The Political Economy of Agricultural Extension in Ethiopia: Economic Growth and Political Control

The central argument in this paper is that, for the past two decades, state-led agricultural extension in Ethiopia, implemented by excluding other players in general and non-state actors in particular, has facilitated uncontested control of the public space by the incumbent Ethiopian People’s Revolutionary Democratic Front (EPRDF). In addition to its presumed economic ramifications, the ongoing agricultural extension scheme that is a major component of transforming smallholder agriculture is driven by political imperatives aimed at effectively controlling the bulk of the Ethiopian electorate whose votes in periodic elections are crucial to the regime’s perpetuation in power.DfI

Infestation of Ixodidae Ticks in Cattle: Prevalence and Associated Risk Factors in Ambo District, Western Ethiopia

In Ethiopia, ticks cause serious economic loss particularly in ruminants. A cross sectional study was conducted in Ambo district, Western Ethiopia from October, 2018 to June, 2019 with the objectives of determining the prevalence, identifying the associated risk factors and the tick species of cattle in the area. From five purposively selected kebeles (the smallest administrative unit of Ethiopia) of the district, a total of 384 cattle were selected by systematic random sampling method. Adult Ixodid ticks were collected from different body parts of infested cattle, preserved in 10% formalin and transported to Ambo University Veterinary Parasitology Laboratory for stereomicroscopic identification to species level. Among 384 cattle examined, 201 (52.34%) cattle were infested with one or two tick species. A higher prevalence of tick infestation was recorded in Degele Gatira kebele (53.25%), followed by Abebe Doyo (50.65%), Gosu Kora (50.65%), Kisose Liban (50.65%), and Senkele Faris (56.59%). The study investigated three genera of Ixodid ticks namely Rhipicephalus (41.7%), Boophilus (0.8%) and Amblyomma (2.60%). Mixed infestations were common including Rh. Boophilus and Amblyomma 24(6.25%) and Rh. Boophilus and Rhipicephalus 4(1.04%). The study identified four species of ticks; namely Rh. (Bo.) decoloratus 109 (28.40%), Rhipicephalus (Boophilus) annulatus 43(11.20%), Amblyomma vareigatum 3(0.80%) and Rhipicephalus evertsi evertsi 11(2.90%). The difference in tick infestation was found to be statistically insignificant (P >0.05) between different age groups and kebeles but statistically significant (P <0.05) among sex groups, breeds, and different body condition scores (P <0.05). In conclusion, this study indicated a high prevalence of tick infestation and identified the most important ticks that can transmit various livestock diseases. A proper tick eradication campaign should be conducted to reduce the tick burden in the study area, and concomitantly reduce tick-borne diseases and associated economic losses

Prevalence of household food insecurity and associated factors in drought-prone pastoralist communities in Borana, Oromia, Ethiopia

AbstractBackground: Food security is a central component of the development agenda in pastoralist communities, especially among those who reside in drought-prone areas.Objective: This study measured the prevalence of household food insecurity and associated factors among pastoralist communities of Borana, Ethiopia. Methods and materials: A community-based cross-sectional study was conducted between July and August 2015 in two pastoralist communities in Borana Zone, Oromia, Ethiopia. Data were collected from 1,058 randomly sampled households through an interviewer-administered structured questionnaire. The data were analysed using SPSS version 21.0. Results: The mean household food insecurity score was 18.21 (value range: 0.00-27.00). Overall, 82.33% of the households were severely food insecure, with 14.56% moderately food insecure. Ownership of private farming land, reliance on crop farming as the main economic activity (β=1.47, p=0.016), and one-way walk time to water sources (β=0.01, p=0.001) were significantly associated with household food insecurity (p<0.05). Likewise, increased family size (β=0.49, p=0.001) and lack of education (β=1.41, p=0.025) were significantly associated with food insecurity. In contrast, dependence on small business (petty trade and shop) as the main economic activity (β=5.14, p=0.001); ownership of milking cow (β=-0.25, p=0.001), bull/heifer (β=-0.16, p=0.002), goat (β=-0.14, p=0.001) or pullet (β=-1.17, p=0.001); ownership of various assets, such as forage (β=-2.50, p=0.009); and participation in village-level saving schemes (β=-1.41, p=0.044) were all significantly associated with reduced household food insecurity. Conclusions: Household food insecurity was widespread in the pastoralist communities of Borana, Ethiopia, affecting a high number of households in all domains: food anxiety, food quality, and quantity of food at the household level. As there were factors that were linked to food insecurity in the study pastoralists, evidence-based innovative interventions via a combination of measures in a medium-to-long-term development plan are vital for sustained household food security. [Ethiop. J. Health Dev. 2021; 35(1):38-49] Keywords: Pastoralist, resilience, food resiliency, food insecurity, Borana, Ethiopi

Health system capacity for Tuberculosis Care in Ethiopia: evidence from national representative survey

Objective The objective of this study was to evaluate the TB health system capacity and its variations by location and types of health facilities in Ethiopia. Settings The study included 873 public and private health facilities all over Ethiopia. Design We used the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all hospitals and randomly selected health centers and private facilities in all regions of Ethiopia. We assessed structural, process and overall health system capacity based on the Donabedian quality of care model. Multiple linear regression and spatial analysis were done to assess TB capacity score variation across regions. Results A total of 873 health facilities were included in the analysis. The overall TB care capacity score was 76.7%, 55.9% and 37.8% in public hospitals, health centers and private facilities respectively. The health system capacity score for TB was higher in the urban (60.4%) facilities compared to that of the rural (50.0%) facilities (β=8.0, 95%CI: 4.4, 11.6). Health centers (β= 16.2, 95%CI: -20.0, -12.3) and private health facilities (β= -38.3, 95%CI: -42.4, -35.1) had lower TB care capacity score than hospitals. Overall TB care capacity score were lower in Western and Southern western Ethiopia and in Benishangul Gumz and Gambella regions. Conclusions The health system capacity score for TB care in Ethiopia varied across regions. Health system capacity improvement interventions should focus on the private sectors and health facilities in the rural and remote areas to ensure equity and improve quality of care

Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS: A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS: Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION: The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness

Capacity of health facilities for diagnosis and treatment of HIV/AIDS in Ethiopia

Background: There are dearth of literature on the capacity of the health system to diagnose and treat HIV/AIDS in Ethiopia. In this study we evaluated the capacity of health facilities for HIV/AIDS care, its spatial distribution and variations by regions and zones in Ethiopia. Methods: We analyzed the Service Provision Assessment plus (SPA+) survey data that were collected in 2014 in all regions of Ethiopia. We assessed structural, process and overall capacity of the health system based on the Donabedian quality of care model. We included 5 structural and 8 process indicators and overall capacity score was constructed by taking the average of all indicators. Multiple linear regression was done using STATA 14 to assess the association of the location and types of health facilities with overall capacity score. Maps displaying the average capacity score at Zonal level were produced using ArcGIS Desktop v10.3 (Environmental Systems Research Institute Inc., Redlands CA, USA). Results: A total of 873 health facilities were included in the analysis. Less than 5% of the private facilities provided antiretroviral therapy (ART); had national ART guideline, baseline CD4 count or viral load and tuberculosis screening mechanisms. Nearly one-third of the health centers (34.9%) provided ART. Public hospitals have better capacity score (77.1%) than health centers (45.9%) and private health facilities (24.8%). The overall capacity score for urban facilities (57.1%) was higher than that of the rural (38.2%) health facilities (β = 15.4, 95% CI: 11.7, 19.2). Health centers (β = − 21.4, 95% CI: -25.4, − 17.4) and private health facilities (β = − 50.9, 95% CI: -54.8, − 47.1) had lower overall capacity score than hospitals. Facilities in Somali (β = − 13.8, 95% CI: -20.6, − 7.0) and SNNPR (β = − 5.0, 95% CI: -9.8, − 0.1) regions had lower overall capacity score than facilities in the Oromia region. Zones located in emerging regions such as Gambella and Benishangul Gumz and in remote areas of Oromia and SNNPR had lower capacity score in terms of process indicators. Conclusions: There is a significant geographical heterogeneity on the capacity of health facilities for HIV/AIDS care and treatment in Ethiopia. Targeted capacity improvement initiatives are recommended with focus on health centers and private health facilities, and emerging Regions and the rural and remote areas

Optimising age adjustment of trichiasis prevalence estimates using data from 162 standardised surveys from seven regions of Ethiopia.

PURPOSE: The prevalence of trichiasis is higher in females and increases markedly with age. Surveys carried out in the daytime, particularly in developing countries, are prone to find older individuals and females at home at the time of the survey. Population-level trichiasis estimates should adjust sample proportions to reflect the demographic breakdown of the population, although the most accurate method of doing this is unclear. METHODS: Having obtained data from 162 surveys carried out in Ethiopia as part of the Global Trachoma Mapping Project from 2012 to 2015, we used internal validation with both Brier and Logarithmic forecast scoring to test stratification models to identify those models with the highest predictive accuracy. Selection of partitions was undertaken by both simple random sampling (SRS) and cluster sampling (CS) over 8192 selections. RESULTS: A total of 4529 (1.9%) cases of trichiasis were identified from 241,139 individuals aged ≥15 years from a total of 4210 kebeles and 122,090 households visited. Overall, the binning method using 5-year bands from age 15 to 69 years, with coarser binning in 20-year age-bands above this age, provided the best predictive accuracy, in both SRS and CS methodologies and for both the Brier and Logarithmic scoring rules. CONCLUSION: The greatest predictive accuracy for trichiasis estimates was found by adjusting for sex and in 5-year age-bands from the age of 15 to 69 years and in 20-year age-bands in those aged 70 years and greater. Trichiasis surveys attempting to make population-level inferences should use this method to optimise surgery backlog estimates

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe