Determinants of undernutrition among settled pastoralists' children aged 6-59 months in Kenya.

The transition from nomadism to sedentary lifestyle has introduced changes in diets and undernutrition is endemic among settled pastoral households. This study aimed to investigate the underlying factors affecting stunting, underweight, and wasting of children aged 6-59 months in Marsabit County, Kenya. A cross-sectional household survey was conducted in six wards capturing pastoral, agro-pastoral, and urban livelihood practices. Using multistage sampling method, 394 children aged 6-59 months participated with written consent from the caregivers. A pretested questionnaire and anthropometric measures were used during data collection. Population characteristics were summarized into means and proportions, while chi-square and analysis of variance were used to evaluate associations between variables. Backward logistic regressions were used to explore predictors of stunting, underweight, and wasting, respectively. The results showed that the mean Height for Age Z-score, Weight for Age Z-score, and Weight for Height Z-score were -1.51, 1.54, and 1.02, respectively. The prevalence of stunting, underweight, and wasting was 38.1%, 23.0%, and 18.5%, respectively. The age of child, source of drinking water, and waste disposal were some of the main factors influencing stunting among children. In conclusion, the prevalence of undernutrition was high compared to the World Health Organization recommended cutoffs. Water sources hygiene, and caregiver's income were some of the main predictors of undernutrition among children. Development agencies need to focus on the supply of potable water, access to toilet facilities, in addition to nutrition education on hygienic complementary feeding practices among pastoral caregivers.

Female Genital Mutilation in Ethiopia's Afar Region: Patterning, Drivers, and Decision-Making.

PURPOSE: To explore the patterning, practices, and drivers of female genital mutilation (FGM) in Ethiopia's Afar region. METHODS: This article draws on mixed-methods research conducted in 2022 in 18 rural communities in three districts of Ethiopia's Afar region. Survey data were collected from 1,022 adolescents and their caregivers. Qualitative interviews were conducted with approximately 270 adults and adolescents. RESULTS: The survey found that FGM remains practically universal (97% of sampled adolescent girls), and infibulation remains the norm (87% of girls). Most adolescent girls and caregivers reported that FGM is required by religion and should continue. When queried about the main reason for FGM, however, most cited culture rather than religion. Female caregivers and adolescent girls were more likely to report that FGM has benefits than risks; the reverse was true for male caregivers. Qualitative evidence suggests that even girls who are not reported as infibulated generally, and that the social benefits of FGM--especially regarding controlling girls' sexuality and facilitating their marriageability--are perceived to outweigh health risks. Where there are shifts in type of FGM, it is largely due to efforts of religious leaders who preach against infibulation and for "milder" types--and the growing scope of fathers to input into mothers' FGM decision-making and advocate for less invasive types. DISCUSSION: Eliminating FGM requires focusing on contexts where the practice is most invasive and progress is not yet visible. Given complex intrahousehold and intragenerational dynamics, this will necessitate engaging whole communities with sustained multipronged approaches to shift social norms.

Determinants of Hemoglobin Among Pregnant Women at Agro-Pastoralist Communities in South Omo Zone, Ethiopia: Community Based Cross-Sectional Study, Nutrition Experience from Movable Community.

Background: Low hemoglobin level is the most common public health problem during pregnancy in developing countries including Ethiopia, which is affecting both mother and fetus. However, the determinants of anemia among pregnant women are not well studied. Objective: To assess the determinates of hemoglobin among pregnant women in rural agro-pastoralist communities in the South Omo zone, Ethiopia. Method: Community-based cross-sectional study was done in rural agro-pastoralist communities. A multistage stratified sampling technique was used to select 526 pregnant women. Data were collected by using structured questionnaires. Hemoglobin level was measured by using HemoCue ® Hb301. Data were analyzed by using a statistical package for the social science version 26. Descriptive (Mean, standard deviation, frequency, range), bivariate and multivariate analysis was carried out to check the association between lower hemoglobin levels and independent variables. The output is presented in tables and figures. Result: The mean (±SD) of hemoglobin concentration was 11.8 ± 1.7. The overall prevalence of anemia was 39.9% [95% CI: 35.5, 44.4], 19.4% (95% CI: 16.0, 23.2) was mild, 19.6% (95% CI: 16.27, 2.5) was moderate and 0.9% (95% CI: 0.25, 2.25) was severe anemia. Not taking IFA (AOR = 5.7(3.3, 9.8)), severe under nutrition (AOR = 8.9(2.1, 37.3)), no fish food (AOR = 2.4(1.3, 4.5)), drinking coffee (AOR = 1.6(1.0, 2.6)), moderate food insecurity (AOR = 2.5(1.4, 4.6)), and no malaria infection (AOR = 0.6(0.4, 0.9)) were statistically significant with anemia. Conclusion: The anaemia is a public health problem in this study area. Therefore, nutrition education and counselling to enhance iron supplementation, dietary diversity and a flesh diets are very essential to enhance haemoglobin levels.

Level of client satisfaction among family planning service users in semi-pastoralist areas of Southeast Ethiopia: a mixed-methods study.

Background: Client satisfaction with family planning services is a crucial metric for gauging healthcare providers' performance. There is a dearth of local data that explores the factors that influence clients' satisfaction with family planning services in semi-pastoral areas using a mixed-methods approach. This study aimed to assess the level of client satisfaction and its associated factors among family planning service users in six public health centers in Southeast Ethiopia. Methods: A multi-centered, concurrent, mixed-method survey using quantitative and qualitative methods was conducted in six public health centers in Southeast Ethiopia from March 15 to April 16, 2022. Four hundred nineteen systematically selected family planning method users and their respective six family planning service providers were approached using a purposive sampling technique. A multivariable binary logistic regression model was used to identify the independent factors associated with clients' satisfaction with family planning services. Results: Four hundred fourteen study participants were finally approached, and client satisfaction with family planning services in those centers was 57.5% with a 95% CI of 52.71%-62.71%. Being in the age group of 25-34 years (AOR = 1.99; 95% CI 1.2, 3.29), married (AOR = 2.41; 95% CI 1.13, 5.15), waiting less than 30 min (AOR = 1.74; 95% CI 1.11, 2.72), and receiving the family planning method they want (AOR = 2.35; 95% CI 1.16, 4.76) were positively associated with client satisfaction. Updating the provider's skills and knowledge, keeping clients' method choices, and leaving free decisions also increased client satisfaction. Conclusions: In this study, client satisfaction with family planning services remains low. Users' age, marital status, waiting time, and wish to receive the method they want were positively associated with client satisfaction.

Exploring the Influence of Sociocultural Factors on the Non-Utilization of Family Planning amongst Women in Ethiopia's Pastoralist Regions.

This study aimed to explore the sociocultural determinants of family planning (FP) utilization among women in pastoralist areas of Ethiopia. A community-based cross-sectional survey was conducted involving 682 reproductive-aged women selected from three regions in pastoralist districts. Hierarchical logistic regression was used to identify factors associated with women who did not use FP. This study revealed that 47% of women did not use FP. Women who did not use FP were more likely to have shorter spacing between births, lack their partner's support, not be involved in decisions regarding large household purchases, and have low household expenditures. Overall, the prevalence of not using FP is significantly high in pastoralist communities in Ethiopia. The authors recommend that investment in women's health and FP be targeted at educational campaigns to raise awareness about FP and its importance. Engaging men and community leaders, promoting their support for FP and contraceptive use, and providing financial assistance to address financial barriers, such as transportation costs and healthcare fees, are important aspects that can increase the utilization of FP methods.

Intimate partner violence and associated factors among married adolescent girls and young women in the pastoralist community of South Ethiopia: is intimate partner violence associated with cultural phenomena?

Background: Violence against women is a major public health problem that affects the physical, sexual, mental, and social wellbeing of more than one-third of all women worldwide. Hence the purpose of this study was to determine the prevalence of physical and sexual intimate partner violence (IPV) and associated factors among married adolescent girls and young women (AGYW) belonging to the pastoralist community of Dassenech district, South Omo Zone, South Ethiopia. Methods: A community-based cross-sectional survey was conducted among married AGYW in the Dassenech district from March 1, 2022, to April 1, 2022. A multi-stage sampling technique was adopted to select 545 participants. The data were collected using pre-tested and standardized WHO multi-country study tools. A binary logistic regression model was fitted to identify the independent predictors of physical and sexual intimate partner violence. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to measure the effect size, and finally, a p-value<0.05 was considered statistically significant. Results: The prevalence of physical IPV among AGYW belonging to the pastoralist community of Dassenech district was 44.1% (95% confidence interval (CI): 40%, 48%) and that of sexual IPV was 39.3% (95% CI: 35%, 43%). The husband only deciding for the household (AOR = 11.36; 95% CI: 6.97, 18.53), the father performing the Dimi cultural ceremony (AOR = 3.70; 95% CI: 2.22, 6.14), and frequent quarrels (AOR = 2.06; 95% CI: 1.07, 3.99) are significantly associated with physical IPV. Both partners drinking alcohol (AOR = 3.47; 95% CI: 1.94, 6.20), the husband only deciding for the household (AOR = 11.23; 95% CI: 6.91, 18.27), and frequent quarrels (AOR = 2.29; 95% CI: 1.15, 4.56) were factors significantly associated with sexual IPV. Conclusion: Physical and sexual intimate partner violence is a significant public health problem in the study area. Therefore, interventional measures to change the attitude of cultural leaders, providing education to married men and women on risky sexual behavior, and empowering women need to be prioritized to prevent the occurrence of this problem.

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.

Household livelihood resilience of pastoralists and smallholders to climate change in Western Himalaya, India.

Smallholders and pastoralists are particularly vulnerable to the impacts of climate change due to their high reliance on socio-ecological systems for their livelihood. Building their resilience to these adverse effects of climate change is crucial for mitigating their vulnerabilities, especially in remote and fragile ecosystems. This study aims to assess the climate change livelihood resilience of smallholders and pastoralists in the Indian Himalayas. We build a livelihood resilience index, using the three dimensions of resilience, namely assimilative capacity, autopoiesis and cognitive ability, and weighed using entropy-TOPSIS approach The dimensions of resilience was estimated through indicators by a household survey of 289 randomly selected respondents across the three districts of Garhwal Himalayas. The results showed that the livelihood resilience of smallholders was greater than pastoralists. Among pastoralists, settlement brought positive changes to their livelihood, opening the gateway to access basic facilities. Key findings of the study indicate that public policy should focus towards information accessibility, encouraging environmental awareness and conservation, promoting social inclusion and cooperatives, and fostering grass root organization structures like forest-level organisation through informality to strengthen the resilience of communities to climate change.

Combatting anthrax outbreaks across Nigeria's national land borders: need to optimize surveillance with epidemiological surveys.

BACKGROUND: Anthrax is a non-contagious zoonotic disease caused by the Gram-positive, spore-forming bacterium Bacillus anthracis. Infection is common in livestock and wild animals such as cattle, goats, sheep, camels, and antelopes. In humans, anthrax may occur after contact with contaminated carcasses or animal products like milk and meat. The best method to prevent anthrax in people is to ensure livestock are vaccinated, which significantly limits the risk of zoonotic spread to humans. However, the rate of vaccination of domesticated animals kept by nomadic pastoralists in West Africa is low. These groups regularly cross over national boundaries with their grazing herds. Nigeria is a country that historically has done comparatively well to contain this public health threat. However, in 2023 several outbreaks of human disease appear linked to the consumption of anthrax-contaminated animal products brought into Nigeria by pastoralists from neighboring countries. Clinical manifestations include skin sores or ulcers, nausea, vomiting, and fever. This article aims to raise awareness of recent outbreaks of anthrax in West Africa and to call for a renewed focus on measures to combat this neglected public health concern to the region. MAIN BODY: The imperative to pinpoint pivotal issues relating to the ongoing emergence of anthrax cases in Nigeria cannot be overstated. By delving into the prevalence of anthrax in both livestock and human populations residing along Nigeria's borders, unraveling the genetic diversity and potential sources of B. anthracis strains, and identifying the primary animal host(s) responsible for transmission, we stand to enhance our understanding of this critical issue. Furthermore, investigating the multifaceted factors contributing to anthrax transmission, assessing community knowledge and practices, mapping common migratory routes of pastoralists, and formulating targeted intervention strategies tailored to the challenges of border communities, are each crucial steps towards effective control and prevention. CONCLUSION: Closing these knowledge gaps on anthrax is not only essential for safeguarding both animal and human health but also for fostering sustainable and resilient communities. Addressing research questions on these interdisciplinary concerns will undoubtedly pave the way for informed decision-making, proactive measures, and a more secure future for Nigeria and its border regions.

Evaluation of a multi-component early warning system for pastoralist populations in Doolo zone, Ethiopia: mixed-methods study.

BACKGROUND: This study evaluated an early warning, alert and response system for a crisis-affected population in Doolo zone, Somali Region, Ethiopia, in 2019-2021, with a history of epidemics of outbreak-prone diseases. To adequately cover an area populated by a semi-nomadic pastoralist, or livestock herding, population with sparse access to healthcare facilities, the surveillance system included four components: health facility indicator-based surveillance, community indicator- and event-based surveillance, and alerts from other actors in the area. This evaluation described the usefulness, acceptability, completeness, timeliness, positive predictive value, and representativeness of these components. METHODS: We carried out a mixed-methods study retrospectively analysing data from the surveillance system February 2019-January 2021 along with key informant interviews with system implementers, and focus group discussions with local communities. Transcripts were analyzed using a mixed deductive and inductive approach. Surveillance quality indicators assessed included completeness, timeliness, and positive predictive value, among others. RESULTS: 1010 signals were analysed; these resulted in 168 verified events, 58 alerts, and 29 responses. Most of the alerts (46/58) and responses (22/29) were initiated through the community event-based branch of the surveillance system. In comparison, one alert and one response was initiated via the community indicator-based branch. Positive predictive value of signals received was about 6%. About 80% of signals were verified within 24 h of reports, and 40% were risk assessed within 48 h. System responses included new mobile clinic sites, measles vaccination catch-ups, and water and sanitation-related interventions. Focus group discussions emphasized that responses generated were an expected return by participant communities for their role in data collection and reporting. Participant communities found the system acceptable when it led to the responses they expected. Some event types, such as those around animal health, led to the community's response expectations not being met. CONCLUSIONS: Event-based surveillance can produce useful data for localized public health action for pastoralist populations. Improvements could include greater community involvement in the system design and potentially incorporating One Health approaches.

Animals in Mortuary Practices of Bronze-Age Pastoral Societies: Caprine Use at the Site of Dunping in Northwestern China.

The late second and first millennium BC witnessed extensive economic, cultural, and political exchanges between pastoralists and sedentary farming states in East Asia. Decades of archaeological fieldwork across northern China have revealed a large number of burial sites associated with pastoralists during the first millennium BC. These sites were characterized by the inhumation of specific animal parts in burials, predominantly the skulls and hooves of sheep, goats, cattle, and horses. However, the selection preference for these animals and how they were integrated into the mortuary contexts of these pastoral societies remain poorly investigated. Here, we report a preliminary analysis of caprine remains from 70 burials at the site of Dunping in the southern Gansu region of northwestern China, dated to approximately the seventh to fourth centuries BC. Based on an examination of species composition, post-depositional effects, traces of human alteration, skeletal element representation, and age at death, we discussed the selection, slaughtering, and inhumation of caprines concerning the mortuary practices at the site. Comparisons between Dunping and several other contemporaneous burial sites in neighboring regions, specifically in terms of the mortality profiles, further highlight distinct patterns in the selection of caprines for mortuary purposes among pastoral societies. These differences suggest varying degrees of emphasis placed on the economic and social significance attributed to caprines. Our findings provide new insights into the roles that caprines played in both ritual performances and subsistence practices among pastoralists in East Asia during the first millennium BC.

SEROPREVALENCE TO SCHISTOSOMA SOLUBLE EGG ANTIGEN AMONG NOMADIC PASTORALISTS RESIDING IN NORTHERN SENEGAL.

Urinary and intestinal schistosomiasis are endemic in Senegal, with prevalence heterogeneous throughout the country. Because of their way of life, nomadic pastoralists are not typically included in epidemiological surveys, and data on the prevalence of schistosomiasis in Senegalese nomadic populations are largely non-existent. The purpose of this study was to determine the seroprevalence of schistosomiasis in Senegalese nomadic pastoralists. A modified snowball sampling survey was conducted among 1,467 nomadic pastoralists aged 6 mo and older in 5 districts in northern Senegal. Dried blood spots from participants of all ages and data regarding demographics were collected to assess IgG antibody responses against Schistosoma mansoni soluble egg antigen (SEA) using a bead-based multiplex assay. Out of 1,467 study subjects, 1,464 (99.8%) provided IgG serological data that cleared quality assurance. Of the participants with appropriate data, 56.6% were male, the median age was 22 yr, and 31.6% were under 15 yr of age. The overall anti-SEA IgG seroprevalence was 19.1% (95% confidence interval [CI]: 17.1-21.1%) with the highest estimates observed in Dagana (35.9%) and the lowest observed in Podor nomadic groups (3.4%). Antibody responses increased significantly with age except for the oldest age groups (>40 yr of age), which saw lower levels of antibody response compared to younger adults. When controlling for age and location by multivariate regression, the male sex was associated with a 2-fold greater odds of anti-SEA IgG seropositivity (aPOR: 2.0; 95% CI: 1.5-2.7). Serosurveys for anti-SEA IgG among nomadic peoples in northern Senegal found a substantial percentage of individuals with evidence for current or previous Schistosoma spp. infection with the highest levels of exposure in the district adjacent to the Diama dam along the Senegal River. With IgG prevalence increased by age except in the older adults, and the male sex significantly associated with seropositivity, these data point toward sex-associated behavioral practices and human environmental modification as risk factors for Schistosoma exposure.

Factors determining antenatal care utilization among mothers of deceased perinates in Ethiopia.

Introduction: Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model. Method: Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR). Result: This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit. Conclusion: The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas.

Constraints to maternal healthcare access among pastoral communities in the Darussalam area of Mudug region, Somalia "a qualitative study".

Background: While countries embrace efforts to achieve Sustainable Development Goals (SDG) goal 3.1 (to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 and end preventable deaths of new-borns and children), an estimated 2.5 million pastoralists in Somalia are struggling to access maternal and child healthcare services. Institutional delivery and access to antenatal care remained to be a challenge in Somalia, where pastoralism is a common means of livelihood. The aim of this study is to explore the maternal health services available for settled pastoralists (transhumant) and their families who still practice nomadic pastoralism in the Mudug region of Somalia. Methods: A qualitative study, including 14 interviews and one FGD, was conducted in Darussalam village (a transhumant village along the border between Somalia and Ethiopia), Puntland State, from December 2022 to January 2023. The study participants were community members who support the maternal and child health clinic (MCH), village administration, and health providers. Results: We found that the efficiency of the health facilities that serve for pastoralist women and children are hampered by staff-related, supply-related, patients-related and referral-related constraints. This study highlights that the absence of essential supplies, the unmet need for training among the staff as well as the absence of important facilities in the MCH such as ambulance and blood bags. Conclusion: Numerous strides could be made in the provision of affordable maternal healthcare to pastoralist communities in Darussalam areas of the Mudug region when organizations that support health care in Somalia and the Ministry of Health include pastoralists' healthcare in their priorities.

Magnitude and factors influencing pastoralist women's maternity waiting home utilization in Teltelle district, Ethiopia: A cross-sectional study.

Background and Aims: Pastoralists in Ethiopia benefit the least from health-sector advances compared to the country's agrarian population. Maternity waiting homes (MWHs) have been established to provide mothers living in remote regions with access to skilled healthcare services during pregnancy, delivery, and postpartum periods. However, there is a dearth of data on the utilization of MWHs in pastoralist areas. Objectives: To assess maternity waiting home utilization and its associated factors among pastoralist women who gave birth in the last 12 months in Teltelle district, Southeastern Ethiopia; 2021. Methods: A community-based cross-sectional study was undertaken from March 1 to June 20, 2021. A multistage sampling technique was used to select the 458 study subjects. A pretested structured questionnaire was used to gather the data. For data entry and analysis, Epi-data version 4.4.3.1 and SPSS version 25.0 were utilized respectively. Models of bivariate and multivariate logistic regression were utilized to identify associated factors. In the multivariable analysis, variables with p < 0.05 were declared significantly associated with maternity waiting home utilization. Result: A total of 458 pastoralist women participated in the study. From the total participants, 26.64% [95% confidence interval: 22.57%-30.70%] of women utilized MWHs. Women's husband education status, complications during their last pregnancy, family support to MWHs, and community involvement and support were found to be significantly associated with the utilization of MWHs. Conclusion and Recommendation: This study found that utilization of MWHs was significantly lower in pastoralist areas of Ethiopia than in agrarian areas. Previous pregnancy complications, family support, husband's literacy, and community support were all significantly associated with improved maternity waiting home utilization. Encouraging community participation and family support are recommended to improve its utilization. Moreover, increasing community involvement in MWHs establishment and sustainability will be expected from the stakeholders.

Sexual and reproductive health services use among adolescents in pastoralist settings, northeastern Ethiopia.

BACKGROUND: Adolescents have special sexual and reproductive health (ASRH) needs and are susceptible to poor health outcomes. The global burden of ill sexual health includes a significant proportion of Adolescents. The existing ASRH services in Ethiopia and particularly in the Afar region are currently not well suited to meet the needs of pastoralist adolescents. This study assesses the level of ASRH service utilization among pastoralists in Afar regional state, Ethiopia. METHOD: A community based cross-sectional study was conducted from January to March 2021 in four randomly chosen pastoralist villages or kebeles of Afar, Ethiopia. A multistage cluster sampling procedure was used to select 766 volunteer adolescents aged 10-19. SRH services uptake was measured asking whether they had used any SRH service components during the last year. Data was collected through face-to-face interviews with a structured questionnaire; data entry was done with Epi info 3.5.1. Logistic regression analyses was used to assess associations with SRH service uptake. SPSS version 23 statistical software package was used for advanced logistic regression analyses to assess the associations between dependent and predictor variables. RESULTS: The study revealed that two-thirds or 513 (67%) of the respondents are aware of ASRH services. However, only one-fourth (24.5%) of the enrolled adolescents used at least one ASRH service in the past twelve months. ASRH services utilization was significantly associated with gender (being female [AOR = 1.87 (CI 1.29-2.70)], being in school [AOR = 2.38(CI: 1.05-5.41), better family income [AOR = 10.92 (CI; 7.10-16.80)], prior discussions of ASRH issues [AOR = 4.53(CI: 2.52, 8.16)], prior sexual exposure [AOR = 4.75(CI: 1.35-16.70)], and being aware of ASRH services [AOR = 1.96 (CI: 1.02-3.822)]. Being pastoralist, religious and cultural restrictions, fear of it becoming known by parents, services not being available, income, and lack of knowledge were found to deter ASRH service uptake. CONCLUSION: Addressing ASRH needs of pastoralist adolescents is more urgent than ever, sexual health problems are increasing where these groups face broad hurdles to SRH service uptake. Although Ethiopian national policy has created an enabling environment for ASRH, multiple implementation issues require special attention to such neglected groups. "Gender-culture-context-appropriate" interventions are favorable to identify and meet the diverse needs of Afar pastoralist adolescents. Afar regional education bureau and concerned stakeholders need to improve adolescent education to overcome social barriers (e.g. humiliation, disgrace, and deterring gender norms) against ASRH services through community outreach programs. In addition, economic empowerment, peer education, adolescent counseling, and parent-youth communication will help address sensitive ASRH issues.

Health facility delivery service utilization and its associated factors among women in the pastoralist regions of Ethiopia: A systematic review and meta-analysis.

Background and Aims: Utilizing health facility delivery services is one of the pillars of lowering maternal mortality. However, the coverage of health facility delivery service utilization continues to be uneven around the world. In Ethiopia, particularly among pastoralist regions, health facility delivery service utilization is less common. Therefore, the purpose of this study was to determine the pooled prevalence of health facility delivery service utilization and identify the associated factors among women in the pastoralist regions of Ethiopia. Methods: A comprehensive systematic search was carried out in PubMed/MEDLINE, Hinary, Cochrane Library, Google Scholar, Google, and Ethiopian online university repositories. Studies were appraised using the JBI appraisal checklist. The analysis was done using STATA version 16. The pooled analysis was conducted using DerSimonian and Laird random-effects model. I 2 test and Eggers & Begg's tests were used to assess the heterogeneity and publication bias, respectively. p < 0.05 was set to determine the statistical significance of all the tests. Results: The pooled prevalence of health facility delivery service utilization was 23.09% (95% CI: 18.05%-28.12%). Have ANC visit during pregnancy (OR = 3.75, [95% CI: 1.84-7.63]), have information regarding maternal health service fee exemption (OR = 9.51, [95% CI: 1.41-64.26]), have a nearby health facility (OR = 3.49, [95% CI: 1.48-8.20]), and women attend secondary and above education (OR = 3.06, [95% CI: 1.77-5.29]) were found to be significant associated factors. Conclusions: Health facility delivery service utilization is very low in pastoralist regions of Ethiopia, and ANC follow-up, distance from the health facility, women's educational status, and information regarding maternal health service fees were identified as significant associated factors. Consequently, strengthening ANC services, introducing free health services to the community, and constructing health facilities for the nearby residents are recommended to improve the practice.

Response to back-to-back outbreaks of circulating vaccine-derived poliovirus type 2 in two nomadic pastoralist settlements in Oti Region, Ghana-2019.

BACKGROUND: The global switch from trivalent oral poliovirus vaccine (OPV) to bivalent OPV in April 2016 without corresponding co-administration of inactivated poliovirus vaccine (IPV) until June 2018, created a cohort of poliovirus type 2 naïve children with risk of developing vaccine-derived poliovirus type 2 (VDPV2). In November and December 2019, two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were confirmed in quick succession through Acute Flaccid Paralysis (AFP) surveillance in two nomadic pastoralist settlements in Oti Region. We investigated to determine the outbreak extent, identify risk factors and implement control and preventive measures. METHODS: We interviewed case-patients' families, abstracted immunization records, assessed AFP surveillance and conducted rapid OPV and IPV vaccination coverage surveys. Using AFP case definition of any child less than 15 years in the community with sudden onset of paralysis from July to November 2019 (in case-patient 1's district) and August to December 2019 (in case-patient 2's district), we conducted active case search. Stool samples from apparently healthy children and close contacts of the case-patients were collected and tested for poliovirus. We conducted environmental assessment of the community to identify potential risk factors. RESULTS: Case-patient 1 was an eight-year-old female who had taken two doses of OPV while case-patient 2 was an eight-month-old male who had taken three out of required four OPV doses in addition to IPV at seven months. Families of both case-patients had either travelled to or received visitors from areas with confirmed cVDPV2. Of all children surveyed, eight (29.6%) of 27 and three (18.8%) of 16 eligible children in communities of case-patient 1 and 2 respectively had received required four doses of OPV. No AFP case was found in both communities and surrounding settlements. Both communities had no source of potable water and toilet facilities. A stool sample from a contact of case-patient 1 tested positive for cVDPV2. CONCLUSION: Outbreaks of cVDPV2 occurred in insanitary, under-vaccinated nomadic pastoralist settlements in Oti Region. Three rounds of monovalent OPV vaccination campaigns for children under 5 years of age in the districts and region as well as countrywide IPV vaccination campaign for poliovirus type 2 naïve cohort were conducted.

Treatment outcomes and challenges of treating tuberculosis in children in a nomadic pastoralist community in Kenya.

Background: Tuberculosis in children has remained a major cause of childhood morbidity and mortality, especially in the developing countries where it has been associated with marginalization, vulnerability and poverty. Study objectives: To evaluate treatment outcomes and determine the challenges experienced by health providers while treating tuberculosis in children in a nomadic pastoralist community in Kenya. Methods: This was a descriptive cross sectional study design utilizing mixed methods, conducted at Lodwar County Referral Hospital in Turkana County- Kenya. We utilized census sampling method to get 59 medical records and 8 nurses. Data were collected using data abstraction form and in-depth interviews. Treatment outcomes were determined quantitatively while challenges were described qualitatively using thematic approach. Results: A total of 59 paediatric patients had been diagnosed with tuberculosis between the months of January 2021 and April 2021. Most of them were new cases. Children who were under five years constituted the highest proportion (61%). Most of the patients had completed their treatment (69.5%), loss to follow up 6.8%, transferred out 11.9%, died 8.5% while those who were not evaluated were 3.4%. Lifestyle and habit, lack of system support and lack of properly formulated dosage for children were the challenges experienced by the health care providers. Conclusion: Although, most of the patients (69.5%) had completed their treatment, treatment complete rate remained below the standard set by the World Health Organisation (90%). Health system posed most of the challenges experienced by the health care providers at the hospital.

Seedling survival after simulating grazing and drought for two species from the Pamirs, northwestern China.

For plant populations to persist, seedling recruitment is essential, requiring seed germination, seedling survival and growth. Drought and grazing potentially reduce seedling recruitment via increased mortality and reduced growth. We studied these seed-related processes for two species indigenous to the Pamir Mountains of Xinjiang in northwestern China: Saussurea glacialis and Plantago lessingii. Seeds collected from Taxkorgan, Xinjiang, had a viability rate of 15.8% for S. glacialis but 100% for P. lessingii. Of the viable seeds, the highest germination rates were 62.9% for S. glacialis and 45.6% for P. lessingii. In a greenhouse experiment, we imposed a series of stressful conditions, involving a combination of simulated grazing and drought events. These had the most severe impact on younger seedlings. Modelling showed that 89% of S. glacialis mortality was due to early simulated grazing, whereas 80% of P. lessingii mortality was due to early simulated drought. Physiological differences could contribute to their differing resilience. S. glacialis may rely on water storage in leaves to survive drought events, but showed no shifts in biomass allocation that would improve grazing tolerance. P. lessingii appears more reliant on its root system to survive grazing, but the root reserves of younger plants could be insufficient to grow deeper in response to drought. After applying all mortality factors, 17.7 seedlings/parent of P. lessingii survived, while only <0.1 seedlings/parent of S. glacialis survived, raising concerns for its capacity to persist in the Pamirs. Inherent genetic differences may underlie the two species' contrasting grazing and drought responses. Thus, differing conservation strategies are required for their utilization and protection.