Magnitude and associated factors of unmet need for family planning among reproductive-aged women in Ethiopia: An umbrella review.

INTRODUCTION: The World Health Organization defines women with an unmet need for family planning as individuals who are fecund, sexually active, and wanting to either to limit childbirth or postpone their next birth but are not utilizing any form of contraception. Previous meta-analyses and systematic reviews have focused on this topic, but no comprehensive summary of the evidence was available. Therefore, the aim of this study was to provide a summary of the findings on the unmet need for family planning among reproductive-aged women in Ethiopia. METHOD: A search was conducted in PubMed, Google Scholar, CINAHL, Scopus, Cochrane Library, and RESEARCH 4 LIFE including Hinari, to identify relevant systematic reviews and meta-analyses of studies on the prevalence and determinants of the unmet need for family planning in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews tool, and the estimates were pooled using a random-effects meta-analysis model. RESULTS: The umbrella review included five studies with a total of 56,169 reproductive-aged women. The pooled prevalence of unmet need for family planning was found to be 27.44% (95% CI: 22.32-32.55), with the heterogeneity index (I square = 99.45%, P = 0.000). Failure to discuss with her partner about family planning methods (OR: 2.90, 95% CI: 1.81, 4.00), being illiterate (OR: 2.17, 95% CI: 1.42, 2.92), age at first marriage (OR: 1.37, 95% CI: 1.30, 1.44), and educational status of woman's partner (OR: 2.61, 95% CI: 0.83, 4.40) were the factors significantly and positively associated with unmet needs for family planning. CONCLUSION: The study concludes that the unmet need for family planning in Ethiopia is a significant issue that can be addressed through increasing the educational levels of women and their partners, promoting open discussions about family planning, and preventing early marriages. Collaboration between families, school administrators, and healthcare providers is essential to mitigating this problem.

Nonpneumatic anti-shock garment utilization for obstetric hemorrhage management and its predictors among obstetric care providers in Ethiopia: a systematic review and meta-analysis.

INTRODUCTION: Non-pneumatic Anti-Shock Garment (NASG) is a lightweight, reusable first aid compression device that squeezes blood from the lower extremities and centralizes blood circulation to vital organs of the body. Postpartum hemorrhage followed by severe preeclampsia/eclampsia is the leading primary cause of maternal death (A reduction in extreme maternal adverse outcomes and faster recovery from shock are more likely to occur with earlier NASG intervention. The median blood loss reduced by half when the NASG was used for obstetric hemorrhage management, which was associated with significantly reduced maternal mortality among the most severe cases. OBJECTIVE: To estimate the pooled prevalence of NASG utilization and its predictors in Ethiopia. METHODS: Appropriate and comprehensive searches of PubMed, MEDLINE, EMBASE, Google Scholar, HINARI, and Scopus were performed. The electronic literature search was last performed on November 18/2023. All observational study designs were eligible for this SRMA. All cross sectional studies reporting the prevalence/proportion of NASG utilization for obstetric hemorrhage management among obstetric care providers and associated factors were included in this SRMA. Primary studies lacking the outcome of interest were excluded from the SRMA. The extracted Microsoft Excel spreadsheet data were imported into STATA software version 17 (STATA Corporation, Texas, USA) for analysis. A random-effects model was used to estimate the pooled prevalence of NASG utilization among obstetric care providers in Ethiopia. The Cochrane Q-test and I2 statistics were computed to assess the heterogeneity among the studies included in the SRMA. RESULT: A total of 1623 articles were found by using our search strategies and seven studies comprising 2335 participants were ultimately included in the SRMA. The pooled prevalence of NASG utilization for obstetric hemorrhage in Ethiopia was 43.34% (95% CI: 35.25, 51.42%). The findings of this subgroup analysis by sample size showed that the pooled prevalence of NASG utilization for obstetric hemorrhage was greater in studies with sample sizes of less than the mean sample size (48.6%; 95% CI: 32.34, 64.86%). Receiving training (AOR = 3.88, 95% CI: 2.08-5.37), having good knowledge (AOR = 1.99, 95% CI: 1.28-3.16), positive attitude (AOR = 2.16, 95% CI: 1.62-2.75) and having available NASGs in the facility (AOR = 4.89, 95%CI: 2.88-8.32) were significantly associated with the use of NASGs for obstetric hemorrhage management. CONCLUSION: The level of NASG utilization for obstetric hemorrhage in Ethiopia is low. Receiving training, good knowledge, positive attitudes and availability of NASG were significantly associated with the utilization of NASG. Therefore, policy makers and other stakeholders should emphasize enhancing the knowledge and attitudes of obstetric care providers through continuous support and training. At the same time, they should work strictly in providing devices for all the health facilities.

Pre-conception folic acid and multivitamin supplementation for the prevention of Neural Tube Defect: An umbrella Review.

BACKGROUND: Previous reviews explored the association between maternal use of folic acid and multivitamin supplements and risk of Neural Tube Defect (NTD) in children, with no definitive conclusion. METHODS: Using PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported the effects of folic acid and/or multivitamin supplementation for the prevention of NTD in offspring were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed. RESULT: Ten SRM with 296,816 study participants were included. The random-effects model analysis revealed that, the pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD globally is found to be 0.43( 0.29, 0.58). In subgroup analysis the pooled effect found to be 0.23in folic acid group, while this estimate is 0.63 and 0.61in groups who took multivitamin. The pooled effect of prevention of NTD was found to be 0.50 in SRMs aimed at occurrence prevention group, while this estimate is 0.20) among SRMs which aimed at reoccurrence prevention, and 0.61 among those SRMs aimed to assess the effect folic acid or multivitamin for prevention of both occurrence and re-occurrence. The pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD was found to be 0.45 in SRMs of observational studies, while this estimate is 0.43among SRMs of randomized controlled trials. CONCLUSION: Prenatal folic acid and /or multivitamin supplementation was associated with a 57% reduction in NTD. Participants who took folic acid supplementation were associated with a slightly higher (77%) percentage of reduction in NTD. An 80% and 50% reduction were observed for re-occurrence and occurrence prevention of NTD. A 57% and 55% reduction of NTD have been found in SRM of RCTs and observational studies. Considering the incorporation of those supplements in NTD prevention strategies during pre-conception period is recommended. More large-scale prospective cohort and RCTs are needed.

Geospatial pattern of HIV seropositivity and its predictors among women in Ethiopia. A spatial and multiscale geographically weighted regression analysis.

BACKGROUND: Although promising efforts have been made so far, HIV remains a public health concern. Women in Ethiopia are disproportionately affected by HIV, accounting for a majority of new infections and AIDS-related deaths. However, the geospatial distribution of HIV among women in Ethiopia is not well understood, making it challenging to develop geographically targeted measures. Besides, to accelerate the pathway of decreasing HIV prevalence and plan geographically specific interventions, understanding the geospatial distribution of HIV seropositivity and its predictors among women plays a significant role. METHODS: A spatial and multiscale geographically weighted regression analysis was conducted using the 2016 EDHS dataset, comprising 14,778 weighted samples of women in the reproductive age group. The EDHS sample underwent two-stage stratification and selection. The data were extracted between October 18 and 30, 2023. Non-spatial analysis was carried out using STATA version 17. Additionally, ArcGIS Pro and Sat Scan version 9.6 were used to visually map HIV seropositivity. Global Moran's I was computed to evaluate the distribution of HIV seropositivity. The Getis-Ord Gi* spatial statistic was utilized to identify significant spatial clusters of cold and hot spot areas. Geographically weighted regression analysis was subsequently performed to identify significant predictors of HIV seropositivity. Significance was established at a P-value <0.05 throughout all statistical analyses. RESULTS: HIV seropositivity among women in Ethiopia is distributed non-randomly (Global Moran's I = 0.16, p-value <0.001 and Z-score = 7.12). Significant hotspot clustering of HIV seropositivity was found in the Addis Ababa, Harari, Dire Dawa, and Gambela region. Poor wealth index, being divorced and widowed, having more than one sexual partner, and early first sexual experience (<15 years) were found to be predictors of geographical variation of HIV seropositivity among women. CONCLUSION: HIV seropositivity among women in Ethiopia varies geographically. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on improving the economic empowerment of women to prevent the from engaging in risky sexual behaviors. Furthermore, comprehensive sex education programs in schools and community settings regarding the consequences of early first sexual debut might play a role in reducing HIV seropositivity among women in Ethiopia.

Virological outcomes of third-line antiretroviral therapy in a global context: a systematic reviews and meta-analysis.

BACKGROUND: Despite remarkable progress, HIV's influence on global health remains firm, demanding continued attention. Understanding the effectiveness of third-line antiretroviral therapy in individuals who do not respond to second-line drugs is crucial for improving treatment strategies. The virological outcomes of third-line antiretroviral therapy vary from study to study, highlighting the need for robust global estimates. METHODS: A comprehensive search of databases including PubMed, MEDLINE, International Scientific Indexing, Web of Science, and Google Scholar, was conducted. STATA version 17 statistical software was used for analysis. A random-effects model was applied to compute the pooled estimates. Subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also performed. The prediction interval is computed to estimate the interval in which a future study will fall. The GRADE tool was also used to determine the quality of the evidence. RESULTS: In this systematic review and meta-analysis, 15 studies involving 1768 HIV patients receiving third-line antiretroviral therapy were included. The pooled viral suppression of third-line antiretroviral therapy was 76.6% (95% CI: 71.5- 81.7%). The viral suppression rates at 6 and 12 months were 75.5% and 78.6%, respectively. Furthermore, third-line therapy effectively suppressed viral RNA copy numbers to ≤ 50 copies/mL, ≤ 200 copies/mL, and ≤ 400 copies/mL with rates of 70.7%, 85.4%, and 85.7%, respectively. CONCLUSION: More than three-fourths of patients on third-line antiretroviral therapy achieve viral suppression. Consequently, improving access to and timely initiation of third-line therapy may positively impact the quality of life for those with second-line treatment failure.

Umbrella review protocol: Global burden and risk factors of erectile dysfunction in diabetic population.

Background: Erectile dysfunction (ED) is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of ED and associated risk factors among diabetic patients in the global context. Methods: Following PRISMA guidelines will be searched for relevant Systematic Review and Meta-analysis studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The quality of the included studies will be assessed using the new regress tool, the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of ED, we will employ a weighted inverse variance random-effects model. We will further conduct subgroup analyses, assess heterogeneity and publication bias, and perform sensitivity analyses to strengthen the robustness of our findings. Prediction intervals will also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance will be declared at p value < 0.05. Discussion: This umbrella review of systemic review and meta-analysis will be the first to systematically explore and integrate evidence regarding the burden of ED and associated risk factors in the diabetic population in a global context. By estimating the worldwide burden and identifying risk factors of ED in this population, the study will contribute to uncovering the hidden burden. Thereby, the issue will get international attention to reduce its consequences on the sexual health of the diabetic population. Besides, it will also provide input and direction for future research outlook.

MORTALITY AND ASSOCIATED FACTORS AMONG INTENSIVE CARE UNIT ADMITTED ADULT PATIENTS WITH MECHANICAL VENTILATION IN ETHIOPIA: A SYSTEMATIC REVIEW AND META-ANALYSIS.

ABSTRACT: Introduction: The global demand for intensive care has risen, given its effectiveness in lowering mortality rates. Mechanical ventilation (MV) is integral to intensive care but introduces risks such as ventilator-associated complications. Ethiopia experiences a high intensive care unit (ICU) mortality rate. Objective: This systematic review and meta-analysis aim to comprehensively synthesize evidence on the mortality of adults undergoing MV in Ethiopia and identify associated factors. Methods: The study extensively searched databases and gray literature for research on MV outcomes, trends, and associated factors in adult ICUs. Adhering to the 2020 PRISMA checklist, a systematic review and meta-analysis sought to establish the mortality rate and key determinants among adult ICU patients on MV. The search incorporated keywords and MeSH terms, excluding studies with unsound methodologies or missing data. Data extraction, quality assessment, and analysis followed established protocols, including the JBI tool for methodological quality evaluation. STATA version 17.0 facilitated analysis, assessing heterogeneity, publication bias, and performing sensitivity and meta-regression analyses. Results: The pooled mortality rate among adult ICU patients undergoing MV was 48.61% (95% CI: 40.82, 56.40%). Significant mortality-contributing factors included medical diagnosis, Glasgow Coma Scale score, sepsis/septic shock, sedation use, multiple-organ dysfunction syndrome, and cardiovascular disease. Although some pooled odds ratios seemed insignificant, closer examination revealed significant associations in individual studies. Conclusion : The study underscores the urgent need for further research, improved ICU infrastructure, and healthcare personnel training in Ethiopia to enhance outcomes for mechanically ventilated patients. Identified factors offer valuable insights for targeted interventions, guiding tailored treatment strategies to reduce mortality. This study contributes to understanding mortality and associated factors in MV patients, informing initiatives to improve critical care outcomes in Ethiopia.

Correction: Immunization coverage and its associated factors among children aged 12-23 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies.

[This corrects the article DOI: 10.1371/journal.pone.0299384.].

Minimum acceptable diet and its predictors among children aged 6-23 months in Ethiopia. A multilevel cloglog regression analysis.

Despite significant progress made previously and the recognized health benefits of optimal feeding practices, ensuring a minimum acceptable diet in developing countries like Ethiopia remains a formidable challenge. Additionally, there is a scarcity of data in this area. Therefore, our study aims to identify predictors of a minimum acceptable diet using a powerful tool called complementary log-log regression analysis. Thus, it contributes to accelerating the pathway of ending child undernutrition thereby promoting optimal child health. A multilevel analysis was conducted among a weighted sample of 1427 children aged 6-23 months using the 2019 Ethiopian Demographic Health Survey (EDHS). The EDHS sample was stratified and selected in two stages. A minimum acceptable diet is defined as a composite of children fed with both minimum dietary diversity and minimum meal frequency. Data extraction took place between August 1 and 30, 2023. We used STATA software version 17 for data analysis. A complementary log-log regression model was fitted to identify significant predictors of the minimum acceptable diet. A p-value of ≤0.05 was used to declare statistically significant predictors. Only 10.44% (95CI: 8.90-12.15) of the children meet the minimum acceptable diet. Child aged (18-23 month) (AOR = 1.78, 95CI:1.14-2.78)], mother's educational level (secondary and above education) (AOR = 279,95CI: 1.51-5.15), number of children three and above [(AOR = 0.78,95CI: 0.53-0.94], institutional delivery [AOR = 1.77,95CI: 1.11-3.11], having postnatal-check-up [AOR = 2.33,95CI: 1.59-3.41] and high community poverty level (AOR = 0.49,95CI: 0.29-0.85) were found to be predictors of minimum acceptable diet. In Ethiopia, only one in ten children achieve a minimum acceptable diet. Which is lower than the global report findings (16%). Enhancing maternal education programs and promoting family planning strategies to reduce household size are essential. Besides, encouraging institutional deliveries and postnatal check-ups are also recommended. It is necessary to implement targeted interventions for poverty reduction in communities to ensure that families can afford nutritious diets for their children.

Uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care unit among selected governmental hospitals in Addis Ababa, Ethiopia, 2022: an institution-based cross-sectional study.

OBJECTIVE: To assess the uncertainty associated with parents of preterm infants hospitalised in neonatal intensive care units of selected governmental hospitals in Addis Ababa, Ethiopia, 2022. DESIGN: A cross-sectional study conducted from 3 March 2022 to 30 March 2022. SETTING: The research was conducted at a government hospital in Addis Ababa, Ethiopia. PARTICIPANTS: Out of 305 eligible participants, 303 were parents of preterm infants' participants with complete data. PRIMARY OUTCOME MEASURE: Levels of parental uncertainty, assessed by using the Mishel scale of uncertainty. Simple and multivariable linear regression analyses were conducted to assess associations between variables. RESULTS: The mean uncertainty expressed by parents was 101.3 (SD=21.12). There were significant associations found with various factors. The sex of the respondent fathers (ß=-4.65, 95% CI -9.32 to -0.025), length of neonatal intensive care unit (NICU) stay >10 days (ß=14.64, 95% CI 8.71 to 20.56), gestational week between 34 and 37 weeks (ß=-7.47, 95% CI -11.42 to -3.52), parents with college degrees and above (ß=-14.15, 95% CI -22.94 to -5.34), parents with neonates who were preterm and had neonatal sepsis (ß=10.42, 95% CI -17.57 to -3.27), parents without a history of neonatal NICU admission (ß=-6.16, 95% CI -11.69 to -0.63) and parents who were housewives (ß=6.51, 95% CI 1.83 to 12.19) all showed significant associations. CONCLUSION: Factors like educational status, gestational week, neonatal admission history and NICU stay length contribute to parental uncertainty. Promoting empathy and clear communication is crucial. Hospitals should develop compassionate protocols for information delivery, including regular updates and effective addressing of concerns. Fostering a supportive environment helps parents express emotions and seek support.

Global COVID-19 vaccine acceptance level and its determinants: an umbrella review.

BACKGROUND: The COVID-19 vaccination is essential for reducing disease burden on a worldwide scale. The success of this strategy will largely depend on how well vaccines are received. Previous reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the COVID-19 vaccination's global acceptance rate and its contributing factors. METHODS: Using PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus and Google Scholar which reported COVID-19 vaccine acceptance and/or its determinants were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias and sensitivity analysis were also assessed. RESULT: Twenty-two SRM with 10,433,306 study participants were included. The pooled COVID-19 vaccine acceptance rate globally is found to be 60.23 (95% CI: 58.27, 62.18). In low-income countries, the pooled level of COVID-19 vaccine acceptance was found to be 54.07(50.31, 57.83) while this magnitude is 64.32 (62.24,66.40) among studies across the globe. Higher level of education (AOR =1.96; 95% CI:1.20, 2.73), good level of knowledge (2.20; 95% CI:1.36, 3.03), favourable attitude (AOR =4.50; 95% CI:2.89, 6.12), previous history of COVID-19 infection (AOR =3.41; 95% CI:1.77, 5.06), male sex (AOR =1.62; 95% CI:1.47, 1.77), and chronic disease (AOR =1.54; 95% CI:1.18, 1.90) were predictors of COVID-19 vaccine acceptance. CONCLUSION: The pooled level of COVID-19 vaccine acceptance highly varied and found to be unacceptably low particularly in low-income countries. Higher level of education, good level of knowledge, favourable attitude, previous history of COVID-19, male sex, and chronic disease were factors of COVID-19 vaccine acceptance rate. A collaborative effort of stakeholders such as policymakers, and vaccine campaign program planners is needed to improve the acceptance rate of COVID-19 vaccine.

Exploring the perceptions of health service providers and adolescents on the utilization of adolescent sexual and reproductive health services in Tikur, 2023: A qualitative study.

Objectives: Globally, twenty-three million adolescents aged 15-19 years have an unmet need for sexual and reproductive health services and are at risk of unintended pregnancy. In Sub-Saharan Africa, including Ethiopia, it might be difficult for adolescents to get access to sexual and reproductive health services that are acceptable to use. Privacy, a fear of sharing health concerns, a sociocultural environment, the unfriendliness of current services, and traditional taboos are some of the key reasons. This study aimed to explore the perspectives of service providers and adolescents on the use of sexual and reproductive health services. Methodology: A qualitative phenomenological study was conducted from January to February 2023 in the Tikur Anbessa specialized hospital. Purposive sampling was applied to select the study participants. A total of 17 in-depth interviews (with 7 adolescents and 10 health providers) were held. Instead of relying on the number of participants, data saturation was used. Thematic analysis was employed in analyzing the data. Result: The findings indicate that obstacles to the use of sexual and reproductive health services include challenges related to the availability of resources and accessibility; resistance from religious beliefs, cultural beliefs, and customs; quality and institutional-related challenges; and stigma and discrimination in sexual and reproductive health services, which pose the biggest barrier to health professionals providing standardized sexual and reproductive health services. Conclusion: A multi-pronged approach should be created to overcome these challenges, including community outreach for sexual and reproductive health and increasing awareness of the importance of early access to sexual and reproductive health through appropriate community forums. Existing sexual and reproductive health services are not promoted to adolescents and youth, and a lack of and difficulty getting resources for sexual and reproductive health services should be resolved.

COVID-19 vaccine acceptance in the second wave of the pandemic among university students in Ethiopia: application of the health belief model.

Background: The first case of COVID-19 virus was reported in Africa on 14 February 2020. The pandemic became more aggressive in the continent during the second wave than the first wave. Promoting vaccination behavior is an unparalleled measure to curb the spread of the pandemic. Regarding this, the health belief model (HBM) is the major model for understanding health behaviors. This study aimed to examine predictors of intended COVID-19 vaccine acceptance in the second wave of the pandemic among university students in Ethiopia using HBM. Methods: A cross-sectional study was conducted among 423 randomly selected medical and health science students at the University of Gondar from 21 August to 15 September 2020. Analysis of data was performed using STATA 14.0. Linear regression analysis was applied and a p value of less than 0.05 was used to declare statistical significance. Results: Among the total participants, 293 [72.2% (95.0%: CI: 67.2-76.8)] of them scored above the mean of COVID-19 vaccine acceptance. HBM explained nearly 46.3% (adjusted R2 = 0.463) variance in intention to receive the COVID-19 vaccine. Year of study (ß = 0.288; 95% CI: 0.144-0.056), using social media (ß = 0.58; 95% CI: 1.546-2.804), existing chronic disease (ß = 0.12; 95% CI: 0.042-0.433), perceived overall health condition (ß = 0.117; 95% CI: 0.307-0.091), perceived susceptibility (ß = 0.58; 95% CI: 1.546-2.804), perceived benefit (ß = 0.338; 95% CI: 1.578-2.863), and cues to action (ß = 0.49; 95% CI: 0.388-0.99) were significantly associated with intended COVID-19 vaccine acceptance at p value < 0.5. Conclusion: Approximately, three-quarters of the participants were above the mean score of COVID-19 vaccine acceptance, which is higher compared to previous reports in resource-limited settings. Interventions in this study setting chould include placing emphasis on the risks of acquiring COVID-19, enhancing perceived benefits of COVID-19 vaccination and improving cues to action by advocating COVID-19 vaccination. Our findings also implied that social media health campaigns are significant factor in COVID-19 vaccination behavioral change in this study setting.