Association between premarital HIV testing and ability to negotiate sexual relations among married women in Ethiopia: a population-based study.

HIV/AIDS prevalence in sub-Saharan Africa remains an issue of concern and young women are disproportionately affected by the disease. Premarital HIV testing is one of the key strategies used in HIV prevention since heterosexual sex remains the primary mode of HIV transmission in sub-Saharan Africa. This study uses the 2016 Ethiopia Demographic and Health Survey to examine the association between premarital HIV testing and the ability to negotiate sexual relations among married women aged 15 to 49 years (N = 3,672). Women's ability to negotiate sexual relations was measured using two variables: the ability to refuse sex and the ability to ask for a condom during intercourse. Descriptive statistics, bivariate, and multiple logistic regression analyses were performed. Only 24.1% of the women had premarital HIV testing. Approximately 46.5% and 32.3% of women reported that they could refuse sexual intercourse and ask their partner to use a condom, respectively. In the multivariable model, having a premarital HIV test was positively associated with the ability to refuse sex odds ratio (95% confidence interval) 1.82 (1.38, 2.41; p < 0.001) and the ability to ask for a condom 2.30 (1.55, 3.41; p < 0.001). Premarital HIV testing can improve women's sexual negotiation ability and possibly prevent future HIV infection.

Awareness of and willingness to use oral HIV self-test kits among Kenyan young adults living in informal urban settlements: a cross-sectional survey.

Self-administered HIV testing may be a promising strategy to improve testing in hard-to-reach young adults, provided they are aware of and willing to use oral HIV self-testing (HIVST). This study examined awareness of and willingness to use oral HIVST among 350 high-risk young adults, aged 18-22, living in Kenya's informal urban settlements. Bivariate and multivariate logistic regressions were used to examine differences in HIVST awareness and willingness by demographic and sexual risk factors. Findings showed that most participants were male (56%) and less than 20 years old (60%). Awareness of oral HIVST was low (19%). However, most participants (75%) were willing to use an oral HIV self-test in the future and ask their sex partner(s) to self-test before having sex (77%). Women (OR = 1.80, 95%CI:1.11, 2.92), older participants (aged 20+) (OR = 2.57, 95% CI:1.48, 4.46), and more educated participants (OR = 2.25, 95%CI:1.36, 3.70) were more willing to use HIVST as compared to men, teen-aged, and less educated participants, respectively. Young adults who reported recent engagement in high-risk sexual behaviors, such as unprotected sex, sex while high or drunk, or sex exchange, were significantly less likely to be willing to use an oral HIV self-test kit (OR = 0.34, 95%CI:0.13,0.86). Those with the highest monthly income (OR = 0.47, 95%CI: 0.25, 0.89) were also less willing to use HIVST. More community- and peer-based efforts are needed to highlight the range of benefits of HIVST (i.e., social, clinical, and structural) to appeal to various youth demographics, in addition to addressing concerns relating to HIVST.

Association between receipt of nutritional counselling during antenatal care visits and anaemia: A cross-sectional study.

BACKGROUND: Anaemia during pregnancy is associated with premature births, low birth weight and increased susceptibility to infection. Almost one-quarter (24.34%) of Ethiopian pregnant women suffer from anaemia. Nutritional counselling during antenatal care (ANC) visits may encourage pregnant women to take a more iron-rich diet and prevent anaemia. The present study examines the association between nutritional counselling during ANC and anaemia among Ethiopian women. METHODS: This cross-sectional study uses the 2016 Ethiopia Demographic and Health Survey (EDHS) data (n = 4, 384). The outcome of interest was anaemia, measured objectively by blood haemoglobin level. The main independent variable was the receipt of nutritional counselling during ANC visits. Univariate, bivariate and multivariable analyses were performed using SAS, version 9.4 (SAS Institute Inc.). RESULTS: Overall, 25.8% of the participants were anaemic and 65.7% received nutritional counselling during ANC visits. Compared with women who received nutritional counselling during ANC visits, a significantly higher proportion of women who did not receive nutritional counselling were anaemic (23.1% vs. 30.8%; p < 0.001). In the multivariable model, compared with women who received nutritional counselling during their ANC visits, the odds of being anaemic were higher among women who did not receive nutritional counselling during their ANC visits adjusted odds ratio = 1.34 (95% confidence interval = 1.07-1.67; p = 0.010). CONCLUSIONS: In a representative sample of Ethiopian women, exposure to nutritional counselling during ANC visits is associated with a lower likelihood of anaemia, independent of potential confounders. Focused ANC counselling that includes nutritional counselling programs during ANC visits can be an effective strategy to prevent and control anaemia.

Socioeconomic empowerment and HIV testing among Ethiopian women: results from the 2016 Ethiopian Demographic and Health Survey.

HIV testing is a cornerstone for early HIV diagnoses which can improve quality of life, survival, and reduce forward transmission. This study examined socioeconomic determinants of HIV testing among women in Ethiopia using the 2016 Ethiopian Demographic and Health Survey. The sample was collected using stratified cluster sampling design and was selected in two stages. A total of 15,683 women aged 15-49 completed the survey. For this study, only 8681 participants were included. Kabeer's theoretical framework on women's empowerment was used for variable selection and analysis. Chi-square test and multiple logistic regression modeling were performed. Overall, 52% of the women reported testing for HIV. In the multivariable-adjusted model, education, residence, wealth index, occupation, living arrangement, and healthcare decision making were significantly (P < 0.05) associated with ever being tested for HIV. For instance, women who don't participate in the decision making of their own health care were less likely to have ever been tested (AOR: 0.77 (0.63-0.94) than those who do. This implies that HIV prevention among Ethiopian women presupposes national policies that promote their overall socioeconomic empowerment. Providing more resources to women, especially to those living in rural areas, might increase HIV testing.

Partner violence and HIV testing uptake among Ethiopian women.

Guided by the Anderson Behavioral Model, the researchers in this study examined the association between emotional violence and HIV testing uptake among women, using the 2016 Ethiopian Demographic and Health Survey. Only 3,637 women between the ages of 15 and 49 years were included. In the bivariate analysis, emotional violence, reported by 42.6% of respondents, was associated with prior HIV testing. In the multiple logistic regression model, emotional violence was not associated with HIV testing uptake among women (p > 0.05). Our findings suggest that efforts to improve women's socio-economic status and decision-making autonomy may be more relevant to increasing HIV testing uptake.

Female Circumcision and Sexual Negotiation Ability of Ethiopian Women.

The following study attempts to assess the link between the circumcision status of Ethiopian women and their ability to negotiate sex. From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 3,445 women aged 15 to 49. Women's sexual negotiation ability was measured by their ability to ask for condom and their ability to refuse sex. We performed a univariate, bivariate, and multiple logistic regression analysis. In the final analysis, only education, residence, media access, and sexually transmitted infections knowledge were independently associated with the sexual negotiation ability of women. Circumcision status was not associated with sexual negotiation ability.

The spatial distribution and expansion of Eucalyptus in its hotspots: Implications on agricultural landscapes.

Fast coppicing plantations like Eucalyptus are becoming an ever increasingly important land use system globally, including the Eucalyptus hotspot highlands of Northwestern Ethiopia. However, comprehensive information regarding species composition is essential for proper planning and policy decisions. The current study mapped the spatial distribution of Eucalyptus globulus (hereafter referred to as Eucalyptus) and identified the key push factors for its expansion. The study used a mapping procedure that uses Landsat imagery together with ground truth data based on supervised training of a pixel-by-pixel classification algorithm within image regions to distinguish areas of Eucalyptus plantations from other classes. High-resolution multispectral and multi-temporal remote-sensing images were combined with ground truth data to produce robust features of Eucalyptus plantation distribution maps. Heckman's Two-Stage econometric model was also employed for determining the major driving factors of Eucalyptus expansion. The results of the mapping algorithm were Eucalyptus plantation distribution maps of 30 × 30 m resolution that showed temporal changes from 1999 to 2021. The findings revealed that Eucalyptus coverage increased by 55% during the period from 1999 to 2010 and the change expressively increased to 69% in 2021 with respect to the reference period. The study also found that a number of push factors influenced the size of land planted with Eucalyptus. The developed maps showing the spatial distribution and expansion of Eucalyptus will help policymakers properly manage the ecosystems and agricultural landscapes of Eucalyptus growing areas.

COVID-19 Vaccine Hesitancy and Its Associated Factors Among Adolescents.

Background: Currently, COVID-19 disease is a major public health issue that affects a large number of people worldwide. The COVID-19 vaccine is one of the best preventative measures. Adolescents between the ages of 12 and 17 are eligible to get the COVID-19 vaccine. The COVID-19 pandemic cannot be stopped if people are reluctant to use this vaccine. However, the extent of COVID-19 vaccine hesitancy and related variables among adolescents are not well understood. Objectives: To assess the magnitude of COVID-19 vaccine hesitancy and its associated factors among adolescents in Seka Chekorsa town, Jimma, Ethiopia. Methods: Institutional-based cross-sectional study employing both qualitative and quantitative methods were used. The study participants were selected using a simple random sampling technique. Data were collected using interviewer-administered questions. Data collected was checked for completeness and entered into EPI data version 3.1. Finally, data were exported to SPSS version 25 for further analysis. The bivariate analysis was used to identify variables eligible for multivariate logistic regressions. In a multivariable analysis to identify factors that have statistically significant association, a p value less than 0.05 and a 95% confidence interval were used. The qualitative data were triangulated with quantitative data. Results: In this study, 379 adolescents were participated, yielding a response rate of 95.2%. The magnitude of COVID-19 vaccine hesitancy among adolescents was 29% (95% CI: 24.3-33.5%). Being female (AOR = 1.89, 95%, 1.81-3.56), primary education (AOR = 2.99, 95% CI: 1.26-3.56), source information from social media (AOR = 2.42, 95% CI: 1.06-5.57), poor knowledge about COVID-19 disease (AOR = 3.18, 95% CI: 1.66-6.12), unfavorable attitude (AOR = 5.2, 95% CI: 2.76-9.79) and poor knowledge towards COVID-19 vaccine (AOR = 5.66, 95% CI, 2.91-11.0) were associated with COVID-19 vaccine hesitancy among adolescents. Conclusion: This study shows that COVID-19 vaccine hesitancy among adolescents is very high. Being female, poor knowledge towards COVID-19 disease and the vaccine, an unfavorable attitude and social media were factors significantly associated with COVID-19 vaccine hesitancy.

Estimating the Economic Values of Restricted Monoculture Eucalyptus Plantations: A Choice Modeling Approach.

Today, evaluating ecological wellbeing and ecosystem services is becoming a great concern towards conserving the natural resource base. Healthy functioning ecosystems have fundamental roles for aiding humankind to lead a healthy life and ensure an improved social welfare. Estimating the non-market benefits of ecosystem services can help experts and the public frame policy directions designed for landscape development. The ecosystem of the Eucalyptus hotspot highlands of northwestern Ethiopia, where this study was carried out, provides services that are essential to changes in the life of the society and biodiversity. However, in recent years, the ecosystem is facing a serious threat from intensive monoculture plantations of Eucalyptus. This has resulted in transformation of the cultural landscapes and a loss of biodiversity. The problem in turn calls for designing appropriate ecological improvement programs. Thus, the current study examined the preferences of residents concerning this area and estimated their willingness to pay (WTP) for the proposed ecosystem improvement programs using a Choice Experiment approach. Data were aggregated from 388 residents using a questionnaire survey in January 2020. The survey contained ecological improvement schemes and a hypothetical event by which respondents expressed their willingness to pay a yearly utility fee as a compensation for the improvement programs. Results showed significant differences in resident preferences towards the proposed ecological improvement attributes. The findings also indicated that the socioeconomic backgrounds of residents contributed for the heterogeneity in their WTP for ecological improvement schemes. Accordingly, the marginal willingness to pay of residents was USD 205/person/year for the respective ecological improvement attributes. The findings suggest that policy makers should consider such attribute-based public preferences while planning landscape development and conservation programs. This study can provide vital policy implications and contribute to knowledge as it presents how the non-market valuations of ecosystems help maximize social welfare.

Association between maternal attitude towards female circumcision and daughter's circumcision status.

OBJECTIVE: Female genital mutilation is a public health problem resulting in multiple health complications. In Ethiopia, female circumcision is widely practiced, with women taking center stage in the perpetuation of the practice. Using the Theory of Planned Behavior for variable selection, the following study assessed the association between maternal attitude towards female circumcision and daughter's circumcision status. METHODS: From the 2016 Ethiopian Demographic and Health Survey, we analyzed a subsample of 6948 women. The outcome variable assessed daughter's circumcision status; the main independent variable assessed participant's opinion towards female circumcision. We conducted univariate, bivariate, and multiple logistic regression analyses. RESULTS: In the bivariate analysis, none of the variables, except for religion, showed any association with daughter's circumcision status. In the multivariable regression model, several variables showed a significant association with daughter's circumcision status. Older, rural, and circumcised women were more likely to have at least one daughter circumcised, but wanting female circumcision to stop, being a Muslim, and having at least a secondary education were negatively associated with daughter's circumcision status. CONCLUSION: Our findings suggest that eliminating female circumcision may require changing maternal attitudes towards the practice by targeting rural, circumcised, and older women with no formal education.

Factors associated with men's opinion about female genital mutilation in Ethiopia.

BACKGROUND: Female genital mutilation (FGM) is considered a human rights violation against women and girls causing serious short and long-term health complications. Despite being a criminal offence in Ethiopia since 2004, the practice continues. Minimal research has been published on factors associated with men's opinion about FGM in Ethiopia. OBJECTIVE AND AIMS: The present cross-sectional study used secondary data to identify factors associated with men's opinions about the practice of FGM. METHODS: Secondary data analysis was conducted using data from 8,718 men who responded to the 2016 Ethiopian Demographic and Health Surveys (EDHS). The dependent variable was men's opinion about FGM. Demographic, socioeconomic, and other characteristics were examined. RESULTS: Variables associated with men's support for FGM were lack of education (AOR = 2.91; 95% CI: 1.93, 4.40, p = <0.001), poor wealth index (AOR, 1.76; 95% CI 1.32, 2.35, p = 0.001), ethnically Afar (AOR = 2.50, 95% CI: 1.27, 4.95, p = 0.009) and Somali (AOR = 2.02, 95% CI: 1.15, 3.54, p = 0.015), Muslim religion (AOR = 1.58, 95% CI 1.13, 2.50, p = 0.007), and support for wife beating with at least one justification (AOR = 2.04, 95% CI: 1.66, 2.50, p = <0.001). CONCLUSION: Lack of education, poor household wealth index, being Muslim and being a member of the Afar or Somali ethnicity and having a tendency that it is appropriate for a husband to beat his wife, were positively associated support for FGM. These findings suggest that context-specific interventions are needed to eradicate the practice.

Attitude towards female circumcision among women in Ethiopia.

Female genital mutilation or cutting (FGM/C) is a global phenomenon mostly practiced in Africa, Asia, and the middle east. It involves the removal of the external female genitalia for non-medical reasons. The practice cuts across different ethnic and religious groups in Africa and is associated with several health complications. The following study assessed attitude towards the practice among Ethiopian women aged 15-49. Using the Ethiopia Demographic and Health Survey from 2016 as a data source, we analyzed a sample of 6984 women. We used the respectable femininity discourse to inform our variable selection. The main outcome variable assessed whether women supported or rejected the continuation of the practice. In the bivariate analysis, all the sociodemographic variables including women's circumcision experience were strongly associated with the outcome variable. In the multiple logistic regression, only education, wealth, religion, and circumcision status were independently associated with women's attitude towards FGM/C. For instance, compared to women with no education, women with at least a secondary education were more than 4 times (AOR 4.2, 95% CI 2.53-7.04, P-Value < 0.001) more likely to agree with the termination of the practice. Our findings suggest that changing attitudes towards FGM/C may require uplifting the social and economic status of women, working with those who have experienced FGM/C and collaborating with religious leaders.

The impact of a small-scale irrigation scheme on malaria transmission in Ziway area, Central Ethiopia.

OBJECTIVE: To assess the impact of a small-scale irrigation scheme in Ziway area, a semi-arid area in the Central Ethiopian Rift Valley, on malaria transmission. METHOD: Parasitological, entomological and socio-economic studies were conducted in a village with and a village without irrigation. Blood smear samples were taken from individuals during the dry and wet seasons of 2005/2006. Socio-economic data were collected from household heads and key agricultural and health informants through interviews and questionnaires. Larval and adult mosquitoes were sampled during the dry and short wet seasons of 2006. Female anopheline mosquitoes were tested by enzyme-linked immunosorbent assay for blood meal sources and sporozoite infections. RESULTS: Malaria prevalence was higher in the irrigated village (19%, P < 0.05) than the non-irrigated village (16%). In the irrigated village, malaria prevalence was higher in the dry season than in the wet season while the reverse occurred in the non-irrigated village. Households with access to irrigation had larger farm land sizes and higher incomes, but also higher prevalence of malaria. Larval and adult abundance of the malaria vectors, Anopheles arabiensis and Anopheles pharoensis, was higher in the irrigated than in the non-irrigated village throughout the study period. Furthermore, the abundance of An. pharoensis was significantly higher than that of An. arabiensis during the dry irrigated period of the year. Canal leakage pools, irrigated fields and irrigation canals were the major breeding habitats of the two vector mosquitoes. Plasmodium falciparum sporozoite infection rates of 1.18% and 0.66% were determined for An. arabiensis and An. pharoensis in the irrigated village. Peak biting activities of the vectors occurred before 22:00 h, which is a source of concern that the effectiveness of ITNs may be compromised as the mosquitoes feed on blood before people go to bed. CONCLUSION: Irrigation schemes along the Ethiopian Rift Valley may intensify malaria by increasing the level of prevalence during the dry season. To reduce the intensity of malaria transmission in the small-scale irrigation schemes currently in operation in Ethiopia, year-round source reduction by using proper irrigation water management, coupled with health education, needs to be incorporated into the existing malaria control strategies.

Complete Genome Sequences of Rice Yellow Mottle Virus Isolates from the Federal Democratic Republic of Ethiopia.

The full-length genomes of two isolates of Rice yellow mottle virus from Ethiopia were sequenced. A comparison with 28 sequences from East Africa showed that they clustered within a new strain named S4et, related to the S4mg and S4ug strains found in the Lake Victoria Basin and Madagascar, respectively.

"He Told Me to Check My Health": A Qualitative Exploration of Social Network Influence on Men's HIV Testing Behavior and HIV Self-Testing Willingness in Tanzania.

Men continue to test for HIV at a low rate in sub-Saharan Africa. Recent quantitative evidence from sub-Saharan Africa indicates that encouragement to test for HIV from men's network members is associated with higher previous HIV testing and HIV self-testing (HIVST) willingness. Leveraging this positive network influence to promote HIVST among men is a promising strategy that could increase HIV testing. This study investigated the reasons and strategies men used to encourage their peers to test for HIV and the outcomes in order to inform the development of a social network-based HIVST intervention for men called STEP (Self-Testing Education and Promotion). Twenty-three men from networks locally referred to as "camps" were interviewed to explore reasons for encouraging HIV testing, strategies to encourage HIV testing, and outcomes of HIV testing encouragement. Reasons men reported for encouraging their peers to test for HIV included awareness of their peers' risky sexual behavior, knowing an HIV-positive peer, and having HIV testing experience. Strategies for encouraging testing included engaging in formal and informal conversations and accompanying friends to the clinic. Encouragement outcomes included HIV testing for some men while others remained untested due to lack of privacy in the clinic and fear of HIV stigma. Willingness to self-test for HIV and an interest to educate peers about HIVST were other outcomes of HIV testing encouragement. These findings underscore the potential of leveraging men's existing HIV testing encouragement strategies to promote HIVST among their peers.

Creating Effective Mobile Phone Apps to Optimize Antiretroviral Therapy Adherence: Perspectives From Stimulant-Using HIV-Positive Men Who Have Sex With Men.

BACKGROUND: The use of stimulant drugs among men who have sex with men (MSM) with human immunodeficiency virus (HIV) is associated with decreased odds of antiretroviral therapy (ART) adherence and elevated risk of forward HIV transmission. Advancing tailored and innovative mobile phone-based ART adherence app interventions for stimulant-using HIV-positive MSM requires greater understanding of their needs and preferences in this emerging area. OBJECTIVE: The purpose of this study is to (1) assess reasons that stimulant-using HIV-positive MSM download and sustain their use of mobile phone apps in general, and (2) obtain feedback on features and functions that these men prefer in a mobile phone app to optimize their ART adherence. METHODS: Focus groups were conducted with stimulant-using HIV-positive MSM (24-57 years of age; mostly non-Hispanic white; 42% once a week or more frequent stimulant drug use) in San Francisco and Minneapolis. Our aim was to explore the mobile phone app features and functions that they considered when deciding to download and sustain their use of general apps over time, as well as specific features and functions that they would like to see incorporated into an ART adherence mobile app. Focus groups were audiorecorded and transcribed verbatim. Thematic analysis was applied to transcripts using line-by-line open coding and organizing codes into meaningful themes. RESULTS: Men reported that they currently had a variety of health and wellness, social media and networking, gaming and entertainment, and utility apps on their mobile phones. Downloading apps to their mobile phones was influenced by the cost of the app, recommendations by a trusted source, and the time it takes to download. In addition, downloading and sustained use of apps was more likely to occur when men had control over most features of the app and apps were perceived to be useful, engaging, secure, and credible. Participants suggested that ART adherence mobile phone apps include social networking features, connections to local resources and their medical chart, and breaking HIV news and updates. Although some men expressed concerns about daily self-monitoring of HIV medication doses, many appreciated receiving a summary of their medication adherence over time and suggested that feedback about missed doses be delivered in an encouraging and humorous manner. CONCLUSIONS: In this study, we were able to recruit a relatively high proportion (42%) of HIV-positive MSM reporting weekly or more stimulant use. These results suggest critical design elements that may need to be considered during development of ART adherence-related mobile phone apps for this, and possibly other, high-risk groups. In particular, finding the optimal balance of security, engagement, usefulness, control capabilities, and credibility will be critical to sustained used of HIV treatment apps.