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

Neo-colonialism is considered by many writers to be a strategy of the former colonialpowers and the new superpowers to implement various socioeconomic and politicalstrategies in developing countries. the Horn of africa, as a parcel of a developingregion, is recognized as a piece of the ‘grand chessboard’ of world geopolitics. inparticular, Us neo-colonialism has become an invisible government in almost allcountries in the Horn of africa. therefore, the main objective of this paper is to examineand write about the origin, discourses, concealment (mask), normative agents, andpotential perils of american neo-colonialism in the Horn of africa. indeed, the paperalso answers the question of whether the Us is a straightforward ally or a neo-colonialistin the Horn of africa. to document this, the paper would be limited to primary sourcessuch as letters, reports, and published secondary texts that have been available to thiswriter to date.
EYWORDS: Neocolonialism; Us concealment; Horn of africa; normative agents

Neo-colonialism is considered by many writers to be a strategy of the former colonialpowers and the new superpowers to implement various socioeconomic and politicalstrategies in developing countries. the Horn of africa, as a parcel of a developingregion, is recognized as a piece of the ‘grand chessboard’ of world geopolitics. inparticular, Us neo-colonialism has become an invisible government in almost allcountries in the Horn of africa. therefore, the main objective of this paper is to examineand write about the origin, discourses, concealment (mask), normative agents, andpotential perils of american neo-colonialism in the Horn of africa. indeed, the paperalso answers the question of whether the Us is a straightforward ally or a neo-colonialistin the Horn of africa. to document this, the paper would be limited to primary sourcessuch as letters, reports, and published secondary texts that have been available to thiswriter to date.
KEYWORDS: Neocolonialism; Us concealment; Horn ofafrica; normative agents

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

Abstract

Introduction: The most common and severe cause of morbidity and mortality among HIV- positive children is opportunistic infections (OIs). All HIV-infected children are at risk of developing a variety of OIs. Healthcare workers, programmers, and other stakeholders are in doubt about using the onset and predictors of OIs among schoolchildren on antiretroviral therapy (ART) due to the presence of conflicting results found in the primary studies. Hence, this study was conducted to provide a single figure of onset and specific predictors of OIs by overcoming the existing heterogeneity in Ethiopia.
Methods: The included studies were searched from different national and international databases systematically. The included studies were cohort in design and published in English between 2015 and 2022. The data were extracted using a validated Microsoft Excel tool after the quality of the included studies was assured. The extracted data were exported to Stata Version 17.0 for further management and analysis. The presence of heterogeneity across studies was checked using the Chi-square test and quantified using the I 2 test. Various methods, including forest plots, publication bias assessment, sensitivity tests, subgroup analysis, and meta-regression, were employed to determine the source of heterogeneity, but none were successful. The overall onset of OIs was estimated by pooling the incidence of primary studies using a random-effects meta-analysis model. The predictors were identified using meta-regression and the presence of significant association was declared using a p-value of 0.05 with 95% CI. The strength of association was reported using an adjusted hazard ratio with 95% CI.
Results: Eleven studies were included in this systematic review and meta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was 5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations. Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) times higher chance of getting OIs when compared with those children having one or both parents. Children who had poor ART adherence had a 2.96 (95% CI: 1.66, 5.29) times higher chance of experiencing OIs than children who had good ART adherence. Finally, the chance of experiencing OIs among rural children was 2.15 (95% CI: 1.63, 2.83) times higher than their counterparts in Ethiopia.
Conclusions: Three in every 33 schoolchildren on ART developed OIs in Ethiopia. Predictors of OIs included schoolchildren without parents, those with poor adherence to ART, and rural residents. This suggests that social support, medication adherence, and access to healthcare services may play important roles in preventing and controlling OIs among schoolchildren living with HIV in rural areas.

Keywords: Ethiopia; children on ART; onset and predictors; opportunistic infections; schoolchildren.