High prevalence of zero-dose children in underserved and special setting populations in Ethiopia using a generalize estimating equation and concentration index analysis.

BACKGROUND: Globally, according to the World Health Organization (WHO) 2023 report, more than 14.3 million children in low- and middle-income countries, primarily in Africa and South-East Asia, are not receiving any vaccinations. Ethiopia is one of the top ten countries contributing to the global number of zero-dose children. OBJECTIVE: To estimate the prevalence of zero-dose children and associated factors in underserved populations of Ethiopia. METHODS: A cross-sectional vaccine coverage survey was conducted in June 2022. The study participants were mothers of children aged 12-35 months. Data were collected using the CommCare application system and later analysed using Stata version 17. Vaccination coverage was estimated using a weighted analysis approach. A generalized estimating equation model was fitted to determine the predictors of zero-dose children. An adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p-value of 0.05 or less was considered statistically significant. RESULTS: The overall prevalence of zero-dose children in the study settings was 33.7% (95% CI: 34.9%, 75.7%). Developing and pastoralist regions, internally displaced peoples, newly formed regions, and conflict-affected areas had the highest prevalence of zero-dose children. Wealth index (poorest [AOR = 2.78; 95% CI: 1.70, 4.53], poorer [AOR = 1.96; 95% CI: 1.02, 3.77]), single marital status [AOR = 2.4; 95% CI: 1.7, 3.3], and maternal age (15-24 years) [AOR = 1.2; 95% CI: 1.1, 1.3] were identified as key determinant factors of zero-dose children in the study settings. Additional factors included fewer than four Antenatal care visits (ANC) [AOR = 1.3; 95% CI: 1.2, 1.4], not receiving Postnatal Care (PNC) services [AOR = 2.1; 95% CI: 1.5, 3.0], unavailability of health facilities within the village [AOR = 3.7; 95% CI: 2.6, 5.4], women-headed household [AOR = 1.3; 95% CI:1.02, 1.7], low gender empowerment [AOR = 1.6; 95% CI: 1.3, 2.1], and medium gender empowerment [AOR = 1.7; 95% CI: 1.2, 2.5]. CONCLUSION: In the study settings, the prevalence of zero-dose children is very high. Poor economic status, disempowerment of women, being unmarried, young maternal age, and underutilizing antenatal or post-natal services are the important predictors. Therefore, it is recommended to target tailored integrated and context-specific service delivery approach. Moreover, extend immunization sessions opening hours during the evening/weekend in the city administrations to meet parents' needs.

Availability of comprehensive emergency obstetric and neonatal care in developing regions in Ethiopia: lessons learned from the USAID transform health activity.

BACKGROUND: In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. METHOD: At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. RESULT: At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. CONCLUSION: The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.

Geographical clustering and geographically weighted regression analysis of home delivery and its determinants in developing regions of Ethiopia: a spatial analysis.

BACKGROUND: Nearly three-fourths of pregnant women in Ethiopia give birth at home. However, the spatial pattern and spatial variables linked to home delivery in developing regions of Ethiopia have not yet been discovered. Thus, this study aimed to explore the geographical variation of home delivery and its determinants among women living in emerging (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of Ethiopia, using geographically weighted regression analysis. METHODS: Data were retrieved from the Demographic and Health Survey program's official database ( http://dhsprogram.com ). In this study, a sample of 441 reproductive-age women in Ethiopia's four emerging regions was used. Global and local statistical analyses and mapping were performed using ArcGIS version 10.6. A Bernoulli model was applied to analyze the purely spatial cluster discovery of home delivery. GWR version 4 was used to model spatial regression analysis. RESULTS: The prevalence of home delivery in the emerging regions of Ethiopia was 76.9% (95% CI: 72.7%, 80.6%) and the spatial distribution of home delivery was clustered with global Moran's I = 0.245. Getis-Ord analysis detected high-home birth practice among women in western parts of the Benishangul Gumz region, the Eastern part of the Gambela region, and the Southern and Central parts of the Afar region. Non-attendance of antenatal care, living in a male-headed household, perception of distance to a health facility as a big problem, residing in a rural area, and having a husband with no education significantly influenced home delivery in geographically weighted regression analysis. CONCLUSIONS: More than three-fourths of mothers in the developing regions of Ethiopia gave birth at home, where high-risk locations have been identified and the spatial distribution has been clustered. Thus, strengthening programs targeted to improve antenatal care service utilization and women's empowerment is important in reducing home birth practice in the study area. Besides, supporting the existing health extension programs on community-based health education through home-to-home visits is also crucial in reaching women residing in rural settings.

Relationship between environmental pollution and economic development in late-developing regions shows an inverted V.

In late-developing regions, new technologies and previous experiences are applied to reduce the impact of economic development on environmental pollution in the early stages. After economic development has reached a certain level, the application of new environmental remediation technologies and methods can accelerate environmental restoration. Therefore, we hypothesized that the relationship between economic development and environmental pollution would exhibit an inverted V in late-developing regions. We examined water quality changes in 353 monitoring sections of 76 urban rivers in Kunming, southwestern China, over the last 33 years to assess the impact of economic development on river water quality. The results indicate that the relationship between the comprehensive pollution index of urban rivers and the economy shows an inverted V, supporting our hypothesis. The inverted V could be divided into four areas: an environmental self-purification area (<2170 USD); an economic development environmental destruction area (2170-5240 USD); an economic development feedback environment area (5240-11,255 USD); and an economic development promotion environment area (>11,255 USD). On the time axis of economic development, the relationship between economic development and environmental pollution is closer to an inverted U in relatively early developing regions, but the experience with and application of new technologies causes the relationship to change from an inverted U to an inverted V in relatively late-developing regions.

Midwives' job satisfaction and intention to leave their current position in developing regions of Ethiopia.

BACKGROUND: The aim of this research was to analyze midwives' job satisfaction and intention to leave in developing regions of Ethiopia. METHODS: A facility-based cross-sectional study was conducted amongst 107 midwives in four developing regions of Ethiopia. All midwives who were working in 26 health facilities participated in the study. A structured self-administered questionnaire, and in depth key informant interview guides, were used to collect data. Job satisfaction was measured by nine dimensions and intention to leave their current position was measured using three questions. RESULTS: More than two-thirds (67%) of the midwives were female, with a mean age of 26.1 (sd±4.2) years old. Less than half (45%) of the midwives were satisfied with their job, less than half (42%) were satisfied with 'work environment' and less than half (45%) were satisfied with 'relationship with management' and 'job requirements'. Relatively better satisfaction rates were reported regarding 'professional status', of which more than half (56%) of midwives were satisfied, followed by more than half (54%) of midwives being satisfied with 'staff interaction'. Almost two-fifths (39%) of midwives intended to leave their current position. CONCLUSION: Job dissatisfaction and intention to leave rates amongst midwives in developing regions in Ethiopia are a source of concern. The majority of midwives were most dissatisfied with their working environment and issues related to payment. Their intention to leave their current position was inversely influenced by job satisfaction. The introduction of both financial and nonfinancial mechanisms could improve midwives' job satisfaction, and improve retention rates within the profession.

Global multidimensional poverty and COVID-19: A decade of progress at risk?

According to the global Multidimensional Poverty Index (MPI), an internationally comparable measure, poverty in developing countries has fallen substantially over the last 15 years. The COVID-19 pandemic and associated economic contraction are negatively impacting multiple dimensions of poverty and jeopardising this progress. This paper uses recent assessments of food insecurity and school closures made by UN agencies to inform microsimulations of potential short-term impacts of the pandemic under alternative scenarios. These simulations use the nationally representative datasets underlying the 2020 update of the global MPI. Because these datasets were collected in various years before the pandemic, we develop models to translate the simulated impacts to 2020. Our approach accounts for the country-specific joint distribution of deprivations in the simulations, recent poverty reduction trends, and resulting differences in the responsiveness of the global MPI to the scenarios. Aggregating results across 70 countries that account for 89% of the global poor according to the 2020 global MPI, we find that the potential setback to multidimensional poverty reduction is between 3.6 and 9.9 years under the alternative scenarios. We argue that the extent to which such disruptions result in persistent increases of poverty and deprivations may be attenuated by appropriate policy responses.

The Experience of International Students and Institutional Recommendations: A Comparison Between the Students From the Developing and Developed Regions.

Prior studies on the experiences of international students in China have mostly focused on their academic, sociocultural, and accommodation experiences. Hence, student health and safety, discrimination, and the services by the International Student Office (ISO) have remained unexplored. Moreover, due to the motivational differences between the students from developing and developed regions, a study that samples students from both regions may depict an exact picture of the experience of international students. Therefore, the objective of this study is to examine the influence of the dimensions (including those dimensions that have been ignored) of the experience of international students on their satisfaction. In addition, we make recommendations regarding Chinese institutes for future students based on a comparison between the students from developing and developed regions. Using hierarchical regression analysis, this study reveals that educational and non-educational experiences vary among students from different regions. Therefore, based on developing (e.g., Asia and Africa) and developed (e.g., America, Europe, and Australia) regions, important recommendations are discussed regarding how educational institutions and the Chinese government could best allocate resources and introduce policies to improve the experience of international students.

An empirical study on industrial eco-efficiency in arid resource exploitation region of northwest China.

Located in the northwest of China, Xinjiang is a typical arid desert area and mineral resources development zone. The lack of water resources and a fragile ecological environment restricts the sustainable development of the region. Based on the industrial panel data of Xinjiang from 2001 to 2015, this paper uses the undesirable output SBM model, Malmquist index model, and Tobit regression model to comprehensively and systematically measure and evaluate the industrial eco-efficiency and its change characteristics from provincial, regional, and prefectural levels. The results show that (1) the industrial eco-efficiency level in Xinjiang is generally low, lower than the national average, but the development trend is good, and it has been steadily rising over time, from 2001 to 2015 and from the "Tenth Five-Year Plan" period to the "Twelfth Five-Year Plan" period. (2) The spatial distribution of industrial ecological efficiency of Xinjiang is not balanced. Northern Xinjiang is larger than that of eastern Xinjiang and the southern Xinjiang. The developments of 14 prefectures are uneven and asynchronous, which can be divided into two development modes: industrial and agriculture and animal husbandry region. (3) Through the decomposition analysis of the Malmquist index, it has been found that the technological progress index is the restriction factor of the changing trend of TFP, while the technical efficiency index and the pure technical efficiency index are the promoting factors. (4) The main factors causing the decline in ecological efficiency are industrial sulfur dioxide emissions, industrial nitrogen oxide emissions, total industrial water consumption, and general industrial solid waste. It can be seen that the emission of air pollutants and excessive industrial water are the main problems in the region. (5) Industrial ecological efficiency is positively correlated with industrial development level, scientific and technological innovations, industrial structure, and environmental planning, whereas negatively correlated with the degree of opening up and industrial agglomeration. (6) Xinjiang is an extremely arid and water-scarce region. These are the keys and prerequisites for saving water resources and strengthening the comprehensive utilization of water resources. Whether in the industrial areas or in the agricultural and animal husbandry areas, water conservation should be given top priority.

Chronic urban hotspots and agricultural drainage drive microbial pollution of karst water resources in rural developing regions.

Contamination of surface and groundwater systems with human and animal faecal matter leads to exposure of reliant populations to disease causing micro-organisms. This exposure route remains a major cause of infection and mortality in developing countries, particularly rural regions. To meet the UN's sustainable development goal 6: Ensure availability and sustainable management of water and sanitation for all, we need to identify the key controls on faecal contamination across relevant settings. We conducted a high-resolution spatial study of E. coli concentration in catchment drainage waters over 6 months in a mixed land-use catchment in the extensive karst region extending across impoverished southwest China. Using a mixed effects modelling framework, we tested how land-use, karst hydrology, antecedent meteorological conditions, agricultural cycles, hydrochemistry, and position in the catchment system affected E. coli concentrations. Land-use was the best predictor of faecal contamination levels. Sites in urban areas were chronically highly contaminated, but water draining from agricultural land was also consistently contaminated and there was a catchment wide pulse of higher E. coli concentrations, turbidity, and discharge during paddy field drainage. E. coli concentration increased with increasing antecedent rainfall across all land-use types and compartments of the karst hydrological system (underground and surface waters), but decreased with increasing pH. This is interpreted to be a result of processes affecting pH, such as water residence time, rather than the direct effect of pH on E. coli survival. Improved containment and treatment of human waste in areas of higher population density would likely reduce contamination hotspots, and further research is needed to identify the nature and distribution of sources in agricultural land.

Clinical trial conduct in special populations and developing regions: An overview of the DOVE study in pediatric patients with sickle cell disease.

Clinical trials conducted in unique patient populations or individuals with rare diseases are typically hampered by limitations in availability of qualified patients, requiring sponsors to broaden their global outreach to achieve enrollment. Engaging clinical study centers in developing regions may offer access to a substantially larger patient pool. However, they provide a unique set of challenges based on local cultures and requirements. The DOVE study (Determining effects Of platelet inhibition on Vaso-occlusive Events) was a clinical trial of prasugrel hydrochloride (prasugrel) in pediatric patients (aged 2 to <18years) with sickle cell anemia. The study was conducted at centers located in both well-developed and developing regions, enrolling 341 children. Study planning and execution required careful consideration of cultural requirements in each region and implementation of additional trial initiation and execution processes to address those needs. Innovative strategies were employed to ensure global consistency and quality in study execution. Significant regional- and country-specific differences were observed in site activation and enrollment. Although site activation processes were more complex and slower in developing countries, enrollment rates were much higher, which helped mitigate the site activation delays and allowed significant contribution to complete study enrollment. Data quality and patient retention in developing countries were equivalent to those observed in more developed countries, further supporting the ability to successfully conduct high-quality global registration trials in those countries. This report provides an overview of the experiences in site identification, site qualification, enrollment, patient retention, and data quality assurance in the DOVE study.

Unequal Distribution of Overweight Adolescents in Immigrant-Rich Areas: Analysis of Disparities among Public and Private School Students in Shanghai, China.

Accelerated urbanization and rising immigration to the big cities in China has resulted in education policies that produce disparate treatment of immigrant and non-immigrant students. The two types of students frequently wind up in different types of junior high schools. However, there is little research on whether disparities exist between students in public and private schools with regard to overweight. This study aims to address this gap through a comparison of the overweight status of junior high school students in public and private schools in Shanghai and explore the possible reasons for the observed differences. Students from two public and two private junior high schools were measured. In order to determine what factors might shape overweight among adolescents. Logistic regression analysis was used to assess associations between overweight and personal characteristics, birth-related factors, levels of physical activity, diet, family socioeconomic status and school environment. Students in private schools proved more likely to be overweight (15.20%, p < 0.05) than public school students (10.18%). Similarly, gender, breastfeeding, parental care and number of classes excluding physical education per day were found to be significant factors. However, private school students were also influenced by gestational age (yes/no: OR = 4.50, p < 0.001), frequency of snacks (sometimes/often: OR = 0.53, p < 0.01) and family income (¥6001-12,000/below ¥6000: OR = 3.27, p < 0.05). Time for lunch was the sole risk factor for public school students in the study (p < 0.05). To reduce the unequal distribution of overweight students between the two types of schools, interventions that consider different multiple risk factors should be implemented.

Developing Global Leaders for Research, Regulation, and Stewardship of Crop Protection Chemistry in the 21st Century.

To provide sufficient food and fiber to the increasing global population, the technologies associated with crop protection are growing ever more sophisticated but, at the same time, societal expectations for the safe use of crop protection chemistry tools are also increasing. The goal of this perspective is to highlight the key issues that face future leaders in crop protection, based on presentations made during a symposium titled "Developing Global Leaders for Research, Regulation and Stewardship of Crop Protection Chemistry in the 21st Century", held in conjunction with the IUPAC 13th International Congress of Pesticide Chemistry in San Francisco, CA, USA, during August 2014. The presentations highlighted the fact that leaders in crop protection must have a good basic scientific training and understand new and evolving technologies, are aware of the needs of both developed and developing countries, and have good communication skills. Concern is expressed over the apparent lack of resources to meet these needs, and ideas are put forward to remedy these deficiencies.

Strategic use of lamivudine in the management of chronic hepatitis B.

Lamivudine is no longer recommended as first-line therapy for chronic hepatitis B. The same advice has been made for adefovir and telbivudine, due to their relatively weak anti-viral activity and low resistance barrier, respectively. Instead, either tenofovir or entecavir is the currently preferred anti-HBV agent, given their potent anti-viral activity and high barrier to resistance. However, these drugs are expensive and their long-term use is often unaffordable for many individuals, including most patients in developing regions, where hepatitis B is generally much more prevalent. Herein, we argue that lack of universal access to the current best anti-viral drugs for hepatitis B should not imply a suboptimal management of chronic hepatitis B which denies therapy to persons who really need it. A wise and strategic use of lamivudine may provide an opportunity to bring the benefit of therapy to large HBV-infected populations, while reducing health care costs.