Structure and ancestry patterns of Ethiopians in genome-wide autosomal DNA.

We review some of the current insights derived from the analyses of new large-scale, genome-wide autosomal variation data studies incorporating Ethiopians. Consistent with their substantial degree of cultural and linguistic diversity, genetic diversity among Ethiopians is higher than that seen across much larger geographic regions worldwide. This genetic variation is associated in part with ethnic identity, geography and linguistic classification. Numerous and varied admixture events have been inferred in Ethiopian groups, for example, involving sources related to present-day groups in West Eurasia and North Africa, with inferred dates spanning a few hundred to more than 4500 years ago. These disparate inferred ancestry patterns are correlated in part with groups' broad linguistic classifications, though with some notable exceptions. While deciphering these complex genetic signals remains challenging with available data, these studies and other projects focused on resolving competing hypotheses on the origins of specific ethnolinguistic groups demonstrate how genetic analyses can complement findings from anthropological and linguistic studies on Ethiopians.

Association between maternity waiting home stay and obstetric outcomes in Yetebon, Ethiopia: a mixed-methods observational cohort study.

BACKGROUND: A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia. METHODS: Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use. RESULTS: During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p < 0.001) and to be post-term (21.5 % vs. 3.8 %, p < 0.001). MWH users were also more likely to undergo a caesarean Sec. (51.0 % vs. 35.4 %, p < 0.05) and less likely (p < 0.05) to have a spontaneous vaginal delivery (49.0 % vs. 63.6 %), obstructed labor (6.5 % vs. 14.4 %) or stillbirth (1.1 % vs. 8.6 %). MWH use (N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12-0.46, p < 0.001) lower risk of childbirth complications, a 94 % (adjusted RR = 0.06, 95 % CI 0.01-0.43, p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13-0.56, p < 0.001) lower risk of maternal complications compared to MWH non-users (N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8-3.5), p < 0.001] and 5-min Apgar scores (adjusted difference = 0.25, 95 % CI 0.06-0.44, p < 0.001) were also higher in offspring of MWH users. Opportunity costs due to missed work and need to arrange for care of children at home, long travel times, and lack of entertainment were suggested as key barriers to MWH utilization. CONCLUSIONS: This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use.

Individual and facility-level factors associated with women's receipt of immediate postpartum family planning counseling in Ethiopia: results from national surveys of women and health facilities.

BACKGROUND: Immediate postpartum family planning (IPPFP) helps prevent unintended and closely spaced pregnancies. Despite Ethiopia's rising facility-based delivery rate and supportive IPPFP policies, the prevalence of postpartum contraceptive use remains low, with little known about disparities in access to IPPFP counseling. We sought to understand if women's receipt of IPPFP counseling varied by individual and facility characteristics. METHODS: We used weighted linked household and facility data from the national Performance Monitoring for Action Ethiopia (PMA-Ethiopia) study. Altogether, 936 women 5-9 weeks postpartum who delivered at a government facility were matched to the nearest facility offering labor and delivery care, corresponding to the facility type in which each woman reported delivering (n = 224 facilities). We explored women's receipt of IPPFP counseling and individual and facility-level characteristics utilizing descriptive statistics. The relationship between women's receipt of IPPFP counseling and individual and facility factors were assessed through multivariate, multilevel models. RESULTS: Approximately one-quarter of postpartum women received IPPFP counseling (27%) and most women delivered government health centers (59%). Nearly all facilities provided IPPFP services (94%); most had short- and long-acting methods available (71 and 87%, respectively) and no recent stockouts (60%). Multivariate analyses revealed significant disparities in IPPFP counseling with lower odds of counseling among primiparous women, those who delivered vaginally, and women who did not receive delivery care from a doctor or health officer (all p < 0.05). Having never used contraception was marginally associated with lower odds of receiving IPPFP counseling (p < 0.10). IPPFP counseling did not differ by age, residence, method availability, or facility type, after adjusting for other individual and facility factors. CONCLUSION: Despite relatively widespread availability of IPPFP services in Ethiopia, receipt of IPPFP counseling remains low. Our results highlight important gaps in IPPFP care, particularly among first-time mothers, women who have never used contraception, women who delivered vaginally, and those who did not receive delivery care from a doctor or health officer. As facility births continue to rise in Ethiopia, health systems and providers must ensure that equitable, high-quality IPPFP services are offered to all women.

Pills and prayers: a comparative qualitative study of community conceptualisations of pre-eclampsia and pluralistic care in Ethiopia, Haiti and Zimbabwe.

BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.

Effectiveness of a culturally appropriate intervention to prevent intimate partner violence and HIV transmission among men, women, and couples in rural Ethiopia: Findings from a cluster-randomized controlled trial.

BACKGROUND: Intimate partner violence (IPV) is associated with increased HIV risk and other adverse health and psychosocial outcomes. We assessed the impact of Unite for a Better Life (UBL), a gender-transformative, participatory intervention delivered to men, women, and couples in Ethiopia in the context of the coffee ceremony, a traditional community-based discussion forum. METHODS AND FINDINGS: Villages (n = 64) in 4 Ethiopian districts were randomly allocated to control, men's UBL, women's UBL, or couples' UBL, and approximately 106 households per village were randomly selected for inclusion in the trial. The intervention included 14 sessions delivered twice weekly by trained facilitators; control arm households were offered a short IPV educational session. Primary outcomes were women's experience of past-year physical or sexual IPV 24 months postintervention. Secondary outcomes included male perpetration of past-year physical or sexual IPV, comprehensive HIV knowledge, and condom use at last intercourse. Additional prespecified outcomes included experience and perpetration of past-year physical and/or sexual IPV and emotional IPV, HIV/AIDs knowledge and behaviors, decision-making, and gender norms. An intention-to-treat (ITT) analysis was conducted, evaluating 6,770 households surveyed at baseline in 2014-2015 (1,680 households, 16 clusters in control; 1,692 households, 16 clusters in couples' UBL; 1,707 households, 16 clusters in women's UBL; 1,691 households, 16 clusters in men's UBL). Follow-up data were available from 88% of baseline respondents and 87% of baseline spouses surveyed in 2017-2018. Results from both unadjusted and adjusted specifications are reported, the latter adjusting for age, education level, marriage length, polygamy, socioeconomic status, and months between intervention and endline. For primary outcomes, there was no effect of any UBL intervention compared to control on women's past-year experience of physical (couples' UBL arm adjusted odds ratio [AOR] = 1.00, 95% confidence interval [CI]: 0.77-1.30, p = 0.973; women's UBL arm AOR = 1.11, 95% CI 0.87-1.42, p = 0.414; men's UBL arm AOR = 1.02, 95% CI: 0.81-1.28, p = 0.865) or sexual IPV (couples' UBL arm AOR = 0.86, 95% CI: 0.62-1.20, p = 0.378; women's UBL arm AOR = 1.15, 95% CI: 0.89-1.50; p = 0.291; men's UBL arm AOR = 0.80, 95% CI: 0.63-1.01, p = 0.062). For the secondary outcomes, only the men's UBL intervention significantly reduced male perpetration of past-year sexual IPV (AOR: 0.73; 95% CI: 0.56-0.94, p = 0.014), and no intervention reduced perpetration of past-year physical IPV. Among women, the couples' UBL intervention significantly improved comprehensive HIV knowledge, and both couples' and women's UBL significantly increased reported condom use at last intercourse. Among additional outcomes of interest, the men's UBL intervention was associated with a significant reduction in women's experience of past-year physical and/or sexual IPV (AOR = 0.81, 95% CI: 0.66-0.99, p = 0.036) and men's perpetration of physical and/or sexual IPV (AOR = 0.78; 95% CI: 0.62-0.98, p = 0.037). UBL delivered to men and couples was associated with a significant reduction in HIV risk behaviors and more equitable intrahousehold decision-making and household task-sharing. The primary limitation is reliance on self-reported data. CONCLUSIONS: A gender-transformative intervention delivered to men was effective in reducing self-reported perpetration of sexual IPV but did not reduce IPV when delivered to couples or women. We found evidence of decreased sexual IPV with men's UBL across men's and women's reports and of increased HIV knowledge and condom use at last intercourse among women. The men's UBL intervention could help accelerate progress towards gender equality and combating HIV/AIDS. TRIAL REGISTRATION: The trial was prospectively registered at clinicaltrials.gov (NCT02311699) and in the American Economic Association registry (AEARCTR-0000211).

Myopia and Childhood Migration: A Study of 607 862 Adolescents.

PURPOSE: Immigration studies can shed light on myopia development and reveal high-risk populations. To this end, we investigated the association among immigration, age at immigration, and myopia occurrence during adolescence. DESIGN: Population-based, retrospective, cross-sectional study. PARTICIPANTS: Six hundred seven thousand eight hundred sixty-two adolescents, Israeli born and immigrants, with origins in the former Union of Soviet Socialist Republics (USSR), Ethiopia, or Israel, assessed for medical fitness for mandatory military service at 17 years of age between 1993 and 2016. METHODS: Myopia and high myopia were defined based on right eye refractive data. Age at immigration was categorized into 0 to 5 years of age, 6 to 11 years of age, and 12 to 19 years of age. Univariate and multivariate logistic regression models were created. Myopia odds ratios (ORs) were calculated according to immigration status, with Israeli-born natives as controls. Next, myopia ORs were calculated according to age at immigration, with Israeli-born of same origin as controls. MAIN OUTCOME MEASURES: Myopia prevalence and ORs. RESULTS: Myopia was less prevalent among immigrants than Israeli-born controls. When stratified according to age at immigration, a decrease in myopia prevalence and ORs with increasing age at migration were observed, most prominent in immigrants arriving after 11 years of age, who also showed lower high-myopia ORs. The immigrants from the USSR and Ethiopia arriving after 11 years of age showed a myopia OR of 0.65 (95% confidence interval [CI], 0.63-0.67; P < 10-205) and 0.52 (95% CI, 0.46-0.58; P < 10-27) compared with the Israeli-born controls. Notably, Ethiopians arriving earlier than 5 years of age showed a 2-fold higher myopia OR than those migrating after 11 years of age. CONCLUSIONS: Immigrants arriving after 11 years of age showed markedly lower ORs for myopia and high myopia relative to Israeli-born controls or those arriving during early childhood, likely because of environmental and lifestyle changes. Differences between immigrants arriving up to 5 years of age and those arriving between 6 and 11 years of age were relatively smaller, suggesting exposures at elementary school age play a greater role in this population.

Adolescent BMI and early-onset type 2 diabetes among Ethiopian immigrants and their descendants: a nationwide study.

BACKGROUND: We assessed in a nationwide cohort the association between adolescent BMI and early-onset (< 40 years) type 2 diabetes among Israelis of Ethiopian origin. METHODS: Normoglycemic adolescents (range 16-20 years old), including 93,806 native Israelis (≥ 3rd generation in Israel) and 27,684 Israelis of Ethiopian origin, were medically assessed for military service between 1996 and 2011. Weight and height were measured. Data were linked to the Israeli National Diabetes Registry. Incident type 2 diabetes by December 31, 2016 was the outcome. Cox regression models stratified by sex and BMI categories were applied. RESULTS: 226 (0.29%) men and 79 (0.18%) women developed diabetes during 992,980 and 530,814 person-years follow-up, respectively, at a mean age of 30.4 and 27.4 years, respectively. Among native Israeli men with normal and high (overweight and obese) BMI, diabetes incidence was 9.5 and 62.0 (per 105 person-years), respectively. The respective incidences were 46.9 and 112.3 among men of Ethiopian origin. After adjustment for sociodemographic confounders, the hazard ratios for type 2 diabetes among Ethiopian men with normal and high BMI were 3.4 (2.3-5.1) and 15.8 (8.3-30.3) respectively, compared to third-generation Israelis with normal BMI. When this analysis was limited to Israeli-born Ethiopian men, the hazard ratios were 4.4 (1.7-11.4) and 29.1 (12.9-70.6), respectively. Results persisted when immigrants of other white Caucasian origin were the reference; and among women with normal, but not high, BMI. CONCLUSIONS: Ethiopian origin is a risk factor for early-onset type 2 diabetes among young men at any BMI, and may require selective interventions.

Effect of guided counseling on nutritional status of pregnant women in West Gojjam zone, Ethiopia: a cluster-randomized controlled trial.

BACKGROUND: Undernutrition during pregnancy affects birth outcomes adversely. In Ethiopia, despite nutrition counseling on the maternal diet being given by the health workers during pregnancy, maternal undernutrition is still high in the country. Hence, this study aimed to assess the effect of guided counseling using the health belief model and the theory of planned behavior on the nutritional status of pregnant women. METHODS: A two-arm parallel cluster randomized controlled community trial was conducted in West Gojjam Zone, Ethiopia, from May 1, 2018, to April 30, 2019. The nutritional status of the women was assessed using mid-upper arm circumference. A total of 694 pregnant women were recruited from the intervention (n=346 ) and control (n=348) clusters. Of which endline data were collected from 313 and 332 pregnant women in the intervention and control clusters, respectively. The intervention was started before 16 weeks of gestation and pregnant women in the intervention group attended 4 counseling sessions. Counseling was given at the participants' homes using a counseling guide with the core contents of the intervention. Leaflets with appropriate pictures and the core messages were given for women in the intervention arm. Women in the control group got the routine nutrition education given by the health care system. Data were collected using interviewer administered structured questionnaires and mid-upper arm circumference was measured using an adult MUAC tape. Descriptive statistics  and linear mixed-effects model were used to assess the intervention effect after adjusting for potential confounders. RESULTS: After the intervention, the prevalence of undernutrition was 16.7% lower in the intervention group compared with the control arm (30.6% Vs 47.3%, P = < 0.001). Women in the intervention group showed significant improvement in nutritional status at the end of the trial than the control group (ß = 0.615, p = < 0.001). CONCLUSION: This study demonstrated that guided counseling using the health belief model and the theory of planned behavior was effective in improving the nutritional status of pregnant women. The results imply the need for the design of model and theory based nutrition counseling guidelines. The trial was registered in Clinical Trials.gov (NCT03627156).

Effect of mass media on comprehensive knowledge of HIV/AIDS and its spatial distribution among reproductive-age women in Ethiopia: a spatial and multilevel analysis.

BACKGROUND: Globally, HIV/AIDS remains a significant public health issue particularly in Sub-Saharan Africa. Media exposure plays a significant role in raising community knowledge about HIV. Therefore, this study aimed to investigate the effect of media on comprehensive knowledge of HIV and its spatial distribution among reproductive-age women in Ethiopia. METHODS: A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Surveys (EDHS). A total weighted sample of 15,683 reproductive-age women was included for analysis. For the spatial analysis, ArcGIS version 10.3 and SaTScan version 9.6 software were employed to explore the spatial distribution of comprehensive knowledge of HIV/AIDS and for identifying significant hotspot areas. For associated factors, the mixed-effect logistic regression model was fitted. Deviance and ICC were used for model comparison. In the multivariable analysis, Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to declare significantly associated factors of comprehensive knowledge of HIV/AIDS. RESULTS: The spatial analysis revealed that the spatial distribution of comprehensive knowledge of HIV/AIDS among reproductive-age women was significantly varied across the country. The SaTScan analysis identified significant clusters in the entire Somali region, the eastern part of Dire Dawa and Harari regions. Being rural (AOR = 1.52,95% CI:1.21-1.91), maternal age 25-34 years (AOR = 1.26,95% CI:1.14-1.40), aged ≥35 years (AOR = 1.20,95%CI:1.07-1.35), being Muslim (AOR = 0.68,95% CI:0.60-0.78), being protestant (AOR = 0.83,95% CI:0.71-0.96), poorer wealth (AOR = 1.26,95%CI:1.06-1.51), middle wealth (AOR = 1.34,95%CI:1.11-1.60), richer wealth (AOR = 1.36,95% CI:1.12-1.63), richest wealth (AOR = 1.72,95% CI:1.37-2.15), reading newspaper (AOR = 1.20,95%CI: 1.06-1.37), listening radio (AOR = 1.24,95% CI:1.10, 1.41), covered by health insurance (AOR = 1.23,95%CI:1.01-1.51), having primary education (AOR = 1.77,95% CI:1.57-1.99), having secondary education (AOR = 2.45,95%CI:2.10-2.86) and having higher education (AOR = 3.04,95%CI:2.52-3.65) were significantly associated with comprehensive knowledge of HIV/AIDS. CONCLUSION: Spatial distribution of comprehensive knowledge of HIV/AIDS among reproductive-age women was significantly varied across the country with significant hotspot areas with poor comprehensive knowledge of HIV/AIDS identified in the Somali region, the eastern part of Dire Dawa and Harari Regions. media exposure was a significant predictor of comprehensive knowledge of HIV/AIDS among reproductive-age women in Ethiopia. Therefore, the government should scale up public health programs in the hot spot areas and provide health information using different media.

Common mental disorders and its associated factors and mental health care services for Ethiopian labour migrants returned from Middle East countries in Addis Ababa, Ethiopia.

BACKGROUND: The migration of young Ethiopian men and women to the Middle East countries was mainly for economic reasons. The migration was largely irregular that posed a wide range of unfavorable life conditions for some of the migrants. The overall objective is to assess common mental disorders and its associated factors for Ethiopian migrants returned from the Middle East countries and to describe mental health care services targeting these migrants. METHODS: The study employed a mixed-methods approach. For the quantitative part, a systematic random sampling technique was used to select a sample of 517 returnees. An interviewer-administered questionnaire based on Self Report Questionnaire-20 was used to collect data from respondents. The qualitative study employed a phenomenological study design to describe mental health care services. Key informant interviews and non-participant observation techniques were used to collect qualitative data. RESULTS: The prevalence of common mental disorder among Ethiopian migrants returned from the Middle East countries was found to be 29.2%. education (AOR=2.90 95%CI: 1.21, 6.94), physical abuse (AOR=12.17 95%CI: 5.87, 25.22), not getting salary properly and timely (AOR=3.35 95%CI: 1.47, 7.63), history of mental illness in the family (AOR=6.75 95%CI: 1.03, 43.95), detention (AOR=4.74 95%CI: 2.60, 8.62), guilty feeling for not fulfilling goal (AOR=9.58 95%CI: 4.43, 20.71), and denial of access to health care (AOR=3.20 95%CI:1.53, 6.67) were significantly associated with a common mental disorder. Shelter based and hospital-based mental health care services were rendered for a few return migrants with mental disorders. The services were primarily targeted, female return migrants. CONCLUSION: The prevalence of common mental disorder was high among migrants returned from the Middle East countries. Despite the high burden of mental distress, only a small proportion of return migrants with mental illness is getting mental health care services.

Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses.

OBJECTIVE: To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia. DESIGN: A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done. SETTING: All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41). CONCLUSIONS: There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.

A qualitative study of health experiences of Ethiopian asylum seekers in Norway.

BACKGROUND: Norway, like other European countries, has a growing refugee population. Upon arrival to Norway, refugees and asylum seekers need to learn about Norwegian society and social services such as healthcare. Despite various programs and assistance, they face numerous challenges using the healthcare system. Understanding the healthcare experiences of Ethiopian refugees and asylum seekers may improve how services such as informational sessions and delivery of medical care are provided. This qualitative study seeks to describe the health-related experiences of Ethiopians who have sought asylum in Norway and shed light on potential barriers to care. METHODS: Individual interviews were conducted with ten Ethiopian refugees and asylum seekers in Norway. Thematic analysis was used to understand the broader context of refugee resettlement and how this experience influences participants' health experiences and health seeking behaviors. RESULTS: We identified three main themes that played a role in participants' health and healthcare experiences. Participants described how 'living in limbo' during their application for residency took a mental toll, the difficulties they had 'using the healthcare system', and the role 'interpersonal factors' had on their experiences. While applying for asylum, participants felt consumed by the process and were affected by the lack of structure in their lives, the conditions in the reception center, and perceived inadequate healthcare. Participants perceived a change in access to services before and after they had been granted residency. Participants learned about the healthcare system both through official information sessions and social networks. Doctor-patient communication and interpersonal factors such as a sense of feeling valued, language, and discrimination had a large impact on perceived quality of care. CONCLUSIONS: Ethiopian refugees and asylum seekers face numerous challenges accessing, using, and interacting with Norway's healthcare system. Contextualizing these challenges within the asylum seeking process may help policy makers better understand, and therefore address, these challenges. Interventions offered at reception centers and in health worker trainings may improve healthcare experiences for this and similar populations.

Ethno-cultural origins, health beliefs and mothers' behavior regarding infant vaccinations in Israel.

To compare the health beliefs and infant vaccination behavior of mothers of four different ethno-cultural backgrounds: Israeli-born Jewish and Arab-Bedouin and immigrants from the Former Soviet Union and Ethiopia; to examine the associations between initial and subsequent infant vaccination behaviors of mothers and to identify predictors of vaccination behaviors. A comparative cross-sectional study was conducted in selected community neighborhoods. A quota sample included 100 mothers with infants aged 18-24 months (N = 400) from each of the four ethno-cultural groups. Data were collected through questionnaires and examination of the infant vaccination cards. Both groups of immigrant mothers had the lowest adherence to the recommended vaccination regime. Our findings indicate that maternal behaviors regarding infant vaccinations were determined mainly by the behavior at the previous recommended vaccination stage. Different ethno-cultural groups presented different sociodemographic predictors of vaccination behaviors. These predictors only affected the vaccinations at the early stage of 2 months. Policy makers should be aware that mother's vaccination behaviors vary according to ethno-cultural groups to establish culturally tailored intervention programs.

Dihydroartemisinin-piperaquine treatment failure in uncomplicated Plasmodium falciparum malaria case imported from Ethiopia.

Dihydroartemisinin-piperaquine (DHA-PPQ) is the artemisinin combination therapy that was recently introduced for the treatment of Plasmodium falciparum uncomplicated malaria, but emerging resistance in South-East Asia is threatening its use. This report describes a case of DHA-PPQ treatment failure in uncomplicated malaria occurring in an immigrant living in Italy, after a travel to Ethiopia. Thirty days after malaria recovery following DHA-PPQ therapy, the patient had malaria recrudescence. According to the genotyping analysis, the same P. falciparum was responsible for both episodes. Thus, it seems important to consider possible malaria recrudescence occurring after DHA-PPQ therapy in patients from African countries.

Health indicators and social gradient in adolescent immigrants' health risk and healthcare experiences.

Few studies have assessed healthcare experiences in apparently healthy adolescents, or whether healthcare attitudes are linked to the two leading adolescent health indicators, smoking and obesity. Even fewer have examined these relationships in adolescent immigrant groups or made comparisons to adolescent non-immigrants. Using a cross-sectional study, healthcare experiences were compared among three groups of adolescents (n = 589) including Russian immigrants (n = 154), Ethiopian immigrants (n = 54), and non-immigrants (n = 381). Bootstrap estimates indicated positive healthcare experiences were less common among Russian adolescent immigrants (OR = 0.38, CI = 0.17, 0.86) compared to non-immigrants, unless the Russian adolescent immigrants reported above average socioeconomic status, in which case they were more likely than non-immigrant adolescents to report positive healthcare experiences (OR = 3.22, CI = 1.05, 9.85). Positive healthcare experiences were less likely among adolescents who were smokers (OR = 0.50, CI = 0.27, 0.91), and more likely for adolescents with a normal or low BMI (OR = 3.16, CI = 1.56, 6.40) and for those relying on parents for health information (OR = 1.97, CI = 1.05, 3.70). CONCLUSION: Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positive healthcare experiences, proactive efforts are needed to engage this group. What is Known: • Health indicators (such as obesity) and healthcare attitudes are linked to healthcare service use among adolescents sampled from outpatient and inpatient populations. What is New: • A social gradient involving socioeconomic status and being an adolescent immigrant was found regarding risky health indicators (i.e., smoking, use of internet as the primary source of health information). • Problematic health indicators, such as smoking, is linked to less positive healthcare attitudes in apparently healthy adolescents (both immigrants and non-immigrants).

DHEAS patterning across childhood in three sub-Saharan populations: Associations with age, sex, ethnicity, and cortisol.

OBJECTIVES: Hormones have many roles in human ontogeny, including the timing of life history 'switch points' across development. Limited hormonal data exist from non-Western children, leaving a significant gap in our understanding of the diversity of life history patterning. This cross-sectional study examines dehydroepiandrosterone sulfate (DHEAS) production in relation to age, sex, ethnicity, and cortisol concentrations, as well as average age of adrenarche, among Aka and Ngandu children of the Central African Republic and Sidama children of Ethiopia. METHODS: Hair was collected from 480 children (160 per population) aged 3-18 years old. These samples were analyzed for DHEAS and cortisol concentrations using ELISAs. A generalized additive model was used to examine DHEAS patterning in relation to age, sex, cortisol, and ethnicity. The derivative of DHEAS as a function of age was used to identify average age of adrenarche in each population. RESULTS: DHEAS patterning in these three populations is distinct from Euro-American patterns of production. In all three groups, the population-level age at adrenarche onset occurs slightly later than Euro-American averages, with both Central African populations experiencing a later onset than the Ethiopian population. CONCLUSIONS: DHEAS patterns and age at adrenarche vary across cultures, perhaps indicating adaptive life history responses in diverse eco-cultural environments. Delayed involution of the fetal zone and DHEAS patterning may offer both cognitive protection and immune defense in high-risk, nutritionally-poor environments. Additional research in the majority world is essential to improving our understanding of the diversity of hormonal development and timing of 'switch points' in life history trajectories.

Mammographic breast density in recent and longer-standing ethiopian immigrants to israel.

High breast density is associated with an increased risk of breast cancer development. Little is known concerning ethnic variations in breast density and its relevant contributing factors. We aimed to study breast density among Ethiopian immigrants to Israel in comparison with Israeli-born women and to determine any effect on breast density of the length of residency in the immigrant population. Mammographic breast density using the BI-RADS system was estimated and compared between 77 women of Ethiopian origin who live in Israel and 177 Israeli-born controls. Logistic regression analysis was performed to estimate the odds ratios (OR) for high density (BI-RADS score ≥ 3) vs low density (BI-RADS score < 3) cases, comparing the 2 origin groups. Ethiopian-born women had a crude OR of 0.15 (95% CI: 0.08-0.26) for high breast density compared with Israeli-born women. Adjustments for various cofounders did not affect the results. Time since immigration to Israel seemed to modify the relationship, with a stronger association for women who immigrated within 2 years prior to mammography (OR:0.07, 95% CI: 0.03-0.17) as opposed to women with a longer residency stay in Israel (OR:0.23, 95% CI:0.10-0.50). Adjustments of various confounders did not alter these findings. Breast density in Ethiopian immigrants to Israel is significantly lower than that of Israeli-born controls. Our study suggests a positive association between time since immigration and breast density. Future studies are required to define the possible effects of dietary change on mammographic density following immigration.

The poetics of mourning and faith-based intervention in maladaptive grieving processes in Ethiopia.

The paper is an inquiry into the poetics of mourning and faith-based intervention in maladaptive grieving processes in Ethiopia. The paper discusses the ways that loss is signified and analyzes the meanings of ethnocultural and psychospiritual practices employed to deal with maladaptive grief processes and their psychological and emotional after-effects. Hermeneutics provided the methodological framework and informed the analysis. The thesis of the paper is that the poetics of mourning and faith-based social interventions are interactionally based meaning making processes. The paper indicates the limitations of the study and their implications for further inquiry.

The Data Hustle: How Beneficiaries Benefit from Continual Data Collection and Humanitarian Aid Research in the Somali Region of Ethiopia.

Based on ethnographic and policy research in the Somali Region of Ethiopia, this article examines how contemporary trends in the humanitarian relief industry to mandate continual data collection, "accountability," and the "localization" of aid have increased demands for participatory and intensive research methodologies in crisis-affected communities. International humanitarian relief agencies hustle to hire local staffs and recruit enough participants for their repeated research projects, while at the same time, the so-called beneficiaries of aid also hustle to participate in data collection as paid informants and temporary employees. Research is an important side gig for many beneficiaries, and beneficiaries' regular participation is vital to reforming humanitarian practice. Beneficiaries are not therefore passive recipients of charity, but actively help produce the representations of crisis and suffering that, in turn, potentially qualify them for aid. Their indispensability and activity within contemporary humanitarian "audit cultures" therefore present emergent but limited forms of counter-hegemonic power.

Emotional alienation as a mediator of the relationship between perceived discrimination and alcohol use among immigrant adolescents in Israel.

Perceived discrimination has been found to be a predictor of immigrant adolescent involvement in alcohol use, yet the psychological mechanism behind this relationship has not been well explored. Drawing on strain theory and the motivational model of alcohol use, the current study aimed to develop and test a concept of emotional alienation. In the proposed model, it is when experiences of discrimination are internalized into painful feelings of detachment, anger, rejection, and failure that the immigrant adolescent may turn to alcohol use. The study involved 365 at-risk immigrant adolescents, aged 15-19 (62% male, mean age 17.1) from the Former Soviet Union and Ethiopia in Israel, from low SES neighborhoods and community centers for youth at risk. The young people self-reported on experiences of discrimination, daily alcohol use, heavy episodic drinking (HED), and drunkenness, together with a new questionnaire examining emotional alienation developed for the study. Findings showed that experiences of alienation fully mediated the relationship between discrimination and problematic alcohol use (drunkenness and HED). In particular, feelings of self-detachment, failure, and rejection were strongly related to alcohol use. Results suggest an importance of understanding the way in which negative reactions from the host society may be internalized into destructive feelings of failure, shame, and rejection, which may lead a young person to involvement in alcohol use.