The Burden of Internal Conflict on Expanded Programs on Immunization in Northwest Ethiopia: Implementation Science Study

AbstractBackground: Despite the rapid progress in immunization service delivery systems worldwide, populations in areas of conflict often have limited or no access to lifesaving vaccines. Hence, evidence generation and translation for context-specific strategies and tailored action would be important, before, during and after an acute humanitarian emergency.Aim: To explore factors affecting immunization service delivery during and after conflict among internally displaced communities in Northwest Ethiopia.Methods: Qualitative and quantitative (record review) methods were applied, phenomenological study design and in-depth interviews were applied to collect the lived experiences of participants in the affected areas. Transcribed and translated data were analyzed and thematized using open code software. A Twenty-four-month record review of quantitative data was analyzed descriptively using an excel sheet to develop immunization coverage trends for tracer antigens.Results: We found that the immunization program had seriously deteriorated during and after the conflict in the study area. The monthly EPI service report in the affected areas showed a decline with the lowest records in December and January when the internal conflict was peak. Security problems, displacement of health workers, destruction of health infrastructures, mixing of the displaced community in the host community and poor coordination among stakeholders and partners, clients having other emergent needs and shortages of resources were important factors for immunization services.Conclusion: Vaccination service delivery was found to have significantly declined in the study area. Security problems affected not only the service utilizers but also the service providers’ wing as well. Coordination of stakeholders and strong leadership systems are crucial in maintaining optimum vaccination service delivery even at the time of conflict. [Ethiop. J. Health Dev. 2021; 35(SI-3):39-48]Key words: Conflict, internally displaced, Immunization service

Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia

AbstractIntroduction: Preventive programs which have proven to be effective in clinical trials may not necessarily impact the health and wellbeing of the community unless they are implemented with fidelity. While cold chain is the backbone of immunization programs, limited studies exist to explain fidelity implementation which likely contributes to a lack of evidence-based instructional practices of cold chain management.Aim: This study aimed to explore the fidelity implementation and challenges of optimal cold chain management in the Benshangul-gumuz region.Methods: A qualitative approach was utilized to explore the underlying challenges to optimum implementation of cold chain management in Benshangul-gumuz region. Observational techniques and key informant interviews with 12 key-informants were conducted. Data was collected at all levels of the health system including, the regional health bureau, Ethiopian Pharmaceuticals Supply Agency hub, district health offices, Health centers, and health posts. Data analysis and interpretation was performed using the framework analysis approach. Open Code 4.02 software was used for analysis.Findings: This study identified three main themes including adherence to intervention, human resource development, and availability and use of resources. The findings also revealed that a significant number of the employees were not adhering to the optimal cold chain management guidelines. Staff development, availability and utilization of equipment and related finances were major fidelity implementation challenges of cold chain management.Conclusions: Across the health facilities under study, implementation fidelity of cold chain management was considered poor. Human resource development, proper allocation and effective management of logistics and related finance could facilitate optimal cold chain management practices, and efforts to save lives through delivery of safe and quality vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3):03-08]Keywords: Cold chain management, Implementation fidelity, Challenges, Ethiopi

How to optimize health facilities and community linkage in order to enhance immunization service? The case of West Amhara Region, Ethiopia

AbstractBackground: Health facility-community linkages are important in designing community-level interventions, appropriate immunization service provision modalities, and changing unhealthy behaviors. However, there is limited evidence on the influence of community and facility linkage on vaccination services in Ethiopia.Aim: This study aimed to explore how the linkage between health facilitiesa and the community could be optimized in order to enhance immunization services.Methods: A Phenomenological study design, using an explanatory approach was applied in the two districts (Shebele Berenta & South Achefer district) of the Amhara region for the month of June , 2020. Forty-six key informants were interviewed using an interview guide and data was analyzed using open code version 4.02. The data was coded, and thematic analysis was applied.Results: The finding revealed that there were community platforms to facilitate community and health facility linkage. Respondents also perceived that the community to health facility linkage was an effective strategy for the Expanded Program on Immunization (EPI) service provision. The study revealed that perception of health care providers, health care providers attitude and practices, shortages of stock (medication and supplies), distance from main road and transportation, irregularity in the implementation of rules and regulations, lack of incentives, inadequate counseling and support, lack of awareness, shortages of human resources and lack of training support for health care workers were barriers for effective community-health facility linkage.Conclusion: The linkage of community and facilities were not approached in the same manner within districts and facilities. Therefore, strengthening a common system for community-health facility linkage and community engagement is critical during immunization services. Establishing a strong strategy of incentivizing mechanisms is vital for the effective implementation of immunization services. An advocacy strategy to mobilize engagement among policy and decision-makers, and other key stakeholders was an important strategy for improving the program. [Ethiop. J. Health Dev. 2021; 35(SI-3):75-85]Keywords: Community, Facility linkage, EPI, Amhara Region, Ethiopi

Assessment of barriers to the implementation of community-based data verification and immunization data discrepancies between health facilities and the community in Tach Gayint district, Northwest Ethiopia.

AbstractIntroduction: While community-based data verification (CBDV) is critical for effective implementation of immunization programs, limited evidence exists detailing its implementation at the local levels thereby threatening data quality which is used to guide decision making.Aim: To explore the barriers to proper implementation of CBDV and determine the level of immunization data discrepancy between the health facilities and community levels in Tach Gayint district of Northwest Ethiopia.Methods: A Mixed methods approach was used. Interviews with twenty-six key informants’ (health experts) in immunization data, and an additional a sample of 324 infants were recruited. All health centers in the district (6) and 2 health posts from each health center (12 in total) were selected using Simple Random Sampling. Key informant interviewees were purposely included from all health facilities. For quantitative data, samples of infants were proportionally allocated for each health facility as per their DPT/Pentavalent-1 vaccine report. Thematic analysis of the qualitative data and descriptive quantitative analysis were performed using statistical software open-code v-4.02 and STATA v14.1 respectively.Results: Only few health facilities implemented CBDV and consider it to be their routine task. Also, barriers to effective implementation of CBDV such as lack of prioritization, poor capacity among health staff, and conflicting job roles were identified. The highest immunization data discrepancy among community and health facilities was observed for the measles-one vaccine (35.4%), and the minimum was for DPT/Pentavalent-1 (25.6%).Conclusion: This study revealed a poor level of CBDV implementation and barriers to its effective implementation which include lack of prioritizing CBDV, limited capacity among health staff in performing CBDV, and conflicting job roles among health staff. There was a high level of immunization data discrepancy for measles-1 and DTP/Pentalent-3 vaccines. Based on our finding, we make the following recommendations: building skills among health workers to perform CBDV, enhancing availability and use of standard CBDV tools, ensuring monitoring, and control mechanism, and setting clear definition of roles regarding CBDV, as well as closing the gap in level of immunization data discrepancy could help foster effective implementation of CBDV. [Ethiop. J. Health Dev. 2021; 35(SI-3):09-15]Key words: Immunization, CBDV, Data discrepancy, Data qualit

A systems and partnership approach to agricultural research for development: Lessons from Ethiopia

In spite of the availability of several improved agricultural technologies generated by the research system in Ethiopia over the last four decades, adoption of these innovations by smallholder farmers has been very low. This has led to stagnation of agricultural productivity and low crop yields, exposing the country to recurrent food shortfalls and national food insecurity. The old approach to agricultural research emphasized developing new technologies mainly through onstation research that were then supposed to reach farmers through the public-sector extension system. The Ethiopian Institute of Agricultural Research (EIAR) has in recent years introduced a shift in agricultural research for development, which is based on the innovation systems approach that involved cultivating partnerships with several actors along the value chain, especially farmers, farmers’ cooperatives and input suppliers. This paper presents the methodology used to facilitate agricultural innovations and the diffusion of new technologies and illustrates the outcomes of this initiative with regard to technology adoption, productivity growth and the market orientation of production. The authors use examples from experiences in scaling up three grain legumes. Compared to the three-year baseline average (2003–05), crop output increased nationally by 89%, 85% and 97% in 2008 for common bean, chickpea and lentil respectively. Nationally, 53–59% of the output growth is attributable to yield growth due to technological change, while the balance is due to area expansion. These results affirm that the new approach has led to accelerated adoption of new and high-yielding or low-risk varieties

Balanced fertilization increases wheat yield response on different soils and agroecological zones in Ethiopia

The response of wheat to the application of different rates of nitrogen (N), phosphorus (P), potassium (K), and sulfur (S) under balanced fertilization on different soil types and agroecologies has not been well studied in Ethiopia. Therefore, the objectives of this study were to (1) determine soil-specific responses of wheat to N, P, K, and S under balanced fertilization; (2) quantify agroecology-specific N, P, K, and S response of wheat under balanced fertilization; and (3) determine nutrient use efficiency of wheat on different soil types under balanced fertilization. Trials were conducted on farmers’ fields across 24 locations covering 4 soil types and 5 agroecological zones (AEZs) from 2013 to 2017. The mean grain yields of wheat significantly varied with applied N and P fertilizer rates with soil types and AEZs. With balanced application of other nutrients, the optimum N rates for wheat were 138 kg N ha−1 on Cambisols and Luvisols, 92 kg N ha−1 on Vertisols, and 176 kg N ha−1 on Nitisols, while the optimum P rate was 20 kg P ha−1 on Cambisols and Vertisols. The nutrient dose–response curve did not reveal consistent pattern for K and S applications on all soil types. The agronomic efficiency of wheat decreased with increasing rates N and P on all soil types. The highest agronomic efficiency of N (15.8 kg grain kg−1 applied N) was recorded with application of 92 kg N ha−1 on Vertisols, while the highest agronomic efficiency of P (49 kg grain kg−1 applied P) was achieved with application of 10 kg P ha−1 on Cambisols. We conclude that applications of 92–138 kg N ha−1, 20 kg P ha−1, 18 kg K ha−1, and 10 kg S ha−1 under balanced application of zinc and boron could be recommended depending on soil type for wheat production in the study areas

institutional framework of in action against land degradation

While econometric and spatial data are increasingly helpful to quantify and locate the extent and costs of land degradation, there is still little understanding of the contextual factors that determine or influence the land users' practices that aggravate or counteract land degradation. In this chapter, we take an institutional economic approach to analyse the persistence of degrading practices, the low adoption of sustainable land management (SLM), or the eventual organisational reaction to land degradation. The chapter reviews four examples of land degradation in different contexts to reveal the multiple driving forces and contextual factors. We then propose a conceptual framework to better understand the incentive structure and factors determining the land users' decision making. A layered analysis of the social phenomena is applied, following Williamson (2000). The chapter shows how actions at different layers can help improve land management. The chapter concludes with practical recommendations for the institutional economic analysis of land degradation

Adsorption of methylene blue dye onto acid-treated tej residue: Kinetic, equilibrium and thermodynamic study

94-102Dye-containing wastewater is a very toxic and a major threat to the deterioration of water quality and makes it unsuitable for domestic purposes. This drives low cost and eco-friendly adsorbents from environmental waste have been investigated to treat dye-containing wastewater. In the present study, tej residues (TR) have been successfully employed as a natural and non-conventional low-cost adsorbent for the removal of methylene blue (MB) dye from an aqueous solution. Optimization of maximum operating condition has been carried out by batch mode experiment and the result shows maximum removal efficiency of 82.1821 % at pH 8.0, adsorbent dosage 0.4g, initial dye concentration 20 ppm, contact time 60 min, and temperature 25°C on the acid-treated surface of tej residue. Adsorption kinetics of the adsorbent has been evaluated by pseudo-first-order, pseudo-second-order and intra-particle diffusion, and it is observed that the pseudo-first-order kinetic model is better fitted with a good correlation coefficient, and the equilibrium data fitted well with the Freundlich isotherm model. The Langmuir isotherm model estimates that the maximum adsorption capacity of the monolayer is found to be 215.053 mg/g. Thermodynamics parameters such as ΔG0, ΔH0 and ΔS0 indicate that the sorption process is feasible and exothermic