BackgroundIrrespective of intensive global efforts to reduce under-five mortality, it remains a significant public health concern. Understanding the causes and trends of under-five mortality is essential for guiding targeted interventions, assessing the effectiveness of public health strategies, and monitoring changes in mortality over time. The health and demographic surveillance system is one of the preferred sources to study the cause of under-five mortality.ObjectiveThis study aims to analyse the causes and trends of under-five deaths in Southwest Ethiopia using Gilgel-Gibe Health and Demographic Surveillance System (GGHDSS) database.MethodsGGHDSS is an open, dynamic cohort that was established in 2005. Fifteen years of mortality data and seven years of Verbal Autopsy (VA) data were extracted from the GGHDSS database for this study. The VA data are part of the fifteen year mortality dataset, in which causes of death were determined through the VA method. After extracting the data from MYSQL and OpenHDS, it was exported to Excel for further cleaning. Finally, the cleaned data were exported to R statistical software for analysis and visualization. Neonatal, infant, and under-five mortality trends were analysed and the proportion of cause specific deaths were identified from the VA data.ResultsBetween 2005 and 2019, 28, 811 children, 13931 (48.35%) female and 14880 (51.65%) male, were born alive and registered in the GGHDSS, among which 1828 (6.34%) of them died before celebrating their fifth birthday. The overall under-five mortality rate was 63.4 (95% CIs; 60.6, 66.3) per 1000 live births while neonatal and infant mortality rates were 30(95% CIs; 28.1, 32) and 50.2 (95% CIs; 47.6, 52.7), respectively. The mortality rate during the surveillance years showed a declining trend among neonatal, infant, and overall under-five children, with average slopes of -2.49, -4.56, and -7.24, respectively. From 1070 under-five deaths captured by the VA method in GGHDSS during 2009-2016, 596 (55.7%) were male and 474 (44.30%) were female. The most common causes of neonatal death were birth asphyxia and perinatal respiratory disorders, bacterial sepsis, and prematurity including respiratory distress. In the post-neonatal period, the most common causes of death were acute lower respiratory infections (including pneumonia and acute bronchitis), intestinal infectious diseases including diarrheal diseases, and malaria. Severe malnutrition, intestinal infectious diseases, and acute lower respiratory infections were responsible for more than half of the deaths among children between 12 and 59 months of age.ConclusionsUnder-five mortality has shown a significant declining trend between 2005 and 2019 at the study setting. Birth asphyxia, neonatal infections, and prematurity were among the most common causes of neonatal deaths, whereas infectious diseases and malnutrition were the main causes of death beyond the neonatal period. Strengthening perinatal and neonatal care, improving prevention and management of childhood infections, and enhancing early nutritional interventions are needed to reduce under-five mortality.

Despite the success in scaling-up antiretroviral therapy (ART) services in Ethiopia, suboptimal adherence to ART has been an existing challenge. There is a dearth of evidence on the status of adherence to ART following the adoption of test and treat strategy in Ethiopia. This study aimed to investigate on the magnitude of suboptimal adherence and its predictors among patients taking ART. A multicenter prospective cohort study was conducted among adults aged 15 years and above who started ART between March and June 2019 in 39 health facilities (HFs) in Ethiopia. Measurements on sociodemographic, behavioral, and clinical characteristics were taken at baseline and 6- and 12-months following ART initiation. Multivariable logistic regression model using generalized estimating equations was used to identify factors associated with suboptimal adherence. In total, 1229 individuals who started ART were included in the study. The proportion of suboptimal adherence was 8.0% and 7.9% at 6- and 12-months, respectively. Younger age (adjusted odds ratio (AOR) = 2.28 (95% confidence interval (CI) 1.10, 4.74)), being single (AOR = 2.08 (95% CI 1.25, 3.48)), and being a farmer (AOR = 3.21 (95% CI 1.84, 5.61)) were associated with increased risk for suboptimal adherence. Similarly, alcohol intake (AOR = 3.31 (95% CI 2.14, 5.11)), missing clinic appointment (AOR = 5.73 (95% CI 3.76, 8.75)), having opportunistic infections (AOR = 2.86 (95% CI 1.67, 4.88)) and presence of comorbidities (AOR = 3.51 (95% CI 1.89, 6.53)) were associated with higher risk for suboptimal adherence. We observed lower rate of suboptimal adherence to ART following the implementation of test and treat strategy in Ethiopia. Various sociodemographic, clinical, and behavioral factors were found to be independent predictors of suboptimal adherence. The findings highlight the importance of person-centered adherence support based on individual characteristics.

BackgroundAdolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Although, the trends of unintended pregnancy and induced abortion have declined over time in Ethiopia, evidence is limited on key determinants for decline in order to propose vital areas of interventions. The current study aimed to identify the determinants of unintended pregnancy and induced abortion among adolescents over the decades.MethodsTrends in the prevalence of unintended pregnancy and induced abortion among adolescent women aged 15-19 years were investigated based using a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000, 2005, 2011, and 2016. Sub-sample of adolescent women data was extracted from each survey. The combined datasets for unintended pregnancy and induced abortion over the study period (2000-2016) was analyzed. The percentage changes of trends of unintended pregnancy and induced abortion with its corresponding 95% CI for each variable were calculated. Multilevel mixed-effects decomposition analysis was applied to identify factors significantly associated with trends of unintended pregnancy and induced abortion among adolescents.ResultsThe trends of unintended pregnancy and induced abortion significantly declined during the study period. Unintended pregnancy among Ethiopian adolescents aged 15-19 years significantly decreased from 307 (41.4%) (95% CI: 35.7, 47.2%, p<0.001) in 2000 to 120 (25.1%) (95% CI: 18.9, 31.4%) in 2016. On the other hand, induced abortion significantly decreased from 62 (8.3%) (95% CI: 5.2, 11.4%) in 2000 to 20 (4.1%) (95% CI: 1.3, 6.9%, p = 0.004) in 2016. Age older than 18 years (Coeff = -0.41, 95%CI, -0.64, -0.18, p<0.001), living in Somali regional state (Coeff = -2.21, 95%CI, -3.27, -1.15, p<0.001) and exposure to media (Coeff = -0.60, 95%CI, -0.87, -0.33, p<0.001) showed a significance association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz regional state (Coeff = -0.17, 95%CI, -0.32, -0.19, p = 0.03) and ANC service utilization history (Coeff = -0.81, 95%CI, -1.45, -0.17, p = 0.01) showed significance association with decline in induced abortion.ConclusionThe trends of unintended pregnancy and induced abortion significantly declined over the past decades in Ethiopia. Adolescent girls aged 17 years and above, exposure to media and living in Somali showed significant association with decline in unintended pregnancy whereas; living in Benshangul-Gumuz and ANC service utilization history showed significant decline with induced abortion. Exposure to media and utilization of Antenatal care (ANC) services may improve adolescent girls' reproductive health uptake.

BACKGROUND:Lack of improved sanitation is the most important contributing factor to diarrheal disease among under-five children in low and middle-income countries. There was no study to identify the effect of Community-Led Total Sanitation and Hygiene intervention on diarrheal diseases in the study area. Hence, this study was designed with the aim of finding the effects of Community-led Total Sanitation and Hygiene implementation for preventing diarrhea among under-five children.METHODS:A community-based Quasi-Experimental study was conducted among a sample of 846 households selected from intervention (kersa) and comparison (mana) districts using the four-stage random cluster-sampling method. A Semi-structured questionnaire was used to collect data. The collected data was cleaned, coded, and entered into EpiData version 3.1 and exported to SPSS version 20 for analysis. Difference-in Difference method with McNemar's tests was used to compare the prevalence of diarrhea between the intervention and comparison districts, and the significance of change between the pre-test and post-test was declared at p-value less than 0.05 with 95% confidence interval.RESULTS:The intervention led to decreased diarrhea prevalence [pp = -8.2, 95% CI: -15.9, -0.5], increased latrine ownership [pp = 5.6, 95% CI: 0.5, 10.8], and increased latrine utilization [pp = 10.7, 95% CI: 4.7, 16.6] in intervention district at post-test compared to the baseline; while the presence of handwashing facility near the latrine, home-based water treatment, and proper water storage and handling practice were decreased at post-test compared to the baseline.CONCLUSION:Implementation of Community-Led Total Sanitation improved sanitation and hygiene status of community that resulted in the reduction of diarrhea diseases in under-five children. Further implementation, evaluation, and scale-up of the interventions are needed to reduce diarrheal disease in under-five children.

Background Adolescents are highly at risk of unintended pregnancy due to physiological, sexual, social and psychological growth. The pregnancy may end with early childbirth, induced abortion and its complications. Trends of unintended pregnancy and induced abortion are higher in developing countries and more than 90% of adolescent births occur in low income countries. Objectives This study determined the trend of unintended pregnancy, induced abortion and associated factors among adolescents in Ethiopia from 2000 to 2016. Methods Trends in the prevalence of unintended pregnancy and abortion among adolescents were investigated based on a series of the Ethiopia Demographic and Health Surveys (EDHS) data for the years 2000 (n=741), 2005 (n=708), 2011 (n= 616), and 2016 (n=479). The combined dataset was used to increase the statistical power of the study in order to detect any association between the study factors and the outcomes, and to examine trends in unintended pregnancy and abortion over the study period (2000–2016). The percentage changes with corresponding 95% CI of the outcome variables were calculated by independent factors to examine the changes over the study period using chi-squared test for trend. Multilevel logistic regression analysis was done to identify factors associated with unintended pregnancy and abortion among adolescents. Results The prevalence of unintended pregnancy among Ethiopian adolescents aged 15-19 years decreased significantly from 41.4% (95% CI: 35.7, 47.2%) in 2000 to 25.1% (95% CI: 18.9, 31.4%) in 2016 (p-value=0.0001). Factors associated with a lower likelihood of unintended pregnancy among adolescents included being aged above 17 years old (AOR=0.30; 95% CI: 0.17-0.51) and married (AOR=0.14; 95% CI:0.07-0.28).While, parity (AOR= 1.68; 95%CI:1.02-2.75), resided in large central (AOR=3.32; 95%CI:1.86-5.63), and metropolis (AOR=3.12; 95%CI:1.20-8.12) regions were significantly associated with higher odds of untended pregnancy. The prevalence of abortion also decreased significantly from 8.3% (95% CI: 5.2, 11.4%) in 2000 to 4.1% (95% CI:1.3, 6.9%) in 2016 (p-value=0.04). Middle wealth index (AOR=0.14; 95% CI: 0.03-0.64), rich wealth (AOR=0.09; 95% CI: 0.01-0.74), female head household (AOR=0.11; 95%CI: 0.01-0.91) and rural resident (AOR=0.08; 95%CI: 0.01-0.45) were factors significantly associated with lower likelihood of abortion. Conclusion Although, the prevalence of unintended pregnancy and abortion among adolescents decreased significantly from 2000 to 2016, still both are public health problems in Ethiopia. Factors associated with higher unintended pregnancy were being below 18 years old, unmarried, higher parity, large central and metropolis regions. Belonging to poorer wealth index, urban resident and male headed households were factors associated with higher abortion rate. Hence, it is important to provide continuous sex education, contraception education and health information about the consequences of unintended pregnancy and abortion for adolescent girls in Ethiopia.

Background Cervical cancer (CC) is the 4(th) most prevalent cancer among females globally. In Ethiopia, around 7,095 new CC cases are diagnosed every year and it is the second common cause of cancer deaths in women. There is limited evidence on survival status as well as about predictors of time to death among CC patients in Ethiopia. Thus, this study investigated the five-year survival status and predictors of time to death among CC patients who had been admitted at Tikur Anbesa specialized Hospital (TASH) from 2014-2019. Methods Facility-based, retrospective-cohort study was conducted at Tikur Anbesa specialized Hospital among 348 patients from June 2014 to June 2019. A systematic random sampling method was employed to select the study participants. Data were extracted from the patient card, and through phone calls. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Kaplan and Meier's method was used to estimate survival functions and Cox-proportional hazard regression analysis was carried out in order to identify the independent predictors of time to death. Results The overall incidence of death was 31 per 100 person-years of follow up. The median (IQR) follow-up time of the entire cohorts was 18.55 (8.96-49.65) months. The independent predictors for time to death included; age older than 50 years [AHR: 1.4; 95% CI: 1.1-1.9], late stage of CC at diagnosis [AHR: 2.2; 95% CI: 1.7-2.9], No CC treatment [AHR: 2.1; 95% CI: 1.5-3.1] and HIV positive [AHR: 2.3; 95% CI: 1.4-3.8]. Conclusion and recommendation The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient's survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia.

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

Schizophrene Psychosen sind die Folge eines multifaktoriellen Geschehens. Bei ihrer Entstehung spielen nicht nur Umwelteinflüsse, sondern auch genetische Faktoren eine wichtige Rolle. Grundlage dieser Faktoren ist ein komplexer Vererbungsmodus, an dem eine Vielzahl genetischer Varianten beteiligt ist. Die biologisch-psychiatrische Forschung hat sich in den letzten drei Jahrzehnten intensiv der molekulargenetischen Erforschung der erblichen Grundlage schizophrener Psychosen gewidmet. Internationale Konsortien führten Kohorten einzelner Forscher zusammen, was eine kontinuierlich ansteigende Fallzahl und somit eine erhöhte statistische Aussagekraft ermöglichte. Im Rahmen des Psychiatric Genomics Consortium (PGC) konnten durch genomweite Assoziationsstudien mit zehntausenden Patienten und Kontrollen erstmals robust replizierbare Marker für schizophrene Psychosen gefunden werden. Durch intensive Phänotypisierung in der longitudinalen PsyCourse-Studie der UMG Göttingen und der LMU München konnten erste Ansätze einer transdiagnostischen klinischen Neuklassifizierung schwerer psychischer Erkrankungen etabliert und so neue, biologisch validierte Krankheitsuntergruppen mit prognostischem Wert identifiziert werden. Sogar in einer afrikanischen Kohorte konnten zum ersten Mal neuartige Umweltfaktoren untersucht werden, die zur Entstehung der Psychose beitragen. Durch den enormen technischen Fortschritt im Bereich der genomischen Hochdurchsatztechnologien („next-generation sequencing“) sind zukünftig neue Erkenntnisse zu erwarten, nicht nur zum Einfluss häufig vorkommender Einzelnukleotidpolymorphismen (SNPs), sondern auch zu selteneren Varianten. Für die erfolgreiche Nutzung dieser technologischen Revolution ist ein Austausch von Daten zwischen Forschungsgruppen unerlässlich.

Food insecurity is a global concern. While it was once characterized mainly as a problem of undernutrition, it is now recognized that a person may be food insecure without experiencing hunger. Numerous studies have demonstrated that food insecurity is strongly related to poor mental health around the world, but the mechanisms that underpin that relationship remain poorly understood. One body of research from nutritional sciences posits that nutrient deficiency impacts brain function, producing symptoms of depression and anxiety. Another body of research from the social sciences posits that the social consequences of having to eat non-preferred foods or obtain food in socially unacceptable ways may compromise mental health through stress. This study was designed to clarify the mechanisms linking food insecurity and mental health using case studies in rural Brazil and urban Ethiopia. Working with samples consisting of about 200 adult household decision-makers (mostly female) recruited between 2015 and 2019 at each site, we tested for nutritional and social mediation of the food insecurity-mental health relationship using multivariable linear regression and mediation analysis. Our analyses found no evidence of mediation in either setting. Moreover, there was no association between nutritional status variables and food insecurity. These findings suggest that food insecurity likely impacts mental health directly through forms of basic needs deprivation, such as worrying about where one's next meal will come from, rather than by acting as a social signal or even by impacting nutritional status. These results underscore the power of basic-needs deprivation for impacting mental health.

Background In resource poor countries like Ethiopia, little is known about the survival of patients treated with antiretroviral therapy which depends on different factors. Evidence shows that mortality has been high particularly in the first 3 to 6 months of initiating antiretroviral therapy. Hence, the study aimed to assess the Epidemiology of survival pattern and its determinants among adult HIV positive patients on highly active antiretroviral therapy. Methods Retrospective cohort study was employed among a total of 455 records of patients who were enrolled on antiretroviral therapy from September 2006 to August 2010. Socio-demographic, clinical, immunological, behavioral, and date of antiretroviral treatment initiation including date of follow up status were extracted. Significant predictor variables were identified by fitting Cox’s proportional hazard model using a backward stepwise method and statistical significance variables were declared based on a p-value less than 0.05. Results A total of 455 adult HIV/AIDS patients on ART contributed to 886.05-person-year of observation and 65.7% were alive and on treatment, 17.1% were lost to follow up and 7.5% died. The study showed that the estimated mortality was 4.4%, 5.3%, 6.1%, 7%, 7.5% and 7.5% at 6, 12, 24, 36, 48 and 60 months of follow up period, respectively. The overall incidence rate of mortality was 4.2 per 100 person-years of observation. In multivariate analysis age 45 and above (AHR: 3.72, 95% CI 1.21–11.4), bedridden functional status (AHR: 17.4, 95% CI 6.21–48.79), poor ART drug adherence (AHR: 4.52,95% CI 2.05–9.96), Tuberculosis co-infection (AHR: 4.1, 95% CI 1.84–9.13), non-disclosure (AHR: 4.9, 95% CI 1.82–12.89) and severe anemia (AHR: 5.1, 95% CI 1.81–14.21) were found predictors. Conclusion Patients with older age, tuberculosis infection, bedridden patients and severe anemia were predictors. Tracing poorly adhered patients and giving drug counseling as well as encouraging them for disclosure to their families is crucial to improve their survival.

Abstract Background Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia. Methods We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities. Results In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs. Conclusions Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.

Studying the relationship between mental illnesses and their environmental and genetic risk factors in low-income countries holds excellent promises. These studies will improve our understanding of how risk factors identified predominantly in high-income countries also apply to other settings and will identify new, sometimes population-specific risk factors. Here we report the successful completion of two intertwined pilot studies on khat abuse, trauma, and psychosis at the Gilgel Gibe Field Research Center in Ethiopia. We found that the Gilgel Gibe Field Research Center offers a unique opportunity to collect well-characterized samples for mental health research and to perform genetic studies that, at this scale, have not been undertaken in Ethiopia yet. We also supported service development, education, and research for strengthening the professional profile of psychiatry at the site.

Background Anemia is the most frequent micronutrient deficiency; globally it has an impact on more than 2 billion people. Different studies have indicated that the prevalence of anemia varies between rural areas and urban centers. This study focused on determining the prevalence and identifying the factors associated with anemia among “apparently healthy” urban and rural residents of Gilgel Gibe Field Research Center. Methods and Participants A comparative cross-sectional study was done using secondary data of Gilgel Gibe Field Research Center. Data of 1,602 (1,258 rural and 344 urban) apparently healthy adults whose hemoglobin level was available were included in the analysis. Data were analyzed by SPSS 20 and separate logistic regression models; urban and rural were fitted. Statistical significance was set at p-values < 0.05 with 95% CI. Results The overall prevalence of anemia was 40.9%. Anemia was higher among rural residents (46.6%) than urban residents (20.1%). In urban centers, being male (AOR = 2.15, 95% CI: [1.03, 4.50]) and illiterate (AOR = 5.76, 95% [CI: 1.27, 26.07]) were significantly associated with anemia. In rural areas, being female (AOR = 1.78, 95% CI: [1.27, 2.52]), presence of heart disease (AOR = 2.63, 95% CI: [1.09, 6.33]), central obesity (AOR = 1.83, 95% CI: [1.31, 2.57]), illiteracy (AOR = 3.62, 95% CI: [1.57, 8.35]), and primary school completion (AOR = 2.69, 95% CI: [1.08, 6.73]) were significantly associated with anemia. Conclusion According to the WHO classification, the overall prevalence of anemia was a severe public health problem. This study also marked urban–rural variation in anemia prevalence, indicating the need for targeting specific areas for intervention. Strengthening strategies aimed at educational empowerment and nutritional education will have a contribution to combating anemia, especially in the rural kebeles of the study area.

Background: Immunization is one of the most powerful and cost-effective public health interventions. Most vaccines in the immunization schedule require two or more doses to trigger adequate immune response; appropriate timing, proper interval between vaccine doses, and completion of all vaccine doses are important to attain optimal protection. Objective: To evaluate and identify factors associated with the timeliness of vaccine doses; assess the interval between vaccine doses; and identify missed opportunities among children aged 12 to 23 months. Methods: A cross-sectional descriptive study was conducted that employed the 30 by 10 modified WHO immunization coverage cluster sampling technique. Considering pastoral and semi-pastoral areas, a total of 60 clusters with a sample of 600 children aged 12 to 23 months and mothers/caregivers were included. Data were collected using smartphones loaded with the Open Data Kit (ODK) system and exported to STATA 12.0 for data description and analysis. Results: The response rate was 97%, with 54.8% of the sample from pastoral areas. About 51% of the respondents were Muslim, 68% had no education, and 67% were aged 30 or above. More than one fifth (21.9%) of children received at least one vaccine dose earlier than the recommended minimum age. Nearly half (47.7%) of children received at least one subsequent dose earlier than an interval of four weeks. The overall rate of missed opportunities was 42.7%, which was higher in pastoral (61.4%) compared to semi-pastoral areas (30.9%) (P <0.001). Children from pastoral areas had a higher rate of missed opportunities compared to children from semipastoral areas (OR=4.05; 95% CI: 2.28-7.22); and children from mothers/caregivers aged 30 or above had a higher rate of missed opportunities than mothers aged <30 (OR=1.89; 95% CI: 1.32-3.13). Conclusions: The study identified high proportions of children who started vaccination earlier than the recommended age (later for the first dose of Oral Polio Vaccine (OPV0)). In addition, multiple vaccine doses were administered before the minimum interval of four weeks. Children in pastoral areas have higher rate of missed opportunities compare to children in semi pastoralist and pastoralist areas for vaccines with same schedule. Recommendations: Strong interpersonal communication between mothers and vaccination providers is vital for the timely administration of vaccines. Emphasis should be placed on regular supervision and periodic in-service training of health workers to practice timely vaccine commencement, and maintain proper intervals between doses. Immunization service providers should give all the recommended vaccines with same schedule to reduce rate of missed opportunities.

Background: Adequate knowledge is key for immunization service provision and related practices, such as providing the right vaccine at the right time, keeping vaccines potent, and to prevent vaccine failures. This study was conducted to assess the knowledge, attitude and practices of immunization service providers in primary health care units in pastoral and semi-pastoral areas of Ethiopia. Methods: A facility-based cross-sectional study was conducted of 1,280 health workers drawn from health centers (233) and health posts (632) in five regions of Ethiopia: Somali, Gambella, Benishangul-Gumuz, Oromiya and SNNPR. Data were collected using a self-administered questionnaire prepared in English and translated into three local languages, and analyzed using STATA version 13.0. Descriptive statistics and binary logistic regression analysis were carried out to determine the magnitude of, and identify associated factors for, knowledge, attitude and practice. A p-value of less than 0.05 was used to declare statistical significance. Results: Of all health center respondents, 389 (61.3%) had a good knowledge of the vaccination schedule; 403 (63.5%) had poor practices relating to vaccine placement in refrigerators; and 321(54%) had poor attitudes in relation to vaccines and vaccination. With respect to the vaccination schedule, midwives and Health officers/Medical Doctors were 0.28(95% CI: 0.08-0.95) times less knowledgeable than nurses; and health workers with more than five years’ work experience were 2.78 (95% CI: 1.54-5.01) times more knowledgeable than health workers who had three years’ work experience. Conclusions and recommendations: In this study, gaps were observed in health service providers’ knowledge, attitudes and practices in relation to immunization. Support to address these gaps – through training, supervision, monitoring and other mechanisms should focus on HEWs whose education is less than or equal to grade 12 at health post level, and on midwives and Health Officers (HOs)/MDs at the health center level. Similarly, attention should be given to enhance the vaccine and vaccination knowledge of semi-pastoral health facility service providers. The government, immunization working partners and other responsible bodies should give attention and take corrective measures to use maximum vaccine preventive potency.[Ethiop.J. Health Dev. 2019;33(Special issue):10-15] Key words: Immunization, Knowledge, Attitude, Practice, Health Worker

Strengthening routine immunization is one of the four prongs of the Global Polio Eradication Initiative. Achieving this requires improving immunization coverage in hard-to-reach areas. The objectives of this analysis were to assess levels of oral polio vaccination coverage and challenges in pastoral and semi-pastoral regions in Ethiopia. The analysis included vaccination-related data for children aged 12-23 months from the 2011 Ethiopian Demographic and Health Survey (EDHS) and from surveys carried out by the CORE Group Polio Project (CGPP) in 2013, 2015, and 2017. The EDHS data were from the entire regions (states) of Somali; Oromia; Southern Nations, Nationalities, and Peoples; Benshangul-Gumuz; and Gambella, whereas the CGPP data were for portions of these states where the CGPP was working and consisted entirely of pastoralist or semi-pastoralist populations. The overall polio immunization coverage rate showed upward trend from 39.6% in the 2011 EDHS to 72.6% for 2017 survey of children in the CGPP intervention areas. The evidence suggests that the CGPP was able to achieve increasing levels of coverage in the hardest-to-reach areas of these states and that the levels were higher than those achieved in the states as a whole. The strategies used by the CGPP/Ethiopia to increase coverage appear to have been effective. Other characteristics associated with full polio immunization included mother's religion and education, whether the mother had heard about polio, knowledge on the effect of many polio vaccine doses, and age at first polio immunization.

Background: Many vaccines are given more than once, at different ages, and in combinations. Parents are expected to retain immunization cardsfor their children, however in Ethiopia, the retention of child immunization cardsis minimal For example, the 2005 and 2011 Ethiopian Demographic and Health Surveys showed that 37% and 29% of immunization cards, respectively, were retained. The CORE Group Polio Project developed an innovative approach to keeping home vaccination records for a long time and safely, in the form of a plastic bag designed to hold the immunization card. The pilot project for this innovation was held in GambellaRegion and AssosaZone, Benishangul-Gumuz Region since 2015. Objective: Evaluate the contribution of plastic bagsfor holding and retaining child immunization cards in Gambella Region and Assosa Zone, Benishangul-Gumuz Region. Methods: The study was a household-based cross-sectional survey and the target population was households with at least one child aged under 2 years who had received at least one vaccination dose. A sample of 239 households (120 from Gambella Region and 119 from Assosa Zone in Benishangul-Gumuz Region) were selected randomly from immunization registration records. Up to 12 kebeles were included from each region, with at least 10 children per kebele. Data were collected using an Amharic language questionnaire and analyzed with STATA version 13.0. Results: Of all 239 respondents, 139 (58.2%) received the plastic bag for retaining immunization cards, while 100 (41.8%) did not receive the bag. Of the139 respondents who received immunization cards, 125 (89.9%) utilized the plastic bag. Of those that utilized the bags to hold immunization cards, 50.4% were from Gambella Region and 49.6% were from Benishangul-GumuzRegion. A total of 125 (58.7%) respondents were presented with the immunization card inside the plastic bag, and 88 (41.3%) respondents received the immunization card with no accompanying plastic bag. However, of all respondents who received the plastic bag, 14 (10%) did not put the card inside it. The reasons given byrespondents were that it was difficult to put the card inside the plastic bag(seven cases, (58.3%)) and that itwas lost/damaged or used for some other purpose (five cases, (41.7%)).A total of 145(70%) respondents reported thatthey placed the plastic bag that contains the immunization card in a secure place, such as in a box, and 53 (25.6%) hung it ona wall. Conclusion: In general, there was 89.5% card retention; 90% of respondents utilized the plastic bag, and 88% of mothers said they would advise others to use the plastic bag.

Background: The availability of immunization services and the readiness of skilled health workers in health institutions to deliver potent vaccines to end users when required to do so are important inputs that contribute to the reduction of child morbidity and mortality from vaccine-preventable diseases (VPDs). Objective: Assess immunization service availability and readiness in primary health care units (PHCUs) in pastoral and semi-pastoral regions of CGPP Ethiopia implementation districts. Methods: A facility-based cross-sectional survey was employed on 14-23 August 2016 in all health centers (HCs) and three randomly selected health posts (HPs) in each HC catchment area in 85 CGPP implementation districts. An observation checklist was filled in by trained data collectors for all study PHCUs. Results: Immunization service availability and service delivery, based on 19 tracer items, were assessed in 860 PHCUs in both pastoral and semi-pastoral areas. In total, 92% of the PHCUs reported providing an immunization service. However, only 18.1% of the PHCUs were observed and 32.4% reported providing immunization on the day data were collected. Overall, immunization service readiness was 56.6%: 85% of the HCs and 46.6% of the HPs were ready for immunization service over the study period. The proportion of PHCUs found to have functional refrigerators was 65%. Conclusions and recommendations: Great variability observed in terms of service readiness among HCs and HPs in this study. All PHCUs should be equipped with functional refrigerators that are regularly maintained; all immunization antigens and schedule immunization services should be available at the PHCUs daily to avoid missed opportunities; cold chain managers/immunization service providers should be given supervisory support to ensure that they record refrigerator temperatures.

To what extent do people agree on the meaning of foods, and does this vary by socioeconomic status, demographics, or household type? Addressing this question is critical for testing hypotheses about the relationship between food insecurity, food meaning, and mental well-being because it speaks directly to the social implications of food behaviors. In this study, we test for a shared cultural model of food meaning in two diverse settings: urban Ethiopia and rural Brazil. Using freelist and pile sort data from 63 respondents in Ethiopia and 62 from Brazil, we show strong consensus on the prestige value of various key food items in each context. Further, consensus varies little across household composition, food security status, and age and gender. This suggests that, in these two settings, consumption of widely available foods is an act that has both biological and social consequences.