Reduced Tillage and Intercropping as a Means to Increase Yield and Financial Return in the Drylands of Tigray, northern Ethiopia: A Case Study under Rainfed and Irrigation Conditions

Intensive tillage is a major sustainability concern in cereal dominated cropping systems in the drylands of Tigray, Ethiopia. Hence, on-farm trials were conducted to investigate the yield and economic advantage of reduced tillage and intercropping for two seasons. A factorial experiment in a complete randomized block design was carried out at Adigudom located in Hintalo-Wajirat district in South-Eastern Tigray in 2014 (rain-fed) and 2015 (irrigated). The experiment consisted of four tillage frequencies (zero, one, two and four) and three types of cropping systems (sole maize, sole soybean and maize-soybean intercropping) in three/four replications. Maize, variety “Melkassa 2”, and soybean, variety “Awassa 91” were used. Grain and biomass yields, and harvest index of both crops were analysed. Yield advantage of intercropping was evaluated using land equivalent ratio (LER) and partial budget analysis was used for the financial evaluation. The grain and biomass yields of both crops were significantly increased (p<0.05) as the tillage frequencies increased from zero to four in both seasons but the frequent tillage with sole cropping was not economically viable as the two times tillage with maize-soybean intercropping gave 126% greater net benefit compared to the four times tillage sole maize, which is practiced by farmers in the study area. The net benefit was strongly influenced by the main effects of tillage and intercropping in both seasons (p<0.001) and by their interaction in 2014 (p<0.05). Significantly higher LER (1.87-2.12) was recorded from maize-soybean intercropping over sole cropping in all the tillages and both seasons. Hence, two alternative options are suggested that farmers could apply in the drylands of Tigray: (i) keeping the sole cropping culture of maize production, and reducing number of tillages from 4 to 2 that would give 374%and 705% Marginal Rate of Return (MRR), respectively, under the rainfed and irrigated conditions compared to zero tillage sole maize; or (ii) intercropping maize with soybean and reducing tillage frequency from 4to 2 that would give 608% and 585% MRR in the respective growing seasons, compared to zero tillage maize-soybean intercropping. Taking these results into account, two times tillage combined with maize-soybean intercropping can be a good option in dryland areas of Tigray to achieve higher total intercrop yield at a low cost and larger LER. Moreover, reduced tillage can minimize soil degradation and benefit farmers with poor access to draft power or female-headed households constrained with labour for ploughing.Keywords: Tillage; Intercropping; Maize; Soybean; Tigray; Ethiopia.Please find erratum for this article here: https://dx.doi.org/10.4314/mejs.v11i1.1

Magnitude of Out of Pocket Health Expenditures and Associated Factors among Civil Servants

In Ethiopia, as other developing countries, public health care is provided at nominally low prices and free to those that does not afford to pay. But the health care consumer population is still to make considerable amount of out-of-pocket health expenditure for various reasons. A cross sectional quantitative study from January to May 2013 was done. Study population was civil servants in Debre Markos town. A total of 467 study participants were selected by using simple random sampling method. Data were collected by trained high school graduates and then the collected data were entered into a computer by using Epi-Data version 3.1 and analysis was performed by using SPSS version 16 for windows. Possible associations between out of pocket health expenditure and its predictors were analyzed by using both bivariate and multivariate analysis. The mean age of the study participants were 41 years. Majorities were between 25 and 44 years of age, 258 (55.2%). The level of education among the study participants indicated that most 380 (81.4%) were graduates of higher education (HE) and majority were Orthodox Christian which accounted 446 (95.5%) followed by Muslims 13 (2.8%). To put it briefly, the study identified that the median of out of pocket health care expenditure accounted 8.26% of total household income. Health status of the household (with or without chronic illness), debt on any of the household, house on construction owned by any household member, educational fee for at least one member of the household and predominantly used health institution were the associated factors that have significant impact on household out of pocket health expenditure. There is economic burden as a result of health care at household level.   Based on the results, the recommendation was introducing social health insurance for all civil servant employees in the study area

Food insecurity among households with and without podoconiosis in East and West Gojjam, Ethiopia

Background: Household food insecurity remained one of the most crucial challenges to economic development and has been aggravated by household health conditions. Nearly one billion people are undernourished of which 98% in developing countries like Ethiopia. Objective: To assess households’ food insecurity among podoconiosis patients and non-podoconiosis in East and West Gojjam Zone,Ethiopia, 2016. Method: A community based comparative cross sectional study was conducted in East and West Gojjam, 2016. Multi-stage sampling technique was employed to select 208 podoconiosis and 400 non-podoconiosis household heads. Data was collected by using structured and pretested questionnaires. The collected data was cleaned, coded and entered into Epi data then exported to SPSS version 22. Descriptive and inferential statistics was performed. Both bivariate and multivariate logistic regression analyses was employed. The association was measured by adjusted odds ratio (AOR), 95%CI (confidence interval) and P < 0.05 was considered statistically significant. Result: A total of 608 study participants were involved in this study. Food insecurity podoconiosis patients and non-podoconiosis household was 83.7%, 53% respectively (p = 0.0001). Podoconiosis and non- podoconiosis whose heads could not read and write AOR = 5.84, (95% CI: 2.14, 15.95) and AOR = 1.70, (95% CI: 1.06, 2.72) were food insecure respectively. Podoconiosis patients without off farm activities AOR = 4.90, (95% CI: 1.60, 14.95), not using fertilizer AOR = 4.38, (95% CI: 1.15, 16.67) and living at > 5 kilo meter distance from market AOR = 4.47, (95% CI: 1.38, 14.48) were food insecure. Non-podoconiosis heads with no perennial plant AOR = 2.11, (95% CI: 1.17, 3.34), not using improved seeds AOR = 2.20, (95% CI: 1.25, 3.87), no access to asset building program AOR = 2.07, (95% CI: 1.27, 3.34), living in medium and low altitude AOR = 8.87, (95% CI: 1.81, 43.40) and AOR = 10.04, (95% CI: 1.90,52.93) were food insecure. Conclusion: Food insecurity was higher among podoconiosis than non-podoconiosis households. Being a female, unable to read and write absence of off farm activities, not using of fertilizers and living in more distance from market were significantly associated with food insecurity among podoconiosis patients. Special emphasis should be given for improvement of food security of podoconiosis and non-podoconiosis households

'I should not feed such a weak woman'. Intimate partner violence among women living with podoconiosis: A qualitative study in northern Ethiopia

Background Intimate Partner Violence (IPV) is a serious, preventable public health problem that affects millions of people worldwide. Research indicates that adults suffering from long term, disabling conditions are more likely to be victims of IPV due to the intersection of disease-associated stigma and discrimination. IPV in turn is known to worsen the overall health and wellbeing of those affected by it. Little research however explores the relationship between neglected tropical diseases such as podoconiosis and IPV. This study explores the relationship between IPV and podoconiosis in northern Ethiopia with the aim of identifying new avenues for limiting disability and promoting the wellbeing of people affected by this neglected tropical disease. Methods The study was conducted in East and West Gojjam zones, located in the Amhara Regional State of Ethiopia. Research participants were first screened using the domestic violence screening tool Hurt-Insult-Threaten-Scream (HITS). Data were collected by native speakers of the local language (Amharic) in the form of semi-structured interviews during January and February 2016. Thematic and content data analysis was carried out, using the Open Code 3.4 qualitative data analysis software for coding. Results A total of 15 women living with podoconiosis and experiencing IPV were interviewed (aged 31 to 75). Women experienced different forms of IPV, including beatings (with or without an object), insults, name calling, undermining, denial of equal rights over common assets, movement monitoring, cheating, abandonment, forced divorce, obstruction of health care access, inhibition of decision-making and sexual coercion. Podoconiosis increases the frequency and severity of IPV and in occasions shapes a change from physical to psychological and financial violence. In turn, frequent episodes of IPV worsen disease outcomes and contribute to disease persistence in the region, in that these impede women’s ability to manage the disease and help perpetuate the conditions of poverty that influence disease onset. Conclusions Women living with podoconiosis are victims of various, overlapping forms of IPV that negatively impact their health and wellbeing. Poverty, scarce IPV prevention services in the area together with a social acceptance of IPV and these women’s decreased ability to work due to the debilitating effects of podoconiosis and childcare responsibilities frequently prompt these women to tolerate IPV and remain in abusive relationships. Tackling disease-associated taboo and stigma, developing accessible IPV interventions, working towards greater gender equality at the household and societal levels and developing sustainable strategies for improving the socio-economic assets of women affected by podoconiosis are all necessary to both prevent IPV and to improve disease outcome

Willingness to pay for footwear, and associated factors related to podoconiosis in northern Ethiopia

Background: In Northern Ethiopia, use of footwear by the rural community is limited, and non-governmental organizations provide footwear for school children as a means of preventing podoconiosis. However, this is not a sustainable strategy. This study assessed willingness to pay for footwear among people with and without podoconiosis. Methods: A comparative cross-sectional community-based study was conducted in Mecha and Gozamen woredas among randomly selected people with and without podoconiosis. Trained health extension workers collected data using an interviewer-administered structured questionnaire. The data were entered into EPI-Data and exported to SPSS version 16.0 statistical software package for analysis. Results: The willingness to pay for footwear among people with and without podoconiosis was 72.3% and 76.7% respectively (p=0.30). People with podoconiosis in the lower quintiles of economic status were less likely to be willing to pay for footwear than those in the higher quintiles. Conclusions: There is substantial willingness to pay for footwear. The expressed willingness to pay indicates demand for footwear in the community, suggesting an opportunity for shoe companies. There are still a substantial proportion of individuals not willing to pay for footwear. This requires intensified public education and social transformation to bring about change in behavior towards footwear use if elimination of podoconiosis within our generation is to be achieved

Using qualitative methods to explore lay explanatory models, health-seeking behaviours and self-care practices of podoconiosis patients in north-west Ethiopia

Background: Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care. Methods: In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia. Results: Explanatory models for podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue. Conclusion: A pluralistic approach to podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care

Developing and validating a clinical algorithm for the diagnosis of podoconiosis

Background Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization–recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis. Methods We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti–specific immunoglobulin G4 in the field using Wb123. Results Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100). Conclusions We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions