In search of Insights from Community of Practice and Use of Telemedicine in Low income Countries: The case of Ethiopia

The use of ICT for exchange of medical records in provision of health care services appears to be a viable option for enhancing the capacity of low income developing countries struggling with shortage of qualified medical personnel. This study seeks to gain a preliminary assessment of whether health professionals who work in the health facilities covered by the Ethio-Indian Telemedicine program have adopted and used the Telemedicine technology to enhance health care services. Among other things, the study also aims to understand the extent to which health professionals in the study area consider Telemedicine as a viable option for delivery of health care services. Survey will be conducted to gather information from users in the study area. The study is primarily informed by literature on Community of Practice, Unified Theory of Acceptance and Use of Technology, and Case Study Research

Malnutrition: Prevalence and its associated factors in People living with HIV/AIDS, in Dilla University Referral Hospital

BACKGROUND: Literatures on prevalence and factors associated with malnutrition among peoples living with HIV/AIDS are limited in Ethiopia and not well documented either. The proper implementation of nutritional support and its integration with the routine highly active antiretroviral therapy package demands a clear picture of the magnitude and associated factors of malnutrition. The objective of this study is, therefore, to assess the prevalence and factors associated with malnutrition among peoples living with HIV/AIDS. METHODS: Institution based cross sectional study was conducted in Dilla University referral Hospital including adult HIV patients who were in highly active anti retroviral therapy. Interview administered questionnaires were used to collect data on socio demographic factors. Besides, HIV related clinical information was extracted from anti retro viral therapy data base and clinical charts. The nutritional status of the patients was determined by Body Mass Index (BMI) where BMI < 18kg/m(2) was defined as malnutrition according to World Health Organization (WHO). Binary logistic regression was used to assess association between different risk factors and malnutrition. Confidence interval of 95% was considered to see the precision of the study and the level of significance was taken at α <0.05. RESULTS: A total of 520 patients were included in the analysis. The overall prevalence of malnutrition was 12.3% (95% CI 9.5–15.0). After full control of all variables; unemployment (OR = 3.61, 95% CI: 3.6 − 7.76), WHO clinical stage four (OR = 12.9, 95% CI: 2.49− 15.25), gastrointestinal symptoms (OR = 5.3, 95% CI: 2.56 − 10.78) and previous (one) opportunistic infection (OR = 3.1, 95% CI 2.06 − 5.46), and two & above previous opportunistic infections (OR = 4.5, 95% CI: 3.38 − 10.57) were significantly associated with malnutrition. However, moderately poor economic condition was found to be protective factor for malnutrition (OR = 0.4, 95% CI: 0.14 − 0.95). CONCLUSION: Unemployment, WHO clinical AIDS stage four, one & more number of previous opportunistic infections and gastrointestinal symptoms were found to be important risk factors for malnutrition among People Living with HIV/AIDS. From this study it has been learnt that nutritional programs should be an integral part of HIV/AIDS continuum of care. Furthermore, it needs to improve household income of PLHIV with employment opportunity and to engage them in income generating activities as well

BUSINESS-IT ALIGNMENT IN THE BANKING SECTOR: A CASE FROM A DEVELOPING COUNTRY

Business-IT Alignment (BITA), one of the widely explored topics in the IS research domain, remains to be challenging. The extant literature provides a long list of factors that need to be managed appropriately to achieve and maintain BITA. Among other things, both the intra-organisational as well as external factors, are found to determine whether organisations succeed to achieve BITA or not. However, previous BITA studies have been criticised for focusing on investigating a few industries and contextual factors in developed countries. This case study is aimed at addressing the lack of BITA studies in developing countries. The data was collected at a bank in Ethiopia through interviews with business as well as IT leaders. The study employed thematic analysis, which revealed several barriers to BITA. Business and IT leaders may find the result of the study invaluable to plan activities that might over- come BITA barriers and improve BITA maturity

Progress towards the 2020 fast track HIV/ AIDS reduction targets across ages in Ethiopia as compared to neighboring countries using global burden of diseases 2017 data

Background Sustainable Development Goal (SDG) 3.3, targets to eliminate HIV from being a public health threat by 2030. For better tracking of this target interim Fast Track milestones for 2020 and composite complementary measures have been indicated. This study measured the Fast Track progress in the epidemiology of HIV/AIDS in Ethiopia across ages compared to neighboring countries. Methods The National Data Management Center for health’s research team at the Ethiopian Public Health Institute has analyzed the Global Burden of Disease (GBD) 2017 secondary data for the year 2010 to 2017 for Ethiopia and its neighbors. GBD 2017 data sources were census, demographic and a health survey, prevention of mother-to-child HIV transmission, antiretroviral treatment programs, sentinel surveillance, and UNAIDS reports. Age-standardized and age-specific HIV/AIDS incidence, prevalence, mortality, Disability-Adjusted Life Years (DALYs), incidence:mortality ratio and incidence:prevalence ratio were calculated with corresponding 95% confidence intervals. Results Ethiopia and neighboring countries recorded slow progress in reducing new HIV infection since 2010. Only Uganda would achieve the 75% target by 2020. Ethiopia, Tanzania, and Uganda already achieved the 75% mortality reduction target set for 2020. The incidence: prevalence ratio for Ethiopia, Rwanda, and Uganda were  1 due to high incidence. The HIV incidence rate in Ethiopia was dropped by 76% among under 5 children in 2017 compared to 2010 and the country would likely to attain the 2020 national target, but far behind achieving the target among the 15–49 age group. Conclusions Ethiopia and neighboring countries have made remarkable progress towards achieving the 75% HIV/AIDS mortality reduction target by 2020, although they progressed poorly in reducing HIV incidence. By recording an incidence:prevalence ratio benchmark of less than 0.03, Ethiopia, Rwanda, and Uganda are well heading towards epidemic control. Nonetheless, the high HIV/AIDS mortality rate in Ethiopia for its incidence requires innovative strategies to reach out undiagnosed cases and to build institutional capacity for generating strong evidence to ensure sustainable epidemic control.publishedVersio

A pilot study of the data demands of different stakeholders for the future Ethiopian dairy sector [version 1; peer review: awaiting peer review]

Background:  This paper describes a pilot study undertaken in 2018, to determine the key data needs of each of the different Ethiopian dairy sector stakeholder groups.  The study aimed to characterise the emerging trends of dairy product production, processing, retailing and consumption in Ethiopia, and to identify and characterise current and future data needs of different stakeholders. Methods:  The study undertook a mapping of the interactions between different stakeholders in the dairy sector, and an interactive evaluation of the institutional data repository and access options.  Focus group discussions and interviews were held in three regions of the country prior to a two-day workshop in the capital Addis Ababa.  Data needs were characterised by type, availability, format, level of detail, methods of dissemination, uptake and use, and the institutional arrangement, including the different roles of public and private sectors in decision making processes. Results:  The study highlighted the main data needs and identified several broader institutional issues constraining the further development of the Ethiopian dairy sector.  The stakeholder groups endorsed the reactivation of a national dairy board, independent of government but closely incorporating government, and with the buy-in and membership of private sector enterprises, including producers, processers, service providers and consumers, to provide clearer facilitative leadership on the dairy industry. Conclusions:  The study workshop provided a timely discussion between diverse stakeholders, including government, and several potential organisations were suggested to host and manage a national dairy database. Importantly, the reactivation of a national dairy board was strongly endorsed.  It was recommended that stakeholder links be established, sector-specific data needs be elevated to higher detail, and a national roll out of herd-specific data recording schemes was called for, to allow for effective evidence-based policies and decision making

A cost-effectiveness analysis of maternal and neonatal health interventions in Ethiopia

Ethiopia is one of the sub-Saharan African countries contributing to the highest number of maternal and neonatal deaths. Coverage of maternal and neonatal health (MNH) interventions has remained very low in Ethiopia. We examined the cost-effectiveness of selected MNH interventions in an Ethiopian setting. We analysed 13 case management and preventive MNH interventions. For all interventions, we used an ingredients-based approach for cost estimation. We employed a static life table model to estimate the health impact of a 20% increase in intervention coverage relative to the baseline. We used disability-adjusted life years (DALYs) as the health outcome measure while costs were expressed in 2018 US$. Analyses were based on local epidemiological, demographic and cost data when available. Our finding shows that 12 out of the 13 interventions included in our analysis were highly cost-effective. Interventions targeting newborns such as neonatal resuscitation (institutional), kangaroo mother care and management of newborn sepsis with injectable antibiotics were the most cost-effective interventions with incremental cost-effectiveness ratios of US$7, US$8 and US$17 per DALY averted, respectively. Obstetric interventions (induction of labour, active management of third stage of labour, management of pre-eclampsia/eclampsia and maternal sepsis, syphilis treatment and tetanus toxoid during pregnancy) and safe abortion cost between US$100 and US$300 per DALY averted. Calcium supplementation for pre-eclampsia and eclampsia prevention was the least cost-effective, with a cost per DALY of about US$3100. Many of the MNH interventions analysed were highly cost-effective, and this evidence can inform the ongoing essential health services package revision in Ethiopia. Our analysis also shows that calcium supplementation does not appear to be cost-effective in our setting.publishedVersio

Inadequate management of pneumonia among children in South Ethiopia: findings from descriptive study.

BACKGROUND: Health system support is crucial for quality child healthcare. Therefore, this baseline survey, which is part of the community-based management study of severe pneumonia, was conducted to assess the state of health system support of IMNCI and iCCM, and health workers' knowledge in managing childhood pneumonia at health facilities. METHODS: A survey was conducted in 99 government health institutions in South Ethiopia from 07 to 14 January, 2018. A questionnaire for health system support and case scenario for the management of severe pneumonia was adapted from the WHO health facility survey tool. The questionnaire's interview, facility observation, case scenario and retrospective record review were all used as data collection methods. Indicators of health system support in the context of an integrated management of childhood illness were used. Proportions for categorical variables and means for continuous variables were also computed for each indicator. Mean score was analysed for assessing the knowledge of health workers in managing the case scenario. RESULTS: In the study area, only 12 (34%) of health centres and 18 (29%) of health posts received supervision, which included the observation of case management. The mean number of essential oral antibiotics for the home treatment of pneumonia available at the facility was 1.1 (95% CI 0.9 to 1.3), whereas the mean number of pre-referral drugs for the treatment of severe pneumonia was 1.3 (95% CI 1.0 to 1.6). Approximately 47 (48%; 95% CI 37.7 to 57.3) of the surveyed health facilities had materials and equipment to support vaccination services, and 71 (72%; 95% CI 62.8 to 80.6) of them had the vaccines on the day of the survey. Only four (4%; 95% CI 0.3 to 8.3) of the health facilities had all the essential job aids and supplies for providing services for pneumonia. The providers' mean knowledge score for the management of severe childhood pneumonia was 14.9 out of 22 correct answers. CONCLUSION: There is a room to improve the health system support to integrated management of neonatal and childhood illness through supply chain management and knowledge of health workers in the management of severe pneumonia by providing training

Can rangelands gain from bush encroachment? Carbon stocks of communal grazing lands invaded by Prosopis juliflora

This research article published by Elsevier Ltd., 2017Rangeland ecosystems are rapidly declining due to overgrazing and bush encroachment. Little is known about how important bush encroachment is for climate change mitigation. We estimated woody plant biomass at different Prosopis juliflora cover to quantify above- and below-ground carbon (C) stocks in Afar, northern Ethiopia. We developed allometric models to estimate aboveground biomass (agB) through destructive harvesting based on crown diameter (CrD), diameter at stump height (DSH), and tree height (H) for twenty P. juliflora and 18 Acacia senegal trees. DSH showed the best model fit in predicting above ground biomass compared to H, CrD, and the combination of those predictor parameters, respectively. Models were highly significant for all agB components. Total C stocks of the entire woody species community were about 40% higher (86 Mg C ha−1) at high than at low (50 Mg C ha−1) P. juliflora encroachment categories. We conclude that allometric models using simple dendrometric parameters are highly valuable for assessing P. juliflora biomass. While in lightly invaded areas, eradication and prevention of further spread might be possible, we propose that the high C stocks of rangelands densely invaded by P. juliflora, where eradication attempts have failed, should be considered for potential C trade measures

Patterns of mortality in domesticated ruminants in Ethiopia

BACKGROUND: Premature death of livestock is a problem in all ruminant production systems. While the number of premature ruminant deaths in a country is a reasonable indicator for the nation's health, few data sources exist in a country like Ethiopia that can be used to generate valid estimates. The present study aimed to establish if three different data sets, each with imperfect information on ruminant mortality, including abortions, could be combined into improved estimates of nationwide mortality in Ethiopia. METHODS: We combined information from a recent survey of ruminant mortality with information from the Living Standards Measurement Study and the Disease Outbreak and Vaccination Reporting dataset. Generalized linear mixed and hurdle models were used for data analysis, with results summarized using predicted outcomes. RESULTS: Analyses indicated that most herds experienced zero mortality and reproductive losses, with rare occasions of larger losses. Diseases causing deaths varied greatly both geographically and over time. There was little agreement between the different datasets. While the models aid the understanding of patterns of mortality and reproductive losses, the degree of variation observed limited the predictive scope. CONCLUSIONS: The models revealed some insight into why mortality rates are variable over time and are therefore less useful in measuring production or health status, and it is suggested that alternative measures of productivity, such as number of offspring raised to 1 year old per dam, would be more stable over time and likely more indicative