Ethiopian Public Health Association

Gender-transformative programing targeting couples is an important strategy to reduce intimate partner violence (IPV), but questions around efficacy and safety remain. This qualitative study explores indications of change and unintended consequences of the gender-transformative Unite for a Better Life (UBL) intervention, using data from the couples’ and control arms of a cluster randomized controlled trial (cRCT) in Ethiopia. The cRCT found no impact on physical and psychological IPV and weak evidence of reductions in sexual IPV in the couples’ arm. We analyzed 33 facilitator feedback questionnaires and 29 in-depth interviews (IDIs) among couples conducted approximately 30-months post intervention; 14 participated in UBL delivered to couples, and 15 were from the control arm. IDIs were conducted separately with each member of the couple and analyzed thematically in Dedoose to explore indications of change attributed to UBL. UBL couples attributed improved household task-sharing, communication, and joint decision-making to the program. Men and women developed more gender-equitable attitudes, leading to more fulfilling relationships. Additionally, most participants in violent relationships reported that UBL led to a reduction or cessation of physical and psychological IPV, and a complete cessation of sexual IPV. These effects were largely attributed to shifts at the individual level for men. Men developed better anger management skills, reduced their alcohol consumption, and increased their knowledge around the consequences of IPV. At the relational level, couples reported increased communication, particularly around sexual desire, and reduced conflict. Additionally, participants reported normative shifts, including decreased acceptance of IPV. There were no reports of changes in control participants nor of major unintended consequences. When delivered to couples, UBL shows promise in shifting individual-level male factors and relational dynamics and reducing conflict and IPV. This suggests that engaging men in couples can be an effective and safe strategy for IPV prevention.

Introduction: Neonatal care in low-resource settings is hindered by shortages of trained staff, inadequate infrastructure, and limited equipment and medications that compromise the management of common neonatal conditions and reduce the quality of care. Our aim was to describe the collaborative efforts between the Italian Agency for Development Cooperation (AICS), the Union of European Neonatal and Perinatal Societies (UENPS), Doctors with Africa Collegio Universitario Aspiranti Medici Missionari (CUAMM), the Ethiopian Pediatrics Society (EPS), and the Ethiopian Federal Ministry of Health (FMoH) to assess resuscitation and respiratory care practices in Ethiopian neonatal intensive care unit (NICU)s, identify gaps, and guide targeted interventions. Methods: A 50-item survey was distributed to 48 Ethiopian NICUs. Based on the survey results, a national workshop in Addis Ababa and a neonatal resuscitation “Train the Trainers” course were scheduled. In parallel, funds were allocated to initiate renovations and equipment upgrade at two selected sites. Results: The survey showed that most units lacked essential resuscitation equipment. Noninvasive respiratory support mainly relied on homemade continuous positive airway pressure systems; mechanical ventilators were available in <40% of units. Caffeine was rarely used, and surfactant was unavailable. The national workshop led to a document shared with the FMoH outlining priorities for subsequent training and resource strengthening. Newly trained instructors conducted four local neonatal resuscitation courses, training 150 healthcare providers. Facility upgrades addressed water, power, medical gas systems, and refurbishment of deteriorated areas. Conclusions: The survey revealed major gaps in neonatal care in Ethiopia. Collaborative efforts by AICS, UENPS, CUAMM, EPS, and FMoH helped reinforce key infrastructures and promote delivery room and respiratory care.

BackgroundNon-contrast CT (NCCT) is first-line imaging for suspected acute ischemic stroke (AIS) but has limited early sensitivity; deep learning (DL) may improve patient-level detection.ObjectivesTo estimate the diagnostic accuracy of DL applied to NCCT for patient-level AIS detection and to examine prespecified sources of between-study heterogeneity.MethodsWe searched MEDLINE, Embase, and Web of Science (January 2010–May 2025). Eligible prospective or retrospective diagnostic studies evaluated DL on NCCT against an appropriate reference standard and reported (or allowed reconstruction of) patient-level 2 × 2 data. Two-gate case–control and lesion-only reports were excluded. Dual reviewers screened/extracted data; risk of bias was assessed with QUADAS-2, and AI-reporting against items adapted from STARD-AI/CLAIM/CONSORT-AI. Bivariate random-effects/HSROC models summarized sensitivity and specificity. Prespecified moderators were posterior-fossa inclusion, reference-standard robustness, and validation type. Sensitivity analyses included external-only cohorts, robust standards, posterior-fossa inclusion, and a “Direct AIS” construct subset.ResultsOf 1,899 records, 16 studies met inclusion; 13 contributed patient-level data to meta-analysis. Summary sensitivity was 0.91 (95% CI, 0.81–0.96) and specificity 0.90 (0.85–0.94). Sensitivity was lower for externally validated models than internally validated ones (0.82 [0.67–0.91] vs. 0.95 [0.89–0.98]) with similar specificity (0.88 [0.83–0.92] vs. 0.93 [0.82–0.97]). Findings were directionally robust across sensitivity analyses. QUADAS-2 frequently indicated concerns in patient selection and index-test domains; AI-reporting quality was mostly moderate, and explicit external validation remained uncommon.ConclusionsDL applied to NCCT shows high accuracy for patient-level AIS detection. However, generalizability is the principal gap; broader external validation and guideline-concordant reporting are needed to support safe clinical adoption.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12883-025-04528-3.

Abstract Background: Despite national progress in reducing child mortality, Ethiopia continues to exhibit significant spatial inequalities in child health outcomes. The Afar region, in particular, remains critically underserved. While technical challenges are often cited, such explanations overlook the deeper structural, political, and institutional drivers of inequality. Objectives: This study investigates how public policy processes and political economy dynamics contribute to persistent spatial inequalities in child health in Ethiopia, with a specific focus on the Afar region. Methods: A qualitative case study design was employed, drawing on 23 semi-structured interviews with federal and regional policymakers, advisors, and development partners, as well as the analysis of 53 policy and historical documents. The analysis is guided by Walt and Gilson’s Policy Triangle and Moncrieffe and Luttrell’s Political Economy Framework, examining actors, context, content, and processes. Results: Four intersecting drivers of spatial inequality were identified: (1) historical marginalisation rooted in exclusionary state formation; (2) institutional fragmentation and weak subnational capacity; (3) dominant policy narratives that prioritise efficiency over equity; and (4) donor influence that reinforces verticalism and policy uniformity. Together, these dynamics reproduce and sustain child health inequities in Afar. Conclusion: Spatial inequalities in child health in Ethiopia are not incidental; they are structurally embedded in governance, policy design, and global-local power relations. Addressing them requires systemic reform grounded in justice, regional inclusion, and responsive decentralisation. This case study contributes to broader debates on inequality, decentralisation, and health governance in low- and middle-income countries.

Antenatal mental health is a crucial but overlooked and neglected element of maternal and infant health care. Various factors have been associated with triggering mental illness during pregnancy. It is essential to explore the stressors and mediators that play a role in causing these health issues and understand how they interact. Therefore, this study aimed to analyze the causal association between stressors and factors influencing mental disorders using the stress process model. A community-based cross-sectional survey was conducted among pregnant women at Dabat Health and Demographic Surveillance Site Northwest, Ethiopia, in June and August 2022. This study aimed to measure common mental disorders in pregnant women using Self-Reported Questionnaire-20 and explore the causal association with stressors variables. A Generalized Structural Equation Model was used to evaluate the effect of stressors and mediators on common antenatal mental disorders. This model, known for its ability to understand the complex relationship between environmental exposures, emotional responses, and cognitive appraisals, was used to evaluate the impact of stressors and mediators on common antenatal mental disorders. The study included 872 pregnant women, of which 114 (13.1%) (95% CI: 10.07, 15.4) reported experiencing symptoms of common antenatal mental disorders. Lack of antenatal care(β=1.4), unplanned pregnancy(β=0.85), and intimate partner violence (β=0.87), all of which were associated with a higher antenatal common mental disorder score. A family history of mental disorders (β=-0.11) was associated with a decreased antenatal common mental disorder score. Moreover, social support (β=-0.19), life-threatening events (β=0.93), and stress-coping mechanisms (β=0.12) appeared to mediate the link between the identified stressors and antenatal common mental disorders. This study highlights the association between psychosocial factors and antenatal mental health, underlining the urgent need for a holistic approach to prenatal care that includes mental well-being. Integrating support systems and stress-coping mechanisms is crucial for improving maternal health outcomes.

There is currently no single, easy-to-use, reliable indicator to assess whether a face has been washed with soap in the context of trachoma elimination. This study aimed to compare survey report, script-based pictorial recall and facial cleanliness indicators as alternatives to structured observation for measuring face washing behaviour. This method validation study was nested in the Stronger-SAFE trial, Oromia Region, Ethiopia. Structured observation was conducted in randomly selected households for three hours from dawn. The primary caregiver in each household participated in a survey to capture (self)-reported behaviour and/or script-based pictorial recall, a routine-based diary activity to covertly capture information on face washing behaviour of themself and any children aged 1-12. Children 4-12 years old directly participated in the survey and pictorial recall in a subset of households. The facial cleanliness of children aged 1-12 was assessed qualitatively and using the quantitative Personal Hygiene Assessment Tool (qPHAT). Prevalence estimates, sensitivity, specificity and predictive values were computed for each behavioural indicator with observation data as the gold standard. The appropriateness of script-based pictorial recall was assessed using baseline and 3-month follow-up data. Baseline data were collected from 204 households in 68 clusters. Survey estimates of face washing and face washing with soap among caregivers and children were 32% to 60% and 5% to 31% higher than observed behaviour, respectively. Face washing prevalence estimates from pictorial recall were lower than survey estimates and comparable with observations for some face washing with soap indicators (0.3% to 13% higher than observations). Specificity of pictorial recall indicators was high (85% to 99%), but the sensitivity was low (0% to 67%), resulting in a low positive predictive value for all indicators. Both qualitative facial cleanliness indicators and qPHAT scores were poorly correlated with observed face washing earlier that morning. Pictorial recall overestimated face washing with soap among both caregivers and children following intervention delivery but not at baseline. Survey (self)-reported data on face washing is highly inaccurate. Script-based pictorial recall does not correctly classify those who wash their face with soap, and is subject to differential bias following intervention exposure, and facial cleanliness is a poor indicator of recent face washing in settings where faces become rapidly dirty again after washing. Alternatives to structured observation cannot be recommended to monitor the effectiveness of face washing interventions in community settings. Trial Registration ISRCTN registry ISRCTN40760473, https://doi.org/10.1186/ISRCTN40760473.

This chapter presents Ethiopia's agricultural resource base – land, water, agroecological/agroclimatic conditions, crop and livestock diversity, human population and institutional capacity. The country possesses approximately 38 million ha of agricultural land, of which about 16 million ha is arable, leaving approximately 22 million ha that is available for further development. Ethiopia has a dozen river basins and nearly 125 billion cubic metres of combined surface and underground water per annum. It is the land of wide-ranging agroecological/agroclimatic diversity where more than 70 plant species are cultivated and the largest head of livestock in Africa is raised each year. The country's population in 2022 of ~121 million comprises 28% between the age of 15 and 29 years and projected to reach ~205 million by 2050. Ethiopia has widely distributed research centres, >3000 researchers, 15,000 farmer training centres and a development agent to smallholder farmer ratio of 1:230, the densest in Africa.

As national trachoma programmes increase efforts to reduce the burden of trachomatous trichiasis (TT), TT case finding and referral are critical public health programme components. Our research aimed to explore the most effective and efficient approaches to finding, referring, and managing TT cases. This was a prospective descriptive study, utilizing both routine programme data and primary data collection. This study compared four different approaches to finding TT cases across three different local government areas (LGAs) in Kano State, Nigeria. Each of the study LGAs was divided into four sub-units to accommodate the four different approaches. The number of outreach attendees was 4795 across the four case finding approaches, and this varied hugely, with the smallest number and proportion (403, 0.26%) in settings only employing house-to-house case finding and the largest number and proportion (1901, 0.99%) when town criers were used. That said, the proportion of TT cases among people presenting at outreach was highest (32.5%) when house-to-house case finding was used and lowest (10.3%) when town criers were used. More female TT patients were found (53-70%) and had surgery (79-85%) compared to male cases, across all approaches. The average project expenditure for finding one TT case was similar for approaches that included house-to-house case finding (USD 5.4-6.3), while it was 3.5 times higher (USD 21.5 per TT case found) when town criers were used. This study found that the house-to-house TT case finding approaches were the most efficient method with the highest yield of TT cases. Including other eye condition and/or vision testing yielded similar results but required more personnel and cost.

Abstract Fungal diseases cause significant yield loss to wheat production. Septoria tritici blotch (STB), caused by the ascomycete fungus Zymoseptoria trtici, is one of the major fungal diseases affecting wheat production worldwide. In Ethiopia, STB is a severe problem that causes significant yield loss in high and mid‐altitude wheat‐growing areas. The use of resistant varieties is one of the sustainable disease management strategies, particularly for resource‐poor farmers in developing countries. Two hundred and fifty bread wheat genotypes were evaluated to identify septoria tritici resistant genotypes and estimate the extent of genetic variability for resistance to STB and other economically important traits using alpha lattice design under natural infestation in two STB hotspot environments. Analysis of variance revealed highly significant differences among genotypes, environment, and genotype × environment interaction for all traits measured. The genetic coefficient of variance was lower than the phenotypic coefficient of variance for all traits studied, and both test environments showed the influence of the environment on trait expression. High and moderate heritability values were observed for the septoria disease severity parameters, indicating that the STB resistance trait was less influenced by the environment. The days to heading and plant height were inversely correlated with disease severity. This suggests that genotypes with tall plant height and long maturity period could be resistant to septoria tritici blotch through escape mechanisms. Four of the genotypes, namely, G‐215, G‐255, G‐257, and G‐258, were found to be resistant across all locations. These and other promising genotypes will be used in future breeding programmes to select or develop high‐yielding and STB‐resistant bread wheat genotypes that can be deployed in septoria tritici blotch‐prone areas. Highly susceptible genotypes will also be used as controls for STB resistance breeding programmes.

Food security in Africa was impacted as a result of supply chain disruptions and government lockdowns brought on by the Coronavirus Disease of 2019 (COVID-19) pandemic. With participation from important actors in the agricultural value chain, the Sasakawa Africa Association (SAA) assessed the effect of COVID-19 on agri-food system in Ethiopia, Mali, Nigeria, and Uganda. Farmers, agro-processors, private service providers, off-takers and merchants, input dealers, and Ministry of Agriculture Extension service personnel are among the value chain actors that took part in the study. The survey, which was held from April 13 to April 16, 2020, used semi-structured tools and questionnaires aimed at the different stakeholders. The study used a cluster sample technique. The data were analyzed using SPSS software, which included frequency counts, percentages, rank correlation, and categorical regression. Based on the severity of the lockdowns associated to COVID-19, the survey found that the outcomes differed by country. The analysis shows a negative association between e-extension and education during the COVID-19 epidemic, but a high and positive correlation (p &lt; 0.01) between extension services and postharvest services, as well as credit availability. Factors such as transportation, labor availability, price fluctuations, output market activity, loan availability, and food and nutrition security were significantly and positively correlated with COVID-19 awareness. Additionally, the respondents indicated that price changes were favourably correlated with labour availability and transportation, and that farming activities were significantly and positively correlated with food and nutrition security, labour availability, and the output market. According to the perspective data collected in every country during the COVID-19 epidemic, postharvest services, agricultural input activities, and food and nutrition security all heavily relied on extension services, with postharvest services having a negative correlation with extension services. The results of the analysis show that COVID-19 impacted several variables that are associated with extension services across the four countries. For instance, the R2 value of the relationship between value chain variables and extension service delivery across Mali (0.485), Nigeria (0.621), Ethiopia (0.426), Uganda (0.529), and the combined countries (0.511) indicates that the variation of the dependent variables can account for 48.5% of the variation in the values of the independent variable (extension service delivery) in Mali, 62.1% in Nigeria, 42.6% in Ethiopia, 52.9% in Uganda, and 51.1% in the combined countries. Farmers' access to agricultural labour, credit services, inputs for agriculture, and output markets was restricted by the ban on travel and social gatherings. Smallholder farmers should employ digital solutions more to strengthen the agricultural value chain's actors' resilience against potential pandemics or conflicts, according to the study's implications for extension services. This will reduce the requirement for extensive personal touch and travel in the delivery of extension services. The study also highlights how crucial it is for extension services to show tangible outcomes and benefits in order to increase farming communities' and value chain actors' resilience in any difficult circumstances. Key words: COVID-19, food systems, extension services, value chain actors, output markets