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Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. People with type 2 diabetes in community or health settings. Comorbid depression or depressive symptoms in people with type 2 diabetes. A narrative review of heterogeneous studies. The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.

Tuberculosis (TB) is an important cause of morbidity and mortality among refugees and migrant populations. These groups are among the most vulnerable populations at increased risk of developing TB. However, there is no systematic review that attempts to summarize TB among refugees and migrant populations. This study aimed to summarize evidence on the magnitude of TB among refugees and migrant populations. The findings of this review will provide evidence to improve TB prevention and control policies in refugees and migrants in refugee camps and in migrant-hosting countries. A systematic search was done to retrieve the articles published from 2014 to 2021 in English language from electronic databases. Key searching terms were used in both free text and Medical Subject Heading (MeSH). Articles which had reported the magnitude of TB among refugees and migrant populations were included in the review. We assessed the risk of bias, and quality of the included studies with a modified version of the Newcastle–Ottawa Scale (NOS). Included studies which had reported incidence or prevalence data were eligible for data synthesis. The results were shown as summary tables. In the present review, more than 3 million refugees and migrants were screened for TB with the data collection period between 1991 and 2017 among the included studies. The incidence and prevalence of TB ranged from 19 to 754 cases per 100,000 population and 18.7 to 535 cases per 100,000 population respectively among the included studies. The current findings show that the most reported countries of origin in TB cases among refugees and migrants were from Asia and Africa; and the incidence and prevalence of TB among refugees and migrant populations is higher than in the host countries. This implies the need to implement and improve TB prevention and control in refugees and migrant populations globally. Trial registration : The protocol of this review was registered on PROSPERO (International prospective register of systematic reviews) with ID number, CRD42020157619 .

The problem of intermittent piped water supplies that exists in low- and middle-income countries is particularly severe in the slums of sub-Saharan Africa. However, little is known about whether there is deterioration of the microbiological quality of the intermittent piped water supply at a household level and whether it is a factor in reducing or increasing the occurrence of acute diarrhea among under-five children in slums of Addis Ababa. This study aimed to determine the association of intermittent piped water supplies and point-of-use (POU) contamination of household stored water by Escherichia coli (E. coli) with acute diarrhea among under-five children in slums of Addis Ababa. A community-based matched case-control study was conducted from November to December, 2014. Cases were defined as under-five children with acute diarrhea during the two weeks before the survey. Controls were matched by age and neighborhood with cases by individual matching. Data were collected using a pre-tested structured questionnaire and E. coli analysis of water from piped water supplies and household stored water. A five-tube method of Most Probable Number (MPN)/100 ml standard procedure was used for E. coli analysis. Multivariable conditional logistic regression with 95% confidence interval (CI) was used for data analysis by controlling potential confounding effects of selected socio-demographic characteristics. During the two weeks before the survey, 87.9% of case households and 51.0% of control households had an intermittent piped water supply for an average of 4.3 days and 3.9 days, respectively. POU contamination of household stored water by E. coli was found in 83.3% of the case households, and 52.1% of the control households. In a fully adjusted model, a periodically intermittent piped water supply (adjusted matched odds ratio (adjusted mOR) = 4.8; 95% CI: 1.3-17.8), POU water contamination in household stored water by E. coli (adjusted mOR = 3.3; 95% CI: 1.1-10.1), water retrieved from water storage containers using handle-less vessels (adjusted mOR = 16.3; 95% CI: 4.4-60.1), and water retrieved by interchangeably using vessels both with and without handle (adjusted mOR = 5.4; 95% CI: 1.1-29.1) were independently associated with acute diarrhea. We conclude that provision of continuously available piped water supplies and education of caregivers about proper water retrieval methods of household stored water can effectively reduce POU contamination of water at the household level and thereby reduce acute diarrhea among under-five children in slums of Addis Ababa. Promotion of household water treatment is also highly encouraged until the City's water authority is able to deliver continuously available piped water supplies.

Background Despite ongoing reports of malaria from health facilities in central Ethiopia, entomological evidence on local vectors remains scarce. This study investigated Anopheles species composition, host preferences, and entomological inoculation rates in this urban setting. Methods A repeated cross-sectional and longitudinal entomological study was conducted in six districts (woredas), each of which had access to one of the three health centers (Akaki, Gelan, and Serti). Adult mosquitoes were collected from the houses of individuals with microscopically confirmed malaria, who served as the index cases, as well as from nearby animal shelters using CDC-LT and PKA. DNA of anophelines was used for species identification, blood meal source analysis, and detection of P. falciparum and P. vivax infections. Results Of 302 Anopheles collected, seven species were identified, including An. christyi (50.0%), An. arabiensis (21.5%), An. amharicus (7.6%), An. cinereus (5.0%), An. garnhami (1.3%), An. stephensi (1.3%), and An. rhodesiensis (0.7%). Two of these species, An. amharicus and An. stephensi , were recorded for the first time in the area. Analysis of abdominal contents of the 192 blood-fed females revealed that bovine blood was the most common (87.0%), followed by goat (34.9%) and human blood (25.5%). All four vector species ( An. arabiensis , An. amharicus , An. stephensi , An. christyi ) showed strong zoophilic (mostly feeding on cattle), though human blood and mixed human–bovine feeds were also detected in each of these species. P. falciparum sporozoites were detected in An. arabiensis , confirming its role in local transmission. Conclusion Seven Anopheles species were identified, of which Anopheles christyi was the most abundant species, followed by An. arabiensis . The presence of An. amharicus and invasive An. stephensi , combined with zoophilic yet opportunistic feeding behavior and P. falciparum -infected An. arabiensis , highlights local variations in the importance of these vectors and ongoing endemic transmission in this urban Ethiopian setting.

Intestinal schistosomiasis caused by Schistosoma mansoni continues to be a significant public health problem in Ethiopia. This study investigated the prevalence and intensity of S.mansoni infection, and contributing factors in Alamata district of Tigray Region, Northern Ethiopia. A community-based cross-sectional study was conducted and 1762 participants were enrolled from five clusters in Alamata district. A questionnaire was used to collect socio-demographic data and risk factors. Stool samples were examined using Kato-katz technique to determine the prevalence and intensity of infection. The data were analyzed using SPSS version 25. Median, inter quartile range (IQR), mean, frequency, and percentage were used to descriptively summarize data. The Wilcoxon Mann-Whitney and Kruskal-Wallis tests were used to compare the differences in mean rank of egg load between different groups. Bivariate and multivariable logistic regression models were used to investigate the association between the odds of being infected with S.mansoni and the different socio-demographic and other factors. The strength of these associations was reported using odds ratio with corresponding 95% confidence intervals, and a P-value below 5% was used to report statistical significance. Out of 1762 residents included in the study 941 (53.4%) were females. The age varied from 5-80 years, with a median age of 25 years (IQR = 27), the overall prevalence of S.mansoni was 21.5% with males accounting for 26% (204/821) of the infections. The proportion of infection was higher among the age groups of 15-19 and 20-29 years at 32.7% and 33.1%, respectively. The mean egg count among the infected study participants was 146.82 eggs per gram of feces (epg) ± (243.17 SD). Factors significantly associated with increased odds of infection were living in Waja cluster (AOR:8.9; 95% CI, 3.5-23.2; P< 0.001); being in the age groups 10-14 (AOR:6.0, 95% CI: 3.1-11.7, P<0.001), 15-19 (AOR:5.8, 95% CI:2.8-12.2, P<0.001), and 20-29 (AOR:3.5, 95% CI:1.8-6.8; P<0.001) years; having direct contact with water while crossing river (AOR: 2.4, 95% CI: 1.5-3.8, P<0.001); and swimming (AOR: 1.4, 95% CI: 1.01-2.0, P = 0.035). The study indicates a notable S.mansoni burden in the area, driven by various risk factors. To effectively address this, enhancing diagnostics, implementing targeted mass drug administration, and conducting comprehensive health education campaigns on disease transmission routes are imperative.

In developing countries, children under the age of five years who live in slums are highly vulnerable to diarrhea. However, there is a paucity of information on the relationship between sanitation facilities and hygienic conditions to acute diarrhea among under-five children in slum areas of Addis Ababa, Ethiopia. Therefore, this study examines the sanitation facilities and hygienic conditions in the slums of Addis Ababa and identifies the main factors significantly associated with acute diarrhea among children aged 0-50 months in those slums. A community-based cross-sectional household survey was carried out between September and November 2014, that then served as the baseline survey of a longitudinal study. For this survey, 697 children aged 0-50 months were recruited from two slum districts in Addis Ababa. A pre-tested structured questionnaire and an observational checklist were used for data collection. Multivariable logistic regression analysis was used to identify sanitation facilities and hygiene-related factors that were significantly associated with acute diarrhea by controlling potential confounding effects of selected socio-demographic factors. Adjusted odds ratio (AOR) with corresponding 95% confidence interval (CI) was used to quantify the strength of association. The prevalence of acute diarrhea among children aged 0-50 months in the study area was 11.9% and 94.6% of the sanitation facilities were unimproved. Sharing of a sanitation facility by six or more households (AOR = 4.7; 95% CI: 2.4-9.4), proximity of sanitation facilities within 15 meters of homes (AOR = 6.6; 95% CI: 2.5-17.0), presence of feces (AOR = 3.9; 95% CI: 1.5-10.3) and flies (AOR = 2.5; 95% CI: 1.3-5.0) on the floor of and/or around sanitation facilities, and presence of uncollected garbage inside house compounds (AOR = 3.2; 95% CI: 1.2-8.4) were significantly associated with acute diarrhea. This study reveals the slum environment to be high risk for diarrhea due to close proximity of sanitation facilities to homes, sharing of sanitation facilities, and poor hygiene of the sanitation facilities and housing compounds. We recommend the development of a comprehensive diarrheal disease prevention program that focuses on improving the cleanliness of the sanitation facilities and housing compounds. Increasing the number of improved sanitation facilities at an appropriate distance from houses is also essential in order to reduce the number of households that share one latrine.

Flaviviruses are a genus of enveloped single-stranded RNA viruses that include dengue virus (DENV), yellow fever virus, West Nile virus (WNV), Japanese encephalitis virus, and Zika virus. Nowadays, diverse serological assays are available to diagnose flaviviruses. However, infection with flaviviruses induces cross-reactive antibodies, which are a challenge for serological diagnosis. This systematic review aimed to assess the magnitude of medically important mosquito-borne flavivirus-induced antibody cross-reactivity and its influence on serological test outcomes. This study was designed based on the PRISMA guidelines. It includes original research articles published between 1994 and 2019 that reported serological cross-reactions between medically important mosquito-borne flaviviruses. Articles were searched on PubMed using controlled vocabulary. Eligibility was assessed by title, abstract, and finally by reading the full paper. The articles included are compared, evaluated, and summarized narratively. A total of 2,911 articles were identified, and finally 14 were included. About 15.4%-84% of antibodies produced against non-DENV flaviviruses were cross-reactive with DENV on different assays. Up to 30% IgM and up to 60% IgG antibodies produced against non-WNV flaviviruses were cross-reactive with WNV on EIA assays. The magnitude of antibodies produced against flaviviruses that are cross-reactive with chikungunya virus ( ) was minimal (only about 7%). The highest antibody cross-reactivity of flaviviruses was reported in IgG-based assays compared to IgM-based assays and assays based on E-specific immunoglobulin compared to NS1-specific immunoglobulin. It was found that preexisting immunity due to vaccination or prior flavivirus exposure to antigenetically related species enhanced the cross-reactive antibody titer. This review found the highest cross-reaction between DENV and non-DENV flaviviruses, especially yellow fever virus, and the least between chikungunya virus and DENV. Moreover, cross-reaction was higher on IgG assays than IgM ones and assays based on Eprotein compared to NS1protein. This implies that the reliability of serological test results in areas where more than one flavivirus exists is questionable. Therefore, interpretation of the existing serological assays should be undertaken with a great caution. Furthermore, research on novel diagnostic signatures for differential diagnosis of flaviviruses is needed.

Background Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions. Methods A population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum ( n  = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, ‘high PPD symptoms’, ( n  = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis. Results Confirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands. Conclusions As in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development.

Background Mental health disorders represent a significant share of disease burden for adolescents and young people and depression is among the leading causes of morbidity within this age group. With rural-urban migration increasing in many settings, and young females being among the main migrants, few studies have examined the impact of such major transitions on mental health. This paper measures levels of depression among young women who are rural-urban migrants in Ethiopia, as well as factors associated with depression. Methods This was part of a largescale study of urban migrant females aged 15–24 in Ethiopia, which took place in seven cities. Multiple categories of migrants were interviewed. We used modified PHQ-9 questions to measure depression and logistic regression models to examine its association with various characteristics including patterns of migration and violence. In all, 4,495 migrant females were interviewed. Results Twenty-one percent of migrant young women displayed symptoms of moderate or severe depression. Symptoms of depression were more common among commercial sex workers (37%) than among other categories of migrants. Factors significantly associated with depression were being in commercial sex work (OR 1.70), migrating before age 15 (OR 1.37), using a broker to find a job (OR 1.53), experiencing forced first sex (OR 2.16) and experiencing beating in the last three months (OR 2.16). Conclusion This study reveals significant levels of depression among young women in Ethiopia who are rural-urban migrants. The study highlights the need to expand measurement of mental health conditions in health surveys and underscores the need for additional investments in mental health infrastructure, programs and services for marginalized groups in sub-Saharan Africa.

Background Although alcohol use disorders contribute a high proportion of population disease burden, the treatment gap is large, especially in low- and middle-income countries. To narrow this gap, contextually relevant evidence is needed to inform service development in low- and middle-income country settings. The aim of this study was to assess the magnitude of the treatment gap for alcohol use disorder, help-seeking behavior, stigma and barriers to care among people with alcohol use disorder in rural Ethiopia. Methods A cross-sectional, house-to-house survey was conducted in Sodo district, south Ethiopia. A sample of 1500 adults was selected using simple random sampling from a census of households and screened for alcohol use disorder using the alcohol use disorders identification tool (AUDIT). Help-seeking, barriers to care and internalized stigma were investigated among people with moderately severe alcohol use disorder (AUDIT score ≥ 16). Poisson regression with robust variance was used to examine factors associated with alcohol use disorder. Results The prevalence of alcohol use disorder (AUDIT ≥8) in the past 12 months was 13.9% (25.8% in men and 2.4% in women, p -value < 0.001). People with alcohol use disorder had increased disability (adjusted prevalence ratio (aPR) 1.03, 95% confidence interval (CI) 1.01, 1.03) and higher depressive symptom scores (aPR 1.02, 95% CI 1.01, 1.04). The treatment gap was very wide, about 87.0% (only 13% sought help) of participants with an AUDIT score ≥ 16 had never sought help for their alcohol problems and 70.0% reported high internalized stigma. Major barriers to seeking help were wanted to handle the problem on their own, believing that it would get better by itself and being unsure about where to go. Conclusions Although alcohol use disorders are common problems in Ethiopian community, the unmet need for treatment is substantial. An integrated care approach has the potential to address this need, but stigma and low awareness may be major barriers to help-seeking. Interventions to reduce stigma and enhance community awareness are recommended.