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IntroductionCervical cancer prevalence and incidence are high in sub-Saharan Africa, especially in Uganda, where screening rates are low, despite government policy recommending screening for all women aged 25-49 every three years. Most prior research focuses on client-related barriers to screening, including women's fears about the screening procedure, lack of partner support, and community-level stigma. Fewer studies elaborate on inner context factors related to health care systems, facilities, and providers. The aim of this study was to use qualitative methods to explore inner context factors that may affect cervical cancer screening in Uganda.MethodsWe recruited 20 health care facility administrators, 6 providers of cervical cancer screening, 2 district health officers, 2 division medical officers, and one government health official for key informant interviews, and 69 women (31 screened and 38 not screened for cervical cancer) for focus group discussions. Participants were recruited from four health care facilities that varied by urbanicity and funding source: one urban public facility, one urban private non-profit facility, one rural public facility, and one rural private non-profit facility.ResultsInner context themes emerged around infrastructure needs (insufficient space, equipment, and supplies) and staffing issues (inadequate staff quantity and training), which contributed to lower quality of care (e.g., long wait-times; painful, rushed exams). Women described privacy concerns as well as discomfort with male and young providers. Women with HIV were prioritized for screening based on funding streams and inability to serve all women given infrastructure and staffing issues. Despite barriers, many stakeholders were committed to providing cervical cancer screening services, and many women saw the value of screening.ConclusionThis study identified inner context barriers related to resource shortfalls, which affected quality of care. Low cost solutions are needed to improve health care readiness and increase reach of cervical cancer screening in Uganda.

The Short Physical Performance Battery (SPPB) is a common tool for examining lower extremity physical functioning and respective intervention effects in older adults. It is primarily used in community-dwelling older adults, but also in multimorbid populations such as nursing home residents. However, previous literature reported floor effects (receiving the lowest score) in this vulnerable population, particularly for the scoring of the 4-meter walking subtest. This study aimed to propose norm values and a scoring system addressing floor effects, to compare sensitivity to performance changes between the original and revised systems, and to externally validate the revised scoring. Data from three randomized controlled trials (PROCARE (n=399, 84.0±7.8 years, 77% female), PROfit (n=97, 82.4±9.8 years, 72% female), and PROGRESS (n=97, 84.6±7.7 years, 75% female)) were re-analyzed. SPPB was administered at baseline and post-intervention. Quartiles for time to complete the 4-meter walking test at baseline of the PROCARE dataset were analyzed, and norm values and a corresponding scoring system (0-4 points) were proposed. Floor effects were analyzed by comparing the number of participants in each scoring category. Sensitivity of the new scoring was evaluated by comparing means and standard deviations of time for completion at baseline and post-interventions. External validation was done using the PROfit and PROGRESS datasets. Based on the adjusted scoring system, a completion time faster than 5.65 seconds (old: 4.82 seconds) corresponded to the highest score (4 points), and a time exceeding 10.80 seconds (old: 8.70 seconds) to the lowest score (1 point). The proposed scoring system reduced the floor effect from 36% to 21%, and analysis of sensitivity revealed a better fit with time to completion. External validation indicated that the proposed scoring categories appropriately reflected participants' functional and cognitive characteristics. The new scoring differentiated walking performance in a multimorbid sample, particularly within the group of low performers and better displayed changes in performance. Thus, it can contribute to detecting changes due to physiological deterioration, limited mobility, and use of walking aids which otherwise may be missed in this vulnerable population.

Cassava peel is an abundant agro-industrial byproduct with feed potential, but its high fiber and antinutritional content limit direct use. Fermentation with Lentinus edodes may improve its nutritional quality. This study evaluated graded levels of L. edodes-fermented cassava peel (FCP) in laying hen diets for effects on nutrient composition, performance, yolk lipid profile, and economic return. A 12-week completely randomized trial involved 200 laying hens assigned to four dietary treatments (0, 5, 10, and 15% L. edodes-FCP; five replicates of 10 hens each). Cassava peel was fermented with L. edodes, dried, and milled before diet formulation. Diets met nutrient requirements and were analyzed for proximate composition and amino acids. Performance parameters included egg production, egg weight, feed conversion ratio (FCR), and hen-day production (HDP). Yolk fatty acids were determined by gas chromatography with flame ionization detection following Folch extraction and classified as saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), and omega-3/-6/-9. Income over feed cost (IOFC) was calculated from feed intake, egg output, and market prices. L. edodes-FCP modified diet composition dose-dependently, increasing crude fiber and ether extract while reducing crude protein and lysine; metabolizable energy peaked at 5%. Egg production and HDP were highest at 5%, whereas egg weight and FCR were unaffected. Yolk SFA and MUFA remained stable, but omega profiles shifted: omega-3 and omega-9 increased at 5% and 15%, while omega-6 peaked at 10% and was lowest at 15%. Higher yolk MUFA and lower SFA were associated with increased laying rate, and omega distribution aligned with dietary energy and sulfur amino acid levels. IOFC was maximized at 5% (≈172% of control) but declined at 10%-15% due to reduced output. Overall, 5% inclusion represents the optimal level for performance and profitability. L. edodes-FCP can be safely incorporated into laying hen diets, with 5% inclusion optimizing performance and profitability. At this level, egg production and HDP increased without affecting egg weight or FCR, and IOFC improved. Higher inclusion levels reduced laying rate, likely due to increased dietary fiber. Yolk lipid profile was favorably modified, particularly with increased omega-3 and omega-9 fatty acids.

Does the perception of Jewish financial success trigger antisemitism? In three studies using both qualitative and quantitative methods, we found that the answer in China was no. In Study 1, we examined Chinese popular discourse on Jewish businesses and found that Jewish managers were seen as models to emulate for both instrumental success and ethical conduct. In Study 2, a survey of Chinese white-collar workers showed a similar pattern: Managerial behaviors perceived as Jewish were rated as more profitable and ethical than those perceived as more Chinese. In Study 3, through an investment-scenario experiment, Chinese participants rated businesses with managers described as adhering to Chinese views of Jewish managerial behavior as more profitable and ethical, and these evaluations were mediated by the extent to which participants perceived the behavior as "Jewish." These results offer insights into how cultural context shapes perceptions of Jewish financial success as either a source of envy or of emulation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The rapid increase in spent lithium iron phosphate (LiFePO4) batteries brings significant challenges related to environmental pollution, human health risks, and resource sustainability. Conventional recycling technologies are often hampered by high energy consumption, secondary pollution, and operational hazards. This study proposes a sustainable mechanochemical approach for recycling spent LiFePO4 black mass, based on the targeted destruction of the stable LiFePO4 crystal structure. Using sodium hydroxide as an efficient co-grinding agent in a solvent-free system, a superior lithium leaching efficiency of 98.83 % was achieved under optimized conditions, while iron co-leaching was effectively suppressed to 0.27 %. Comprehensive characterizations, including X-ray diffraction, X-ray photoelectron spectroscopy, and Mössbauer spectroscopy confirmed the destruction of the LiFePO4 crystal structure, the formation of Li3PO4, and the oxidation of Fe2+. An economic assessment demonstrates the viability of this procedure, yielding a net profit of $0.9659 per kilogram of LiFePO4 black mass. This work presents an efficient, economically viable, and environmentally benign mechanochemical strategy for LiFePO4 battery recycling, offering fundamental insights into crystal structure destruction for sustainable resource recovery.

The social and solidarity bioeconomy (SSB) is an adaptive strategy that facilitates collective persistence and sustainable use of biological resources under increasingly precarious socio-economic and environmental conditions. Communal living which is present across biological systems often evolves in response to environmental pressures such as uneven resource distribution, environmental stress, and predation. Similarly, human economic systems operate as an adaptive response to ecological and social conditions such as inequity and environmental degradation. Guided by principles of social and solidarity economies, the SSB prioritizes democratic governance, sustainability, and collective well-being over profit maximization of resources used in the bioeconomy. Participation in the SSB parallels evolutionary strategies of cooperative living observed across biological kingdoms where collaboration can enhance resilience under harsh conditions. Within this framework, Communities of Practice (CoPs) such as community gardens and community bio labs, serve as important sites of knowledge sharing, resource pooling, and collective innovation. By fostering cooperation around shared domains of interest, CoPs are uniquely positioned to strengthen the development of a more equitable, democratic, and ecologically sustainable bioeconomy.

Women who gestate and give birth to infants or who provide oocytes in surrogacy arrangements are most often described as "surrogates," "gestational carriers," or "donors," rather than mothers. This terminology is used not only by the women themselves but also by those wishing to become parents via surrogacy and by those who profit from surrogacy. Caregiving parents predominantly discourage their children from using language that ascribes parenthood to those who gestated and gave birth to them or provided the gametes for their conception. In rationalising this linguistic choice, the importance of gestation, birth, and genetics is downplayed. This perspective paper discusses the significance of genetic and gestational motherhood for children born via surrogacy. In doing this, it explores the foetal and neonatal experiences of gestational motherhood. Insights from adoption and donor conception are also presented, highlighting the limitations and harms of treating infants as "blank slates." In addition, the paper reviews research on the language used by individuals born via surrogacy and donor conception to describe the women who gestated and gave birth to them or those who provided the gametes for their conception. It is concluded that it is beneficial for children for the language of surrogacy to recognise the multiplicity of their mothers.

Chiral non-benzenoid nanographenes (NGs) remain highly appealing, yet underexplored synthetic targets due to the lack of feasible synthetic strategies to simultaneously construct non-hexagonal rings and stable chirality. Herein, we demonstrate a novel synthetic strategy to construct a chiral saddle-shaped nanographene (cSNG) via stepwise oxidation of an anthracene-containing oligophenylene precursor. Scholl-type oxidation first yields a key intermediate featuring sp3-defect heptagons, and subsequent oxidative dehydrogenation furnishes target cSNG incorporating two heptagon-embedded [4]helicenes. The structure of cSNG is unambiguously confirmed by single-crystal analysis, demonstrating its saddle-shaped geometry with intrinsic chirality. Remarkably, due to the heptagon-embedded [4]helicene subunits, cSNG exists as configurationally stable enantiomers which enable chiral resolution, leading to pronounced chiroptical responses and enhanced dissymmetry factors, compared with its sp3-defect precursor. Moreover, profiting from chiral saddle geometry with shape-adaptive character, cSNG presents strong host-guest interactions with fullerenes, with association constants up to 2.3 × 104 M-1 for C60 and 8.7 × 104 M-1 for C70, which are among the highest values reported for negatively curved nanographenes. Crystallographic analysis of cocrystals of cSNG with C60 further revealed a distinct 1:3 binding mode for supramolecular complexation, featuring two fullerenes accommodated within the saddle cavity and two additional fullerenes externally shared between neighboring saddle units.

Dietary supplements are currently attracting a lot of public attention. Many people readily consume, for example, selenium-containing dietary supplements without having second thoughts. Therefore, this study investigated whether the intake of selenium-containing dietary supplements is associated with proven benefits for the health of the human organism. This is weighed against the risks of poisoning through an overdose of the preparations. 70 selenium supplements from Germany and the U.S. were analyzed by composition, dosage, price, and labeling based on manufacturer information. The results were then evaluated graphically. Additionally, a literature review covered legal aspects, selenium biochemistry, food selenium content, and data on intoxications from poison control centers. Selenium-containing dietary supplements from Germany and the USA differ notably in dosage, with median values of 200 µg for U.S. products and 150 µg for German products. The German Federal Institute for Risk Assessment, however, advises against exceeding 45 µg per day. German supplements are, on average, EUR 0.07 more expensive based on daily treatment costs. Further disparities exist in active ingredient forms and labeling, with many products lacking clear origin and exceeding legal limits in health claims. Data from German poison centers and international studies reveal repeated cases of intoxication, highlighting serious consumer risks due to insufficient regulation. Stricter regulatory measures would be in the interest of consumer protection. No recommendation can be made in favor of initiating selenium supplementation without a medically diagnosed selenium deficiency. The economic profit comes at the expense of insecure consumers who want to promote their health without being able to judge all facets of supplementation with selenium.

This study examines the impact of excise tax increases on cigarette prices in Montenegro, offering insights into the tobacco industry's pricing strategies. Using both panel quantile regression and fixed-effects models, the research estimates excise tax pass-through to cigarette prices across different price ranges and market segments. The analysis is based on monthly price data from 2010 to 2022 for 269 cigarette brands. The findings reveal partial tax pass-through for lower-priced brands, while premium brands experience over-shifting, meaning tax increases are more than fully passed on to consumers. Slim cigarettes remain relatively affordable, as their prices never fully reflect tax increases. This pricing strategy allows the industry to maintain a substantial price gap between premium and low-cost cigarettes while sustaining profitability. Industry-driven cross-price subsidies for low-cost cigarettes undermine the intended impact of excise tax increases by maintaining their affordability and consumption. This highlights the need for comprehensive reforms in Montenegro's tobacco tax policy to ensure effective tobacco control.

American Indian and Alaska Native (AI/AN) adults experience type 2 diabetes (T2DM) at twice the rate of non-Hispanic White adults in the United States. Although AI/ANs receive T2DM care across various settings, most research in this group has been conducted within the Indian Health Service. We sought to understand the experience of AI/AN adults with T2DM accessing a commercial healthcare system for diabetes care. The qualitative portion of a multi-method study on diabetes care and medication adherence. AI/AN adults, aged 18-65, with T2DM and a recorded A1C level in the last year. This study was conducted in a large non-profit commercial healthcare system spanning five states in the Western United States. Participants completed electronic surveys and were invited to participate in qualitative interviews. Semi-structured interviews were conducted with 15 participants. Interview transcripts were coded and analyzed using a combination inductive-deductive approach to thematic analysis. Four main themes emerged: difficulty navigating healthcare system bureaucracy, digital devices facilitating access to care, positive relationships with healthcare providers, and a mixed desire for cultural care accommodation. Participants identified opportunities to improve diabetes care, including offering diabetes education both at diagnosis and intermittent refresher education, ensuring care aligns with up-to-date guidelines, and improving access to necessary resources. While participants were satisfied with their diabetes care, difficulty navigating healthcare system bureaucracy impeded participants' ability to complete self-care tasks. Furthermore, our findings indicate more work is needed to understand the role of culturally tailored care in this setting.

Customer churn is a major problem in the fiercely competitive telecom industry. It directly influences the profitability of a company and its future in the industry. There have already been successful applications of machine learning and deep learning (ML/DL) techniques to detect client churn. learning (ML/DL) techniques to detect client churn. However, in certain situations, ML/DL-based algorithms fall short of providing encouraging outcomes when it comes to classifying customer churn. The use of machine learning classifiers and conventional feature encoding techniques in earlier studies on customer turnover estimation produced promising predictions. But the role of the optimized feature set remains important for improving efficiency and reducing feature dimension. This research proposes a modular churn prediction framework that integrates data preparation, feature optimization through hybrid feature selection, class balancing, and predictive modeling into a unified pipeline. This is done through a Multi-stage Hybrid Feature Selection (MHFS) technique that combines Mutual Information (MI) for preliminary relevance filtering, Recursive Feature Elimination (RFE) for iterative refinement, Boruta for rigorous variable validation, and Parallel Simulated Annealing (SA) for global optimization. Furthermore, a 5 × 3 nested stratified cross-validation is used to guarantee objective model evaluation where feature selection and SMOTE are performed exclusively within inner training folds, while outer folds remain completely unseen for performance assessment. Multiple ML algorithms are used for training, including Random Forest, XGBoost, LightGBM, SVM, Extra Trees, and Logistic Regression, along with Tabular Neural Network. The framework is evaluated using two comprehensive telecommunications datasets, Cell2Cell and IBM Telco. It will ensure the efficacy of the proposed framework across different churn settings datasets, which is then combined with nested cross-validation on the training set. The experimental results show that the proposed hybrid framework achieves competitive predictive performance while substantially reducing feature dimensionality (from 28 to 16 features in IBM Telco and from 57 to 25 features in Cell2Cell). Using XGBoost, the framework achieves an accuracy of 81.60% on IBM telco and 77.52% on the cell2cell dataset. These results show that the proposed framework provides competitive performance while significantly reducing feature dimensions.

Fasciolosis, caused by the liver fluke Fasciola hepatica, is a climate-sensitive parasitic disease that threatens livestock health, productivity and farm profitability, with broader implications for food security, rural livelihoods, and sustainable food systems. The disease is endemic in Victoria, Australia, where environmental and climatic conditions favour parasite transmission at the livestock-environment interface. This study used high-resolution (5&#xa0;km2) climate data from 40,504 grid points across Victoria to validate a Growing Degree Days (GDD) model for estimating fasciolosis risk over the past 50&#xa0;years (1975-2024) and to project future risk for 2050 and 2090 under medium (RCP 4.5) and high (RCP 8.5) representative concentration pathways. Linear regression analysis identified a strong relationship between observed fasciolosis prevalence and modelled risk values (R2&#xa0;=&#xa0;0.94, p&#xa0;<&#xa0;0.003). Historical data analyses showed substantial interannual variability, with consistently higher risk in eastern Victoria, followed by the western and northern regions. Under future climate scenarios, fasciolosis risk increased spatially 2-fold in Barwon and 3-fold in the Great South Coast, particularly under the RCP 8.5 scenario in 2090. Risk remained sustained in Gippsland, especially in southern areas, covering 35% of the region, while a modest increase (5%) was projected for Greater Melbourne relative to a baseline risk of 45%. These findings highlight important One Health implications, as climate-driven changes in fasciolosis risk may undermine livestock productivity, and challenge the resilience of livestock-derived food systems. The study provides an evidence base to support climate-responsive surveillance, risk-based control strategies, and integrated animal health and environmental policy development.

Corruption in healthcare is ubiquitous across countries but differs in extent and nature based on the socio-political context and historical development of their health service systems. We review various approaches to defining and analysing corruption and examine their application to the health sector. Commonly adopted measures of corruption based on these frameworks, by covering certain actions and excluding others, tend to highlight poor countries as being more corrupt. These frameworks are largely ahistorical, and lack a systems approach, and consequently, miss institutionalised forms and types of corruption at higher levels between and within countries. The failure of anticorruption efforts makes it necessary to interrogate and understand the nature of corruption, its forms, types, and measurement, through a lens that can lead to effectively addressing the phenomenon from the perspective of low-and-middle income countries. We propose an expanded framework for understanding the systemic pathways of corruption, across the multiple levels and actors in the health system. We then discuss its relevance to low-and-middle-income countries, with a specific focus on India. We argue that historical socio-political structures, with a colonial hangover and elite dominance, legitimising only one health knowledge system (conventional biomedicine) and its medical professionals, have led to a healthcare system design which is unaffordable, unsustainable, unregulated and alienated from the majority of the population even while it creates a dependency on biomedical experts and institutions. The medical industrial complex &#x2012; the network of providers and industries in healthcare &#x2012; prioritises profit over health benefits, and contributes to escalating corruption in the healthcare sector, thereby pushing inappropriate solutions and policy choices. Such an ecosystem is fertile ground for corruption as it results in huge unmet needs and unreasonable expectations from the health services, underpaid health workers, weak regulatory structures, and poor accountability.

Ocean alkalinity enhancement (OAE) is a promising carbon dioxide removal (CDR) strategy with the theoretical potential to sequester gigatonnes of atmospheric CO2 each year. Electrochemical OAE, where seawater alkalinity is increased by removing hydrochloric acid (HCl), has attracted particular interest, but the viability of this approach at climate-relevant scales hinges on the development of low-cost, carbon-neutral strategies for HCl disposal. Here, we demonstrate a two-stage process that helps address this challenge by first neutralizing HCl using common mafic and ultramafic rocks and then recovering valuable products from the resulting solutions. This process can yield coproducts such as amorphous silica and nickel/cobalt-bearing mixed hydroxide precipitates while converting HCl into a saline solution that can be discharged to the ocean without reversing alkalinity gains. A techno-economic case study in Washington state, USA, estimates the net cost of acid neutralization at <$200 per tonne of CO2 removed via OAE, with the potential for future net profitability with certain process improvements.

In many low-income and middle-income countries, access to specialised surgical care is limited by infrastructure gaps, workforce shortages and weak financing, leading to unmet needs and cross-border inequities. The African Network of Medical Excellence (ANME) was created as a public-non-government organisation partnership to strengthen national health systems through specialised centres of excellence providing free, high-quality care. This paper outlines the design, implementation and outcomes of the ANME Regional Programme (RP), a coordinated cross-border referral system.The RP operates through formal agreements with Ministries of Health, structured referral pathways, specialist outreach missions, and full coverage of patient travel, accommodation, surgery, follow-up and essential medicines. Two ANME hospitals-the Salam Centre for Cardiac Surgery in Sudan and the Children's Surgical Hospital in Uganda-serve as regional hubs. By December 2024, 190 screening and follow-up missions had reached over 16&#x2009;000&#x2009;patients across 28 countries, with 2024 receiving specialised surgical care.Outcomes confirm the feasibility and safety of this model. At the Salam Centre, early postoperative mortality among RP-referred patients was lower than that of host-country patients (1.8% vs 2.9%), reflecting effective case selection and continuity of care. At the Children's Surgical Hospital in Uganda, early implementation of the paediatric RP addressed major unmet needs for complex congenital conditions, with no postoperative deaths reported.The ANME regional programme demonstrates how a not-for-profit, government-supported referral system can expand equitable access to specialised care, strengthen local capacity and support sustainable, rights-based health system development. Its approach offers transferable lessons for regional collaboration in other resource-limited settings.

Diarrhea caused by amoxicillin (A) or amoxicillin-clavulanate (AC) is common in children, and the induced dysbiosis is often characterized by a severe reduction in bifidobacteria. However, bifidobacteria are extremely antibiotic-sensitive, and their co-administration with antibiotics is likely unwise. The B. breve PRL2020 strain is an A- and AC-resistant probiotic. In a multicenter, randomized, controlled, non-profit study, we tested the tolerability and efficacy of the PRL2020 strain when co-administered to children (3-12 years; N&#x2009;=&#x2009;121) undergoing A or AC therapy, attempting to interpret the results obtained by observing the intestinal microbiota in a subgroup (N&#x2009;=&#x2009;41) of enrolled children. In children treated with the probiotic, the therapy was well tolerated and the incidence of diarrhea was significantly reduced by approximately 70% (p&#x2009;<&#x2009;0.01). Considering only children with diarrhea, in the probiotic-treated group the onset was postponed by about 15&#xa0;h, and the symptom lasted 19&#xa0;h less. Gut microbiota richness was significantly reduced in both groups, without significant differences between probiotic-treated and control children. At the phylum level, antibiotic treatment was associated with an increase in Proteobacteria and a reduction in Actinobacteria, with larger apparent shifts in the control group. Bifidobacteria, particularly B. breve, decreased in controls and increased in treated subjects (p&#x2009;<&#x2009;0.05), despite not being among the most abundant taxa contributing to the majority of the microbial community. Finally, although only in a trend-based manner, butyrate-producing bacteria decreased less in probiotic-treated children, whereas an increase in succinate-consuming bacteria was observed in controls. Co-administering the B. breve PRL2020 strain with A or AC in children significantly reduces diarrheal symptoms and antibiotic-related dysbiotic status. New blinded, placebo-controlled studies with a more robust sample size for microbiota analysis will have to confirm our data.

The electrochemical upcycling of plastic waste into high-value chemicals using renewable electricity is a promising route toward a circular economy. However, the electrocatalytic oxidation of polyethylene terephthalate (PET)-derived ethylene glycol (EG) to glycolic acid (GA) is severely limited by the narrow voltage window and rapid deactivation of noble-metal catalysts, primarily due to competitive hydroxyl adsorption and intermediate poisoning. Inspired by the spatial compartmentalization in enzymatic catalysis, we decouple reactant activation and oxygen species management through a spinel Co3O4-mediated OH-sponge effect, which buffers local OH- concentration, thus preventing Pt-oxidation and supplies active oxygen species enabling targeted conversion to GA. The resulting catalyst achieves an unprecedented GA selectivity of >95% over an ultrawide potential range of 0.5-1.5 V (vs RHE). It demonstrates exceptional durability, operating stably for over 2000 h in a half-cell and >650 h in a membrane electrode assembly. Techno-economic analysis indicates the process can yield a net profit of approximately $720 per ton of PET waste processed. This work provides a biomimetic design principle that simultaneously addresses the challenges of selectivity, stability, and operational flexibility, advancing the viability of electrochemical plastic upcycling.

The small-scale dairy industry plays a crucial role in improving rural livelihoods, nutrition and income generation in Ethiopia. However, its productivity and sustainability are constrained by socio-economic, institutional and climatic factors. This study identifies the key determinants influencing productivity and sustainability in the small-scale dairy sector of the Salale Zone, Oromia, Ethiopia. Primary data were collected from 250 smallholder dairy farmers using structured questionnaires. Ordered Logit regression model with marginal effects estimation was employed to assess factors affecting the likelihood of achieving higher dairy productivity under varying household, institutional and environmental conditions. The results indicate that age of household head (&#x3b2; = 0.012), education level (&#x3b2; = 0.040), land ownership (&#x3b2; = 0.490), access to social networks (&#x3b2; = 0.188), infrastructure (&#x3b2; = 0.150) and veterinary services (&#x3b2; = 0.160) significantly enhanced productivity. Conversely, larger household size (&#x3b2; = -0.038), low economic status (&#x3b2; = -0.275), market inefficiencies (&#x3b2; = -0.230), high feed prices (&#x3b2; = -0.290), milk adulteration (&#x3b2; = -0.270), price fluctuations (&#x3b2; = -0.340), seasonal feed shortages (&#x3b2; = -0.175) and climatic variability (&#x3b2; = -0.250) reduced performance. Marginal effects analysis showed that market inefficiencies, adulteration and price fluctuations decreased dairy success by 35%, 29% and 22%, respectively, while improved feed access, infrastructure, finance and training increased it by 31%, 27%, 24% and 18%. The findings highlight the combined influence of socio-economic, institutional and climatic factors on dairy productivity and provide empirical insights for enhancing efficiency, profitability and sustainability in Ethiopia's small-scale dairy industry.