Southern Nations Research Articles

Optimal planning and sizing of microgrid cluster for performance enhancement

Access to electricity is a key indicator of a country’s development. In developing nations like Ethiopia, this metric is particularly crucial for assessing progress. Currently, about 45.8% of Ethiopia’s population lacks access to electricity, with rural areas experiencing even higher rates, reaching 57.2%. The Southern Nations, Nationalities, and People’s (SNNP) region faces the greatest challenge, with 62.1% of its population lacking electricity. Ethiopia aims to achieve universal electricity access by 2030, and microgrid (MG) development is expected to play a pivotal role in meeting this goal. This study employs a multi-tier framework (MTF) to categorize village households based on electricity access, considering factors like income level and willingness to pay, to support the MG development process. Three villages—Toba, Koza, and Womba—in the SNNP region were selected for optimal MG sizing. Sensitivity variables such as global horizontal irradiance (GHI) variation, photovoltaic (PV) and battery prices, battery usage limits, and capacity shortage levels were analyzed for their impact on net present cost (NPC), initial capital cost, and cost of energy (COE) using HOMER Pro software. For example, in the Toba MG, increasing the capacity shortage from 0 to 10% reduced the COE from 0.1195 $/kWh to 0.09104 $/kWh, a 23.82% decrease. Additionally, fluctuations in PV and battery prices had a direct impact on the system’s NPC. The study also explored the impact of clustering the microgrids by interconnecting the three individual systems and conducting a techno-economic analysis. The comparison between standalone MG operation and clustered microgrids revealed that, despite the added cost of interconnection, the benefits in terms of technological, economic, and reliable operation of the clustered system were comparable to standalone microgrids. Finally, a feasibility study was conducted for the potential grid extension of the Toba MG, which is located 130 km from the nearest substation in Sawla.

Navigating employment and overeducation: comparative study of immigrant experiences in 17 Western European nations

ABSTRACT The labor market integration of migrants, focusing on employment and job quality, differs notably across Southern and Continental-Northern European nations, often involving trade-offs. Nonetheless, little is known about whether these diverse migrant inclusion models in European labor markets extend to the combination of employment and overeducation. Additionally, the role of gender in this context remains unclear. While overeducation is more prevalent among immigrants compared to native, its prevalence varies across countries. To fill this gap, we analyzed data from the 2015–2019 European Labor Force Survey in 17 European countries, considering gender and migrant origin – Western vs. non-Western. Results show that non-Western migrants and migrant women face more challenges than Western migrants and male counterparts, respectively. Among males, a trade-off model predominates, with low employment penalties but high overeducation penalties in Mediterranean countries, and vice versa in Continental and some Nordic nations. For females, those in Southern Europe align with the Mediterranean trade-off model, while those in most Continental and Nordic countries experience a double penalty. In Liberal countries, male migrants tend toward the Mediterranean trade-off model, while female migrants align with the integration model.

Prevalence, spatial variation and determinants of zero-dose children in Ethiopia: Spatial and multilevel analyses

ObjectivesVaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. Study designA community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. MethodsThe study included a total of 1334 children aged 12–35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. ResultsThe prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples’ Region) regions had high zero-dose proportions. Maternal age 15–19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. ConclusionsThe prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases.

Finger Millet (&amp;lt;i&amp;gt;Eleusine Coracana&amp;lt;/i&amp;gt; (L.) Gaertn) Production Status, Challenges, and Seed Source in Ethiopia; A Review

Similar to other cereal crops finger millet is being produced in a large volume in Ethiopia, as they are the principal staple food crop. Finger millet is considered as underutilized cereal crop which is commonly grown in the northern, west-northern, and western parts of the country and it is considered as a crop which is important to overcome malnutrition. Regions including Tigray, Amhara, Oromiya, Benishangul-Gumuz, Southern Nation and Nationalities Peoples (SNNP) and Gambela are considered as the potential regions for the production of finger millet in Ethiopia. Relatively, it is considered as drought tolerant as compared to other major cereals such as rice, wheat, and barley. In addition to this finger millet is considered as a highly resilient crop which can grow in different weather conditions, including drought, floods, and marginal soils. In Ethiopia it is commonly grown for the preparation of local foods like ‘injera’ and porridge and local drink such as ‘areki’ or ‘tella’. About 26 varieties of finger millet are cultivated in main season in the country. In Ethiopia, there are a limited source of cereal crop seeds which includes, farmer’s own saved seeds and government seed distributing companies. In this review the status of production, seed source and nutritional importance of finger millet in Ethiopia is presented.

Person-centered abortion care in public health facilities across four regions of Ethiopia: a cross-sectional quantitative study of client experiences.

Ethiopia has made remarkable progress in expanding access to and provision of comprehensive abortion care. However, complications due to unsafe abortion persist. As efforts to increase quality of comprehensive abortion care continue, evaluating service quality is critical. Although "women-centered" abortion care is a central component of Ethiopia's technical guidelines for safe abortion, research has mostly focused on access to care, availability of services, and meeting clinical criteria, rather than examining service quality from abortion clients' perspectives. This study assesses the quality of comprehensive abortion care (CAC) in public health facilities, from clients' perspectives, in four regions of Ethiopia to examine how person-centered care differs based on facility and service characteristics. We conducted 1,870 client exit surveys in 2018 using structured questionnaires with women who received induced abortion or postabortion care services from 76 public health facilities across four regions: Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and People's. We operationalized person-centered care by mapping 30 indicators of quality to five of the six domains in the Person-Centered Care Framework for Reproductive Health Equity developed by Sudhinaraset and colleagues (2017): dignity & respect; autonomy; communication & supportive care; trust, privacy, and confidentiality; and health facility environment. We calculated descriptive, bivariate, and multivariable statistics to examine associations between service characteristics and person-centered care. CAC clients reported high levels of person-centered care, with exceptionally positive experiences for outcomes in the dignity and respect and trust, privacy, and confidentiality domains. However, there was notable room for improving client experiences across three domains: autonomy, communication and supportive care, and health facility environment. Client-reported quality outcomes differed significantly by diagnosis (induced or postabortion care), region, health facility type, and procedure type. Clients in Amhara, clients at tertiary and primary hospitals, and clients who received postabortion care reported lower levels of person-centered care. The positive experiences reported by comprehensive abortion care clients bolster evidence of the impact of the Ethiopian government's strategy to increase abortion access in the public health sector. However, notable disparities exist for key subgroups, particularly those seeking postabortion care and people visiting tertiary and primary hospitals. Quality improvement efforts should concentrate on improving abortion clients' autonomy, communication and supportive care, and the health facility environment. The Ethiopian Ministry of Health and its partners must dedicate resources to improve postabortion care quality, integration of reproductive health services within CAC, and pain management for MA clients as vital interventions.

Understanding cultural dynamics shaping clinical reasoning skills: A dialogical exploration.

Our study examined the influence of national cultural predispositions on training medical professionals and doctor-patient dynamics using a dialogical approach, guided by Hofstede's framework. This framework provided valuable insights into how cultural tendencies shape the learning and application of clinical reasoning skills in different cultural contexts. We found that dimensions such as power distance and individualism versus collectivism significantly influenced clinical reasoning, while other dimensions had more nuanced effects. Junior doctors in Southern nations, despite initially lagging behind, developed advanced clinical reasoning skills with experience, eventually matching their Northern counterparts. The study highlighted the link between cultural norms and educational practices, variations in family involvement during reasoning, adherence to clinical guidelines and doctors' emotional engagement in clinical care between Southern and Northern contexts. Additionally, we recognised that effective clinical reasoning extends beyond technical knowledge, involving an understanding and integration of cultural dynamics into patient care. This highlights the pressing need to prioritise this topic.

Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis.

In the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratory support. The severity of the illness raises the likelihood of death in patients who require MV. Several studies have been done in Ethiopia; however, the mortality rate differs among them. The objective of this systematic review and meta-analysis is to provide a pooled prevalence of mortality and associated factors among ICU-admitted patients receiving MV in Ethiopian hospitals. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysis in this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Science and found 22 articles that met our inclusion criteria. We used a random-effects model. To identify heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger's regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses. In this systematic review and meta-analysis, the pooled prevalence of mortality among 7507 ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95% CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities, and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest prevalence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10, 100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score<8 (OR = 6.58, 95%CI = 1.96, 22.11), admission with medical cases (OR = 4.12, 95%CI = 2.00, 8.48), Multi Organ Dysfunction Syndrome (MODS) (OR = 2.70, 95%CI = 4.11, 12.62), and vasopressor treatment (OR = 19.06, 95%CI = 9.34, 38.88) were all statistically associated with mortality. Our review found that the pooled prevalence of mortality among mechanically ventilated ICU-admitted patients in Ethiopia was considerably high compared to similar studies in the United States (US), China, and other countries. Sepsis, GCS<8, medical cases, MODS, and use of vasopressors were statistically associated with mortality. Clinicians should exercise caution while mechanically ventilating ICU-admitted patients with these factors. However, it should be noted that the exact cause and effect relationship could not be established with this meta-analysis, as the available evidence is not sufficient. Thus, more studies using prospective methods will be required.

Retrospective Analysis of Cholera/Acute Watery Diarrhea Outbreaks in Ethiopia From 2001 To 2023: Incidence, Case Fatality Rate, and Seasonal and Multiyear Epidemic Patterns.

The Ethiopian government has developed the multisectoral cholera elimination plan (NCP) with an aim of reducing cholera incidence and case fatality rate (CFR). To better understand and monitor the progress of this plan, a comprehensive review of national cholera epidemiology is needed. Reported data on cholera/acute watery diarrhea (AWD) cases in the past 20 years were extracted from the Ethiopian Public Health Institute and World Health Organization databases. Descriptive statistics, Pearson χ2, and logistic regression analyses were conducted. From January 2001 to November 2023, a total of 215 205 cholera/AWD cases, 2355 deaths with a cumulative CFR of 1.10% (95% confidence interval [CI], 1.092-1.095), and a mean annual incidence rate of 8.9/100 000 (95% CI, 6.5-11.3) were reported. Two major upsurges of cholera epidemics were found in the last two decades with mean attack rate (AR) of 20.57/100 000 in 2006-2010 and 14.83/100 000 in 2016-2020. Another resurgence of outbreaks occured in 2021-2023 (mean AR, 8.63/100 000). In 2015-2023, 54.0% (53 990/99 945) of cases were aged 15-44 years. National cholera CFR (3.13% [95% CI: 2.1-4.5]) was the highest in 2022. The 2015-2023 cumulative cholera CFR was different across regions: Benishangul Gumuz (6.07%), Gambela (1.89%), Sidama (1.42%), Southern Nation, Nationalities, and Peoples' (1.34%), Oromia (1.10%), and Amhara (1.09%). Cholera/AWD patients in older adults (≥45 years), severe dehydration, peak rainy season (June-August), and outpatients were associated with higher risk of death. Cholera has been a public health problem in Ethiopia with case fatalities still above the global target. Case management needs to be improved particularly in outpatients and older populations. Outbreak preparedness should be rolled out well in advance of the typical rainy seasons. Significant investments are essential to advance the cholera surveillance system at healthcare setting and community level. Underlying factors of cholera deaths per areas should be further investigated to guide appropriate interventions to meet the NCP target by 2028.

Spatial Variation and Determinants of Inadequate Minimum Meal Frequency among Children Aged 6-23 Months in Ethiopia: Spatial and multilevel analysis using Ethiopian Mini Demographic and Health Survey (EMDHS) 2019.

Introduction: Minimum meal frequency is the number of times children eat in a day. Without adequate meal frequency, infants and young children are prone to malnutrition. There is little information on the spatial distribution and determinants of inadequate meal frequency at the national level. Therefore, we aimed to investigate the spatial distribution and determinants of inadequate meal frequency among young children in Ethiopia. Methods: The most recent Ethiopian demographic and health survey data was used. The analysis was conducted using a weighted sample of 1,610 children aged 6-23 months old. The Global Moran's I was estimated to assess the regional variation in minimum meal frequency. Further, a multivariable multilevel logistic regression model was fitted to identify factors associated with inadequate meal frequency. The AOR (adjusted odds ratio) at 95% CI (confidence interval) was computed to assess the strength and significance of the relationship between explanatory variables and the outcome variable. Factors with a p-value of <0.05 are declared statistically significant. Results: This study revealed that the prevalence of inadequate meal frequency was found to be 30.56% (95% CI: 28.33-32.88). We identified statistically significant clusters of high inadequate meal frequency, notably observed in Somalia, northern Amhara, the eastern part of southern nations and nationalities, and the southwestern Oromia regions. Child age, antenatal care (ANC) visit, marital status, and community level illiteracy were significant factors that were associated with inadequate meal frequency. Conclusion: According to the study findings, the proportion of inadequate meal frequency among young children in Ethiopia was higher and also distributed non-randomly across Ethiopian regions. As a result, policymakers and other concerned bodies should prioritize risky areas in designing intervention. Thus, special attention should be given to the Somalia region, the northern part of Amhara, the eastern part of Southern nations and nationalities, and southwestern Oromia.

Geotechnical Study for Assessing Slope Stability at the Proposed Weito Dam Site in Ethiopia: Implications for Environmental Sustainability and Resilience

There is a proposed dam at Weito in Ethiopia’s Southern Nations Nationalities and People Regional State. This embankment-type dam primarily serves irrigation purposes. Weito’s proposed dam’s slope stability is the primary focus of this investigation. The objective is to assess the geological and geotechnical conditions influencing slope stability using the slope mass rating (SMR) classification system. This study examined various slope stability parameters. Uniaxial compressive strength, rock quality designation, joint condition, discontinuity spacing, joint orientation, and groundwater conditions were measured. An analysis of field data, including geological structures and lithology, was used to generate a structural discontinuity map. The slope mass rating was calculated to assess rock mass stability. The study area was examined for faults, joints, fractures, and shear zones during fieldwork. Schmidt hammer tests indicated a range of 10.5–50 MPa uniaxial compressive strength. Rock quality designation values were also within 72.5% to 95%. Additionally, the joint spacing of rocks varied from 3.95 cm to 47.5 cm. Rock mass ratings ranged from 39% to 62%. The study contributes to the understanding of the geological conditions at the Weito dam site and ensures the dam’s safe design and construction.

Quality of hospital labour and delivery care: A multilevel analysis in Southern Nations and Nationalities People's Region of Ethiopia.

Ethiopia has one of the highest maternal mortality ratios in Africa. Few have examined the quality of labour and delivery (L&D) care in the country. This study evaluated the quality of routine L&D care and identified patient-level and hospital-level factors associated with the quality of care in a subset of government hospitals. This was a facility-based, cross-sectional study using direct non-participant observation carried out in 2016. All mothers who received routine L&D care services at government hospitals (n = 20) in one of the populous regions of Ethiopia, Southern Nations Nationalities and People's Region (SNNPR), were included. Mixed effects multilevel linear regression modeling was employed in two stages using hospital as a random effect, with quality of L&D care as the outcome and selected patient and hospital characteristics as independent variables. Patient characteristics included woman's age, number of previous births, number of skilled attendants involved in care process, and presence of any danger sign in current pregnancy. Hospital characteristics included teaching hospital status, mean number of attended births in the previous year, number of fulltime skilled attendants in the L&D ward, whether the hospital had offered refresher training on L&D care in the previous 12 months, and the extent to which the hospital met the 2014 Ethiopian Ministry of Health standards regarding to resources available for providing quality of L&D care (measured on a 0-100% scale). These standards pertain to availability of human resource by category and training status, availability of essential drugs, supplies and equipment in L&D ward, availability of laboratory services and safe blood, and availability of essential guidelines for key L&D care processes. On average, the hospitals met two-thirds of the standards for L&D care quality, with substantial variation between hospitals (standard deviation 10.9 percentage points). While the highest performing hospital met 91.3% of standards, the lowest performing hospital met only 35.8% of the standards. Hospitals had the highest adherence to standards in the domain of immediate and essential newborn care practices (86.8%), followed by the domain of care during the second and third stages of labour (77.9%). Hospitals scored substantially lower in the domains of active management of third stage of labour (AMTSL) (42.2%), interpersonal communication (47.2%), and initial assessment of the woman in labour (59.6%). We found the quality of L&D care score was significantly higher for women who had a history of any danger sign (β = 5.66; p-value = 0.001) and for women who were cared for at a teaching hospital (β = 12.10; p-value = 0.005). Additionally, hospitals with lower volume and more resources available for L&D care (P-values < 0.01) had higher L&D quality scores. Overall, the quality of L&D care provided to labouring mothers at government hospitals in SNNPR was limited. Lack of adherence to standards in the areas of the critical tasks of initial assessment, AMTSL, interpersonal communication during L&D, and respect for women's preferences are especially concerning. Without greater attention to the quality of L&D care, regardless of how accessible hospital L&D care becomes, maternal and neonatal mortality rates are unlikely to decrease substantially.

TB-related catastrophic costs in Ethiopia

&lt;sec&gt;&lt;title&gt;OBJECTIVES&lt;/title&gt;To measure the progress towards reducing TB-related catastrophic costs in 19 zones of Amhara, Oromia, SNNP (Southern Nations and Nationalities, and Peoples) and Sidama Regions of Ethiopia.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;METHODS&lt;/title&gt;A baseline survey was conducted in randomly selected health facilities from all districts within the 19 zones from November 2020 to February 2021. Interventions targeting the major drivers of catastrophic costs identified in the baseline survey, such as installation of 126 GeneXpert and 13 Truenat machines, securing connectivity of 372 GeneXpert, establishing alternative specimen referral systems, and capacity-building of health workers, were implemented. A follow-up survey was conducted from October to December 2022. The WHO generic tool was used to collect data based on probability proportional to size. Data were entered into STATA software, and the proportion of catastrophic costs was calculated and compared between the two surveys.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;RESULTS&lt;/title&gt;A total of 433 and 397 patients participated in the baseline and follow-up surveys, respectively. The proportion of catastrophic costs reduced from 64.7% to 43.8% (P &lt; 0.0001). The share of direct non-medical costs decreased from 76.2% to 19.2%, while medical and indirect costs increased from 11.6% and 12.3% to 30.4% and 52.4 %.&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;CONCLUSION&lt;/title&gt;The proportion of households facing TB-related catastrophic costs has significantly reduced over the 2-year period. However, it remains unacceptably high and varies among regions. Further reducing the catastrophic costs requires multisectoral response, reviewing the TB service exemption policy, further decentralisation and improving the quality of TB services.&lt;/sec&gt;

Individual and community level determinants of delayed antenatal care initiation in Ethiopia: A multilevel analysis of the 2019 Ethiopian Mini Demographic Health Survey.

Antenatal care (ANC) is essential health care and medical support provided to pregnant women, with the aim of promoting optimal health for both the mother and the developing baby. Pregnant women should initiate ANC within the first trimester of pregnancy to access a wide range of crucial services. Early initiation of ANC significantly reduces adverse pregnancy outcomes, yet many women in Sub-Saharan Africa delay its initiation. The aim of this study was to assess prevalence and determinants of delayed ANC initiation in Ethiopia. We conducted a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The study involved women of reproductive age who had given birth within the five years prior to the survey and had attended ANC for their most recent child. A total weighted sample of 2,895 pregnant women were included in the analysis. Due to the hierarchical nature of the data, we employed a multi-level logistic regression model to examine both individual and community level factors associated with delayed ANC initiation. The findings of the regressions were presented with odds ratios (OR), 95% confidence intervals (CI), and p-values. All the statistical analysis were performed using STATA-14 software. This study showed that 62.3% (95% CI: 60.5, 64.1) of pregnant women in Ethiopia delayed ANC initiation. Participants, on average, began their ANC at 4 months gestational age. Women with no education (AOR = 2.1; 95% CI: 1.4, 3.0), poorest wealth status (AOR = 1.9; 95% CI: 1.3, 2.8), from the Southern Nations, Nationalities, and Peoples (SNNP) region (AOR = 2.1; 95% CI: 1.3, 3.3), and those who gave birth at home (AOR = 1.4; 95% CI: 1.1, 1.7) were more likely to delay ANC initiation. The prevalence of delayed ANC initiation in Ethiopia was high. Enhancing mothers' education, empowering them through economic initiatives, improving their health-seeking behavior towards facility delivery, and universally reinforcing standardized ANC, along with collaborating with the existing local community structure to disseminate health information, are recommended measures to reduce delayed ANC initiation.

Recovery Rate and Predictors for Cure of Admitted COVID-19 Patients in Ethiopia; A Systemic Review and Meta-Analysis

BACKGROUND. Despite the global efforts to curb COVID-19 infection using vaccines and drugs, the burden of illness, hospitalization, and death are continued as a deadly pandemic. Previous study finding estimated recovery time of 2 weeks for mild and 3 to 6 weeks for hospitalized cases. However, in low and middle-income countries like Ethiopia, recovery rate and viral negative conversion time are lowballed and underestimated due to the new variant incidence, limited resources and lacked skilled healthcare providers for admitted COVID-19 patients. This study aimed to estimate pooled recovery rate, and predictors for cure among admitted COVID-19 patients in Ethiopia. METHODS. Five electronic databases (Medline, PubMed, HINARY, Africa Journals Online, and Google Scholar) were searched. A total of 529 articles were extracted from cohort studies published in English spanning from December 30, 2019, to December 30, 2023. PRISMA guidelines were adhered to articles screening and extracted using Microsoft Excel. The quality of eligible articles was evaluated using the JBI checklist. The pooled effect size and adjusted odds ratio (AOR) with 95% confidence intervals were determined using the random-effect meta-regression using STATA version 17. Heterogeneity among studies was assessed using Cochran's Q-test, and the variation was estimated by I2, and presented in a forest plot. Subgroup analysis was also used to identify sources of heterogeneity among studies. RESULT. A total of 12 studies were included in the final meta-analysis. During the recovery screening of 5,152 admitted COVID-19 cases, 4,411 participants were discharged as cured. The pooled recovery rate was estimated at 90.6% (95% CI: 87.1-94.23, I² = 96.11%, P = 0.001). In subgroup analysis, Addis Ababa exhibited the highest recovery rate with 95.1%, followed by Oromia (94.6%), and Southern nation nationalities (SNN) region (91.55%). The recovery rate was higher for individuals aged 15-30 years (AHR = 2.01, 95% CI: 1.41-2.86, P = 0.001), males’ gender (AHR=1.46, 95% CI: 1.14-1.88, P=0.002), and cases admitted with ≥37.5°C (AHR = 2.01, 95% CI: 1.41-2.86, P = 0.001) compared to their counterparts. This manuscript is ongoing a submitted for registered in Prospero. CONCLUSION. In Ethiopia, nearly nine in every ten (90%) admitted COVID-19 cases recovered. However, the recovery rate exhibits a significant variation across each study region, setting, and pandemic phase. Therefore, healthcare providers prioritize care for critical cases to increase the overall survival rate of admitted patients.

Determinants of implanon discontinuation among women in Gedeo Zone, South Ethiopia: a case–control study

BackgroundThe main public health problem that has a significant impact on the high fertility rate, unintended pregnancies, and induced abortion is Implanon cessation. In addition to Implanon being underutilized in Ethiopia, the rate of cessation is higher among women who started using it. Nevertheless, little is known about the factors that lead to Implanon cessation.ObjectivesThe study was aimed to determine the factors that led women to discontinue Implanon in Gedeo Zone, Southern Nation Nationalities and Peoples Region, southern Ethiopia, 2019.MethodA community-based unmatched case–control study design was carried out. Cases and controls were selected by a multi-stage sampling with a 1:2 case-to-control ratio. Data was entered into EPi-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. A bivariate and multivariable logistic regression was used to identify the factors affecting Implanon discontinuation. The adjusted odd ratio (AOR) with 95% Confidence Interval (CI) was used to determine the precision of estimates, and statistical significance was declared at a p-value of 0.05.ResultFrom 516 women included in to the study, 495 (cases = 166 and controls = 329) women have responded to the questionnaires making a response rate of 96%. Monthly income 500—1000 birr [AOR: 0.3; 95% CI (0.2–0.5)], above 1000 birr [AOR: 0.2; 95% CI (0.1–0.4)], history of abortion [AOR: 2.0; 95% CI (1.0–4.1)], birth spacing [AOR: 0.6; 95% CI (0.3–0.9)], partner objection [AOR: 2.4; 95% CI (1.4–4.2)] were significantly associated factors.ConclusionThis study identified that monthly income, having abortion history, birth spacing, partner objection were the factors that affect Implanon discontinuation. To reduce implanon discontinuation, reducing abortion, involving partner and increasing the birth spacing, appropriate counseling before the insertion and appropriate follow-up by a health care practitioner are highly recommended.

Population structure and spatial distribution of Mycobacterium tuberculosis in Ethiopia

Ethiopia is one of the countries with a high tuberculosis (TB) burden, yet little is known about the spatial distribution of Mycobacterium tuberculosis (Mtb) lineages. This study identifies the spoligotyping of 1735 archived Mtb isolates from the National Drug Resistance Survey, collected between November 2011 and June 2013, to investigate Mtb population structure and spatial distribution. Spoligotype International Types (SITs) and lineages were retrieved from online databases. The distribution of lineages was evaluated using Fisher’s exact test and logistic regression models. The Global Moran’s Index and Getis-Ord Gi statistic were utilized to identify hotspot areas. Our results showed that spoligotypes could be interpreted and led to 4 lineages and 283 spoligotype patterns in 91% of the isolates, including 4% of those with multidrug/rifampicin resistance (MDR/RR) TB. The identified Mtb lineages were lineage 1 (1.8%), lineage 3 (25.9%), lineage 4 (70.6%) and lineage 7 (1.6%). The proportion of lineages 3 and 4 varied by regions, with lineage 3 being significantly greater than lineage 4 in reports from Gambella (AOR = 4.37, P < 0.001) and Tigray (AOR = 3.44, P = 0.001) and lineage 4 being significantly higher in Southern Nations Nationalities and Peoples Region (AOR = 1.97, P = 0.026) than lineage 3. Hotspots for lineage 1 were located in eastern Ethiopia, while a lineage 7 hotspot was identified in northern and western Ethiopia. The five prevalent spoligotypes, which were SIT149, SIT53, SIT25, SIT37 and SIT26 account for 42.8% of all isolates under investigation, while SIT149, SIT53 and SIT21 account for 52–57.8% of drug-resistant TB cases. TB and drug resistant TB are mainly caused by lineages 3 and 4, and significant proportions of the prevalent spoligotypes also influence drug-resistant TB and the total TB burden. Regional variations in lineages may result from both local and cross-border spread.

Searching for precursor activity of Type IIn Supernovae

We conducted a search for luminous outbursts prior to the explosion of Type IIn supernovae (SNe IIn). We built a sample of 27 objects spectroscopically classified as SNe IIn and all located at $z&lt;0.015$. Using deep archival SN fields images ---taken up to nearly 20 years prior to the SN explosions themselves--- from transient surveys (PTF, ZTF, DES and CHASE) and major astronomical observatories (European Southern Observatory, ESO and National Optical Astronomy Observatory, NOAO), we found at least one outburst years to months before the explosion of seven SNe IIn, with the earliest precursor being 10 years prior to the explosion of SN 2019bxq. The maximum absolute magnitudes of the outbursts range between $-$11.5 mag and $-$15 mag, and the eruptive phases last for a few weeks to a few years. The $g-r$ colour measured for three objects during their outburst is relatively red, with $g-r$ ranging between 0.5 and 1.0 mag. This is similar to the colour expected during the eruptions of luminous blue variables. We note that the light curves of SNe with pre-SN outbursts have faster decline rates than those of the SNe that do not show pre-SN outbursts. SN 2011fh is remarkable, as it is still visible 12 years after the luminous SN-like event, indicating that the progenitor possibly survived, or that the interaction is still ongoing. We detect precursor activity in 29&lt;!PCT!&gt; of bona fide SNe IIn in our sample. However, a quantitative assessment of the observational biases affecting the sample suggests that this fraction is an underestimation of the intrinsic precursor occurrence rate.

Integrating nutrition in the Sasakawa Africa Association extension services: Knowledge, attitude and practices among smallholder farmers

This survey aimed to establish nutrition-related knowledge, attitudes and practices, and to observe how gender influences household food-related decision-making processes in the Sasakawa Africa Association (SAA) intervention areas in the Oromia and Southern Nation Nationalities and People regions of Ethiopia. The findings would inform implementation of communication for nutrition social and behaviour change among small-holder farmers as part of the SAA corporate strategy on nutrition-sensitive agriculture. The study population was smallholder farmers supported by SAA from which 311 respondents were selected through multistage sampling. Data were collected via a mixed methods approach consisting of a household survey, focus group discussions (FGDs) and key informant interviews (KIIs). Quantitative data were analysed using descriptive statistics while qualitative data was analysed using a narrative and content approach. The study focused on knowledge, attitudes and practices related to production and consumption of micronutrient-rich foods. Majority (59.5%) of the respondents were male. Men were the main decision makers on staple or commercial food crop production and proportion of produced crops to be consumed at home or sold in the market. Women mainly made decisions regarding production and consumption of fruits and vegetables, intra-household food distribution, preservation and storage. There was a lack of knowledge on iron and vitamin A fortified or biofortified sources of food. Nearly three quarters (72%) of women did not meet the minimum dietary diversity for women, a proxy indicator of adequacy of micronutrient intake and diet quality. The mean dietary diversity score was 3.8 with animal source foods being the least consumed. Not having sufficient money to buy food, unavailability of different food groups and poor intra-household food distribution were among the key reasons for lack of diverse diets. Majority of the respondents were aware of the importance of production and consumption of micronutrient-rich foods. However, there was a gap in practice and awareness about biofortified and fortified foods. While most of the respondents had produced fruits and vegetables in home gardens in the three months prior to this survey, more than half (54%) of the respondents thought it was not likely that they would produce fruits and vegetables for home consumption. More targeted nutrition campaigns are required to increase the ability of small-holder farmers to adopt best practices while reducing the barriers associated with access and consumption. Promotion of fruit and vegetable production in home gardens could be considered as option for improving household dietary quality as well as empowering women to make more decisions. Key words: Sasakawa Africa Association, Small-holder farmers, Nutrition, Knowledge, Practices

Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study

BackgroundDespite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People’s Region (SNNPR) of Ethiopia.MethodsA community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI.ResultsFrom a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness.ConclusionLow LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country’s malaria elimination goal.

Spatial distribution of zero-dose children in Ethiopia: evidence for a targeted intervention from a large-scale cross-sectional evaluation survey.

Ethiopia is the fourth leading contributor to the global total of zero-dose children (those who lack the first dose of diphtheria-tetanus-pertussis containing vaccine) and has substantial regional variations in zero-dose children. This study explored the spatial pattern of zero-dose children aged 12-35 months in Ethiopia. A survey was conducted in pastoralist regions, developing regions, newly-established regions, conflict-affected areas, underserved urban populations, hard-to-reach areas, internally displaced populations, and refugees. Spatial autocorrelation was measured using the Global Moran'sIstatistic. Getis-Ord Gi* statistics was applied to calculate the spatial variability of the high and low prevalence rates of zero-dose children. The spatial interpolation technique was also applied to estimate unknown values that fall between known values. Inverse distance weighting interpolation method was used to predict the risk of zero-dose children. ArcGIS version 10.8 was used for the spatial analysis. A total of 3,646 children aged 12-35 months were included in the study. The spatial distribution of zero-dose children in Ethiopia was non-random (Global Moran'sI = 0.178971, p < 0.001). According to the hotspot analysis, western, eastern and northern parts of Somali and western and central parts of Afar regions had the highest load of zero-dose children (hotspot areas) followed by the Northeastern part of Amhara and southeastern part of Oromia regions. On the other hand, Southern Nations, Nationalities, and Peoples, Sidama, and the Eastern part of the Southwest Ethiopia peoples regions were identified as cold spot areas. The spatial interpolation analysis corresponded with the hotspot analysis results where western and central parts of Afar and western, eastern and northern parts of Somali regions were identified as high-risk areas for zero-dose children. However, Addis Ababa, Dire Dawa, Harari, Southern Nations, Nationalities, and Peoples, Sidama, Southwest Ethiopia Peoples, and parts of Oromia were found to be low-risk areas for zero-dose children. The spatial analysis identified that zero-dose children had a significant spatial variation across the study areas. High clusters of zero-dose children were detected in Afar and Somali regions. Implementing routine and mop-up vaccination campaigns in the identified hotspot areas will help Ethiopia to improve coverage and reduce immunization inequalities.