Illnesses associated with consuming infected milk and milk products are a widespread problem inlow and middle-income countries. Shiga toxin-producing Escherichia coli (STEC) is a bacteriumcommonly found in raw milk and causes foodborne diseases ranging from mild diarrhea to severehemorrhagic colitis and hemolytic uremic syndrome. This study aimed to investigate the viru-lence gene and antimicrobial resistance profiles of Shiga toxin-producing E. coli strains isolatedfrom raw milk in dairy farms in and around Bahir Dar town. Raw milk samples (n = 128)collected from December 2021 to July 2022 were cultured, and E. coli strains were isolated usingstandard methods. Shiga toxin-producing E. coli strains were identified genotypically by thepresence of the virulence markers using a single-plex polymerase chain reaction. The antibioticsusceptibility testing of Shiga toxin-producing E. coli isolates was done by the agar disk diffusionmethod. In total, 32 E. coli isolates were recovered from milk samples from lactating animals. PCRscreening of these isolates resulted in 19 (59.3%) positives for Shiga toxin-producing E. coli. Thestx2 gene was detected in 53% of cases, followed by stx1 (31%) and eae (16%. The STEC isolateswere highly sensitive to ciprofloxacin (94.7%) and kanamycin (89.5%), while exhibiting signif-icant resistance to amoxicillin (89.5%) and streptomycin (73.7%). The present study points outthe occurrence of virulent and antibiotic-resistant Shiga toxin-producing E. coli strains in raw milkthat could pose a potential risk to public health. Further analysis by whole genome sequencing isnecessary for an in-depth assessment and understanding of their virulence and resistance factors.Moreover, large-scale studies are needed to identify the prevalence and potential risk factors andto prevent the spread of antibiotic-resistant STEC strains in the milk production chain.

Background Due to the high burden of mortality from acute communicable and non-communicable diseases,emergency department’s mortality has become one of the major health indices in Ethiopia that should be evaluatedregularly in every health institution. However, there are inconsistencies between studies, and there is no systematicreview or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this studyaimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departmentsof Ethiopian hospitals.Methods This systematic review was conducted according to the guidelines of Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search ofdatabases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. Allobservational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopianhospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewersindependently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity ofstudies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis andmeta-regression were used. Egger’s test and funnel plots were used to assess publication bias. STATA version 17.0software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance.Results A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studiescomprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients inthe Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooledprevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa,respectively. Moreover, subgroup analysis based on patients’ age revealed that the pooled prevalence of mortalityamong adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a ruralresident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI:1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality forpatients in the emergency departments.
Conclusion and recommendations This study found that the overall prevalence of mortality among patients inemergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholdersto improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach healthfacilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, andimproving first-line management at referral hospitals will help to reduce the high mortality in our country.Keywords Associated factors, Emergency department, Ethiopia, Meta-analysis, Mortality

This study presents a novel approach for optimizing UAV (unmanned aerial vehicle) Multicircularflight control by developing a fractional order proportional integral derivative (FOPID)-based hybridEagle strategy particle swarm optimization ant lion optimizer (HESPSOALO). The proposed algorithmcombines the strengths of particle swarm optimization (PSO) and the ant lion optimizer (ALO), whichare enhanced by the Eagle strategy to systematically fine-tune the FOPID controller parameters.This hybrid optimization method aims to improve system stability, responsiveness, and disturbancerejection in UAVs, particularly in challenging dynamic flight conditions. The proposed approachwas validated against traditional control methods that utilize FOPID (Base), the Base HESPSOALOalgorithm, the FOPID-based HPSOGWO (Hybrid Particle Swarm Optimization-Gray Wolf Optimizer),and the FOPID-based HGWOALO (Hybrid Gray Wolf Optimization-Ant Lion Optimizer) with a setof benchmark functions used in the analysis. The results demonstrate a minimization of positionand angular errors, reduced oscillations, and overall improved control stability for the FOPID-basedHESPSOALO compared with the other methods. Furthermore, a multicriteria decision-making(MCDM) framework is applied to evaluate the overall performance of alternative control strategiesutilizing the CRiteria importance through intercriteria correlation (CRITIC) and technique of orderpreference by similarity to ideal solution (TOPSIS) techniques. The MCDM analysis demonstratesthat among the evaluated criteria, Kp has the highest importance, with a weight of 0.244019,whereas Kd is deemed the least significant, with a weight of 0.161023. The ranking results revealthat the HESPSOALO algorithm (Base) is the best-performing controller method, with a rankingscore of 0.571161, indicating its superior control performance across major metrics. In contrast, theFOPID + HPSOGWO controller method ranks the lowest, with a score of 0.282794. The findings havesignificant industrial implications, particularly in sectors where UAVs are critical for precision tasks,such as logistics, agriculture, surveillance, and environmental monitoring. By optimizing the FOPIDcontroller parameters, the HESPSOALO algorithm enhances UAV stability, responsiveness, andreliability in dynamic environments, resulting in more precise control and robust performance undervarying conditions. This improvement may reduce operational risks and maintenance costs whileincreasing efficiency, prolonging UAV service life, and achieving energy savings. This study provides arobust solution for UAV control based on the potential of hybrid optimization algorithms to improveUAV precision and reliability in autonomous flight.Keywords: UAV multicircular flight control, FOPID, Hybrid optimization, CRITIC, TOPSIS

This study investigates how effectively Intergovernmental Authority on Development (IGAD) has addressed the crisis in Somalia since 1991, using realism theory as its analytical framework. It employs a qualitative case study approach to delve into IGAD's interventions and their implications, conducting an in-depth analysis of IGAD's official documents, resolutions, and crisisrelated reports concerning Somalia. By applying realism theory, the study scrutinizes IGAD's actions and motivations from a perspective centered on power politics, highlighting the significance of state interests and regional stability. It suggests that IGAD member states may resist to cooperate when they perceive IGAD's engagement in Somalia is regarded as a threat to their security interests. Despite IGAD's numerous peace initiatives, achieving sustainable peace in Somalia remains elusive. The paper asserts that while IGAD has made substantial efforts to resolve the Somalia conflict, its effectiveness has been constrained by the complexity of the conflict, external influences, and divergent interests among member states. To enhance IGAD's effectiveness, the study recommends various actions, including promoting regional economic integration, mobilizing external resources, improving transparency and accountability, fostering regional identity and solidarity, and maintaining a balanced power dynamic to prevent dominance by any single entity. Applying these measures could significantly improve IGAD's capacity to support peace and stability in Somalia and the entire East Africa region.



Keywords: Horn of Africa, IGAD, Somalia, Peace and security, Realism theory, Regional cooperation

Background: Heart failure is a leading cause of hospital readmissions in the Amhara region, Northwest Ethiopia.Aim: This study aimed to determine the number of readmissions and identify the determinants among patients with heartfailure at referral hospitals in the Amhara region, Northwest Ethiopia, in 2023.Methods: A cross‐sectional study was conducted with 663 heart failure patients in Amhara region referral hospitals fromSeptember 2022 to February 2023. Simple random sampling was used for patient selection, and data were collected throughchart reviews and interviewer‐administered questionnaires. Zero‐inflated negative binomial models were applied for dataanalysis. Data collection tools were pre‐tested for reliability and validity.Results: Among 663 patients, 237 (35.7%) were readmitted at least once. An increased respiratory rate (IRR = 1.015; 95%CI: 1.0004, 1.031; p < 0.044) and longer medication duration (IRR = 1.011; 95% CI: 1.016, 1.051; p < 0.0001) were asso-ciated with more readmissions. Patients with poor social support had 59.4% fewer readmissions compared to those withgood social support (IRR = −1.595; 95% CI: −0.02, −0.005; p < 0.041). A higher body mass index (IRR = 0.115; 95% CI:0.035, 0.196; p < 0.004) was linked with a higher likelihood of remaining in the “always‐zero” group, while an increasedpulse rate reduced the odds (IRR = −0.013; 95% CI: −0.025, −0.008; p < 0.036). The mortality rate among readmittedpatients was 11.39%.Conclusion: This study found significant readmission rates among HF patients. Factors such as respiratory rate andmedication duration were linked to increased readmissions, while poor social support was associated with fewerreadmissions, this likely reflects limited healthcare access in low‐ and middle‐income countries among individuals withlower social support. The high mortality rate underscores the need for targeted interventions to improve patientoutcomes.

Enhancing heat transfer in thermal systems is crucial for energy efficiency. The use of Nano-fluids and twistedtape inserts in circular pipes are the most widely used passive heat transfer improvement techniques. Whilenanofluids, especially CuO-water, enhance thermal conductivity, twisted tapes create swirl flow to disturbboundary layers. The Nusselt number, friction factor, and thermal performance parameters of a circular pipecontaining Nano-fluids and twisted tapes at 180 and 120 degrees are studied numerically in this work. Thetwisted tape inserts are modeled as idealized helical baffles to induce secondary swirl flows, thereby disruptingthermal boundary layers and improving heat exchange. The research yields findings for a strip twist ratio of threeand a turbulent flow range of Re 4000–20,000. The RNG k–ε model is utilized to solve the governing equationsand a steady heat flux of 30,000 W/m2 is supplied. The highest simulation findings of Nusselt number for Nano-fluid are 5.25, 9.85, and 12.5 % higher in comparison to Gnielinski relations of water for plain tube and twistedtape inserts at 180 and 120 degrees respectively. However, increased pressure drop is noted as a trade-off, theoverall thermal performance factor of 1.42 was achieved for Nano-fluid flow in a pipe with a 120◦ twisted tapeinsert which yields a significant heat transfer improvement.
Keywords: CuO-water nano-fluid, Turbulent flow, Twisted tape, Heat transfer enhancement, CFD

Introduction One of the most important but underappreciated roles of nurses is patient advocacy. To advocatefor patients effectively, the nurses should have a favorable attitude towards patient advocacy. Despite this fact, thenurses’ attitude towards patient advocacy was not known in Ethiopia. Thus, this study aimed to assess nurses’ attitudetowards patient advocacy and its associated factors in East Gojjam Zone Public Hospitals, Northwest in 2023.Methods Institutional-based cross-sectional study design was conducted among 385 nurses in East Gojjam ZonePublic Hospitals from March 1 to April 30, 2023. Nurses were selected using simple random sampling techniquesfrom 11 public hospitals. The data were collected in a self-administered way. Binary logistic regression was used fordata analysis. All independent variables having a P value of < 0.25 in the bivariable logistic regression were fitted intoa multivariable logistic regression. The AOR at a 95% confidence interval was used to identify the strength of theassociation, and a p value of 0.05 was used to declare it statistically significant at the final model.Result A total of 385 nurses participated in the study, for a 91% response rate. Among these, 49.9% of nurses hadan unfavorable attitude. Being working in a primary hospital [AOR = 2.3; 95% CI: (1.4–3.8)], poor cooperation ofnurses [AOR = 1.7; 95% CI: (1.1–2.8)], being unsatisfied with the job [AOR = 1.7; 95% CI: (1.1–2.7)], and poor perceivedsupervision of work [AOR = 6.2; 95% CI: (3.7–9.8)] were factors associated with nurses’ attitudes towards patientadvocacy.Conclusion The number of nurses who had an unfavorable attitude towards patient advocacy was high. Workingin a primary hospital, poor cooperation with others, being dissatisfied with the job, and having an unfavorableperception towards the supervision of work were the factors associated with the unfavorable attitude of nursestowards patient advocacy. It is recommended that all hospitals better support the nurses to increase their jobsatisfaction and have good supervision of the nurses’ activities.Keywords Advocacy, Attitude, Nurse

Background: Evidence-based practice is clinical decision-making using the best evidence available in the context of individual patients' preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses' implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.
Methods: An explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.
Result: Nurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8-59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31- 40 years old [AOR = 0.61, 95% CI: (0.38-0.99)], 41-50 years [AOR = 0.32, 95% CI: (0.15-0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39-8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 - 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36-4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43-4.23)] were factors associated with poor levels of nurses' implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.
Conclusion: Nurses' implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

Keywords: Ethiopia; Evidence-based practice; Nurses; Nursing process.

Background and Purpose: Staphylococcus aureus is a common pathogen responsible for causing various human and animalinfections and is well known for its ability to develop resistance to multiple antibiotics. This study aimed to evaluate the occurrence ofmethicillin-resistant Staphylococcus aureus (MRSA) in bulk milk and dairy farms in northwestern Ethiopia and to determine theirphenotypic and genotypic antimicrobial susceptibility patterns.Methods: We collected 50 bulk milk samples from 50 dairy farms and 50 hand swabs from dairy milkers. The cefoxitin disk diffusiontest and PCR-based assays were used to identify MRSA isolates. In addition, cefoxitin-resistant isolates were tested for susceptibilityto other antibiotics using the Kirby-Bauer disk diffusion method.Results: The results showed that MRSA was detected in 8 samples: 6 from bulk milk samples (12%) and 2 from hand swabs (4%). AllMRSA isolates exhibited a high resistance rate to penicillin (100%), followed by tetracycline (75%), ciprofloxacin (25%), chloram-phenicol (25%), erythromycin (25%), gentamycin (12.5%), and trimethoprim-sulfamethoxazole (12.5%). Moreover, 72% of theisolates showed resistance to three or more antibiotic classes and were classified as multidrug-resistant.Conclusion: This study identified methicillin-resistant Staphylococcus aureus and multidrug-resistant MRSA in bulk milk and dairyfarms in northwestern Ethiopia. These findings highlight the potential risk of transmission of these antibiotic-resistant bacteria tohumans and the need for improved antibiotic stewardship in the dairy sector using the One Health approach.Keywords: dairy farms, Ethiopia, humans, MRSA, bulk milk, resistance

AbstractIntroduction The emergence of First-line Antiretroviral Therapy (ART) regimens fails; it necessitates the use of morecostly and less tolerable second-line medications. Therefore, it is crucial to identify and address factors that increasethe likelihood of first-line ART regimen failure in children. Although numerous primary studies have examinedthe incidence of first-line ART failure among HIV-infected children in Ethiopia, national-level data on the onsetand predictors remain inconsistent. Hence, this study was conducted to fill the gaps in determining the onset of first-line ART failure and its predictors among HIV-infected children in Ethiopia.Methods Articles related to our topic of interest were searched using a systematic approach in national and interna-tional electronic databases. The retrospective follow-up cohort studies published in English up to 2022 were included.The data were extracted using a Microsoft Excel spread sheet and exported into Stata™ Version 17.0 for further man-agement and analysis. The level of heterogeneity was quantified using I 2 test together with a 95% confidence interval(CI). The incidence of the primary estimates was estimated using a random effects model in the Dersimonian-Laired-method. Subgroup analysis, Meta regression, and sensitivity analysis were computed to identify the source of het-erogeneity but not explained. The predictors of first-line ART failure were explained using relative risk (RR) with 95%confidence interval (CI).Results Ten studies having a total of 5446 children were included. The pooled onset of first-line ART failure was 3.18(95% CI: 1.91, 4.44) per 100 child-years of observations. Those study participants who began ART at an advanced WHOclinical stage at ART initiation had a 3.05 (95% CI: 1.47, 6.36), having poor ART adherence had a 2.19 (95% CI: 1.29, 3.70),and having TB-HIV coinfection at ART initiation had a 1.43 (95% CI: 1.06, 1.94) times higher chance of experiencingfirst-line ART failure than their corresponding counterparts.Conclusion The onset of first-line ART failure was high to achieve the 2030 UNAIDS target of ending the AIDSepidemic. Advanced WHO clinical stage, poor first-line ART adherence, and having TB-HIV coinfection were identifiedpredictors. Hence, community HIV screening should continue to strengthen early ART initiation, and the attention
of ART adherence should be kept to achieve ending the AIDS epidemic. The baseline tests and diagnosis, like TB diag-nosis should be maintained for HIV-infected children while they begin ART.Keywords First-line ART failure, Onset, Predictors, Children, Ethiopia