Oromia Region Of Ethiopia Research Articles

Lived experiences of tuberculosis patients and their implications for early tuberculosis case identification and management in pastoralist community setting: a qualitative study in Borena zone, Oromia region of Ethiopia

BackgroundEthiopia has highly diversified population with notable socioeconomic and cultural differences. Regardless of the differences, short course directly observed treatment,where patients should take drugs under direct observasion of health care providers, is uniformly applied all over the country. Evidences are scarce on how well does this uniform approach fits with the pastoral community setting. The purpose of this study was to explore lived experiences of TB patients in the pastoral community under the uniform approach, and their implications to early case identification and management.MethodQualitative method with phenomenological study design was undertaken to explore lived experiences of TB patients. Patients from all levels of health care (hospital, health center and health post) were included. Experience of both drug susceptible and drug resistant TB patients were documented. Twenty one patients, who consented to in the study, were selected by a convenience sampling method. In-depth interview was conducted using a semi-structured interview guide and the interview ended subsequent to information saturation. The interview was audio recorded; and field notes were also taken. Data analysis was done concurrently with the data collection using a word processor designed for qualitative text analysis. InductiveThematic analysis was undertaken to identify key themes.ResultsTwenty one patients (eight from hospitals, nine from health centers and four from health posts) were interviewed. Three of the eight hospital patients were on drug resistant tuberculosis (TB) treatment. Sixty two codes, five code categories and three themes emerged from the interviews. The three themes were health system, stigma and discrimination, and socioeconomic problem related experiences. Inaccessibility to health facilities due to scattered settlement and mobility, delay in care seeking TB symptoms, low index of suspecting TB by care providers, fear of stigma and indirect treatment related costs were some of the codes identified.ConclusionTB patients in the pastoral setting were experiencing multifaceted challenges with the current application of ‘one-size-fits-all’ approach which implied hampered timely case identification and compromised patient management. Therefore, designing context appropriate intervention approach is required to ensure unprejudiced services.

Knowledge, Utilization and Associated Factors of Postpartum Family Planning Among Women Who Had Delivered a Baby in the Past Year in Oromia Regional State, Ethiopia.

BackgroundGlobally, 95% of women wants to avoid pregnancy for at least two years after giving birth, but 70% of them are not using contraception; majority of them were from developing countries. Postpartum family planning (PPFP) enables families to avoid unplanned pregnancies following 12 months after childbirth. Different studies in Ethiopia showed that the majority of postpartum women do not use PPFP. Moreover, the level of PPFP knowledge and utilization in West Shewa, Oromia region of Ethiopia is unclear.PurposeThis study aimed to assess the knowledge, utilization and associated factors of postpartum family planning (PPFP) Oromia regional state, Ethiopia.MethodsA community-based cross-sectional study was conducted in Ambo town, West Shewa Zone of Oromia regional state from April 01 to July 30, 2019. A sample of 367 postnatal women participated in the study. An interview administered questionnaire was used to collect the data and the collected data were entered into Epi Info version 7.1 and analyzed with SPSS version 23. Study participants’ characteristics were described using frequency and percentage. Bivariate and multivariate logistic regression was carried out to identify the associated factors with the outcome variables.ResultsA total of 354 women were participated in the study making a response rate of 96.4%. About 249 (70.3%) of the respondents had good knowledge about PPFP and 144 (40.7%) had utilized PPFP services. Higher education level [AOR= 3.4, 95% CI: 1.3–6.9], history of family planning utilization [AOR= 2.8, 95% CI: 2.1–4.4] and having ANC follow-up [AOR=2.1, 95% CI: 1.1–4.0] had showed a positive association with knowledge of PPFP. Meanwhile, knowledge of PPFP [AOR=2.1, 95% CI: 1.6–3.1], a grand multi-para women [AOR=1.7, 95% CI (1.3–3.6)] and received routine PNC service [AOR=2.5, 95% CI: 1.3–5.9] were associated with the utilization of PPFP.Conclusion and RecommendationAlthough the majority of the women knew about PPFP, more than half of them did not utilize PPFP. Due emphasis should be given to improve the utilization of PPFP.

Soil Loss Estimation for Conservation Planning in the Welmel Watershed of the Genale Dawa Basin, Ethiopia

As a form of environmental degradation, soil degradation directly or indirectly affects many lives through decreased agricultural yields, increased flooding and habitat loss. Soil loss has been increasing in most parts of the world and is most pronounced in tropical developing countries where there is poor or zero soil and water conservation (SWC) planning and management activities. Identifying areas prone to soil erosion has also been inadequate, having not been informed by dedicated scientific studies. This is true of the poorly understood watershed of Welmel in the Oromia region of Ethiopia, where most livelihoods heavily rely upon agriculture. To plan effective SWC management techniques, a solid knowledge of spatial variations across different climate, land use and soil erosion is essential. This study has aimed at identifying potential areas needing SWC practices through conducting a spatial modeling of soil erosion within the Welmel watershed’s Genale Dawa basin using a geographic information system (GIS), remote sensing (RS), multiple factors as land uses and climate. The Welmel catchment is located in southeastern Ethiopia and extends between 5°0′0″ N–7°45′00″ N and 39°0′0″ E–41°15′0″ E. The revised universal soil loss equation (RUSLE), which was previously adapted to Ethiopian conditions, was used to estimate potential soil loss. It used information on interpolated rainfall erosivity (R), soil erodibility (K), vegetation cover (C) and topography (LS) from a digital elevation model (DEM) and that of conservation practices (P) from satellite images. The study demonstrates that the RUSLE using GIS and RS considering different climates and land management practices provides a great advantage in that it allows one to spatially analyze multilayer data in order to identify soil erosion-prone areas and thereby develop the most appropriate watershed management strategy. The mean soil loss was determined to be 31 tons ha−1 year−1 and it varied between 0 and 169 tons ha−1 year−1. About 79% of the watershed lies within the tolerable level of 11 tons ha−1 year−1. However, the remaining 21% has a high soil truncation trait, mainly due to its steeper slope and use as cultivated land. Our study identifies cultivated and deforested areas of the watershed as the potential SWC practice demanding areas. Thus, the application of RUSEL using GIS across different land management practices and climate zones is a potential tool for identifying SWC demanding sites. This remains helpful in efforts towards sustainable land management practices for the sustainable livelihood of the local human population.

Program and Caseload Implications of Adopting the Global MUAC Criteria for Community Management of Acute Malnutrition in Children Under 5 Years Old in Ethiopia

Abstract Objectives Ethiopia has been hesitant to shift to the global MUAC-based definitions for acute malnutrition given the two to four times potential increase in caseload suggested by several cross-sectional surveys. Thus, the objective of this study was to provide specific evidence on the caseload implications for Ethiopia of aligning with the WHO recommended criteria. Methods A cluster-randomized control study was conducted in four districts of Amhara and Oromia regions of Ethiopia in a total of 36 health posts (HPs). Districts and HPs were selected based on previous high case report. In each district, an equal numbers of HPs were randomly assigned to use either the global MUAC criteria of <11.5 cm for severe acute malnutrition (SAM) and the moderate acute malnutrition (MAM) criteria of ≥11.5cm to <12.5 cm (intervention) or the current Ethiopian criteria of <11 cm for SAM and ≥11 cm to <12 cm for MAM (control). All 6–59 mo children were screened regularly for 16 wks. Malnourished children were admitted to the study according to the criteria assigned to their HP. Results A total of 349 SAM and 986 MAM new cases were admitted during the 16 wk recruitment. Of the new SAM cases, 225 were in intervention and 124 were in control HPs. The ratio of SAM in intervention compared to control HPs was 1.78 (1.14–2.42, 95%CI), which indicates an increase in admissions of 78% (P = 0.019). The mean (±SD) monthly SAM admissions per HPs were 1.71 (0.53) in control and 2.97 (3.31) in intervention (P = 0.191). For MAM, 592 cases were in intervention and 394 were in control for a ratio of 1.50 (1.11–1.89). The global MUAC criteria increased caseload by 50% (P = 0.015) compared to control. The mean monthly new MAM admissions per HPs were 5.47 (4.02) in control and 8.22 (3.28) in intervention (P = 0.045). The mean number of children served during biweekly combined sessions for SAM and MAM was 19.67 (9.28) in intervention and 13.08 (8.28) in control (P = 0.026). For sessions restricted to SAM, a mean of 4.26 (4.11) was served in intervention and 1.92 (1.88) in control (P = 0.028). Conclusions The increases in cases and workload resulting from shifting from Ethiopia's current national SAM and MAM admission and discharge criteria to the WHO criteria are likely to be on a smaller scale than is usually claimed based on various cross-sectional surveys. Most HPs were not overwhelmed due to the shift. Funding Sources Bill and Melinda Gates Foundation.

Review on Enset (Enseteventr icosum) Value Chain in Ethiopia

Enset is one of the main staple or co-staple crop produced and marketed in most of SNNPR and Oromia Regions of Ethiopia. The objectives this review paper is:- to assess the production and marketing of enset in Ethiopia, to identifying major challenges and opportunities of enset production and marketing in Ethiopia and to reviewing the enset value chain actors with their specific roles. In line with this, the main constraints of Enset production are mentioned as, pest and disease spatially Enset Bacterial Wilt caused by Xanthomonas musacearum and technology limitation, limited access to improved disease resistant varieties, and limited capacity in research and development. The main constraints of Enset Product marketing are low price for the products, poor product handling and packaging, imperfect pricing system and lack of transparency in market information system mainly in the rural to town and city market. The main value chain actors involved along Enset product value chain are producers, local collectors, wholesalers, retailers, hotels Consumers. Keywords: Challenges, Enset, Opportunities, Value chain actors DOI: 10.7176/JRDM/65-03 Publication date: May 31 st 2020

Risk Perception and Management in Smallholder Vegetable Farming in Eastern Ethiopia

This study examines vegetable producing farmers’ risk perception and management strategies. Using survey data collected from 385 smallholder vegetable farmers from East Hararghe zone of Oromia region of Ethiopia, descriptive statistics and factor analysis were used for analyzing farmers risk attitude, classifying risk sources and management strategies. The analysis of risk attitude indicated that the majority of vegetable farmers considered themselves to be risk-takers towards important farm decisions which would help in the adoption of risk management strategies. The result of factor analysis identified low profitability, energy inaccessibility, production, price variability, human / social and institutional factors as principal sources of risk. Moreover, factor analysis also identified production management, loss minimizing and diversification as risk management strategies adopted by smallholder vegetable farmers. Policy makers should focus on enhancing the profitability of smallholder vegetable farmers, stabilizing input and output price, managing production risk, expanding energy access and facilitating the provision of necessary farm inputs. Moreover, it is also necessary to make the operation of cooperatives/unions accountable and their input provision fair and efficient. Keywords : Vegetable farming, factor analysis, risk perception, risk management, risk attitude. DOI: 10.7176/JNSR/10-4-01 Publication date: February 29 th 2020

Epidemiology of COVID-19 Outbreak in Oromia Region of Ethiopia: The First Six Months Surveillance – 13 March 2020 to 13 September 2020

Background: Despite unrelenting global efforts to contain its spread, Coronavirus disease 2019 (COVID-19) is still causing unprecedented crises globally with no proven vaccine or cure so far. Ethiopia reported its first case on 13 March 2020 but has an accelerated increase in caseload and geographic distribution since recently. We now describe the epidemiology of COVID-19 in Oromia Regional State, the largest and most populous region in Ethiopia, during the early months of the outbreak.Methods: We analyzed data from the COVID-19 surveillance database of the Oromia Regional Health Bureau. We included RT-PCR confirmed COVID-19 cases diagnosed at healthcare facilities across the region during the period of 13 March to 13 September 2020.Findings: COVID-19 was confirmed in 8955 (5·5%) of 164206 individuals tested during the surveillance period. The test positivity rate increased from an average of 1·0% in the first three months to 6·3% in August and September. About 70% (6230) of the cases were male; the mean age was 30·0 years (SD=13·3) and 87·8% were between 10 and 49 years of age. Only 64 (0·7%) of the cases had symptoms at diagnosis. Among symptomatic cases, cough was the most common, reported in 48 (75·0%) and fever the least common, reported in 11 (17·2%) of cases. Moreover, only 6 (0·1%) cases presented with severe disease. Overall, 4346 (48·5%) have recovered from the virus and a total of 52 deaths were reported with a case fatality rate of 1·2%. However, the reported case fatality rate should be interpreted cautiously since in 44 (84·6%) of those reported as COVID-19 death, the virus was detected from a dead body.Interpretation: The COVID-19 infection rate in the Oromia Region of Ethiopia is surging six months after the onset of the pandemic in the country. So far, the proportion of symptomatic cases and severe diseases besides the fatality rate are lower than reports from most other developing and developed countries. This epidemiologic profile might have prevented the anticipated health system crisis to date, but it can hinder efforts to contain the outbreak.Funding: NoneDeclaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The authors have obtained authorization to use the surveillance data from Oromia Regional Health Bureau Public Health Emergency Management and Health Research Directorate

Evaluation of the Adoption of Improved Agricultural Practices and Factors That Affect Adoption of Tef (<i>Eragrostis tef (Zucc) Trotter</i>) in Ethiopia

The average grain yield is low (at 1.75tha-1). Therefore, this study aimed to analyse the adoption of improved tef practices impacting yield and factors affecting the adoption of the improved agricultural practice in four regions of Ethiopia. Household surveys and crop cut surveys were used. Four districts, 101 each in Amhara, SNNP, Tigray, and 100 farmers in Oromia regions of Ethiopia were assessed in the study. Therefore, a total of 403 respondent farmers, were used. Data were analysed using SSPS. Among the seven improved agricultural practices assessed, fertilizer application, variety selection, and use, land preparation, and herbicide application showed higher adoption among the farmers. The correlation analysis results revealed that yield is positively and significantly correlated with land preparation (r=0.492), row planting (r=0.351) hand weeding (0.306), fertilizer application (r=0.143). This implies that the adoptions of these improved practices were contributing to yield increment. The result clearly indicated that the adoption of improved practices was influenced by a composite of demographic, socio-economic, and institutional factors. The partial budget analysis was employed using previous variable cost data collected in the Ada district by Debre Zeit Agricultural Research Centre. The result revealed that the highest increased income showed in Lume districts (positive net change in benefits) 37,431.2 birr ha-1 followed by Siyadebirenawayu districts which were 31,131.73 birr ha-1. However, the increased income in Lemo and Lalye Maychew were minima l9513.34 birr ha-1 and 11,469.95 birrs ha-1 respectively. The benefit-cost ratio for Lume and Siyadebir enawayu districts were 3.9 and 3.3, respectively. However, the benefit-cost ratio for Lemo and Lalye Maychew were 1.7 and 1.9, respectively. The variables significantly affect the adoption of tef improved practices by farmers were age, education level, family size, farm size, extension service provision. To solve problems of inadequate use of improved practices, Development Agents and Agricultural experts should provide farmers with more practical pieces of training under farmers’ direct participation in the demonstration centres. In order to attain food security, the nation policymakers should devise more effective farmers’ training mechanisms and provide more applicable tef production mechanizations effective on the process of tef production.

Smallholder Farmers’ Decision to Participate in Vegetable Marketing and the Volume of Sales in West Shewa Zone of Oromia National Regional State, Ethiopia

This study examines vegetable producers’ market participation and sales volume using cross-sectional data obtained from 385 randomly and proportionately sampled households from West Shewa zone, Oromia region of Ethiopia. Heckman two-step procedure was used to analyse the determinants of participation in vegetables markets and volume of sales during the study period. Probit model shows that education level, distance to nearest market, access to irrigation, use of pesticide and participation in any civic organization significantly affect market participation decision. Further, results from ordinary least squares regression show that sex of household head, land size, distance to farmer training centre, access to irrigation, use of pesticide and participation in civic organization significantly affect the level of market participation of the farm households in vegetable markets. The findings imply that support for female households, improving adult based education, participation in civic organization, infrastructure, access to irrigation and improved inputs are a means to increase vegetable production market participation and sales volume in West Shewa, Ethiopia.

Nutrition-specific and nutrition-sensitive factors associated with mid-upper arm circumference as a measure of nutritional status in pregnant Ethiopian women: Implications for programming in the first 1000 days.

Poor nutritional status in pregnancy expressed as low mid-upper arm circumference (MUAC) is associated with low birth weight. The study aims were to assess the nutritional status of pregnant Ethiopian women using MUAC and examine association with nutrition-specific and nutrition-sensitive factors, using baseline data of a prospective longitudinal observational birth cohort study conducted in three rural districts in the Oromia region of Ethiopia. Recruitment into the cohort was rolling over a period of nine months, and the data used for this analysis were collected while the women were between 12–32 weeks of gestation. Detailed household socio-demographics, agricultural production, women’s health, morbidity and diets, with weights, heights and MUAC, and anemia prevalence (HemoCue) were collected. The prevalence of low MUAC (< 23 cm) was 41%. Controlling for location and clustering, wealth quintile (OR = 0.88, CI = 0.82 to 0.96, p<0.01) was associated with decreased risk of low MUAC, while trimester (OR = 1.31, CI = 1.16 to 1.48, p<0.001) was associated with increased risk of low MUAC. The only significant factor amenable to nutrition-specific interventions was altitude-adjusted anemia, which was associated with increased risk of low MUAC (OR = 1.28, CI = 1.09 to 1.49, p<0.01). Significant factors amenable to nutrition-sensitive factors and associated with higher odds of low MUAC were household food insecurity (OR = 1.04, CI = 1.02 to 1.06, p<0.001), distance to the clinic in minutes (OR = 1.01, CI = 1.0 to 1.01, p<0.0001) and season of recruitment (lean versus non lean) (OR = 1.30, CI = 1.10 to 1.54, p<0.01). Literacy (OR = 0.85, CI = 0.74 to 0.98, p<0.05) and numeracy (OR = 0.75, CI = 0.62 to 0.91, p<0.01) were also significantly associated with lower odds of low MUAC. Poor nutritional status in pregnancy expressed as percent with low MUAC was high in Ethiopian women. It was associated with several nutrition-specific and -sensitive factors indicating the importance of multisectoral actions in improving outcomes within the first 1000 days.

Indigenous Knowledge on cultivation and consumption of Enset (Enset ventricosum) in Kercha District; West Guji Zone, Oromia Region of Ethiopia

Enset (Enset ventricosum) is a perennial herbaceous root crop with long broad leaves and bulky pseudo-stem. It is one of the important food secure plant due to drought resisting property. This research was conducted with the objective of assessing indigenous knowledge of enset farming and its consumption experienced in Kercha district, west Guji zone, and Oromia region of Ethiopia. Four kebeles were selected purposively based on the enset vegetation coverage and 80 informants were selected by stratified sampling method. Data was collected using open questionnaires, interview and field observation and it was analyzed using SPSS software and Microsoft Excel. The present result showed that 21 enset varieties have been identified and not all of them were preferred for cultivation. Instead, farmers select and maintain these local varieties that best meet their needs using their indigenous knowledge. This selection was mostly based on the criteria farmers used to use. Accordingly, 25% of them based on resistance to pest and disease, and 22.5% of them based on maturation period are the most criteria the farmers would always consider. Although most farmers cultivate enset in the home garden, the mode cultivation was varying from highland to lowland. For example 82,.75% of respondents use mono-cropping and 17.25% of them use the intercropping system in the highland area while, in Midland areas, 86.25% of respondents use intercropping and 13.75% of them use mono-cropping mode of cultivation. However, it is used for many purposes the present result showed that enset is cultivated mainly for food as 63.75% of respondents’ feedback in the district where the corm and the pseudo-stem are the most important sources of food. The types of food from these parts are locally known ‘Kocho or Warqe’, ‘Bulla or Haruro’ and ‘Amicho or Ham'o’. From these, the major products prepared are locally known as are 'quncisa,' 'wodhamo', 'hocoqo' and 'qixa'. Hence, despite the enset has the potential for food security and income generation which is known by indigenous people, it has been cultivating by the traditional farming system. So, further investigation is required to scale up the knowledge of farmers to the modern farming system.

A qualitative exploration of care-seeking pathways for sick children in the rural Oromia region of Ethiopia

BackgroundEthiopia has experienced rapid improvements in its healthcare infrastructure, such as through the recent scale up of integrated community case management (iCCM) delivered by community-based health extension workers (HEWs) targeting children under the age of five. Despite notable improvements in child outcomes, the use of HEWs delivering iCCM remains very low. The aim of our study was to explain this phenomenon by examining care-seeking practices and treatment for sick children in two rural districts in the Oromia Region of Ethiopia.MethodsUsing qualitative methods, we explored perceptions of child illness, influences on decision-making processes occurring over the course of a child’s illness and caregiver perceptions of available community-based sources of child illness care. Sixteen focus group discussions (FGDs) and 40 in-depth interviews (IDIs) were held with mothers of children under age five. For additional perspective, 16 IDIs were conducted fathers and 22 IDIs with health extension workers and community health volunteers.ResultsCaregivers often described the act of care-seeking for a sick child as a time of considerable uncertainty. In particular, mothers of sick children described the cultural, social and community-based resources available to minimize this uncertainty as well as constraints and strategies for accessing these resources in order to receive treatment for a sick child. The level of trust and familiarity were the most common dynamics noted as influencing care-seeking strategies; trust in biomedical and government providers was often low.ConclusionsOverall, our research highlights the multiple and dynamic influences on care-seeking for sick children in rural Ethiopia. An understanding of these influences is critical for the success of existing and future health interventions and continued improvement of child health in Ethiopia.

Determinants and Constraints of Pulse Production and Consumption among Farming Households of Ethiopia

In low income countries the agricultural sector is essential to growth, poverty reduction, and food security. Pulse crops are important components of crop production in Ethiopia's smallholders agriculture, providing an economic advantage to small farm holders as an alternative source of protein and other nutrients, cash income, that seeks to address food security. This study sought to gain an understanding of determinants and constraints to production and usage of pulse crops based on data collected in 2013 from 256 households in Oromia region of Ethiopia. Determinants of production and consumption were identified using logistic regression. The result showed that Haricot bean was produced, but not widely consumed. Lentil was widely consumed but not produced. Production of haricot bean was hampered by problems related to weed control, disease, pests, yield and soil quality, a seasonal market, and a shortage of farmland. Consumption of haricot bean was low due to perceived gastrointestinal distress after eating and the culture of it being a taboo food. Logistic regression showed household head educational status and age, land size and household size statistically significantly (p-value&lt;0.05) affected household pulse (haricot bean and lentil) consumption frequency. Agronomic, market, culture and household characteristics related determinants and constraints were identified. Also a mismatch of production and consumption was observed in the study. It is recommended that agronomic and market concerns related to production of haricot bean and other pulses be addressed and that household food preparation techniques for pulses that reduce gastrointestinal symptoms be promoted and evaluated.

A contagious bovine pleuropneumonia outbreak on a research farm in Ethiopia, and its dynamics over an eight-month period.

Contagious bovine pleuropneumonia (CBPP) was recognised on Bako Agricultural Research Farm, in the Oromia Region of Ethiopia, for the first time on 5 May 2011. The outbreak was investigated by combining recognition of clinical signs, post-mortem examination, mycoplasma isolation and serological testing using competitive enzymelinked immunosorbent assay (c-ELISA). The clinical cases were monitored for eight months; sick animals were treated with a range of antibiotics and isolated if necessary. The outbreak of CBPP was confirmed both bacteriologically and serologically and had spread to almost the entire herd (96.7%) within the eight-month observation period. Of the animals that recovered after antibiotic treatment, 12.3% fell sick again, showed typical signs of CBPP and were considered to be carriers. The role of treatment in the prevention of the spread of CBPP was minimal. Newly purchased animals that were not tested and quarantined before being introduced onto the farm were suspected to have been the most probable source of infection.

Multidrug-resistant Mycobacterium tuberculosis and associated risk factors in Oromia Region of Ethiopia

The aim of this study was to determine risk factors for tuberculosis (TB) caused by multidrug-resistant Mycobacterium tuberculosis (MDR-TB) in Oromia Region, Ethiopia. A 6-month case-control study was performed in 2013-14. Sputum samples and standardized questionnaire data (demographics, treatment, TB contact history, underlying disease, history of imprisonment) were collected from cases with suspected MDR-TB aged ≥ 18 years. Sputum was processed locally in the Oromia Public Health Laboratory using standard techniques. Data from MDR-TB cases and TB-positive controls were compared using logistic regression analysis. For each factor, the association with outcome variables was estimated by calculating the odds ratio (OR) together with the 95% confidence interval (95% CI). Of 439 suspected MDR-TB cases, 265 had a confirmed M. tuberculosis infection, of whom 88 (33%) had laboratory-confirmed MDR-TB. Over two-thirds (65%) were between 18 and 39 years of age. On multivariate analysis, an occupation of farming, known TB contact history, alcohol use, HIV infection, previous known TB history, and previous TB treatment outcome were predictors of MDR-TB. The rate of MDR-TB was high among suspected cases in the Oromia Region of Ethiopia. Local MDR-TB detection capacity and local epidemiology studies are essential to detect MDR-TB and guide the use of the sparse resources to optimize MDR-TB control. If TB is suspected, the presence of any of the above factors should alert Oromia Region clinicians and public health professionals to screen for MDR-TB.

Roles and responsibilities in newborn care in four African sites.

ObjectivesTo explore roles and responsibilities in newborn care in the intra‐ and postpartum period in Nigeria, Tanzania and Ethiopia.MethodsQualitative data were collected using in‐depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses.ResultsWe found that birth attendants were the main decision‐makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first‐time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision‐maker in the family.ConclusionInterventions should move beyond a focus on the mother–child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

Perceptions, Impacts and Rewards of Row Planting of Teff

This study analyzes the perceptions, impacts, and rewards of farmers who adopted row planting for the production of teff as a result of being exposed to a technology promotion campaign for row planting of teff in the Oromia region of Ethiopia.

Knowledge and Skills Retention Among Frontline Health Workers: Community Maternal and Newborn Health Training in Rural Ethiopia

We examined the degree to which the skills and knowledge of health workers in Ethiopia were retained 18 months after initial maternal and newborn health training and sought to identify factors associated with 18-month skills assessment performance. A nonexperimental, descriptive design was employed to assess 18-month skills performance on the topics of Prevent Problems Before Baby Is Born and Prevent Problems After Baby Is Born. Assessment was conducted by project personnel who also received the maternal and newborn health training and additional training to reliably assess health worker performance. Among the 732 health workers who participated in maternal and newborn health training in 6 rural districts of the Amhara and Oromia regions of Ethiopia (including pretesting before training and a posttraining posttest), 75 health extension workers (78%) and 234 guide team members (37%) participated in 18-month posttest. Among health extension workers in both regions, strong knowledge retention was noted in 10 of 14 care steps for Prevent Problems Before Baby Is Born and in 14 of 16 care steps of Prevent Problems After Baby Is Born. Lower knowledge retention was observed among guide team members in the Amhara region. Across regions, health workers scored lowest on steps that involved nonaction (eg, do not give oxytocin). Educational attainment and age were among the few variables found to significantly predict test performance, although participants varied substantially by other sociodemographic characteristics. Results demonstrated an overall strong retention of knowledge and skills among health extension workers and highlighted the need for improvement among some guide team members. Refresher training and development of strategies to improve knowledge of retention of low-performing steps were recommended.

Perceptions of home and self-injection of Sayana® Press in Ethiopia: a qualitative study

ObjectiveSayana® Press,11Sayana Press is a registered trademark of Pfizer Inc. a new subcutaneous formulation and presentation of a popular injectable contraceptive, has the potential to expand non-clinic access to contraception, including home and self-injection (HSI). This study collected information from potential users and stakeholders on their perceptions and preferences, the feasibility of an HSI of Sayana Press program and key policy considerations. Study designPATH conducted 62 interviews and 7 focus groups with family planning users, non-users, physicians, other health care providers and key informants in the Oromia region of Ethiopia. Participants watched a demonstration and tested the device on a model mid-interview. The study did not involve product use in humans. ResultsWomen found the product easy to use, liked the simple design and valued the time and expense that could be saved through HSI of Sayana Press (HSI-SP). Of those with inhibitions about their ability to self-inject, most shifted their opinion favorably after demonstration. The majority of other stakeholders also supported HSI-SP and thought it could increase contraceptive use in Ethiopia, and they suggested that any successful program must include proper training and supervision, particularly regarding product storage and waste management. ConclusionThe data provide findings to stimulate further research and support future planning. They suggest that HSI-SP may meet the needs of many women if key requirements and challenges are met. It may also be necessary to revise policies and guidelines to integrate the approach with national family planning strategies. ImplicationsThis study provides the first available data on perceptions, feasibility and requirements for HSI of Sayana Press in a low-resource setting. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

Comparison of Cryptococcal Antigenemia between Antiretroviral Naïve and Antiretroviral Experienced HIV Positive Patients at Two Hospitals in Ethiopia

BackgroundCryptococcal meningitis is a major cause of HIV/AIDS-related deaths in Africa. Cryptococcosis is a neglected killer. However, meningitis can be prevented by early cryptococcal antigen (CrAg) screening and preemptive antifungal treatment during a prolonged period of detectable, subclinical infection. We determined the prevalence of cryptococcal antigenemia in comparison to CD4 count and clinical symptoms.MethodsWe surveyed 254 consenting HIV-infected participants to obtain demographic information and clinical history. Serum CrAg was measured by latex agglutination at two sites in the Oromia region of Ethiopia among all persons receiving a CD4 count.ResultsOf the 254 participants, 127(50.0%) were ART-naïve, 121(47.6%) were ART-experienced, and 6(2.4%) were ART-defaulters. The prevalence of cryptococcal antigenemia was 10.2% overall being 14.2% among ART-naive, 4.1% among ART-experienced, and 50% (3/6) among ART-defaulters, irrespective of CD4 count. Cryptococcal antigenemia was more frequently detected from ART-naïve patients (p = 0.012) and ART-defaulters (p = 0.001) compared with ART-experienced. Serum CrAg positivity was 20.9% in persons with CD4≤150 cells/µL, 12.2% in 151–200 cells/µL, 5.8% among 201–350 CD4/µL, and none above 350 cells/µL. Potential meningitis symptoms were common in the outpatient cohort irrespective of CrAg-status, with only fever and altered mental status statistically more common in CrAg-positive compared to CrAg-negative persons (P<0.05), yet no symptom had a positive predictive value >33%.ConclusionWe report a 20.9% cryptococcal antigenemia prevalence among those with CD4+ T cells count ≤150 cells/µL, irrespective of ART status, with even higher CrAg prevalence in ART-naïves and ART-defaulters. These groups are target populations for CrAg screening at entry into HIV care.