The Carter Center

Exclusive breastfeeding is defined as feeding infants only breast milk for the first six months of life, with no additional liquids or solids except prescribed medicines, vitamins, or mineral supplements. This study aimed to compare the prevalence of exclusive breastfeeding and identify factors associated with its practice among employed and unemployed mothers in Arada Subcity, Addis Ababa, Ethiopia, in 2024. A community-based comparative cross-sectional study was conducted from July–August 2024 in four randomly selected woredas of Arada Subcity, Addis Ababa. Using proportional stratified sampling, 808 mother–infant dyads (404 employed, 404 unemployed) with infants aged 0–6 months were enrolled. Exclusive breastfeeding status was determined using a 24-hour recall method, using a pretested interviewer-administered questionnaire adapted from the WHO Infant and Young Child Feeding indicators and the 2016 Ethiopian Demographic and Health Survey. multilevel logistic regression identified factors associated with EBF, reported as adjusted odds ratios (AORs) with 95% CIs. Exclusive breastfeeding during the first six months was reported by 440 mothers (54.7%): 69.0% (95% CI 64.3, 73.4) of nonemployed mothers and 40.3% (95% CI 35.6, 45.1) of employed mothers. Nonemployed mothers had 3.3 times greater odds of practicing EBF (AOR 3.3, 95% CI 2.47, 4.4). Among unemployed mothers, EBF was positively associated with being married, having ≥ 3 years of birth spacing, lacking religious barriers, being comfortable discussing breastfeeding, and receiving counseling. Among employed mothers, higher odds of EBF were linked to working < 20 h/week, being married, having a lower income, the absence of religious barriers, perceived workplace support, and high confidence in breastfeeding while employed. The prevalence of exclusive breastfeeding in Arada was low and more common among nonemployed mothers. EBF practices are significantly influenced by multiple factors. Strengthening workplace support; enhancing family and social support; addressing religious barriers; improving maternal confidence; ensuring effective counseling; and creating supportive environments at home, workplaces, and health facilities are recommended to improve EBF practices in cities. Not applicable.

There has been discussion regarding the definition of the clinical sign trachomatous trichiasis (TT) for the purposes of determining elimination of trachoma as a public health problem, and whether the definition should include the presence of trachomatous scarring (TS). A multi-country observational study was conducted in Ethiopia, Uganda and Nigeria to assess whether TS grading by field graders using the WHO simplified system in trachoma surveys are comparable with expert grading of tarsal conjunctival scarring (TCS) using a detailed system. The primary outcome was the proportion of eyes graded as "No TS" in the surveys but with TCS from expert photographic grading (the negative predictive value, NPV). In Ethiopia, Uganda and Nigeria, 545 (438 trichiasis cases and 107 comparisons), 256 (156 trichiasis cases and 100 comparisons), and 468 (352 trichiasis cases and 116 comparisons) participants, respectively, were enrolled. In Ethiopia, among 111 trichiatic eyes graded "No TS" in the surveys, 103 (92.8%) had TCS in expert photo grading, NPV 7.2% (95% CI 3.2%-13.7%). In Uganda, among 28 trichiatic eyes graded "No TS" in the surveys, 19 (67.9%) had TCS in expert photo grading, NPV 32.1% (95% CI 15.9%-52.4%). In Nigeria, among 111 trichiatic eyes graded "No TS" in the surveys, 100 (90.1%) had TCS in expert photo grading, NPV 9.9% (95% CI 5.0%-17.0%). Across settings, among eyes misdiagnosed as "No TS" in the survey, 174/250 (69.6%) had extensive TCS (patches of scarring occupying ≥1/3 of the upper tarsal conjunctiva). Trichiatic eyes with TCS had more severe entropion, trichiasis, conjunctival inflammation, and corneal opacity than those without TCS. In all three settings, including TS to define a trichiasis "trachomatous" in a survey could result in the underestimation of the burden of TT. However, TCS can be effectively used to determine TT severity and management.

BackgroundBacterial bloodstream infections are a major global health concern, particularly in resource-limited settings including Ethiopia. There is a lack of updated and comprehensive data that integrates microbiological data and clinical findings. Therefore, this study aimed to characterize bacterial profiles, antimicrobial susceptibility, and associated factors in patients suspected of bloodstream infections at the University of Gondar Comprehensive Specialized Hospital.MethodsA cross-sectional study analyzed electronic records from January 2019 to December 2021. Sociodemographic, clinical, and blood culture data were analyzed. Descriptive statistics and binary logistic regression were employed to identify factors associated with bloodstream infections. Descriptive statistics such as frequency and percentage were computed. Furthermore, a binary and multivariable logistic regression model was fitted to determine the relationship between BSI and associated factors. Variables with p-values of &amp;lt;0.05 from the multivariable logistic regression were used to show the presence of statistically significant associations.ResultsA total of 4,727 patients’ records were included in the study. Among these, 14.8% (701/4,727) were bacterial bloodstream infections, with Gram-negative bacteria accounting for 63.5% (445/701) of cases. The most common bacteria were Klebsiella pneumoniae (29.0%), Staphylococcus aureus (23.5%), and Escherichia coli (8.4%). The study revealed a high resistance level to several antibiotics, with approximately 60.9% of the isolates demonstrating multidrug resistance. Klebsiella oxytoca, Klebsiella pneumoniae, and Escherichia coli exhibited high levels of multidrug resistance. The study identified emergency OPD [AOR = 3.2; (95% CI: 1.50–6.74)], oncology ward [AOR = 3.0; (95% CI: 1.21–7.17)], and surgical ward [AOR = 3.3; (95% CI: 1.27–8.43)] as factors associated with increased susceptibility to bloodstream infections.ConclusionThe overall prevalence of bacterial isolates was high with concerning levels of multi-drug resistance. The study identified significant associations between bloodstream infections with age groups and presentation in specific clinical settings, such as the emergency OPD, oncology ward, and surgical ward. Strict regulation of antibiotic stewardship and the implementation of effective infection control programs should be enforced.

Trachoma recrudescence is a serious concern for trachoma control programs. Programs define recrudescence as the return of trachomatous inflammation-follicular (TF) prevalence above elimination threshold (≥5%) on district-level trachoma surveillance surveys (TSSs). This study aimed to determine potential correlates of trachoma recrudescence within a historically highly endemic region. Between 2015 and 2021, population-based TSSs were conducted in 51 districts of Amhara, Ethiopia. District estimates were calculated accounting for multistage design; logistic regression was used to estimate the association of key correlates with recrudescence at the district level. Among the 51 districts, 17 (33%) were recrudescent. Correlates of recrudescence included indicators of historic trachoma burden, such as higher trachomatous inflammation-intense (TI) prevalence (odds ratio [OR]: 2.6, CI: 1.4-5.3) and higher Chlamydia trachomatis (Ct) infection prevalence (OR: 2.9, CI: 1.1-9.9) at the first recorded impact survey. The increased prevalence of children with clean faces (OR: 0.4, CI: 0.21-1.0) and the increased prevalence of travel time to a water source ≤ 30 min (OR: 0.5, CI: 0.2-1.1) at the TSS were associated with a protective effect from recrudescence. Data on historical trachoma burden as well as current water and sanitation conditions may help programs predict where recrudescence is more likely to occur and thus help programs sustain elimination as a public health problem.

A 6-week course of tetracycline eye ointment is an alternative to single -dose oral azithromycin in annual mass drug administration for trachoma control. Compliance with the recommended tetracycline eye ointment regimen has not been well characterised when administered as part of a trachoma control program. A routine mass drug administration for trachoma was carried out in 40 communities in the Amhara region of Ethiopia. Two tubes of tetracycline eye ointment, to be administered twice daily for 6 weeks, was offered to all children under 6 months of age, to pregnant women who declined to take azithromycin, and to all individuals with a macrolide allergy. Seven weeks following the mass drug administration, a treatment compliance survey was performed for all community members documented to have received tetracycline eye ointment during the mass drug administration. Of the 491 individuals documented as having received tetracycline eye ointment from the treatment records, 367 completed the survey, of which 214 recalled being offered tetracycline eye ointment. A total of 105 (49%) respondents reported taking ≥1 daily dose of tetracycline eye ointment on most days of the week for at least the first week. Only 20 (9%) respondents reported taking at least 1 tetracycline eye ointment dose per week for 6 weeks. The most common reasons for low compliance included 'saving it for a future infection' and 'stopped because I (or my child) seemed healthy'. The odds of low compliance were greater for those who reported not having adequate counselling (e.g., odds ratio [OR] 5.3, 95% CI 2.5-28.9 when low compliance was defined as not taking a tetracycline eye ointment dose for most days of at least the first week). Compliance with tetracycline eye ointment was low when administered by a trachoma program during a routine mass drug administration, especially for those reporting inadequate counselling. Further research with a larger sample size and varied settings is warranted to better understand and improve compliance.

BackgroundUnmet need for family planning is a proportion of women among reproductive age group who want to stop or delay childbearing but are not using any method of contraception. One in ten married women face unmet need for family planning world-wide whereas, one in five women in Africa. Thus, by understanding factors associated with unmet need specific to the study area; the study contributes to planning and intervention of programs, gives additional finding for controversies in earlier studies, and also helps as a baseline for other researchers conducting studies on similar topics.MethodsA community-based unmatched case-control study was conducted from March 29-April 25, 2021 G.C on 462 currently married reproductive age women (154 cases and 308 controls) in Dewa Chefa District. Currently married reproductive-age women who were fecund, and wanted to limit or delay childbearing but were not using any contraceptive methods were taken as cases and currently married reproductive-age women who were using family planning or did not want to use were taken as controls. A structured and pre-tested questionnaire was used to collect data. Collected data were entered into Epi-data 3.1 and exported to SPSS 23 for analysis. Binary Logistic regression was conducted and variables with p-value < 0.05 were taken as statistically significant.ResultsA total of 462 women participated in this study, with 100% response rate. The mean age of the respondents was 27.92 years (with SD of ± 6.3) Age of woman 35–49 [AOR = 6.6 (1.1–39)], having poor knowledge on family planning [AOR = 1.9 (1.1–3.1)], using family planning decided by husband [AOR = 3.8 (2.1–6.9)], using family planning decided together [AOR = 2.3 (1.07–5.1)] and have no support and disapproval of husband for family planning use [AOR = 2.1 (1.08-4)] were factors significantly associated with unmet need.Conclusion and recommendationsAge of the woman, main decider of family planning use, knowledge about family planning and support and approval of spouse for family planning use were found to have significant association with unmet need for family planning. Thus, family planning providers, District health office, and other concerned bodies should strengthen female empowerment and male involvement in the program with strong couple counseling to reduce unmet need.

In order to sustain the overall competitiveness of the wind power industry, unrelenting focus is required on working toward the advancement of enabling technologies and research studies that are associated with wind farm systems. First, wind farm technologies that include various turbine generator systems coupled with different power transmission configurations have enormous impact in determining the quality of wind power production. In addition, modern wind farms are expected to implement robust power control algorithms to meet more advanced requirements of electricity generation. Accordingly, this study explores the statuses of wind energy harvesting technologies and wind farm control strategies by discussing their recent and future impact on transforming the wind power industry. Doubly fed induction generator (DFIG)-based wind energy harvesting technology is well-matured and has exhibited an excellent track-record in past and recent experiences, but its capability of being further scalable for large-scale power production is limited as it is largely incompatible with high-voltage power transmission networks. On the other hand, permanent magnet synchronous generator (PMSG)-based technology is making significant advancements to attain the maximum possible efficiency level in greatly facilitating larger scale power generation, although the construction of bulky and costly power transmission systems is required. In this regard, future technological advances in the wind farm industry are expected to reasonably optimize the design and cost of high-voltage power transmission systems. Similarly, an increasing number of research studies are introducing a number of power optimization-based control models to create an ideal integration of the aforementioned wind farm technologies so as to ultimately enhance the reliability of electricity production by maintaining the systems’ safety. Yet, additional work is still expected to be undertaken in the future for a more extended evaluation of the performances of many different control models under a similar environment.

In developing countries, the diagnosis of congenital heart diseases (CHD) is growing as the availability of echocardiography is increasing with most diagnoses made after birth. However, the access to pediatric surgery is still low and is mainly done by global surgical campaigns rather than local surgeons. Ethiopia has trained its local surgeons, and this is expected to improve the care of children with CHD. We aimed to evaluate the experience of local pediatric CHD surgery and its outcome in a single-center in Ethiopia. A hospital-based retrospective cohort study was done by including all patients with CHD and acquired heart disease in patients under the age of 18 operated at children's cardiac center in Addis Ababa Ethiopia. We set in-hospital mortality, 30-day mortality, and the prevalence of complications including major complications after cardiac surgery as the primary outcomes. A total of 76 children were operated. The mean age at the time of diagnosis and surgery was 4 (±5) and 7 (±5) years, respectively. Forty-one (54%) were female. Ninety five percent of the 76 operated children were with the diagnoses of congenital heart diseases while the rest (5%) with acquired heart disease. Of those with congenital heart disease, Patent ductus arteriosus (PDA) accounted for (33.3%), Ventricular septal defect (VSD) for 29.5% and Atrial Septal Defect (ASD) for 10% and Tetralogy of Fallot (TOF) for 5%. According to the RACS-1 category, 26 (35.1%) were in category 1, 33 (44.6%) were in category 2, 15 (20.3%) were in category 3 and none of the children were in category 4 and 5. In-hospital mortality was 2.6% whereas there was no patient who died within 30 days after discharge. Operative mortality was 2.6%. Various types of lesions were treated in the hands of the local teams with VSD and PDA ligations as the commonest of all. The 30day mortality was within acceptable range and this outcome shows congenital and acquired heart diseases can be operated on in developing countries with good outcome despite the limited resources.