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    Campylobacter colonization and undernutrition in infants in rural eastern Ethiopia - a longitudinal community-based birth cohort study.
    (Frontiers Media S.A., 2025-01-07) Chen D; McKune SL; Yang Y; Usmane IA; Ahmed IA; Amin JK; Ibrahim AM; Seran AJ; Shaik N; Ojeda A; Hassen BM; Deblais L; Ahmedo BU; Hassen KA; Bhrane M; Li X; Singh N; Roba KT; French NP; Rajashekara G; Manary MJ; Hassen JY; Havelaar AH; CAGED Research Team
    Background: Campylobacter is associated with environmental enteric dysfunction (EED) and malnutrition in children. Campylobacter infection could be a linchpin between livestock fecal exposure and health outcomes in low-resource smallholder settings. Methods: We followed a birth cohort of 106 infants in rural smallholder households in eastern Ethiopia up to 13 months of age. We measured anthropometry, surveyed sociodemographic determinants, and collected stool and urine samples. A short survey was conducted during monthly visits, infant stool samples were collected, and Campylobacter spp. was quantified using genus-specific qPCR. In month 13, we collected stool and urine samples to assay for EED biomarkers. We employed regression analyses to assess the associations of household determinants with Campylobacter colonization, EED, and growth faltering. Results: The Campylobacter load in infant stools increased with age. The mean length-for-age Z-score (LAZ) decreased from −0.45 at 3–4 months of age to −2.06 at 13 months, while the prevalence of stunting increased from 3 to 51%. The prevalence of EED at 13 months of age was 56%. A higher Campylobacter load was associated with more frequent diarrhea. Prelacteal feeding significantly increased Campylobacter load in the first month of life. Over the whole follow-up period, Campylobacter load was increased by keeping chickens unconfined at home and unsanitary disposal of infant stools while decreased by mothers’ handwashing with soap. Longitudinally, Campylobacter load was positively associated with food insecurity, introduction of complementary foods, and raw milk consumption. There were no significant associations between Campylobacter load, EED, and LAZ. Conclusion: This study found that most determinants associated with increased Campylobacter infection were related to suboptimal feeding practices and hygiene. The findings related to livestock-associated risks were inconclusive. Although stunting, EED, and Campylobacter prevalence rates all increased to high levels by the end of the first year of life, no significant association between them was identified. While additional research is needed to investigate whether findings from this study are replicable in other populations, community efforts to improve infant and young child feeding practices and food hygiene, and water, sanitation, and hygiene (WaSH) at the household level, could reduce (cross-)contamination at the point of exposure.
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    Prevalence and Load of the Campylobacter Genus in Infants and Associated Household Contacts in Rural Eastern Ethiopia: a Longitudinal Study from the Campylobacter Genomics and Environmental Enteric Dysfunction (CAGED) Project
    (American Society for Microbiology, 2023-07-26) Deblais L; Ojeda A; Brhane M; Mummed B; Hassen KA; Ahmedo BU; Weldesenbet YD; Amin JK; Ahmed IA; Usmane IA; Yusuf EA; Seran AJ; Abrahim FI; Game HT; Mummed BA; Usmail MM; Umer KA; Dawid MM; Gebreyes W; French N; Hassen JY; Roba KT; Mohammed A; Yimer G; Saleem C; Chen D; Singh N; Manary MJ; McKune SL; Havelaar AH; Rajashekara G; Elkins CA
    In our previous cross-sectional study, multiple species of Campylobacter were detected (88%) in stool samples from children (12 to 14 months of age) in rural eastern Ethiopia. This study assessed the temporal fecal carriage of Campylobacter in infants and identified putative reservoirs associated with these infections in infants from the same region. The prevalence and load of Campylobacter were determined using genus-specific real-time PCR. Stool samples from 106 infants (n = 1,073) were collected monthly from birth until 376 days of age (DOA). Human stool samples (mothers and siblings), livestock feces (cattle, chickens, goats, and sheep), and environmental samples (soil and drinking water) from the 106 households were collected twice per household (n = 1,644). Campylobacter was most prevalent in livestock feces (goats, 99%; sheep, 98%; cattle, 99%; chickens, 93%), followed by human stool samples (siblings, 91%; mothers, 83%; infants, 64%) and environmental samples (soil, 58%; drinking water, 43%). The prevalence of Campylobacter in infant stool samples significantly increased with age, from 30% at 27 DOA to 89% at 360 DOA (1% increase/day in the odds of being colonized) (P < 0.001). The Campylobacter load increased linearly (P < 0.001) with age from 2.95 logs at 25 DOA to 4.13 logs at 360 DOA. Within a household, the Campylobacter load in infant stool samples was positively correlated with the load in mother stool samples (r2 = 0.18) and soil collected inside the house (r2 = 0.36), which were in turn both correlated with Campylobacter loads in chicken and cattle feces (0.60 < r2 < 0.63) (P < 0.01). In conclusion, a high proportion of infants are infected with Campylobacter in eastern Ethiopia, and contact with the mother and contaminated soil may be associated with early infections. IMPORTANCE A high Campylobacter prevalence during early childhood has been associated with environmental enteric dysfunction (EED) and stunting, especially in low-resource settings. Our previous study demonstrated that Campylobacter was frequently found (88%) in children from eastern Ethiopia; however, little is known about potential Campylobacter reservoirs and transmission pathways leading to infection of infants by Campylobacter during early growth. In the longitudinal study presented here, Campylobacter was frequently detected in infants within the 106 surveyed households from eastern Ethiopia, and the prevalence was age dependent. Furthermore, preliminary analyses highlighted the potential role of the mother, soil, and livestock in the transmission of Campylobacter to the infant. Further work will explore the species and genetic composition of Campylobacter in infants and putative reservoirs using PCR and whole-genome and metagenomic sequencing. The findings from these studies can lead to the development of interventions to minimize the risk of transmission of Campylobacter to infants and, potentially, EED and stunting.
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    Unravelling the reservoirs for colonisation of infants with Campylobacter spp. in rural Ethiopia: protocol for a longitudinal study during a global pandemic and political tensions.
    (BMJ Publishing Group Ltd, 2022-10-05) Havelaar AH; Brhane M; Ahmed IA; Kedir J; Chen D; Deblais L; French N; Gebreyes WA; Hassen JY; Li X; Manary MJ; Mekuria Z; Ibrahim AM; Mummed B; Ojeda A; Rajashekara G; Roba KT; Saleem C; Singh N; Usmane IA; Yang Y; Yimer G; McKune S
    INTRODUCTION: Undernutrition is an underlying cause of mortality in children under five (CU5) years of age. Animal-source foods have been shown to decrease malnutrition in CU5. Livestock are important reservoirs for Campylobacter bacteria, which are recognised as risk factors for child malnutrition. Increasing livestock production may be beneficial for improving nutrition of children but these benefits may be negated by increased exposure to Campylobacter and research is needed to evaluate the complex pathways of Campylobacter exposure and infection applicable to low-income and middle-income countries. We aim to identify reservoirs of infection with Campylobacter spp. of infants in rural Eastern Ethiopia and evaluate interactions with child health (environmental enteric dysfunction and stunting) in the context of their sociodemographic environment. METHODS AND ANALYSIS: This longitudinal study involves 115 infants who are followed from birth to 12 months of age and are selected randomly from 10 kebeles of Haramaya woreda, East Hararghe zone, Oromia region, Ethiopia. Questionnaire-based information is obtained on demographics, livelihoods, wealth, health, nutrition and women empowerment; animal ownership/management and diseases; and water, sanitation and hygiene. Faecal samples are collected from infants, mothers, siblings and livestock, drinking water and soil. These samples are analysed by a range of phenotypic and genotypic microbiological methods to characterise the genetic structure of the Campylobacter population in each of these reservoirs, which will support inference about the main sources of exposure for infants. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Florida Internal Review Board (IRB201903141), the Haramaya University Institutional Health Research Ethics Committee (COHMS/1010/3796/20) and the Ethiopia National Research Ethics Review Committee (SM/14.1/1059/20). Written informed consent is obtained from all participating households. Research findings will be disseminated to stakeholders through conferences and peer-reviewed journals and through the Feed the Future Innovation Lab for Livestock Systems.
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    The world at our doorstep : evaluating an Internet-based social studies programme : a thesis presented in partial fulfilment of the requirements for the degree of Master of Education, at Massey University, Palmerston North, New Zealand
    (Massey University, 2002) Warren, Susan Mary
    If young people are to know how most of the world lives, to understand the problems faced by developing nations, and to see people in other countries and situations as real, whole people, they need more than figures and news reports. Internet-based programmes in the virtual field trip style are being increasingly used to enable students to experience other places and cultures without leaving the classroom. However, to date there have been few evaluations that examine whether these programmes have the intended impact on student learning and attitudes. This thesis examines one such programme, the Ethiopia Connection run by World Vision New Zealand during March 2001. The programme was evaluated using a theory-driven evaluation methodology. First, a programme theory was derived from the literature and from the expectations of participant teachers. Factors identified as central to the success of the programme were interactivity, active learning, student choice, collaboration, access to experts, integration of several aspects of a topic, authenticity and ease of use. Next the implementation of the programme was observed. A total of 296 schools and over 20,000 students participated in the Ethiopia Connection, with varying patterns of involvement according to factors such as internet access, time available and teacher skills. Lastly the impact of the programme was evaluated in terms of student learning, attitude change and participants' perceptions of the programme. Despite the inherent difficulties in evaluating learning in a programme so dependent on teachers' differing implementations, and in assessing attitude change over short time frames, there were strong indications that the programme succeeded in its goal of developing understanding and compassion for people in the developing world. As a result of this evaluation, the programme theory outlined above was confirmed. Recommendations are made for future World Vision internet programmes, for internet- based social studies programmes in general and for future research directions.
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    Exploring grassroots leprosy organisations : is social inclusion and empowerment possible for members? : case studies in Ethiopia and China : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University
    (Massey University, 2005) Duff, Isabelle
    This thesis explores reasons for the recent emergence of grassroots leprosy organisations and through case studies of two such organisations, ENAELP in Ethiopia and HANDA in China, shows that varying measures of social inclusion and empowerment are achievable by members working collectively and in solidarity. Two major factors contributing to the emergence of these organisations are the common experience of leprosy plus the failure of welfare programmes, both of which provide significant impetus to members for collective action. The key to success for a grassroots leprosy organisation is recognising the importance of operating with a participatory development approach which attributes equal importance to processes and results, cultivating a strong sense of ownership by members and opening the way to the empowering journey of self-determination. While some international anti-leprosy organisations cling to assumptions that decision-making and self-determination by leprosy affected people for themselves is not possible, others strongly support these grassroots endeavours. Although leprosy has been a scourge and a source of fear for thousands of years with social exclusion and disempowerment resulting for millions of people, this thesis concludes that grassroots leprosy organisations have the potential to transform historical perceptions of the disease. In addition, these organisations provide opportunities for leprosy-affected people to demonstrate how they wish society to regard and consider them. This thesis did not take a static view of social inclusion and empowerment, but rather analysed changes in terms of how they are moving towards these two inter-related goals. There is no doubt that movement towards both social inclusion and empowerment is occurring, showing that the finest struggles with the best results are those fought by oppressed people themselves (Freire, 1989).
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    The longest journey : the resettlement of Ethiopian and Eritrean refugees in Auckland : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Social Work at Massey University
    (Massey University, 1996) Shadbolt, Maureen P.
    This study examines the resettlement experiences of a group of Ethiopian and Eritrean refugees who had been resident in New Zealand for at least six to eighteen months. It was expected that such individuals would have passed through the initial stages of coming to terms with a culture totally alien to their own and would be established, to a greater or lesser extent, within their local areas. In documenting the refugees' experiences, the research focus was on the degree to which their requirements had been recognised and fulfilled. The research design actively involved the refugees in the identification of their resettlement needs, both long and short term. An assessment was also carried out as to the extent to which their requirements had been met by current service provision. The major area of unsatisfied need was in the area of helping family, a traditional expectation. Providing assistance to family members takes two forms - the remittance of money to Ethiopia, Eritrea or the countries of first asylum, as well as the making of applications for family reunification. In reality, both these options have required that the resettled refugee be in receipt of his/her own income rather than welfare support or receive aid from sponsors or other family members in the United States. Most of the refugees involved felt shamed by their incapacity to fulfil these cultural expectations with regard to their family responsibilities. Associated with the desire to help one's family was the need to improve oneself - to leam English, to take courses in order to qualify for higher status, better paid job opportunities and so become independent of the unemployment benefit or other welfare support. This was a goal expressed by both men and women. For men, if married, the desire was to be able to provide their wives and children with the opportunities to have a good education and to live in peace and security. In considering Zucker's (1983) framework for the problem areas in refugee resettlement, it appears that most of the refugees studied are coping reasonably well with cultural adjustment on a personal level. Most are operating independently within New Zealand society, they have come to terms with a new culture and to some degree most are starting to improve their social status. Only the most disadvantaged with regard to English language ability still have problems in this area. For the Ethiopian and Eritrean refugees,their major concerns with resettlement lie in the systemic management and philosophical areas. The lack of supportive Government policy towards the resettlement of refugees in this country, particularly in regard to the provision of access to English language classes and criteria and assistance for family reunification are reflected at community level by the fragmentation of services and a lack of resources. Refugee policy presently seems to proceed on a piecemeal basis without strategic planning. To hasten and ease the adaptation of refugees to New Zealand society, the writer would urge the development of a comprehensive strategic plan which would address areas of need such as education and entry to the workforce, would have a commitment to cultural appropriateness, and which would include a range of formal and informal provisions.
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    A critical examination of the role and impact of NGOs in the provision of housing for the poor of Addis Ababa : application of a rights based lens : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand
    (Massey University, 2013) Fraser, Amy
    Our world today is experiencing the fastest urban growth rates in history, with developing countries at the forefront of this trend. This rapid urban growth is contributing to a multitude of problems, since countries lack the resources and institutional capacity to manage them effectively. As a result, the prevalence of slum and squatter settlements is escalating within the urban environment. This thesis seeks to critically examine the role and impact of NGOs in the provision of housing for the poor of Addis Ababa, Ethiopia. The study argues that housing is a human right and explores whether a rights based approach is an effective means for NGOs to employ, in order to achieve successful housing provision. The methodological approach to this study was largely qualitative, due to the fact that it deals with matters relating to social relationships and issues of power. This mode of enquiry has provided a deep understanding of the issues facing NGOs working in Addis Ababa. The primary mode of data collection was semi-structured interviews, which were carried out during the four weeks of field research in Addis Ababa. The findings of this research reveal that the role and impact of NGOs seeking to provide housing within Addis Ababa is extremely limited, due to a number of serious and debilitating factors, including a restrictive policy environment, excessive bureaucracy, and a lack of sound governance. In addition, it was discovered that the employment of a rights based framework for housing provision would be exceptionally difficult within Addis Ababa, thus posing serious risks for NGOs and the communities in which they work. This thesis highlights the importance of context and how it can change the suitability and roles played by those within the development sector.