Maternal socio-economic status determines animal source food consumption of children aged 6-23 months in East African countries: a multilevel mixed-effects generalized linear model.

Background: Nutrient deficiencies in Africa persist due to limited access to animal-source foods, causing a higher undernutrition prevalence, with 30.7% stunted children under five, which is higher than the global average of 22.0%. In African regions, there needs to be more information on access, consumption, and factors influencing children's animal-source food consumption. Therefore, we comprehensively analyse data from the Demographic and Health Surveys (DHS) to determine factors associated with children's (aged 6-23 months) consumption of animal-source foods (ASFs) in East African countries, which is crucial for policy and program development. Methods: We utilized cross-sectional pooled DHS data from nine East African countries reported from 2015 to 2021. The sample size consisted of 18,686 weighted children aged 6-23 months who were included. The DHS data were collected from women (15-49 years old) from households in each enumeration area of each country. We calculated the pooled proportion of consumption of foods of animal origin using multi-level logistic regression analysis to determine factors of ASFs, and the strength of the association was measured by an adjusted odds ratio (AOR) with a 95% CI and a p-value < 0.05, which was declared as significant. Result: The study found that 51.07% (95% CI: 50.26-51.88%) of infants and young children in East Africa consume ASFs, with variation across countries, of which 28.26% (95% CI: 26.31-30.29%) was the lowest in Burundi and 55.81% (95% CI: 53.39-58.21%) was the highest ASF consumption in Zimbabwe. The amount of ASF consumed grows with children's age and varies greatly between countries. In addition, children in the wealthiest quintile and with the highest educational attainment consume more ASFs. However, those who lived in rural areas consumed fewer ASFs. Conclusion: The consumption of ASFs increased with the age of children, maternal education, and household wealth index. The government and non-government sectors should implement public health interventions targeting rural residents and poor households to increase access to and consumption of ASFs for children aged 6-23 months in East Africa.

Investigating factors influencing overweight and obesity among adult households in Ethiopia: a multilevel ordered analysis of 2016 EDHS data.

Background: In both high- and low-income countries, including Ethiopia, overweight and obesity have emerged as public health issues of the 21st century. Hence, obtaining conclusive evidence concerning the factors that influence adults' body mass index is important. Therefore, using representative data, our study sought to provide solid evidence on factors influencing overweight and obesity among adults in Ethiopia. Methods: The 2016 Ethiopia Demographic and Health Survey (EDHS), a dataset composed of a nationally representative sample of the survey, served as the basis for the study. Both descriptive and analytic findings were produced using STATA version 14. The data collection were conducted from January to June 2016. A total sample of 39,749 adults, 18 years and older, were included. Predictors were assessed using multivariable ordinal logistic regression analysis, and the results were presented as an adjusted proportional ratio (POR) with a 95% confidence interval. Statistical significance was declared at a p-value of <0.05. Results: Overall, the magnitude of overweight and obesity among adults in Ethiopia was 8.5% (95% CI: 8.2% to 8.7%) and 2.9% (95% CI: 2.7% to 3.1%), respectively. Predictor variables such as smoking (POR = 0.53, 95% CI: 0.42-0.67); being female (POR = 1.21, 95% CI: 1.13-1.30); being married (POR = 1.91, 95% CI: 1.26-2.90); having a secondary education (POR = 1.42, 95% CI: 2.23-1.64); having a diploma and above education (POR = 1.78, 95% CI: 1.44-2.21); having a poorer (POR = 1.22, 95% CI: 1.13-1.31), middle (POR = 1.30, 95% CI: 1.20-1.40), richer (POR = 1.35, 95% CI: 1.25-1.47), and richest (POR = 3.13, 95% CI: 2.79-3.51) wealth index rating; and having a rural residence (POR = 0.48, 95% CI: 0.43-0.54) were significantly associated with overweight and obesity. Conclusions: Overall, 8.5% and 2.9% of Ethiopian adults were overweight and obese, respectively. Factors such as smoking, sex, marital status, educational status, wealth index, residence, and region were significantly associated with overweight and obesity among adult households. As a result, enhancing lifestyle modifications is enormous, and it is necessary to have more tangible evidence concerning the factors influencing body mass index utilizing more representative data from local and global.

Impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia: Implications for future pandemics.

BACKGROUND: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia. METHODS: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level. RESULTS: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (ß: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (ß: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (ß: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (ß: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (ß: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (ß: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia. CONCLUSION: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services.

Fetal malnutrition among neonates in African countries: a CAN score systematic review and meta-analysis.

BACKGROUND: To reduce neonatal mortality, it is necessary to identify neonates with fetal malnutrition at birth using the clinical assessment score (CAN score). Furthermore, comprehensive summary data that shows burden of fetal malnutrition in Africa is scarce. As a result, this systematic review and meta-analysis aimed to assess fetal malnutrition among newborns in Africa. METHOD: The PRISMA guidelines were used for this study. Articles were obtained from databases and websites. The outcome of the study was fetal malnutrition, as determined using the CAN score. The meta-analysis of the primary and secondary outcomes was performed using Stata version 18 statistical software. The pooled prevalence with a 95% CI was estimated using the random effect method with the Der Simonian Liard model. RESULTS: This meta-analysis and systematic review included 5356 newborns from 13 studies. The pooled prevalence of fetal malnutrition (FM) among newborns diagnosed using the CAN score in Africa was 19% [95% CI: 17, 22]. Based on subgroup analysis by publication year, the lowest prevalence of fetal malnutrition 17% (95% CI: 9-27) was observed in the studies published in the years 2020-2023. Maternal and fetal factors were significantly associated with fetal malnutrition. CONCLUSION: Nearly one-fifth of neonates delivered in Africa were found to have fetal malnutrition based on the clinical evaluation of nutritional status. It has also been established that maternal malnutrition, a lack of proper treatment during pregnancy, maternal malnutrition, and newborn morbidities were associated with fetal malnutrition. To prevent fetal malnutrition, integrated efforts should be made for early maternal infection screening. Furthermore, maternal nutritional therapy should be explored for malnourished pregnant women.

Burden of irregular menstrual cycle and its predictors among reproductive-age women in Ethiopia: Systematic review and meta-analysis.

Introduction: Irregular menstrual cycle has negative health and psychosocial repercussions for women of reproductive age worldwide. However, there is no national data for policymakers and health planners in Ethiopia. Therefore, this review aimed to determine the overall burden of irregular menstrual cycle and predictors among reproductive-age women in Ethiopia. Methods: International databases (SCOPUS, CINAHL, CAB Abstract, EMBASE, PubMed, Web of Science, Google, and Google Scholar) and lists of references were employed to search literature in Ethiopia. The random-effects model was used to calculate the odds ratios of the outcome variable using STATA version 18. The heterogeneity of the studies was measured by computing I 2 and p-values. In addition, sensitivity analysis and funnel plots were performed to test the stability of pooled data in the presence of outliers and publication bias. Results: The review includes 21 studies and 9109 populations. The overall burden of irregular menstrual cycles among reproductive-age women was 35% (95% CI: 30-41) with I 2 = 96.96%. Sleeping for <5 h a day (AOR: 2.49; 95% CI: 1.49-3.49) and a stressful life (AOR: 3.15; 95% CI: 1.44-4.85) were predictors of irregular menstrual cycles. Conclusion: More than one in every three reproductive-age women in Ethiopia experience irregular menstrual cycles. Sleeping for <5 h a day and stress increase the likelihood of an irregular menstrual cycle, which can be modified by improving sleeping hours and decreasing stress stimulators through psychotherapy.

Body image dissatisfaction is associated with perceived body weight among secondary school adolescents in Harar Town, eastern Ethiopia.

Purpose: Body image dissatisfaction has emerged as an important determinant of dietary and physical activity, which in turn determine adolescents' nutritional status. Hence, it is important to understand predictors of body image dissatisfaction. Therefore, this study aimed to assess body image dissatisfaction and its associated factors among secondary school adolescents in the study area. Methods: Data collected for other purposes were used to assess body image dissatisfaction among adolescents in Harar town. Body image dissatisfaction was assessed using the Body Part Satisfaction Scale. Data processing and analysis were performed using STATA version 14, and binary logistic regression was used to identify factors associated with body image dissatisfaction. Factors associated with body image dissatisfaction were determined by estimating AOR along with 95% CI and the statistical significance was declared at a p-value less than or equal to 0.05. Result: The prevalence of body image dissatisfaction was 22.06% [95% CI (19.63, 24.70)]. This study also revealed that males were more dissatisfied with their upper torso and face, and females were more dissatisfied with their middle torso, lower torso, height, and weight than males. In this study, body image dissatisfaction was associated with perception of being fat [AOR = 1.89, 95% CI (1.23, 2.91)], anxiety [AOR = 1.59, 95% CI (1.02, 2.48)], and cigarette smoking [AOR = 1.63, 95% CI (1.03, 2.58)]. Conclusion: Almost one in five secondary school adolescents in Harar had body image dissatisfaction, which was significantly associated with perceptions of being fat, anxiety, and smoking. In this study, a significant number of the adolescents experienced body image dissatisfaction. Hence, all concerned bodies have to take action to reduce the burden.

Health service providers experience of psycho-emotional violence and associated factors among urban hospitals in Eastern Ethiopia.

Background: Psycho-emotional violence, a type of workplace violence targeting healthcare workers, varies across countries, occasions, and professions in the healthcare sector. Unfortunately, there is a scarcity of comprehensive studies focusing on violence against healthcare workers in Ethiopia, which may also encompass psycho-gender-based emotional violence against healthcare workers. Therefore, there is a compelling need for in-depth research to address this gap and develop effective strategies to mitigate psycho-emotional violence in the healthcare sector in Ethiopia, especially in the eastern region. Hence, we aimed to identify the prevalence of and factors associated with workplace psycho-emotional violence against healthcare providers in eastern Ethiopia. Methods: This institution-based cross-sectional study was conducted among 744 health professionals working in urban public hospitals in eastern Ethiopia. Multistage stratified random sampling was used, and data were collected using a standardized structured tool adopted from the WHO workplace violence assessment tool. Binary and multivariable logistic regression analyses were employed to identify factors associated with psycho-emotional workplace violence. Adjusted odds ratio (OR) with 95% confidence interval (CI) was reported, and a p-value of 0.05 was used as the cut-off point to declare significance. Results: Workplace psycho-emotional violence was reported by 57.39% of the healthcare workers. The absence of guidelines for gender-based abuse [AOR = 35.62, 95% CI:17.47, 72.64], presence of measures that improve surroundings (class lighting and privacy) [AOR = 0.58, 95% CI: 0.35, 0.98], training on workplace violence coping mechanism [AOR = 0.16, 95%CI: 0.26, 0.98], spending more than 50% of their time with HIV/AIDS patients [AOR = 1.96, 95%CI:1.05, 3.72], and spending more than 50% of their time with psychiatric patients [AOR = 1.92, 95%CI:1.08, 3.43] were factors significantly associated with workplace violence against health professionals. Conclusion: The prevalence of workplace psycho-emotional violence against health professionals in eastern Ethiopia was relatively high. Improving the working environment decreases the chance of workplace violence; however, there is a lack of guidelines for gender-based violence, the absence of training on coping mechanisms, and spending more time with psychiatric and HIV/AIDS patients' increases workplace violence. We recommend that health institutions develop gender abuse mitigation guidelines and provide training on coping mechanisms.

Chronic Microvascular Complication of Type 1 Diabetes Mellitus and Its Predictors Among Children with Type 1 Diabetes Mellitus in Ethiopia; A Single Center Experience: Ambi Directional Cohort Study.

Introduction: Type 1 diabetes mellitus is the most common pediatric endocrine disorder. Poor glycemic control in diabetes mellitus can result in microvascular complications (retinopathy, neuropathy, and nephropathy). There is no study done in our setting either about prevalence of pediatric type 1 diabetes mellitus or chronic microvascular complication among these patients, which gap this study is expected to fill. Objective: This study aimed to assess the risk and predictors of chronic microvascular complication of type 1 diabetes mellitus among children with diabetes at Haramaya University Hiwot Fana Compressive Specialized Hospital from September 10, 2021 to January 30, 2023. Methods: A hospital-based Ambi directional cohort study was conducted. Survival data are described by follow-up time and Kaplan-Meier graph. To determine predictors associated with chronic microvascular complication we used a Poisson regression optimal model selected using the information criterion. All associations are tested at the 95% confidence level and a reported IRR P-value less than 0.05 is declared as a significant association between variables. Results: A total of 124 children with type 1 diabetes mellitus were followed with total 407.5 years risk time. The overall incidence rate of chronic microvascular complication was 83 per 1000 population per year (95% CI: 59-116). The median time for detection of microvascular complication was 7 years after diagnosis. Being male with IRR 1.71 (95% CI: 0. 0.81-3.56), being at pubertal age IRR 1.91 (95% CI: 1.05-3.48), longer diabetes mellitus duration IRR 1.13 (95% CI: 1.07-1.28), and poor glycemic control IRR 1.50 (95% CI: 0.46-4.97) were found to be at higher risk for chronic microvascular complication. Conclusion: There was high incidence of chronic microvascular complication of diabetes mellitus. Being pubertal age group and more than 3 years duration after diagnosis had statistically significant association with complication.

Epidemiology of hyperglycemia during pregnancy in Ethiopia: prevalence, associated factors, and feto-maternal outcomes: systematic review and meta-analysis.

BACKGROUND: Hyperglycemia in pregnancy (HIP) is a significant medical complication affecting pregnant women globally and is considered a public health burden due to the negative outcomes it can cause for both mother and infant. The aim of this systematic review and meta-analysis was to examine the prevalence, risk factors, and feto-maternal outcomes of HIP in Ethiopia. METHODS: To gather relevant information for this study, both published and unpublished studies were searched for in several major databases, including PubMed, Embase, HINARI, Web of Science direct, and Google Scholar, as well as other sources. The Joanna Briggs Institute (JBI) tool was used to evaluate the methodological quality of the findings from these studies. Data was then extracted and summarized using a template in Microsoft Excel software, and the extracted data was analyzed using Stata software version 16.0. If significant heterogeneity was found between studies, subgroup analyses were conducted to further examine the data. RESULT: Eighteen studies were included in this systematic review and meta-analysis, involving a total sample size of 50,816 pregnant women in Ethiopia. The prevalence of HIP among pregnant women varied considerably across the primary studies, ranging from 0.4 to 26.2%. The pooled prevalence of HIP among pregnant women in Ethiopia was found to be 6.9% (95% C 2.2-11.6). Pregnant women with a family history of diabetes had 2.5 times higher odds of developing HIP compared to those without a family history of diabetes (OR = 2.49; 95% CI = 2.02, 2.96). However, there was no significant association found between HIP and maternal obesity (OR 2.31, 95% CI = 0.85, 3.78) or previous history of abortion (OR 3.89; 95% CI 0.85, 6.94). The common fetal outcomes associated with HIP were admission to the intensive care unit (46.2; 95% CI 27.4, 65.1), macrosomia (27.3%; 95% CI 9.4%, 45.1%), and preterm birth (16.9; 95% CI 12.5, 21.3). Additionally, hypertensive disorders of pregnancy (28.0%; 95% CI 15.2, 40.8) and operative delivery (51.4%; 95% CI 35.9, 66.8) were more common among women with HIP in Ethiopia. CONCLUSION: Although there was some variation between studies, the meta-analysis revealed that approximately seven out of 100 pregnant women in Ethiopia had HIP. A family history of diabetes was found to be a significant predictor of HIP in Ethiopia. Additionally, HIP was associated with various serious adverse outcomes for both mothers and infants in Ethiopia. These findings highlight the need for national guidelines to ensure that pregnant women are uniformly screened for HIP.

Diarrheal disease and associated factors among children aged 6 to 59 months in Oda Bultum District, Eastern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Diarrhea is a serious health problem in children under the age of five that is both preventable and treatable. In low-income countries like Ethiopia, children under the age five years frequently experience diarrhea. However, the burden and associated factors of these diarrheal diseases are understudied in Eastern Ethiopia, Thus, this study aimed to determine the factors associated with the prevalence of diarrheal diseases in Eastern Ethiopia from September 1-30, 2022. METHODS: A cross-sectional study was conducted on the total of 602 children aged 6 to 59 months in Oda Bultum district in eastern Ethiopia. A multistage sampling method was used. Three kebeles were selected from nine kebeles by the lottery method. Data was entered into Epi data 4.0.2 and exported to SPSS version 21 for analysis. Descriptive analysis was used for frequency, mean, and standard deviations. In addition, bivariable, and multivariable Poisson regression model was used to identify predictors of diarrhea along with a 95% confidence interval. Finally, statistical significance was declared at a p-value of 0.05. RESULT: A total of 602 children were included in this study. The prevalence of diarrhea 7.4% (47/602), 95% CI; 5.5-9.7%) among the children. Factors such as being unvaccinated for any vaccine (AOR = 10.82, 95%CI; 4.58-25.48) and born from a mother who had medium level of empowerment (AOR = 0.34, 95%CI; 0.11-0.88) in the household had statistically significant association with diarrhea among the children compared to their counterparts. CONCLUSION: The study found that nearly one out of thirteen children aged 6 to 59 months had any form of diarrheal diseases in Oda Bultum District, Eastern Ethiopia. In addition, the study revealed that children who were vaccinated for their age developed diarrhea less likely compared to those who did not receive any form of vaccine for their age. Moreover, children with mothers who had a medium level of empowerment were less likely to get diarrhea than children with mothers who had a low level of empowerment.

Coverage and determinants of HIV testing and counseling services among mothers attending antenatal care in sub-Saharan African countries: a multilevel analysis.

BACKGROUND: HIV/AIDS is one of the top global public health threats that causes significant cases, deaths, and socioeconomic impact. Even though both HIV testing and counseling are identified as essential HIV interventions during pregnancy, large population-representative data shows that service coverage and determinants are limited. Therefore, this study aimed to assess the coverage and determinants of HIV testing and counseling services among pregnant mothers attending antenatal care services in sub-Saharan African countries using different nationwide data. METHODS: This study was conducted on large national-representative data from the Demographic Health Survey (DHS) using multilevel analysis. Data extraction, cleaning, coding, and statistical analysis were performed using STATA version 17. Weighting was used to ensure the representativeness of the sample and to obtain reliable estimates and standard errors. The multivariable multilevel logistic regression model was used to identify the determinants of HIV testing and counseling during the antenatal care visit. Adjusted odds ratios with 95% confidence intervals were used to measure statistical significance. RESULTS: A total of 83,584 women attending antenatal care were included in this study. HIV testing and counseling coverage in sub-Saharan Africa was found to be 62.87% with a 95% CI of 62.54-63.19%. The HIV testing and counseling determinants included being in the age group of 35-49 (AOR = 1.64; 95% CI: 1.46-1.83), secondary and above education levels (AOR = 1.50; 95% CI: 1.39-1.60), having at least four ANC visits (AOR = 1.85; 95% CI: 1.68-2.02), living in an urban area (AOR = 1.40; 95% CI: 1.30-1.52), and living in countries such as Rwanda (AOR = 6.19; 95% CI: 5.19-7.38) and Mauritania (AOR = 0.02; 95% CI: 0.01-0.03). CONCLUSION: This study revealed that HIV testing and counseling coverage was 62.87% in sub-Saharan Africa. Factors affecting the HIV testing and counseling coverage were age, education, frequency of antenatal care visits, residence area, and living in Rwanda and Mauritania. Therefore, to increase HIV testing and counseling coverage in sub-Saharan Africa, policymakers on maternal health and other stakeholders should work with an integrated approach with other sectors and give prior attention to modifiable factors such as promoting women's education and the comprehensiveness of antenatal care follow-up services during the follow-up.

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.

The effect of health insurance coverage on antenatal care utilizations in Ethiopia: evidence from national survey.

Background: About three-fourths of maternal near-miss events and two-fifths of the risk of neonatal mortality can be reduced by having at least one antenatal visit. Several studies have identified potential factors related to maternal health seeking behavior. However, the association between health insurance membership and antenatal care utilization was not well investigated in Ethiopia. Therefore, this study was aimed at assessing the effect of health insurance coverage on antenatal care use in Ethiopia. Methods: The study utilized data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). The analysis included a weighted sample of 3,919 women who gave birth in the last five years. A logistic regression model was employed to assess the association between antenatal care use and health insurance coverage and other covariates. The results were presented as adjusted odds ratios (AOR) at a 95% confidence interval (CI). Statistical significance was declared at a p-value <0.05 in all analyses. Results: Antenatal care was used by 43% (95% CI: 41.46 to 44.56%) of Ethiopian women. Those with health insurance coverage had higher odds of antenatal care use than those without health insurance coverage. Women were 33% more likely to use antenatal care (ANC) if they were covered by health insurance. Age, Media access, marital status, education status, wealth index, and economic regions were also factors associated with antenatal care utilizations. Conclusions: According to our findings, less than half of Ethiopian women had four or more antenatal care visits. Health insurance membership, respondent age, media access, marital status, education status, wealth index, and economic region were factors associated with antenatal care utilization. Improving health insurance, women's economic empowerment, and education coverage are critical determinants of antenatal care utilization.

In-hospital mortality and length of stay of patients with hypertensive crisis treated at public hospitals in Harari Regional State, Eastern Ethiopia.

Hypertensive crisis poses substantial cardiovascular morbidity and mortality. This study aimed to assess in-hospital mortality, length of stay (LOS), and their predictors among patients with hypertensive crisis treated at public hospitals in Harari Regional State, Eastern Ethiopia. An institutional-based retrospective cohort study was conducted from October 1 to 31, 2022. The medical records of 328 patients with hypertensive crisis treated at two public hospitals between September 1, 2017 and August 31, 2022 were reviewed. Cox proportional hazards regression and negative binomial regression were used to identify predictors of in-hospital mortality and LOS, respectively. The in-hospital mortality rate of patients with hypertensive crisis was 18.94 (95% confidence interval (CI): 12.08-29.70) per 1000 person-day observation. The median (interquartile range) LOS of these patients was 10 (4-120) hours. Age ≥65 years (adjusted hazard ratio (AHR): 3.30; 95% CI: 1.17- 9.33); increment in initial systolic blood pressure (AHR: 1.040; 95% CI: 1.014-1.066); and having acute brain-related damage (AHR: 4.02; 95% CI: 1.48-10.88) were predictors of in-hospital mortality. Rural residence (adjusted incident-rate ratio (IRR): 1.34; 95% CI: 1.03-1.75); having a history of medication discontinuation (adjusted IRR: 1.59; 95% CI: 1.16-2.18); comorbidity (adjusted IRR: 1.90; 95% CI: 1.49-2.43); acute brain-related damage (adjusted IRR: 13.32; 95% CI: 9.22-19.24), acute cardiac-related damage (adjusted IRR: 7.40; 95% CI: 4.90-11.16); and acute kidney injury (adjusted IRR: 7.64; 95% CI: 5.46-10.69) were predictors of LOS. Thus, it is necessary to develop strategies that allow early screening and follow-up of patients at risk.

Co-occurrence of hypertension and type 2 diabetes: prevalence and associated factors among Haramaya University employees in Eastern Ethiopia.

Background: Both hypertension (HTN) and diabetes are public health concerns in low- and middle-income countries, particularly in sub-Saharan African countries. The co-occurrence of HTN and diabetes is associated with an increased risk of mortality, morbidity, and reduced productivity in the working force. In Ethiopia, there is limited evidence on the co-occurrence of HTN and type 2 diabetes (T2DM). Therefore, this study was conducted to assess the co-occurrence of HTN and T2DM and their associated factors among Haramaya University employees in Eastern Ethiopia. Methods: A cross-sectional survey was conducted among 1,200 employees at Haramaya University using a simple random sampling technique from December 2018 to February 2019. Demographic and behavioral factors were collected on a semi-structured questionnaire, followed by measurement of anthropometry and blood pressure. Blood glucose and lipid profile measurements were performed by collecting 6 ml of venous blood samples after 8 h of overnight fasting. Data were entered into EpiData 3.1 version and analyzed using Stata 16 software. Bivariable and multivariable logistic regressions were applied to observe the association between independent variables with co-occurrence of HPN and T2DM using odds ratio, 95% confidence interval (CI), and p-values of ≤ 0.05 were considered statistically significant. Results: The prevalence of HTN and T2DM was 27.3 and 7.4%, respectively. The co-occurrence of HTN and T2DM was 3.8%. The study found that being older (AOR = 3.97; 95 % CI: 1.80-8.74), khat chewing (AOR = 2.76; 95 % CI: 1.23-6.18), body mass index ≥ 25 kg/m2 (AOR = 5.11; 95 % CI: 2.06-12.66), and sedentary behavior ≥8 h per day (AOR = 6.44; 95 % CI: 2.89-14.34) were statistically associated with co-occurrence of HTN and T2DM. On the other hand, consuming fruits and vegetables (AOR = 0.10; 95 % CI: 0.04-0.22) and a higher level of education (AOR = 0.39; 95% CI: 0.17-0.89) were negatively statistically associated with the co-occurrence of HTN and T2DM. Conclusion: The co-occurrence of HTN and T2DM was prevalent among the study participants. This may create a substantial load on the healthcare system as an end result of increased demand for healthcare services. Therefore, rigorous efforts are needed to develop strategies for screening employees to tackle the alarming increase in HTN and T2DM in university employees.

Minimum Dietary Diversity Among Children Aged 6-59 Months in East Africa Countries: A Multilevel Analysis.

Objective: To find out the determinants of minimum dietary diversity (MDD) among under-five children in East Africa based on the 2017 revised indicator. Methods: Secondary data from the demographic and health survey (DHS) of eight countries in East Africa were combined. A total of 27,223 weighted samples of children aged 6-59 months were included. Multi-level logistic regression analysis was employed to identify the determinants of dietary diversity. Results: The magnitude of adequate MDD in East Africa was found to be 10.47% with 95% CI (10.12-10.84) with the lowest and highest magnitude in Ethiopia and Rwanda respectively. Having a mother in the age group of 35-49, having a mother with higher educational attainment, and having a post-natal check-up within 2 months were significant factors in determining adequate MDD. Conclusion: The magnitude of adequate MDD intake among children aged 6-59 months in East Africa is relatively low. Therefore, strengthening interventions focused on improving the economic status of households, the educational status of mothers, and diversified food consumption of children aged 6-59 months should get priority to improve the recommended feeding practice of children.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022.

Background: Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region. Methods: A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model. Results: Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71). Conclusion: We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Antenatal care utilization and nutrition counseling are strongly associated with infant and young child feeding knowledge among rural/semi-urban women in Harari region, Eastern Ethiopia.

There is a gap in evidence linking antenatal care (ANC) utilization, nutrition counseling, and knowledge of pregnant women about infant and young child feeding (IYCF), particularly in low-income settings. Therefore, this study aimed to identify the association between ANC follow-up and nutrition counseling with IYCF knowledge. A cross-sectional study was conducted among 390 pregnant women in the rural kebeles of the Harari region from January to June 2019. Data were collected using face-to-face interviews on tablet computers. Bivariate and multivariate logistic regression were employed. An adjusted odds ratio (with 95% CI) was used to determine the strength of association between IYCF knowledge with ANC follow-up and nutrition counseling by adjusting for educational status, occupation, gravida, and distance to the nearest health center. Overall, 54.4% [95% CI 49.2, 59.2] of currently pregnant women were knowledgeable about IYCF of which only 20% started ANC follow-up and 24.4% received nutrition counseling. Out of 288 multigravida women, only 51.4% had ANC follow-up during their last pregnancy. In the adjusted model, ANC follow-up during the current pregnancy (AOR 1.85, 95% CI 1.07-3.22), those who received nutrition counseling (AOR 1.92, 95% CI 1.09-3.38), literate in education (AOR 1.71, 95% CI 1.07-2.73), multigravida (AOR 1.96, 95% CI 1.12-3.43), and far from the nearest health center (AOR 0.95, 95% CI 0.93-0.97) were significantly associated with the mothers IYCF knowledge. Thus, health care providers should encourage mothers to attend ANC during pregnancy and provide nutrition counseling about the IYCF.

Trends and determinants of pregnancy loss in eastern Ethiopia from 2008 to 2019: analysis of health and demographic surveillance data.

BACKGROUND: Pregnancy losses remain a neglected issue and it will be taking more than a century before a pregnant woman in Sub Sahara has the same chance of her baby being born alive as a woman in a high-income country. Pregnancy loss data are limited and not universal in Sub Saharan countries. This study was aimed to assess the magnitude and determinants of pregnancy loss in eastern Ethiopia. METHODS: This study was conducted in, open continues and dynamic cohort of population, Kersa Health and Demographic Survillance site (HDSS) in Eastern Ethiopia in 2008-2019. All mothers who had known pregnancy outcomes during the period and reside in Kersa HDSS were considered. The prevalence proportions were calculated as the sum of all pregnancy loss divided by the number births in the specified year. Log-Binomial regression was used to determine factors associated with pregnancy loss. Prevalence Proportion Ratio (PPR) was used to report the magnitude and strength of association. A p-value of less than 0.05 was considered statistically significant. RESULTS: From 39,153 included pregnancies, 810 (20.7; 95%CI:19.32, 22.15 per 1000 births) experienced pregnancy loss. Stillbirth was higher than abortion (11.14 Vs. 9.55 per 1000 births). Lacking own income (aPPR:1.26; 95%CI: 1.01, 1.58), being daily laborer (aPPR:1.44; 95%:1.08, 306) history of previous pregnancy loss (aPPR:2.26, 95%CI:1.69, 3.03), unwanted pregnancy (aPPR:1.26; 95%CI:1.01, 1.80), not receiving antenatal care (aPPR:1.59; 95%CI: 1.19, 2.13) and not receive the TT-vaccine during pregnancy (aPPR:1.33; 95%CI: 1.08, 1.80) were positively associated with pregnancy loss. CONCLUSIONS: The overall rate pregnancy loss was ranged between 19.32, 22.15 per 1000 births with higher still births than miscarriage or abortion. Pregnancy loss was positively associated with social factors reproductive health factors, and maternal health service utilization.

Prevalence of Group B Streptococcus Recto-Vaginal Colonization, Vertical Transmission, and Antibiotic Susceptibility Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

Background: Maternal Group B Streptococcus (GBS) recto-vaginal colonization is the most common route for early onset neonatal GBS diseases. A good understanding of the rate of maternal GBS colonization, vertical transmission rate, and antibiotic susceptibility profiles is needed to formulate a broad protection mechanism, like vaccine preparation. For that reason, this meta-analysis aimed at determining the pooled prevalence of GBS recto-vaginal colonization, vertical transmission rate, and antibiotic susceptibility profiles in Ethiopia. Methods: Both published and unpublished studies were searched from MEDLINE/PubMed, CINAHL (EBSCO), Embase, Cochrane Library, SCOPUS, Web of Sciences databases, and Google Scholar. Independent selection was then carried out by the authors based on the eligibility criteria and data extraction using Microsoft excel. The authors then used STATA version 14.1 software for further cleaning and analysis. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Using the random-effect model, the prevalence with a 95% confidence interval (CI) and forest plot were used to present the findings. Besides, the studies' heterogeneity was assessed using Cochrane chi-square (I2) statistics, while Egger intercept was used to assess publication bias. Results: This review included nineteen studies. The pooled prevalence of recto-vaginal colonization was 15% (95% CI: 11, 19), while the prevalence of vertical transmission was 51% (95% CI: 45, 58) and highest-level susceptibility to vancomycin was 99% (95% CI: 98, 100). However, the GBS susceptibility to tetracycline was 23% (95% CI: 9, 36). Conclusions: Nearly one out of seven pregnant women in Ethiopia had recto-vaginal colonization of GBS. As a result, half of the pregnancies end with vertical transmission of GBS. Hence, the review emphasizes that policy and programs should consider planning and implementing prophylactic programs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287540.