Personal inhalable paper dust exposure and potential determinants among paper industry workers in Ethiopia.

PURPOSE: Excessive paper dust during paper production may harm the workers' respiratory health. We wanted to assess the inhalable paper dust levels and its determinants among paper industry workers. METHODS: A study was conducted in Ethiopia to assess the level of personal inhalable paper dust exposure among four paper mills. A total of 150 samples were collected using the IOM sampler attached to Side Kick Casella pumps at a flow rate of 2 L/min. The samples were analyzed in Nemko Norlab, Norway. Linear mixed-effect models were applied to identify determinants of inhalable paper dust. RESULTS: The geometric mean of personal inhalable paper dust was 3.3 mg/m3 with 80% of the measurements exceeding the Swedish occupational exposure limit (OEL) of 2 mg/m3. The linear mixed-effects model showed that the level of dust was 28% higher when using high-speed than when using low-speed rewinding machines, while paper mills with an average of more than four machines per job group had 22% higher exposure than paper mills with a lower number of machines. Furthermore, working in packing and preparation was associated with higher dust exposure than in other areas. CONCLUSIONS: The dust exposure levels were above the Swedish OEL for 80% of the samples. This indicates that preventive measures should be established in the industry. The exposure model identified high-speed rewinding machines, a high number of machines, and work in preparation and packing as associated with high levels of paper dust exposure.

Assessment of occupational exposure to lead among workers engaged in a city bus garage in Addis Ababa, Ethiopia: a comparative cross-sectional study.

BACKGROUND: Lead is one of the most nonessential toxic heavy metal agents found in automotive garages. The occupational exposure of garage workers to lead commonly poses acute and chronic health risks that can be prevented. In Ethiopia, there have been limited studies on lead exposure among garage workers, who overemphasize exposure to lead. This study aimed to assess occupational blood lead levels and associated factors in garage workers using a cross-sectional comparative design. METHODS: A comparative cross-sectional study design was used to compare the occupational blood lead levels of 36 randomly selected garage workers and 34 office workers who were matched by age and sex. Blood specimens were collected by trained medical laboratory experts. The collected blood samples were tested in a certified laboratory using a microwave plasma atomic emission spectrometry (MP-AES) device at a wavelength of 405.78 nm. Excel and SPSS Version 26 were used for data management and analysis, respectively. RESULTS: The mean (SD) age of the exposed group was 39.0 (7.5) years, whereas the mean age of the unexposed group was 38.0 (6.1) years. The occupational mean (SD) blood-lead-level in the exposed groups was 29.7 (12.2) µg/dl, compared to 14.8 (9.9) µg/dl among the unexposed groups. The mean blood-lead level among the exposed workers was significantly different from that among the unexposed workers (P < 0.01). Of all the study participants, only 22.2% of the exposed groups had blood lead levels higher than the World Health Organization's recommended limit of 40 µg/dl. The main significant predictors of occupational blood-lead-level exposure among workers were extra working hours, service years, and having a previous (prior) employment history in a garage. The occupations of the two groups did not significantly differ in terms of blood-lead levels (p > 0.05). CONCLUSIONS: The BLL of the Garage workers was significantly greater than that of the Non-Garage workers. Hence, it is advised that garage management should encourage workers to use exposure prevention methods, such as washing their hands before eating and taking showers after the completion of work, by providing regular occupational safety training.

Burden of Childhood Diarrhea and Its Associated Factors in Ethiopia: A Review of Observational Studies.

Objectives: This systematic review and meta-analysis aimed to: i) determine the pooled prevalence of acute diarrhea; and ii) synthesize and summarize current evidence on factors of acute diarrheal illnesses among under-five children in Ethiopia. Methods: A comprehensive systematic search was conducted in PubMed, SCOPUS, HINARI, Science Direct, Google Scholar, Global Index Medicus, Directory of Open Access Journals (DOAJ), and the Cochrane Library. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The methodological quality of each included article was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for cross-sectional and case-control studies. A random-effect meta-analysis model was used to estimate the pooled prevalence of diarrheal illnesses. Heterogeneity and publication bias were assessed using I2 test statistics and Egger's test, respectively. The statistical analysis was done using STATA™ software version 14. Results: Fifty-three studies covering over 27,458 under-five children who met the inclusion criteria were included. The pooled prevalence of diarrhea among under-five children in Ethiopia was found to be 20.8% (95% CI: 18.69-22.84, n = 44, I2 = 94.9%, p < 0.001). Our analysis revealed a higher prevalence of childhood diarrhea in age groups of 12-23 months 25.42% (95%CI: 21.50-29.35, I2 = 89.4%, p < 0.001). In general, the evidence suggests that diarrheal risk factors could include: i) child level determinants (child's age 0-23 months, not being vaccinated against rotavirus, lack of exclusive breastfeeding, and being an under-nourished child); ii) parental level determinants {mothers poor handwashing practices [pooled odds ratio (OR) = 3.05; 95% CI:2.08-4.54] and a history of maternal recent diarrhea (pooled OR = 3.19, 95%CI: 1.94-5.25)}; and iii) Water, Sanitation and Hygiene (WASH) determinants [lack of toilet facility (pooled OR = 1.56, 95%CI: 1.05-2.33)], lack handwashing facility (pooled OR = 4.16, 95%CI: 2.49-6.95) and not treating drinking water (pooled OR = 2.28, 95% CI: 1.50-3.46). Conclusion: In Ethiopia, the prevalence of diarrhea among children under the age of five remains high and is still a public health problem. The contributing factors to acute diarrheal illnesses were child, parental, and WASH factors. A continued focus on improving access to WASH facilities, along with enhancing maternal hygiene behavior will accelerate reductions in diarrheal disease burden in Ethiopia.

Fine particulate matter air pollution and health implications for Nairobi, Kenya.

Background: Continuous ambient air quality monitoring in Kenya has been limited, resulting in a sparse data base on the health impacts of air pollution for the country. We have operated a centrally located monitor in Nairobi for measuring fine particulate matter (PM2.5), the pollutant that has demonstrated impact on health. Here, we describe the temporal levels and trends in PM2.5 data for Nairobi and evaluate associated health implications. Methods: We used a centrally located reference sensor, the beta attenuation monitor (BAM-1022), to measure hourly PM2.5 concentrations over a 3-year period (21 August 2019 to 20 August 2022). We used, at minimum, 75% of the daily hourly concentration to represent the 24-hour concentrations for a given calendar day. To estimate the deaths attributable to air pollution, we used the World Health Organization (WHO) AirQ+ tool with input as PM2.5 concentration data, local mortality statistics, and population sizes. Results: The daily (24-hour) mean (±SEM) PM2.5 concentration was 19. 2 ± 0.6 (µg/m3). Pollutant levels were lowest at 03:00 and, peaked at 20:00. Sundays had the lowest daily concentrations, which increased on Mondays and remained high through Saturdays. By season, the pollutant concentrations were lowest in April and highest in August. The mean annual concentration was 18.4 ± 7.1 (µg/m3), which was estimated to lead to between 400 and 1,400 premature deaths of the city's population in 2021 hence contributing 5%-8% of the 17,432 adult deaths excluding accidents when referenced to WHO recommended 2021 air quality guideline for annual thresholds of 5 µg/m3. Conclusion: Fine particulate matter air pollution in Nairobi showed daily, day-of-week, and seasonal fluctuations consistent with the anthropogenic source mix, particularly from motor vehicles. The long-term population exposure to PM2.5 was 3.7 times higher than the WHO annual guideline of 5 µg/m3 and estimated to lead to a substantial burden of attributable deaths. An updated regulation targeting measures to reduce vehicular emissions is recommended.

Welding fume exposure and prevalence of chronic respiratory symptoms among welders in micro- and small-scale enterprise in Akaki Kality sub-city, Addis Ababa, Ethiopia: a comparative cross-sectional study.

BACKGROUND: Exposure to welding fumes can lead to different respiratory health disorders, including lung cancer, due to long-term exposures. In Ethiopia, large numbers of people are engaged in the welding sector. Often, these workers are exposed to welding fumes at their workplaces, however, the level of exposure and its health effects have never been studied. OBJECTIVE: To measure the level of personal welding fume exposure and assess chronic respiratory symptoms and associated factors, among micro and small-scale enterprise metal workshop workers, in Akaki Kality Sub city, Ethiopia. METHODS: A comparative cross-sectional study involving 226 welders and 217 controls. Chronic respiratory symptoms were assessed using a standardized questionnaire adopted from the American Thoracic Society (ATS). Welding fumes were collected from the welder's breathing zone using 37 mm close-faced plastic cassettes fitted with Polyvinyl Chloride (PVC) filters connected to Casella pumps at an airflow rate of 2 L/min. RESULT: The overall prevalence of chronic respiratory symptoms among welders and controls were 54 (23.9%) and 20 (9.2%) respectively. The geometric mean and geometric standard deviation (GSD) of personal welding fume exposure, among welders was 5.98 mg/m3 (± GSD = 1.54). In this study, 53.3% of the samples exceeded the Occupational Exposure Limit defined by the American Conference of Governmental Industrial Hygiene. Chronic respiratory symptoms were significantly associated with educational status (Adjusted Odds Ratio (AOR): 5.11, 95% CI: 1.35, 19.33), respiratory protective equipment use (AOR: 3.33, 95% CI: 1.52, 7.31), safety training (AOR: 2.41, 95% CI: 1.10, 5.28), smoking (AOR:3.57, 95% CI: 1.54, 8.23), welding machine maintenance (AOR: 1.87, 95% CI: 1.01, 3.59) and welding site (i.e. indoors vs. outdoor) (AOR: 6.85. 95% CI: 2.36, 19.89). CONCLUSIONS: The prevalence of chronic respiratory symptoms among welding workers was significantly higher than controls. More than half of the samples exceeded the Occupational Exposure Limit. Educational status, implementation of safety training, and welding sites were significantly associated with chronic respiratory symptoms. The results suggested a need to reduce welding fume exposure to improve the respiratory health of the workers.

Impact of Covid -19 incidence rate and government-initiated risk communication measures on individual's NPI practices.

BACKGROUND: Non-pharmaceutical interventions (NPI) are the most widely recognized public health measures recognized globally to prevent the spread of Covid-19. NPIs' effectiveness may depend on the type, combination of applied interventions, and the level of proper public compliance with the NPIs. The expected outcome of behavioural practices varies relative to the intervention duration. OBJECTIVES: This study aimed to assess the trend of community compliance to NPI with Covid-19 incidence and government-initiated interventions, and its variation by residence and sociodemographic characteristics of people. METHODS: A weekly non-participatory field survey on individuals' NPI practices was observed from the 41st epidemiological week of October 5th, 2020, to the 26th epidemiological week of July 4th, 2021, a total of 39 weeks. The survey covered all 14 regional and national capital cities in Ethiopia. Data collection for the three NPI behaviours (i.e., respiratory hygiene, hand hygiene, and physical distance) was managed weekly at eight public service locations using the Open Data Kit (ODK) tool. The Covid- 19 incidence data and public health measures information from August 3rd, 2020 to July 4th, 2021 were obtained from the Ethiopian Public Health Institute (EPHI). RESULTS: More than 180,000 individuals were observed for their NPI practice, with an average of 5,000 observations in a week. About 43% of the observations were made in Addis Ababa, 56% were male and 75% were middle age group (18-50 years). The overall level of NPI compliance was high at the beginning of the observation then peaked around the 13th- 15th epidemiological weeks then declined during the rest of the weeks. The peak NPI compliance periods followed the high Covid-19 death incidence and government-initiated intensive public health measures weeks. Respiratory hygiene had the highest compliance above 41% whereas hand hygiene was the lowest (4%). There was a significant difference between residents of the capital city and regional cities in their level of compliance with NPI. Females comply more than males, and individuals had increased NPI compliance at the bank service and workplaces compared to those in the transport services at P = 0.000. CONCLUSION: An increased level of compliance with NPI was observed following intensive government-initiated Covid-19 prevention measures and an increased Covid-19 death incidence. Therefore, the intensity of government-initiated risk communication and public advocacy programs should be strengthened, possibly for similar respiratory disease pandemics in the future.

Bacterial contamination of coffee and personal exposure to inhalable dust and endotoxin in primary coffee processing factories in Ethiopia.

INTRODUCTION AND OBJECTIVE: Endotoxins from gram-negative bacteria might be released when the coffee cherries are processed and may cause respiratory health problems among workers in the coffee industry. The relationship between bacterial contamination and occupational exposure to endotoxin levels has not been thoroughly explored previously in primary coffee processing factories in Ethiopia, or elsewhere. The aim of this study was to characterize the level of personal endotoxin exposure and its relations with bacterial contamination of coffee cherries in such factories in Ethiopia. MATERIAL AND METHODS: A cross-sectional study was conducted from March 2020 - February 2021 in 9 primary coffee processing factories in 3 regions in Ethiopia. A total of 180 personal air samples were collected to analyze workers' exposure to inhalable dust and endotoxin. Correlation tests were performed to assess the relationship between total bacteria and endotoxin levels and between inhalable dust and endotoxin levels. RESULTS: The geometric mean (GM) of personal inhalable dust exposure among machine room workers and hand pickers were 9.58 mg/m3 and 2.56 mg/m3, respectively. The overall GM of endotoxin exposure among machine room workers and hand pickers were 10,198 EU/m3 and 780 EU/m3, respectively. Gram-negative bacteria were found in all 54 coffee samples. The correlation between inhalable dust and endotoxin exposure was significant (r=0.80; P <0.01). CONCLUSIONS: About 92% of the samples from hand pickers and all samples from machine room workers exceeded the occupational exposure limit of 90 EU/m3 recommended by the Dutch Expert Committee on Occupational Standards. Prevention and control of bacterial contamination of the coffee in primary coffee processing are suggested to reduce endotoxin exposure that might cause respiratory health problems among coffee workers.

Exploring Community Perceptions of COVID-19 and Vaccine Hesitancy in Selected Cities of Ethiopia: A Qualitative Study.

Even though the COVID-19 vaccine has been available and free of charge to the targeted population in Ethiopia, the vaccination rate was lower than needed to achieve herd immunity at community level. This study aimed to explore community perceptions of COVID-19 and vaccine hesitancy in selected cities of Ethiopia involving 70 in-depth interviews and 28 focused group discussions. The audio-taped data were transcribed verbatim, translated into English, and analyzed using a qualitative content analysis approach using the ATLAS.ti software version 8. The findings revealed that COVID-19 was perceived as evil and caused fear and frustration upon its emergence. The community initially used traditional remedies for its prevention but later transitioned to employing non-pharmaceutical interventions. The primary reasons for vaccine hesitancy were misinformation and misconceptions, such as connecting the vaccine with the mark of the beast, a lack of trust due to the multiple vaccine types, a shorter production timeline resulting in distrust of its effectiveness, and a fear of pain and side effects. Based on our findings, we recommend monitoring the use of social media and countering misinformation with the correct information and continuous public health campaigns. Further studies should be conducted to assess the types and magnitude of impacts from the myths and misconceptions on vaccination uptake.

Pregnant women's perception on the health effects of household air pollution in Rural Butajira, Ethiopia: a phenomenological qualitative study.

BACKGROUND: Household air pollution is the major public health problem in developing countries. Pregnant women spent the majority of their time at home and are the most affected population by household air pollution. Exploring the perception of pregnant women on adverse health effects is important to enhance the mitigation strategies. Therefore, this study aim to explore the pregnant women's perceptions about health effects of household air pollution in rural Butajira, Ethiopia. METHODS: A phenomenological qualitative study design was conducted among 15 selected pregnant women. All interviews were carried out at the participants´ house and audio-recorded while housing and cooking conditions were observed and appropriate notes were taken for each. The collected data were transcribed verbatim and translated into the English language. Then, the data were imported into Open code software to manage the overall data coding processes and analyzed thematically. RESULTS: Study participants perceived that respiratory problems such as coughing, sneezing and asthma and eye problem were the major health problem caused by household air pollution among pregnant women. Study participants also mentioned asphyxiated, abortion, reduces weight, and hydrocephalus was caused by household air pollution on the foetus. Study participants perceived that financial inability, spouse negligence, autonomy and knowledge level of the women were the barriers to tackling household air pollution. Study participant also suggested that opening the door and window; using improved cookstove and reduce workload were the perceived solution for household air pollution. CONCLUSIONS: This study explores pregnant women's perceptions on health effects of household air pollution. The finding of this study was important to deliver suitable intervention strategies to mitigate household air pollution. Therefore, educating the women on way of mitigating household air pollution, improving existing structure of the house and minimize the time to stay in the kitchen is important to mitigate household air pollution exposure.

Fine particulate matter air pollution and the mortality of children under five: a multilevel analysis of the Ethiopian Demographic and Health Survey of 2016.

Background: Every year, polluted air is costing the globe 543,000 deaths of children under five. The particulate matter below 2.5 µm diameter (PM2.5) is a part of air pollution that has adverse effects on children's health. In Ethiopia, the effect of ambient PM2.5 is least explored. This study aimed to assess the association between PM2.5 and under-five mortality in Ethiopia. Methods: The study used the data from the Ethiopian Demographic Health Surveys conducted in 2016, collected between January 18 and June 27. All children under five who had data on child mortality and location coordinates were included in the study. Exposure to ambient PM2.5 concentration was a satellite-based estimate by the Atmospheric Composition Analysis Group at Washington and Dalhousie University, in the United States and Canada, respectively. Annual mean pollution levels and mortality datasets were matched by children's geographical location and dates of birth, death, and interview. The relationship between ambient PM2.5 and under-five mortality was determined by a multilevel multivariable logistic regression on R software. The statistical analyses were two-sided at a 95% confidence interval. Results: The study addressed 10,452 children with the proportion of under-five mortality being 5.4% (95% CI 5.0-6.8%). The estimated lifetime annual mean exposure of ambient total PM2.5 was 20.1 ± 3.3 µgm-3. A 10-unit increase in the lifetime annual mean ambient total PM2.5 was associated with 2.29 [95% CI 1.44, 3.65] times more odds of under-five mortality after adjusting for other variables. Conclusion: Children under five are exposed to higher levels of ambient PM2.5 concentration, exceeding the limit set by the World Health Organization. Ambient PM2.5 is significantly associated with under-five mortality, adjusting for other variables. Strong measures need to be taken to reduce air pollution.

The coexistence of stunting and overweight or obesity in Ethiopian children: prevalence, trends and associated factors.

BACKGROUND: Double burden of childhood malnutrition is a condition where undernutrition (stunting) along with overweight and obesity coexist within individuals, households, and populations. It reflects a new layer of malnutrition and an understudied phenomenon in many low-income settings. To date, the prevalence and factors that are associated with concurrent stunting and overweight or obesity (overweight/obesity) (CSO) in the same children have not been well researched in Ethiopia. Hence, this study aimed to assess the prevalence, trends, and factors associated with the coexistence of stunting and overweight or obesity among children aged 0-59 months in Ethiopia. METHODS: Pooled data from 2005, 2011 and 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A total of 23,756 (weighted sample) children aged 0-59 months were included in the study. Height-for-age z-scores (HAZ) less than - 2 SD and weight-for-height z-scores (WHZ) above 2 SD were calculated, and children were classified as stunted and overweight/obese, respectively. A child who is simultaneously stunted and overweight/obese was considered as having HAZ below - 2 SD and WHZ above 2 SD computed into a variable named CSO, and reported as a binary outcome (yes or no). Multilevel logistic regression analysis that adjusts for sampling weights and clustering was used to identify factors associated with CSO. RESULTS: The prevalence of stunting, overweight or obesity, and CSO among under-five children was 43.12% [95% CI: (42.50, 43.75%)], 2.62% [95% CI: (2.42, 2.83%)], and 1.33% [95% CI: (1.18, 1.48%)], respectively. The percentage of CSO children was reported to have declined from 2.36% [95% CI: (1.94-2.85)] in 2005 to 0.87% [95%CI: (0.07-1.07)] in 2011, and the same appeared to have increased slightly to 1.34% [95%CI: (1.13-1.59)] in 2016. Children who were currently breastfeeding [AOR: 1.64, 95%CI: (1.01-2.72)], born to an overweight mother [AOR: 2.65, 95%CI: (1.19-5.88)], and lived in families with 1-4 household members [AOR: 1.52, 95%CI: (1.02-2.26)] were significantly associated with CSO. At the community level the odds of having CSO were higher among children included from EDHS-2005 [AOR: 4.38, 95%CI: (2.42-7.95)]. CONCLUSION: The study revealed that less than 2% of children had CSO in Ethiopia. CSO was linked to factors at both the individual (i.e. breastfeeding status, maternal overweight, and household size) and community-levels. Overall, the study findings indicated the necessity of focused interventions to simultaneously address double burden of childhood malnutrition in Ethiopia. To further combat the double burden of malnutrition, early identification of at-risk children, including those born to overweight women and children living with multiple household members, is indispensable.

Nonfatal Occupational Injuries Among Artisanal and Small-scale Gold Mining Workers in Ethiopia.

Background: Artisanal and Small-scale Gold Mining (ASGM) is widely practiced in Ethiopia. Injuries are among the public health concerns in the mining sector. This study aimed to assess the prevalence of nonfatal occupational injuries and associated factors among workers in ASGM in Ethiopia. Methods: A cross-sectional study design was employed from April to June 2020. A total of 403 participants were selected with a simple random sampling technique. A structured questionnaire was utilized for the data collection. Descriptive statistics were used to characterize the information and binary logistic regression was applied to test the association. Predictor variables with P-value < .05 with an Odds ratio of 95% CI in multivariable analysis were considered as associated factors. Results: A total of 403 participants were interviewed with a response rate of 95.5%. The prevalence of nonfatal occupational injury was 25.1% in the past 12 months. About one-third of the injuries, 32 (31.7%), were on the upper extremity and feet, 18 (17.8%). Symptoms of mercury toxicity (AOR: 2.39, 95% CI [1.27-4.52]), 1 to 4 years of work experience (AOR: 4.50, 95% CI [1.57-12.9]), full work shift (AOR: 6.06, 95% CI [1.97-18.7]), and job in the task of mining activities (AOR: 4.83, 95% CI [1.48-15.7]) were associated with the injury. Conclusion: A substantially high prevalence of injuries was observed. Work-related factors were found to be significantly associated with the occurrence of injury. The government body, mining sector, and workers are advised to apply interventions focusing on the improvement of working conditions and safety practices to minimize injury.

The spatial and temporal variation of fine particulate matter pollution in Ethiopia: Data from the Atmospheric Composition Analysis Group (1998-2019).

BACKGROUND: Evidence suggests ambient fine particulate matter (PM2.5) is a risk factor for cardiovascular diseases, lung cancer morbidity and mortality, and all-cause mortality. Countries that implement strong policies are able to reduce ambient PM2.5 concentration. In Ethiopia, however, PM2.5 monitoring stations, laboratory technicians, and equipment are staggeringly limited. In this study, the spatial and temporal variation of PM2.5 in Ethiopia was assessed. METHODS: Satellite-based PM2.5 estimates, from the year 1998 to 2019, by Atmospheric Composition Analysis Group (ACAG) at a spatial resolution of 0.01° X 0.01° was used. The annual mean PM2.5 concentration for all administrative regions and zones in Ethiopia was extracted. The average mean from the twenty-two years was also calculated. The trend of PM2.5 concentration was graphed and quantitatively calculated using the Mann-Kendall test. The slope of the change over time was estimated using the Theil-Sen slope. At the zonal administration level, for the average annual mean, spatial dependency using univariate Global Moran's I and clustering and outlier tests using Anselin Local Moran's were performed. RESULTS: The country's average annual mean PM2.5 concentration was 17 µgm-3. The Afar region had the highest concentration, 27.9 µgm-3. The Mann-Kendall S was positive and significant at p<0.001. The spatial distribution of satellite-based ambient PM2.5 concentration was non-random. Significant highest value clustering of ambient total PM2.5 concentration exists in the Afar, Eastern Tigray, and Eastern and Southeastern Amhara while the significant lowest value dispersing was observed in the Southern Oromia and Somali region. CONCLUSION: At the national and regional levels, the annual mean ambient PM2.5 concentration is beyond the World Health Organization (WHO)-recommended level. The ambient PM2.5 concentration distribution is spatially dependent and significantly clustered in space. Installation of additional ground-based PM2.5 monitoring devices, particularly in regions where PM2.5 concentration is higher, is recommended. Validating satellite-based PM2.5 data with ground-based measurements in the country is also advised.

Concurrent wasting and stunting among under-five children in the context of Ethiopia: A generalised mixed-effects modelling.

Concurrent wasting and stunting (WaSt) is a condition where both wasting and stunting exist in a child at the same time. This study aimed to assess the prevalence of WaSt and to identify potential associated factors in Ethiopia.  A total of 33,650 children aged between 0 and 59 months were included in the analysis from the four waves of the Ethiopian Demographic and Health Survey. A mixed-effects logistic regression model was used to identify the determinants of WaSt. The prevalence of WaSt was found to be 4.7% (95% confidence interval [CI]: (4.5-4.9)), with respectively 2.5% (95% CI: 2.1-3.1) and 4.9% (95% CI: 4.7-5.2) among children in urban and rural settings. Children: (i) in the age group 12-23 months (adjusted odds ratio [AOR]: 4.16, 95% CI: (3.20-5.42)) and 24-59 months (AOR: 3.08, 95% CI: (2.28-4.17)); (ii) who were perceived by their mothers to be smaller than normal at birth (AOR: 1.98, 95% CI: (1.57-2.50)); (iii) had diarrhoea (AOR: 1.38, 95% CI: (1.11-1.71)); and (iv) fever in the past 2 weeks (AOR: 1.38, 95% CI: (1.10-1.71)) reported higher odds of WaSt. Being a female child (AOR: 0.57, 95% CI: (0.48-0.69)), having received measles vaccination (AOR: 0.71, 95% CI: (0.55-0.89)), having a mother with a normal body mass index (18.5-24.9 kg/m2 ) (AOR: 0.57, 95% CI: (0.48-0.68)), having a wealthier household (AOR: 0.67, 95% CI: (0.50-0.90)), and living in rural setting (AOR: 0.49, 95% CI: (0.32-0.74)) were associated with reduced odds of WaSt. The prevalence of WaSt was high, with approximately 1 in 20 Ethiopian children suffering from the condition and needing a prompt response to minimize the poor health and developmental outcomes. Children perceived by their mother to be smaller than normal at birth, older children, and babies with diarrhoea and fever had higher odds of WaSt.

Determinants of undernutrition among young children in Ethiopia.

Ethiopia is one of the countries in sub-Saharan Africa with the highest burden of childhood undernutrition. Despite the high burden of this scourge, little is known about the magnitude and contributing determinants to anthropometric failure among children aged 0-23 months, a period regarded as the best window of opportunity for interventions against undernutrition. This study examined factors associated with undernutrition (stunting, wasting, and underweight) among Ethiopian children aged 0-23 months. This study used a total weighted sample of 2146 children aged 0-23 months from the 2019 Ethiopian Mini Demographic and Health Survey. The data were cleaned and weighted using STATA version 14.0. Height-for-age (HFA), weight-for-height (WFH), and weight-for-age (WFA) z-scores < - 2 SD were calculated and classified as stunted, wasting, and underweight, respectively. Multilevel mixed-effects logistic regression models adjusted for cluster and survey weights were used. Adjusted odds ratio (AOR) and 95% confidence interval (CI) were estimated. Statistical significance was declared at p < 0.05. The overall weighted prevalence of stunting, wasting, and underweight respectively were 27.21% [95% CI (25.32-29.18)], 7.80% [95% CI (6.71-9.03)], and 16.44% [95% CI (14.90-18.09)] among children aged 0-23 months in Ethiopia. Female children were less likely to be associated with stunting [AOR: 0.68, 95% CI (0.54-0.86)], wasting [AOR: 0.70, 95% CI (0.51, 0.98)], and underweight [AOR: 0.64, 95% CI (0.49, 0.83)] than their male counterparts. Conversely, older children aged 12-17 months [AOR: 2.22, 95% CI (1.52, 3.23)] and 18-23 months [AOR: 4.16, 95% CI (2.75, 6.27)] were significantly at an increased odds of becoming stunted. Similarly, the likelihood of being underweight was higher in older age groups: 6-11 months [AOR: 1.74, 95% CI (1.15, 2.63)], 12-17 months [AOR: 2.13, 95% CI (1.40, 3.24)], and 18-23 months [AOR: 4.08, 95% CI (2.58, 6.44)] compared with the children younger than 6 months. Lower wealth quintile was one of the other significant determinants of stunting and underweight. The study's findings indicated that the most consistent significant risk factors for undernutrition among children aged 0-23 months are: male sex, older age groups and lower wealth quintile. These findings emphasize the importance of strengthening nutrition-specific and sensitive interventions that address the immediate and underlying drivers of childhood undernutrition in early life, as well as targeting low-income households with male children, in order for Ethiopia to meet the Sustainable Development Goals (SDGs) 1,2 and 3 by 2030.

"Blood lead level among battery factory workers in low and middle-income countries: Systematic review and meta-analysis".

Introduction: Lead is one of the most health-hazardous causes of acute and chronic poisoning at workplaces. A limited study was conducted on the blood lead concentration among battery factory workers in low and middle-income countries. Therefore, this study will improve workplace health and safety conditions of workers in this sector and serve as baseline data for further studies in this segment of the working setup. Objective: This review aims to identify the pooled mean blood lead level among battery factory workers in low and middle-income countries. Methods: The search methods considered the following electronic bibliographic databases: google scholar, PubMed, and other gray literature. A funnel plot and Begg test were used to see the publication bias. The heterogeneity of studies was checked using I-square statistics with a cut of point 75% and the Joanna Briggs Institute (JBI) quality assessment tool was applied to ensure the quality of the included articles. A random-effect model was applied to pool the blood lead level intoxication. The sub-group analysis and Meta-regression analysis were conducted by country and year of publication to control heterogeneity and to show variation. We included the articles published from 2000 to 2021 year in the English language. Results: Through the search strategies, 135 articles were identified and 43 full-text articles were selected for evaluation, and finally, eighteen (18) articles fit the inclusion criteria. From the 18 studies included in the meta-analysis, the mean pooled blood lead level of workers was 37.996 µg/dl (95% CI: 30.680-45.312) which is higher than the threshold limit value set by American conference of governmental industrial hygienists (20 µg/dl). In subgroup analysis by year in the random effect model, the pooled mean of blood lead level from 2006 to 2011= 43.20 µg/dL (35.91-50.50), 2012-2015 = 37.78 µg/dl (25.23-50.29), and 2016-2020 = 36.53 µg/dl (19.44-53.62). Conclusions: This review showed that the pooled mean blood lead level of workers exposed to lead battery factories was (37.996 µg/dl) which is above the threshold limit value (20 µg/dl). Therefore, attention should be given by employers, government, and researchers to improve the health of working populations exposed to lead exposure in low and middle-income countries through the provision of occupational health and safety services like periodical medical checkups, treatments, and provision of training and adequate and appropriate personal protective equipment.Systematic review registration: Identifier: CRD42022322827.

Association between water, sanitation and hygiene (WASH) and child undernutrition in Ethiopia: a hierarchical approach.

BACKGROUND: Undernutrition is a significant public health challenge and one of the leading causes of child mortality in a wide range of developing countries, including Ethiopia. Poor access to water, sanitation, and hygiene (WASH) facilities commonly contributes to child growth failure. There is a paucity of information on the interrelationship between WASH and child undernutrition (stunting and wasting). This study aimed to assess the association between WASH and undernutrition among under-five-year-old children in Ethiopia. METHODS: A secondary data analysis was undertaken based on the Ethiopian Demographic and Health Surveys (EDHS) conducted from 2000 to 2016. A total of 33,763 recent live births extracted from the EDHS reports were included in the current analysis. Multilevel logistic regression models were used to investigate the association between WASH and child undernutrition. Relevant factors from EDHS data were identified after extensive literature review. RESULTS: The overall prevalences of stunting and wasting were 47.29% [95% CI: (46.75, 47.82%)] and 10.98% [95% CI: (10.65, 11.32%)], respectively. Children from households having unimproved toilet facilities [AOR: 1.20, 95% CI: (1.05,1.39)], practicing open defecation [AOR: 1.29, 95% CI: (1.11,1.51)], and living in households with dirt floors [AOR: 1.32, 95% CI: (1.12,1.57)] were associated with higher odds of being stunted. Children from households having unimproved drinking water sources were significantly less likely to be wasted [AOR: 0.85, 95% CI: (0.76,0.95)] and stunted [AOR: 0.91, 95% CI: (0.83, 0.99)]. We found no statistical differences between improved sanitation, safe disposal of a child's stool, or improved household flooring and child wasting. CONCLUSION: The present study confirms that the quality of access to sanitation and housing conditions affects child linear growth indicators. Besides, household sources of drinking water did not predict the occurrence of either wasting or stunting. Further longitudinal and interventional studies are needed to determine whether individual and joint access to WASH facilities was strongly associated with child stunting and wasting.

Earning pocket money and girls' menstrual hygiene management in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Many adolescent girls in Ethiopia and elsewhere missed school during their monthly cycles due to a lack of affordable menstrual absorbent materials or money to buy sanitary pads. So far, few studies have looked into the relationship between earning pocket money and maintaining good menstrual hygiene. Hence, this systematic review and meta-analysis aimed to synthesize the best available evidence regarding the association between earning pocket money and menstrual hygiene management among adolescents in Ethiopia. METHODS: We systematically searched PubMed, Hinari, Science Direct, Cochrane Library, ProQuest, POPLINE, African Journal Online, Direct of Open Access Journals, and Google Scholar for studies examining the association between earning pocket money and menstrual hygiene management among adolescent girls in Ethiopia, without restriction in a publication year. The Joanna Briggs Institute quality assessment tool for the cross-sectional studies was used to assess the quality of included studies. A prefabricated checklist, including variables: first author, publication year, sample size, type of questionnaire, and the region was used to extract data from the selected articles. A random-effect meta-analysis model was used to estimate the pooled odds ratio (OR) of the association between earning pocket money and menstrual hygiene management. The heterogeneity and publication bias was assessed by using I2 test statistics and Egger's test, respectively. RESULTS: Data from nine studies involving 4783 adolescent girls were extracted. The meta-analysis revealed that adolescent girls who earned pocket money from their parents or relative had 1.64 times higher odds of having good menstrual hygiene management than their counterparts [pooled OR = 1.64, 95% CI: 1.16-2.34, I2:66.7%, n = 7 (number of studies)]. Similarly, the likelihood of having good menstrual hygiene management was lower by 49% among adolescent girls who did not receive any pocket money from their parents compared to their counterparts (pooled OR = 0.51, 95% CI: 0.35-0.74, I2:48.4%, n = 2). CONCLUSIONS: The findings revealed that adolescent girls who earned pocket money were more likely to practice good menstrual hygiene management. Progress toward better menstrual hygiene will necessitate consideration of this factor.

Respiratory Health among Pesticide Sprayers at Flower Farms in Ethiopia.

BACKGROUND: Pesticide use in Ethiopia has become a common practice in which large-scale flower farms are the main consumers. Workers on flower farms might be exposed to pesticides while spraying or while performing other tasks related to pesticide use and management. It is unclear whether working as a flower farm sprayer is associated with respiratory health problems. OBJECTIVE: The objective of this study was to compare respiratory symptoms and lung function indices between pesticide sprayers and non-spraying workers. METHOD: A cross-sectional study was conducted on 15 flower farms, involving all-male sprayers as the pesticide-exposed group and all other male workers as a control group. Data were collected using a standard questionnaire for respiratory symptoms developed by the British Medical Research Council and the American Thoracic Society. Lung function tests were performed to determine forced vital capacity (FVC), forced expiratory volume at one second (FEV1), mid 50 expiratory flow, and the ratio of FEV1 to FVC. Chi-squared tests and Poisson regression analyses were used to compare respiratory symptoms between the two working groups. General linear regression models were used to compare lung function test indices between spraying and non-spraying working groups. The significance level was set to 0.05. RESULTS: A total of 285 male workers participated (152 sprayers and 133 non-spraying workers). The mean age of the workers was 25 years for sprayers and 24 years for non-sprayers. The proportions of cough, cough with sputum, breathlessness, and wheezing were similar in the two groups, while chest tightness was significantly high in the non-spraying group. Sprayers had significantly higher FVC and FEV1 than the non-spraying group. CONCLUSIONS: Respiratory symptoms were not different between the sprayers and non-spraying workers except that the non-spraying workers had increased chest tightness. FVC and FEV1 were significantly higher among sprayers relative to non-sprayers. The results must be interpreted with caution, as the sprayers used respiratory protective equipment, which probably reduced their exposure to the pesticides. Also, the workers were young, and a healthy worker effect might be present among the sprayers.

Seasonal Variability Influence on the Prevalence of Diarrhoea among Under-Five-Year-old Children in Kersa District, Eastern Ethiopia: A Community-Based Longitudinal Study.

Background: The health effects of climate change have been found to be a global concern for the last 2 centuries. However, the effect of climate variability on diarrhoea among under-five-year-old children is perhaps undocumented or otherwise unknown. The aim of the present study was to determine the effect of climate variability on diarrhoea among children under 5 years of age. Methods: A community-based longitudinal study was conducted over 8 repeated visits from June 2016 to May 2018 at the Kersa Demographic Surveillance and Health Research Center. A total of 500 randomly selected households and their 48 improved water sources were included in the survey from 3 agro-ecological zones, the rural and urban areas of the study area. Data was collected on household characteristics, diarrhoea, WASH practices, water quality and quantity in households, and improved water sources. A structured pre-tested questionnaire, an observational check list and laboratory tests were used for data collection. The data was entered into Epi Data Version 3.01 and transferred to Stata Version 12 for analysis. Multilevel mixed-effect Poisson regression was used to determine the relationship between predictors and outcome variables. A P-value of less than .05 was the cut-off point for statistically significant. Results: The prevalence of diarrhoea in 2 weeks among children under 5 years of age was 17.2% (95% CI: 15.8-19.71). Rainfall, E. coli contamination of drinking water at the source and in the home, 20 L of water consumption per capita per day, sharing water sources with animals and home water treatment by residents of the mid- and lowlands were all predictors of diarrhoea. The space-time scan statistic confirmed that child diarrhoea had random variation in both space and time. Conclusion: Climate variability has influenced the prevalence of diarrhoea among under-five-year-old children. Climate-resilient measures should be taken to reduce the burden of diarrhoea in the community.