Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: : Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Funding Information: have received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. 764632. Research work of . D. Fialová has also been supported by the INOMED project NO.CZ.02.1.01/0.0/0.0/18_069/0010046 co-financed by the European Union, Progress Q42 at the Faculty of Pharmacy, Charles University (KSKF-research group 2, chaired by Assoc. Prof. D. Fialová), START/MED/093 CZ.02.2.69/0.0/0.0/19_073/0016935, SVV260 551 and I-CARE4OLD H2020 -965341. Acknowledgments: The authors would like to thank the Research Assistants, University of Gondar and Gondar University Hospital, for their administrative and technical support in fulfilling the EuroAgeism H2020 ESR7 project data collection in Ethiopia.Peer reviewedPublisher PD

A Large-Scale Genome-Wide Association Analyses of Ethiopian Sorghum Landrace Collection Reveal Loci Associated With Important Traits

The eastern Africa region, Ethiopia and its surroundings, is considered as the center of origin and diversity for sorghum, and has contributed to global sorghum genetic improvement. The germplasm from this region harbors enormous genetic variation for various traits but little is known regarding the genetic architecture of most traits. Here, 1425 Ethiopian landrace accessions were phenotyped under field conditions for presence or absence of awns, panicle compactness and shape, panicle exsertion, pericarp color, glume cover, plant height and smut resistance under diverse environmental conditions in Ethiopia. In addition, F1 hybrids obtained from a subset of 1341 accessions crossed to an A1 cytoplasmic male sterile line, ATx623, were scored for fertility/sterility reactions. Subsequently, genotyping-by-sequencing generated a total of 879,407 SNPs from which 72,190 robust SNP markers were selected after stringent quality control (QC). Pairwise distance-based hierarchical clustering identified 11 distinct groups. Of the genotypes assigned to either one of the 11 sub-populations, 65% had high ancestry membership coefficient with the likelihood of more than 0.60 and the remaining 35% represented highly admixed accessions. A genome-wide association study (GWAS) identified loci and SNPs associated with aforementioned traits. GWAS based on compressed mixed linear model (CMLM) identified SNPs with significant association (FDR ≤ 0.05) to the different traits studied. The percentage of total phenotypic variation explained with significant SNPs across traits ranged from 2 to 43%. Candidate genes showing significant association with different traits were identified. The sorghum bHLH transcription factor, ABORTED MICROSPORES was identified as a strong candidate gene conditioning male fertility. Notably, sorghum CLAVATA1 receptor like kinase, known for regulation of plant growth, and the ETHYLENE RESPONSIVE TRANSCRIPTION FACTOR gene RAP2-7, known to suppress transition to flowering, were significantly associated with plant height. In addition, the YELLOW SEED1 like MYB transcription factor and TANNIN1 showed strong association with pericarp color validating previous observations. Overall, the genetic architecture of natural variation representing the complex Ethiopian sorghum germplasm was established. The study contributes to the characterization of genes and alleles controlling agronomic traits, and will serve as a source of markers for molecular breeding

Routine health management information system data in Ethiopia: consistency, trends, and challenges.

Background: Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective: To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods: We analysed national Health Management Information System data on 19 indicators of maternal health, neonatal survival, immunization, child nutrition, malaria, and tuberculosis over the 2012-2018 time period. The analyses were conducted by 38 analysts from the Ministry of Health, Ethiopia, and two government agencies who participated in the Operational Research and Coaching for Analysts (ORCA) project between June 2018 and June 2020. Using a World Health Organization Data Quality Review toolkit, we assessed indicator definitions, completeness, internal consistency over time and between related indicators, and external consistency compared with other data sources. Results: Several services reported coverage of above 100%. For many indicators, denominators were based on poor-quality population data estimates. Data on individual vaccinations had relatively good internal consistency. In contrast, there was low external consistency for data on fully vaccinated children, with the routine Health Management Information System showing 89% coverage but the Demographic and Health Survey estimate at 39%. Maternal health indicators displayed increasing coverage over time. Indicators on child nutrition, malaria, and tuberculosis were less consistent. Data on neonatal mortality were incomplete and operationalised as mortality on day 0-6. Our comparisons with survey and population projections indicated that one in eight early neonatal deaths were reported in the routine Health Management Information System. Data quality varied between regions. Conclusions: The quality of routine data gathered in the health system needs further attention. We suggest regular triangulation with data from other sources. We recommend addressing the denominator issues, reducing the complexity of indicators, and aligning indicators to international definitions

Finger Millet Production in Ethiopia: Opportunities, Problem Diagnosis, Key Challenges and Recommendations for Breeding

Finger millet (Eleusine coracana (L.) Gaertn) is a highly nutritious crop, predominantly grown in the semi-arid tropics of the world. Finger millet has a niche market opportunity due to its human health benefits and being rich in calcium, iron and dietary fiber and gluten-free. Ethiopia is the center of the genetic diversity of the crop. However, the productivity of finger millet in the country is low (<2.4 tons ha−1) compared with its potential yield (6 tons ha−1). The yield gap in Ethiopia is due to a range of biotic and abiotic stresses and socio-economic constraints that are yet to be systemically documented and prioritized to guide future production and improved variety development and release. The objective of this study was to document finger millet production opportunities, constraints and farmer-preferred traits in Ethiopia as a guide to variety design in improvement programs. A participatory rural appraisal (PRA) study was undertaken in six selected districts of the Southern Nation Nationalities People Region (SNNPR) and Oromia Region in Ethiopia. Data were collected from 240 and 180 participant farmers through a semi-structured questionnaire and focus group discussion, respectively. Finger millet was the most important crop in the study areas grown mainly for a combination of uses, including for food, feed and cash (reported by 38.8% of respondent farmers), food and feed (14.5%), food and cash (13.7%), food (11.5%) and food, cash, feed and construction material (9.7%). Hand weeding was used by 59.2% of the respondent farmers, followed by hand weeding and chemical herbicides (40.8%). Finger millet was mainly planted as a sole crop (reported by 97.0% respondents), mixed (1.7%) and sole and mixed (1.3%). About 75.6% of respondent farmers only practiced finger millet rotation with other crops. Respondent farmers indicated their source of fresh seed was from the Bureau of Agriculture (49.1%), farmer-to-farmer seed exchange (22.1%), own saved seed (7.5%), local producers (7.5%), research institutions (5.8%), unknown sources (4.1%), local market (3.5%) and cooperatives (0.42%). The total cost of finger millet production per hectare was calculated at 1249 USD with a total income of 2139 USD/ha, making a benefit to cost ratio of 1.71:1.00 and indicating the relatively low yield gains using the currently grown varieties. The main constraints to finger millet production in the study areas were drought stress (reported by 41.3% respondents), lack of improved varieties (12.9%), lack of financial resources (11.3%), small land holdings (10.8%), limited access to seed (10.0%), a shortage of fertilizers (5.4%), poor soil fertility (4.6%), shortage of draught power (1.3%), labour shortages (1.3%) and high labour costs (1.3%). The most important farmer-preferred traits in a finger millet variety were high grain yield, compact head shape, ‘enjera’-making quality, high marketability and early maturity, resolved through principal component analysis. The above-mentioned production constraints and farmer-preferred traits are strategic drivers to enhance finger millet productivity and need to be incorporated into Ethiopia’s finger millet breeding and technology development

Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia

Few studies have been conducted on multimorbidity (two or more chronic diseases) and rational geriatric prescribing in Africa. This study examined the prevalence and determinants of multimorbidity, polypharmacy (five or more long-term medications), and potentially inappropriate medication (PIM) use according to the 2019 Beers criteria among the older adults attending chronic care clinics from a single institution in Ethiopia. A hospital-based cross-sectional study was conducted among 320 randomly selected older adults from 12 March 2020 to 30 August 2020. A multivariable logistic regression analysis was performed to identify the predictor variables. The prevalence of multimorbidity, polypharmacy, and PIM exposure was 59.1%, 24.1%, and 47.2%, respectively. Diuretics (10%), insulin sliding scale (8.8%), amitriptyline (7.8%), and aspirin (6.9%) were among the most frequently prescribed PIMs. Older patients experiencing pain flare-ups were more likely to have multimorbidity (adjusted odds ratio (AOR): 1.64, 95% confidence intervals: 1.13–2.39). Persistent anger (AOR: 3.33; 1.71–6.47) and use of mobility aids (AOR: 2.41, 1.35–4.28) were associated with polypharmacy. Moreover, cognitive impairment (AOR: 1.65, 1.15–2.34) and health deterioration (AOR: 1.61, 1.11–2.32) increased the likelihood of PIM exposure. High prevalence of multimorbidity and PIM use was observed in Ethiopia. Several important determinants that can be modified by applying PIM criteria in routine practice were also identified

Finger Millet Production in Ethiopia: Opportunities, Problem Diagnosis, Key Challenges and Recommendations for Breeding

Finger millet (Eleusine coracana (L.) Gaertn) is a highly nutritious crop, predominantly grown in the semi-arid tropics of the world. Finger millet has a niche market opportunity due to its human health benefits and being rich in calcium, iron and dietary fiber and gluten-free. Ethiopia is the center of the genetic diversity of the crop. However, the productivity of finger millet in the country is low (−1) compared with its potential yield (6 tons ha−1). The yield gap in Ethiopia is due to a range of biotic and abiotic stresses and socio-economic constraints that are yet to be systemically documented and prioritized to guide future production and improved variety development and release. The objective of this study was to document finger millet production opportunities, constraints and farmer-preferred traits in Ethiopia as a guide to variety design in improvement programs. A participatory rural appraisal (PRA) study was undertaken in six selected districts of the Southern Nation Nationalities People Region (SNNPR) and Oromia Region in Ethiopia. Data were collected from 240 and 180 participant farmers through a semi-structured questionnaire and focus group discussion, respectively. Finger millet was the most important crop in the study areas grown mainly for a combination of uses, including for food, feed and cash (reported by 38.8% of respondent farmers), food and feed (14.5%), food and cash (13.7%), food (11.5%) and food, cash, feed and construction material (9.7%). Hand weeding was used by 59.2% of the respondent farmers, followed by hand weeding and chemical herbicides (40.8%). Finger millet was mainly planted as a sole crop (reported by 97.0% respondents), mixed (1.7%) and sole and mixed (1.3%). About 75.6% of respondent farmers only practiced finger millet rotation with other crops. Respondent farmers indicated their source of fresh seed was from the Bureau of Agriculture (49.1%), farmer-to-farmer seed exchange (22.1%), own saved seed (7.5%), local producers (7.5%), research institutions (5.8%), unknown sources (4.1%), local market (3.5%) and cooperatives (0.42%). The total cost of finger millet production per hectare was calculated at 1249 USD with a total income of 2139 USD/ha, making a benefit to cost ratio of 1.71:1.00 and indicating the relatively low yield gains using the currently grown varieties. The main constraints to finger millet production in the study areas were drought stress (reported by 41.3% respondents), lack of improved varieties (12.9%), lack of financial resources (11.3%), small land holdings (10.8%), limited access to seed (10.0%), a shortage of fertilizers (5.4%), poor soil fertility (4.6%), shortage of draught power (1.3%), labour shortages (1.3%) and high labour costs (1.3%). The most important farmer-preferred traits in a finger millet variety were high grain yield, compact head shape, ‘enjera’-making quality, high marketability and early maturity, resolved through principal component analysis. The above-mentioned production constraints and farmer-preferred traits are strategic drivers to enhance finger millet productivity and need to be incorporated into Ethiopia’s finger millet breeding and technology development

Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study.

OBJECTIVE: A routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data. DESIGN: This was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework. SETTING: This study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts. PARTICIPANTS: We visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment. OUTCOME MEASURES: We assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions. RESULTS: There was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting. CONCLUSION: We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation