The effect of chimney fitted improved stove on kitchen fine particulate matter (PM2.5) concentrations in rural Ethiopia: Evidence from a randomized controlled trial.

BACKGROUND: Millions of Ethiopian people cook with biomass fuels using traditional stoves, releasing harmful pollutants and contributing to a significant public health crisis. Improved stoves offer a potential escape route, but their effectiveness needs close scrutiny. This study delves into the impact of chimney-fitted stoves on kitchen PM2.5 concentrations in rural Ethiopian households. METHOD: We conducted a randomized controlled trial with 86 households equally divided (1:1 ratio) between intervention and control groups. The 24-h average kitchen PM2.5 concentrations was measured using Particle and Temperature Sensor (PATS+) at baseline and after intervention. All relevant sociodemographic and cooking related characteristics were collected at baseline and dynamic characteristics were updated during air monitoring visits. Three distinct statistical models, including independent sample t-tests, paired sample t-tests and one-way analysis of variance were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software for Windows (v 24.0). RESULT: At baseline, the average 24-h kitchen PM2.5 concentrations were 482 µg/m3 (95% CI: 408, 557) for the control and 405 µg/m3 (95% CI: 318, 492) for the intervention groups. Despite remaining elevated at 449 µg/m3 (95% CI: 401, 496) in the control group, PM2.5 concentrations reduced to 104 µg/m3 (95% CI: 90,118) in the intervention group, indicating a statistically significant difference (t = 6.97, p < 0.001). All three statistical analyses delivered remarkably consistent results, estimating a PM2.5 reductions of 74% with the before-and-after approach, 76% when comparing groups, and 74% for difference in difference analysis. Beyond the overall reduction, homes with primary school completed women, larger kitchens, smaller family size, and those specifically baking Injera (the traditional energy-intensive staple food), witnessed even greater drops in PM2.5 levels. CONCLUSION: Pregnant women in our study encountered dangerously high PM2.5 exposures in their kitchens. While the intervention achieved a significant PM2.5 reductions, unfortunately remained above the WHO's safe limit, highlighting the need for further interventions.

Effect of a chimney-fitted improved stove on pregnancy outcomes in Northwest Ethiopia: a randomized controlled trial.

BACKGROUND: Exposure to household air pollution during pregnancy has been linked to adverse pregnancy outcomes. Improved stove was implemented in Ethiopia to reduce this exposure and related health problems. However, the effects of improved stove interventions on pregnancy outcomes remains uncertain. METHOD: Individually randomized stove replacement trial was conducted among 422 households in six low-income rural kebeles of Northwestern Ethiopia. Pregnant women without known health conditions were recruited at ≤ 24 weeks gestation and randomized to an intervention or control group with a 1:1 ratio. A baseline survey was collected and a balance test was done. Two-sided independent samples t-test for continuous outcomes and chi-square for categorical variables were used to compare the effect of the intervention between the groups. Mean differences with 95% CIs were calculated and a p-value of < 0.05 was considered statistically significant. RESULT: In this study, the mean birth weight was 3065 g (SD = 453) among the intervention group and not statistically different from 2995 g (SD = 541) of control group. After adjusting for covariates, infants born from intervention group weighed 55 g more [95% CI: - 43 to 170) than infants born from the control group, but the difference was not statistically significant (P = 0.274). The respective percentages for low birth weight were 8% and 10.3% for intervention and control groups respectively (P = 0.346). However, the average gestational age at delivery was higher among improved stove users (38 weeks (SD = 8.2) compared to control groups 36.5 weeks (SD = 9.6) with statistically significant difference at 0.91 weeks (95% CI: 0.52 to 1.30 weeks, p < 0.001). The corresponding difference in risk ratio for preterm birth is 0.94 (95% CI:0.92 to 0.97; p < 0.001). The percentages for maternal complications, stillbirth, and miscarriage in the intervention group were not statistically different from the control group. CONCLUSIONS: While the increase in average birth weight among babies born to mothers using improved stoves was not statistically significant, babies had a longer gestational age on average, offering valuable health benefits. However, the study didn't find a significant impact on other pregnancy outcomes like stillbirth, miscarriage, or maternal complications. TRIAL REGISTRATION: The study was registered at the Pan African Clinical Trial Registry website under the code PACTR202111534227089, ( https://pactr.samrc.ac.za/ (Identifier). The first trial registration date was (11/11/2021).

Phenotypic characterization of Raya cattle in northern Ethiopia.

Thirteen qualitative and six morphometric variables on a total of 651 adult cattle (76 oxen and 575 cows) from four purposively selected districts were recorded to characterize the cattle populations in and around the breeding tract of Raya cattle. General linear model, frequency, and multivariate analysis procedures of Statistical Analysis Software (SAS 9.0) were used to analyze the data by splitting and merging the sexes. Higher measurement values for oxen were recorded over the cows. Location affects the studied traits significantly. The cattle population from Habru district was significantly differentiated from Raya cattle. Among the districts of Raya cattle, lowest values for most of the linear measurements were observed in Kobo district. Majority of the Raya cattle possess upright, lyre-shaped horn, small, and erected hump placed at the cervical thoracic position, large dewlap, naval flap, and perpetual sheath sizes and dominantly dark red body color with uniform body color pattern. Stepwise discriminant function analysis reveals horn length, ear length, and height at wither were the first three most important morphometric variables used in discriminating the cattle populations. Canonical discrimination analysis showed that the first canonical structure explains majority (94.13%) of the total variation with eigenvalue of 2.07 and canonical correlation of 82.14%. Discriminant function analysis showed the classification of an average 61% of the studied animals into their respective districts. Pairwise Mahalanobis distances between populations from different districts were found to be highly significant. Habru cattle population relates distantly from Raya cattle except its short distance with Kobo district. The shortest distance was observed between Raya cattle of Alamata and Raya Azebo districts. In conclusion, cattle from Alamata, Raya Azebo, and Kobo districts can be categorized as Raya cattle, while strong similarities between the first two districts in showing the real characteristics and morphology of Raya cattle were also revealed.

Research ethics review practices: experiences of the Armauer Hansen Research Institute/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center Ethics Review Committee, Ethiopia.

The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs.

Experimental assessment of antidiarrheal and antisecretory activity of 80% methanolic leaf extract of Zehneria scabra in mice.

BACKGROUND: The leaf of Zehneria scabra is traditionally used for the management of diarrhea in Ethiopia. Its use, however, has not been scientifically validated for safety and efficacy. The aim of this study was to investigate antidiarrheal and antisecretory effects of hydroalcolic leaf extract of Z. scabra in mice models. METHODS: For each of antidiarrheal, gastrointestinal motility and antisecretory activity study Swiss albino mice were divided in to five groups. Group I was treated as control group and received 10 ml/kg of 2% Tween-80 orally; Group II served as a positive control and took standard drug in each of the experiments orally; Group III, IV and V were test groups which received the methanolic extract orally at 100, 200 and 400 mg/kg, respectively. Depending on the model total weight of fecal output, total weight of wet feces, total number of fecal output, number of wet faeces, length of intestinal transit and intestinal weight were collected. Finally, data were analyzed using one-way ANOVA followed by Tukey's post test. RESULT: In castor oil induced diarrhea model, the extract dose produced a significant reduction in mean stool score (1.94 ± 0.102) at 200 mg/kg. Moreover, the 100, 200, and 400 mg/kg doses inhibited stool frequency by 40, 45 and 55%, respectively. All test doses of extract and loperamide (3mg/kg) reduced fecal fluid content significantly (p<0.01). The 100 mg/kg dose of extract produced 25.74% reduction of fluid content (p<0.001) while both 200 and 400 mg/kg showed 29.70 % (p<0.001) compared to negative control group. CONCLUSION: The extract of Zehineria scabra showed antidiarrheal and antisecretory activity in mice model. Moreover, the extract found to be safe at dose of 2000mg/kg in mice model. The findings suggest the validity of the acclaimed effect of Zehineria scabra as antidiarrheal agent in Ethiopian traditional herbal medicine.

Amyand's hernia containing appendiceal neuroma presenting as incarcerated inguinal hernia: A rare case report from Ethiopia.

INTRODUCTION AND IMPORTANCE: Amyand's hernia is a rare type of inguinal hernia which involves either a normal or diseased appendix within the hernia sac. We report an extremely rare case of appendiceal neuroma, presenting as an incarcerated Amyand's hernia. CASE PRESENTATION: A 55-year-old male patient presented in the emergency department due to a persistent right inguinal painful swelling. Clinical examination revealed a 5 cm × 3 cm firm and irreducible right groin mass. A diagnosis of an incarcerated right inguinal hernia was made, and the patient was prepared for surgery. Intraoperatively, a 5 cm × 3 cm firm mass originating from the distal part of the appendix was found in the hernia sac. An appendectomy and a modified Bassini hernia repair were done. The result of the histological examination revealed appendiceal neuroma, and no further surgical intervention was needed. DISCUSSION: Amyand's hernia encompasses various pathological features, including a normal, inflamed, or perforated appendix, and rarely appendiceal tumors. In the literature, we found about eight cases of malignant appendiceal tumors reported. Most of the cases indicate that the treatment of Amyand's hernia containing appendiceal tumors was an appendectomy alone, while one report with adenocarcinoma required a right hemicolectomy after biopsy result. Notably, there are no documented cases of appendiceal neuromas presenting as inguinal hernias in our search of English literature using Google Scholar and PubMed search engines. CONCLUSION: Amyand's hernia-containing appendiceal neuroma is an extremely rare entity. It is important to do histopathologic study to differentiate appendiceal neuroma from malignant tumors. In case of Amyand's hernia with appendiceal neuroma, simple appendectomy with hernia repair is adequate treatment.

Kitchen fine particulate matter (PM2.5) concentrations from biomass fuel use in rural households of Northwest Ethiopia.

Background: Combustion of solid biomass fuels using traditional stoves which is the daily routine for 3 billion people emits various air pollutants including fine particulate matter which is one of the widely recognized risk factors for various cardiorespiratory and other health problems. But, there is only limited evidences of kitchen PM2.5 concentrations in rural Ethiopia. Objective: This study is aimed to estimate the 24-h average kitchen area concentrations of PM2.5 and to identify associated factors in rural households of northwest Ethiopia. Method: The average kitchen area PM2.5 concentrations were measured using a low-cost light-scattering Particle and Temperature Sensor Plus (PATS+) for a 24-h sampling period. Data from the PATS+ was downloaded in electronic form for further analysis. Other characteristics were collected using face-to-face interviews. Independent sample t-test and one-way analysis of variance were used to test differences in PM2.5 concentrations between and among various characteristics, respectively. Result: Mixed fuels were the most common cooking biomass fuel. The 24-h average kitchen PM2.5 concentrations was estimated to be 405 µg/m3, ranging from 52 to 965 µg/m3. The average concentrations were 639 vs. 336 µg/m3 (p < 0.001) in the thatched and corrugated iron sheet roof kitchens, respectively. The average concentration was also higher among mixed fuel users at 493 vs. 347 µg/m3 (p = 0.042) compared with firewood users and 493 vs. 233 µg/m3 (p = 0.007) as compared with crop residue fuel users. Statistically significant differences were also observed across starter fuel types 613 vs. 343 µg/m3 (p = 0.016) for kerosene vs. dried leaves and Injera baking events 523 vs. 343 µg/m3 (p < 0.001) for baked vs. not baked events. Conclusion: The average kitchen PM2.5 concentrations in the study area exceeded the world health organization indoor air quality guideline value of 15 µg/m3 which can put pregnant women at greater risk and contribute to poor pregnancy outcomes. Thatched roof kitchen, mixed cooking fuel, kerosene fire starter, and Injera baking events were positively associated with high-level average kitchen PM2.5. concentration. Simple cost-effective interventions like the use of chimney-fitted improved stoves and sensitizing women about factors that aggravate kitchen PM2.5 concentrations could reduce kitchen PM 2.5 levels in the future.

Environmental exposures and adverse pregnancy outcomes in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Maternal exposures to environmental hazards during pregnancy are key determinants of birth outcomes that affect health, cognitive and economic status later in life. In Ethiopia, various epidemiological evidences have suggested associations between environmental exposures such as household air pollution, cigarette smoking, and pesticide exposure and pregnancy outcomes such as low birth weight, preterm birth, and birth defects. OBJECTIVE: This review aimed at generating summarized evidence on the association between maternal exposure to environmental factors (household air pollution, cigarette smoking, and pesticide) and pregnancy outcomes (birth weight, preterm birth, and birth defects) in Ethiopia. METHOD: A systematic literature search was performed using PubMed, Google Scholar, and the Cochrane Library databases. All observational study designs were eligible for inclusion in the review. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) quality assessment tools adopted for case-control and cross-sectional studies. The random-effects model was applied in computing the pooled estimates and their corresponding 95% confidence interval (CI). Funnel and Doi plots were used for detecting the potential publication bias. All statistical analyses were performed using comprehensive meta-analysis (CMA 2.0) and MetaXL version 5.3 software. RESULT: The pooled estimates revealed that prenatal biomass fuel use increased the risk of giving a low birth weight baby by twofold (OR = 2.10, 95% CI: 1.33-3.31), and has no separate kitchen increases the risk of having low birth weight baby nearly by two and half times (OR = 2.48, 95% CI: 1.25-4.92). Overall, using biomass fuel as the main energy source for cooking and /or having no separate kitchen from the main house is 2.37 times more likely to give low birth weight babies (OR = 2.37, 95% CI: 1.58-3.53). Active cigarette smoker women were 4 times (OR = 4.11, 95% CI: 2.82-5.89) more prone to have low birth weight babies than nonsmokers; and passive smoker women were 2.6 times (OR = 2.63, 95% CI: 1.09-6.35) more risked to give low birth weight babies. It was also estimated that active cigarette smoker women were nearly 4 times (OR = 3.90, 95% CI: 2.36-6.45) more likely to give preterm birth babies. Pesticide exposure during pregnancy also increases the risk of the birth defect 4 times (OR = 4.44, 95% CI: 2.61-7.57) compared with non-exposed pregnant women. CONCLUSION: Household air pollution from biomass fuel use, active and passive cigarette smoking, and pesticide exposures are significantly associated environmental risk factors for low birth weight, preterm birth, and birth defects in Ethiopia. Therefore, Pregnant and lactating women should be aware of these environmental hazards during pregnancy. Promoting clean energy and improved and efficient stoves at the household level will help to reduce household air pollution-related adverse health effects. TRIAL REGISTRATION: PROSPERO 2022: CRD42022337140.

Qualitative Analysis of Onsite Sanitation Challenges in an Urban Setting: The Case of Jimma Town, Ethiopia.

On-site sanitation is the most popular sanitation option for households in many African countries, including Ethiopia. Despite the option being common, there are challenges attributed to the sustainability of those facilities. This community-based exploratory study aimed to explore the challenges in the provision of safe urban on-site sanitation in Jimma town, Ethiopia. Data were collected through key informant semi-structured interviews, transit walks through the village, and focus group discussion (FGD). The FGD was audio recorded and notes were taken by experts. Records and notes were transcribed separately and thematically analyzed. Three major themes or challenges were discovered. Accordingly, the first theme was the community's perception and taboos surrounding human waste. The second theme was urban land use and informal settlements. Ensuring standards separately for sanitation facilities is difficult because of the expansion of illegal settlements. The third theme was poor sanitation planning, operation and maintenance, and institutional setting. Urbanization without infrastructure generally has a complex nature that leads to a fragile sanitation situation in the future. The results suggest the need for multi-dimensional system development and a collaborative sanitation master plan. Furthermore, interventions aimed at breaking the taboo on human waste as a sanitation platform may turn challenges into opportunities.

Production, optimization, and characterization of Ethiopian variant Prosopis juliflora based biodiesel.

Considering the need for biodiesel production from non-edible oil sources and taking into account the fact that Prosopis Juliflora (JF) is identified as a highly invasive species in Ethiopia, this research focuses on biodiesel production from a possible and promising alternative feedstock. The objective of this study is to analyze Ethiopian variant Juliflora based biodiesel (JFB) production through transesterification, carry out optimization by exploring the effects of various process parameters and characterization of functional groups (with GC-MS,FT-IR and NMR) including rheological behavior, not yet been reported earlier. As per ASTM protocol testing, the methyl ester of Juliflora has been found to have the following main fuel properties: kinematic viscosity (mm2/s) 3.395, cetane number 52.9, acid number (mgkoh/g) 0.28, density (gm/ml) 0.880, calorific value (MJ/kg) 44.4, methyl ester content (%) 99.8, and flashpoint (°C) 128, copper strip corrosion value 1a,%FFA (free fatty acid) 0.14. When compared with those of diesel, the viscosity, density, and flash point of JFB are seen to be higher than those of diesel, although it has a similar calorific value but more importantly higher than most of the other biodiesels. Based on an assessment using response surface methodology, methanol concentration together with catalyst loading, temperature, and reaction time are determined to be the most important influencing process parameters. The best molar ratio for methanolysis was observed to be 6:1 with a catalyst concentration of 0.5 wt% at 55 °C for 60 min for biodiesel yield at 65%. The JFB maximum yield of 130 ml at 70 min and the minimum yield of 40 ml at 10 min demonstrate that as mixing time increases, JFB yield tend to increase up to a certain time limit. The maximum raw oil yield rom crushed seed with hexane solvent was observed to be 480 ml within 3 days from 2.5 kg of crushed seed. The Fourier transform infrared analysis (FT-IR) revealed the presence of all desired functional groups necessary for biodiesel on OH radicals at wave numbers of 3314.40 cm-1, Aliphatic methyl C-H at 2942.48 cm- 1 with a functional group (CH-3-,-CH2-), and methylene C-H at 2832.59 cm-1. The gas chromatography-mass spectrometer (GC-MS) study confirmed the higher ester content present in the JFB with a higher unsaturation level of 68.81%. The fatty acid, oleic acid has a lower saturation level of 4.5%, while palmitic acid has a lower threshold level of 2.08%. The Rheometer test showed that shear stress and viscosity reduced with increasing temperature within the range of biodiesel requirements, and the Newtonian behavior was confirmed. The JFB has a fairly high viscosity and shear rate at low temperatures. The 1H NMR (nuclear magnetic resonance) study established that JFB has a necessary ingredient; and aliphatic resonances occur in the chemical shift region of 1.5-3.0 ppm. Significant regions indicate protons bound to heteroaromatics, aldehydes, as shown by 13C NMR spectrum. The findings from the FT-IR, GC-MS, 1H NMR, and 13C NMR are in agreement thus validating the presence of numerous functional groups in JFB as such. Since JFB possesses the requisite biodiesel fuel attributes, Prosopis Juliflora need to be pursued as a promising biodiesel feedstock in Ethiopia for alleviating the burden of imported fuels while also addressing difficulties with emissions released by the combustion of fossil fuels.

Experimental evaluation of fresh human feces biogas and compost potential: Evidence for circular economy from waste streams in Ethiopia.

Biogas toilets are one of the most resource-efficient sanitation technologies. The technology has dual purposes of generating energy and stabilizing waste-producing biofertilizers. In Ethiopia, knowledge of human feces' energy potential is limited to optimize the development of biogas toilet facilities. Therefore, this study was aimed to evaluate the biogas and biofertilizer potential of human feces in Jimma City, Ethiopia, which may contribute to the development of sustainable sanitation technologies. The study was lab-based experimental design. In the lab-scale batch experiment, fresh human excreta samples were collected using a urine diversion raised toilet. Using ultimate and proximate laboratory analyses, the theoretical yield of biogas was predicted. Then a series of anaerobic digestion batch experiments were conducted to determine the practical energy yield. The bio-fertilizer potential of human feces was determined by analyzing the nutrient contents of human feces. The findings of this study showed that the bio-methane yield from the experimental results has a mean of 0.393 m3 kg-1, which is 14.16 MJ kg-1. The bio-methane meter cube per capita per head per year were 28.71 (28.03-29.27) from the experimental result and 45.26 for the theoretical yield of methane. In this study, the bio-fertilizer potential of human feces was evaluated using nutrient analysis, specifically the NPK (nitrogen, phosphorus, and potassium). Accordingly, human feces contain potassium (2.29 mg kg-1), phosphorus (1.12 mg kg-1), and nitrogen (3.71 mg kg-1). This finding suggests the bio-methane potential of human feces can be used for energy recovery and alternative sanitation options, providing a positive remedy for the sanitation crisis in urban settings.

Production systems and breeding practices of Begaria cattle breed as input for a community-based breeding program.

This study aimed to describe the production systems and breeding practices of Begaria cattle breeds as a resource for community-based conservation and breeding program. A semi-structured questionnaire and focus group discussions were employed to identify and describe the breeding practice of the farmer. Three kebeles: Almahal, Fanguso, and Mankush were considered for the study. The data were analyzed using R software. Cattle were kept for a variety of reasons, including milk, breeding, meat, cash, and saving. It was typical throughout the study area to see herd mixing and keeping together (4.7 ± 0.33 herds on average), herd movement during the dry season, and breeding bull sharing (1.9 ± 1.55 shared bulls). During the summer season, cattle rearing in the areas was hindered by feed and water shortages. The breed's major reproduction constraints were abortion (24 %), repeat breeding (19), and calf mortality (14). The primary reason for keeping Begaria cattle was for milk (29 %), cash (26), meat (22), and breeding (0.22). The average age at first calving (AFC), calving interval (CI) and milk yield per day of the breed were 41.5 ± 1.63, 16.0 ± 0.43 months, and 3.2 ± 0.12 L respectively. The average age of breeding bull selection was 3 ± 0.1 years, and it was based on several criteria, including their phenotype, growth, and white coat colour. Based on the current findings, it is recommended that a multi-trait selection program be designed with full stakeholder participation.

Evidence-Based User Interface Sanitation Technology Selection for Urban Slums: A Multi-Criteria Analysis; The Case of Jimma Town, Ethiopia.

Slums are urban areas with insufficient public services and access to sanitation. Evidence-based selection of sustainable sanitation options is critical for addressing the sanitation crisis in slums. This mixed methods study was conducted in Jimma Town, southwest Ethiopia, to assess sanitation status and prioritize sustainable sanitation options for slums. The study was done in 2 phases: quantitative and qualitative. The quantitative cross-sectional household survey aimed to assess sanitation status and the qualitative exploratory method to explore alternative sanitation options and prioritize sustainable alternatives. A total of 310 households were chosen using systematic random sampling methods, of which 302 participated. Data was gathered through interviews, which were supplemented with questionnaires and observation checklists, and 2 focus group discussions (FGD) were held. First, FGD was with expertise in the sanitation sector, and the second was with community members. The state of sanitation was summarized, and multi-criteria analysis (MCA) was used to prioritize sustainable sanitation options. According to our findings, 68% of households had access to improved facilities, and 22.5% didn't have any form of toilet facility. About 7 off-site and on-site user interface sanitation technology options were considered in the selection of alternative sanitation technologies, and each option was evaluated against 17 health, economic, social, technical, and environmental criteria. In the final analysis, the options with the highest scores for the setting were flush to septic tanks, compost toilets, and biogas toilets. Mobilizing such a promising sanitation option is recommended for future interventions.

Antidiarrheal and Antisecretory Effect of 80% Hydromethanolic Leaf Extract of Moringa stenopetala Baker f. in Mice.

INTRODUCTION: In Ethiopia, different medicinal plants have been claimed and used to treat diarrheal diseases. However, these claimed effects for most medicinal plants have not been scientifically verified. One of such plants in Ethiopian folkloric medicine is Moringa stenopetala, which is usually consumed as a vegetable in southern Ethiopia. Thus, this study aimed to evaluate the antidiarrheal and antisecretory effects of 80% methanolic leaf extract of Moringa stenopetala in different mice models. METHOD: Using Swiss albino mice, castor oil-induced diarrhea, charcoal meal-based gastrointestinal motility, and castor oil-induced secretion models were employed to assess antidiarrheal activity. In all of the test models, animals were randomly assigned into five groups consisting of six animals in each group. Group I received 0.5 ml of the vehicle (2% tween-80), while group II was treated with standard drug (3 mg/kg loperamide) in the respective models, whereas groups III to V received 150, 300, and 450 mg/kg of the methanolic leaf extracts of Moringa stenopetala. Onset, frequency, consistency, and weight of stool (diarrhea) were recorded, and different parameters and percentage proportions were calculated. Data were analyzed using one-way ANOVA followed by Tukey's test, and p < 0.05 was considered statistically significant at 95% confidence of interval. RESULT: In the castor oil-induced diarrheal model, the percentage inhibition of diarrhea was 48.5, 58.6, and 60% for the respective doses of 150, 300, and 450 mg/kg of the extract. And, the extract showed a 36.8, 54.4, and 55.9% reduction of peristalsis in charcoal meal-based gastrointestinal motility test compared to the negative control group. Moreover, in the antisecretory assay, the 150, 300, and 450 mg/kg doses of MEMS inhibited fluid contents of the stool by 11.5, 54.54, and 61.82%, respectively, relative to the vehicle-treated group. CONCLUSION: The findings revealed that the 80% methanolic leaf extract of Moringa stenopetala extract has shown antidiarrheal activity.

Childhood Malnutrition and the Association with Diarrhea, Water supply, Sanitation, and Hygiene Practices in Kersa and Omo Nada Districts of Jimma Zone, Ethiopia.

BACKGROUND: Inadequate water supply, sanitation, hygiene practices, and diarrhea are related to malnutrition, but there is limited evidence in Ethiopia about their association. Thus, the objective of this study was to describe childhood malnutrition and the association with diarrhea, water supply, sanitation and hygiene practices. METHODS: A case-control study design was performed from December 2018 to January 2019 in Kersa and Omo Nada districts of the Jimma Zone, Ethiopia. Both children aged 6 to 59 months were chosen randomly from malnourished and well-nourished children in 128 cases and 256 controls, respectively. Bodyweight, length/height, mid-upper arm circumference, and presence of edema of the children were measured according to the WHO references. Then, the nutritional status of the children was identified as a case or control using the cutoff points recommended by the WHO. To see the association-dependent and independent variables, logistic regression analysis was used. RESULTS: A total of 378 children were included in this study (98.44%). Malnutrition was significantly increased among children who delayed breastfeeding initiation(AOR = 3.12; 95% CI: 1.62-6.00), had diarrhea (AOR = 9.22; 95% CI: 5.25-16.20), were living in households indexed as the poorest (AOR = 2.50; 95% CI: 1.12-5.62), defecated in a pit latrine without slab/open pit (AOR = 2.49; 95% CI: 1.17-5.30), collecting drinking water from less than/equal to 1 km distance (AOR = 4.77; 95% CI: 1.01-22.71) and sometimes practiced hand washing at the critical times (AOR = 2.58; 95% CI: 1.16-5.74) compared with their counterparts. However, lactating during the survey (AOR = 0.35; 95% CI: 0.18-0.67), water collection from unprotected sources (AOR = 0.22; 95% CI: 0.05-0.95) and collection and disposal of under-5 children feces elsewhere (AOR = 0.06; 95% CI: 0.01-0.49) significantly reduced the likelihood of malnutrition. CONCLUSIONS: Early initiation of exclusive breastfeeding, diarrhea prevention, and the use of improved latrine and handwashing practices at critical times could be important variables to improve the nutritional status of children.

Association between microbial water quality, sanitation and hygiene practices and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia.

INTRODUCTION: Diarrhea is one of the leading causes of child morbidity and mortality in low- and middle-income countries like Ethiopia. The use of safe drinking water and improved sanitation are important practices to prevent diarrhea. However, limited research has been done to link water supply, sanitation and hygiene practices and childhood diarrhea. Therefore, this study aimed at assessing the association between microbial quality of drinking water, sanitation and hygiene practices and childhood diarrhea. METHODS: Community-based matched case-control study design was applied on 198 paired children from June to July 2019 in Kersa and Omo Nada districts of Jimma Zone, Ethiopia. Cases are children < 5 years of age with diarrhea during the two weeks before the survey. The controls are children without diarrhea during the two weeks before the survey. Twenty-five percent matched pair samples of water were taken from households of cases and controls. Data were collected using structured questionnaire by interviewing mothers/caregivers. A sample of water was collected in nonreactive borosilicate glass bottles and analyzed by the membrane filtration method to count fecal indicator bacteria. A conditional logistic regression model was used; variables with p-value less than 0.05 were considered as significantly associated with childhood diarrhea. RESULTS: A total of 396 (each case matched with control) under-five children with their mothers/caregivers were included in this study. In the analysis, variables like presence of under-five child in their home (AOR = 2.76; 95% CI: 1.33-5.71), wealth status (AOR = 5.39; 95% CI: 1.99-14.55), main sources of drinking water (AOR = 4.01; 95% CI: 1.40-11.44), hand washing practice before water collection (AOR = 4.28; 95% CI: 1.46-12.56), treating water at household level (AOR = 1.22; 95% CI: 0.48-3.09), latrine use all the times of the day and night (AOR = 0.22; 95% CI: 0.06-0.78), using pit as method of waste disposal (AOR = 4.91; 95% CI: 1.39-13.29) and use of soap for hand washing (AOR = 2.89; 95% CI: 1.35-6.15) were significantly associated with childhood diarrhea. Moreover, 30% of sampled water from cases and 26% of sampled water from controls families were free from Escherichia coli whereas all sampled water analyzed for Total coliforms were positive. CONCLUSIONS: We conclude that the main sources of drinking water, hand washing before water drawing from a storage container, domestic waste disposal place and use of soap for hand washing were the most important factors for the prevention of childhood diarrhea.

Effectiveness of solar disinfection water treatment method for reducing childhood diarrhoea: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to pool out the available evidence on the effectiveness of the solar disinfection water treatment method for reducing childhood diarrhoea. DESIGN: Systematic review and meta-analysis. SETTING: Global. METHODS: Searches were conducted in Medline/PubMed, Scopus, Google Scholar, Cochrane Library databases and references to other studies. The review included all children living anywhere in the world regardless of sex, ethnicity and socioeconomic status published in English until December 2019. Studies that compared the diarrhoea incidence between the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The outcome of interest was the change in observed diarrhoea incidence and the risk from baseline to postintervention. Two independent reviewers critically appraised the selected studies. Effect sizes were expressed as risk ratios, and their 95% CIs were calculated for analysis. RESULTS: We identified 10 eligible studies conducted in Africa, Latin America and Asia that included 5795 children aged from 1 to 15 years. In all identified studies, solar disinfection reduced the risk of diarrhoea in children, and the effect was statistically significant in eight of the studies. The estimated pooled risk ratio of childhood diarrhoea among participants that used the solar disinfection water treatment method was 0.62 (95% CI 0.53 to 0.72). The overall pooled results indicated that the intervention of solar disinfection water treatment had reduced the risk of childhood diarrhoea by 38%. CONCLUSIONS: The intervention of solar disinfection water treatment significantly reduced the risk of childhood diarrhoea. However, the risk of bias and marked heterogeneity of the included studies precluded definitive conclusions. Further high-quality studies are needed to determine whether solar disinfection water treatment is an important method to reduce childhood diarrhoea. PROSPERO REGISTRATION NUMBER: CRD42020159243.

The effectiveness of solar disinfection water treatment method for reducing childhood diarrhea: a systematic review and meta-analysis protocol.

BACKGROUND: Several studies employing the effectiveness of solar disinfection water treatment method for reducing diarrhea have reported heterogeneous outcomes, necessitating a systematic review to provide an exhaustive summary of current evidence. Thus, the objective of this review is to pool out the available evidence on the effectiveness of solar disinfection water treatment method for reducing childhood diarrhea. METHODS: Searches will be conducted in PubMed/Medline, Scopus, Google Scholar, Cochrane Library databases, and reference of other studies published through in December 2019. Studies that compare the diarrhea incidence among the intervention group who were exposed to solar disinfection water treatment and the control group who were not exposed to such water treatment were included. The primary outcome of the study is the change in observed diarrhea incidence risk from baseline to post-intervention. Randomized controlled trial study designs will be included. Selected studies will be critically appraised by two independent reviewers. Extracted data will include details about the interventions, populations, study methods, and outcomes of significance to the review question and objectives. Effect sizes will be expressed as risk ratio, and their 95% confidence intervals will be calculated for analysis. DISCUSSION: This review and meta-analysis will systematically explore and integrate the evidence available on the effectiveness of solar disinfection water treatment method for reducing diarrhea. In this review, information about the potential impact of solar disinfection water treatment to inactivate pathogenic microbes for reducing diarrhea will be gathered and summarized. The findings from this study will provide directions for future research and public health professionals with an understanding of the importance of solar disinfection water treatment and point to directions for applicability of the interventions in the community.

Water supply, sanitation and hygiene interventions and childhood diarrhea in Kersa and Omo Nada districts of Jimma Zone, Ethiopia: a comparative cross-sectional study.

BACKGROUND: Diarrhea is a major public health problem that disproportionately affects children in developing countries, including Ethiopia. Most of the diseases can be prevented through safe drinking water supply and provision of basic sanitation and hygiene. However, there is a paucity of information on childhood diarrhea related to interventions in kebeles (smallest administrative structure) where community-led total sanitation (CLTS) implemented and not implemented (non-CLTS). Thus, the aim of this study was to assess and compare the association of water supply, sanitation and hygiene interventions, and childhood diarrhea in CLTS implemented and non-implemented kebeles. METHOD: A comparative cross-sectional study was conducted in Kersa and Omo Nada districts of Jimma Zone, Ethiopia from July 22 to August 9, 2018. Systematically selected 756 households with under-5 children were included in the study. Data were collected through interview using structured questionnaires. Water samples were collected in nonreactive borosilicate glass bottles. The binary logistic regression model was used; variables with a p value < 0.05 were considered as significantly associated with childhood diarrhea. RESULTS: The prevalence of childhood diarrhea in the past 2 weeks was 17.7% (95% CI: 13.9-21.5) in CLTS kebeles and 22.0% (95% CI: 17.8-26.2) in non-CLTS kebeles. The occurrence of childhood diarrhea, increased among children whose families did not treat drinking water at home compared to those who treated in both CLTS (AOR = 2.35; 95% CI: 1.02-05.98) and non-CLTS (AOR = 1.98; 95% CI: 0.82-4.78) kebeles. About 96% of households in CLTS and 91% of households in non-CLTS kebeles had pit latrine with and without superstructure. Children from families that used water and soap to wash their hands were 76% less likely to have diarrhea in CLTS kebeles (AOR = 0.76; 95% CI: 0.31-1.88) and 54% less likely to have diarrhea in non-CLTS kebeles (AOR = 0.54; 95% CI: 0.17-1.72) when compared to children from families who used only water. The odds of having diarrhea was 1.63 times higher among children whose families live in CLTS non-implemented kebeles compared to those children whose families live in CLTS implemented kebeles (AOR = 1.63; 95% CI: 0.98-2.68). CONCLUSIONS: No significant difference was observed in the prevalence of childhood diarrhea between CLTS and non-CLTS kebeles.