Mortality of neonates born to mothers of extreme reproductive age in Ethiopia; multilevel mixed effect analysis of Ethiopian demographic and health survey data of 2016.

Introduction: Neonatal mortality is still a major public health problem in middle- and low-income countries like Ethiopia. Despite strategies and efforts made to reduce neonatal death, the mortality rate declines at a slower pace in the country. Though there are studies conducted on neonatal mortality and its determinants, our searches of the literature have found no study on the extent of mortality of neonates born to mothers of extreme reproductive age in the study area. Therefore, this study aimed to assess the magnitude and factors associated with the mortality of neonates born to mothers of extreme reproductive age in Ethiopia. Methods: Secondary data analysis was conducted using 2016 Ethiopian Demographic and Health Survey data. The final study contained an overall weighted sample of 2,269 live births. To determine the significant factors in newborn deaths, a multilevel binary logistic regression was fitted. For measuring the clustering impact, the intra-cluster correlation coefficient, median odds ratio, proportional change in variance, and deviation were employed for model comparison. The adjusted odds ratio with a 95% confidence interval was presented in the multivariable multilevel logistic regression analysis to identify statistically significant factors in neonatal mortality. A P-value of less than 0.05 was declared statistically significant. Results: The neonatal mortality rate of babies born to extreme aged reproductive women in Ethiopia was 34 (95% Cl, 22.2%-42.23%) per 1,000 live birth. Being twin pregnancy (AOR = 10; 95% Cl: 8.61-20.21), being from pastoralist region (AOR = 3.9; 95% Cl: 1.71-8.09), having larger baby size (AOR = 2.93; 95% Cl: 1.4-9.12) increase the odds of neonatal mortality. On the other hand, individual level media exposure (AOR = 0.3; 95% Cl: 0.09-0.91) and community level media exposure (AOR = 0.24; 95% Cl: 0.07-0.83), being term gestation (AOR = 0.14; 95% Cl: 0.01-0.81) decreases the odds of neonatal mortality born to mothers of extreme reproductive age. Conclusion: Ethiopia had a greater rate of neonatal death among babies born at the extremes of reproductive age than overall reproductive life. Multiple pregnancies, larger baby sizes, emerging regions, term gestation, and media exposure were found to be significant factors associated with the mortality of neonates born to mothers of extreme reproductive age. Therefore, the concerned bodies should give emphasis to mothers giving birth before the age of 20 and above 35, access to media, healthy pregnancy, and special attention to pastoralists to reduce the burden of neonatal mortality.

Minimum milk feeding frequency and its associated factors among non-breastfed children aged 6-23 months in sub-saharan Africa: a multilevel analysis of the recent demographic and health survey data.

BACKGROUND: Poor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset. METHODS: Data from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. RESULTS: The pooled magnitude of minimum milk feeding frequency among non-breastfed children aged 6-23 months in sub-Saharan African countries was 12.39% (95% CI: 11.85%, 12.97%). Factors like maternal educational level [AOR = 1.61; 95% CI (1.35, 1.91)], marital status of the mother [AOR = 0.77; 95% CI (0.67, 0.89)], maternal working status [AOR = 0.80; 95% CI (0.71, 0.91)], media exposure [AOR = 1.50; 95% CI (1.27, 1.77)], wealth index [AOR = 1.21; 95% CI (1.03, 1.42)], place of delivery [AOR = 1.45; 95% CI (1.22, 1.72)], ANC visit attended during pregnancy [AOR = 0.49; 95% CI (0.39, 0.62)], PNC checkup [AOR = 1.57; 95% CI (1.40, 1.76)], child's age [AOR = 0.70; 95% CI (0.53, 0.93)], and residence [AOR = 2.15; 95% CI (1.87, 2.46)] were significantly associated with minimum milk feeding frequency. CONCLUSIONS: In sub-Saharan Africa, the proportion of minimum milk feeding frequency among non-breastfed children aged between 6 and 23 months was low. The likelihood of minimum milk feeding frequency increases with high levels of education, unemployment, media exposure, rich wealth status, being unmarried, having a child born in a health facility, getting PNC checks, being between 6 and 8 months old, and living in an urban area. Hence, promoting women's education, increasing the economic status of the household, disseminating nutrition information through media, strengthening maternal health service utilization like health facility delivery and PNC services, and giving prior attention to mothers with older children and from rural areas are strongly recommended.

The prevalence of adolescent fatherhood and its associated factors in East African countries.

BACKGROUND: In developing nations, the phenomenon of adolescent fatherhood poses significant challenges, including increased risk of poverty, limited educational opportunities, and potential negative health outcomes for both the young fathers and their children. However, an overwhelming majority of research has concentrated on teenage motherhood. Adolescent fatherhood in poor nations has been the subject of little research. Few public health initiatives address adolescent fatherhood, in contrast to adolescent motherhood. Although there is currently more being done in industrialized nations to recognize adolescent fatherhood in clinical settings and the academic community. Undeveloped nations such as East Africa still have more problems that need to be resolved. Therefore, this study aimed to investigate the prevalence of and factors contributing to adolescent fatherhood in East Africa. METHODS: Data from the Demographic and Health Surveys (DHS), collected between 2011 and 2022 in 12 East African nations, were used in this analysis. For a weighted sample of 36,316 male adolescents aged 15-24 years, we examined variables, as well as the prevalence of adolescent fatherhood. Univariate and multivariable logistic regression analyses were performed to identify candidate factors and significant explanatory variables associated with the outcome variable. The results are presented using adjusted odds ratios (AORs) at 95% confidence intervals (CIs). P values of ≤ 0.2 and < 0.05 were used to investigate statistically significant factors in the univariate and multivariable logistic regression analyses, respectively. RESULTS: The overall prevalence of adolescent fatherhood was 11.15% (95% CI = 10.83,11.48) in East Africa. Age at first sex 20-24 years (AOR = 0.44, 95% CI:0.41,0.48), age-20-24 years old (AOR = 17.03,95% CI = 15.01,19.33), secondary/higher education (AOR = 0.57, 95% CI = 0.49,0.67), poor wealth (AOR = 2.27, 95% CI = 2.05,2.52), middle wealth (AOR = 1.70, 95% CI = 1.51,1.90), employed (AOR = 3.92, 95% CI = 3.40,4.54), utilized modern contraceptives (AOR = 0.75, 95% CI = 0.69,0.81), and female household heads (AOR = 0.43, 95% CI = 0.39,0.48) were associated with adolescent fatherhood. CONCLUSIONS: Adolescent fatherhood is more prevalent, in East Africa. These findings highlight the complexity of adolescent fatherhood and suggest that multiple factors, including socio-demographic characteristics and reproductive health behaviors, play a role in determining the likelihood of becoming an adolescent father. Understanding these associations can inform targeted interventions and policies aimed at reducing adolescent fatherhood rates and addressing the specific needs and challenges faced by young fathers in East Africa. Further research and interventions should focus on promoting education, economic opportunities, and access to modern contraceptives, while also addressing gender dynamics and social norms that contribute to adolescent fatherhood in the region.

Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression.

BACKGROUND: In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries. METHODS: Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study. RESULTS: In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women. CONCLUSIONS AND RECOMMENDATIONS: This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.

Recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries: a multilevel analysis of the recent demographic and health survey.

INTRODUCTION: Diarrhea is a common public health problem and the third leading cause of death in the world among children under the age of five years. An estimated 2 billion cases and 1.9 million deaths are recorded among children under the age of five years every year. It causes body fluid loss and electrolyte imbalance. Even though, early initiation of recommended homemade fluid is a simple and effective approach to prevent diarrhea-related complications and mortality of children, recommended homemade fluid utilization for the treatment of diarrhea is still low in sub-Saharan African countries. Therefore, this study aimed to assess the magnitude of recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries. METHOD: The most recent Demographic and Health Survey dataset of 21 sub-Saharan African countries from 2015 to 2022 was used for data analysis. A total of 33,341 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results. RESULT: The overall recommended homemade fluid utilization for the treatment of diarrhea among children under five in sub-Saharan African countries was 19.08% (95% CI = 18.66, 19.51), which ranged from 4.34% in Burundi to 72.53% in South Africa. In the multivariable analysis, being an educated mother/caregiver (primary and secondary level) (AOR = 1.15, 95% CI: 1.04, 1.27) and (AOR = 1.30, 95% CI: 1.15, 1.1.47), the primary and secondary level of fathers education (AOR = 1.53, 95% CI: 1.37, 1.71) and (AOR = 1.41, 95% CI: 1.19, 1.1.68), having antenatal care follow-up (AOR = 1.16, 95% CI: 1.01, 1.33), having multiple children (AOR = 1.17, 95% CI: 1.07, 1.28), and being an urban dweller (AOR = 1.15, 95% CI: 1.04, 1.27) were factors associated with recommended homemade fluid utilization. CONCLUSION: The overall recommended homemade fluid utilization for the treatment of diarrhea was low. Individual and community-level variables were associated with recommended homemade fluid utilization for the treatment of diarrhea. Therefore, special consideration should be given to rural dwellers and caregivers who have three and below children. Furthermore, better to strengthen the antenatal care service, mother/caregiver education, and father's education to enhance recommended homemade fluid utilization for the treatment of diarrhea.

Unhealthy food consumption and its determinants among children aged 6 to 23 months in sub-Saharan Africa: a multilevel analysis of the demographic and health survey.

BACKGROUND: Unhealthy food consumption that begins early in life is associated with a higher risk of nutrient inadequacy and related chronic diseases later in life. Healthy eating and consumption of important nutrients help to maintain a healthy body weight and reduce the risk of developing chronic conditions. Research from sub-Saharan Africa regarding consumption of unhealthy foods remains limited, with no studies quantifying the pooled prevalence among young children. Therefore, this study is intended to assess the pooled prevalence and determinants of unhealthy food consumption among children aged 6 to 23 months. METHODS: Data from the most recent demographic and health surveys of five countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 16,226 children aged 6 to 23 months was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant. RESULTS: The pooled prevalence of unhealthy food consumption among children aged 6 to 23 months was 13.41% (95% CI: 12.89-13.94%). Higher consumption of unhealthy foods was reported among mothers with low education [adjusted odds ratio (AOR) = 0.37; 95% confidence interval (CI) (0.30, 0.46)], unmarried women [AOR = 1.19; 95% CI (1.05, 1.34)], who had no media exposure [AOR = 0.64; 95% CI (0.56, 0.72)], delivered at home [AOR = 0.74; 95% CI (0.62, 0.87)], who hadn't had a PNC checkup [AOR = 0.66; 95% CI (0.60, 0.73)], wealthier households [AOR = 1.20; 95% CI (1.05, 1.37)], older children (aged ≥ 9 months) [AOR = 3.88; 95% CI (3.25, 4.63)], and low community level media exposure [AOR = 1.18; 95% CI (1.04, 1.34)]. CONCLUSION: Nearly one out of seven children aged 6 to 23 months consumed unhealthy foods. Maternal educational level, marital status of the mother, exposure to media, wealth index, place of delivery, PNC checkup, and the current age of the child were factors significantly associated with unhealthy food consumption. Therefore, improving women's education, disseminating nutrition-related information through the media, providing more attention to poor and unmarried women, and strengthening health facility delivery and postnatal care services are recommended.

Incidence and Predictors of Major Adverse Drug Reactions Among Human Immunodeficiency Virus-infected Children on Antiretroviral Treatment in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia: A Multicenter Retrospective Follow-up Study.

PURPOSE: Major adverse drug reactions (ADRs) are the leading causes of poor adherence, switching of drugs, morbidity, and mortality. A limited studies was conducted to investigate major ADR in developing countries including Ethiopia, and the purpose of this study was to assess the incidence and predictors of major ADRs among HIV-infected children receiving antiretroviral therapy (ART) in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted among 460 children receiving ART from January 1, 2014 to December 31, 2021. A simple random sampling technique was employed, and data were collected using Kobo Toolbox software and then deployed to STATA 14 for analysis. The Kaplan-Meier survival curve and the log-rank test were used to estimate and compare survival times. Both bivariable and multivariable Weibull regression models were fitted to identify predictors. Finally, an adjusted hazards ratio (AHR) with a 95% CI was computed, and variables with P < 0.05 were considered statistically significant predictors of major ADR. FINDINGS: The overall incidence rate of major ADRs was 5.8 (95% CI, 4.6-7.3) per 1000 child months. Being female (AHR, 2.71; 95% CI, 1.52-4.84), tuberculosis (TB)-HIV co-infection (AHR, 2.49; 95% CI, 1.32-4.68), World Health Organization stage (III and IV) (AHR, 2.52; 95% CI, 1.39-4.56), zidovudine-based (AHR, 2.84; 95% CI, 1.11-7.31), and stavudine-based (AHR, 5.96; 95% CI, 1.63-21.84) regimens were found to be significant predictors of major ADRs. IMPLICATIONS: The major ADR incidence rate was high. Health professionals should employ early screening and close follow-up for children with advanced World Health Organization clinical staging, females, those with TB-HIV co-infection, and those receiving stavudine- and zidovudine-based initial regimens to reduce the incidence of major ADRs.

Comprehensive Knowledge, Attitudes, Behaviors, and Associated Factors of HIV/AIDS in Gondar City Public Health Facilities Among HIV Testing and Counselling Service Users, Northwest Ethiopia, 2022; an Ordinal Logistic Regression Analysis.

Background: The primary cause of HIV transmission is a failure to deliver proper HIV/AIDS information, which is a major public health issue in low- and middle-income nations. While global health coverage continues, there is still little understanding of HIV/AIDS in Ethiopia, and there is a data gap. As a result, the aim of this study was to investigate the factors that influence comprehensive HIV/AIDS knowledge among HIV testing and counselling (HTC) service users in Gondar, northwest Ethiopia. Methods: A facility-based cross-sectional study was conducted from June to July 2022. About 423 clients were included. Data on HIV/AIDS knowledge, attitude, and behavior were collected. Stata 17 was used to analyze. A pre-tested questionnaires were used. Using ordinal logistic regression model, variables having p values of 0.2 and <0.05 were chosen as a candidate variable in binary and final model. Results: The total knowledge, favorable attitude, and good behaviors of HIV/AIDS were approximately 258 (61%), 220 (52%), and 210 (49.5%), respectively. Being male (AOR = 1.39, 95% CI = 1.28-3.01), age from 31 to 35 years (AOR = 2.13, 95% CI = 1.88-4.18), and above 36 years old (AOR = 2.21, 95% CI = 1.98-3.44), primary (AOR = 1.21, 95% CI = 1.67-3.20), and higher education (AOR = 1.19, 95% CI = 1.03-3.01), employed (AOR = 1.33, 95% CI = 1.09, 3.37), and media exposure (AOR = 2.02, 95% CI = 1.21, 3.61) were factors associated with comprehensive knowledge of HIV/AIDS, respectively. Conclusion: The study participants' knowledge, attitudes, and behaviors regarding HIV/AIDS were rather low. Since HIV/AIDS is still a major public health issue, if the concerned body uses and designs media effectively, encouraging females to attend school, it will have a better chance of combating HIV/AIDS by increasing their knowledge.

Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016.

INTRODUCTION: Tetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data. METHOD: Secondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant. RESULT: From the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage. CONCLUSION: The finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.

Mapping stunted children in Ethiopia using two decades of data between 2000 and 2019. A geospatial analysis through the Bayesian approach.

BACKGROUND: Childhood stunting is a major public health problem globally, resulting in poor cognition and educational performance, low adult wages, low productivity, and an increased risk of nutrition-related chronic diseases in adulthood life. Accurate and reliable data on the prevalence of stunting over time with a sub-national estimate are scarce in Ethiopia. OBJECTIVE: Our objective was to investigate the spatiotemporal distributions and ecological level drivers of stunting among under-five children over time in Ethiopia. METHODS: A geospatial analysis using the Bayesian framework was employed to map the spatial variations of stunting among children aged less than five years. The data for the primary outcome were obtained from the Ethiopian Demographic and Health Surveys (2000-2019) and covariates data were accessed from different publicly available credible sources. The spatial binomial regression model was fitted to identify drivers of child stunting using the Bayesian approach. RESULT: The national prevalence of stunting was 47.9 in 2000, 43.3 in 2005, 37.3 in 2011, 36.6 in 2016, and 35.9 in 2019, with a total reduction rate of 25%. Substantial spatial clustering of stunting was observed in the Northern (Tigray), Northcentral (Amhara), and Northwestern (Amhara) parts of Ethiopia. Temperature (mean regression coefficient (ß): -0.19; 95% credible interval (95% CrI): -0.25, -0.12) and population density (ß: -0.012; 95% CrI: -0.016, -0.009) were negatively associated with stunting, whereas travel time to the nearest cities (ß: 0.12; 95% CrI: 0.064, 0.17) was positively associated with child stunting in Ethiopia. CONCLUSION: The prevalence of stunting varied substantially at subnational and local levels over time. Clustering of stunted children were observed in the Northern parts of Ethiopia. Temperature, population density and travel time to the nearest cities were identified as the drivers of stunting in children. Improving community awareness of child nutrition through community health extension programs should be strengthened.

Major maternal related determinants of non-breastfeeding among mothers in Ethiopia: A multilevel analysis from DHS Ethiopia 2016.

INTRODUCTION: In Ethiopia, the burden of non-breastfeeding is still high despite substantial improvements in breastfeeding. However, the determinants of non-breastfeeding were poorly understood. Therefore, the aim of this study was to identify the maternal -related factors associated with non-breastfeeding. METHODS: An in-depth analysis of data from the Ethiopian Demographic and Health Survey 2016 (EDHS 2016) was used. A total weighted sample of 11,007 children was included in the analysis. Multilevel logistic regression models were fitted to identify factors associated with non-breastfeeding. A p-value < of 0.05 was used to identify factors significantly associated with non-breastfeeding. RESULTS: The prevalence of non-breastfeeding in Ethiopia was 5.28%. The odds of not breastfeeding were 1.5 times higher among women aged 35to 49 years (AOR = 1.5 CI: 1.034, 2.267) than among women aged 15to 24 years. The odds of not breastfeeding were higher among children whose mothers had BMIs of 18.5-24.9 (AOR = 1.6 CI: 1.097, 2.368) and 25-29.9 (AOR = 2.445 CI: 1.36, 4.394) than among women with BMIs of < 18.5. In addition, not breastfeeding was also significantly associated with ANC follow-up, where mothers who had 1-3 ANC follow-up had a 54% decreased odds (AOR = 0.651 CI: 0.46,0.921) compared to mothers who had no ANC follow-up. Demographically, mothers from Somalia region were five times (AOR = 5.485 CI: 1.654, 18.183) and mothers from SNNP region were almost four times (AOR = 3.997 CI: 1.352, 11.809) more likely to not breastfeed than mothers residing in Addis Ababa. CONCLUSIONS: Although breastfeeding practices are gradually improving in Ethiopia, the number of children not breastfed remains high. Individual-level characteristics (women's age, body mass index, and ANC follow-up) and community-level characteristics (geographic region) were statistically significant determinants of non-breastfeeding. Therefore, it is good for the federal minister of Health, planners, policy and decision- makers, and other concerned child health programmers to prioritize both individual and community factors.

Prevalence, spatial distribution and determinants of infant mortality in Ethiopia: Findings from the 2019 Ethiopian Demographic and Health Survey.

INTRODUCTION: Infant mortality declined globally in the last three decades. However, it is still a major public health concern in Ethiopia. The burden of infant mortality varies geographically with the highest rate in Sub-Saharan Africa. Although different kinds of literature are available regarding infant mortality in Ethiopia, an up to date information is needed to design strategies against the problem. Thus, this study aimed to determine the prevalence, show the spatial variations and identify determinants of infant mortality in Ethiopia. METHODS: The prevalence, spatial distribution, and predictors of infant mortality among 5,687 weighted live births were investigated using secondary data from the Ethiopian Demographic and Health Survey 2019. Spatial autocorrelation analysis was used to determine the spatial dependency of infant mortality. The spatial clustering of infant mortality was studied using hotspot analyses. In an unsampled area, ordinary interpolation was employed to forecast infant mortality. A mixed multilevel logistic regression model was used to find determinants of infant mortality. Variables with a p-value less than 0.05 were judged statistically significant and adjusted odds ratios with 95 percent confidence intervals were calculated. RESULT: The prevalence of infant mortality in Ethiopia was 44.5 infant deaths per 1000 live births with significant spatial variations across the country. The highest rate of infant mortality was observed in Eastern, Northwestern, and Southwestern parts of Ethiopia. Maternal age between 15&19 (adjusted odds ratio (AOR) = 2.51, 95% Confidence Interval (CI): 1.37, 4.61) and 45&49(AOR = 5.72, 95% CI: 2.81, 11.67), having no antenatal care follow-up (AOR = 1.71, 95% CI: 1.05, 2.79) and Somali region (AOR = 2.78, 95% CI: 1.05, 7.36) were significantly associated with infant mortality in Ethiopia. CONCLUSION: In Ethiopia, infant mortality was higher than the worldwide objective with significant spatial variations. As a result, policy measures and strategies aimed at lowering infant mortality should be devised and strengthened in clustered areas of the country. Special attention should be also given to infants born to mothers in the age groups of 15-19 and 45-49, infants of mothers with no antenatal care checkups, and infants born to mothers living in the Somali region.

COVID-19 vaccine acceptance rate and its predictors in Ethiopia: A systematic review and meta-analysis.

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I2), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P. VALUE: 0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P. VALUE: 0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P. VALUE: 0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Applied nutritional investigation spatial variation and determinants of stunting among children aged less than 5 y in Ethiopia: A spatial and multilevel analysis of Ethiopian Demographic and Health Survey 2019.

OBJECTIVES: Stunting is a major global public health problem, associated with physical and cognitive impairments. Spatial variations in childhood stunting were observed due to changes in contextual variables from area to area, implying that geography is a crucial component in the development of strategies against childhood stunting. However, to our knowledge, there are no up-to-date studies on the distribution of childhood stunting and its determinants in Ethiopia. Thus, the aim of this study was to investigate the spatial distribution and determinants of stunting among children aged <5 y in Ethiopia. METHODS: Geospatial and multilevel analysis of the Ethiopia Demographic and Health Survey 2019 data was done to investigate the spatial distribution and determinants of stunting among children aged <5 y in Ethiopia. The analysis included 5753 weighted children aged <5. Spatial autocorrelations analysis was done to assess the spatial dependency of stunting. Hot spot and cluster outlier analysis was used to observe the spatial clustering of stunting. Kriging interpolation was used to predict stunting in an unsampled area. A multilevel logistic regression model was fitted to identify determinants of stunting. Adjusted odds ratio with 95% confidence interval (CI) was calculated and variables having a P < 0.05 were declared statistically significant. RESULT: The national prevalence of stunting was 36.81% (95% CI, 35.48%-38.15%), with significant spatial variations across Ethiopia. Spatial clustering of stunting was detected in the northern, northwestern, northeastern, and southwestern parts of Ethiopia. Age and sex of the child, birth interval, birth type, household wealth status, maternal education, region, and community-level illiteracy were factors significantly associated with stunting. CONCLUSION: Stunting significantly varies across Ethiopia, with the highest prevalence in Northern Ethiopia. Older age, poor family wealth, maternal illiteracy, and community illiteracy level were the significant determinants of stunting in children aged <5 y in this study. Policymakers should design interventions to reduce stunting among children aged <5 y through accessing education for women and applying economic empowerment strategies in the hot spot areas.

Spatial distribution and determinants of newbornsnot receiving postnatal check-up withintwodays after birth in Ethiopia: a spatial and multilevel analysis of EDHS 2016.

BACKGROUND: Accessibility and utilization of postnatal newborn check-ups within 2 days after delivery are critical for a child's survival, growth, and development. However, the service delivery is not yet improved and fluctuates across the geographical locations in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of newborns not received postnatal check-ups within 2 days after birth in Ethiopia. METHODS: A secondary data analysis of the Ethiopia Demographic and Health Survey (EDHS) 2016 was done among live births within 2 years preceding the survey. A multilevel binary logistic regression model was fitted to identify the factors associated with the outcome variable. Adjusted Odds Ratio with 95% (Confidence Interval) was calculated and used as a measure of associations and variables with a p-value < 0.05, were declared as statistically significant. RESULTS: A total of 4036 live newborns in Ethiopia were included in the analysis, of whom half (51.21%) were females. The mean age of the mothers was 33+ SD 1.3, and more than 60 % (61.56%) of the mothers were not educated. The national prevalence of newborns not receiving postnatal check-ups within 2 days after birth was 84.29 (95% CI: 83.10-85.41) with significant spatial variations across the study area. Mothers who had no ANC visits were 58% higher than (AOR = 0.42(0.27-0.66) mothers who had > 4 ANC visits. Mothers who gave birth at home and others were 80% (AOR = 0.02(0.01-0.29) and 25% (AOR = 0.76(0.59-0.99), higher than mothers delivered at hospital. Rural mothers were 1.90 times higher (AOR = 1.90(1.29-2.81) than urban mothers, and mothers live in administrative regions of Afar 66% (AOR = 0.34(0.16-0.69), Oromia 47% (AOR = 0.53(0.30-0.91), Somali 60% (AOR = 0.40 (0.22-0.74),Benishangul 50% (AOR = 0.50 (0.27-0.92), SNNPR 67% (AOR = 0.33(0.19-0.57), Gambela 70% (AOR = 0.30 (0.16-0.56), Harari 56% (AOR = 0.44 (0.25-0.78), and Dire Dawa70% (AOR = 0.30 (0.17-0.54) were higher than Addis Abeba for not receiving postnatal checkup of new born within the first 2 days, respectively. CONCLUSIONS: Low postnatal check-up utilization remains a big challenge in Ethiopia, with significant spatial variations across regional and local levels. Spatial clustering of not receiving postanal check-ups within 2 days was observed in Afar, Oromia, Gambela, Benishangul, SNNPR, Harari, and Dire Dawa regions. Residence, ANC visits, place of delivery, and administrative regions were significantly associated with not receiving postnatal check-ups. Geographically targeted interventions to improve ANC follow-up and institutional delivery should be strengthened.

Spatial distribution and associated factors of community based health insurance coverage in Ethiopia: further analysis of Ethiopian demography and health survey, 2019.

BACKGROUND: Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income households excluded from formal insurance and taken as a soft option by many countries. Therefore, exploring the spatial distribution of health insurance is crucial to prioritizing and designing targeted intervention policies in the country. METHODS: A total of 8,663 households aged 15-95 years old were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of community based health insurance. ArcGIS version 10.3 was used to visualize the distribution of community-based health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of community-based health insurance coverage. RESULTS: Community based health insurance coverage among households had spatial variations across the country by regions (Moran's I: 0.252, p < 0.0001). Community based health insurance in Amhara (p < 0.0001) and Tigray (p < 0.0001) regions clustered spatially. Age from 15-29 and 30-39 years (Adjusted Odds Ratio 0.46(AOR = 0.46, CI: 0.36,0.60) and 0.77(AOR = 0.77, CI: 0.63,0.96), primary education level 1.57(AOR = 1.57, CI: 1.15,2.15), wealth index of middle and richer (1.71(AOR = 1.71, CI: 1.30,2.24) and 1.79(AOR = 1.79, CI: 1.34,2.41), family size > 5, 0.82(AOR = 0.82, CI: 0.69,0.96),respectively and regions Afar, Oromia, Somali, Benishangul Gumuz, SNNPR, Gambella, Harari, Addis Ababa and Dire Dawa was 0.002(AOR = 0.002, CI: 0.006,0.04), 0.11(AOR = 0.11, CI: 0.06,0.21) 0.02(AOR = 0.02, CI: 0.007,0.04), 0.04(AOR = 0.04, CI: 0.02,0.08), 0.09(AOR = 0.09, CI: 0.05,0.18),0.004(AOR = 0.004,CI:0.02,0.08),0.06(AOR = 0.06,CI:0.03,0.14), 0.07(AOR = 0.07, CI: 0.03,0.16) and 0.03(AOR = 0.03, CI: 0.02,0.07) times less likely utilize community based health insurance than the Amhara region respectively in Ethiopia. CONCLUSION: Community based health insurance coverage among households in Ethiopia was found very low still. The government needs to develop consistent financial and technical support and create awareness for regions with lower health insurance coverage.

The Co-Utilization of Oral Rehydration Solution and Zinc for Treating Diarrhea and Its Associated Factors Among Under-Five Children in Ethiopia: Further Analysis of EDHS 2016.

Introduction: Diarrhea causes a loss of body water and salt, which can lead to dehydration and death. The use of oral rehydration salts and zinc together is regarded as an effective treatment for diarrhea in resource-poor settings like Ethiopia. However, studies that examine the co-utilization of oral rehydration solution and zinc in the treatment of diarrhea are limited Ethiopia. Objective: To assess the prevalence and associated factors of oral rehydration solution and zinc co-utilization to treat diarrhea in children under the age of five in Ethiopia, EDHS 2016. Methods: Secondary data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used to investigate the prevalence and factors associated with the co-utilization of ORS and zinc to treat diarrhea in under-five children. A multilevel binary logistic regression model was fitted to identify factors associated with the co-utilization of ORS and zinc. Adjusted odds ratios (AOR) with 95% CI were calculated and used as a measure of associations, and variables having a p-value of less than 0.05 were declared as statistically significant. Results: The national prevalence of ORS and zinc co-utilization was 16.65% (14.66%, 18.84%). Maternal educational status (AOR = 1.45; 95% CI; (1.01, 2.09)), household size (AOR = 1.53; 95% CI; 1.09, 2.16) and distance to health facilities at the community level (AOR = 1.60, 95% CI = 1.02, 2.58) were variables significantly associated with the co-use of ORS and zinc. Conclusion: The co-utilization of ORS and zinc for the management of diarrhea was low in Ethiopia. Education, household size, and distance to health facilities at the community level were significantly associated with the co-utilization of ORS and zinc in Ethiopia.

Spatial variation and determinants of underweight among children under 5 y of age in Ethiopia: A multilevel and spatial analysis based on data from the 2019 Ethiopian Demographic and Health Survey.

OBJECTIVES: Childhood underweight is a critical public health problem that needs urgent attention in developing countries like Ethiopia. Despite its variation between localities, the determinant factors and its geospatial variation have not been adequately addressed across the various regions of the country. Therefore, the aim of this study was to investigate the spatial variation and determinant factors of underweight among children under 5 y of age in Ethiopia. METHODS: The total weighted samples of 5753 children aged <5 y were included in this study. The data were taken from the 2019 Ethiopian Demographic and Health Survey (EDHS 2019). Arc GIS software was used to analyze geospatial variations to identify the hot- and cold spot areas of underweight in Ethiopia. A multilevel multivariable logistic regression model was used to identify the determinant factors of underweight. Excel, STATA-16, and ArcGIS software were used for the data management and analysis. In the multivariable multilevel analysis, adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to declare significant determinants of underweight among children aged <5 y. RESULTS: Among 5753 children aged <5 y in Ethiopia, 21.3% were underweight during the 2019 EDHS. The distribution showed that there was a geospatial variation of underweight among children aged <5 y in Ethiopia; the Global Moran's index value was 0.36 with P < 0.001. In multivariable multilevel analysis, the significant factors associated with underweight were the sex of the child (aOR, 1.25; 95% CI, 1.09-1.44); age of the child, with the highest odds of being underweight observed in the age group of 24 to 35 mo (aOR, 3.52; 95% CI, 2.60-4.74); wealth index, with poorer children having higher odds of being underweight (aOR, 2.25; 95% CI, 1.58-3.24); and the regions, with the highest odds of underweight was observed in Tigray (aOR, 5.63; 95% CI, 2.79-11.36) and Afar (aOR, 4.71; 95% CI, 2.33-9.51). CONCLUSIONS: Underweight has significant spatial variation in Ethiopia, with spatial clustering in the northern and eastern parts of the country. It is recommended that in regions like Tigray, Afar, and Somali, as well as some areas in Gambella, priority steps be taken to reduce the burden of underweight in children aged <5 y. Thus, nutritional intervention programs should be strengthened and intervention strategies developed, with special emphasis on families with poor wealth index in the hotspot areas.

The effect of gestational age, low birth weight and parity on birth asphyxia among neonates in sub-Saharan Africa: systematic review and meta-analysis: 2021.

BACKGROUND: Despite simple and proven cost-effective measures were available to prevent birth asphyxia; studies suggested that there has been limited progress in preventing birth asphyxia even in healthy full-term neonates. In Sub-Saharan Africa, Inconsistency of magnitude of birth asphyxia and its association gestational age, Low birth Weight and Parity among different studies has been observed through time. OBJECTIVE: This study aimed to estimate the Pooled magnitude of birth asphyxia and its association with gestational age, Low birth Weight and Parity among Neonates in Sub-Saharan Africa. METHOD: PubMed, Cochrane library and Google scholar databases were searched for relevant literatures. In addition, reference lists of included studies were retrieved to obtain birth asphyxia related articles. Appropriate search term was established and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Sub-Saharan africa and published in English language. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Heterogeneity across the included studies was evaluated by using the inconsistency index (I2) test. Funnel plot and the Egger's regression test were used to test publication bias. A weighted inverse variance random effects- model was used to estimate the pooled prevalence of birth asphyxia among neonates in Sub-Saharan Africa. STATA™ version 11softwarewasused to conduct the meta-analysis. RESULT: A total of 40 studies with 176,334 study participants were included in this systematic review and meta-analysis. The overall pooled magnitude of birth asphyxia in Sub-Saharan Africa was 17.28% (95% CI; (15.5, 19.04). low birth weight (AOR = 2.58(95% CI: 1.36, 4.88)), primigravida (AOR = 1.15 (95% CI: 0.84, 1.46) andMeconium-stained amniotic fluid (AOR = 6(95% CI: 3.69, 9.74)) werevariables significantly associated with the pooled prevalence of birth asphyxia. CONCLUSION: The pooled magnitude of birth asphyxia was found to be high in Sub-Saharan Africa. Low birthweight and Meconium-stained amniotic fluid were variables significantly associated with birth asphyxia in Sub-Saharan Africa. Hence, it is better to develop early detection and management strategies for the affected neonates with low birth weight and born from mothers intrapartum meconium stained amniotic fluid.