The Debate on Environmentally Motivated Unilateral Trade Measures in the World Trade Organization: The Way Forward

This Article analyzes and critically examines the various approaches to resolving the trade and environment conflict in the WTO, with specific regard to the regulation of unilateral trade measures. Part II describes the various approaches by WTO Members to the reconciliation of the two regimes. Part III discusses the responses to the various approaches. An appraisal is made from the perspective adopted by the paper in Parts IV through VI, and finally conclusions are drawn

Knowledge, risk perception, and condom utilization pattern among female sex workers in Dire Dawa, Eastern Ethiopia 2016: a cross-sectional study

Introduction: in 2015, in Dire Dawa administration city, adult HIV prevalence was 3.26 with 9,523 HIV positive population, & 251 annual AIDS deaths. Female sex workers are one of the high-risk groups for contracting HIV. Therefore, this study has assessed the level of HIV/AIDS knowledge, risk perception and condom utilization pattern among female sex workers' in Diredawa city. Methods: a cross-sectional study was conducted from April 15-June 25, 2016, in Dire Dawa among 156 female sex workers using convenient sampling method. Respondents were interviewed face-to-face using a pretested questionnaire. Training was provided to the data collectors and supervisors. Close supervision was done and double data entry was performed. Then the data were checked for completeness, consistency and entered into Epi Info v3.1 and analyzed using SPSS v20. The descriptive statistical analysis was used to compute frequency, mean, mode and proportion of the findings of this study. The results were presented using tables, charts, graphs, and texts. Results: among the 156 female sex workers (FSWs), 99 (63.5%) had been working on commercial sex for more than one year, 92 (59%) were usually street-based, and 80 (51.3%) had partners between 2-3 per night. Only, 17 (10.9%) respondents mentioned three and above ways of HIV/AIDS transmission and prevention methods. Less than two-thirds (64.1%) of FSWs used a condom with all partners. One hundred thirty-eight (88.5%) of participants were engaged in unsafe sexual practice at least once since their engagement in sex work. Majority of FSWs (85.3%)) believed that their occupation is hazardous and 145 (92.9%) reported that they were unhappy being a commercial sex worker. Regarding risk perception, 79 (50.64%) and 37 (23.7%) of respondents perceived their chances of contracting HIV/STIs to be high and moderate respectively. Conclusion: Knowledge about HIV/STIs and magnitude of condom utilization were good. However, a high number of unsafe sex and unsatisfactory risk perception attitudes were observed. Thus, a collaborative effort is needed to create awareness regarding risk perception attitude and increase the level of their practice towards the prevention of unsafe sex

Prevalence of chronic kidney disease and associated factors among patients visiting renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia:A cross-sectional study design

Objective: This study aimed to assess the magnitude of chronic kidney disease among patients attending the renal unit of St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Institution-based cross-sectional study was conducted among 620 randomly selected patients who visited St. Paul's Hospital Millennium Medical College renal unit from 1 January to 31 December, 2019. Data on sociodemographic characteristics, clinical conditions, behavioral risk factors, electrolytes, and renal function tests were extracted from patients' medical records. To enter and analyze data, EpiData 3.1 and SPSS 22 were used, respectively. Bivariable and multivariable logistic regression analyses were conducted to see the association between predictor variables and chronic kidney disease. Adjusted odds ratio at 95% confidence interval was used to describe significant association. A p-value Results: Of 620 patients, 139 (22.4%; 95% confidence interval: 19.2, 25.6) and 61 (9.8%; 95% confidence interval: 7.4, 12.3) had chronic kidney disease using cut-off value of 90 and 60 ml/min/1.73 m(2), respectively. Having urinary tract obstruction (adjusted odds ratio = 2.32; 95% confidence interval: 1.32, 4.06), hypertension (adjusted odds ratio = 4.06; 95% confidence interval: 2.50, 6.59), diabetes mellitus (adjusted odds ratio = 2.80; 95% confidence interval: 1.62, 4.85), cardiovascular disease (adjusted odds ratio = 2.54; 95% confidence interval: 1.60, 4.01), and age (adjusted odds ratio = 1.83; 95% confidence interval: 1.44, 3.57), family history of chronic kidney disease (adjusted odds ratio = 2.26; 95% confidence interval: 1.36, 3.75) were factors positively associated with having chronic kidney disease. Conclusion: Nearly, one out of five and one out of ten patients who visited the renal unit had chronic kidney disease using the two thresholds as a cut value. Patients with concomitant urinary tract obstruction, age, hypertension, diabetes mellitus, cardiovascular disease, and a family history of chronic kidney disease were more likely to develop chronic kidney disease. Regular screening for chronic kidney disease, optimal blood sugar, and blood pressure management should be practiced

Prevalence and Determinants of Low Birth Weight in Ethiopia: A Systematic Review and Meta-Analysis

Introduction: Low birth weight was defined as weight at birth less than 2500 grams. This had numerous negative outcomes such as fetal and  neonatal mortality and morbidity. It was estimated that between year 2000 to 2018, twenty million (15% to 20%) of all births worldwide had low birth weight yearly. Data analyzed from the Swedish Childhood Diabetes Register (SCDR) indicated that, low birth weight infants. were 24% higher odds of developing type-1 diabetes, hypertension, obesity and dyslipidemia in future compared to normal birth weight infants. In Ethiopia, the proportion of births weighing less than 2.5 kg at birth in the past three DHS surveys was 14% in 2005, 11% in 2011, and 13% in 2016. That differed with WHO 2025 goal of achieving 30% reduction in the number of infants born with weight lower than 2500g. Objectives: This systematic review study was aimed to explicitly assess and determine the contributing factors of low birth weight in Ethiopia for intervention. Methodology: Cross-sectional, case-control and cohort studies were conducted in English language. A search of studies in the main databases; PubMed, EMBASE, CINAHL, Web of Science, Scopus, and other gray literature sources was conducted. In respect to eligibility criteria, the  investigators included observational studies that had been conducted at a facility setting in different parts of Ethiopia on the prevalence and factors associated with low birth weight, published and accessible from 2000 - 2018 then written in English. Articles with irretrievable full text records with unrelated outcome measures with missing or insufficient outcomes, reviews, commentaries, editorial, case series/reports, and patient stories were excluded. Meta-analyses with random effects, subgroup analyses, and meta-regression were performed. Publication bias was measured using the Egger regression test and visual funnel plot inspection. Pooled odds ratio was done by using RevMan 5.3 software. 16 studies fulfilled the eligibility criteria. Result: The underlying causes were multi-factorial. Antenatal Care(ANC) and pregnancy complication increased the risk of low birth weight of  infants in Ethiopia. Maternal harmful substance exposure(pesticide, noise, radiation and alcohol consumption), undernutrition, infections, poor socioeconomic status, history of chronic diseases, hepatitis B carriers, intrauterine growth restrictions (IUGR) were reported. The pooled prevalence of low birth weight was 18% (95% CI: 13.9%, 22.2%). Gestational age less than 37weeks was (AOR,7.8; 95% CI: 4.7, 12.95), no antenatal care (AOR,3.39; 95% CI: 1.65, 6.98), rural residence (AOR,2.44; 95% CI: 1.94, 3.08) and women with medical illness during pregnancy (AOR,4.36; 95% CI: 2.55, 7.44) that was significantly associated with low birth weight in Ethiopia. Conclusion: The pooled prevalence of low birth weight was high in Ethiopia. Most rural mothers were unable to follow antenatal care and maternal medical illnesses during pregnancy were significantly contributing factors. The meta-regression confirmed that the sample size and the  methodological quality could partially explain the statistical heterogeneity. Recommandations: Almost all these factors can be prevented by scaling up Antenatal Care (ANC) with the help of Community Health Workers/ Volunteers(CHW/Vs), quality health facilities and improve on the socioeconomic status of the population. Policy makers to assimilate and take action  to the multiple abnormalities found by formulating a management plan for patients with multiple organ disease in the maternity mortality reports. Keywords: low birth weight; prematurity; Ethiopia; systematic review; meta-analysi

Cancellation of elective surgery and associated factors among patients scheduled for elective surgeries in public hospitals in Harari regional state, Eastern Ethiopia

BackgroundCanceling elective surgeries is a significant problem in many hospitals leading to patient dissatisfaction, increased costs, and emotional trauma for patients and their families. Despite this, there is limited information about the cancellation of elective surgeries in Ethiopia, mainly in the study area.ObjectiveThis study aimed to assess the magnitude of cancellation and associated factors among patients scheduled for elective surgeries in public hospitals in the Harari Regional State, Eastern Ethiopia, from 1 August to 30 August 2021.MethodsA hospital-based cross-sectional study was conducted on 378 patients scheduled for elective surgeries. Data were gathered using a non-random sequential sampling approach. In addition, a structured face-to-face interviewer-administered questionnaire was employed. The gathered information was input into Epidata version 3.1 and then exported to Statistical Package for Social Software version 26. To find the variables associated with the cancellation of elective surgeries, binary and multi-variable logistic regression analyses were conducted. In the binary analysis, all variables with a p-value of less than 0.25 were included in the multivariable analysis. Finally, a 0.05 p-value with a 95% confidence interval and an adjusted odds ratio was used to declare a significant association.ResultsThis study included 378 patients scheduled for elective surgeries. Among those, 35.2% of the surgeries were canceled (95% confidence interval: 29.4–39.6). Being female (adjusted odds ratio: 2.46; 95% confidence interval: 1.44–4.203), lack of formal education (adjusted odds ratio: 2.03; 95% confidence interval: 1.15–3.58), place of residence (adjusted odds ratio: 1.70; 95% confidence interval: 1.03–2.81), increase in blood pressure (adjusted odds ratio: 5.09; 95% confidence interval:1.90–13.59), and ophthalmologic surgery (adjusted odds ratio: 3.76; 95% confidence interval: 1.41–10.0) were factors associated with the cancellation of elective surgeries.ConclusionIn this study, nearly one third of scheduled elective surgery was canceled. The primary contributing variables to the surgery cancellations were being female, lack of formal education, place of residence, ophthalmologic surgery, and increased blood pressure. Therefore, timely evidence-based reporting through the supervision team was advised to decrease cancellations

Xpert MTB/RIF assay for the diagnosis of Mycobacterium tuberculosis and its Rifampicin resistance at Felege Hiwot and Debre Tabor Hospitals, Northwest Ethiopia: A preliminary implementation research

Background: The World Health Organization endorsed GeneXpert MTB/RIF (Xpert) assay for the diagnosis of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB) in 2010. However, the practice of using this novel diagnostic method is still limited in a high TB and human immunodeficiency virus (HIV) burden settings, including Ethiopia. Therefore, we conducted this study aimed at describing the first implementation status of Xpert assay in the diagnosis of TB and MDR-TB at Felege Hiwot Referral Hospital (FHRH) and Debre Tabor General Hospital (DTGH), Northwest Ethiopia.Methods: We analyzed the records of 1922 (FHRH=544 and DTGH=1378) presumptive TB patients diagnosed using Xpert test from 1 November 2015 to 30 April 2016 at FHRH and DTGH, Northwest Ethiopia. All patients who had registered data on their sex, age, HIV status, presumptive MDR-TB status and Xpert results were included for analysis. Data were retrieved directly from GeneXpert result registration log book using data extraction sheet. Data were entered, cleaned, and analyzed using SPSS statistical software package; p < 0.05 was considered to be significant.Results: Overall Xpert assay properly diagnosed 14.6% of the cases (258/1922). Among these, rifampicin (RIF) resistance was detected at 9.3% (24/258). In the studied settings, clinical data showed that 81.0% (1556/1922) of the cases were MDR- TB. Among the study subjects, 888 (46.2 %) of them were HIV positive. However, TB-HIV co-infection rate was at 41.9% (108/258). Of the total patients registered, 1005 (52.3%) of whom were males. The mean age of patients was 31.1 years with SD of 17.5. Significant predictors of the Xpert test were: age (p=0.000), sex (p=0.009), HIV status (p=0.003) and presumptive MDR-TB (p=0.000).Conclusions: In the studied areas, large proportion of clinically TB suspected patients were wrongly diagnosed with MDR-TB. Therefore, the use of Xpert assay in health settings with no culture facility will decrease the unnecessary use of anti-TB drugs and improve rapid TB, and MDR-TB detection and proper management of the cases. [Ethiop. J. Health Dev. 2016;30(2):60-65]Keywords: TB, GeneXpert, MTB/RIF assay, Northwest Ethiopi

Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07–3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09–3.38), literate in education (AOR 1.71, 95% CI 1.07–2.73), multigravida (AOR 1.96, 95% CI 1.12–3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93–0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF

Trade and environment in the WTO: the status of unilateral trade measures taken for environmental purposes

Bibliography: p. 143-15