Institutions, sustainable land use and consumer welfare: the case of forest and grazing lands in northern Ethiopia

Land is an essential factor of production. Institutions that govern its efficient use determine the sustainability of this essential resource. In Ethiopia all land is publicly owned. Such an institutional setting is said to have resulted in the major degradation of Ethiopia's land resources and dissipation of the resource rent. An alternative to this is assigning a private property institution. In this paper, we examine the consumer welfare effects of a change in the institutional setting on communal forest and grazing lands, using a cross-section data set of 200 households in Northern Ethiopia. Findings suggest that changing the current institutional setting could indeed be welfare reducin

Farm Size and the Share of Irrigated Land in total Landholding: the case of Water-Harvesting Irrigation in Ethiopia

Rain-fall shortage constrains production in small-holder agriculture in developing countries and with ongoing climate change these shortages may increase. Rain-water harvesting are interesting technologies that decrease this risk. Therefore, one would expect an increasing use of these technologies in drought-prone areas. However, data collected in Ethiopia shows that the share of irrigated land in total landholding declines with farm size. This study investigates why the share declines with farm size using panel data collected in 2005 and in 2010. A random-effect tobit model is estimated for the share of irrigated land as a function of variables affecting returns, market prices, source of finance and expectation formation. The findings show farm-specific factors such as credit per hectare, distance to market, ease of selling output, landholding, regional differences, aridity and distance of plots from natural water sources significantly affect the share. Thus, encouraging investment has to consider farm-size, and also geographical, environmental and regional diversity.Land Economics/Use, Resource /Energy Economics and Policy,

Determinants of Dietary Adequacy Among School Age Children in Guraghe Zone, Southern Ethiopia

Dietary diversity (DD) is a validated proxy indicator of micronutrient adequacy among different age groups including infants, children and women. This study assessed level of dietary adequacy and its associated factors among school age children in Guraghe Zone, Ethiopia. Survey was conducted among 769 children aged 6 to 12 years of with their care givers using multistage sampling method. Data were collected by using structured questionnaire containing the ten food groups for minimum dietary diversity for women and other parts. Adequate dietary diversity was categorized those children who consume at least five food groups. Bivariate and multivariable binary logistic regression with odds ratios (95% CI) was computed. Overall 769 children were included in the study, with a mean age of 8 years. The mean dietary diversity score was 4.9 (±1.42). About 444 (58.3%) had an inadequate dietary diversity. Those children from extended family size had 1.3 times to have inadequate DD level (AOR=1.3). Children from female headed households, did not attend formal education had 1.3 and 1.4 times higher odds of having an inadequate DD level (AOR=1.3 and 1.4). Similarly, children living with uneducated caregiver had six fold more likely to have an adequate DD level (AOR=6.7). The dietary diversity of children in the study area was below average. Household head, caregiver\u27s educational status, occupation of the household head, father/female headed household and family size were found to be associated with DD score. There should be awareness creation through existing Health extension platform and back yard vegetation should be improved

Medication Reconciliation as a Medication Safety Initiative

Medication errors and their adverse outcomes are the most common cause of patient injuries in hospitals. Medication reconciliation is the safety strategy usually called for, to prevent medication errors that occur at care transitions. This strategy has been adopted as a standard practice in many developed countries. However, in Ethiopia, there were no published studies on medication reconciliation, nor evidence-based interventions aimed to tackle the burden of medication errors. This thesis was a medication safety initiative focusing on medication reconciliation intervention overall, and explored the journey to medication reconciliation service implementation as a medication safety strategy in Ethiopian public hospitals. Given the lack of consistent reports regarding the impact of this strategy, the journey to implementation was guided by synthesise of the evidence supporting the effectiveness of this intervention. The findings of our systematic reviews have shown that medication reconciliation interventions carried out through pharmacist assessment at hospital transitions were found to be an effective strategy for improving clinical outcomes (e.g. adverse drug event-related hospital visits, all-cause readmissions, and emergency department visits), as well as process outcomes, such as the occurrence of medication errors. Therefore, the overarching aim of this thesis was to implement a pharmacist-led medication reconciliation intervention in resource-limited settings. Implementation of medication reconciliation is not an ultimate end but sustainability is an issue, and this should be corroborated by corresponding changes in attitudes, teamwork, communication, culture and leadership. For this purpose, the thesis employed methods from both safety and implementation sciences for successful implementation of the medication reconciliation program. System approaches to patient safety, such as patient safety culture has been explored, and patients’ experiences of medication-related adverse events have been discussed followed by a theoretically robust evidence-based exploration of the barriers to implementation. Patient safety culture in Ethiopian public hospitals has been found lower than the benchmark studies. Importantly, understaffing followed by problems during handoffs and care transitions and punitive response to error were identified as major safety problems. Particularly, handoffs and care transitions were largely affected by the lack of teamwork across units, punitive response to error reporting and managerial inaction for promoting patient safety. In addition to system factors presumed to affect patient safety, other factors such as individual healthcare professionals, patient, and task factors have been identified as challenges to achieve an optimal patient safety in the Ethiopian public hospitals. Resource limitations (e.g. material deficiencies, poor infrastructure) have been indicated as the greatest barriers for patient safety. Patients expressed a range of perceived experiences related to their medication, and a number of strategies required to improve patient safety practices have been suggested. Changes in practice, processes, structure, and systems were believed to help improve patient safety in the Ethiopian health care system. The results of this thesis have demonstrated that hospital pharmacists were very much enthusiastic for their extended roles and were positive towards the future of the profession; however, there were many factors that likely influenced their behaviour in the clinical practice, and these behavioural determinants were predominantly related to ‘Knowledge’, ‘Skills’, ‘Environmental constraints’, ‘Motivation and goals’, ‘Social influences’, and ‘Social/professional role’. While medication errors were highly prevalent at the time of hospital admission, this thesis has also found that pharmacist-led medication reconciliation was able to minimize medication errors significantly. Thus, implementation of medication reconciliation as a medication safety strategy is feasible, and pharmacists may be regarded as key resource personnel for the safe use of medications at the time of hospital admission. However, the sustainability of this service utilization is highly dependent on other behavioural determinants, such as knowledge and skill, competing priorities, and reimbursement for clinical services

False Aneurysms: Varied Presentations in General Surgery

An aneurysm by definition is a permanent localized arterial dilation with 50 percent or greater increase in size over the normal diameter of the affected artery. Aneurysms have been classified as true or false (pseudo) aneurysms. True aneurysms involve all three layers of the arterial wall (intima, media, & adventitia). A false or pseudo-aneurysm is a collection of blood or hematoma which had leaked from a defect in the wall of an artery to be later variably confined by the surrounding interstitial tissues. The varied presentationsof six patients with false aneurysms admitted and treated on General Surgical wards are presented with the pertinent literature on the subject reviewed along with a review of the records of patients that presented at Gondar University Hospital (GUH) with the diagnosis of false aneurysm over a six years period

Thoracic empyema: Cause and Treatment Outcome at Gondar University Teaching Hospital, Northwest Ethiopia

Background: Despite improved antimicrobial therapy and multiple options for drainage of infected pleural space, thoracic empyema (TE) continues to cause significant morbidity and mortality. The objectives of this study were to assess the causes and treatment outcome of patients with thoracic empyema.Methods: Patients aged ≥ 13year with TE who were admitted to Gondar University Teaching Hospital, Northwest Ethiopia, from Nov 1999 to Dec 2007 were included. Retrospectively, medical records were reviewed and demographic and clinical data were collected.Results: Records of 81 patients were analyzed; majority (82%) were below the age 50 year. The mean duration of symptoms prior to presentation and hospital stay was 97.4 and 38days, respectively. HIV/AIDS was detected in 60%. Causes of empyema were pulmonary tuberculosis (56%), pneumonia (36%) and lung abscess (7%). Closed chest tube was inserted in 86% of cases and was successful in 93% of them. Case-fatality was 12% and poor outcome occurred in 26%.Conclusions: Early identification of TE and aggressive management with antibiotics or antituberculosis, drainage with chest tube, and surgical treatment when closed tube drainage fails is recommended to improve the high mortality and morbidity

Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis.

OBJECTIVES: This review aimed to determine the pooled prevalence of preoperative anxiety and its associated factors among patients undergoing surgery in low/middle-income countries (LMICs). METHODS: We searched PubMed, SCOPUS, CINAHL, Embase and PsychINFO to identify peer-reviewed studies on the prevalence and factors associated with preoperative anxiety among patients undergoing surgery using predefined eligibility criteria. Studies were pooled to estimate the prevalence of preoperative anxiety using a random-effect meta-analysis model. Heterogeneity was assessed using I² statistics. Funnel plot asymmetry and Egger's regression tests were used to check for publication bias. RESULT: Our search identified 2110 studies, of which 27 studies from 12 countries with 5575 participants were included in the final meta-analysis. Of the total 27 studies, 11 used the State-Trait Anxiety Inventory to screen anxiety, followed by the Amsterdam Preoperative Anxiety and Information scale, used by four studies. The pooled prevalence of preoperative anxiety among patients undergoing surgery in LMICs was 55.7% (95% CI 48.60 to 62.93). Our subgroup analysis found that a higher pooled prevalence of preoperative anxiety was found among female surgical patients (59.36%, 95% CI 48.16 to 70.52, I2=95.43, p<0.001) and studies conducted in Asia (62.59%, 95% CI 48.65 to 76.53, I2=97.48, p<0.001). CONCLUSION: Our meta-analysis indicated that around one in two patients undergoing surgery in LMICs suffer from preoperative anxiety, which needs due attention. Routine screening of preoperative anxiety symptoms among patients scheduled for surgery is vital. PROSPERO REGISTRATION NUMBER: CRD42020161934

HIV self-testing practices among Health Care Workers: feasibility and options for accelerating HIV testing services in Ethiopia

Introduction: HIV is still an enormous global burden and it is also causing loss of huge health care workers (HCWs) on the already limited human resource capacity in health care services in Sub-Saharan Africa. Variety of methods of accelerating HIV testing is required to increase the rate of HIV testing and expand treatment services. Therefore, this study was aimed to find out the prevalence, feasibility and options of HIV self-testing practices in Ethiopia. Methods: A cross-sectional study design triangulated with qualitative method was conducted from February to May, 2012. The data was collected using a semi-structured pretested questionnaire and in-depth interview, at government and private health centers or clinics and hospitals. During the data collection all the available healthcare workers (HCWs) which encompass the internship students including: Medical, Health Officer, Nurses, Midwives and Laboratory students, and health professionals working in the selected health institutions were involved.Results: A total of 307 HCWs were included in the analysis and we found that 288(94.4%) of them were ever tested for HIV, of which majority 203 (70.5%) were tested by themselves though 244(80%) of the HCWs had motivation or interest to be tested by themselves. Generally, of the ever tested only 85(29.5%) were tested by the help of health care providers/counselors other than self. Regarding the place where the HCWs had the test, majority 136 (69.4%) tested by themselves at the health facility and the rest were tested at their home, office, market and church. The main reason stated for self-testing was the need for confidentiality for the test result, which was mentioned by 205(82%). Moreover, 35(14.0%) claims lack of time to access the ordinary counseling and testing services. Conclusion: This study depicts high rate of HIV self-testing practice among HCWs. This shows that HIV self-testing can be considered as one pillar to increase the HIV-testing services and a means for the HIV prevention and control policy, through increasing HIV testing uptake and awareness of HIV status. However, the implementation may require the role of different stakeholders and decision makers with further study to extend the options.Key words: HIV, VCT, self-test, health care workers, Ethiopi