Factors associated with compliance with weekly iron and folic acid supplementation among school adolescent girls in Debub Achefer district, northwest Ethiopia: school-based cross-sectional study.

Iron deficiency anemia is a public health problem among adolescents that could be addressed by weekly Iron Folic Acid Supplementation (IFAS). The Ethiopian government piloted weekly IFAS in schools, where its effectiveness depends on compliance. We assessed the determinants of compliance with the weekly IFAS in Ethiopia. A school-based survey was conducted in 506 adolescent girls on weekly IFAS. Compliance was considered when girls reported WIFAS for at least three months without discontinuation. Bivariable and multivariable logistic regression models were modeled, with odds ratios reported. Out of 506, 25.8% had limited access to educational resources, and 79.4% had no information on IFAS. Among these, 47.9% (95% CI: 45.5-49.9%) had poor compliance with weekly IFAS. Non-compliance was mainly due to school absenteeism (55.9%). Important predictors of poor compliance were adolescent girls' marital status (AOR = 5.21; 1.55-17.6), academic standing (AOR = 4.37; 2.20-8.70), family income (AOR = 1.85; 1.09-3.15), access to health education materials (AOR = 1.57; 1.02-2.40), problems with IFAS (AOR = 2.44; 1.26-4.74), a discouraging home environment for the program (AOR = 2.27; 1.54-3.34), and a lack of knowledge of the IFAS program (AOR = 1.40; 0.97-2.03). Compliance with weekly IFAS is optimal, which could be improved via strong adherence support and feasible supplementation schedules.

Patterns of basic pneumococcal conjugated vaccine coverage in Ethiopia from 2015 to 2018; further analysis of Ethiopian DHS (2016-2019).

Background: Geographic variation is crucial in spotting performance gaps in immunization programs, including the Pneumococcal Conjugated Vaccine (PCV). This will help speed up targeted vaccination and disease elimination programs in resource-limited countries. Thus, this study aimed to investigate the geographic variation and determinants of PCV vaccination coverage among children aged under five years old in Ethiopia. Methods: This analysis was carried out based on the 2016 and 2019 nationally representative Ethiopia Demographic and Health Survey (EDHS). We included two surveys of 10,640 children aged 12-23 months. The spatial analysis also covered 645 and 305 clusters with geographical information for both 2016 and 2019, respectively. We explored the spatial distribution, global spatial autocorrelation, spatial interpolation, and Stats Can windows of children with PCV-3 vaccination. P-values were generated using 999 Monte Carlo simulations to identify statistically significant clusters. To understand the coverage of PCV-3 in all areas of the country, we employed the ordinary Kriging interpolation method to estimate the coverage in unsampled areas. We also used hierarchical multivariate logistic regression to identify the factors associated with the utilization of the PCV vaccine (full vaccination). Results: Except for Addis Ababa, children in all regions have lower odds of receiving all three PCV vaccines compared to the Tigray region. Residence, sex of a child, mother's literacy status, household wealth index, and place of delivery were significant factors associated with receiving the third dose of PCV. Spatial analysis also showed the Somali and Afar regions had the lowest coverage, while the Addis Ababa and Tigray regions had higher coverage in both surveys. Conclusion: Even though the coverage of the full PCV vaccine improved from 2016 to 2019, variation was observed among regions and between rural and urban areas. The wealth index and educational status of mothers were the most important determinants of PCV vaccine utilization. Hence, the mass campaign might boost coverage in nomadic and semi-nomadic regions and rural areas. Similarly, programs that narrow the gap due to low socioeconomic differences should be formulated and implemented to increase uptake and general coverage.

The burdens, associated factors, and reasons for traditional uvulectomy in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Traditional uvulectomy is a harmful procedure in which the entire or a portion of the uvula is removed by traditional practitioners. It causes complications like septicemia, transmission of infectious diseases, anemia, excessive bleeding, infection, tetanus, meningitis, and death. A summary of national data was lacking, thus, the study aimed to determine the pooled national burden and determinants of traditional uvulectomy in Ethiopia. METHODS: Studies were retrieved from PubMed, EMBASE, CINHAL (EBSCO), Google Scholar, Web of Sciences, MEDLINE, Cochrane Library, SCOPUS, and Google databases. Finally, 19 studies were included. The methodological quality of the included studies was assessed using the JBI checklist. Data synthesis and statistical analysis were conducted using STATA Version 17 software. Heterogeneity and publication bias were assessed. Forest plots were used to present the pooled and summarized with random-effects meta-analysis models. RESULTS: Totally 19 articles with 23,559 study participants were included in this systematic review and meta-analysis. The overall pooled prevalence of uvulectomy in Ethiopia was 44 % (95 % CI: 31%-57 %). The highest prevalence was observed among studies conducted in the Tigray region (63 % (95 % CI: 34%-94 %), between the year 2011-2014 (58 % (95 % CI: 29%-87 %)) and, community setting (57 % (95 % CI: 36%-78 %). Mothers' educational status (AOR: 1.66, 95 % CI: 1.31-2.01) and residence (AOR: 1.70, 95 % CI: 1.16-2.23) were found to be significantly associated with traditional uvulectomy in Ethiopia. Frequently cited reasons for traditional uvulectomy were to prevent swelling, pus, and rupture of the uvula, for better care, prevention of sore throats and coughs, religion, and culture. CONCLUSION: The pooled result revealed that almost half of children are still subjected to traditional uvulectomy in Ethiopia. There is a need to intensify awareness creation campaigns against the practice by giving special attention to rural residents and uneducated ones.

Parents' intention toward early marriage of their adolescent girls in eastern Ethiopia: A community-based cross-sectional study from a social norms perspective.

Background: Strong social norms around early marriage put pressure on parents to marry off their adolescent girls at an early age. Early marriage is widely practiced in many parts of Ethiopia. However, early marriage studies rarely address the role of social norms. This study aims to examine the role of social norms on parents' intention to marry off adolescent girls early in Eastern Ethiopia. Method: A community-based cross-sectional study was conducted from September to November 2019. A multistage sampling procedure was applied to select the study participants. Factors related to parents' intention for early marriage were assessed through the lens of the Theory of Planned Behavior (TPB). Adjusted Prevalence Ratio (PR) was calculated using a log-binomial model to identify factors associated with intention toward early marriage. Results: A total of 859 mothers and 859 fathers of unmarried girls were included in the study. The prevalence of intention to marry off their daughter early among mothers was 39.70% (95% CI = 36.4-43.0%) and 43.54% (95%CI = 40.2-47.1%) among fathers of adolescent girls [chi2(1) = 41.8; P < 0.001]. The intention for an early marriage was higher among mothers and fathers with favorable attitude towards early marriage, in those who believe that most people in their reference group conform to early marriage norms (empirical expectation), in those who believe that most people in their reference group expect them to conform to early marriage norms (normative expectation) and among fathers who did not know the legal age of marriage for adolescent girls and those who did not know the health consequences of early marriage. The prevalence of intention toward early marriage was lower among mothers (APR = 0.49; 95% CI: 0.36-0.65) and fathers (APR = 0.62; 95% CI: 0.49-0.78) in urban areas; and among mothers (APR = 0.41; 95% CI: 0.27-0.62) and fathers (APR = 0.50; 95% CI: 0.38-0.67) with higher educational level. Conclusion: The social norms that promote intention for early marriage are still high among parents, especially among those living in rural areas and uneducated. Hence, interventions that aim to reduce early marriage need to address locally relevant social norms.

Early Marriage among young girls in Eastern Ethiopia: trend during 2008-2018.

Early marriage practices undermine girls' autonomy and seriously affect their physical and mental wellbeing. Monitoring the trends and understanding the drivers is essential in intervening against early marriage. However, many studies on early marriage in Ethiopia are cross-sectional, focusing only on the magnitude at a single point in time. Hence, we extracted data of girls of 10-17 years from Kersa Health and Demographic Surveillance System (Kersa HDSS) database for the period of 2008-2018 in order to examine the trends of early marriage. In this data note we provide the details of a research database of 24,452 girls in the age group of 10-17 years. The extracted data include date of marriage and the girls' socio-demographic variables. Other variables considered to be potentially associated with timing of marriage were also extracted. The purpose of this publication is to describe the dataset for external researchers who may be interested in making use of it as a secondary use of their routinely collected data. This dataset is available at    https://doi.org/10.6084/m9.figshare.15034812.