Impact of Covid -19 incidence rate and government-initiated risk communication measures on individual's NPI practices.

BACKGROUND: Non-pharmaceutical interventions (NPI) are the most widely recognized public health measures recognized globally to prevent the spread of Covid-19. NPIs' effectiveness may depend on the type, combination of applied interventions, and the level of proper public compliance with the NPIs. The expected outcome of behavioural practices varies relative to the intervention duration. OBJECTIVES: This study aimed to assess the trend of community compliance to NPI with Covid-19 incidence and government-initiated interventions, and its variation by residence and sociodemographic characteristics of people. METHODS: A weekly non-participatory field survey on individuals' NPI practices was observed from the 41st epidemiological week of October 5th, 2020, to the 26th epidemiological week of July 4th, 2021, a total of 39 weeks. The survey covered all 14 regional and national capital cities in Ethiopia. Data collection for the three NPI behaviours (i.e., respiratory hygiene, hand hygiene, and physical distance) was managed weekly at eight public service locations using the Open Data Kit (ODK) tool. The Covid- 19 incidence data and public health measures information from August 3rd, 2020 to July 4th, 2021 were obtained from the Ethiopian Public Health Institute (EPHI). RESULTS: More than 180,000 individuals were observed for their NPI practice, with an average of 5,000 observations in a week. About 43% of the observations were made in Addis Ababa, 56% were male and 75% were middle age group (18-50 years). The overall level of NPI compliance was high at the beginning of the observation then peaked around the 13th- 15th epidemiological weeks then declined during the rest of the weeks. The peak NPI compliance periods followed the high Covid-19 death incidence and government-initiated intensive public health measures weeks. Respiratory hygiene had the highest compliance above 41% whereas hand hygiene was the lowest (4%). There was a significant difference between residents of the capital city and regional cities in their level of compliance with NPI. Females comply more than males, and individuals had increased NPI compliance at the bank service and workplaces compared to those in the transport services at P = 0.000. CONCLUSION: An increased level of compliance with NPI was observed following intensive government-initiated Covid-19 prevention measures and an increased Covid-19 death incidence. Therefore, the intensity of government-initiated risk communication and public advocacy programs should be strengthened, possibly for similar respiratory disease pandemics in the future.

Household air pollution and pneumococcal density related to nasopharyngeal inflammation in mothers and children in Ethiopia: A cross-sectional study.

BACKGROUND: Three billion people in low- and middle-income countries are exposed to household air pollution as they use biomass fuel for cooking. We investigated the associations between solid fuel use and nasopharyngeal (NP) inflammation, as well as the associations between high pneumococcal density and NP inflammation, in mothers and children in rural and urban Ethiopia. MATERIALS AND METHODS: Sixty pairs of mothers (median age, 30 years; range, 19-45 years) with a child (median age, 9 months; range, 1-24 months) were included from rural Butajira (n = 30) and urban Addis Ababa (n = 30) in Ethiopia. The cohort was randomly selected from a previous study of 545 mother/child pairs included 2016. Questionnaire-based data were collected which included fuel type used (solid: wood, charcoal, dung or crop waste; cleaner: electricity, liquefied petroleum gas). Nasopharyngeal (NP) samples were collected from all mothers and children and analyzed for the levels of 18 cytokines using a Luminex immunoassay. Pneumococcal DNA densities were measured by a real-time multiplex PCR and a high pneumococcal density was defined as a cyclic threshold (Ct) value ≤ 30. RESULTS: Mothers from rural areas had higher median CXCL8 levels in NP secretions than those from urban areas (8000 versus 1900 pg/mL; p < 0.01), while rural children had slightly higher IL-10 levels than those from the urban area (26 vs 13 pg/mL; p = 0.04). No associations between fuel type and cytokine levels were found. However, a high pneumococcal density was associated with higher levels of cytokines in both mothers (CCL4, CXCL8, IL-1ß, IL-6 and VEGF-A) and children (CCL4, CXCL8, IL-1ß, IL-6 and IL-18). CONCLUSIONS: No significant associations were found between solid fuel use and NP inflammation in Ethiopian mothers and children, but the inflammatory activity was higher in individuals living in the rural compared to the urban area. In addition, high cytokine levels were associated with high pneumococcal density in both mothers and children, indicating a significant impact of NP pathogens on inflammatory mediator levels in upper airways.

Exploring Community Perceptions of COVID-19 and Vaccine Hesitancy in Selected Cities of Ethiopia: A Qualitative Study.

Even though the COVID-19 vaccine has been available and free of charge to the targeted population in Ethiopia, the vaccination rate was lower than needed to achieve herd immunity at community level. This study aimed to explore community perceptions of COVID-19 and vaccine hesitancy in selected cities of Ethiopia involving 70 in-depth interviews and 28 focused group discussions. The audio-taped data were transcribed verbatim, translated into English, and analyzed using a qualitative content analysis approach using the ATLAS.ti software version 8. The findings revealed that COVID-19 was perceived as evil and caused fear and frustration upon its emergence. The community initially used traditional remedies for its prevention but later transitioned to employing non-pharmaceutical interventions. The primary reasons for vaccine hesitancy were misinformation and misconceptions, such as connecting the vaccine with the mark of the beast, a lack of trust due to the multiple vaccine types, a shorter production timeline resulting in distrust of its effectiveness, and a fear of pain and side effects. Based on our findings, we recommend monitoring the use of social media and countering misinformation with the correct information and continuous public health campaigns. Further studies should be conducted to assess the types and magnitude of impacts from the myths and misconceptions on vaccination uptake.

Utilization Status and Perceived Barriers Towards Long-Acting Reversible Contraceptives Among Female Youth College Students in Northern Ethiopia: A Mixed-Methods Study.

Background: In Ethiopia, teenage sexual activity, unintended pregnancy, and unsafe abortions among youth college students have become the most prevalent public health problems. Contraceptive misuse, low use, and a high unmet need for long-acting reversible contraceptives are attributed to the high rate of unintended pregnancy. Objective: To assess the utilization status of long-acting reversible contraceptives and to explore the perceived barriers among youth female college students in Mekelle City, Northern Ethiopia, in 2019. Methods: An institutional-based, concurrent, mixed cross-sectional study with quantitative and qualitative components was conducted among four private and two public colleges in Mekelle City from March 1 to April 30, 2019. A total of 580 female youth college students were included in the quantitative study, and six in-depth and four key informant interviews were conducted for the qualitative study. The quantitative data were analyzed using descriptive statistics, frequency, and percentages. The chi-square test was done to assess the crude association between the outcome variable and independent categorical variables. A p-value of <0.05 was considered a statistically significant difference. In addition, ATLAS.ti qualitative software version 7.5 was used to code and analyze the qualitative data. Results: With a 93.8% response rate, 544 female youth college students participated, and 177 (32.5%) were sexually active. Seventy-five (42.3%) of students had a history of pregnancy, and of these, 85% of the pregnancies were unplanned. The utilization of long-acting reversible contraceptives among sexually active college students was 7.3%. Qualitatively, the following themes emerged as perceived barriers to the utilization of long-acting reversible contraceptives: knowledge barriers, fear of side effects, misperceptions, health providers' approach, discrimination, and poor confidentiality. Conclusion: This study revealed low utilization of long-acting reversible contraceptives among college students. The findings indicate that college students are at high risk of unintended pregnancy, unsafe abortion, and complications.

Randomized Controlled Trials on Chronic Obstructive Pulmonary Disease in Africa: A Systematic Review.

Background: The rising burden of chronic obstructive pulmonary disease (COPD) in African countries is attributed to the growing and aging of the populations, lifestyles, and environmental changes. This systematic review aims to map the available evidence on COPD interventions in Africa. Methods: We performed a systematic search in 6 databases (including local African databases) and registries with updates through January 2022. We included randomized controlled trials (RCTs) that included patients diagnosed with COPD and were conducted in Africa, studying outcomes on acute respiratory episodes and rates, physical and functional abilities, and adverse events. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study quality was assessed using the Cochrane risk of bias tool. We primarily summarized the results in narrative form. Results: Out of 1594 identified publications, we included 18 studies with a total of 1504 participants, conducted in Egypt, South Africa, and Tunisia. Eight studies investigated interventions for patients in stable phases treated in outpatient settings, and 10 included patients with acute COPD exacerbations treated in emergency or intensive care settings. The interventions mainly included ventilatory support and pharmacological and rehabilitative interventions. Reported treatment effects were heterogeneous, ranging from no beneficial effects to clinically relevant benefits. Conclusions: The included studies were conducted in countries with high infrastructural development and half of them were set in intensive care units. Despite the paucity of RCTs on COPD management, research activities have been increasing over the last several years.

Misconceptions About Female Cancers Contributing to Late Presentation to Health Facilities in Ethiopia: A Qualitative Study.

Introduction: Morbidity and mortality from female cancers is a major public health problem in low- and middle-income countries, including Ethiopia. More than three quarters of women visiting health facilities are diagnosed with late-stage cervical and breast cancer. Evidence reveals that misconception affects timely health seeking behavior which could have averted expensive treatment and poor survival. This study aimed to explore misconceptions about female cancers that may have contributed to late presentation of the problem to health facilities in Sidama region, Ethiopia. Methods: A descriptive qualitative study was carried out in June 2021. Nine focus group discussions (six with women and three with men) and 14 key informants were conducted. Data were collected using interview guide until all information get saturated. Data were inductively coded and qualitative content analysis was applied. Results: A total of 63 (24 men and 39 women) people participated in this study. Nearly all (12) key informant interviewees have awareness about cervical and breast cancer, yet reported that their community members clearly lack awareness and they are working to improve misconceptions regarding cervical and breast cancer. The focus group discussion participants (15 men and 36 women) reported lack of detailed information related to cervical and breast cancer. Women believe that cervical and breast cancer mainly resulted from poor hygiene, trauma, having multiple sexual partners, early marriage, breast exposure to heat, not breast feeding, birth complication, urinating in the sun, hereditary, devil's intrusion and God's punishment. Conclusion: There were misconceptions among the community on what cervical and breast cancer mean, how they could happen, what the symptoms are, why and when to screen, when to seek health care and how to use modern treatment options. Therefore, we recommended the design of social and behavioral change strategies to address the misconceptions among different population groups.

Household fuel use and its association with potential respiratory pathogens among healthy mothers and children in Ethiopia.

BACKGROUND: Over 90% of Ethiopians still rely on solid fuels for cooking food. The pollution from the burning process causes adverse respiratory outcomes including respiratory infections. This study aimed to assess the association of the pollution with nasopharyngeal occurrence of potential pathogens. METHODS: We conducted a comparative cross-sectional study in urban and rural settings in Ethiopia in 2016. Questionnaire-based data were collected from 168 mothers and 175 children aged below two years. Multiplex real-time PCR assays were performed on nasopharyngeal secretions for detection of bacteria and viruses and for the identification of pneumococcal serotypes/groups. RESULTS: High rates of bacteria and viruses in the nasopharynx were detected by PCR among both the children and the mothers. Among the detected viruses, enterovirus was more commonly detected among rural children than among children from urban areas. Streptococcus pneumoniae and Haemophilus influenzae were both more prevalent among children and mothers from rural areas compared with urban groups and among those using solid fuels compared with cleaner fuel users. Children from rural households using solid fuels and children whose mothers had educational status below high school had four times higher odds for detection of S. pneumoniae compared with those households using cleaner energy or those children having mothers with a higher educational status, respectively. One or more serotype/serogroup was identified in about 40% of the samples that were positive for pneumococci. Out of all identified serotypes/serogroups, 43% in the children and 45% in the mothers belonged to PCV13, indicating the larger majority of detected pneumococci being non-PCV13 serotypes. CONCLUSION: This study presented a high carriage rate of S. pneumoniae and H. influenzae among both children and their mothers, especially in rural areas and among solid fuel users. Thus, interventions should target cleaner energy sources to the public and promote maternal education.

Breast self-examination practice and predictors among female secondary school teachers in Addis Ababa, Ethiopia: using the health belief model.

BACKGROUND: Breast cancer is the most frequently diagnosed reproductive organ cancer among women in Ethiopia. Even though breast self-examination (BSE) is shown to be the least expensive, less time-consuming, and non-invasive screening method, the practice of breast self-examination in Ethiopia is poor. Therefore this study aimed to assess breast self-examination practice and predictors among female secondary school teachers using the Health Belief Model. MATERIALS AND METHODS: An institution-based, cross-sectional study was conducted among 589 female secondary school teachers in Addis Ababa, Ethiopia. A self-administered questionnaire containing socio-demographic characteristics, sources of information, knowledge, perception on breast self-examination, and BSE practice was prepared based on the Champion's revised Health Belief Model and used as a data collection instrument. Multi-variable binary logistic regression was employed to identify the predictors of breast self-examination practice with significance set at p < 0.05 by controlling possible confounders. RESULT: Breast self-examination was practiced by 43.6% of female secondary school teachers. Television and radio were the commonest sources of information about breast cancer and breast self-examination. Personal history of breast problem (AOR 3.27, 95% CI 1.13-9.45), teaching experience (AOR 2.46, 95% CI 1.33-4.56), knowledge (AOR 1.06, 95% CI 1.01-1.12) and perceived self-efficacy (AOR 1.07, 95% CI 1.01-1.12) were significantly associated with BSE practice. CONCLUSION: The practice of breast self-examination was found to be low. Perceived self-efficacy, personal history of breast problems, and the knowledge level of female teachers were factors associated with the practice of BSE. This suggests the need for educational programs to enhance knowledge regarding breast cancer and improve the practice of breast self-examination.

The high frequency of alcohol advertising during televised English Premier League football games shown in Ethiopia.

BACKGROUND: Excessive alcohol consumption is an important risk factor for increased morbidity, mortality and other social harms globally. Televised sport allows the promotion of alcoholic drinks to a large and often young audience, and thus can be used to develop new markets for alcohol in low- and middle-income countries. This study aimed to analyse the alcohol advertising displayed during televised English Premier League (EPL) games, which is widely viewed in Ethiopia, and are particularly popular among young people. METHODS: Nineteen live televised EPL football matches broadcast in Ethiopia on the SuperSport channels over 4 weeks of the 2018/19 season were digitally recorded from the digital satellite television. Exposure to alcohol advertising was measured by calculating the total elapsed time duration with the alcohol content from the pre-match to the end of the post-game period of the broadcast. RESULTS: Data were available for a total of 2451 min broadcast time. Alcohol advertising accounted for 205.2 min (8.4%) with a mean duration of 10.8 min per match (range 5.5 to 22.6). The dominant format of alcohol advertisement was the display of logos associated with an alcoholic drink on the television (TV) screen, which accounted for approximately 43% of the total alcohol advertising time. This was followed by pitch side virtual display (17.7%) and a glass of alcohol drink on the TV screen (17.6%). Over three quarters of alcoholic drink advertising (77.7%) was during active football playing time. None of the advertisements on the televised football games showed cigarettes. CONCLUSION: There is a high frequency of exposure to alcohol advertising during televised EPL matches in Ethiopia. It is important to ensure that the newly introduced domestic ban on alcohol advertising is also applied to foreign satellite broadcasters. This is likely to have relevance to other sub-Saharan African countries in promoting public health strategies to reduce harm from alcohol consumption.

Determinants of asthma in Ethiopia: age and sex matched case control study with special reference to household fuel exposure and housing characteristics.

BACKGROUND: Asthma is a chronic inflammatory disorder characterized by airway obstruction and hyper-responsiveness. Studies suggest that household fuel exposure and housing characteristics are associated with air way related allergy. But there remains to be a considerable uncertainty about whether that reflects an association with asthma. This study endeavored to bridge the gap by identifying factors associated with asthma, with special reference to household fuel exposure and housing characteristics in selected public hospitals in Addis Ababa, Ethiopia. METHODS: We conducted a hospital-based matched case-control study. A total of 483 study participants were selected from two Ethiopian referral hospitals using a sequential sampling technique, with 161 cases and 322 controls. Standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) and the American Thoracic Society Division of Lung Disease (ATS-DLD-78) were used to collect household related data. Conditional logistic regression model was applied to identify the determinants of asthma. Both crude and adjusted odds ratios with 95% confidence interval (CI) were used to identify predictors of asthma. RESULTS: The response rate for both cases and controls was 99.17%. The odds of developing asthma was about four times higher among those who used agricultural residues for cooking (AOR: 3.81, 95% CI: 1.05, 13.79)., about five times higher among those who used wood for cooking (AOR: 4.95, 95% CI: 2.1, 11.69), nearly five times higher among those who had family history of asthma (AOR: 4.72, 95% CI: 1.54, 14.45), just over six times higher among those who smoke tobacco (AOR: 6.16, 95% CI: 1.31, 29.09) and over ten times higher among those who do not practice door opening, while cooking (AOR: 10.25, 95% CI: 3.97, 26.49). CONCLUSION: Family history of asthma, tobacco smoking, use of solid fuels including, woods and agricultural residues were associated with development of asthma. To reduce the risk of asthma, people should practice door opening, while cooking, and must avoid using wood and agricultural residues for cooking and should also refrain from tobacco smoking.

Trends in non-pharmaceutical intervention (NPI) related community practice for the prevention of COVID-19 in Addis Ababa, Ethiopia.

BACKGROUND: The COVID-19 pandemic has affected Ethiopia since March 13, 2020, when the first case was detected in Addis Ababa. Since then, the incidence of cases has continued to increase day by day. As a result, the health sector has recommended universal preventive measures to be practiced by the public. However, studies on adherence to these preventive measures are limited. OBJECTIVE: To monitor the status of preventive practices of the population related to hand washing, physical distancing, and respiratory hygiene practices at selected sites within the city of Addis Ababa. METHODS: Weekly cross-sectional non-participatory observations were done during the period of April-June, 2020. Data was collected using the Open Data Kit (ODK) tool in ten public sites involving eight public facilities targeted for individual observations. Ten individuals were randomly observed at each facility over two days a week at peak hours of public services. WHO operational definitions of the preventive behaviors were adopted for this study. Observations were conducted anonymously at gates or entrances of public facilities and places. RESULTS: A total of 12,056 individual observations with 53% males and 82% in an estimated age range of 18-50 years age group were involved in this study. There was an increase in the practice of respiratory hygiene from 14% in week one to 77% in week 10, while those of hand hygiene and physical distancing changed little over the weeks from their baseline of 24% and 34%, respectively. Overall, respiratory hygiene demonstrated an increased rate of 6% per week, while hand hygiene and physical distancing had less than a 1% change per week, Females and the estimated age group of 18-50 years had practice changes in respiratory hygiene with no difference in hand hygiene and physical distancing practices. Respiratory hygiene took about six weeks to reach a level of 77% from its baseline of 24%, making an increment of about 9% per week. CONCLUSION: The public practice of respiratory hygiene improved threefold whereas hand hygiene and physical distancing revealed no change. Regularly sustained public mobilization and mass education are required to sustain the achievements gained in respiratory hygiene and further hand hygiene and physical distancing.

High Levels of Fine Particulate Matter (PM2.5) Concentrations from Burning Solid Fuels in Rural Households of Butajira, Ethiopia.

The use of solid fuel, known to emit pollutants which cause damage to human health, is the primary energy option in Ethiopia. Thus, the aim of this study was to measure the level of household air pollution by using the 24-h mean concentration of fine particulate matter (PM2.5) in 150 randomly recruited households in rural Butajira, Ethiopia. Data relating to household and cooking practices were obtained by conducting face-to-face interviews with the mothers. The 24-h mean (standard deviation) and median PM2.5 concentrations were 410 (220) and 340 µg/m3, respectively. Households using only traditional stoves and those who did not open the door or a window during cooking had a significantly higher mean concentration compared with their counterparts. There is a statistically significant correlation between the mean concentration of PM2.5 and the self-reported cooking duration. The pollution level was up to 16 times higher than the WHO 24-h guideline limit of 25 µg/m3, thus leaving the mothers and children who spend the most time at the domestic hearth at risk of the adverse health effects from solid fuel use in Ethiopia. Thus, effective short- and long-term interventions are urgently needed.

Prevalence of and socioeconomic gradient in low birth weight in Ethiopia: further analysis of the 2016 demographic and health survey data.

BACKGROUND: Evidence suggests appearance of socioeconomic gradient in the probability of low birth weight (LBW). Such evidence, however, is scanty in Ethiopia. The study aimed to examine the prevalence of and socioeconomic gradient in LBW in Ethiopia. METHOD: Data for the study were drawn from the Ethiopia Demographic and Health Survey conducted in 2016. The 2016 EDHS is the fourth wave in the series of nationally representative household surveys carried out in the country to deliver up-to-date health and demographic indicators for the Ethiopian population. Women aged 15 to 49 years were the main focus of the survey, with data also gathered from men aged 15 to 59 years and under five children. The study pursued complex sampling strategy to draw samples representative at national as well as at urban and rural levels. The data are available to the public domain and were accessed from the MEASURE DHS following registration. Multivariable logistic regression model and marginal standardization were used to estimate socioeconomic gradient in the probability of LBW. We performed sensitivity analysis to evaluate variation of LBW according to different categories of socioeconomic position. Maternal education and household wealth were used as measures of the socioeconomic position in the study. RESULTS: 13.2% (95% confidence interval = 10.73, 15.65) of births were complicated by LBW. The findings showed that socioeconomic gradient was evident between maternal education and LBW; as education increases from no education to secondary education, the probability of occurrence of LBW consistently declined. However, no gradient in LBW was detected for household wealth. CONCLUSIONS: We have identified education gradient in LBW, with the highest burden of LBW occurring among the non-educated women. To redress the observed education disparity in LBW, targeted interventions need to be implemented with greater emphasis placed on illiterate women.

Respiratory Symptoms and Lung Function among Ethiopian Women in Relation to Household Fuel Use.

Exposure to household air pollution has been linked to chronic obstructive pulmonary disease, respiratory symptoms and reduced lung function. This study aims to assess respiratory symptoms and lung function among Ethiopian women in relation to exposure to HAP. We conducted a cross-sectional study among non-smoking women responsible for household cooking. Data was collected on socio-demographic characteristics, respiratory symptoms and risk factors using a validated questionnaire. Spirometry with reversibility testing was performed according to American Thoracic Society/European Respiratory Society guidelines. We used independent t-test and multivariable logistic regression to compare the means and measure association respectively. A total of 545 women participated in the study out of which 231 (42.3%) performed spirometry with at least three acceptable manoeuvres. Everyone in the rural group and 43% of the urban group were exposed to HAP from solid fuels during cooking. The odds of developing at least one respiratory symptom when compared with those using cleaner fuels are twice as high for women cooking within the living house. We also found significantly lower forced expiratory volume in the first second (FEV1) (L) among solid fuels users compared with cleaner energy users. Given the larger population settlement in the rural areas and the use of solid fuel as the only energy source, there is a higher risk of developing chronic respiratory health problems for those women in Ethiopia.

Predictors of cervical cancer screening practice among HIV positive women attending adult anti-retroviral treatment clinics in Bishoftu town, Ethiopia: the application of a health belief model.

BACKGROUND: Cervical cancer is a global public health problem and the second most common cancer causing morbidity and mortality in Ethiopia. Few available evidences revealed that despite distribution and severity of cervical cancer among HIV-positive women and the ease with which it can be prevented, cervical cancer screening practice in Ethiopia among them is considerably low. Thus, this study aims to assess predictors of cervical cancer screening practice among HIV-positive women by applying health belief model concepts. METHODS: Facility based cross-sectional study was conducted in Bishoftu. Data was collected from 475 women who visit the health facilities for anti-retroviral services using interviewer-administered questionnaires. Champion's revised Health Belief Model sub-scales were used as data collection tools containing sources of information, knowledge, perception on cervical cancer screening and cervical cancer screening practice as variables. Frequencies, percentage, mean and standard deviation were used to describe findings. Multi-variable logistic regression and 95% confidence intervals were considered to identify predictors of cervical cancer screening practice by controlling possible confounders. RESULTS: Cervical cancer screening practice among HIV-positive women in this study was 25%. Health proffesionals were the main sources of information about cervical cancer and its screening. There was a difference between the 'ever' and 'never' screened groups in mean scores of their perceived severity, perceived benefit, perceived barrier, perceived self-efficacy, perceived threat and net-benefit towards screening (P < 0.05). Perceived self-efficacy (AOR 1.24, 95%CI 1.13-1.37), perceived threat (AOR 1.08, 95%CI 1.05-1.12) and perceived net-benefit (AOR 1.18, 95% CI 1.12, 1.24) were the predictors of cervical cancer screening practice. CONCLUSIONS: Cervical cancer screening practice in this study was lower than that of the recommended coverage of the target group by the national guideline (80%). This finding has an important implication for public health intervention aimed at cervical cancer prevention. Morever, womens' perceptions on cervical cancer screening had a significant influence on the utilization of cervical cancer screening service. Therefore, educational programmes geared towards severity of the case, availability of screeningand helpfulness of being screened can significantly improve the uptake of cervical cancer screening.

Socio-Cultural Reasons and Community Perceptions Regarding Indoor Cooking Using Biomass Fuel and Traditional Stoves in Rural Ethiopia: A Qualitative Study.

Around three billion people in the world and 90% of the rural households in low-and middle-income countries are exposed to wood smoke with varying exposure levels and resulting health risks. We aimed to explore perceptions of the community towards indoor cooking and the socio-cultural barriers to bring change in Butajira, rural Ethiopia. We conducted a qualitative study involving ten separate focus group discussions with purposively selected members of the community and two key informant interviews with health extension workers. Content analysis was carried out using ATLAS.ti software. Participants reported the use of fuel wood and traditional three-stone cook stove to cook food. Economic status, lack of commitment, cultural views and concern along with safety and security issues were found to be barriers to change from traditional to cleaner methods of cooking. The community perceived wood smoke to have effects on their eyes and respiratory health, though they culturally viewed it as beneficial for postpartum mothers and newborns, avoiding bad smell and insects and in order to strengthen the fabric of their houses. Health education at community level is essential in order to bring about change in the cultural views and cooking behaviors focusing on opening windows and keeping young children away during cooking.

Prevalence and belief in the continuation of female genital cutting among high school girls: a cross - sectional study in Hadiya zone, Southern Ethiopia.

BACKGROUND: Female Genital Cutting is a cultural practice among many ethnic groups in Ethiopia that has affected many girls over the past centuries. Although the trend is slowly decreasing in Ethiopia, the magnitude is still very high as the procedure has no known benefit but has many consequences. The objective of this study was to assess the prevalence and belief in the continuation of FGC among High School Girls in Hadiya Zone. METHODS: A cross-sectional quantitative survey was carried out among high school girls in Hadiya Zone from January to February 2011. A multi-staged cluster sampling method was used for sample selection. In total, 780 girls completed a self-administered questionnaire for this study. Statistical analysis was done using bivariate and multivariate logistic regression. RESULTS: Of 780 high school girls, 82.2% were circumcised at a mean age of 11(±2.3) years. Half of the total participants responded that FGC was being practiced in their village. About 60% of the circumcisions were performed by traditional circumcisers while health professionals had performed 30% of them. A few of the circumcised girls (9.4%) supported their status as a circumcised girl, but only 5% believe in the continuation of FGC. The odds of being cut was higher among girls whose fathers and mothers had educational status under high school level (AOR = 2.04; 95% CI: 1.25, 3.09) and (AOR = 1.84; 95% CI: 1.01, 3.38) respectively when compared to those whose parents had attended high school and above. The odds of believing in the continuation of FGC was 2.33(95% CI: 1.01, 5.33) times higher among those who responded that FGC was practiced in their areas. CONCLUSION: While there is an urgent need to stop the practice of FGC in Hadiya Zone, cultural beliefs related to the hygiene of female genitalia and other social factors contribute to sustaining the practice. Local organizations in collaboration with religious institutions and community leaders should work together to engage in a process of change within the entire community by arranging awareness creation programmes on the harmfulness of the practice especially in the rural areas of the zone.