Palliative Care in HIV/AIDS

In the era of HIV, palliative care is important to improve the quality of life of people living with HIV. The core activities of palliative care are control of symptoms and psychological, social, and spiritual problems. As a matter of fact, people living with HIV have a high burden of physical, psychological, and social difficulties which require palliative care that is holistic care. This implies palliative care for people living with HIV improves their emotion, physical symptoms, and psychosocial and spiritual functions. It can be provided by trained healthcare professionals, families, and community caregivers. HIV care and treatment guidelines should address the principles of palliative care, and policy should be in place to enforce its implementation for improving the quality of life of people living with HIV

The Influence of Sire and Dam Genotype on Pre and Post Weaning Weight of Horro (Zebu) and Their Crosses with Holstein Friesian and Jersey cattle

The influence of sire and dam genotypes on birth weight (BW), weaning weight (WW), pre-weaning average daily gain (DG), post-weaning average daily gain  (PDG) and  one year weight  (YW)  in calves of  Horro and crosses of these indigenous with Bos Taurus (Holestian Friesian and  Jersey)  were investigated from data collected from Bako Agricultural Research center during the year 1980-2008. Least squares means were analysed using General Linear Model (GLM) of Statistical Analyses System (SAS). Sire and dam genotype, sex, dam age, parity and Julian birth date were considered in the fixed effects model with addition of age at weight measurement as a covariate. Calves sired by pure Holstein Friesian bulls 3.8kg heavier than the sired by Horro bulls and 1.2 kg heavier the calves sired by Holestian Friesian-Horro at birth. The no difference in BW of calves by the Jersey, Jersey-Horro and Horro bulls. The influence of dam genotypes on the pre and post weaning weight of calves was highly significant (P<0.05). Holestian Friesian-Horro dams produced the heavier (P<0.05) calves at weaning than Horro and Jersey- Horro dams, whereas at one year weight no significant difference between Horro and Holestian Friesian-Horro dams. The result also indicated that  pre and post weaning weight of  the calves sired  by pure  Holestian Friesian bulls  were superior (P<0.05) to others. Keywords: Dam genotype, Holstein Friesian, Horro, Jersey, sire genotype

Self-management of adults living with HIV on antiretroviral therapy in North-west Ethiopia

Background: As a result of the introduction of antiretroviral therapy (ART), human immunodeficiency virus (HIV) is becoming a long-term condition requiring effective self-management behaviour to maintain physical health and well-being. In Ethiopia, treatment guidelines have been revised to encourage individual engagement in self-management behaviours. However, HIV-related complications remain common. There is no established evidence on the self-management behaviour of adults living with HIV (ALWHIV) on ART in Ethiopia. Aim: The overall aim of this study was to determine the daily self-management behaviours and influencing factors among adults living with HIV on ART in Ethiopia and the most effective interventions to improve these behaviours. Methods: Individual and Family Self-Management Theory guided the studies included in this thesis. The study employed a systematic review and sequential explanatory mixed methods. A systematic review of experimental studies addressing interventions to improve self-management of adults living with HIV on ART was also conducted. The reviewed papers’ methodological quality was assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used for data extraction. Finally, a narrative synthesis was undertaken for the included studies; due to study heterogeneity, it was not possible to conduct a meta-analysis. The study employed sequential explanatory mixed methods. A quantitative study on a sample of 415 adults living with HIV on ART was carried out to identify the level of self-management (SM) and influencing factors in the study population. A face-to-face survey tool was used, and the data were entered and analysed using SPSS version 25.0. A qualitative study, informed by the survey findings was conducted to explore the key findings of the survey in greater depth. Eleven interviews were conducted to explore the self-management (SM) behaviours. The participants volunteered to be contacted during the preceding quantitative study. The audio-recorded interview data and field notes were transcribed and translated into English. Data were entered into NVivo 12 for data management and analysis. The interview data were coded inductively and subjected to thematic analysis. Results: The survey findings indicated a low level of SM behaviours amongst the study population compared to global studies. Factors influencing self-management were interconnected and included educational status, residence, self-efficacy, spiritual practices, income, medication adherence support, disclosure of HIV status, and experiences of stigma and discrimination. The systematic review identified multi-component interventions to improve self-management behaviours. Skills training with phone counselling, counselling with a symptom management manual, and technology-assisted interventions were commonly identified as effective interventions to enhance self-management behaviours. Conclusions: This study set out to add to the understanding of SM of ALWHIV in the Ethiopian context and identify feasible interventions that could be implemented to address known barriers to SM. The barriers have been mapped to contextually appropriate, evidence-informed interventions to generate policy and practice recommendations that could help to address the SM challenges faced by ALWHIV in Ethiopia. The thesis has elucidated the complex, inter-related factors at the individual, socio-demographic, disease-related and health care level that influence an individual’s ability to self-manage their HIV condition. Multi-component practical interventions are suggested for HIV care providers.Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 202

Growth Determinants of Micro and Small Enterprises: Evidence from Northern Ethiopia

This study aims to investigate the growth determinants of MSEs based on a survey covering 178 randomly selected MSEs from Mekelle city, Tigray regional state of Ethiopia through the test of four main hypotheses that are formulated concerning the role of gender of owner, initial investment on the firm, location and sector in which the firm operates as a main determinants of growth of an enterprise. Semi-structured questionnaire and interview were used to collect data, and the binary choice model which is logistic regression was used to identify factors that significantly affect the growth of MSEs using change in employment size since startup as a measure of firm growth in which about 76.4% of MSEs are found survival and the remaining 23.6% are growing. The binary choice logit model result shows that there is a significant gender difference on the growth of MSEs with male owner growing faster than those owned by female. In addition, the initial investment on the firm, the location and the sector in which the MSEs operates matter a lot for the growth of these enterprises. Hence, government and non government organizations that are concerned with unemployment reduction and poverty alleviation through the promotion and development of MSEs need to take these factors in to account to accomplish better result and increase the potential contribution of MSEs to the economic growth of the country. Key words: Determinants, Employment, Growth, Micro and Small Enterprises (MSEs), Binary Choice Model, Survival, Tigray, Ethiopia

Soil organic carbon dynamics along chrono-sequence land-use systems in the highlands of Ethiopia

Soil organic carbon (SOC) dynamics along land-use changes influences the terrestrial and global carbon cycle, the climate, soil fertility, agricultural productivity, and food security. Taking soils under native forests as an appropriate ecological reference, we studied changes in soil organic carbon stock along eight land-use types in the highlands of Ethiopia. The general objective of the study was to investigate the dynamics of SOC stock following chrono-sequence land-use/cover systems in the highlands of Ethiopia. The specific objectives were to: (1) analyze loss due to land degradation; (2) analyze gain due to land restoration; and (3) estimate partial balance of SOC stock for the highlands of Ethiopia. The study followed the principle of the Forest Transition Theory (FTT). Eleven sub-areas were considered from the highlands of Ethiopia. A total of 241 auger composite samples from the topsoil (0−20 cm depth) were collected during December 2017 to June 2018, and analyzed at CropNut soil lab in Nairobi. The study results revealed that there were statistically significant variations (P < 0.05) across the land-use types with the mean stocks ranging from 31.4 Mg SOC ha−1 in soils of intensively grazed lands to 145.0 Mg SOC ha−1 in soils of guasa grasslands. Soils of natural/pristine vegetation and protected guasa grasslands contain the highest amount of SOC stock. Therefore, there should be more aggressive efforts towards an effective protection of these ecosystems. Soils under intensively used croplands and intensively grazed lands lost, respectively, 64.95% and 78.16%, SOC stocks originally accumulated in the top surface layers of the pristine forests. This points for the need to adopt locally feasible land management practices that lead to increased SOC stock and simultaneously reduced CO2 and greenhouse gas emissions from croplands and intensively grazed lands of the highlands of Ethiopia. Compared to stocks of SOC of intensively grazed lands (31.44 Mg SOC ha−1 ), the annual stock gains in soils of controlled grazing lands (4.60 Mg ha−1 ) were > gains in soils of enclosures (3.17 Mg ha−1 ) > gains in soils of afforestation (2.35 Mg SOC ha−1 ), which signifies that converting degraded lands to either controlled grazing lands, enclosures, or afforestation would be a promising practice for an enhanced carbon sequestration across the highlands of Ethiopia. This practice is in line with the United Nations’ Sustainable Development Goals. The estimated regional partial stock balance revealed that the loss and gain ratio was 35.1 in 1991, and it declined to 15.4 in 2001, 2.2 in 2011 and 1.8 in 2015. These decreasing ratios indicate the possibility of closing the gap between the losses and the gains in the near future, and eventually shifting to higher rates of gains than losses. It is also important to note that determined efforts towards the effective protection of natural forests and the creation of enclosures and reforestation areas by local communities for enhanced carbon sequestration will benefit them from payments of carbon emission reduction (CER) credits

Khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia: a community-based study

IntroductionDespite its deleterious consequences, khat chewing is escalating worldwide. However, there is a lack of evidence about the extent of khat chewing among pregnant women in Ethiopia, particularly in the current study area. Therefore, this study aimed to assess the prevalence of current khat chewing and its associated factors among pregnant women in Chiro district, eastern Ethiopia.MethodsThis community-based cross-sectional study was conducted in Chiro district from November 1 to 30, 2022 G.C. Study participants were selected using the systematic random sampling technique. An interview-administered structured questionnaire was used to collect data through a house-to-house survey. The data were entered into EpiData version 3.1 and analyzed in STATA 14 software. Characteristics of study participants were summarized using descriptive analysis, and binary logistic regression was used to identify determinants of khat chewing.ResultsA total of 409 pregnant women participated in this study, with a response rate of 99%. The overall prevalence of khat chewing was 60.4% (95% CI: 55.5%, 65.2%). Religion (AOR: 2.08; 95% CI: 1.13, 3.82), khat cultivation (AOR: 0.43; 95% CI: 0.25, 0.77), partner khat use (AOR: 5.54; 95% CI: 3.11, 9.88), pre-pregnancy khat use (AOR: 9.95; 95% CI: 5.55, 17.81), antenatal care (ANC) visit (AOR: 2.71; 95% CI: 1.41, 5.21), and mental distress (AOR: 4.89; 95% CI: 2.38, 10.02) were significantly associated with current khat chewing.ConclusionThe majority of pregnant women in the study area practice khat chewing. Thus, accessible and comprehensive pre-conception and pre-natal care incorporating the prevention and management of antenatal khat chewing is crucial to overcome this problem. Provision of mental healthcare involving partners of pregnant women is also important to reduce the extent and impacts of khat chewing during pregnancy. Further longitudinal studies triangulated with qualitative designs are recommended

Characterizing and evaluating the impacts of national land restoration initiatives on ecosystem services in Ethiopia

Land restoration is considered to be the remedy for 21st century global challenges of land degradation. As a result, various land restoration and conservation efforts are underway at different scales. Ethiopia is one of the countries with huge investments in land restoration. Tremendous land management practices have been implemented across the country since the 1970s. However, the spatial distribution of the interventions has not been documented, and there is no systematic, quantitative evidence on whether land restoration efforts have achieved the restoration of desired ecosystem services. Therefore, we carried out a meta‐analysis of peer‐reviewed scientific literature related to land restoration efforts and their impacts in Ethiopia. Results show that most of the large‐scale projects have been implemented in the highlands, specifically in Tigray and Amhara regions covering about 24 agro‐ecological zones, and land restoration impact studies are mostly focused in the highlands but restricted in about 11 agro‐ecological zones. The highest mean effect on agricultural productivity is obtained from the combination of bunds and biological interventions followed by conservation agriculture practices with 170 % and 18% increases, respectively. However, bunds alone, biological intervention alone, and terracing (Fanya Juu) reveal negative effects on productivity. The mean effect of all land restoration interventions on soil organic carbon is positive, the highest effect being from “bunds + biological” (139%) followed by exclosure (90%). Reduced soil erosion and runoff are the dominant impacts of all interventions. The results can be used to improve existing guidelines to better match land restoration options with specific desired ecosystem functions and services. While the focus of this study was on the evaluation of the impacts of land restoration efforts on selected ecosystem services, impacts on livelihood and national socio‐economy have not been examined. Thus, strengthening socio‐economic studies at national scale to assess the sustainability of land restoration initiatives are an essential next step

Data-driven similar response units for agricultural technology targeting: An example from Ethiopia

Ethiopia has heterogeneous topographic, climatic and socio-ecological systems. Recommendations of agricultural inputs and management practices based on coarse domains such as agro-ecological zones (AEZ) may not lead to accurate targeting, mainly due to large intra-zone variations. The lack of well-targeted recommendations may contribute to the underperformance of promising technologies. Therefore, there is a need to define units where similar environmental and biophysical features prevail, based on which specific recommendations can be made for similar response units (SRUs). We used unsupervised machine learning algorithms to identify areas of high similarity or homogeneous zones called ‘SRUs’ that can guide the targeting of agricultural technologies. SRUs are landscape entities defined by integrating relevant environmental covariates with the intention to identify areas of similar responses. Using environmental spatial data layers such as edaphic and ecological variables for delineation of the SRUs, we applied K- and X-means clustering techniques to generate various granular levels of zonation and define areas of high similarity. The results of the clustering were validated through expert consultation and by comparison with an existing operational AEZ map of Ethiopia. We also augmented validation of the heterogeneity of the SRUs by using field-based crop response to fertiliser application experimental data. The expert consultation highlighted that the SRUs can provide improved clustering of areas of high similarity for targeting interventions. Comparison with the AEZ map indicated that SRUs with the same number of AEZ units captured heterogeneity better with less within-cluster variability of the former. In addition, SRUs show lower within-cluster variability to optimal crop response to fertiliser application compared with AEZs with the same number of classes. This implies that the SRUs can be used for refined agricultural input and technology targeting. The work in this study also developed an operational framework that users can deploy to fetch data from the cloud and generate SRUs for their areas of interest

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

The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.

BACKGROUND: Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%). CONCLUSIONS/SIGNIFICANCE: Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation