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Abstract Background Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine podoconiosis patient's willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. Methods A cross-sectional study was conducted among randomly selected untreated podoconiosis patients (n = 393) in Baso Liben woreda , northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. Results The majority of podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. Conclusions The considerable WTP estimates showed that podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate podoconiosis treatment service with other NTDs and the government's primary health care system.

BACKGROUND: In Ethiopia, 38% of children under 5 years of age are stunted (low height for age). A novel government-led intervention called the Sustainable Undernutrition Reduction in Ethiopia (SURE) aims to tackle the burden of stunting by improving complementary feeding and dietary diversity among young children. The SURE programme design applies a transtheoretical model of behaviour change, whereby exposure to recommended infant and young child feeding (IYCF) and nutrition-sensitive agriculture messages is a first stage to adopting key behaviours. This qualitative study explored the fidelity and dose of the IYCF and nutrition-sensitive agriculture messages delivered by extension workers. METHODS: A qualitative study was conducted across four regions in Ethiopia (Oromiya, Amhara, SNNP and Tigray) between April and October 2017. Across the four regions, 81 key informant interviews, 90 FGDs and 81 observations were conducted with 180 extension workers, 18 development agents and 54 mother-father pairs. Digitally recorded audio files were transcribed verbatim, and the data were analysed based on a framework analysis approach using NVivo (version 12) by coding and categorising texts into major themes and sub-themes. RESULTS: SURE target households had the intended exposure to messages about exclusive breastfeeding, timing of initiation of complementary feeding, food groups, diversified food consumption, irrigation, rearing small animals and vegetables. Few households reported receiving messages on the content or frequency of complementary feeding of a child beyond 6 months of age. Frequency of household visits and hence exposure to SURE messages was also variable. Agricultural messages delivered during household visits focussed on improving standard agricultural practices and rarely covered the importance of nutrition-sensitive agriculture to improve household or child nutrition. CONCLUSION: Despite variability observed in the breadth and depth of messages delivered, large-scale behaviour change communication programmes can achieve moderate to good message exposure among target groups. Qualitative data provide an in-depth insight into fidelity and may supplement our understanding of programme roll-out and implementation. Further research is required to understand longer-term message saturation including frequency and reach.

Introduction: Diarrheal diseases are threat everywhere, but its frequency and impact are more severe in developing countries. Diarrhea occurs world-wide and causes 4% of all deaths and 5% of health loss to disability. In 2016, it was the eighth leading cause of mortality. Moreover, data from the World Health Organization indicated that diarrheal diseases are causes for an estimated 2 million deaths annually. Therefore, this study aimed to assess diarrheal diseases and associated behavioural factors. Method: An institution based cross-sectional study was conducted. A stratified random sampling method was employed to select 1050 study participants. Participants were interviewed using structured questionnaire. To analysis the data, binary logistic regression and multivariable logistic regression analysis was conducted. Results: The two weeks prevalence of diarrhea was found to be 3.4%. Further, 1.6%, 10.5%, 10.7% and 9% of the food handlers had acute watery diarrhea, cough, an infection of runny nose and incidence of any fever respectively. Regular hand washing after toilet (AOR = 0.13 with 95% CI: 0.024, 0.72), using toilet while wearing protective clothes/gown (AOR = 5.39 with 95% CI; 1.59, 18.32), habit of eating raw beef and raw vegetables (AOR = 6.27 with 95% CI: 1.89–20.78), type of toilet (AOR = 4.07 with 95% CI: 0.29–6.67 were associated significantly with diarrhea. Conclusion: This assessment proved to be an essential activity for reduction of community diarrheal diseases, as a significant number of food handlers had diarrhea. Good sanitation, hygiene practice and a healthy lifestyle behavior can prevent diarrhea. A strong political commitment with appropriate budgetary allocation is essential for the control of diarrheal diseases.

Abstract Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. Methods An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. Results A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. Conclusions The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

Abstract Background Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. Methods An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. Results A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. Conclusions The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

BACKGROUND: Scaling up mental healthcare through integration into primary care remains the main strategy to address the extensive unmet mental health need in low-income countries. For integrated care to achieve its goal, a clear understanding of the organisational processes that can promote and hinder the integration and delivery of mental health care is essential. Theory of Change (ToC), a method employed in the planning, implementation and evaluation of complex community initiatives, is an innovative approach that has the potential to assist in the development of a comprehensive mental health care plan (MHCP), which can inform the delivery of integrated care. We used the ToC approach to develop a MHCP in a rural district in Ethiopia. The work was part of a cross-country study, the Programme for Improving Mental Health Care (PRIME) which focuses on developing evidence on the integration of mental health in to primary care. METHODS: An iterative ToC development process was undertaken involving multiple workshops with stakeholders from diverse backgrounds that included representatives from the community, faith and traditional healers, community associations, non-governmental organisations, Zonal, Regional and Federal level government offices, higher education institutions, social work and mental health specialists (psychiatrists and psychiatric nurses). The objective of this study is to report the process of implementing the ToC approach in developing mental health care plan. RESULTS: A total of 46 persons participated in four ToC workshops. Four critical path dimensions were identified: community, health facility, administrative and higher level care organisation. The ToC participants were actively engaged in the process and the ToC encouraged strong commitment among participants. Key opportunities and barriers to implementation and how to overcome these were suggested. During the workshops, a map incorporating the key agreed outcomes and outcome indicators was developed and finalized later. CONCLUSIONS: The ToC approach was found to be an important component in the development of the MHCP and to encourage broad political support for the integration of mental health services into primary care. The method may have broader applicability in planning complex health interventions in low resource settings.

OBJECTIVE: Globally, interest in excellence has grown exponentially, with public and private institutions shifting their attention from meeting targets to achieving excellence. Centres of Excellence (CoEs) are standing at the forefront of healthcare, research and innovations responding to the world's most complex problems. However, their potential is hindered by conceptual ambiguity. We conducted a global synthesis of the evidence to conceptualise CoEs. DESIGN: Scoping review, following Arksey and O'Malley's framework and methodological enhancement by Levac et al and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES: PubMed, Scopus, CINAHL, Google Scholar and the Google engine until 1 January 2021. ELIGIBILITY: Articles that describe CoE as the main theme. RESULTS: The search resulted in 52 161 potential publications, with 78 articles met the eligibility criteria. The 78 articles were from 33 countries, of which 35 were from the USA, 3 each from Nigeria, South Africa, Spain and India, and 2 each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece and Peru. The rest 17 were from various countries. The articles involved six thematic areas—healthcare, education, research, industry, information technology and general concepts on CoE. The analysis documented success stories of using the brand 'CoE'—an influential brand to stimulate best practices. We identified 12 essential foundations of CoE—specialised expertise; infrastructure; innovation; high-impact research; quality service; accreditation or standards; leadership; organisational structure; strategy; collaboration and partnership; sustainable funding or financial mechanisms; and entrepreneurship. CONCLUSIONS: CoEs have significant scientific, political, economic and social impacts. However, there are inconsistent use and self-designation of the brand without approval by an independent, external process of evaluation and with high ambiguity between 'CoEs' and the ordinary 'institutions' or ...

Objective- Globally, interest in excellence has grown exponentially, with public and private institutions shifting their attention from meeting targets to achieving excellence. Centres of Excellence (CoEs) are standing at the forefront of healthcare, research and innovations responding to the world's most complex problems. However, their potential is hindered by conceptual ambiguity. We conducted a global synthesis of the evidence to conceptualise CoEs. Design- Scoping review, following Arksey and O'Malley's framework and methodological enhancement by Levac et al and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Data sources- PubMed, Scopus, CINAHL, Google Scholar and the Google engine until 1 January 2021. Eligibility- Articles that describe CoE as the main theme. Results- The search resulted in 52 161 potential publications, with 78 articles met the eligibility criteria. The 78 articles were from 33 countries, of which 35 were from the USA, 3 each from Nigeria, South Africa, Spain and India, and 2 each from Ethiopia, Canada, Russia, Colombia, Sweden, Greece and Peru. The rest 17 were from various countries. The articles involved six thematic areas—healthcare, education, research, industry, information technology and general concepts on CoE. The analysis documented success stories of using the brand 'CoE'—an influential brand to stimulate best practices. We identified 12 essential foundations of CoE—specialised expertise; infrastructure; innovation; high-impact research; quality service; accreditation or standards; leadership; organisational structure; strategy; collaboration and partnership; sustainable funding or financial mechanisms; and entrepreneurship. Conclusions- CoEs have significant scientific, political, economic and social impacts. However, there are inconsistent use and self-designation of the brand without approval by an independent, external process of evaluation and with high ambiguity between 'CoEs' and the ordinary 'institutions' or ...

OBJECTIVES: The Ethiopian government designed the SURE program which aims to reduce the prevalence of stunting by improving complementary feeding and dietary diversity as part of its national nutrition program. This study was conducted to test the feasibility of the SURE program before its implementation. METHODS: A qualitative research design with purposive sampling was employed for this study. A five-day overall SURE program training was provided for 6 health extension workers (HEWs) and 10 agriculture extension workers (AEWs). Trainees completed pre-post knowledge tests. Following their training, two pairs of health and agriculture extension workers jointly conducted household visits in each of three selected kebeles (sub-unit of district) to assess needs and counsel mother-father pairs. They also facilitated women's and men's group dialogues to reinforce messages in gender-specific peer groups. Research assistants and investigators observed 12 joint household visits. To further assess the program, 24 semi-structured interviews with extension workers and mother-father pairs and 6 focus group discussions with men's and women's groups were conducted. Data were analyzed using Nvivo version 11. RESULTS: Health and agriculture extension workers gained demonstrable knowledge about infant and young child feeding and nutrition-sensitive agricultural practices following their training, but they largely failed to apply the 3A's counselling process (assess, analyze and act) and delivered inconsistent messages during the counselling visits based on observation. However, they felt that they can realistically continue to work together. Pairs of mothers and fathers visited were supportive of the joint HEWs and AEWs visits. Focus group discussants from women's groups reported that segregating the group discussions by gender was helpful to ensure their participation and expression of ideas. CONCLUSIONS: The SURE training provided to HEWs and AEWs resulted in knowledge retention. The integrated service delivery model of the ...

OBJECTIVES: Despite much nutrition research conducted in Ethiopia, none has described existing opportunities for synergy or possible missed opportunities to use research to inform policy and program decisions to foster accelerated progress. The study aimed to describe prevailing processes on evidence use in formulating nutrition policy and program decisions and identify potential barriers and opportunities for evidence-based decision-making for nutrition for Ethiopia's context. METHODS: In 2017, 29 purposively selected key informants (KIs) were interviewed. They were identified using a consultative stakeholder mapping workshop and represented National Nutrition Program coordinators, key actors in government sectors, program coordinators from selected local and international NGOs, local and international universities and research institutes involved in nutrition research and key actors in policy decision-making. A framework analysis including identifying themes, coding, indexing, charting, mapping and interpretation was used. A validation workshop discussed findings and added perspectives to interpretation. RESULTS: The KIs perceived that demand for evidence from the Ethiopian government had been increasing over time. Majority referred to poor research quality as a barrier for using research in decision-making processes. Other challenges identified included limited cross-linkage, coordination gaps between researchers and decision makers, and inadequate translation of research evidence into meaningful information for policy makers. Availability of different forums, research dissemination conferences and suitable institutional structures that enable research and evidence dissemination were considered to be opportunities that should be leveraged to inform policy making. CONCLUSIONS: The quality of research, and of collaborative engagement between those who produce evidence and decision makers who formulate policies need to be strengthened. Regular evidence dissemination events and publication of action oriented easy ...