Prevalence, spatial variation and determinants of zero-dose children in Ethiopia: Spatial and multilevel analyses.

OBJECTIVES: Vaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. STUDY DESIGN: A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. METHODS: The study included a total of 1334 children aged 12-35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. RESULTS: The prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples' Region) regions had high zero-dose proportions. Maternal age 15-19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. CONCLUSIONS: The prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases.

Pregnancy termination and determinant factors among women of reproductive age in Kenya, evidence from Kenyan Demographic and Health Survey 2022: Multilevel analysis.

BACKGROUND: Pregnancy termination is one of the common causes of maternal mortality, particularly in developing countries, and remains a global public health concern despite the efforts made to enhance maternal healthcare services. Maternal mortality is still the highest in sub-Saharan Africa, including Kenya, due to pregnancy termination. OBJECTIVES: This study aimed to investigate the current burden of pregnancy termination and its determinants among reproductive-age women in Kenya. DESIGN: A cross-sectional study design with multilevel analysis. METHODS: The total weighted samples of 19,530 women of reproductive age were included in this study. The data were taken from the Kenyan Demographic and Health Survey 2022. A multilevel multivariable logistic regression model was used to identify the determinant factors of pregnancy termination. In the multivariable multilevel analysis, the adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare significant determinants of pregnancy termination among women of reproductive age. RESULTS: The overall prevalence of pregnancy termination among women of reproductive age in Kenya was 14.19%. The determinant factors associated with pregnancy termination were the age of the women; as age increased, the risk of pregnancy termination increased, 25-29 years (AOR = 2.23; 95 CI (1.08-4.60)), 30-34 years (AOR = 2.98; 95% CI (1.43-6.18)), 35-39 years (AOR = 3.24; 95% CI (1.55-6.76)), 40-44 years (AOR = 4.57; 95% CI (2.16-9.68)), 45- 49 years (AOR = 5.16; 95% CI (2.33-9.98)); marital status: married (AOR = 5.63; 95% CI (3.08-10.29)), ever married (AOR = 5.05; 95% CI (2.74-9.33)); wealth index: richest (AOR = 1.32; 95% CI (1.05-1.63)); employment status: employed (AOR = 1.23; 95% CI (1.09-1.38)); preceding birth interval: greater than 24 months (AOR = 1.21; 95% CI (1.06-1.38)); urban residence (AOR = 1.25; 95% CI (1.06-1.46)); and Islamic followers (AOR = 1.64; 95% CI (1.31-2.06)). CONCLUSION: Pregnancy termination among women of reproductive age in Kenya has become an important public health concern. Policymakers and other stakeholders should focus on maternal healthcare service programs to prevent the termination of pregnancy. The determinant factors are an important input to developing strategies to improve the accessibility of maternal healthcare services in the country.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey.

Introduction: Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data. Methods: Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant. Results: The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use. Conclusion: Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

Intimate partner violence and associated factors among women during the COVID-19 pandemic in Ethiopia: a systematic review and meta-analysis.

Background: During the Coronavirus Disease 2019 (COVID-19) pandemic, intimate partner violence increased globally, but most notably in Africa. Conditions such as movement restrictions, staying home, and school closures increased the risk of domestic violence against women. Intimate partner violence is violence demonstrated by an intimate partner against women including physical, sexual, and psychological violence. Despite existing laws against intimate partner violence in Ethiopia, enforcement by law and the judicial system remains inadequate. Thus, this research aims to identify factors contributing to intimate partner violence among women during the COVID-19 pandemic, drawing insights from the current literature. Method: We searched electronic databases, including PubMed, Google Scholar, CINAHL, Cochrane, and others. Two reviewers separately carried out the search, study selection, critical appraisal, and data extraction. A third party was involved in resolving disagreements among the reviewers. All 10 studies included in this study were published in English, with publication dates before 25 February 2024. Articles lacking an abstract and/or full-text, studies that did not identify the intended outcome, and qualitative studies were excluded from the analysis. A Microsoft Excel checklist was used to extract the data, which were then exported to STATA 11. I 2, funnel plots, and Egger's test were employed to measure heterogeneity and detect publication bias, respectively. A random-effects model was used to estimate the pooled prevalence of intimate partner violence and associated factors among women during the COVID-19 pandemic. Result: The meta-analysis includes a sample size of 6,280 women from 10 articles. The pooled prevalence of intimate partner violence and associated factors among women during the COVID-19 pandemic was found to be 31.60% (95% CI: 21.10-42.11) and significant factors were partner alcohol use with a pooled odds ratio of 1.93 (95% CI: 1.60-2.23), income loss during the COVID-19 pandemic with a pooled odds ratio of 9.86 (95% CI: 6.35-15.70), partner's literacy level/education status with a pooled odds ratio of 2.03 (95% CI: 1.57-2.63), and decision-making in the household with a pooled odds ratio of 1.82 (95% CI: 1.33-2.50). Conclusion: This systematic review and meta-analysis found preliminary evidence that intimate partner violence increased during the COVID-19 pandemic. A partner who has a history of alcohol use, women who had lost income during COVID-19, a partner who has no formal education, and household decisions made by the husband alone were statistically significant factors for intimate partner violence during the COVID-19 pandemic. This implies that the health sector must play a significant role in providing women who are victims of violence with comprehensive healthcare, advocating that violence against women should be viewed as unacceptable, and improving literacy to minimize the consequences of intimate partner violence among women.

Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Infectious diseases remain the leading causes of death in low and middle-income countries including Ethiopia. The existence of emerging, re-emerging, and drug-resistant infectious agents maximizes the importance of infection prevention and control. Healthcare workers are the key actors in the prevention and control of infection. As a result assessing the knowledge, attitude, and practice of healthcare workers toward infection prevention and control is very critical in the prevention and control of infectious diseases. Therefore, this systematic review and meta-analysis aimed to assess the knowledge, attitude, and practice of healthcare providers toward infection prevention in Ethiopia. METHOD: PubMed, Scopus, SEMANTIC SCHOLAR, Google Scholar, and Addis Ababa University Digital Library were systematically searched for relevant literature until November 18/2023. The quality of the included studies was assessed using the Joanna Briggs Institute quality appraisal tool. Data were abstracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11. A random-effects model was used to estimate the pooled prevalence. Heterogeneity among reported studies was assessed by Forest plot, Cochran's Q-statistics, and I2 test. Publication bias was checked using funnel plots, and Egger's regression test. In addition, sub-group and sensitivity analyses were conducted. RESULT: A total of 7,681 articles were retrieved of which 19 studies with 5,650 healthcare workers were included in this systematic review and meta-analysis. About 74.5% (95% CI, 65.88, 83.12), 66.71% (95% CI 55.15, 78.28), and 55.2% (95% CI 48.22, 62.18) of healthcare workers were knowledgeable, had positive attitudes, and good standard of practice on infection prevention respectively. CONCLUSION: Despite acceptable knowledge and attitude, about half of the healthcare workers have unsafe infection prevention and control practices in Ethiopia. Hence, serious attention should be given to healthcare workers' application of infection prevention standards in their working environment.

Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses.

BACKGROUND: Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern. METHODS: Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant. RESULTS: Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood. CONCLUSION: Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.

Ethiopian women's tokophobia of childbirth and its predictors: a systematic review and meta-analysis.

Background: Fear of childbirth is recognized as a growing problem in developing countries, including Ethiopia. The impact of this fear on women's reproductive choices and decisions is significant. Therefore, the systematic review and meta-analysis will help to consolidate the existing research on childbirth-related fear in Ethiopia. Synthesizing the findings and providing a pooled prevalence estimate, can contribute to a better understanding of the scale of the problem in the country. Objective: This systematic review and meta-analysis assessed the pooled prevalence of childbirth-related fear and its associated factors among pregnant mothers in Ethiopia. Methods: PubMed, Google Scholar, and African Journals Online were searched for included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of childbirth-related fear. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific region where the study was conducted. Funnel plot and Egger's regression test were used to check for publication bias. STATA version 14 statistical software was used for meta-analysis. Results: A total of 2,015 pregnant mothers were included. The combined prevalence of fear of childbirth among pregnant mothers was found to be 21% (95% CI: 19-22; I 2 = 0.00%, p value < 0.001). Based on the subgroup analysis, the prevalence of fear of childbirth among pregnant mothers was 24% in SNNPRs, 25% in Oromia, and 11% in Addis Ababa. Conclusion: The findings of the meta-analysis indicating a high prevalence of fear of childbirth among pregnant mothers in Ethiopia and identifying associated risk factors highlight the importance of addressing this issue within the healthcare system. Integrating prevention-based services for mothers with childbirth fears into the antenatal care model could be a valuable approach to support women and mitigate the impact of fear on their reproductive experiences. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/#myprospero, identifier [CRD42023411103].

Early neonatal mortality and determinants in Ethiopia: multilevel analysis of Ethiopian demographic and health survey, 2019.

INTRODUCTION: Despite remarkable achievements in improving maternal and child health, early neonatal deaths still persist, with a sluggish decline in Ethiopia. As a pressing public health issue, it requires frequent and current studies to make appropriate interventions. Therefore, by using the most recent Ethiopian Mini Demographic Health Survey Data of 2019, we aimed to assess the magnitude and factors associated with early neonatal mortality in Ethiopia. METHODS: Secondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2019. A total weighted sample of 5,753 live births was included for this study. A multilevel logistic regression model was used to identify the determinants of early neonatal mortality. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant. RESULTS: The prevalence of early neonatal mortality in Ethiopia was 26.5 (95% Cl; 22.5-31.08) per 1000 live births. Maternal age 20-35 (AOR, 0.38; 95% Cl, 0.38-0.69), richer wealth index (AOR, 0.47; 95% Cl, 0.23-0.96), having no antenatal care visit (AOR, 1.86; 95% Cl, 1.05-3.30), first birth order (AOR, 3.41; 95% Cl, 1.54-7.56), multiple pregnancy (AOR, 18.5; 95% Cl 8.8-38.9), presence of less than two number of under-five children (AOR, 5.83; 95% Cl, 1.71-19.79) and Somali region (AOR, 3.49; 95% Cl, 1.70-12.52) were significantly associated with early neonatal mortality. CONCLUSION: This study showed that, in comparison to other developing nations, the nation had a higher rate of early newborn mortality. Thus, programmers and policymakers should adjust their designs and policies in accordance with the needs of newborns and children's health. The Somali region, extreme maternal age, and ANC utilization among expectant moms should all be given special consideration.

Spatial Variation and Determinants of Inadequate Minimum Meal Frequency among Children Aged 6-23 Months in Ethiopia: Spatial and multilevel analysis using Ethiopian Mini Demographic and Health Survey (EMDHS) 2019.

Introduction: Minimum meal frequency is the number of times children eat in a day. Without adequate meal frequency, infants and young children are prone to malnutrition. There is little information on the spatial distribution and determinants of inadequate meal frequency at the national level. Therefore, we aimed to investigate the spatial distribution and determinants of inadequate meal frequency among young children in Ethiopia. Methods: The most recent Ethiopian demographic and health survey data was used. The analysis was conducted using a weighted sample of 1,610 children aged 6-23 months old. The Global Moran's I was estimated to assess the regional variation in minimum meal frequency. Further, a multivariable multilevel logistic regression model was fitted to identify factors associated with inadequate meal frequency. The AOR (adjusted odds ratio) at 95% CI (confidence interval) was computed to assess the strength and significance of the relationship between explanatory variables and the outcome variable. Factors with a p-value of <0.05 are declared statistically significant. Results: This study revealed that the prevalence of inadequate meal frequency was found to be 30.56% (95% CI: 28.33-32.88). We identified statistically significant clusters of high inadequate meal frequency, notably observed in Somalia, northern Amhara, the eastern part of southern nations and nationalities, and the southwestern Oromia regions. Child age, antenatal care (ANC) visit, marital status, and community level illiteracy were significant factors that were associated with inadequate meal frequency. Conclusion: According to the study findings, the proportion of inadequate meal frequency among young children in Ethiopia was higher and also distributed non-randomly across Ethiopian regions. As a result, policymakers and other concerned bodies should prioritize risky areas in designing intervention. Thus, special attention should be given to the Somalia region, the northern part of Amhara, the eastern part of Southern nations and nationalities, and southwestern Oromia.

Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data.

Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.

Tinea capitis and its associated factors among school children in Gondar town northwest, Ethiopia.

INTRODUCTION: Tinea capitis is a global public health concern with a unique therapeutic challenge and mostly affects children. The burden is double in developing countries. There is no study on school-going children from the urban residence in Ethiopia. OBJECTIVE: To determine the prevalence of Tinea capitis and its associated factors among school children in Gondar town northwest, Ethiopia 2021. METHODS: An institution-based cross-sectional study was conducted among school children in Gondar town from November 20 to December 20, 2021. Data was collected through an interviewer-administered structured questionnaire. A stratified simple random sampling technique was employed. Then data were entered into EPI Info version 7.22 and transferred to Statistical package for social science (SPSS) version 22 for further analysis. The binary logistic regression model was employed to identify factors associated with tinea capitis, and the strength of association and statistical significance was declared using the adjusted odds ratios with its corresponding 95% CI, and p-value ≤ 0.05 respectively. RESULT: The prevalence of tinea capitis among school children in Gondar town was found to be 29.4%. Public school student (AOR = 2.79 95% CI: 1.34-5.87), widowed mother (AOR = 6.09, 95% CI: 1.83-11.23), students in the age group of 5-8 years (AOR = 3.79 95% CI: 1.68-8.55), animal contact (AOR = 2.61 95% CI: 1.15-5.90), and family similar illness category (AOR = 8.49 95% CI: 3.73-11.39) have risen the likelihood of tinea capitis among school children. CONCLUSIONS: The prevalence of tinea capitis was higher. Young age, children from widowed marital status, illiterate mother, history of share blades, animal contact, a family similar illness, and lower number of living rooms are important factors contributing to tinea capitis among school children. Health education for the mother on the mode of transmission, prevention, and improve the low socioeconomic status of the parent is crucial. KEY TERMS: Children, Ethiopia, Gondar, School age, Tinea capitis.

Spatial distribution and determinants of measles vaccination dropout among under-five children in Ethiopia: A spatial and multilevel analysis of 2019 Ethiopian demographic and health survey.

BACKGROUND: Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia. METHODS: Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. RESULTS: In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout. CONCLUSIONS: Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia.

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.

Determinants of preterm birth among reproductive age women in sub-Saharan Africa: Evidence from the most recent Demographic and Health Survey data-2019-2022.

INTRODUCTION: Preterm birth is the leading cause of both infant and neonatal mortality. It also had long-term consequences for the physical and neurological development of a growing child. The majority of these and related problems occur in low- and middle-income countries, particularly in sub-Saharan Africa, due to resource scarcity to sustain the lives of premature babies. Despite this, there is a paucity of recent information on the pooled prevalence and factors associated with preterm birth in sub-Saharan Africa. Therefore, this study aimed to update the pooled prevalence and determinants of preterm birth in sub-Saharan Africa based on the most recent Demographic and Health Survey data. METHODS: A cross-sectional study design using the most recent demographic and health survey data from eight sub-Saharan African countries was used. We included a total weighted sample of 74,871 reproductive-aged women who gave birth in the five years preceding the survey. We used a multilevel logistic regression model to identify associated factors of preterm birth in sub-Saharan Africa. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant. RESULTS: In this study, the pooled prevalence of preterm birth among reproductive-aged women in eight sub-Saharan African countries was 3.11% (95% CI: 2.98-3.25). Working mothers (AOR = 0.61; 95% CI: 0.38-0.97), being married (AOR = 0.63; 95% CI: 0.40-0.99), and having media exposure (AOR = 0.59; 95% CI: 0.36-0.96) decrease the odds of preterm birth. On the other hand, being low birth weight (AOR = 17.7; 95% CI: 10.7-29.3), having multiple pregnancies (AOR = 3.43; 95% CI: 1.82-6.45), having a history of terminated pregnancies (AOR = 1.56; 95% CI: 1.01-2.41), being un-educated (AOR = 3.16; 95% CI: 1.12-8.93), being of a maternal age above 35 (AOR = 1.63; 95% CI: 1.08-2.45), maternal alcohol use (AOR = 19.18; 95% CI: 13.6-38.8), and being in the low socio-economic status (AOR = 1.85; 95% CI: 1.11-3.07) of the community increase the odds of preterm birth. CONCLUSION: The burden of preterm birth among reproductive-age women in sub-Saharan Africa showed improvements as compared to previous findings. To further lessen the burden, policymakers and other pertinent organizations must prioritize maternal health, expand media access, educate and empower women, and promote a healthy lifestyle for reproductive-age women.

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.

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.

Coverage and determinants of second-dose measles vaccination among under-five children in East Africa countries: a systematic review and meta-analysis.

Background: One of the biggest breakthroughs of contemporary medicine is measles vaccination. It is essential for the total elimination of measles. Understanding the magnitude and determinants of effective second-dose measles vaccination coverage is a critical task. Accordingly, we set out to check the best available evidence of the pooled second-dose measles vaccination coverage among under-five children in East Africa. Method: We searched electronic databases such as PubMed, Google Scholar, Cochrane, and others. Two reviewers separately carried out the search of the Joanna Briggs Institute, selection of studies, critical appraisal, and data extraction. A third party was involved in resolving the disagreement among the reviewers. Seven studies included in this study, four from Ethiopia, two from Kenya, and one from Tanzania were cross-sectional and published in English language, with publication dates before 29 November 2023. Articles lacking full-text, the intended outcome, and that are not qualitative studies were excluded from the analysis. The Microsoft Excel checklist was used to extract the data and then exported to STATA 11. In addition, I2, Funnel plots, and Egger's test were employed to measure heterogeneity and detect publication bias, respectively. A random effect model was used. Result: The meta-analysis includes a total sample size of 4,962 children from seven articles. The pooled prevalence of second-dose measles vaccination among under-five children in East Africa was found to be 32.22% [95% CI; (18.82, 45.63)], and the significant factors were as follows: birth order (1.72; OR = 95% CI: 1.32, 2.23), information about measles-containing second-dose vaccine (MCV 2) (7.39; OR = 95% CI: 5.21, 10.50), mother's marital status (1.47; OR = 95% CI: 1.05, 2.07), complete immunization for other vaccines (2.17; OR = 95% CI: 1.49, 3.17), and distance of vaccination site (3.31; OR = 95% CI: 2.42, 4.53). Conclusion: The current study found that pooled prevalence of second-dose measles vaccination coverage among under-five children was still very low. It was also observed that birth order, distance of the vaccination site, complete immunization for other vaccines, mother's marital status, and information about MCV were factors associated with second-dose measles vaccination. These factors imply that there is a need for countries and their partners to act urgently to secure political commitment, expand primary health service and health education, and increase vaccination coverage.

Rotavirus vaccine dose-two dropout and its associated factors among children who received rotavirus vaccine dose-one in Sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey.

Rotavirus is the most common cause of diarrhea in children worldwide. In 2016, rotavirus infection resulted in 258 173 300 episodes of diarrhea and 128 500 child deaths in the globe. The study aimed to assess the magnitude of Rotavirus vaccine dose-two dropout and associated factors among children who received rotavirus vaccine dose-one in sub-Saharan African countries. The appended and most recent demographic and health survey (DHS) dataset of 17 sub-Saharan African countries was used for data analysis. A total of 73,396 weighted samples were used. Factors associated with the outcome variable were considered significant if their p-values were ≤ .05 in the multilevel mixed-effect logistic regression model. The overall Rotavirus vaccine dose-two dropouts was 10.77% (95% CI 10.55%, 11.00%), which ranged from 2.77% in Rwanda to 37.67% in Uganda. Being younger, late birth order, having difficulty accessing health facilities, having no media exposure, having no work, having home delivery, having no antenatal follow-up, and having no postnatal checkup were factors significantly associated with the outcome variable. The overall Rotavirus vaccine dose-two dropout was higher in sub-Saharan African countries which implies that vaccine dropout is still a great issue in the region. Special attention should be given to those mothers who are young, who have no work, who give birth at home, who experienced difficulty in accessing health facilities, and late birth orders. Furthermore, targeted interventions should be considered for improving access and utilization of media, antenatal care, and postnatal care services.

Survey of knowledge, practice, and associated factors toward home management of childhood fever among parents visiting Gondar health facilities in 2022.

Background: Fever is a typical symptom of many sicknesses, but for children under the age of five, fever can have devastating consequences and represents a source of worry for parents. To the best of our knowledge, no research on home management of fever in children has been conducted in Ethiopia. We aimed to assess knowledge, practices, and associated factors towards home management of childhood fever among parents visiting Gondar Town health facilities in 2022. Method: This multicenter institutional-based cross-sectional study was conducted in Gondar public health facilities from June 1st-June 30th, 2022. Participants were fathers and mothers of children aged 0-5 years. A stratified random sampling technique was used. Data were collected through face-to-face interviews using a pretested structured questionnaire. Results: Approximately, 40.2% (95% CI: 35.5%, 45.2%) of parents had good knowledge and only 12.8% (95% CI: 9.7-15.8) of parents practiced home fever management. Being married [Adjusted odds ratio [(AOR) = 2.1 (1.2, 3.2)], having a primary or higher level of education [AOR = 2.4 (1.17, 4.9)] [AOR = 2.0 (1.02-4.6)], respectively, and number of children [AOR = 1.8 (1.63, 2.03)] were factors associated with parental knowledge. Likewise, being married [AOR = 3.05 (2.27.50-3.83)], receiving counseling from health care providers [AOR = 2.12 (1.53-3.32)], and being male [AOR = 2.03 (1.50-3.00)] were significant predictors of practice. Conclusion: Inadequate levels of knowledge and numerous irrational practices related to home fever management were predominant among parents, which needs to be addressed. Evidence-based health education is essential for parents to enhance their level of knowledge and practice to effectively treat fever at home.