Time to Treatment Failure and Its Predictors Among Second-Line ART Clients in Amhara Region, Ethiopia: A Retrospective Follow-Up Study.

Background: Second-line antiretroviral treatment failure has become a major public health issue, and the time to treatment failure among second-line ART clients varies globally, and the Sub-Saharan African region having a high rate of second-line ART treatment failures. In addition, after the ART treatment guideline changed there is limited information on Ethiopia. Therefore, this study aimed to assess time to treatment failure and its determinants among second-line ART clients in Amhara Region, Ethiopia. Methods: A multi-centered retrospective follow-up study was conducted. A random sample of 860 people on second-line ART was selected by using a computer-generated simple random sampling technique from January 30, 2016, to January 30, 2021, at the University of Gondar Compressive Specialized Hospital, Felege Hiwot Compressive Specialized Referral Hospital, and Debre Tabor Compressive Specialized Referral Hospital, in Amhara region, Ethiopia. Data was captured using a checklist. Results: A total of 81 (9.4%) ART clients developed second-line treatment failure, with a median follow-up time of 29 months with an interquartile range (IQR: 18, 41]. The risk of second-line treatment failure is higher among patients aged 15 to 30 years (adjusted hazard ratio (AHR) = 2.01, 95% confidence interval (CI): [1.16, 3.48]). Being unable to read and write (AHR = 1.312, 95% CI: [1.068, 1.613]), and poor ART drug adherence (AHR = 3.067, 95% CI: [1.845, 5.099]) were significant predictors of second-line ART treatment failures. Conclusion: In the current study, the time to second-line ART treatment failure was high compared with a previous similar study in Ethiopia. Factors like being younger age, ART clients who are not being able to read and write, and having poor ART drug adherence was significant predictors of second-line ART treatment failure.

Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021.

BACKGROUND: Diabetic neuropathy is the most common complication in both Type-1 and Type-2 DM patients with more than one half of all patients developing nerve dysfunction in their lifetime. Although, risk prediction model was developed for diabetic neuropathy in developed countries, It is not applicable in clinical practice, due to poor data, methodological problems, inappropriately analyzed and reported. To date, no risk prediction model developed for diabetic neuropathy among DM in Ethiopia, Therefore, this study aimed prediction the risk of diabetic neuropathy among DM patients, used for guiding in clinical decision making for clinicians. OBJECTIVE: Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021. METHODS: A retrospective follow up study was conducted with a total of 808 DM patients were enrolled from January 1,2005 to December 30,2021 at two selected referral hospitals in Amhara regional state. Multi-stage sampling techniques were used and the data was collected by checklist from medical records by Kobo collect and exported to STATA version-17 for analysis. Lasso method were used to select predictors and entered to multivariable logistic regression with P-value<0.05 was used for nomogram development. Model performance was assessed by AUC and calibration plot. Internal validation was done through bootstrapping method and decision curve analysis was performed to evaluate net benefit of model. RESULTS: The incidence proportion of diabetic neuropathy among DM patients was 21.29% (95% CI; 18.59, 24.25). In multivariable logistic regression glycemic control, other comorbidities, physical activity, hypertension, alcohol drinking, type of treatment, white blood cells and red blood cells count were statistically significant. Nomogram was developed, has discriminating power AUC; 73.2% (95% CI; 69.0%, 77.3%) and calibration test (P-value = 0.45). It was internally validated by bootstrapping method with discrimination performance 71.7 (95% CI; 67.2%, 75.9%). It had less optimism coefficient (0.015). To make nomogram accessible, mobile based tool were developed. In machine learning, classification and regression tree has discriminating performance of 70.2% (95% CI; 65.8%, 74.6%). The model had high net benefit at different threshold probabilities in both nomogram and classification and regression tree. CONCLUSION: The developed nomogram and decision tree, has good level of accuracy and well calibration, easily individualized prediction of diabetic neuropathy. Both models had added net benefit in clinical practice and to be clinically applicable mobile based tool were developed.

The psychological impact of COVID-19 pandemic and associated factors among college and university students in Ethiopia: a systematic review and meta-analysis, 2022.

Background: The Corona virus disease 19 (COVID-19) pandemic is a human tragedy that occurred in this era. It poses an unprecedented psychological, social, economic, and health crisis. The mental health and well-being of entire societies are suffering as a result of this crisis, but the suffering is greater in students at all levels of education and must be addressed immediately. Thus, this study was aimed to estimate the pooled prevalence and associated factors of the psychological impact of COVID-19 among higher education students. Methods: The potential studies were searched via PubMed, HINARI, the Cochrane Library, and Google Scholar. Studies were appraised using the Joanna Briggs Institute appraisal checklist. Micro Soft Excel was used to extract the data, which was then exported to Stata version 14 for analysis. Heterogeneity between studies was tested using Cochrane statistics and the I2 test, and small-study effects were checked using Egger's statistical test. A random-effects model was employed to estimate the pooled prevalence of the psychological impact of COVID-19 and its associated factor. Results: After reviewing 227 studies, eight fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of the psychological impact of Corona virus disease 19 among higher education students in Ethiopia, including depression, anxiety, and stress was 43.49% (95% CI: 29.59, 57.40%), 46.27% (95% CI: 32.77, 59.78%), and 31.43% (95% CI: 22.71, 40.15), respectively. Having a medical illness, being an urban resident, living with parents, having relative death due to pandemics, and having a non-health field of study were identified as significant associated factors for the impact of the pandemic in higher education students. Conclusion: The COVID-19 pandemic had a significant psychological impact on college and university students. Depression, anxiety, and stress were the most commonly reported psychological impacts across studies among higher education students. Hence, applying tele-psychotherapy using, smartphones, and social media platforms has an effect on reducing the impact. Programs for preventing and controlling epidemics should be developed by the government and higher education institutions that incorporate mental health interventions and build resilience.

Prognostication of treatment non-compliance among patients with multidrug-resistant tuberculosis in the course of their follow-up: a logistic regression-based machine learning algorithm.

Introduction: Drug compliance is the act of taking medication on schedule or taking medication as prescribed and obeying other medical instructions. It is the most crucial aspect in the treatment of chronic diseases particularly for patients with multidrug-resistant tuberculosis (MDR-TB). Drug non-compliance is the main reason for causing drug resistance and poor treatment outcomes. Hence, developing a risk prediction model by using early obtainable prognostic determinants of non-compliance is vital in averting the existing, unacceptably high level of poor treatment outcomes and reducing drug resistance among MDR-TB patients. Materials and methods: A retrospective follow-up study was conducted on a total of 517 MDR-TB patients in Northwest Ethiopia. A logistic regression-based machine learning algorithm was used to develop a risk score for the prediction of treatment non-compliance among MDR-TB patients in selected referral hospitals of Northwest Ethiopia. The data were incorporated in EpiData version 3.1 and exported to STATA version 16 and R version 4.0.5 software for analysis. A simplified risk prediction model was developed, and its performance was reported. It was also internally validated by using a bootstrapping method. Results: Educational status, registration group (previously treated/new), treatment support, model of care, and khat use were significant prognostic features of treatment non-compliance. The model has a discriminatory power of area under curve (AUC) = 0.79 with a 95% CI of 0.74-0.85 and a calibration test of p-value = 0.5. It was internally validated by using a bootstrapping method, and it has a relatively corrected discriminatory performance of AUC = 0.78 with a 95% CI of 0.73-0.86 and an optimism coefficient of 0.013. Conclusion: Educational status, registration group, treatment supporter, model of care, and khat use are important features that can predict treatment non-compliance of MDR-TB patients. The risk score developed has a satisfactory level of accuracy and good calibration. In addition, it is clinically interpretable and easy to use in clinical practice, because its features are easily ascertainable even at the initial stage of patient enrolment. Hence, it becomes important to reduce poor treatment outcomes and drug resistance.

Contraceptive dynamics among women with disabilities in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Contraceptive dynamics is the use of contraception, unmet need, discontinuation, and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Even though certain studies have been conducted in high-income countries, research is scarce on the degree of contraceptive method mix, unmet needs, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. METHODS: The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (MEDLINE), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health. Grey literature databases will be searched using electronic search engines such as Google Scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. Any type of study design (e.g., randomized controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case-control or nested case-control studies, qualitative, cross-sectional studies) will be included in this scoping review. There will be no restrictions on publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines will be used to report all parts of the protocol and scoping review. DISCUSSION: When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. Despite these facts, they are the most marginalized people on the planet. This is, therefore, critical to map available evidence and identify knowledge gaps on contraceptive dynamics. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

Effects of armed conflicts on childhood undernutrition in Africa: a systematic review and meta-analysis.

BACKGROUND: Undernutrition is defined as not consuming enough nutrients and energy to meet one's needs for maintaining good health. It is exacerbated by armed conflict. Individuals cannot stick to jobs because of a lack of safety during conflicts, which has an impact on families' ability to purchase food. However, there is a paucity of evidence on pooled evidence on the impact of armed conflict on childhood undernutrition among children aged 6 to 59 months in Africa. Therefore, this review aimed to examine the effects of armed conflict on the magnitude of undernutrition, particularly stunting, underweight, and wasting among children in Africa. METHODS: A comprehensive literature search was conducted using electronic databases (PubMed, Hinari, and Google Scholar database) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. Small-study effects were checked using Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence and associated factors of undernutrition among children aged 6-59 months in Africa. RESULTS: Of a total of 585 articles retrieved from the databases, 12 studies met our inclusion criteria. The pooled prevalence of wasting, stunting, and being underweight among conflict-affected African countries was 20.25% (95%CI = 15.08-25.43), 34.18% (95% CI = 26.34-42.02), and 24.00% (95%CI = 16.35-31.65), respectively. The most consistent factors associated with childhood stunting, wasting, and being underweight in Africa were low mother's education, prolonged duration of armed conflict, and rural place of residence. CONCLUSION: The severity of malnutrition crises will be assisted by a better understanding of the variables associated with child malnutrition, which will improve the effectiveness of development and humanitarian responses. We urge that health planners, policymakers, and the general public prioritize children with acute malnutrition in Africa's conflict-affected areas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367487.

Development and validation of a risk prediction model for lost to follow-up among adults on active antiretroviral therapy in Ethiopia: a retrospective follow-up study.

BACKGROUND: Over 420,000 people have initiated life-saving antiretroviral therapy (ART) in Ethiopia; however, lost-to-follow-up (LTFU) rates continues to be high. A clinical decision tool is needed to identify patients at higher risk for LTFU to provide individualized risk prediction to intervention. Therefore, this study aimed to develop and validate a statistical risk prediction tool that predicts the probability of LTFU among adult clients on ART. METHODS: A retrospective follow-up study was conducted among 432 clients on ART in Gondar Town, northwest, Ethiopia. Prognostic determinates included in the analysis were determined by multivariable logistic regression. The area under the receiver operating characteristic (AUROC) and calibration plot were used to assess the model discriminative ability and predictive accuracy, respectively. Individual risk prediction for LTFU was determined using both regression formula and score chart rule. Youden index value was used to determine the cut-point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA). RESULTS: The incidence of LTFU was 11.19 (95% CI 8.95-13.99) per 100-persons years of observation. Potential prognostic determinants for LTFU were rural residence, not using prophylaxis (either cotrimoxazole or Isoniazid or both), patient on appointment spacing model (ASM), poor drug adherence level, normal Body mass index (BMI), and high viral load (viral copies > 1000 copies/ml). The AUROC was 85.9% (95% CI 82.0-89.6) for the prediction model and the risk score was 81.0% (95% CI 76.7-85.3) which was a good discrimination probability. The maximum sensitivity and specificity of the probability of LTFU using the prediction model were 72.07% and 83.49%, respectively. The calibration plot of the model was good (p-value = 0.350). The DCA indicated that the model provides a higher net benefit following patients based on the risk prediction tool. CONCLUSION: The incidence of LTFU among clients on ART in Gondar town was high (> 3%). The risk prediction model presents an accurate and easily applicable prognostic prediction tool for clients on ART. A prospective follow-up study and external validation of the model is warranted before using the model.

Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study.

BACKGROUND: Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children. METHODS: A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association. RESULTS: A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years' follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure. CONCLUSION: In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.

Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis.

Background: Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation. Methods: This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy. Results: Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers. Conclusion: The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.

Spatial distribution and factors associated with low birth weight in Ethiopia using data from Ethiopian Demographic and Health Survey 2016: spatial and multilevel analysis.

Objective: This study aimed to assess the spatial distribution, individual and community-level factors associated with low birth weight in Ethiopia. Method: Secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 2110 neonates were included in this study. Spatial autocorrelation analysis was conducted to assess the spatial clustering of LBW. Besides, the spatial scan statistics and ordinary kriging interpolation were done to detect the local level clusters and to assess predicted risk areas, respectively. Furthermore, a multilevel logistic regression model was fitted to determine individual and community-level factors associated with LBW. Finally, most likely clusters with log-likelihood ratio (LLR), relative risk and p value from spatial scan statistics and adjusted OR (AOR) with 95% CI for multilevel logistic regression model were reported. Results: LBW was spatially clustered in Ethiopia. Primary (LLR=11.57; p=0.002) clusters were detected in the Amhara region. Neonates within this spatial window had a 2.66 times higher risk of being LBW babies as compared with those outside the window. Besides, secondary (LLR=11.4; p=0.003; LLR=10.14, p=0.0075) clusters were identified at southwest Oromia, north Oromia, south Afar and southeast Amhara regions. Neonates who were born from severely anaemic (AOR=1.40, 95% CI (1.03 to 2.15)), and uneducated (AOR=1.90, 95% CI (1.23 to 2.93)) mothers, those who were born before 37 weeks of gestation (AOR=5.97, 95% CI (3.26 to 10.95)) and women (AOR=1.41, 95% CI (1.05 to 1.89)), had significantly higher odds of being LBW babies. Conclusion: The high-risk areas of LBW were detected in Afar, Amhara and Oromia regions. Therefore, targeting the policy interventions in those hotspot areas and focusing on the improvement of maternal education, strengthening anaemia control programmes and elimination of modifiable causes of prematurity could be vital for reducing the LBW disparity in Ethiopia.

Tenofovir Disoproxil Fumarate-Associated Renal Dysfunction Among Adult People Living with HIV at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: A Comparative Retrospective Cohort Study.

BACKGROUND: The use of tenofovir disoproxil fumarate (TDF) has been reported to be a significant contributor to renal dysfunction. However, patients in Ethiopia may be different than in other parts of the world, and findings from such studies may not apply in this setting. OBJECTIVE: This study aimed to assess TDF-associated renal dysfunction among adult people living with HIV (PLHIV) at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: This retrospective cohort study included adult PLHIV between January 2015 and June 2019. The Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to estimate glomerular filtration rate (eGFR). Renal dysfunction was defined as eGFR <60 mL/min/1.73 m2. Data were entered into Epi Info™ 7 and analyzed by using SPSS® software version 20. The Kaplan-Meier method was used to estimate the survival curves. Cox proportional hazards models were used to identify predictors of renal dysfunction using a 95% confidence interval and p-value ≤ 0.05 as a statistical significance. RESULTS: Out of 400 participants, 200 were TDF-based ART groups, and 200 were non-TDF-based ART groups. The incidence of renal dysfunction of TDF and the non-TDF group was 28.31 per 100 person-years (PYs) and 12.53 per 100 PYs, respectively. Adult PLHIV taking TDF-based regimens were 1.70 (adjusted HR = 1.70; 95% CI = 1.02-2.82) times at higher risk of renal dysfunction than non-TDF-based regimens. Age ≥55, diabetes mellitus, concurrent nephrotoxic drug use, and combined use of ritonavir-boosted protease inhibitors were also associated significantly with renal dysfunction. CONCLUSION: The incidence rate of renal dysfunction among TDF users is higher than non-TDF users. Exposure to TDF is a significant risk of renal dysfunction in adult PLHIV. Clinicians should regularly monitor the renal function of adult PLHIV who are taking TDF.

Prevalence of childhood Cancer among children attending referral hospitals of outpatient Department in Ethiopia.

INTRODUCTION: Childhood cancer is one of the leading causes of morbidity and mortality in the pediatrics age group. The problem affects both developed and developing countries. A high mortality rate has been observed in low-income counties. Despite its high fatality rate, less attention has been paid to the problem in developing countries, including Ethiopia. For this reason, childhood cancer is not well documented in the study setting. Therefore, we assessed the prevalence of childhood cancer in Ethiopia. METHODS: Institution based cross-sectional study design from January 1, 2019, to March 30, 2019, was conducted in the pediatrics treatment center. A systematic random sampling technique has used to select 1270 children in the pediatric outpatient department. The data were entered using Epi info version 7 and exported to SPSS version 20 for analysis. We checked model fitness for the advanced statistical methods, but it was difficult to proceed with logistic regression model to see the association between dependent and explanatory variables because of the unmet x2 assumption. We presented the results by using tables and figures. RESULTS: From the total 1270 study participants, 1257 were included in the final analysis provided that a 98.97% response rate. Out of these, 10(0.8%) children were diagnosed with cancer. Regarding its types, two each, Acute Lymphocytic Leukemia, Wilms tumor, Hodgkin lymphoma, and one each non-Hodgkin lymphoma, Parotid cancer, Retinoblastoma, and Breast cancer were reported. The prevalence of childhood cancer was 0.9 and 0.7% among male and female children, respectively. CONCLUSIONS: Eight children diagnosed with cancer per 1000 children who visited the pediatric outpatient department. Even though childhood cancers have little attention from policymakers, the prevalence of childhood cancer remains prevalent. Therefore, researchers and policymakers shall give special emphasis to childhood cancer.

Community cervical cancer screening: Barriers to successful home-based HPV self-sampling in Dabat district, North Gondar, Ethiopia. A qualitative study.

OBJECTIVE: To explore the barriers to successful home-based human papillomavirus (HPV) self-sampling in North Gondar, Ethiopia. METHODS: The study participants were women who had previously participated in a community-wide home-based HPV self-sampling pilot study, community health workers, women's development army leaders, and the sample collectors of the home-based HPV self-sampling pilot study. A community based qualitative descriptive study was conducted. We applied purposive and convenience sampling. In total, 47 women participated in the study (in-depth interviews n = 22, four focus group discussions n = 25, 6-7 participants each). The study employed thematic analysis for clustering the emerged themes. RESULTS: Husband disapproval was identified as the main barrier to the acceptance of home-based HPV self-sampling. Social influence, lack of knowledge about cervical cancer and screening, lack of health education on cervical cancer and HPV-based screening, feeling healthy, and religious influence were identified as additional barriers. Fear of using Evalyn brush® for self-sampling was found to be the main barrier to the provision of a quality sample. The inability of the sample collectors to check the proper utilization of Evalyn brush® and the difficulty in understanding the instructions did also contribute to the low-quality. Providing health education concerning cervical cancer and HPV self-sapling to women, male involvement in the screening program, and linking the screening service to existing local health facilities were suggested to guarantee the success of home-based HPV self-sampling. CONCLUSIONS: Educating women regarding cervical cancer and HPV testing, providing clear instructions on how to collect self-sample, and male involvement in the screening program are prerequisites for a successful implementation of home-based HPV testing. Women empowerment should also be focused to overcome the identified sociocultural barriers. Furthermore, the screening program should guarantee the timely provision of the test results and offering women follow-up examinations and treatment for abnormal findings.

Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria.

OBJECTIVES: To identify the incidence of postpartum glucose intolerance and develop a prediction model based on antenatal characteristics to predict postpartum glucose intolerance. DESIGN: Prospective cohort study. SETTING: Gondar town public health facilities in Northwest Ethiopia. PARTICIPANTS: Women who had gestational diabetes mellitus were advised to undergo postpartum oral glucose tolerance test at 6-12 weeks of delivery. MAIN OUTCOME: Postpartum glucose intolerance. DATA ANALYSIS: Predictors of postpartum glucose intolerance were identified using multivariable logistic regression analysis. The discriminative power of the predictor variables for postpartum glucose intolerance and the model accuracy were computed by area under the receiver operating characteristic curve and estimated by area under the curve (AUC) with 95% CI. RESULTS: A total of 112 (85.5%) women with gestational diabetes mellitus returned and completed the postpartum oral glucose tolerance test. The incidence of postpartum glucose intolerance was 21.4% (95% CI14.3 to 28.4), inclusive of 18.7% pre-diabetes and 2.7% diabetes. Multivariable logistic regression analysis revealed that advanced maternal age, high fasting plasma glucose level at diagnosis, overweight and/or obesity, and antenatal depression were predictors of postpartum glucose intolerance. The AUC of the final reduced model to predict postpartum glucose intolerance was 0.884 (95% CI 0.822 to 0.937). Fasting plasma glucose at diagnosis of gestational diabetes mellitus (AUC=0.736, 95% CI0.616 to 0.845) and overweight and/or obesity (AUC=0.718, 95% CI 0.614 to 0.814) were better predictors of postpartum glucose intolerance. Moreover, the AUC for the combined predictors of fasting plasma glucose at diagnosis and mid-upper arm circumference was 0.822 (95% CI 0.722 to 0.907), which was the best predictor. CONCLUSIONS: The incidence of postpartum glucose intolerance was high among women with gestational diabetes mellitus. Antenatal predictors modestly predicted postpartum glucose intolerance. The findings suggest ongoing glucose screening is indicated for all women with gestational diabetes mellitus.

Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia.

BACKGROUND: Maternity continuum of care is a model of integrated components of maternal health service from pregnancy to the post-partum period to improve maternal, neonatal and child health. In Ethiopia, the magnitude of antenatal care, skilled delivery, and post-natal care have shown improvement. However, there is limited evidence of the woman who attends continuing from antenatal care to post-partum care. OBJECTIVE: To assess completion of maternity continuum of care and its associated factors among women, in Motta town and Hulet Eji Enese district, Northwest Ethiopia. METHODS: A community based cross-sectional study with a stratified cluster sampling technique was conducted among 819 women 6week-6month post-partum period in Motta town and Hulet Eji Enese district. The data were collected from March 12, 2019 to April1, 2019 by face to face interviews, using a pretested structured questionnaire. Binary logistic regression (bi-variable and multivariable) model was done. Adjusted odds ratio with respect to 95% confidence interval was employed in the strength and direction of the association between covariates and outcome variable. Besides, a P value<0.05 was used to declare statistical significance. RESULTS: A total of 819 women with100% response rate participated and Completion of maternity continuum of care was found to be 47% (43.2%-50.2%) in the study. Educational attainment of Secondary school and above (adjusted odds ratio(AOR) = 3.5; 1.9-6.3), urban residence (AOR = 4.6; 95%CI 2.5-8.5), women reach to a health facility within 30minute(AOR = 2.1; 95%CI 1.2-3.7), a woman was the primary decision maker for attending maternity continuum of care(AOR = 3.5;95%CI 1.9-6.3), index pregnancy-related complication(AOR = 2.4;95%CI 1.1-5.3), starting antenatal care within second trimester (AOR = 3.4;95%CI 2.1-5.6) and antenatal care visit 3-4 times(AOR = 2.1;95%CI 1.2-3.8) were statistically significant with completion of maternity continuum of care. CONCLUSIONS: The completion of maternity continuum of care is low in the study area. Improving the educational status of women, engaging the rural community, physical accessibility of health facility, woman empowerment for decision making, emphasis on giving care for pregnancy-related complication, and early gestational age antenatal care at least 3 or more visits suggested to increase completion of maternity continuum of care.

Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia.

BACKGROUND: Gestational diabetes mellitus is a rising global public health problem that can have short- and long-term sequelae for both mother and offspring. However, there are limited evidences on the effect of gestational diabetes mellitus on adverse neonatal outcomes using the updated international diagnostic criteria on adverse effects on neonatal outcomes. Therefore, this study was aimed to examine the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes in Ethiopia. METHODS: A prospective cohort study was conducted among pregnant women recruited from antenatal clinics and followed through pregnancy to delivery. Gestational diabetes mellitus was diagnosed using a two-hour 75g oral glucose tolerance test strategy with recent criteria. Multivariable log-binomial model was used to identify the effects of gestational diabetes mellitus on the risk of adverse neonatal outcomes which includes macrosomia, low birth weight, large for gestational age, small for gestational age, preterm birth, low Apgar score at the first minute, low Apgar score at fifth minute, and composite adverse neonatal outcome. RESULTS: Among pregnant women (n=1027) included in the follow up data on neonatal outcomes were available for 684 (118 newborns of mothers with gestational diabetes mellitus and 566 newborns of women without gestational diabetes mellitus). There was a statistical baseline difference between the two groups by maternal age, dietary diversity status, level of physical activity, and antenatal depression. The incidence of composite adverse neonatal outcome was significantly higher (P<0.001) among newborns from mothers with gestational diabetes mellitus (51.7%) than among newborns from mothers without gestational diabetes mellitus (25.8%). Significantly higher risk of developing adverse neonatal outcomes among newborns from gestational diabetes mellitus mothers was observed for composite adverse neonatal outcome (Adjust Relative Risk (ARR)=1.72; 95% CI: 1.35, 2.19), macrosomia (ARR= 3.81; 95% CI: 1.95, 7.45), large for gestational age (ARR= 2.38; 95% CI: 1.41, 4.03), preterm birth (ARR= 2.03; 95% CI: 1.17, 3.53), low Apgar score at the first minute (ARR= 1.71; 95% CI: 1.02, 2.86), and fifth minute (ARR= 2.14; 95% CI: 1.05, 4.36). However, no significant differences in the risk of low birth weight and small for gestational age by gestational diabetes mellitus status. CONCLUSIONS: Gestational diabetes mellitus increases the risk of adverse neonatal outcomes particularly macrosomia, large for gestational age, preterm birth, and poor Apgar score. Hence, the role of preventing gestational diabetes mellitus is quite crucial to improve neonatal outcomes.

Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia.

BACKGROUND: Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. METHODS: A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. RESULTS: A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. CONCLUSIONS: Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.

Prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia.

BACKGROUND: Globally, Gestational Diabetes Mellitus (GDM) is rising, but it is a neglected health threat to mothers and their children in low resource countries. Although, GDM is known in Ethiopia, information regarding it remains scarce by recent diagnostic criteria. Therefore, this study aimed to determine the prevalence of GDM and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia. METHODS: A cross-sectional study was conducted among 1027 pregnant women selected by the systematic random sampling technique. The universal one-step screening and diagnostic strategy was done using a two-hour 75 g oral glucose tolerance test. GDM was diagnosed using updated diagnostic criteria (2017 American Diabetes Association (ADA) or 2013 World Health Organization (WHO) or modified International Association of the Diabetes and Pregnancy Study Groups diagnostic criteria (IADPSG)). Binary logistic regression model was used to identify factors associated with GDM. RESULTS: Of the total 1027 pregnant women, 12.8% (95% CI: 10.8-14.8) were diagnosed with GDM. Overweight and/or obesity (MUAC ≥28 cm) (AOR = 2.25, 95% CI: 1.18-4.26), previous history of GDM (AOR = 5.82, 95% CI: 2.57-13.18), family history of diabetes (AOR = 4.03, 95% CI: 1.57-10.35), low physical activity (AOR = 3.36, 95% CI: 1.60-7.04), inadequate dietary diversity (AOR = 1.9, 95% CI: 1.02-3.53), and antenatal depression (AOR = 4.12, 95% CI: 1.85-9.20) were significantly associated with GDM. CONCLUSIONS: The prevalence of GDM among women attending antenatal care at Gondar town public health facilities was high. Previous history of GDM, antenatal depression, family history of diabetes, low physical activity, overweight and/or obesity and inadequate dietary diversity were significantly associated with GDM. Routine screening of pregnant women and healthy lifestyle are strongly recommended.

Prevalence and determinants of gestational diabetes mellitus in Africa based on the updated international diagnostic criteria: a systematic review and meta-analysis.

BACKGROUND: Gestational diabetes mellitus (GDM) is a major public health problem and threat to maternal and child health in Africa. No prior review has been conducted in Africa using the updated GDM diagnostic criteria. Therefore, this review aimed to estimate the pooled prevalence and determinants of GDM in Africa by using current international diagnostic criteria. METHODS: A systematic review and meta-analysis was conducted by comprehensive search of the published studies in Africa. Electronic databases (PubMed, Scopus, Cochrane Library, EMBASE, Google Scholar, CINAHL, Web of Science, Science direct and African Journals Online) were searched using relevant search terms. Data were extracted on an excel sheet and Stata/ SE 14.0 software was used to perform the meta-analysis. Heterogeneity of included studies were assessed using I 2 and Q test statistics. I2 > 50% and Q test with its respective p-value < 0.05 were suggestive for the presence of a significant heterogeneity. Publication bias was assessed using the Egger's regression test and funnel plot. Subgroup and sensitivity analyses were done. A random effects model was used to estimate the pooled prevalence of GDM and odds ratio (OR) with 95% confidence interval (CI). RESULT: A total of 23 studies were included in the final analysis. The pooled prevalence of GDM in Africa was 13.61% (95% CI: 10.99, 16.23; I2 = 96.1%), and 14.28% (95% CI, 11.39, 17.16; I2 = 96.4%) in the sub-Saharan African region. The prevalence was highest in Central Africa 20.4% (95% CI, 1.55, 38.54), and lowest in Northern Africa 7.57% (95% CI, 5.89, 9.25) sub- regions. Overweight and obesity, macrosomia, family history of diabetes, history of stillbirth, history of abortion, chronic hypertension and history of previous GDM had positively associated with GDM. CONCLUSIONS: The prevalence of GDM is high in Africa. Being overweighed and/or obese, ever had macrocosmic baby, family history of diabetes, history of stillbirth, history of abortion or miscarriage, chronic hypertension and history of previous GDM were factors associated with GDM. Preventing overweighed and obese, giving due attention to women having high-risk cases for GDM in pregnancy are strongly recommended to mitigate the burden. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (2018:CRD42018116843).

Undernutrition and its determinants among Ethiopian adolescent girls: a protocol for systematic review and meta-analysis.

INTRODUCTION: In Ethiopia, undernutrition is the common public health concern, swaying the lives of lots of adolescent girls. Its sequelae are not only limited to them, but rather their upcoming offspring are vulnerable too. Even though some studies have been carried out in different parts of the country, the national pooled prevalence and determinants of undernutrition are not known. Therefore, this study is aimed at determining the pooled prevalence and determinants of undernutrition among adolescent girls in Ethiopia. METHODS: Published articles will be retrieved from databases such as Medline and PubMed. Electronic search engines such as Google Scholar and Google will be used. To identify eligible studies, the Joanna Briggs Institute quality appraisal checklists prepared for different study designs will be used. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to maintain the scientific robustness of the study. The presence of heterogeneity among studies will be examined by forest plot as well as I2 heterogeneity test. Potential causes of heterogeneity will be explored by carrying out sensitivity and subgroup analyses. The DerSimonian and Laird random-effects model will be used provided that heterogeneity is observed. Publication bias will be examined by observing funnel plots, and objectively by Egger's regression test. If the funnel plot is asymmetric and/or Egger's test was found to be statistically significant (p<0.05), the trim and fill (Duval and Tweedie's) analysis will be performed. The presence of a statistical association between independent and dependent variables will be declared if the p value is <0.05 with the 95% CI. ETHICS AND DISSEMINATION: Since this is a systematic review and meta-analysis, ethical clearance will not be a concern. The results of the study will be published in a peer-reviewed reputable journal and presented at different scientific research conferences. TRIAL REGISTRATION NUMBER: CRD42018106180.