribution folic acid and zinc fortification of iodized salt to nutrient intake among the Ethiopian population. MethodsThe 2013 Ethiopian National Food Consumption Survey and various food composition tables were used to estimate baseline individual-level micronutrient intake. Usual intake was estimated using the Simulating Intake of Micronutrients for Policy Learning and Engagement macro tool. Discretionary salt consumption was calculated from total salt intake estimated using urinary sodium excretion. Fortificant addition rates were set to obtain maximum nutrient intake while simultaneously constraining that population with intake above the tolerable upper intake level to <5%. Addis Ababa and Somali (N = 2271), the regions with relatively the lowest and highest micronutrient deficiency prevalence in Ethiopia, were selected. ResultBaseline median intake of Zn was below the estimated average requirement for all demographic groups. Inadequate Zn intake ranged from 73% to 99%, the highest prevalence being observed among women in lower class of wealth quintiles from Somali region. Dietary folate inadequacy was as low as 2% among men in Addis Ababa but almost all (99%) women from Somali region had inadequate folate intake. Calculated discretionary salt intake was 7.5 g/d for adult men and women and 3.4 g/d for children. With addition 0.8 mg Zn and 30 μg of folic acid per gram of salt, multiple salt fortification is estimated to reduce Zn inadequacy by 38 percentage points in urban areas and19 percentage points in rural areas. Modeled reduction in folate inadequacy were 18% in urban areas and 22% in rural areas. ConclusionsMultiple salt fortification could be an effective approach to address micronutrient adequacy in Ethiopia given efficacious, technological, and economical feasibility.

The trends and spatiotemporal variability of temperature and rainfall in Hulbarag district, Silte Zone, Ethiopia

Ethiopia gets its agricultural water primarily from rainfall. This study was intended to investigate current climate variability and trends across space and time. Daily gridded temperature and rainfall data from 1993 to 2022 in the Hulbarag district, Silte Zone of Ethiopia was obtained from the Ethiopian National Metrological Institute and the Climate Hazard Group Infrared Precipitation with Station. The trends and variability of temperature and rainfall were analyzed using the Mann-Kendall trend test, Sen's slope, coefficient of variation, precipitation concentration index, and rainfall anomaly index. The results indicated that annual, spring, and summer rainfall revealed statistically significant decreasing trends at Hulbarag and Sankura stations, with the magnitude of −13.4, −11.6, and −10.6 mm per year and −6.8, −3.6 and −10.9 mm per year respectively. Conversely, autumn and winter season rainfall showed statistically significant increasing trends at Hulbarag and Sankura stations, with the magnitude of 5.1 and 5.5mm per year and 3.4 and 1.84mm per year consecutively. Between 43 % and 47 % of the observation periods had negative anomalies. The average yearly temperature, average yearly minimum temperature, and average yearly maximum temperatures at Sankura and Fonko stations all displayed statistically significant increasing trends, with a magnitude of 0.091 °C, 0.009 °C and 0.051 °C per year and 0.03 °C,0.01 °C and 0.0022 °C per year successively. It is advisable to develop a farming system that is climate-resilient by improving the adaptive capacity of wheat and maize-growing farmers by expanding the availability of early maturing seeds, changing crop calendars, and enhancing proactive and credible climate information services.

From imperial power to regional policeman: Ethiopian peacekeeping and the developmental state

Abstract Why and how do African states become peacekeepers? Through a single-case study, this article accounts for a transformation in peace and security: how Ethiopia became the world's prime source of blue helmets in the early twenty-first century, having largely shunned peacekeeping in preceding decades. We propose that peacekeeping came to serve as an unexpectedly useful technology to pursue state-building agendas. Historically, regional proxy wars undermined state-building efforts in Ethiopia and mismanagement of ethno-linguistic diversity rendered it vulnerable to externally supported rebellions. In the 2000s, an evolving approach to peacekeeping dovetailed with the ruling Ethiopian People's Revolutionary Democratic Front's (EPRDF) vision for recalibrating political order domestically and in the Horn of Africa. EPRDF became convinced that changing Ethiopia required changing its surrounding region. Regional intervention as peacekeeping was supported by global powers and helped bind neighbouring states to Ethiopia in new ways. This entailed the crafting of deep political ties in Somalia, South Sudan and Sudan that mitigated historical fears of Ethiopian hegemony and shielded EPRDF state-building from outside destabilization. Moreover, as Ethiopia's increasingly prominent role in United Nations and African Union missions improved the external environment for the EPRDF developmental state, it also expanded Ethiopian National Defence Force's role in the political economy, buttressing the party-state's hegemony.

Mycobacterium tuberculosis and human immunodeficiency virus co-infection and associated variables among presumptive pulmonary tuberculosis patients in Ethiopia; a health institution based cross-sectional study

BackgroundCo-infection of Mycobacterium tuberculosis (MTB) and the Human Immunodeficiency Virus (HIV) is a major global public health issue, particularly in border areas of resource-limited nations, including Ethiopia. ObjectiveTo explore the prevalence and associated variables of MTB/HIV co-infection among PTB presumptive patients in Northwest Ethiopia. MethodsFrom February to August 2021, a cross-sectional institutional investigation was conducted at the Metema and Abrehajira hospitals. Semi-structured questionnaires were used to collect socio-demographic and clinical data. The MTB/RIF Xpert assay was used to process sputum, and 3 ml of veins blood was collected for HIV rapid test (STAT-PAK, ABON, and SD BIOLINE HIV test algorithm) following the Ethiopian National HIV test algorithm. The Gene Xpert assay's sample processing control was checked to ensure data quality. Data entered into Epi-Data were exported to SPSS version 20 for analysis. Statistically significant variables (p-value ≤0.2) from bivariable analysis were included in multivariable analysis. A p-value ≤ 0.05 was judged statistically significant. ResultsThis study included 314 PTB presumptive patients with a median age of 35.0 years, of which 178 (56.69 %) were males. Among all patients, 40(12.7 %) and 51(16.2 %) were PTB, and HIV seropositivity, respectively. Of the PTB patients, 14/40 (35 %) (95 % CI: 24.4–45.6) were co-infected with HIV/AIDS. Married patients were 70 % less likely than unmarried individuals (AOR = 0.3 CI; 0.07–0.98) to have MTB/HIV co-infection. Patients who had contact history with MDR-TB patients (AOR = 5 CI; 1.37–18.00), and those who had a history of alcohol use (AOR = 12.2 CI; 2.56–57.8) were more likely to have MTB-HIV co-infection than their peers. ConclusionOur findings showed that MTB-HIV co-infection is one of the most important community health concerns in the study area. Therefore, MTB/HIV cooperation activities should be fully in place to prevent co-infection and its impact on the population.

Performance investigation of solar ejector cooling system: Case study area-Addis Ababa, Ethiopia

This study investigates the performance of a solar ejector cooling system under both on-design and off-design operating conditions, focusing on the case study area of Addis Ababa, Ethiopia. Data crucial to the analysis were gathered from the Ethiopian National Meteorology Agency (ENMA) over six consecutive years (2013-2018). The system's performance was evaluated through hourly and monthly analyses under on-design conditions, yielding promising results. Under on-design conditions, the system demonstrated favorable performance metrics. Specifically, at noontime in March, when the design points were set at Tg = 90°C, Tc = 30°C, and Te= 12°C, the system achieved a total hourly maximum coefficient of performance (COP) of 0.2049 and a cooling capacity of 186.9 W/m². Furthermore, the study determined that a collector area of 22.3 m² per ton of cooling capacity is required during noontime for all cooling seasons in Addis Ababa, Ethiopia. Additionally, an off-design operating condition map was developed for the system. The findings indicate that the solar ejector cooling system can effectively provide cooling during office hours (8:00-15:00) in Addis Ababa, Ethiopia.

The Ethiopian National Immunization Technical Advisory Group (E-NITAG): Establishment, Achievements and the Future.

The National Immunization Program (NIP) was introduced in Ethiopia in 1980. The NIP has expanded the number of vaccines from six to more than 14 in 2023. However, decisions on new vaccine introduction and other vaccine-related matters were not systematically deliberated nationally. Thus, the need to establish a national body to deliberate on vaccine and vaccination matters, in addition to the global immunization advisory groups, has been emphasized in the last decade. This article presents the establishment and achievements of the Ethiopian NITAG. The E-NITAG was established in 2016 and maintained its active role in providing recommendations for new vaccine introduction and improving the delivery of routine vaccines. The external assessment indicated the E-NITAG was highly functional and played a critical role in enhancing the vaccination practice in Ethiopia, especially during the COVID-19 pandemic. The absence of a dedicated secretariat staff was the major bottleneck to expanding the role of the E-NITAG beyond responding to MOH requests. The E-NITAG must be strengthened by establishing a secretariat that can eventually grow as an independent institution to address complex vaccine-related issues the NIP needs to address.

Assessment of Climate Trend, Meteorological Drought and Farmers' Perception to Climate Change and Variability in Hadero Tunto District, Southern Ethiopia

Currently, climate change and variability are a hot issue, and more attention needs to be paid to their impact on Ethiopia. Farmers' perception plays a significant role in successfully implementing of adaptation strategies to reduce climate change impacts. The main objective of this study was to assess climate trends, meteorological drought and farmers' perception of climate change variability in Hadero Tunto district, Kembata Tembaro Zone, Southern Ethiopia. To determine historical climate trends, 30 years of rainfall and temperature data were obtained from the Hawassa branch of the Ethiopian National Meteorological Service, and trend analysis was performed. The multistage sampling technique was used to select 150 farm households to be surveyed. The modified Mann–Kendall and Sens' slope estimator trend tests were applied to detect the statistical significance of the trend as well as the magnitude in the time series data. The standardized precipitation index was computed for short and long-term scales to characterize the moisture content in the study area. Results of the standardized precipitation index revealed that the total number of drought events was higher in spring than summer. Still, the most extreme drought was recorded in summer. The years 1987 and 2015 experienced extreme drought in summer with indices values of -2.89 and -2.03, respectively, while, -2.27 was the spring season of 2003. In the long-term scale, -1.7 was recorded as the severe value. The historical average annual maximum and minimum temperatures both showed a significant upward trend. Historical annual rainfall shows a negligible downward trend from 1987 to 2016. This trend of rising temperatures and changing rainfall threatens smallholders´ agriculture, who are already limited by access to basic equipment and land use challenges. The descriptive result revealed that most people perceived long-term variability in the rainfall amount and distribution pattern and an increasing trend and variability of temperature. Based on these results, the study recommends that agricultural extension services be enhanced to sensitize the farmers about climate change, thus improving their perception. Further, studies at a larger scale to illustrate the associations between farmers' perceptions of climate change with meteorological data to figure out the risk of climate change are also critical

The Red Sea Regional Security Complex: The Implications of the Red Sea Forum for Ethiopian National Security

The Red Sea Forum (RSF), since its foundation in December 2018, has attracted the attention of politicians and scholars near and far. The exclusion of Ethiopia from the forum disappointed the government, though the country is the most populous and anchor state in the Horn of Africa. Many of the objectives set by RSF are apparently unattainable without the direct or indirect participation of Ethiopia. The aim of this study, therefore, is to examine the implications of the Red Sea Forum for the national security of Ethiopia. The study employed a qualitative research method. In doing so, both primary and secondary sources were consulted. Beyond reviewing published and unpublished materials, key informant interviews were conducted with purposively selected experts from the Ethiopian Navy Force, the Maritime Institute of Ethiopia, and the Ministry of Foreign Affairs. The study asserted that the Red Sea Region has a complex security terrain where security alignment and realignment with regional and non-regional powers are persistent mechanisms of survival. This is caused by asymmetrical power distribution and security dilemmas among regional states. Among others, neutralising the subversive activities of Egypt, serving as a platform for potential funding and access to energy resources, helping to mitigate the tragic deaths of Ethiopian immigrants crossing the sea, and serving as a source of naval technical know-how and maritime information are some of the potential benefits of being a member of the RSF. Port shutdowns, naval blockades, suffocation of alternative port access, and damage to underwater internet cables in the Red Sea are some of the perceived threats from RSF identified in the study. To enhance the potential benefits and mitigate the perceived threats from RSF, Ethiopia should adopt multilateral diplomacy and military deterrence as a counter strategies.

Antenatal care coverage in a low-resource setting: Estimations from the Birhan Cohort.

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. The study population were women enrolled and followed during pregnancy between December 2018 and April 2020. ANC visits were measured by prospective facility chart abstraction and self-report at enrollment. The primary study outcomes were the total number of ANC visits attended during pregnancy and the coverage of at least one, four, or eight ANC visits. Additionally, we estimated ANC retention patterns. We included 2069 women, of which 150 (7.2%) women enrolled <13 weeks of gestation with complete prospective facility reporting. Among these 150 women, ANC coverage of at least one visit was 97.3%, whereas coverage of four visits or more was 34.0%. Among all women, coverage of one ANC visit was 92.3%, while coverage of four or more visits was 28.8%. No women were found to have attended eight or more ANC visits. On retention in care, 70.3% of participants who had an ANC visit between weeks 28 and <36 of gestation did not return for a subsequent visit. Despite the high proportion of pregnant women who accessed ANC at least once in our study area, the coverage of four visits remains low. Further efforts are needed to enhance access to more ANC visits, retain women in care, and adhere to the most recent Ethiopian National ANC guideline of at least eight ANC visits. It is essential to identify the factors that lead a large proportion of women to discontinue ANC follow-up.

Impact of Coaches’ Transformational Leadership on Soccer Players’ Satisfaction in Selected Ethiopian Super and National League Football Clubs

The primary goal of the current study was to determine how coaches’ transformational leadership philosophies affected player contentment on the selected Ethiopian Super League and National League football teams. A transformational leader encourages and inspires others to step outside of their comfort zones and find creative solutions to issues. A key factor in creating and sustaining player performance and athlete satisfaction is the coaching approach. The goal of the study was to ascertain how soccer players’ contentment with their particular football teams was impacted by coaches’ transformational leadership approaches. The study design was a correlational research design. The study subjects in the sample consisted of 227 soccer players. SPSS version 20.0 was used in this study for data entry, computation, and processing. The study results of independent t-tests and multiple linear regression models were revealed to be fit. Athlete satisfaction predicted by the regression model was significant and fit. The present study revealed that the national league’s mean score was lower than the super league’s mean in the independent t-test results. The study showed that the most crucial coach behavior to improve athletes’ satisfaction is transformational coaching leadership style. Because of this, the Ethiopian Football Federation and other regional football federations may consider how transformative leaders’ leadership philosophies affect athlete satisfaction.

Incidence anddeterminants ofout-of-pocket health expenditure inEthiopia 2012-16.

This study assesses the incidence of catastrophic health expenditure (CHE) and identifies the significant factors that expose households to higher levels of out-of-pocket (OOP) health expenditure. Data from the fifth and the sixth Ethiopian National Health Accounts household surveys, which were conducted in 2012-13 and 2015-16, respectively, are used. The incidence of CHE is estimated using both the capacity-to-pay and the budget share approaches. To ensure the robustness of our findings, both unconditional and conditional quantile estimators are adopted as multivariate regression techniques to estimate the impact of socio-economic variables on the distribution of households' OOP expenditure. Our findings show that the incidence of CHE in Ethiopia ranges from 1.7% to 4.7% depending on the approach and the threshold adopted. Larger families, the unemployed, the extremely poor, those who seek care at private-owned providers and families with members affected by chronic illness face higher OOP expenditure. Hence, policy should target those with these identified socio-economic characteristics in the provision of financial risk protection such as fee waiver systems and subsidies.

Intention to Undergo Clinical Breast Examination and Its Associated Factors among Women Attending Rural Primary Healthcare Facilities in South Central Ethiopia

Background: Breast cancer is a global public health problem with higher mortality in developing countries. The Ethiopian National Cancer Control Plan recommends clinical breast examination (CBE) for all women aged >18 years. However, there is low breast examination practice in Ethiopia. Therefore, this study aimed to describe level of intention to undergo CBE and associated factors among women visited selected rural healthcare facilities in south central Ethiopia using Theory of Planned Behavior (TPB). Methods: This study used facility-based cross-sectional study design. A total of 420 women participated in this study. Interviewer-administered structured questionnaire was adopted from previously published research works and Ajzen’s TPB manual. Statistical Package for Social Sciences (SPSS), version 27, was used for analysis. Binary logistic regression model was used to determine factors associated with intention to undergo CBE. Results: In this study, nine out of ten women had never had CBE. Mean score for intention to undergo CBE was 12.55 (SD ± 3.22; min 5, max 20). Intention to undergo CBE was negatively associated with being in the second and middle wealth quantiles compared to the highest wealth quantile, and with the spouse not being able to read or write compared to having attended formal education. Positive attitude and higher subjective norm had relevant association with intention to undergo CBE. Conclusion: The high score for intention to undergo CBE should encourage primary healthcare facilities to offer CBE. Behavioral change communication interventions could address women’s attitude, subjective norm, and spouse’s education associated with intention to undergo CBE.

El Niño and other climatic drivers of epidemic malaria in Ethiopia: new tools for national health adaptation plans

BackgroundEthiopia has a history of climate related malaria epidemics. An improved understanding of malaria–climate interactions is needed to inform malaria control and national adaptation plans.MethodsMalaria–climate associations in Ethiopia were assessed using (a) monthly climate data (1981–2016) from the Ethiopian National Meteorological Agency (NMA), (b) sea surface temperatures (SSTs) from the eastern Pacific, Indian Ocean and Tropical Atlantic and (c) historical malaria epidemic information obtained from the literature. Data analysed spanned 1950–2016. Individual analyses were undertaken over relevant time periods. The impact of the El Niño Southern Oscillation (ENSO) on seasonal and spatial patterns of rainfall and minimum temperature (Tmin) and maximum temperature (Tmax) was explored using NMA online Maprooms. The relationship of historic malaria epidemics (local or widespread) and concurrent ENSO phases (El Niño, Neutral, La Niña) and climate conditions (including drought) was explored in various ways. The relationships between SSTs (ENSO, Indian Ocean Dipole and Tropical Atlantic), rainfall, Tmin, Tmax and malaria epidemics in Amhara region were also explored.ResultsEl Niño events are strongly related to higher Tmax across the country, drought in north-west Ethiopia during the July–August–September (JAS) rainy season and unusually heavy rain in the semi-arid south-east during the October–November–December (OND) season. La Niña conditions approximate the reverse. At the national level malaria epidemics mostly occur following the JAS rainy season and widespread epidemics are commonly associated with El Niño events when Tmax is high, and drought is common. In the Amhara region, malaria epidemics were not associated with ENSO, but with warm Tropical Atlantic SSTs and higher rainfall.ConclusionMalaria–climate relationships in Ethiopia are complex, unravelling them requires good climate and malaria data (as well as data on potential confounders) and an understanding of the regional and local climate system. The development of climate informed early warning systems must, therefore, target a specific region and season when predictability is high and where the climate drivers of malaria are sufficiently well understood. An El Niño event is likely in the coming years. Warming temperatures, political instability in some regions, and declining investments from international donors, implies an increasing risk of climate-related malaria epidemics.