Assessment of local land and water institutions in the Blue Nile and their impact on environmental management

Land and water institutions play a vital role in managing and sustaining land and water resources as well as enhancing economic development and poverty alleviation efforts. While a lot has been done in terms of understanding the micro-determinants of farmers’ decisions in land and water conservation, there is little attempt to understand the broad macro-institutional and organizational issues that influence land and water management decisions. The objective of the study was to assess institutional arrangements and challenges for improved land and water management in the Ethiopian part of the Blue Nile Basin (Tana and Beles subbasins). Focus group discussions and key informant interviews were held in Amhara and Benishangul Gumuz regions with important stakeholders such as the bureaus of Agriculture and Rural Development, Water Resources Development, Environmental Protection and Land Use Administration (EPLUA), National Agricultural Research Systems, and important NGOs, operating in the area of land and water management, and selected community members. As the major findings in this study, we outlined major land and water-related institutional arrangements that are currently in place and their design features, in order to identify those institutions related to superior performance. We highlighted major institutional and policy gaps and actions that are required to respond to emerging issues of environmental degradation, upstream/downstream linkages and climate change. Such analysis of institutions and their design features provides useful insights and contributes to the debate on institutional reform for improved land and water management in the Blue Nile Basin, in general. By doing so, it identifies the gaps in institutional arrangements and policies and potential remedies.Length: pp.185-231InstitutionsOrganizationsWater policyRiver basinsWater managementLand managementWatershed management

Importance of irrigated agriculture to the Ethiopian economy: capturing the direct net benefits of irrigation

Irrigated farming / National income / Economic growth / Crops / Prices / Sensitivity analysis / Crop management / Irrigation schemes / Ethiopia

Economics of selected water control technologies and their successful use: The case of Ethiopia

Using a production function, marginal productivity of farm inputs and benefit-cost analysis, we explore the economics of selected water control technologies. From the production function, all farm inputs, including irrigation water is found to have a significant and positive effect on yield. Marginal value products of farm inputs are found to be positive but their magnitudes differ by type of control structures, crop type, agro-ecology and regions. The net present values of all water control structures are positive. There is a favorable precondition for sustainable adoption of these controls technologies and institutionalizing some sort of cost recovery schemes. The level of education, the ratio of irrigated land allocated to irrigated annuals and perennials, access to markets and off-farm income are found to have significant effect on successful use of these control structures. Recommendations and policy implications are drawn accordingly.Keywords: water control, NPV, production function, instrumental variables regression; Africa

Transboundary water governance institutional architecture: reflections from Ethiopia and Sudan

Transboundary water resource governance is premised on equitable water and water-related benefit sharing. Using the case of the Blue Nile (Ethiopia and Sudan), we explore the conceptual issues that need consideration in the crafting of cross-border cooperation within the water sector. First, drawing on global experiences with transboundary water management, we evaluate how upstream and downstream concerns are addressed by transboundary water management institutions. Second, we explore the kinds of institutional design and the issues which need to be considered to result in ‘win-win’ scenarios for both upstream and downstream users, as well as the mechanisms of benefit sharing negotiated amongst different stakeholders. Third, we examine ways of addressing equity and livelihoods in transboundary institutional arrangements. Finally, we attempt to assess how transboundary institutions can address broader historical, political and economic issues and their implications for sustainable transboundary water governance. This paper raises key issues that need to be addressed in establishing transboundary governance institutions.Length: pp.246-253Water governanceInstitutionsInternational watersInternational cooperationRiver basin management

Contamination rate of commonly consumed fresh vegetables and fruits with parasites of medically importance in Wolkite and Butajira Towns of Gurage Zone, Southern Ethiopia

Intestinal parasitic infections are among the most common on causes  of disease in humans, responsible for considerable morbidity and mortality. Commonly consumed raw vegetables and fruits are among the ways through which humans become infected with parasites of medical importance. A prospective cross-sectional study with an aim of describing the parasite contamination rate of raw fresh vegetables and fruits sold at the central open-aired market of Butajira and Wolkite towns, in southern Ethiopia was conducted on a total of 270 fresh vegetable and fruits samples. Standardized parasitological techniques were employed to detect diagnostic stages of parasites.98 out of the 270 (36.3%) samples were found positive for intestinal parasites. Remarkably, twenty eight out of the forty five cabbage samples analyzed, 62.2%, were found to be contaminated with parasites of medical importance, registering the highest level of contamination. On the contrary Avocado was found to be the least contaminated produce with contamination rate of 17.7% (8/45). Significant association was observed between the kind of vegetables analyzed and existence of parasites (p=0.002). This study identified high rate of contamination in commonly consumed vegetables and fruits. The authors believe that the role fruits and vegetables paly in the transmission of intestinal parasitic infections to humans is un questionable. Substantial attention is needed from all relevant bodies to tackle this problem

Importance of irrigated agriculture to the Ethiopian economy: Capturing the direct net benefits of irrigation

Abstract Irrigation development is seen as one of the means to reduce poverty and promote economic growth. While a lot of effort is exerted towards irrigation development, little attempt is done to quantify the contribution of irrigation to national income in Ethiopia. This study is an attempt to quantify the actual and expected contribution of irrigation to the Ethiopian national economy for 2005/06 cropping season and 2009/10 using adjusted net gross margin analysis. Our results show that irrigation in the study sites generates an average income of about USD 323/ ha. This compares to the calculated gross margin for rainfed which is USD 147/ha. This indicates that after accounting for annual investment replacement cost net gross margin from irrigation is more than twice higher than gross margin from rainfed agriculture. On the other hand, the contribution coming from the large scale sugar growing estates in 2009/2010 is estimated to be USD 217.5 million which amounts to 2.9 and 1.2 percent of the agricultural and overall GDP respectively. Similarly the contribution coming from large scale commercial farms growing crops other than sugar cane is expected to increase to USD 35.8 million in 2009/2010 which accounts to 0.4 and 0.2 percent of the agricultural and overall GDP respectively. This implies that large scale commercial farms will contribute about 3.3 and 1.4 of the agricultural and overall GDP respectively. In summary, our results indicate that under conservative estimates the future contribution of irrigation to agricultural and overall GDP will be about 9 and 3.7 percent respectively. When some of the assumptions related to cropping pattern, input and output prices, 128 and efficiency levels are relaxed, the contribution of smallholder managed irrigation to agricultural and overall GDP will vary between 4 to 6 and 1.8 to 1.9 percent respectively. Similarly, the contribution from large scale irrigation to agricultural and overall GDP will be in the range of 3 to 6 and 1.2 to 2.5 percent respectively. Overall, the future contribution of irrigation to agricultural GDP will be in the range of 7 to 12 percent while the contribution to overall GDP will be in the range of about 4 percent. To enhance the contribution of irrigation to national economy, besides increasing the presence of physical water infrastructure, however, there is a need to: i) improve provision of agricultural inputs, ii) promote high value crops through the extension system, iii) create good market conditions, and iv) increase the efficiency of small and large schemes

Mycobacterium Tuberculosis and Nontuberculous Mycobacteria Isolates from Presumptive Pulmonary Tuberculosis Patients Attending A Tertiary Hospital in Addis Ababa, Ethiopia

BACKGROUND፡ Mycobacterial infections are known to cause a public health problem globally. The burden of pulmonary disease from nontuberculous mycobacteria is reportedly on the rise in different parts of the world despite the fact that there is limited data about the disease in sub-Saharan Africa including Ethiopia. Hence, we aimed to assess the magnitude of M. tuberculosis and nontuberculous mycobacteria (NTM) among presumptive pulmonary tuberculosis patients attending St. Paul’s hospital Medical College, Addis Ababa, Ethiopia.METHODS: A cross-sectional study was conducted from June to September 20/2016. Morning sputum specimens were collected, processed and cultured in Lowenstein Jensen medium and BACTEC MGIT 960 media. The nontuberculous mycobacteria were further confirmed and characterized by Genotype CM/AS assays. The socio-demographic, clinical and chest x-ray data were collected using a structured questionnaire. The data was analyzed using SPSS version 20.RESULTS: Out of 275 presumptive tuberculosis patients enrolled in the study, 29(10.5%) were culture positive for Mycobacteria. Of these, 3(10.3%) were found to be NTM and 26(89.6%) were Mycobacterium tuberculosis complex. Of the NTM, two were unidentified and one typed as M.peregrinum. There was no coisolation of Mycobacterium tuberculosis complex and nontuberculous mycobacteria. Overall, 6(23.1%) Mycobacterium tuberculosis complex isolates were resistant to at least one antituberculosis drug. Of these, two were multidrug resistanttuberculosis cases (7.7%) detected from previously treated patients.CONCLUSION: Relatively low magnitude of Mycobacterium tuberculosis complex and nontuberculous mycobacteria isolates were seen in the study area. Therefore, further study using a large sample size is needed to be done to consider nontuberculous mycobacteria infection as a differential diagnosis in presumptive pulmonary tuberculosis patients

Protocol for the evaluation of a complex intervention aiming at increased utilisation of primary child health services in Ethiopia: a before and after study in intervention and comparison areas.

BACKGROUND: By expanding primary health care services, Ethiopia has reduced under-five mor4tality. Utilisation of these services is still low, and concerted efforts are needed for continued improvements in newborn and child survival. "Optimizing the Health Extension Program" is a complex intervention based on a logic framework developed from an analysis of barriers to the utilisation of primary child health services. This intervention includes innovative components to engage the community, strengthen the capacity of primary health care workers, and reinforce the local ownership and accountability of the primary child health services. This paper presents a protocol for the process and outcome evaluation, using a pragmatic trial design including before-and-after assessments in both intervention and comparison areas across four Ethiopian regions. The study has an integrated research capacity building initiative, including ten Ph.D. students recruited from Ethiopian Regional Health Bureaus and universities. METHODS: Baseline and endline surveys 2 years apart include household, facility, health worker, and district health office modules in intervention and comparison areas across Amhara, Southern Nations Nationalities and Peoples, Oromia, and Tigray regions. The effectiveness of the intervention on the seeking and receiving of appropriate care will be estimated by difference-in-differences analysis, adjusting for clustering and for relevant confounders. The process evaluation follows the guidelines of the UK Medical Research Council. The implementation is monitored using data that we anticipate will be used to describe the fidelity, reach, dose, contextual factors and cost. The participating Ph.D. students plan to perform in-depth analyses on different topics including equity, referral, newborn care practices, quality-of-care, geographic differences, and other process evaluation components. DISCUSSION: This protocol describes an evaluation of a complex intervention that aims at increased utilisation of primary and child health services. This unique collaborative effort includes key stakeholders from the Ethiopian health system, the implementing non-governmental organisations and universities, and combines state-of-the art effectiveness estimates and process evaluation with capacity building. The lessons learned from the project will inform efforts to engage communities and increase utilisation of care for children in other parts of Ethiopia and beyond. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12040912, retrospectively registered on 19 December, 2017

Does a complex intervention targeting communities, health facilities and district health managers increase the utilisation of community-based child health services? A before and after study in intervention and comparison areas of Ethiopia.

INTRODUCTION: Ethiopia successfully reduced mortality in children below 5 years of age during the past few decades, but the utilisation of child health services was still low. Optimising the Health Extension Programme was a 2-year intervention in 26 districts, focusing on community engagement, capacity strengthening of primary care workers and reinforcement of district accountability of child health services. We report the intervention's effectiveness on care utilisation for common childhood illnesses. METHODS: We included a representative sample of 5773 households with 2874 under-five children at baseline (December 2016 to February 2017) and 10 788 households and 5639 under-five children at endline surveys (December 2018 to February 2019) in intervention and comparison areas. Health facilities were also included. We assessed the effect of the intervention using difference-in-differences analyses. RESULTS: There were 31 intervention activities; many were one-off and implemented late. In eight districts, activities were interrupted for 4 months. Care-seeking for any illness in the 2 weeks before the survey for children aged 2-59 months at baseline was 58% (95% CI 47 to 68) in intervention and 49% (95% CI 39 to 60) in comparison areas. At end-line it was 39% (95% CI 32 to 45) in intervention and 34% (95% CI 27 to 41) in comparison areas (difference-in-differences -4 percentage points, adjusted OR 0.49, 95% CI 0.12 to 1.95). The intervention neither had an effect on care-seeking among sick neonates, nor on household participation in community engagement forums, supportive supervision of primary care workers, nor on indicators of district accountability for child health services. CONCLUSION: We found no evidence to suggest that the intervention increased the utilisation of care for sick children. The lack of effect could partly be attributed to the short implementation period of a complex intervention and implementation interruption. Future funding schemes should take into consideration that complex interventions that include behaviour change may need an extended implementation period. TRIAL REGISTRATION NUMBER: ISRCTN12040912