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At least 19 records
All sourcesNASA NTRSDOE OSTI
DOE OSTI2024

Small-Scale Irrigation: Improving Food Security under Changing Climate and Water Resource Conditions in Ethiopia

We develop a new systems modeling tool that integrates knowledge from hydrology, agriculture, and economics to understand the effect of small-scale irrigation on food security and groundwater sustainability in Ethiopia. Irrigation is an effective tool to mitigate climate impacts and improve agricultural yields. Small-scale irrigation, such as decentralized groundwater irrigation, is well suited for developing countries where smallholder farming communities are widely dispersed and can only afford small infrastructure investment. We study the underlying interdependencies between food and water systems in Ethiopia, where small-holder agriculture is the foundation of the nation’s economy and climate variability has led to great challenges to its food security. Our coupled market and crop model with groundwater module captures the interdependencies of climate, water availability (including irrigation), crop yield, farmland allocation, crop production, transport and consumption based on a system approach across multiple spatial scales. We study the implication of small-scale irrigation to Ethiopia’s food security and water resource conditions as a “what-if” question by comparing an irrigation scenario to the calibrated baseline in 2015, a year of significant drought and crop failure over a large portion of Ethiopia. Our model offers fresh insights into geographic disparities in outcomes that are driven by baseline climate variability, soil fertility, and market conditions. In general, we find that small-scale irrigation can potentially improve food security through increases in food consumption, but it requires policy support to direct the increases of production to domestic consumption while maintaining a sustainable groundwater condition. By using Ethiopia as an example, we show the strength of our model to study how water infrastructure resources support critical functions and service in water and food systems.

Zhang, Ying↗
DOE OSTI2024

Drug providers’ perspectives on antibiotic misuse practices in eastern Ethiopia: a qualitative study

Objective Antibiotic misuse includes using them to treat colds and influenza, obtaining them without a prescription, not finishing the prescribed course and sharing them with others. Although drug providers are well positioned to advise clients on proper stewardship practices, antibiotic misuse continues to rise in Ethiopia. It necessitates an understanding of why drug providers failed to limit such risky behaviours. This study aimed to explore drug providers’ perspectives on antibiotic misuse practices in eastern Ethiopia. Setting The study was conducted in rural Haramaya district and Harar town, eastern Ethiopia. Design and participants An exploratory qualitative study was undertaken between March and June 2023, among the 15 drug providers. In-depth interviews were conducted using pilot-tested, semistructured questions. The interviews were transcribed verbatim, translated into English and analysed thematically. The analyses considered the entire dataset and field notes. Results The study identified self-medication pressures, non-prescribed dispensing motives, insufficient regulatory functions and a lack of specific antibiotic use policy as the key contributors to antibiotic misuse. We found previous usage experience, a desire to avoid extra costs and a lack of essential diagnostics and antibiotics in public institutions as the key drivers of non-prescribed antibiotic access from private drug suppliers. Non-prescribed antibiotic dispensing in pharmacies was driven by client satisfaction, financial gain, business survival and market competition from informal sellers. Antibiotic misuse in the setting has also been linked to traditional and ineffective dispensing audits, inadequate regulatory oversights and policy gaps. Conclusion This study highlights profits and oversimplified access to antibiotics as the main motivations for their misuse. It also identifies the traditional antibiotic dispensing audit as an inefficient regulatory operation. Hence, enforcing specific antibiotic usage policy guidance that entails an automated practice audit, a responsible office and insurance coverage for persons with financial limitations can help optimise antibiotic use while reducing resistance consequences.

General & Internal Medicine↗
DOE OSTI2022

Investigation of Plasmodium falciparum pfhrp2 and pfhrp3 gene deletions and performance of a rapid diagnostic test for identifying asymptomatic malaria infection in northern Ethiopia, 2015

Background: Rapid diagnostic tests (RDTs) are widely used for malaria diagnosis of both symptomatic and asymptomatic infections. Although RDTs are a reliable and practical diagnostic tool, the sensitivity of histidine-rich protein 2 (HRP2)-based RDTs can be reduced if pfhrp2 or pfhrp3 (pfhrp2/3) gene deletions exist in the Plasmodium falciparum parasite population. This study evaluated dried blood spot (DBS) samples collected from a national household survey to investigate the presence of pfhrp2/3 deletions and the performance of the RDT used in the cross-sectional survey in a low transmission setting. Methods: The 2015 Ethiopia Malaria Indicator Survey tested household members by RDT and collected DBS samples. DBS (n = 2648) from three regions in northern Ethiopia were tested by multiplex bead-based antigen detection assay after completion of the survey. The multiplex assay detected pan-Plasmodium lactate dehydrogenase (LDH), pAldolase, and HRP2 antigens in samples. Samples suspected for pfhrp2/3 gene deletions (pLDH and/or pAldolase positive but low or absent HRP2) were further investigated by molecular assays for gene deletions. Antigen results were also compared to each individual’s RDT results. Dose–response logistic regression models were fit to estimate RDT level of detection (LOD) antigen concentrations at which 50, 75, 90, and 95% of the RDTs returned a positive result during this survey. Results: Out of 2,648 samples assayed, 29 were positive for pLDH or pAldolase antigens but low or absent for HRP2 signal, and 15 of these samples (51.7%) were successfully genotyped for pfhrp2/3. Of these 15 P. falciparum infections, eight showed single deletions in pfhrp3, one showed a single pfhrp2 deletion, and six were pfhrp2/3 double-deletions. Six pfhrp2 deletions were observed in Tigray and one in Amhara. Twenty-five were positive for HRP2 by the survey RDT while the more sensitive bead assay detected 30 HRP2-positive samples. A lower concentration of HRP2 antigen generated a positive test result by RDT compared to pLDH (95% LOD: 16.9 ng/mL vs. 319.2 ng/mL, respectively). Conclusions: There is evidence of dual pfhrp2/3 gene deletions in the Tigray and Amhara regions of Ethiopia in 2015. As the prevalence of malaria was very low (< 2%), it is difficult to make strong conclusions on RDT performance, but these results challenge the utility of biomarkers in household surveys in very low transmission settings.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Emergency department overcrowding and its associated factors at HARME medical emergency center in Eastern Ethiopia

Introduction: Emergency department (ED) overcrowding has become a significant concern as it can lead to compromised patient care in emergency settings. Various tools have been used to evaluate overcrowding in ED. However, there is a lack of data regarding this issue in resource-limited countries, including Ethiopia. This study aimed to validate NEDOCS, assess level of ED overcrowding and identify associated factors at HARME Medical Emergency Center, located in Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia. Methods: A cross-sectional study was conducted at the HARME Medical Emergency Center, Hiwot Fana Comprehensive Specialized Hospital, involving a total of 899 patients during 120 sampling intervals. The area under the receiver operating characteristic curves (AUC) was calculated to evaluate the agreement between objective and subjective assessments of ED overcrowding. A multivariable logistic regression analysis was employed to identify factors associated with ED overcrowding and statistically significant association was declared using 95% confidence level and a p-value < 0.05. Results: The interrater agreement showed a strong correlation with a Cohen's kappa (κ) of 0.80. The National Emergency Department Overcrowding Study Score demonstrated a strong association with subjective assessments from residents and case team nurses, with an AUC of 0.81 and 0.79, respectively. According to residents' perceptions, ED were considered overcrowded 65.8% of the time. Factors significantly associated with ED overcrowding included waiting time for triage (AOR: 2.24; 95% CI: 1.54–3.27), working time (AOR: 2.23; 95% CI: 1.52–3.26), length of stay (AOR: 2.40; 95% CI: 1.27–4.54), saturation level (AOR: 2.35; 95% CI: 1.31–4.20), chronic illness (AOR: 2.19; 95% CI: 1.37–3.53), and abnormal pulse rate (AOR: 1.52; 95% CI: 1.06–2.16). Conclusion: The study revealed that ED were overcrowded approximately two-thirds of the time.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2018

Smallholder Crop Area Mapped with Wall-To-Wall WorldView Sub-Meter Panchromatic Image Texture: A Test Case for Tigray, Ethiopia

Global food production in the developing world occurs within sub-hectare fields that are difficult to identify with moderate resolution satellite imagery. Knowledge about the distribution of these fields is critical in food security programs. We developed a semi-automated image segmentation approach using wall-to-wall sub-meter imagery with high-performance computing to map crop area (CA) throughout Tigray, Ethiopia that encompasses over 41,000 km (exp 2). Multiple processing streams were tested to minimize mapping error while applying five unique smoothing kernels to capture differences in land surface texture associated to CA. Typically, very-small fields (mean < 2 ha) have a smooth image roughness compared to natural scrub/shrub woody vegetation at the ~1m scale and these features can be segmented in panchromatic imagery with multi-level histogram thresholding. Multi-temporal very-high resolution (VHR) panchromatic imagery with multi-spectral VHR are sufficient in extracting critical CA information needed in food security programs. A 2011 to 2015 CA map was produced, using over 3000 WorldView-1 panchromatic images wall-to-wall in 1/2 deg mosaics for Tigray, Ethiopia. CA was evaluated with nearly 3000 WorldView-2 2m multispectral 250 X 250 m image subsets by seven expert interpretations, and with in-situ global positioning system photography. CA estimates ranged from 32 to 41% in sub regions of Tigray with median maximum per bin commission and omission errors of 11% and 1% respectively, with most of the error occurring in bins <15%. This empirical, simple, and low direct cost approach via U.S. government license agreement to access commercial VHR data, could be a viable big-data high-performance computing methodology to extract wall-to-wall CA for other regions of the world that have very-small agriculture fields with similar image texture."

Ethiopia↗
DOE OSTI2023

Gender gap in perspectives of the impacts of degradation and restoration on ecosystem services in Ethiopia

Abstract The importance of land restoration has garnered increasing attention on the global stage through large‐scale initiatives such as the Bonn Challenge. However, policies and strategies are often gender‐blind and designed in compliance with entrenched social hierarchies, exacerbating pre‐existing social inequalities that affect restoration initiatives. The challenge of developing gender‐responsive policies and initiatives is accentuated by a persistent lack of sex‐disaggregated data concerning men's and women's differing perceptions and experiences. This study aims to help fill this gap by capturing the differences in men and women's perceptions of ecosystem services before and after restoration interventions in Ethiopia. Towards that end, in October 2021, we collected data from fifty‐nine (59) paired husband‐wife households and six gender‐segregated focus group discussions in two regions of Ethiopia: Amhara and Southern Nations, and Nationalities and Peoples (SNNP). Kendall's concordance analysis established a strong degree of disagreement between men's and women's ratings of restoration outcomes for most indicators. Men attributed degradation to landscape conditions and natural forces, while women considered the lack of appropriate restoration strategies as a precursor for accelerated degradation. The study also reveals that men tended to benefit more than women from enhanced ecosystem services post‐restoration, with increased labour and land management burdens often falling on the shoulders of women. Based on these findings, we argue that including men's and women's perspectives from the earliest planning phases of restoration initiatives is essential to ensure greater equity in benefit‐sharing, mitigate trade‐offs for women, and build more nuanced, just and successful approaches to restoration.

Mponela, Powell↗
DOE OSTI2023

Knowledge of lactation amenorrhea method among postpartum women in Ethiopia: a facility-based cross-sectional study

While the importance of knowledge about contraceptives in improving their utilization and thereby reducing the risk of unintended pregnancies is well documented, there are limited studies documented about the Lactational Amenorrhea Method (LAM). Thus, understanding the knowledge of postpartum mothers about LAM is essential for designing tailored interventions. This study assessed the level of knowledge about LAM and its associated factors among postpartum mothers in Ethiopia. A facility-based cross-sectional study was conducted among 3148 randomly selected postpartum participants. The study utilized multistage sampling approach in hospitals located across five regions and one city administration in Ethiopia. Data were collected using face-to-face interviews at discharge. A participant was categorized as having knowledge of LAM if she correctly answered the three LAM criteria: amenorrhea, the first 6 months, and exclusive breast feeding. A binary logistic regression model was used to identify factors associated with knowledge of LAM. Variables with p < 0.25 in the binary logistic regression were included in the multiple logistic regression. Then, associations were described using the adjusted odds ratio (AOR) along with the 95% confidence interval (CI), and statistical significance was declared at p < 0.05. Only four in 10 participants (40.6%; 95% CI 38.9–42.3) had knowledge of LAM. Participants who attended college or above educational level (AOR = 2.1, 95% CI 1.5–2.8), those with parity of two (AOR = 2.3; 95% CI 1.6–3.6) or more than two (AOR = 2.4; 95% CI 1.5–4.0), those who expressed a desire for further fertility (AOR = 1.3; 95% CI 1.1–1.5), individuals who received counselling on LAM (AOR = 3.0; 95% CI 2.6–3.7), and those who gave birth in hospital (AOR = 2.6; 95% CI 1.4–2.6) had higher odds of knowledge about LAM, compared to their counter parts. In contrary, participants resided far away from health facilities had 30% lower odd of knowledge about LAM compared to those resided near the health facilities (AOR = 0.70; 95% CI 0.6–0.8). The proportion of participants who had knowledge of LAM was low. Strengthening counseling about LAM during antenatal care and delivery with due attention to women with limited access to health facilities should be considered for increasing their level of knowledge on LAM.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2024

Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study

Background: Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia. Methods: A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan–Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU. Results: Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up. Conclusion: In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.

60 APPLIED LIFE SCIENCES↗
NASA NTRS2020

Lower Omo Food Security & Agriculture: Mapping Land Cover Change in Unprotected and Protected Areas in the Lower Omo River Valley, Ethiopia

Ethiopia is home to unique wildlife, biodiversity, and ecosystem services and, like much of the world, is undergoing population growth, development, and land use change. As a result, some biodiverse regions may be at risk of being urbanized, cultivated as agricultural plots, or losing access to water bodies that are essential for maintaining both terrestrial and aquatic life. The DEVELOP team partnered with the Ethiopian Wildlife Conservation Authority to quantify the land cover change between the years 1994, 2010, and 2018. The team utilized Ethiopia’s dry season (January to May) for training point development which was crucial in differentiating the level of greenness between the four land cover classes: water, natural vegetation, cultivated land, and bare ground. The study area covered 62,000 km2 of the Lower Omo River Valley and includes eight protected areas. Data from Landsat 5 Thematic Mapper, Landsat 7 Enhanced Thematic Mapper Plus, Landsat 8 Operational Land Imager, and Shuttle Radar Topography Mission were used to employ a Random Forest classifier and identify the four classes within Google Earth Engine. For each of the supervised classifications, overall model accuracy was between 83% (2018) and 89% (1994). Between 1994 and 2018, the Lower Omo Valley experienced an overall increase of 258% (919 km2) in water and 291% (7,188 km2) in cultivated areas, while experiencing a 9% (2,761 km2) decrease in natural vegetation and 19% (5,346 km2) bare ground. There was an increase in water and cultivated land and a decrease in natural vegetation and bare ground in unprotected areas and all protected areas. However, protected areas maintained natural vegetation better than unprotected areas and only experienced a 1% (59 km2) loss compared to a 10% (2,701 km2) loss in unprotected areas.

Food Security & Agriculture↗
NASA NTRS2020

Lower Omo Food Security & Agriculture: Mapping Land Cover Change in Unprotected and Protected Areas in the Lower Omo River Valley, Ethiopia

Ethiopia is home to unique wildlife, biodiversity, and ecosystem services and, like much of the world, is undergoing population growth, development, and land use change. As a result, some biodiverse regions may be at risk of being urbanized, cultivated as agricultural plots, or losing access to water bodies that are essential for maintaining both terrestrial and aquatic life. The DEVELOP team partnered with the Ethiopian Wildlife Conservation Authority to quantify the land cover change between the years 1994, 2010, and 2018. The team utilized Ethiopia’s dry season (January to May) for training point development which was crucial in differentiating the level of greenness between the four land cover classes: water, natural vegetation, cultivated land, and bare ground. The study area covered 62,000 sq.km of the Lower Omo River Valley and includes eight protected areas. We used Landsat 5 Thematic Mapper, Landsat 7 Enhanced Thematic Mapper Plus, Landsat 8 Operational Land Imager, and Shuttle Radar Topography Mission imagery within Google Earth Engine to employ a Random Forest Classifier and identify these four distinct classes. For each of our supervised classifications, overall model accuracy was between 83% (2018) and 89% (1994). Between 1994 and 2018, the Lower Omo Valley experienced an overall increase of 258.57% in water bodies and 291.23% in cultivated areas, while experiencing an 8.91% decrease in natural vegetation and 18.76% bare ground. There was an increase in water bodies and cultivated land and a decrease in natural vegetation and bare ground in unprotected areas and all protected areas. However, protected areas disproportionately experienced an increase in land cover change, including Tama Community Conservation Area which saw a 17,272.33% increase between 1994 and 2018.

Food Security & Agriculture↗
DOE OSTI2021

Predicting distribution of malaria vector larval habitats in Ethiopia by integrating distributed hydrologic modeling with remotely sensed data

Abstract Larval source management has gained renewed interest as a malaria control strategy in Africa but the widespread and transient nature of larval breeding sites poses a challenge to its implementation. To address this problem, we propose combining an integrated high resolution (50 m) distributed hydrological model and remotely sensed data to simulate potential malaria vector aquatic habitats. The novelty of our approach lies in its consideration of irrigation practices and its ability to resolve complex ponding processes that contribute to potential larval habitats. The simulation was performed for the year of 2018 using ParFlow-Common Land Model (CLM) in a sugarcane plantation in the Oromia region, Ethiopia to examine the effects of rainfall and irrigation. The model was calibrated using field observations of larval habitats to successfully predict ponding at all surveyed locations from the validation dataset. Results show that without irrigation, at least half of the area inside the farms had a 40% probability of potential larval habitat occurrence. With irrigation, the probability increased to 56%. Irrigation dampened the seasonality of the potential larval habitats such that the peak larval habitat occurrence window during the rainy season was extended into the dry season. Furthermore, the stability of the habitats was prolonged, with a significant shift from semi-permanent to permanent habitats. Our study provides a hydrological perspective on the impact of environmental modification on malaria vector ecology, which can potentially inform malaria control strategies through better water management.

59 BASIC BIOLOGICAL SCIENCES↗
NASA NTRS2022

Desert Locust Cropland Damage Differentiated from Drought, with Multi-Source Remote Sensing in Ethiopia

In 2020, Ethiopia had the worst desert locust outbreak in 25 years, leading to food insecurity. Locust research has typically focused on predicting the paths and breeding grounds based on ground surveys and remote sensing of outbreak factors. In this study, we hypothesized that it is possible to detect desert locust cropland damage through the analysis of fine-scale (5–10 m) resolution satellite remote sensing datasets. We performed our analysis on 121 swarm point locations on croplands derived from the Food and Agriculture Organization (FAO) of the United Nations, and 94 ‘non-affected’ random cropland sample points generated for this study that are distributed within 20–25 km from the ‘center’ of swarm affected sample locations. Integrated Drought Condition Indices (IDCIs) and Vegetation Health Indices (VHIs) calculated for the affected sample locations for 2000–2020 were strongly correlated (R(exp 2) > 0.90) with that of the corresponding non-affected group of sample sites. Drought indices were strongly correlated with the evaluation Standardized Precipitation Evapotranspiration Indices (SPEIs) and showed that 2020 was the wettest year since 2000. In 2020, the NDVI and backscatter coefficient of cropland phenologies from the affected versus non-affected cropland sample sites showed a slightly wider, but significant gap in March (short growing season) and August-October (long growing season). Thus, slightly wider gaps in cropland phenologies between the affected and non-affected sites were likely induced from the locust damage, not drought, with fine scale data representing a larger gap.

Desert locust↗
DOE OSTI2024

Inappropriate antibiotic access practices at the community level in Eastern Ethiopia

Access to antibiotic medications is critical to achieving the Sustainable Development Goal for good health and well-being. However, non-prescribed and informal sources are implicated as the most common causes of inappropriate antibiotic access practices, resulting in untargeted therapy, which leads to antibiotic resistance. Hence, knowing antibiotic access practices at the community level is essential to target misuse sources. In this study, 2256 household representatives were surveyed between July and September 2023 to examine their antibiotic access practices. Of 1245 household members who received antibiotics, 45.6% did so inappropriately. Non-prescribed antibiotic access was more common among urban residents and individuals not enrolled in health insurance schemes. This means of antibiotic access was also more common among individuals concerned about distance, drug availability, and healthcare convenience at public facilities. In addition, women and rural individuals were more likely to get antibiotics from unauthorized sources. Unrestricted antibiotic dispensing practices in urban areas enabled their non-prescribed access, while unlicensed providers prevailed with this access practice in rural areas. In this regard, personal behaviors and healthcare-related gaps such as the lack of health insurance, inconvenience, and drug unavailability have led community members to seek antibiotics from unofficial and non-prescribed sources. Targeting the identified behavioral and institutional factors can enhance antibiotic access through prescriptions, hence reducing antibiotic resistance.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2023

Willingness to Receive mHealth Services Among Patients with Diabetes on Chronic Follow-up in Public Hospitals in Eastern Ethiopia: Multicenter Mixed-Method Study

Background: Management of diabetes requires a long-term care strategy, including support for adherence to a healthy lifestyle and treatment. Exploring the willingness of patients with diabetes to receive mHealth services is essential for designing efficient and effective services. This study aimedto determine willingness to receive mHealth services and associated factors, as well as explore the barriers to receive mHealth services among patients with diabetes. Methods: A multicenter mixed-method study was employed from September 1 to November 30, 2022. For the quantitative part, a total of 365 patients with diabetes receiving chronic follow-up at three public hospitals were enrolled. Data were gathered using structured questionnaires administered by interviewers, entered into Epi-data version 4.6, and analyzed using Stata version 17. A binary and multivariable logistic regression model was computed to identify the associated factors. For qualitative, eight key informants and seven in-depth interviews were conducted. After verbatim transcription and translation, the data were thematically analyzed using ATLAS.ti V. 7.5. Results: Overall, 77.3% had access to a mobile phone, and 74.5% of them were willing to receive mHealth services. Higher odds of willingness to receive mHealth services were reported among patients with an age below 35 years [AOR = 4.11 (1.15– 14.71)], attended formal education [AOR = 2.63 (1.19– 5.77)], without comorbidity [AOR = 3.6 (1.54– 8.41)], < 1-hour travel to reach a health facility [AOR = 3.57 (1.03– 12.36)], answered unknown calls [AOR = 2.3 (1.04– 5.13)], and were satisfied with health-care provider service [AOR = 2.44 (1.04– 5.72)]. In the qualitative part, infrastructure, health facilities, socioeconomic factors, and patients’ behavioral factors were major identified barriers to receiving mHealth services. Conclusion: In this study, the willingness to receive mHealth services for those who have access to mobile phones increased. Additionally, the study highlighted common barriers to receiving mHealth services.

60 APPLIED LIFE SCIENCES↗