Management of Flood-Based Farming in Guguf, Northern Ethiopia

Spate irrigation is the source of moisture for crop production in the semi-arid lowlands of Raya Valley. Despite its higher potential to suport rainfed agriculture, management of flood based farming has received less emphasis. Thus, the study attempted to examine the management of floods across the Guguf irrigation schemes. Survey data were collected from 78 households selected using systematic sampling in 2018. Data were analyzed using desriptive statistics, Chi- square and one-way ANOVA. Results showed that the participation of every farmer in the operation and maintenance activities is mandatory to receive flood. The rule of water distribution based on individual farmer‘s contribution helps to mobilize the minimum labor required to run the spate system. Frequent operation and maintenance activities carried out in upstream canals due to erosive flashy floods. The effect of scheme location was significant overall, F (2, 75) = 24.42, p = 0.000, η2= .48. Maize planted in Kusra, the lower scheme, has failed during its early growth stage more clarify the situation. Despite the location based flood water distribution among primary canals, distribution within the canal starts first by drawing lottery among the head, middle and tail users. In using the flood, users gradually developed different traditional water rights and distribution rules including the rule for operation and maintenance of the spate system. Instead of the present location based flood distribution that favors to farmers at the head of the spate system, even a small flood can be sufficient if allocated based on crop type and growth stage. Keywords: Guguf, management, flood-based farming, allocation, Northern Ethiopia DOI: 10.7176/JAAS/61-02 Publication date: February 29th 202

Nutritional Status of Adolescent Girls from Rural Communities of Tigray, Northern Ethiopia

Background: Addressing the nutritional needs of adolescents could be an important step towards breaking the vicious cycle of intergenerational malnutrition. Objective: Assess nutritional status of rural adolescent girls. Design: Cross-sectional. Methods: Anthropometric and socio-demographic information from 211 adolescent girls representing 650 randomly selected households from thirteen communities in Tigray was used in data analysis. Height-for-age and BMI-for-age were compared to the 2007 WHO growth reference. Data were analyzed using SAS, Version 9.1. Results: None of the households reported access to adolescent micronutrient supplementation. The girls were shorter and thinner than the 2007 WHO reference population. The cross-sectional prevalence of stunting and thinness were 26.5% and 58.3%, respectively. Lack of latrine facilities was significantly associated with stunting (p = 0.0033) and thinness (p <0.0001). Age was strong predictor of stunting (r(2) = 0.8838, p <0.0001) and thinness (r(2) = 0.3324, p <0.0001). Conclusion: Undernutrition was prevalent among the girls. Strategies to improve the nutritional status of girls need to go beyond the conventional maternal and child health care programs to reach girls before conception to break the intergenerational cycle of malnutrition. Further, carefully designed longitudinal studies are needed to identify the reasons for poor growth throughout the period of adolescence in this population. [Ethiop. J. Health Dev. 2009; 23(1):5-11

Impact of Mueusems in Cultural Scoiety - A Case Study

Museums with strong brands or those that inhabit iconic buildings are increasingly used as cultural motifs in the destination-marketing strategies of public tourist bodies. Recent examples include the use of the British Museum in Visit Britain's Culture is Great campaign, or the Turner Contemporary as a symbol of Margate's brand enhancement. The latest figures from the Association of Leading Visitor Attractions (ALVA) once again underlined the importance of museums to the visitor economy. Meanwhile, the new Arts Council England and Visit England partnership, which aims to help destinations develop their cultural tourism, provides an opportunity for museums to take a strategic lead in this area. But could it also result in greater reliance on marketing-orientated approaches that might not benefit the entire museum sector

Community-based Rehabilitation Intervention for people with Schizophrenia in Ethiopia (RISE): study protocol for a cluster randomised controlled trial.

BACKGROUND: Care for most people with schizophrenia is best delivered in the community and evidence-based guidelines recommend combining both medication and a psychosocial intervention, such as community-based rehabilitation. There is emerging evidence that community-based rehabilitation for schizophrenia is effective at reducing disability in middle-income country settings, yet there is no published evidence on the effectiveness in settings with fewer mental health resources. This paper describes the protocol of a study that aims to evaluate the effectiveness of community-based rehabilitation as an adjunct to health facility-based care in rural Ethiopia. METHODS: This is a cluster randomised trial set in a rural district in Ethiopia, with sub-district as the unit of randomisation. Participants will be recruited from an existing cohort of people with schizophrenia receiving treatment in primary care. Fifty-four sub-districts will be randomly allocated in a 1:1 ratio to facility-based care plus community-based rehabilitation (intervention arm) or facility-based care alone (control arm). Facility-based care consists of treatment by a nurse or health officer in primary care (antipsychotic medication, basic psychoeducation and follow-up) with referral to a psychiatric nurse-led outpatient clinic or psychiatric hospital when required. Trained community-based rehabilitation workers will deliver a manualised community-based rehabilitation intervention, with regular individual and group supervision. We aim to recruit 182 people with schizophrenia and their caregivers. Potential participants will be screened for eligibility, including enduring or disabling illness. Participants will be recruited after providing informed consent or, for participants without decision-making capacity, after the primary caregiver gives permission on behalf of the participant. The primary outcome is disability measured with the 36-item WHO Disability Assessment Schedule (WHODAS) version 2.0 at 12 months. The sample size will allow us to detect a 20 % difference in WHODAS 2.0 scores between treatment arms with 85 % power. Secondary outcomes include change in symptom severity, economic activity, physical restraint, discrimination and caregiver burden. DISCUSSION: This is the first trial of community-based rehabilitation for schizophrenia and will determine, as a proof of concept, the added value of community-based rehabilitation compared to facility-based care alone in a low-income country with scarce mental health resources. TRIAL REGISTRATION: Clinical Trials.gov Identifier NCT02160249 . Registered on 3 June 2014

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) cluster-randomised controlled trial:An exploratory analysis of impact on food insecurity, underweight, alcohol use disorder and depressive symptoms

We evaluated the effectiveness of community-based rehabilitation (CBR) in reducing depressive symptoms, alcohol use disorder, food insecurity and underweight in people with schizophrenia. This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Fifty-four sub-districts were allocated in a 1:1 ratio to the facility-based care [FBC] plus CBR arm and the FBC alone arm. Lay workers delivered CBR over 12 months. We assessed food insecurity (self-reported hunger), underweight (BMI&lt; 18.5 kg/m2), depressive symptoms (PHQ-9) and alcohol use disorder (AUDIT ≥ 8) at 6 and 12 months. Seventy-nine participants with schizophrenia in 24 sub-districts were assigned to CBR plus FBC and 87 participants in 24 sub-districts were assigned to FBC only. There was no evidence of an intervention effect on food insecurity (aOR 0.52, 95% CI 0.16-1.67; p = 0.27), underweight (aOR 0.44, 95% CI 0.17-1.12; p = 0.08), alcohol use disorder (aOR 0.82, 95% CI 0.24-2.74; p = 0.74) or depressive symptoms (adjusted mean difference - 0.06, 95% CI -1.35, 1.22; p = 0.92). Psychosocial interventions in low-resource settings should support access to treatment amongst people with schizophrenia, and further research should explore how impacts on economic, physical and mental health outcomes can be achieved

Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE):results of a 12-month cluster-randomised controlled trial

BACKGROUND: Community-based rehabilitation (CBR) is recommended to address the social and clinical needs of people with schizophrenia in resource-poor settings. We evaluated the effectiveness of CBR at reducing disability at 12 months in people with schizophrenia who had disabling illness after having had the opportunity to access facility-based care for 6 months METHODS: This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Eligible clusters were subdistricts in Sodo district that had not participated in the pilot study. Available subdistricts were randomised (in a 1:1 ratio) to either the intervention group (CBR plus facility-based care) or to the control group (facility-based care alone). An optimisation procedure (accounting for the subdistrict mean WHO Disability Assessment Schedule (WHODAS) score and the potential number of participants per subdistrict) was applied for each of the eight health facilities in the district. An independent statistician, masked to the intervention or control label, used a computer programme to randomly choose the allocation sequence from the set of optimal ones. We recruited adults with disabling illness as a result of schizophrenia. The subdistricts were eligible for inclusion if they included participants that met the eligibility criteria. Researchers recruiting and assessing participants were masked to allocation status. Facility-based care was a task-shared model of mental health care integrated within primary care. CBR was delivered by lay workers over a 12-month period, comprising of home visits (psychoeducation, adherence support, family intervention, and crisis management) and community mobilisation. The primary outcome was disability, measured with the proxy-rated 36-item WHODAS score at 12 months. The subdistricts that had primary outcome data available were included in the primary analysis. This study is registered with ClinicalTrials.gov, NCT02160249.FINDINGS: Enrolment took place between Sept 16, 2015 and Mar 11, 2016. 54 subdistricts were randomised (27 to the CBR plus facility-based care group and 27 to the facility-based care group). After exclusion of subdistricts without eligible participants, we enrolled 79 participants (66% men and 34% women) from 24 subdistricts assigned to CBR plus facility-based care and 87 participants (59% men and 41% women) from 24 subdistricts assigned to facility-based care only. The primary analysis included 149 (90%) participants in 46 subdistricts (73 participants in 22 subdistricts in the CBR plus facility-based care group and 76 participants in 24 subdistricts in the facility-based care group). At 12 months, the mean WHODAS scores were 46·1 (SD 23·3) in the facility-based care group and 40·6 (22·5) in the CBR plus facility-based care group, indicating a favourable intervention effect (adjusted mean difference -8·13 [95% CI -15·85 to -0·40]; p=0·039; effect size 0·35). Four (5%) CBR plus facility-based care group participants and nine (10%) facility-based care group participants had one or more serious adverse events (death, suicide attempt, and hospitalisation).INTERPRETATION: CBR delivered by lay workers combined with task-shared facility-based care, was effective in reducing disability among people with schizophrenia. The RISE study CBR model is particularly relevant to low-income countries with few mental health specialists.FUNDING: Wellcome Trust

Frequent use of paracetamol and risk of allergic disease among women in an Ethiopian population

Introduction The hypothesis that paracetamol might increase the risk of asthma and other allergic diseases have gained support from a range of independent studies. However, in studies based in developed countries, the possibility that paracetamol and asthma are associated through aspirin avoidance is difficult to exclude. Objectives To explore this hypothesis among women in a developing country, where we have previously reported aspirin avoidance to be rare. Methods In 2005/6 a population based cohort of 1065 pregnant women was established in Butajira, Ethiopia and baseline demographic data collected. At 3 years post birth, an interview-based questionnaire administered to 945 (94%) of these women collected data on asthma, eczema, and hay fever in the past 12 month, frequency of paracetamol use and potential confounders. Allergen skin tests to Dermatophagoides pteronyssinus and cockroach were also performed. The independent effects of paracetamol use on allergic outcomes were determined using multiple logistic regression analysis. Findings The prevalence of asthma, eczema and hay fever was 1.7%, 0.9% and 3.8% respectively; of any one of these conditions 5.5%, and of allergen sensitization 7.8%. Paracetamol use in the past month was reported by 29%, and associations of borderline significance were seen for eczema (adjusted OR (95% CI) = 8.51 (1.68 to 43.19) for 1–3 tablets and 2.19 (0.36 to 13.38) for ≥4 tablets, compared to no tablets in the past month; overall p = 0.055) and for ‘any allergic condition’ (adjusted OR (95% CI) = 2.73 (1.22 to 6.11) for 1–3 tablets and 1.35 (0.67 to 2.70) for ≥4 tablets compared to 0 in the past month; overall p = 0.071). Conclusions This study provides further cross-sectional evidence that paracetamol use increases the risk of allergic disease

Micro water harvesting for climate change mitigation: Trade-offs between health and poverty reduction in Northern Ethiopia

Water harvesting is an important tool for mitigating the adverse effects of climate change. This report investigates the trade-offs between health and poverty reduction by considering the impacts of water harvesting on health in Tigray region, northern Ethiopia. In particular, we assess the prevalence of malaria in association with ponds and wells. Moreover, the determinants of malaria incidence are explored with multivariate analysis. Additionally, we investigate people¿s willingness to pay (WTP) for improved malaria control using a contingent valuation method (CVM). In particular, we applied a double-bounded dichotomous choice CV surveys to elicit households¿ WTP for improved health services to control malaria. With interval regression, the WTP was explained as a function of household characteristics, health and health service conditions, and village level factors. The malaria prevalence rate is very high, more than 30 percent in low land communities, although rates are higher after rainy season. This suggests that ponds and wells are important factors in determining the prevalence of malaria. Better conditions of housing and toilet type, availability of bed nets reduce incidence. Pond and well ownership affects the WTP for improved malaria control in a negative and positive way respectively indicating differences in their economic attractiveness. WTP decreases with altitude and thus malaria incidence. Education and household asset holding generally increases WTP for improved health services. The results suggest that valuation results on household¿s WTP in poor economies may be underestimated because of cash constraint. Consequently, alternative payment vehicles in eliciting households¿ WTP have to be considered. Similarly, the estimated mean WTP for the external health cost of wells and ponds may be underestimated. In our case, ponds and wells are not fully exploited, as our results suggest that they do not contribute to household income or welfare. In that case, the presence of ponds and wells pose high external costs to the econom

Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries.

BACKGROUND: Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs) to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda) participating in the PRogramme for Improving Mental health carE (PRIME). The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care. METHODS: A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts. RESULTS: The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care. CONCLUSIONS: The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential for sustainable delivery of quality mental health care integrated into primary care