Evaluation of Different Agricultural Lime Sources for their Agronomic Effectiveness, Yield of Food Barley and Faba Bean and Acid Soil Properties in the Central Highlands of Ethiopia

አህፅሮት አሲዳማ አፈርን በኖራ ማከም የአፈርን ጤናማነትና ለምነት ቀጣይ ለማድረግ  ምርጥ የአፈር አያያዝ ዘዴ ሆኖ ተገኝቷል፡፡ ይሁን እንጂ የኖራ ፍቱን ውጤታማነት የሚለካው በምንጩ/የተገኘበት ቦታ፣ ስርቱ/ኬሚካላዊ ይዘቱ፣ የንፁህነትና የድቀት ደረጃውን ግምት ውስጥ በማስገባት ነው፡፡ የዚህ ጥናት ዓላማ በአገርቷ የተለያዩ ቦታዎች  የሚመረቱ ለእርሻ ግብዓት የሚዉሉ ኖራዎችን ብቃት ለመገምገም ነው፡፡ የኖራዎቹም የብቃት ማረጋገጫ የተሠራው በሆለታ ግብርና ምርምር ማዕከል የአፈር ላቦራቶሪ ነው፡፡ ከብቃት ማረጋገጫ ሥራው በኋላ በማዕከሉ የሙከራ ማሣና በሮብ-ገበያ የአርሶአደር ማሣ ላይ የኖራዎቹ ውጤት በአፈሩ ባህርይና በሰብል ምርት ላይ የሚያመጣው ለውጥ ተገምግሟል፡፡ ትርቲመንቶቹ አራት የኖራ ዓይነቶችና አንድ ኮንትሮል (ምንም ዓይነት ኖራ የሌለው) ሲሆኑ በራንደማይዝድ ኮምፕልት ብሎክ ዲዛይን በሦስት ድግግሞሽ ተሞክሯል፡፡ የጥናቱ ውጤት የሚያሳየው አራቱም ኖራዎች ለእርሻ ግብዓት የሚዉሉ መሆናቸው ነው፡፡ የጥናቱ ውጤት በተጨማሪ የሚያሳየው ስታቲስትካል ልዩነት ባለው መልኩ በኖራዎቹ መካከል በአፈር ባህርይና በሰብል ምርት ላይ ከፍተኛ ውጤት ባይገኝም፣ ከኮንትሮል (ምንም ዓይነት ኖራ ከሌለው) ጋር ስነፃፀር ከፍተኛ ውጤት ተገኝቷል፡፡ይህ ግኝት የሚያሣየው በአገርቷ የሚመረቱ የእርሻ ኖራዎች የአገርቷን አስዳማ አፈር ለማከም ምቹ እንደሆኑና ምርታማነትን እንደሚጨምሩ ታውቋል፡፡ ስለዚህ በምዕራብ፣ሰሜን ምዕራብ እና መካከለኛ የአገርቷ ክፍል የሚኖሩ የገንዘብ ውስንነት ያለባቸውና ከሩቅ ሥፍራ ኖራዎችን ለማጓጓዝ የማይችሉ አርሶአደሮች ከቅርባቸው ያለውን በመጠቀም አስዳማ አፈራቸውን ማከም እንደሚችሉ ነው፡፡   Abstract  The potentials of lime to restore soil health and fertility of the acidic soils is one of the best options of sustainable soil fertility management practices. However, the liming effects depend on its source, composition, purity, and fineness. The study initiated to evaluate the effectiveness of different lime materials produced in Ethiopia. Lime samples collected from different producing factories and were characterized at Holeta Agricultural Research Centre. Following characterization on station and on-farm experiments were conducted to evaluate crop and soil response for the different lime sources. The treatments comprised of four different lime materials and control laid out in randomized complete block design with three replications. The result showed that all lime sources fulfill the standards of agricultural lime. The result also showed that there were significant differences between and among lime sources on soil properties as well as crop yield but highly significant between the control treatments. This implies that the lime materials can be suitably used nationally to ameliorate soil acidity and increase crop productivity. Thus, the resource-poor farmers dwelling in western, northwestern, and central highlands who cannot afford to transport the lime sources from far distances can make use of the lime sources near to areas as there is no significant difference

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Augmenting Diabetes Care & Self-Management: What can digital health offer?

Background: The main recommendations for people living with diabetes are: optimally adhere to glucose lowering medications, frequently monitor their blood glucose levels, regularly engage in physical activity, and avoid the consumption of an unhealthy diet. Suboptimal adherence to these recommendations is associated with experiencing poor glycemic control which results in micro- and macro-vascular complications, poor quality of life, and a higher risk of premature death. Therefore, patients with diabetes require an evidence-based medical treatment coupled with effective self-management interventions to maintain a healthy lifestyle and increase disease management capability. Digital health has a strong potential to improve patient outcomes by facilitating diabetes self-management education and personalizing clinical, behavioral, and self-management goals. This dissertation discusses the role of digital health for improving diabetes self-management and outcomes. More broadly, the main aspects of digital health solutions and what it may offer to healthcare and public health, in general, are also discussed. Methods: A systematic review and meta-analysis was conducted to determine the effectiveness of digital interventions for improving glycemic control in persons with poorly controlled type 2 diabetes. Multivariable meta-regression was also used to identify the effective components of digital interventions. Three meta-analytic methods, namely, Analysis of Covariance (ANCOVA), Simple Analysis of Change Scores (SACS) and Simple Analysis of Final Values (SAFV) were used to compare the effectiveness of digital interventions. In addition, two empirical studies were conducted to identify popular diabetes application (apps) and investigate the role of diabetes mobile app use for glycemic control and self-care behavior among the digital community of persons with diabetes. Facebook groups, targeted Facebook advertisements (ads) and diabetes-specific patient forums were used to collect data from 1682 respondents. Results: A statistically significant reduction of glycated haemoglobin (HbA1c) levels favoring participants of digital interventions was found after pooling the effect estimates. This was confirmed by all of the three different meta-analytic methods although there was a slight difference in the estimates and their confidence intervals. Higher baseline HbA1c-levels and Behavior Change Techniques (BCTs), such as ‘problem solving’ and ‘self-monitoring outcomes of behaviour’, were significantly associated with reduced HbA1c-level. More than half of the respondents with type 1 (n=549, 52.2%) and more than one-third of those with type 2 diabetes (n=210, 33.3%) reported using diabetes apps for self-management. One hundred forty-five different diabetes apps were reported by respondents. Of these apps, “mySugr” was the most popular app. Continuous glucose monitor (CGM) apps, such as “Dexcom”, “Freestyle Libre”, and “Xdrip+”, were also popular, particularly among respondents with type 1 diabetes. The use of diabetes apps for self-management was associated with reduced the odds of experiencing hyperglycaemia in persons with type 2 diabetes (by 37%, AOR = 0.63(95% confidence interval (CI): 0.41 - 0.96)). In both persons with type 1 and type 2 diabetes, the use of diabetes apps for self-management was also independently associated with an increased cumulative self-care behavior scores. Conclusions: The results of this dissertation indicate that digital health augments diabetes self-management and is associated with improving clinical (HbA1c, hyperglycaemia and hypoglycaemia) and behavioral (self-care behavior) outcomes. Hence, it looks reasonable to endorse the use of diabetes apps for self-management. However, to date, many of these apps are faulty and only a small minority of them meets clinical recommendations for diabetes care. Clinicians should therefore consider prescribing evidence-based and regulatory body-approved diabetes apps. National and international regulatory bodies need to further regulate diabetes apps and ensure clinical safety and effectiveness

Popular Diabetes Apps and the Impact of Diabetes App Use on Self-Care Behaviour: A Survey Among the Digital Community of Persons With Diabetes on Social Media

INTRODUCTION: This study aimed to identify popular diabetes applications (apps) and to investigate the association of diabetes app use and other factors with cumulative self-care behaviour. METHODS: From November 2017 to March 2018, we conducted a web-based survey with persons 18 years of age and above. We recruited respondents via diabetes Facebook groups, online patient-forums and targeted Facebook advertisements (ads). Data on participants' demographic, clinical, and self-management characteristics, as well as on self-care behaviour and characteristics of the diabetes apps use were collected. Self-care behaviour was measured using a licensed version of the Summary of Diabetes Self-care Activities (SDSCA) questionnaire. The cumulative self-care score was calculated by summing up scores for “general diet,” “specific diet,” “exercise,” “blood glucose testing,” “foot care” and “smoking.” To identify popular diabetes apps, users were requested to list all apps they use for diabetes self-management. Two sample t-test and multiple linear regression stratified by type of diabetes were performed to examine associations between app use and self-care behaviour, by controlling for key confounders. RESULTS: One thousand fifty two respondents with type 1 and 630 respondents with type 2 diabetes mellitus (DM) entered the survey. More than half, 549 (52.2%), and one third, 210 (33.3%), of respondents with type 1 and 2 DM, respectively, reported using diabetes apps for self-management. “mySugr” and continuous glucose monitoring apps, such as “Dexcom,” “Freestyle Libre,” and “Xdrip+” were some of the most popular diabetes apps. In both respondent groups, the cumulative self-care behaviour score was significantly higher among diabetes app users (compared to non-users) and scores for three individual self-care components, namely “blood glucose monitoring,” “general diet,” and “physical activity” were significantly higher among diabetes app users than among non-users. After adjusting for confounding factors, diabetes app use increased the cumulative self-care score by 1.08 (95%CI: 0.46–1.7) units among persons with type 1 DM and by 1.18 (95%CI: 0.26–2.09) units among persons with type 2 DM, respectively. CONCLUSION: For both, persons with type 1 and type 2 diabetes, using diabetes apps for self-management was positively associated with self-care behaviour. Our findings suggest that apps can support changes in lifestyle and glucose monitoring in these populations

Human Resource Information System implementation readiness in the Ethiopian health sector: a cross-sectional study

BACKGROUND: Health workforce information systems in low-income countries tend to be defective with poor relationship to information sources. Human Resource Information System (HRIS) is currently in a pilot implementation phase in the Federal Ministry of Health and Regional Health Bureaus of Ethiopia. Before scaling up the implementation, it is important to understand the implementation readiness of hospitals and health departments. The aims of this study were to assess the readiness for HRIS implementation, identify associated factors, and explore the implementation challenges in public hospitals and health departments of the Amhara National Regional State, Ethiopia. METHODS: An institution-based cross-sectional study supplemented with a qualitative study was conducted from the 15th of February to the 30th of March 2016 in 19 public hospitals and health departments of the Amhara National Regional State, Ethiopia. A self-administered questionnaire was used to collect the data. The questionnaire includes items on socio-demographic characteristics and questions measuring technical, personal, and organizational factors adapted from the 32-item questionnaire of the Management Science for Health (MSH) HRIS readiness assessment tool. The data were entered and analyzed with statistical software. Descriptive statistics and bivariate and multivariable logistic regression analyses were performed. Odds ratios with 95% confidence interval were computed to identify the factors statistically associated with readiness of HRIS implementation. In-depth interviews and observation checklists were used to collect qualitative data. Thematic content analysis was used to analyze the qualitative data. RESULTS: A total of 246 human resource (HR) employees and 16 key informants have been included in the study. The HR employee’s level of readiness for HRIS implementation in this study was 35.8%. Employee’s Internet access (AOR = 2.59, 95%CI = 1.19, 5.62), availability of separate HR section (AOR = 8.08, 95%CI = 3.69, 17.70), basic computer skills (AOR = 6.74, 95%CI = 2.75, 16.56), and fear of unemployment (AOR = 2.83, 95%CI = 1.27, 6.32) were associated with readiness of HRIS implementation. Poor logistic supply, lack of competency, poor commitment, and shortage of finance were the challenges of HRIS implementation. CONCLUSION: In this study, readiness of HRIS implementation was low. Strategies targeting to improve skills, awareness, and attitude of HR employees would facilitate the implementation process

Skilled delivery inequality in Ethiopia: To what extent are the poorest and uneducated mothers benefiting?

BACKGROUND: The fifth Millennium Development Goal (MDG) targeted at improving maternal health. In this regard, Ethiopia has shown substantial progresses in the past two decades. Nonetheless, these impressive gains are unevenly distributed among Ethiopian women with different socio-economic characteristics. This study aimed at investigating levels and trends of skilled delivery service, and wealth and education related inequalities from 2000 to 16. METHODS: Longitudinal data analysis was conducted on Ethiopian Demographic and Health Survey (EDHS) data of 2000, 2005, 2011 and 2016. The outcome variable was skilled delivery, while data on economic status and education level were used as dimensions of inequality. Rate Ratio (RR) and Rate Difference (RD) inequality measures were applied. STATA for windows version 10.1 statistical software was utilized for data analysis and presentation. The strength of association of inequality dimensions with the outcome variable was assessed using a 95% confidence interval. RESULTS: From total deliveries, 5.62%, 6.3%, 10.8% and 28% of them were attended by skilled birth attendant in 2000, 2005, 2011 and 2016 respectively. In the most recent survey (EDHS 2016), proportion of births attended by skilled birth attendance among women who completed secondary and above education was about 5.42 [95% CI (4.53, 6.09)] times more when compared to women with no formal education. Proportion of births attended by skilled birth attendance among women in the richest quintile was about 5.11 [95% CI (3.98, 6.12)] times higher than that of women in the poorest quintile. Moreover, gap of inequality on receiving skilled delivery service has increased substantially from 24.2 (2000) to 53.8 (2016) percentage points between women in the richest and poorest quintiles; and from 44.9 (2000) to 76.0 (2016) percentage points between women who completed secondary and above education and women with no formal education. CONCLUSIONS: Skilled birth attendance remained low and virtually unchanged during the period 2000–2011, but increased substantially in 2016. Gap on wealth and education related inequalities increased linearly during 2000–16. Most pronounced inequalities were observed in women’s level of education revealing women with no formal education were the most underserved subgroups. Encouraging women in education and economic development programs should be strengthened as part of the effort to attain Universal Health Coverage (UHC) of Sustainable Development Goals (SDGs) in Ethiopia

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey

BACKGROUND: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). METHODS: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. RESULTS: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. CONCLUSION: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control

Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital

INTRODUCTION: Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. METHODS: An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. RESULTS: Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. CONCLUSION: Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice

Maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture

BACKGROUND: Maternal mortality and morbidity are the priority agenda for sub-Saharan Africa including Ethiopia. Uterine rupture is the leading cause of maternal and fetal death in developing countries. Limited evidence is available on the magnitude of uterine rupture; maternal and fetal outcomes of uterine rupture and factors associated with maternal death secondary to uterine rupture in Ethiopia. This study aimed to assess the magnitude of uterine rupture; maternal and fetal outcome of uterine rupture and factors associated with maternal death secondary to uterine rupture in Debremarkos Referral Hospital, Northwest Ethiopia. METHODS: An institutional-based cross-sectional study was conducted in December 2015 in Debremarkos referral hospital, Northwest Ethiopia. A total of 242 records of mothers with uterine rupture at Debremarkos referral Hospital during the year 2011–2014 were included in the study. Secondary data was collected from the records of mothers admitted for the management of uterine rupture. Descriptive statistics were performed to characterize the study population. Bivariate and multivariable logistic regression model was fitted to identify factors associated with maternal death secondary to uterine rupture. Odds ratio with 95% confidence interval was computed to determine the level of significance. RESULTS: A total of 10,379 deliveries were attended A total of 242 uterine rupture cases were included in this study. The magnitude of uterine rupture was 2.44% (1 in 41 deliveries). Sixteen (6.6%) mothers died from uterine rupture. Fourteen (5.8%) had experienced Vesico Vaginal Fistula. The majority of the mothers, 72% (176), admitted for uterine rupture stayed in hospital for 6–10 days. Fetal outcome was grave, 98.3% (238) were stillborn. Place of labor [Adjusted odds ratio (AOR): 6.92, 95% confidence interval (CI): (1.16, 33.74)], occurrence of hypo volume shock [AOR: 3.48, 95% CI: (1.01, 11.96)] and postoperative severe anemia [AOR: 0.092, 95% CI: (0.01, 0.956)] were significantly associated with maternal death secondary to uterine rupture. CONCLUSION: The magnitude of uterine rupture was high in the study area. Initiation of labor at health institutions, early treatment of hypo-volumia and prevention of postoperative anemia is recommended to decrease maternal death secondary to uterine rupture