A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana.

We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving 'respected motherhood' ('what matters most') in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = - 1.20; 95% CI - 1.99, - 0.39) and depressive symptoms (d = - 1.96; 95% CI - 2.89, - 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma.

Smallholder farmers' vulnerability to climate change and variability: Evidence from three agroecologies in the Upper Blue Nile, Ethiopia.

This study delves into the profound impact of climate change on agriculture in Ethiopia, particularly the vulnerabilities faced by smallholder farmers and the resulting implications for poverty. Focusing on three distinct agroecologies, namely: highland, midland, and lowland zones. The study employed a robust methodology, combining a cross-sectional survey, spatial-temporal trend analysis using GIS, and the development of an overall vulnerability index through the balanced weighted average method. The study, encompassing 646 households, combines data from a variety of sources and analytical tools like the vulnerability index, ArcGIS 10.8, and ERDA's IMAGINE 2015. Utilizing the LVI-IPCC scale, the study shows that climate change is an immediate vulnerability in all agroecological zones. It identifies highland areas as the most sensitive and exposed regions, while lowland households are found to be the most vulnerable in terms of overall vulnerabilities. The research reveals specific challenges faced by communities, such as inadequate health facilities and insufficient food and water supplies in both highland and lowland agroecosystems. Additionally, our investigation has observed a significant alteration in land use practices, specifically the shift from communal grazing land to private cultivation and plantations, emphasizing eucalyptus. This alteration enhances the ecosystem's vulnerability to climate disturbances. The study suggests targeted interventions, such as advocating for sustainable land-use practices, afforestation, and adopting climate-smart agriculture practices. It is important to implement policy measures that prioritize conserving and restoring shrubland, grazing land, and natural forests to ensure both long-term socio-economic and ecosystem resilience. The study's nuanced insights are instrumental in understanding the diverse challenges posed by climate change in Ethiopian agriculture, supporting informed policymaking and sustainable interventions.

Groundwater Potential Zone Mapping Using Analytical Hierarchy Process and GIS in Muga Watershed, Abay Basin, Ethiopia.

Groundwater is an important resource that contributes significantly to the total annual water supply. The purpose of the present study is to assess and delineate the groundwater recharge zone using geospatial technology through an analytical hierarchal process (AHP) method in to the Muga watershed, Abay Basin. Remote sensing satellite images and the corresponding data are used for the preparation of thematic layers, viz., geology, rainfall, slope, soil, curvature, topography wetness index, elevation, drainage density, land use land cover, and lineament density of the study watershed. All thematic layers are integrated with a multicriteria evaluation technique. Weighted overlay index analysis is carried out to give rank for each parameter. The weight is assigned for each thematic layer depending on the AHP technique. The reliability of the output is checked by the calculated consistency index and consistency ratio which is reasonably acceptable (0.044 < 0.1). Verification is done by considering the groundwater well locations in the validation datasets. The receiver operating characteristic curve and area under curve (=82.9%) are used to explore the prediction accuracy.

Impacts of land use and land cover change on ecosystem service values in the Afroalpine area of Guna Mountain, Northwest Ethiopia.

Ecosystem service changes caused by land use and land cover change (LULCC) is an important indictor and early warning of ecological changes. However, few attempts have been made to evaluate the effects of LULCC on ecosystem services in the Afroalpine highlands of Northwestern Ethiopia. Therefore, this study aimed to analyze the impacts of LULCC on ecosystem services values in the afro-alpine area of Guna Mountain, Northwestern Ethiopia. Image classification was carried out using Landsat imageries of 1995, 2008, and 2020 following Random Forest algorithm with Google Earth Engine(GEE) based on filtered sample points. A modified benefit transfer method was used to evaluate ecosystem service value (ESV) changes in response to LULCC. The results revealed that the most notable feature of LULCC in the afro-alpine area of Guna Mountain was the expansion of cropland and built-up areas at the expense of grassland, forest, and shrubland. The overall ESV of the study site was estimated at USD 46.97 × 106 in 1995, USD 36.77 × 106 in 2008, and USD 37.19 × 106 in 2020. The net ESVs of the study site declined by USD 9.78 × 106 between 1995 and 2020. The regulating service values accounted for the greatest share, accounting for over 42% in all periods, followed by provisioning and supporting service values, which accounted for over 29% and 13%, respectively, while cultural services accounted for the smallest amount of the total ESV. The ecosystem service value of food production experienced the highest increase. However, the values of the remaining 16 types of ecosystem services declined with varying degrees of reduction over the study periods. The results of this study is necessary for land-use planners and decision-makers who require site-specific information on impacts of LULCC on ecosystem service.

The Spatiotemporal Dynamics of Land Use Land Cover Change, and Its Impact on Soil Erosion in Tagaw Watershed, Blue Nile Basin, Ethiopia.

The Blue Nile basin is one of the hot-spots of soil erosion areas in Ethiopia. However, the impact of land use changes on soil erosion is poorly understood in the Tagaw watershed. Hence, the objective of the study is to assess the impact of land use changes on soil erosion in Tagaw watershed over the last 31 years. Rainfall, soil, satellite images and topographic data are acquired from field survey and secondary sources. A Revised Universal Soil Loss Equation (RUSLE) model is used to estimate soil erosion. The mean annual and total potential soil losses of the watershed are 19.3, 22.9, 26 and 0.06-503.56, 0.11-516.67, and 0.00-543.5 tons ha-1 yr-1 for 1995, 2006 and 2016 respectively. The highest soil loss is found for bare land. The RUSLE model further showed that the highest soil erosion occurred in 2016 whereas the lowest soil erosion occurred in 1995.

Timelines to Cervical Cancer Diagnosis and Treatment at a Tertiary Hospital in Botswana.

PURPOSE: To describe the timelines leading to presentation, diagnosis and definitive treatment among cervical cancer patients at a tertiary treatment center in Botswana. PATIENTS AND METHODS: This was a retrospective study that evaluated timelines to diagnosis and linkage to definitive treatment among cervical cancer patients in Botswana. Medical records of 149 patients admitted at Princess Marina Hospital (PMH) from 2012 to 2014 were reviewed from August 2016 to February 2017. Data collected included socio-demographics, stage of disease at presentation, symptom duration at presentation, diagnosis to definitive treatment interval and treatment outcomes on discharge. STATA 12 was used for data analysis. Frequencies and percentages were used to analyse and present the data. This paper is limited to the analysis of records with documented duration of symptoms, histology turnaround time and the diagnosis to treatment interval. RESULTS: The median duration of symptoms at presentation (N= 80) was 120 days (range 1-1290). Women who were HIV seropositive, of secondary level education or higher, below 50 years and those with cervical cancer screening history reported shorter duration of symptoms at presentation. Median histopathology turnaround time (N=123) was 27 days (range 3-274), median diagnosis to definitive chemoradiation interval (N=81) was 89 days (range 16-305) while median waiting time for surgery (N=7) was 60 days (range 29-279). Overall, the patients' journey from the community to definitive treatment was about six months. CONCLUSION: Delayed cervical cancer diagnosis and treatment is multifactorial and entails a complex interplay between patient health-seeking behavioural patterns, robustness of the patient referral and follow-up mechanisms, availability of prompt histopathology services and relay of results, and timely linkage to definitive care. Prioritization of strategies to address hurdles in all these aspects will not only reduce waiting times but also ensure timely management and improved outcomes among patients with cervical cancer.

'Mothers moving towards empowerment' intervention to reduce stigma and improve treatment adherence in pregnant women living with HIV in Botswana: study protocol for a pragmatic clinical trial.

BACKGROUND: With high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period. METHODS: This study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status). DISCUSSION: Our trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana. TRIAL REGISTRATION: ClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.

Synovial sarcoma.

Here we report a rare variety of soft tissue tumor, vulvar synovial sarcoma, arise on 21 years old girl which was managed with local resection.

Management of post abortion complications in Botswana -The need for a standardized approach.

BACKGROUND: Post abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed at assessing the management of post abortion complications in Botswana. METHODS: A retrospective study was conducted at four hospitals in Botswana in 2014. Socio-demographic, patient management and outcomes data were extracted from patients' medical records. Descriptive statistics and chi-square test were used to analyze and present the data. RESULT: A total of 619 patients' medical records were reviewed. The duration of hospital stay prior to uterine evacuation ranged from less than an hour to 480 hours. All the patients received either prophylactic or therapeutic antibiotics. Use of parenteral antibiotics was significantly associated with severity of abortion, second trimester abortion, use of blood products and the interval between management's decision and uterine evacuation. Uterine evacuation for retained products of conception was achieved by metallic curettage among 516 (83.4%) patients and by vacuum aspiration in 18 (2.9%). At all the study sites, Misoprostol or Oxytocin were used concurrently with surgical evacuation of the uterus. None use of analgesics or anesthetics in the four hospitals ranged between 12.4% to 28.8%. CONCLUSION: There is evidence of delayed patient care and prolonged hospital stay. Metallic curette was the primary method used for uterine evacuation across all the facilities. Pain management and antibiotics use was not standardized. A protocol has to be developed with the aim of standardizing post abortion care.

High Levels of Post-Abortion Complication in a Setting Where Abortion Service Is Not Legalized.

BACKGROUND: Maternal mortality due to abortion complications stands among the three leading causes of maternal death in Botswana where there is a restrictive abortion law. This study aimed at assessing the patterns and determinants of post-abortion complications. METHODS: A retrospective institution based cross-sectional study was conducted at four hospitals from January to August 2014. Data were extracted from patients' records with regards to their socio-demographic variables, abortion complications and length of hospital stay. Descriptive statistics and bivariate analysis were employed. RESULT: A total of 619 patients' records were reviewed with a mean (SD) age of 27.12 (5.97) years. The majority of abortions (95.5%) were reported to be spontaneous and 3.9% of the abortions were induced by the patient. Two thirds of the patients were admitted as their first visit to the hospitals and one third were referrals from other health facilities. Two thirds of the patients were admitted as a result of incomplete abortion followed by inevitable abortion (16.8%). Offensive vaginal discharge (17.9%), tender uterus (11.3%), septic shock (3.9%) and pelvic peritonitis (2.4%) were among the physical findings recorded on admission. Clinically detectable anaemia evidenced by pallor was found to be the leading major complication in 193 (31.2%) of the cases followed by hypovolemic and septic shock 65 (10.5%). There were a total of 9 abortion related deaths with a case fatality rate of 1.5%. Self-induced abortion and delayed uterine evacuation of more than six hours were found to have significant association with post-abortion complications (p-values of 0.018 and 0.035 respectively). CONCLUSION: Abortion related complications and deaths are high in our setting where abortion is illegal. Mechanisms need to be devised in the health facilities to evacuate the uterus in good time whenever it is indicated and to be equipped to handle the fatal complications. There is an indication for clinical audit on post-abortion care to insure implementation of standard protocol and reduce complications.

Assessment of client satisfaction in labor and delivery services at a maternity referral hospital in Ethiopia.

INTRODUCTION: Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study is aimed to assess the client`s satisfaction in a maternal health care setting. METHODS: This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. RESULTS: The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client's address away from Addis Ababa were found to be the predictors of client satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. CONCLUSION: Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems.

Correlates of unintended pregnancy in Ethiopia: results from a national survey.

BACKGROUND: Unintended pregnancy has been a major reproductive health challenge in resource poor settings including Ethiopia. It has adverse consequences to the mother, child and the health sector's resources. Understanding the extent of unintended pregnancy and the factors associated is crucial to devise evidence based interventions. The analysis was aimed at assessing the unintended pregnancy prevalence rate among pregnant women and the factors predisposing to unintended pregnancy. METHODS: This secondary data analysis was done on women's dataset from the 2011 Ethiopian Demographic and Health Survey (DHS). A total of 1267 pregnant women were included in the analysis. Multiple logistic regression analysis was performed using SPSS software to identify the factors associated with unintended pregnancy. Odds Ratio with 95% confidence interval (95% CI) was computed to assess the association of different factors with unintended pregnancy. RESULTS: The overall prevalence of unintended pregnancy was found to be 24%: those who wanted it at a later time and not at all accounted for 17.1% and 6.9%, respectively. The unintended pregnancy rate ranged from 1.5% in Afar Regional State to 39.8% in Oromiya Regional State. Women who knew the timing of ovulation had a 45% reduced chance of unintended pregnancy (OR (95% CI): 0.55 (0.35, 0.85)). Ever use of family planning, presence of five or more born children, and two or more births in the past five years were associated with unintended pregnancy (OR (95% CI): 1.79 (1.31, 2.45), 2.36 (1.01, 5.49) and 2.00 (1.12, 3.58), respectively). CONCLUSIONS: A significant proportion of the current pregnancies were found to be unintended with significant variations among the different regions. Women already burdened with higher fertility were suffering from unintended pregnancy. Family planning programs need to concentrate on the highly affected regions and target women with higher fertility to reduce the level of unintended pregnancy at national level.