Assessing livelihood resilience in drought-affected areas: Lessons from Raya Kobo district, northeast Ethiopia.

In comparison to other types of resilience, livelihood resilience in the context of climate-related extremes like droughts is grounded in actual-life scenarios with the purpose of carefully assessing and improving the resiliency of individuals, households, communities, and nations. This study assesses households' livelihood resilience to droughts in Raya Kobo District. A mixed approach with a concurrent research design was used to achieve this goal. The quantitative data were collected from 354 randomly selected survey respondents, while the qualitative data were collected from purposefully chosen FGD and KI participants. Principal Component Analysis (PCA) and Multiple Linear Regression (MLR) models were employed to analyse the quantitative data, whereas thematic data analysis was used to analyse the qualitative data through the creation of major and sub-themes. To determine households' livelihood resilience, the livelihood resilience index (LRI) was measured using thirty-eight indicators of resilience based on the five livelihood assets. The study identified fifteen latent dimensions, such as infrastructure, technology, water harvesting scheme, land quality, cropping season, household working capacity, farm experience, educational status, social trust, risk response, social security, support service, income, crop diversity, and assets. The average score of these latent dimensions is 0.3999, suggesting that households in the study area are less resilient. The MLR results show a positive association between the latent dimensions and LRI and the relative importance of the latent dimensions for LRI. These findings provide significant policy implications regarding mitigating vulnerability, strengthening resilience, and establishing pathways out of livelihood insecurity. Education, healthcare, road construction, agricultural inputs (pesticides, herbicides, chemical fertilizers, and improved seeds), irrigation technologies (small-scale drip irrigation systems and human-powered pedals), income diversification, social trust, risk response, social security, support services, and asset building should be the focus of policymakers.

Attitudes of Healthcare Workers about Prevention and Control of Nosocomial Multidrug-Resistant Tuberculosis Infection in Two Top-Ranked Tuberculosis Specialized Public Hospitals of Ethiopia.

Background: Tuberculosis (TB) exists as a human curse since antiquity. Around 9.5 million cases and 1.5 million deaths were reported due to TB in 2021. Ethiopia is one of the high-burdenmultidrug-resistant (MDR) TB countries. MDR-TB is acquired either by poor adherence to treatment or by primary infection with a drug-resistant strain, which has a high transmission rate from patients to healthcare workers (HCWs). Hospital outbreaks of MDR-TB are common in Africa. Hence, this study aimed to score the attitude of HCWs working in the two nationally top-rankedTB-specialized hospitals in Ethiopia, Saint Peter's and ALERT TB-specialized public hospitals about the infection prevention and control (IPC) of nosocomial MDR-TB. Methods: A cross-sectional study was conducted from December 1, 2020, to March 31, 2021. A simple random sampling method was applied to select 384 HCWs. The data collection tool was a self-administered interview structured questionnaire. The data were analyzed using SPSS software. Descriptive statistics were applied to score attitude. Bivariate and multivariable logistic regression models were performed to identify the independent determinants of attitude. The odds ratio was used to test the degree of association between variables at a 95% confidence interval (CI). The level of statistical significance was fixed at p value < 0.05. Results: Among the respondents, 87% of the HCWs held favourable attitudes about the nosocomial MDR-TB-IPC. The favourable attitude score had a significant association with the monthly salary earned between 7001 and 9000 ETB (Ethiopian Birr) (AOR = 3.34, 95% CI: 1.11, 10.05) and the previous training obtained on TB/MDR-TB (AOR = 2.96, 95% CI: 1.32, 6.62). Conclusions: Almost one in seven HCWs has an unfavourable attitude. Prior training received and earning monthly income above 7000 ETB are independent determinants of a favourable attitude score. Refreshment training and a reasonable increment in monthly income should be strengthened in TB-specialized hospitals in Ethiopia.

Pott's paraplegia and role of neuroimaging in resource limited setting: A case report and brief review of the literatures.

BACKGROUND: Tuberculosis (TB) is the leading cause of morbidity and mortality in low and middle income countries (LMIC). Approximately 50% of cases of skeletal TB involve the spine. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. The clinical and radiologic features of Pott's disease may mimic other spine diseases such as, metastatic lesions and other infectious etiologies, this is especially imperative in older patients. CASE REPORT: We report a 60-year-old right handed male patient presented with back pain, paraparesis, and sensory symptoms 2 weeks duration. He has history of dry cough, fatigue, and reduced appetite, but no history of weight loss, fever, night sweat, and bowel/bladder incontinence. No contact history with TB patients. He has a borderline hypertension and diabetes mellitus. Serology for HIV was negative. Thoraco-lumbar magnetic resonance image (MRI) showed destruction of L2 and L3 vertebral body and the inter-vertebral disc; with T2 hyper and T1 hypointensity of the affected vertebral bodies. Probable tuberculous spondylitis with paraparesis was considered and the patient was initiated on antituberculous regimen and short course steroid therapy. After five months treatment, the patient showed significant clinical and radiological improvement. CONCLUSION: In summary, the present case describes, a patient with Pott's paraplegia due to probable spine tuberculosis and showed significant clinical and radiological improvement following initiation of antituberculous drugs and short course of steroid; indicating the crucial role of imaging in the diagnosis of TB, especially in resource limited settings.

Thyroid Profile and Factors Associated with Hypothyroidism Among Multidrug-Resistant Tuberculosis Patients Attending Saint Peter's Specialized Hospital Addis Ababa, Ethiopia.

BACKGROUND: The emergence of MDR-TB is a global public health problem. Hypothyroidism is one of the severe adverse drug reactions (ADRs) in MDR-TB patients on treatment. Representative data on hypothyroidism and its associated factors among MDR-TB patients are lacking. OBJECTIVE: To determine thyroid profiles and associated risk factors among multidrug-resistant TB patients during therapy with anti-MDR-TB regimen in Saint Peter Specialized Hospital Addis Ababa, Ethiopia from January to November 2020. METHODS: A cross-sectional study was conducted in MDR-TB patients in Addis Ababa, Ethiopia. A total of 162 patients, who were older than 18 years, had bacteriologically confirmed MDR-TB and on treatment for more than one month were enrolled consecutively from the TB registration book. However, critically sick patients and those who were receiving additional drugs known to cause severe ADRs were excluded. Simple descriptive statistics were used to present the socio-demographic and clinical characteristics of the patients. A logistic regression model was used to assess the association between independent and dependent variables. A p-value <0.05 was considered as statistically significant in all analyses. RESULTS: Mean age of the study participant was 35.9 ± 13.6 years. The prevalence of hypothyroidism was 32 (19.8%). The presence of co-morbidity, being underweight, and prothionamide use were significantly associated with hypothyroidism in MDR-TB patients on treatment. CONCLUSION: Hypothyroidism occurs commonly among MDR-TB patients. Presence of co-morbidity, being underweight, and prothionamide drug use are the factors associated with hypothyroidism. Monitoring of thyroid function test during MDR-TB treatment and factors associated with hypothyroidism require attention to prevent complication.

Women's satisfaction with their urban health extension programme and associated factors in Gondar administrative city, northwest Ethiopia: a community-based cross-sectional study.

OBJECTIVES: Ethiopia is a developing country striving to achieve universal health coverage using the health extension programme. There is limited evidence about Ethiopian women's satisfaction with their urban health extension programme. Thus, this study was aimed at assessing the level of women's satisfaction with their urban health extension services and associated factors in Gondar administrative city of northwest Ethiopia and elucidate factors associated with its access and use. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: Randomly selected 744 women were interviewed using a structured interviewer-administered questionnaire. OUTCOME: Satisfaction of women over 17 years of age with their urban health extension programme (use and services). RESULTS: Some 29.4% (95% CI 26.2 to 32.5) of women were satisfied with their urban health extension programme. Divorced women (adjusted OR (AOR): 0.35, 95% CI 0.14 to 0.85), women in the age group of 45-53 years (AOR: 0.35, 95% CI 0.14 to 0.85), private employees (AOR: 0.35, 95% CI 0.14 to 0.85), unsatisfactory knowledge (AOR: 0.13, 95% CI 0.07 to 0.25) and perceived accessibility of health extension workers (AOR: 0.99, 95% CI 0.06 to 0.17) were factors associated with women's satisfaction with their urban health extension programme. CONCLUSIONS: Women's satisfaction with their urban health extension programme was low. This finding was associated with age, marital status, occupation, knowledge of participants and women's perceived accessibility of services. Therefore, increasing awareness about the programme, promoting and improving accessibility of services, particularly by mothers, may augment the utilisation of the programme ultimately leads to efficient use of scarce healthcare resources in Ethiopia.

Urban Health Extension Program and Health Services Utilization in Northwest Ethiopia: A Community-Based Study.

PURPOSE: Ethiopia is one of the developing countries striving to achieve universal health coverage using the health extension program (HEP). However, there is limited evidence on the utilization of the urban health extension program (UHEP), particularly in the northwest part of the country. Therefore, this study aimed to assess the level of urban health extension program utilization and its associated factors in Gondar administrative city, northwest Ethiopia. PATIENTS AND METHODS: A community-based cross-sectional study was employed from March 15 to May 30, 2019. A total of 626 systematically selected mothers were interviewed using an interviewer-administered structured questionnaire. Binary logistic regression analysis was computed. In the final multivariable logistic regression analysis, a P-value of less than 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare the factors associated with the utilization of urban health extension services. RESULTS: The utilization level of urban health extension services was found to be 59.5% (95% Cl=55.8-63.6). The result indicated that two-fifths of the participants were not utilizing the services. Private employees (AOR=0.37, 95% Cl=0.21-0.63), housewives (AOR=0.36, 95% Cl=0.20-0.64), merchants (AOR=0.08, 95% Cl=0.03-0.17), satisfactory knowledge (AOR=4.37, 95% Cl=2.73-6.96), perceived accessibility of services (AOR=1.68, 95% CI=1.02-2.74), and perceived competence of HEWs (AOR=1.97, 95% Cl=1.22-3.18) were factors significantly associated with the utilization of urban health extension services. CONCLUSION: The overall utilization of the urban health extension program was low compared to the national recommendation. Occupation, knowledge of participants towards UHEP, accessibility of health extension services, and participants' perception about the competency of HEWs were factors associated with utilization of UHEP. Therefore, awareness creation, in-service training, improving the accessibility of services and frequency of contact with mothers at the household level will increase the services utilization.

Low enrollment and high treatment success in children with drug-resistant tuberculosis in Ethiopia: A ten years national retrospective cohort study.

BACKGROUND: Limited evidence exists on the treatment outcome and factors that are associated with the duration from the initiation of treatment to death or treatment failure in children with drug resistant tuberculosis (DR-TB). Thus, we aimed to determine the proportion of treatment enrollment, status of treatment outcome and determine factors that are associated with the duration from treatment initiation to death or treatment failure in children treated for DR-TB in Ethiopia. METHODS: We conducted a retrospective cohort study in children younger than 15 years old who were treated for DR-TB from February 2009 to February 2019 in Ethiopia. We collected data on socio-demographic and clinical characteristics from clinical charts, registration books and laboratory result reports on 155 children. Proportion of enrollment to the treatment was calculated by dividing the total number of children who were receiving the treatment by the total number of DR-TB patients treated during the specified years. We used Cox proportional hazard models to determine factors that were associated with the duration from the beginning of the treatment to death or treatment failure. Data was analyzed using STATA version 14. RESULTS: Of the 3,478 DR-TB patients enrolled into the treatment and fulfilling our inclusion criteria during the past ten years, 155 (4.5%) were children. Of the 155 children, 75 (48.4%) completed the treatment and 51 (32.9%) were cured. Furthermore, 18 (11.6%) children were died, seven (4.5%) lost to follow up and treatment of four (2.6%) children was failed. The overall treatment success was 126 (81.3%). Age younger than 5 years old [Adjusted Hazard Ratio (AHR) = 3.2, 95%CI (1.2-8.3)], HIV sero-reactivity [AHR = 5.3, 95%CI (1.8-14.9)] and being anemic [AHR = 4.3, 95%CI (1.8-10.3)] were significantly associated with the duration from the enrollment into the treatment to death or treatment failure. CONCLUSION: In this study, the proportion of children enrolled into DR-TB treatment was lower than the proportion of adults enrolled to the treatment (4.5% in children versus 95.5% in adults) in last ten years. Our findings also suggest that children with DR-TB can be successfully treated with standardized long term regimen. Further prospective cohort study is required to investigate factors contributing to death or treatment failure.