Amhara Regional Health Bureau

Abstract Background: Despite the availability of an effective vaccine, measles remains a major public health problem in Ethiopia, with recurrent outbreaks reported in several areas in Amhara Regional State. Understanding measles vaccination coverage and real-world protective effectiveness is critical for assessing immunization program performance and guiding elimination strategies. Therefore, this study was conducted to determine the regional measles vaccine coverage and the vaccine protective effectiveness level in the region. Methods: A retrospective test-negative case-control analysis of measles surveillance data and retrospective analysis of district health information system 2 (DHIS2) data from 2019-2024 was employed to determine vaccine effectiveness and vaccine coverage respectively. Measles vaccine coverage was determined by dividing the number of children vaccinated as numerator to the expected number of children legible for vaccination as denominator. Measles vaccine effectiveness level was determined using field evaluation approaches of vaccine effectiveness. The adjusted vaccine effectiveness was calculated using the multivariable logistic regression after adjustment of potential confounders, including age, sex, residence, and outbreak year. Results: Measles vaccination coverage for both vaccine doses showed variation across geographic locations, time periods with clear seasonal and monthly differences. A total of 3417 participants comprising 2528 cases and 889 controls were enrolled in the analysis of measles vaccine effectiveness. A cumulative vaccine effectiveness estimates was 67% in the region with a clear variation across different years. The subgroup analysis showed comparable level of measles vaccine effectiveness (66.6% vs 66.9%) between males and females. The higher level of measles vaccine effectiveness estimates, 76.2%, among children aged 9 months-2 years while lower vaccine effectiveness estimates, 41.1%, was demonstrated among individuals aged ≥15 years. Conclusion: It was identified a high and increasing administrative measles vaccine coverage with geographical disparities. The estimated overall vaccine effectiveness level was low far apart from the expected level of protection against the vaccine coverage. Two vaccine doses administered individuals had a higher protection level than a single dose received individuals. There was a better vaccine protection level during the recent periods of vaccination compared to earlier periods. Therefore, it is important to increase the access of vaccines to the most unreachable areas maintaining vaccine integrity during delivery. Vaccine coverage should be monitored based on the head count of legible children in each district in the region. It is also important to strengthen the routine measles vaccination practices in any situations and booster dose should also be administered for those older age children.

Abstract Background - The World Health Organization recommends integrase inhibitor dolutegravir as the first- and second-line treatment of choice for Human Immunodeficiency Virus in July 2019 for all populations. Since 2019, Ethiopia's Ministry of Health has advised adults, adolescents, and expectant mothers to use it as their initial antiretroviral treatment regimen. There are limited studies demonstrating the adherence, effectiveness, and safety of children and adolescent dolutegravir regimen therapy in Ethiopia. Methods - institutional based retrospective follow up study conducted by involving children and adolescent with dolutegravir regimen therapy at antiretroviral therapy clinic of Amhara Region Specialized Hospitals. Eligible children and adolescents were consecutively recruited at admission and followed up for one (1) year. The sample size of ART children and adolescents was 403 included in the study. A simple random sampling technique by lottery methods was used. Data were collecting using structured questionnaire from client medical record folder. The data was analysis by using SPSS Version 25 software and evaluate the data with Binary logistic regression Model. Descriptive statistics were computed depending on the nature of the variables. Binary logistic regression Model used to assess predictors. Predictors considered statistically significant if P -value was less than 0.05. Result - In total, 90.1% of participants adhered well to the treatment. At the start, 65.9% of those on DTG were in WHO Clinical Stage III. After follow-up, 67.4% were in Stage I and 32.6% in Stage II. Initially, 97.8% had viral loads above 200 copies/mL, but after one year on DTG, 87.4% were dropped below the threshold. CD4 counts improved significantly: 51.6% began below 200 cells/mm³, but with most now at 350 or higher. Additionally, 33.3% of patients reported adverse drug effects (ADEs) following the DTG regimen. Conclusion - This study indicated that the use of DTG-based ART in children and adolescents is safe with minor ADEs. In addition, the DTG regimen is successful in this population, especially in treatment-experienced children who had high viral load before converting to DTG-based therapy. However, the majority of kids and teenagers adhered well to DTG regimens.

According to the Picker Institute model, patient-centred care (PCC) includes respect for patients’ values, preferences, and expressed needs; information, communication, and education; access to care; emotional support; involvement of family and friends; continuity and transition; physical comfort; and coordination and integration of care. It is one of the six aims for quality improvement guiding today’s health care systems. However, PCC remains underutilized by both patients and professionals, and significant challenges persist in its implementation worldwide. Additionally, few studies have examined the level of and factors associated with PCC practices in Ethiopia. To assess PCC practices and their associated factors among outpatient attendants at primary hospitals in the South Gondar Zone, Northwest Ethiopia, in 2024. A facility-based explanatory sequential mixed-methods study was conducted from March 18 to May 10, 2024. A total of 567 participants were selected using systematic random sampling. Binary logistic regression with adjusted odds ratios (AORs), 95% CIs, and p-values was used for quantitative data analysis. For the qualitative part, nine participants were selected for in-depth interviews. Thematic analysis was performed using Open Code 4.3, and the qualitative findings were used to explain the quantitative results. The proportion of PCC was 50.5% (95% CI: 46.3%-54.7%). In the qualitative analysis, PCC was categorized into two sub-themes: satisfactory PCC and not satisfactory PCC. The multivariable analysis showed that age above 34 years (AOR = 1.85; 95% CI: 1.186–2.89), consultation and empathy (AOR = 2.26; 95% CI: 1.39–3.7), shared decision-making (SDM) (AOR = 3.70; 95% CI: 2.36–5.75), perceived quality of services (AOR = 3.26; 95% CI: 2.014–5.26), medical care (AOR = 1.87; 95% CI: 1.16-3.00) and perceived workload on providers (AOR = 1.72; 95% CI: 1.033–2.847) were significantly associated with PCC. The qualitative findings indicated that informational factors, provider intimacy, shared-decision making, social support, availability of medicines, and medical care were factors affecting PCC. Half of the outpatients received good PCC at primary hospitals in the South Gondar Zone. Age, perceived quality of services, consultation and empathy, SDM, and perceived workload on providers were among the variables associated with PCC. This suggests that increased attention needed including awareness creation for patients, attendants, and providers, as well as close supervision of healthcare professionals’ interactions with patients, to enhance the implementation of PCC.

Bacterial vaginosis (BV) and aerobic vaginitis (AV) are characterized by an imbalance of vaginal microbiome, becomes a serious public health crisis especially in low and middle income country. To determine the Prevalence, Antimicrobial Resistance (AMR), and Associated Factors of Bacterial Vaginosis and Aerobic Vaginitis among Women Suspected of sexually transmitted infections (STIs) in Bahir Dar, Ethiopia. A facility-based cross-sectional study was conducted among 261 women suspected of STIs at selected health institutions in Bahir Dar City, northwest Ethiopia (February–May 2025). All eligible women were invited to minimize selection bias and ensure broad representation. Data was collected through structured interview, vaginal swab samples were collected and used for Gram stain methods to evaluate BV and AV scores according to the Nugent’s and Donder’s criteria, respectively. In situation of AV cases the aerobic bacterial pathogens and their antibiotic resistance were determined using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Logistic regression was used to assess associations, with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Variables with a p-value less than 0.05 were considered statistically significant. The overall prevalence of bacterial vaginosis (BV) was 20.7% (54/261), while aerobic vaginitis (AV) was 17.2% (45/261), with a dual infection rate of 2.7% (7/261). Among 45 aerobic bacterial isolates, 25 (55.6%) were Gram-positive and 20 (44.4%) were Gram-negative. The most common species were Staphylococcus aureus (13/45, 28.9%) and Escherichia coli (12/45, 26.7%). Gram-positive species showed variable resistance, with 20% classified as MDR. All E. coli and K. pneumoniae isolates were MDR, while P. aeruginosa showed partial resistance; overall MDR prevalence was 49%. The most important factors significantly associated with BV were single marital status, occupation (commercial sex worker, housewife), vaginal pH > 4.5, Donders’ score (moderate to severe), and history of STI or abortion. For AV, key factors included occupation (housewife, commercial sex worker), vaginal burning sensation, vaginal pH > 4.5, positive BV status, and Nugent score indicating BV. Bacterial vaginosis and aerobic vaginitis were prevalent among STI-suspected women in Bahir Dar, Ethiopia, with substantial multidrug resistance and significant associations with selected socio-demographic and clinical factors, underscoring the need for improved screening and resistance-guided management.

Limb-Body Wall Complex (LBWC) is a rare and typically lethal congenital anomaly characterized by severe defects of the ventral body wall, limbs, and neural tube. It is considered one of the most severe malformation syndromes. Its etiology remains uncertain, with proposed mechanisms including abnormal embryonic folding, vascular disruption, and early amnion rupture. We report a stillborn neonate delivered at Alem Ketema Enat Hospital, North Shoa, Amhara, Ethiopia, to a 27-year-old multiparous woman with no antenatal care. The neonate presented with multiple congenital anomalies consistent with the caudal variant of LBWC, including a large abdominal wall defect with evisceration of viscera, spinal dysraphism, and limb deformities. Unique to this case was the coexistence of a well-defined skin-covered sacrococcygeal mass distinct from the spinal defect, absence of external genitalia, imperforate anus, and unilateral clubfoot—an unusual constellation of findings rarely documented together in previous reports. The umbilical cord was notably short, further supporting the diagnosis. This case expands the phenotypic spectrum of the caudal variant of LBWC and highlights the diagnostic challenges in low-resource settings where routine prenatal ultrasonography is unavailable. The combination of these caudal defects suggests a failure of early embryonic folding in this region. Early antenatal screening and access to skilled sonography are essential for the timely identification of lethal congenital malformations, appropriate counseling, and informed pregnancy management in such environments. This report serves as the first from Ethiopia documenting this specific presentation, underscoring the urgent need to strengthen anomaly detection programs.

Herbal medicine has historically played an important role in healthcare in Ethiopia. However, its use in prehospital settings, where individuals self-administer herbal remedies before seeking formal healthcare, is not well understood. There is limited evidence of its prevalence, factors associated with its use, and potential safety implications. Therefore, this study aimed to assess the prevalence of prehospital herbal medicine use, identify determinants, and explore potential safety risks among patients admitted to Jimma Medical Center (JMC) in Southwestern Ethiopia. A hospital-based cross-sectional study was conducted among 217 patients admitted to the medical wards of Jimma Medical Center (JMC) between June and September 2021. Data were collected using a pretested, structured questionnaire. And a literature review was conducted to evaluate the potential toxicity and herb-drug interactions associated with the herbal medicines used by the patients. The data were analyzed using SPSS version 21. Descriptive statistics were used to summarize the findings, while bivariate and multivariate logistic regression analyses were employed to identify factors associated with pre-hospital herbal medicine use. A P-value < 0.05 was considered statistically significant. The prevalence of prehospital herbal medicine use was 34%. Most patients (78.7%) did not inform healthcare providers about their herbal use. Additionally, prehospital herbal medicine usage is influenced by age (AOR = 0.281, 95% CI: 0.115–0.683), secondary educational level (AOR = 2.7, 95% CI: 1.101–6.485), and lack of insurance coverage (AOR = 2.1, 95% CI: 1.083–4.004). This indicates that demographic, socioeconomic, and cultural factors jointly influence prehospital herbal medicine use. The study also found that Ocimum gratissimum, Ruta chalepensis, Croton macrostachyus, Zingiber officinale, Eucalyptus globulus, Echinops kebericho, and Carica papaya were the most utilized herbal medicines in the studied area. Furthermore, the literature review revealed potential herb-drug interactions and toxicity risks, especially with Zingiber officinale, Carica papaya, Eucalyptus globulus, and Ruta chalepensis. Prehospital use of herbal medicines was relatively high and often undisclosed to healthcare providers, raising safety concerns due to potential toxicities and herb-drug interactions. Age, education, and insurance status significantly influenced herbal medicine use. These findings emphasize the need for healthcare providers to proactively inquire about herbal medicine use during patient assessments, as well as for community awareness programs promoting the safe use of herbal remedies.

Understanding the spatiotemporal drought variability is essential for effective climate resilience and resource management in drought-prone areas. Therefore, this study aimed to assess the dynamics of meteorological and agricultural droughts in the Rift Valley Lake Basin (RVLB) of Ethiopia by using the Standardized Precipitation Index (SPI-1, SPI-4) derived from CHIRPS data (1985–2024) and remote sensing-based vegetation indices (NDVI, VCI, TCI, VHI) from MODIS data (2001–2024). The data were processed using Google Earth Engine and spatial statistical tools, including Spearman correlation, ordinary least squares (OLS), and geographically weighted regression (GWR), to examine the relationships between drought indices and root zone soil moisture. The metrics demonstrated that CHIRPS accurately captures spatial and temporal rainfall variability. The findings revealed significant temporal and spatial variability in drought severity, with major events occurring in 1985, 1987, 1990, 2002, 2009, 2016, and 2020. The study highlighted the compounded effects of thermal and moisture stress on vegetation. Strong negative correlations were identified between land surface temperature (LST) and vegetation indices, emphasizing the role of high temperatures in exacerbating drought stress. VHI identified a larger drought-affected area (severe: 10%, moderate: 30.26%) than VCI (severe: 1.42%, moderate: 15.37%). The GWR model outperformed OLS (Adjusted R2 = 0.95) with randomly distributed residuals (Moran’s I), capturing strong spatial relationships between TCI (3.19 in central and north; − 4.45 in south), SPI-1, and root zone soil moisture (~ 1.20). Predicted drought risk ranged from 0.05 to 5.78, peaking in the central basin where short-term rainfall deficits and high temperatures intensified severity. In conclusion, a multi-index, spatially explicit drought monitoring framework is crucial for early warning, targeted interventions, and adaptive agricultural planning. Integrating real-time remote sensing, climate-smart practices, and localized water management can strengthen resilience and support sustainable development under a changing climate.

The livestock sector in Ethiopia has great potential to assist socioeconomic development and transformation. The sector contributes 20-40% to the total gross domestic product (GDP) of the country. Yet, land use/land cover (LULC) changes look to influence the balance of livestock feed resources. This study looks into how LULC has changed over time in Farta District, Ethiopia, while assessing grassland dynamics and animal feed balance. Landsat-7 and Sentinel-2 images for 2005 and 2020 were collected via Google Earth Engine for the LULC analysis. Field observation and key informant interviews were conducted to collect data from three rural villages (kebelles). The maximum likelihood method was used to classify the past and the present LULCs. Markov chain model and Google Earth Engine were similarly used to classify and predict the LULC for the year 2035. Descriptive statistics and thematic textual analysis were additionally employed to analyze quantitative and qualitative data. The results revealed significant changes in LULC during the study period (2005-2020) and a critical shortfall in livestock feed availability. Livestock feed balance projections suggest that the livestock population could rise from 312,021 to 558,402 by 2035, implying a feed demand of 557,092 tons. Socioeconomic factors, notably low farmer participation in decision making and land laws, were observed impacting livestock feed resources. We recommend that focus should be given on improved pasture management, better use of crop residues, and integrated livestock-crop systems to address the livestock feed crisis. Adopting effective land management policies is crucial to mitigate LULC changes and protect grasslands for future livestock feed.

BackgroundDiabetic Ketoacidosis (DKA) is a critical and potentially fatal complication predominantly seen in individuals diagnosed with Type 1 Diabetes Mellitus (T1DM), though it may also arise in those with Type 2 Diabetes Mellitus (T2DM) under specific circumstances. Although DKA is preventable through effective diabetes management strategies, the consequences can be severe if the condition is not addressed promptly. The timely recognition of DKA, coupled with suitable medical treatment, is essential to enhance patient outcomes and mitigate the risk of enduring complications related to this condition. The objective of this research was to identify the risk factors of DKA in diabetic patients receiving care at public hospitals in the East Gojjam Zone of Northwestern Ethiopia.MethodsAn unmatched case-control study was carried out in selected public hospitals located in the East Gojjam Zone between April 10 and July 30, 2023. Five public hospitals were randomly selected, and a systematic random sampling technique was employed to recruit 408 study participants. Logistic regression analysis was performed to identify variables significantly associated with the outcomes, using a significance level of P < 0.05 and a 95% confidence interval.ResultsThe study included 102 cases and 306 controls. Several key risk factors for DKA were identified, including the absence of regular follow-up [AOR = 2.21, 95% CI (1.31–3.71)], not being a member of health insurance [AOR = 3.30, 95% CI (1.75–6.24)], distance from a health facility greater than 5 km [AOR = 1.85, 95% CI (1.09–3.14)], infection [AOR = 2.15, 95% CI (1.12–3.89)], and reduction in insulin dosage [AOR = 2.13, 95% CI (1.19–3.83)].ConclusionsThe findings declared that lack of regular follow-up, living more than five kilometers from a healthcare facility, reducing insulin doses without adequate medical guidance, lack of community-based health insurance, and the presence of infections significantly increase the likelihood of DKA. Therefore, healthcare providers should intervene on the identified risk factors for DKA to prevent the occurrence of DKA.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12902-025-02023-x.