Magnitude of psychological distress and associated factors among war survivor women in Northern, Ethiopia, 2022: a community-based cross-sectional survey.

BACKGROUND: Civilian war and internal conflicts increase the incidences of mental health conditions among war survivors. It is crucial to assess war-related psychological consequences in war-affected areas in Ethiopia to intervene in the future. Thus, this study aimed to determine the magnitude of psychological distress and associated factors of psychological distress among war survivor women in Northern, Ethiopia. METHODS: A community-based cross-sectional survey was conducted, and 1596 war survivor women were recruited to participate using a face-to-face interviews with a census sampling technique from May 1-30, 2022. The psychological distress was assessed using a Kessler psychological distress scale (K10). Bi-variable and multi-variable logistic regression analyses were used, and variables with a p-value less than 0.05 in the multivariable analyses were considered statistically significant. RESULT: In this study, the response rate was 100% and the prevalence of psychological distress was 44.90% at a 95% CI: (42.40, 47.40). Psychological distress was significantly associated with the education of ability to read and write (AOR = 2.92; 95% CI: 2.12, 4.01), primary education and above (AOR = 3.08; 95% CI: 2.09, 4.54), housewife (AOR = 5.07; 95%CI: 2.64, 9.74), farmer (AOR = 8.92; 95%CI: 4.03, 19.70), emotional violence (AOR = 1.52; 95%CI: 1.05, 2.18), physical violence (AOR = 3.85; 95%CI: 2.37, 6.26) and sexual violence (AOR = 3.25; 95%CI: 1.98, 5.33) whereas being separate was protective for psychological distress (AOR = 0.38; 95%CI: 0.16, 0.92). CONCLUSION: The prevalence of psychological distress was found to be high. Therefore, women who are housewives, married, farmers, educated, and who have experienced violence must be the focus of governmental and private collaborative interventions to prevent war-related psychological morbidity and mortality.

Comprehensive HIV knowledge and associated factors among reproductive-age women: analysis of the Gambia Demographic and Health Survey 2019/2020.

INTRODUCTION: Globally, there are 37.7 million people living with human immunodeficiency virus (HIV). So far, there is no study done in Gambia which assessed comprehensive HIV knowledge and its associated factors. Therefore, this study aims to assess comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia. OBJECTIVE: To assess the prevalence of comprehensive HIV knowledge and its associated factors among reproductive-age women in Gambia. METHODS: The study used the Gambian Demographic and Health Survey, which was conducted from 21 November 2019 to 30 March 2020 in Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Logistic regression analysis was used to identify factors associated with HIV comprehensive knowledge. Statistical significance was declared at a P value of less than 0.05 with a 95% confidence interval (CI). RESULTS: The overall prevalence of comprehensive HIV knowledge was 27.1% (25.1-36.2%). Older age [adjusted odds ratio (AOR) of 1.20 (95% CI 1.16-1.26)], using contraceptive [AOR of 1.15 (95% CI 1.01-1.31)], higher education [AOR of 4.73 (95% CI 3.86-5.81)], rich wealth quintile [AOR of 1.61 (95% CI 1.37-1.87)], media exposure [AOR of 1.76 (95% CI 1.39-2.23)], ever tested for HIV [AOR of 1.55 (95% CI 1.42-1.74)], visited health facility within the last 12 months [AOR of 1.26 (95% CI 1.12-1.41)] and decision-making autonomy [AOR of 1.42 (95% CI 1.27-1.60)] were positively associated with comprehensive HIV knowledge. However, being married [AOR of 0.72 (95% CI 0.62-0.82)] was negatively associated with comprehensive HIV knowledge. CONCLUSIONS: The prevalence of comprehensive HIV knowledge was low in Gambia. Educational interventions that focused mainly on awareness creation about HIV/AIDS should be designed especially for married women and lower socio-economic status. An effort has to be made to address those disparities at the national level.

Oral hygiene behaviour and its determinants among preparatory school students in Gondar city, Northwest Ethiopia: A cross-sectional study.

OBJECTIVES: This study aimed to evaluate oral hygiene behaviour and its determinants among preparatory school students in Gondar city, Northwest Ethiopia. METHODS: Institutional-based cross-sectional study was conducted among 423 students to evaluate their oral hygiene behaviour and determinant factors (sociodemographic attributes, oral hygiene knowledge, and attitude to oral hygiene behaviours). Linear regression was employed to identify factors associated with oral hygiene behaviour. A p-value of <0.05 and a 95% confidence interval were used to declare statistical significance. RESULTS: A total of 407 students participated with a response rate of 96.2%. The mean age of the participants was 18 (SD ±1.3). The mean oral hygiene behaviour (OHB) score was about 7.89 ± 3.43. Only 9.2%, 21.4%, and 5.7% were brushing their teeth at least twice a day, cleaning their tongue, and flossing at least once a day respectively. Father's educational status (able to read and write (ß = 1.99, 95% CI: 0.62, 3.38), completed secondary school (ß = 1.68, 95% CI: 0.18, 3.18), and diploma and higher (ß = 1.75, 95% CI: 0.33, 3.18)), being from private school (ß = 3.25, 95%CI: 2.30, 4.19), knowledge about OHB (ß = 0.16, 95% CI: 0.01, 0.30), and attitude towards OHB (ß = 0.11, 95% CI: 0.08, 0.14) were significant factors positively associated with better oral hygiene behaviour. CONCLUSION: Oral hygiene behaviour was poor among preparatory school students in Gondar city. Father's educational status, students' oral hygiene knowledge, and attitude were found to be significant factors affecting students' oral hygiene behaviour. Thus, tailored school-based oral health communication programs are highly required to improve students' oral hygiene behaviour.

Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia.

INTRODUCTION: Child mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact of pairing Orthodox priests with community health workers, known locally as the Health Development Army (HDA), on newborns' nutritional status, early illness identification and treatment, and vaccination completeness.Ensuring intervention efficacy with scientific rigour is essential, but there are often delays in adopting evidence into policy and programmes. Here, we present a protocol for conducting parallel implementation research alongside an efficacy study to understand intervention implementability and scalability. This will help develop a scale-up strategy for effective elements of the intervention to ensure rapid implementation at scale. METHODS AND ANALYSIS: We will conduct a stakeholder analysis of key implementation stakeholders and readiness surveys to assess their readiness to scale up the intervention. We will conduct semistructured interviews and focus group discussions with stakeholders, including HDA members, health workers, Orthodox priests, and caregivers, to determine the core intervention elements that need to be scaled, barriers and facilitators to scaling up the intervention in diverse sociocultural settings, as well as the human and technical requirements for national and regional implementation. Finally, to determine the financial resources necessary for sustaining and scaling the intervention, we will conduct activity-based costing to estimate implementation costs from the provider's perspective. ETHICS AND DISSEMINATION: The study received approval from the University of Gondar Institutional Review Board (approval no: VP/RTT/05/1030/2022) and the University of Washington Human Subjects Division (approval no: STUDY00015369). Participants will consent to participate. Results will be disseminated through workshops with stakeholders, local community meetings, presentations at local and international conferences, and journal publications. The study will provide evidence for factors to consider in developing a scale-up strategy to integrate the intervention into routine health system practices.

Determinants of Malnutrition and its associated factors among pregnant and lactating women under armed conflict areas in North Gondar Zone, Northwest Ethiopia: a community-based study.

INTRODUCTION: Maternal malnutrition remains a major public health problem, particularly in low and middle-income countries and war-affected areas like Ethiopia. Malnourished pregnant and lactating women with low nutrient stores have babies with poor mental and physical development, increasing the risk of poor birth outcomes. Despite the fact that the majority of Ethiopian mothers are malnourished, there is little evidence in war-affected areas. Therefore, the objective of this study was to assess the prevalence of undernutrition and associated factors among pregnant and lactating mothers in the war affected area of North Gondar Zone, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from April 10 to May 25, 2022. A multistage random sampling technique was used to select 1560 pregnant and lactating mothers. MUAC was to ascertain the outcome variable. Data was entered and analyzed by using EPI INFO version 3.5.3 and SPSS version 24, respectively. A multivariable logistic regression analysis was employed to identify the factors associated with acute malnutrition. An adjusted odds ratio (AOR) with a 95% confidence interval was used to show the strength of the association, while a P-value of 0.05 was used to declare the significance of the association. RESULTS: The prevalence of acute malnutrition among pregnant and lactating women was 34.3% at the 95% CI (31.9-36.8). The age of the mothers (AOR = 0.73; 95% CI: 0.54, 0.99), family size 6-8 (AOR = 1.21; 95% CI: 1.03, 1.82), and greater than or equal to 9 family sizes (AOR = 0.44; 95% CI: 0.19, 0.97), were significantly associated with acute malnutrition. CONCLUSIONS: In the current study, the prevalence of acute malnutrition among pregnant and lactating mothers is high in the study area. Mother's age and family size were factors associated with acute malnutrition in war-affected areas. As a result, mothers with large families will require special assistance to reduce the impact of malnutrition.

Problems with accessing healthcare and associated factors among reproductive-aged women in the Gambia using Gambia Demographic and Health Survey 2019/2020: a cross-sectional study.

OBJECTIVES: To assess problems with accessing healthcare and its associated factors among reproductived-age women in the Gambia using the Gambia Demographic and Health Survey 2019/2020. DESIGN: A community-based cross-sectional study. SETTING: This study was based on a large, community-based cross-sectional survey, conducted from 2019 to 2020 in the Gambia. The survey employed a stratified two-stage cluster sampling technique to recruit study participants. Descriptive statistics and logistic regression models were used to summarise descriptive data and identify factors associated with problems of accessing healthcare, respectively. A p value of less than 0.05 and 95% CI were used to determine statistical significance. PARTICIPANTS: A total of 11 865 reproductive-aged women (15-49 years) were included in the study. The mean age of the women was 28.21 with an SD of 9.33 and ranges 15-49 years. Regarding marital status, 7526 (63.43%) were married. RESULTS: The magnitude of problems with accessing healthcare among reproductive-aged women in the Gambia was 45.5% (95% CI: 44.6%, 46.4%). Age (adjusted OR (AOR)=1.48, 95% CI: 1.12, 1.95), being from rural residence (AOR=1.28, 95% CI: 1.07, 1.53), parity (AOR=1.07, 95% CI: 1.03, 1.12), middle (AOR=0.54, 95% CI: 0.46, 0.64) and greater wealth (AOR=0.30, 95% CI: 0.25, 0.37), giving birth at health institutions (AOR=0.69, 95% CI: 0.58, 0.80), currently working (AOR=0.77, 95% CI: 0.68, 0.86) and geographical region were significantly associated with problems of accessing healthcare. CONCLUSION: Problems of accessing healthcare among women of reproductive age were high in the Gambia. Age, region, working status, parity, residence, wealth and place of delivery were the identified factors associated with problems of accessing healthcare. Policymakers and public health experts should consider those factors while designing maternal healthcare programmes. Affordable healthcare service programmes should be designed to increase healthcare access in the Gambia.

Prevalence and Determinants of Premarital Sexual Practice among Youths in Ethiopia: Based on the Ethiopian Demographic and Health Survey Data.

Background: Premarital sexual practice becomes a common phenomenon among youths in Ethiopia. It is usually associated with unwanted pregnancies, abortions, and sexually transmitted diseases including HIV/AIDS. Objective: This study is aimed at assessing the magnitude and determinants of premarital sexual practice among Ethiopian youths. Methods: A community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. A total of 7389 youths with the age range from 19 to 24 were included in the present study. Bivariable and multivariable binary logistic regression analyses were employed to identify factors associated with premarital sex. A 95% CI and p value < 0.05 were used to declare statistical significance. Result: The prevalence of premarital sexual practice was 10.8% (95% CI, 10%-11.5%). Being in the age group of 20-24 (AOR = 3.6, 95% CI (2.8, 4.6)), male sex (AOR = 1.7, 95% CI (1.3, 2.2)), employed (AOR = 1.4, 95% CI (1.03, 1.8)), from pastoral region (AOR = 1.4, 95% CI (1.3,2.4)), having mobile phone (AOR = 1.7, 95% CI, (1.3, 2.3)), ever use of internet (AOR = 1.8, 95% CI (1.3, 2.5)), ever drinking alcohol (AOR = 2.4, 95% CI (1.7, 2.5)), ever chewed khat (AOR = 2.4, 95% CI (1.6, 3.5), and ever tested for HIV (AOR = 1.3, 95% CI (1.1,1.6)) were statistically significant factors associated with premarital sex. Conclusion: For every 10 youths, at least one of them had sexual intercourse before they got married. Being in the age group of 20-24, male sex, employed, from a pastoral region, having a mobile phone, ever use of the internet, alcohol drinking, khat chewing, and ever tested for HIV were important factors affecting premarital sex. Thus, national sexual education and reproductive health behavior change interventions should give due attention to those groups. Furthermore, adequate education should be given about premarital sexual intercourse when youths come for HIV tests.

Safe stool disposal and associated factors among mothers of children aged under-two years in Gambia: Evidence from Gambia Demographic Health Survey 2019/20.

BACKGROUND: Appropriate disposal of child stool is vital in preventing the spread of faecal-oral diseases. According to WHO/ UNICEF Joint Monitoring Program, Safe child stool disposal includes disposing a stool in a Flush or pour-flush toilet/latrine (to a piped sewer system, septic tank, pit latrine), Ventilated improved pit (VIP) latrine or a Pit latrine with slab. OBJECTIVE: The study aimed to assess safe child stool disposal practice and associated factors among mothers with children aged under-two years in Gambia. METHODS: This study was based on a large community-based cross-sectional survey, conducted from 21 November 2019 to 30 March 2020 in Gambia. The survey employed a two-staged stratified cluster sampling technique to recruit study participants. Descriptive statistics and logistic regression models were used to summarize descriptive data and identify factors associated with safe waste disposal, respectively. A p-value of less than 0.05 and 95% confidence interval were used to determine statistical significance. RESULTS: The prevalence of safe stool disposal among mothers with children aged under-two years were 56.3% (95% CI: 54.6%, 58.1%). Mothers aged 25-34 (AOR = 0.78 (95%CI: 0.62, 0.98)), the highest wealth quintile (AOR = 0.43 (95%CI: 0.33, 0.56)), being exposed to media (AOR = 1.37 (95%CI: 1.07, 1.76)), increasing age of children (AOR = 1.06 (1.05, 1.07)), Being employed (AOR = 1.31 (1.11, 1.55)) and Geographic region were significantly associated with safe child disposal practice. CONCLUSION: The prevalence of safe child stool disposal was low in Gambia. Age of the mother, age of the child, region, wealth index, media exposure and occupational status of the mother were significantly associated with safe child stool disposal. Public health intervention strategies designed to promote safe child stools disposal need to conduct thorough community assessments to identify community-specific facilitators, needs and barriers. Additionally, public health experts and policy makers should take into consideration the geographical and wealth inequalities when designing programs aimed to improve safe child stool disposal practice.

An Evaluation of Community Health Workers' Knowledge, Attitude and Personal Lifestyle Behaviour in Non-Communicable Disease Health Promotion and Their Association with Self-Efficacy and NCD-Risk Perception.

Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion.

Exploring the determinants of exclusive breastfeeding among infants under six months in the Gambia using gambian demographic and health survey data of 2019-20.

INTRODUCTION: For infants, no one is as nutritious as breastmilk for the rest of their lives. It is a great guarantee for their future health, especially if they can exclusively breastfeed for the next few months, from the moment they are born until the end of the fifth month. Although breastfeeding rates are very low, there is no data record about it in the Gambia. OBJECTIVE: This study aimed to assess the status of exclusive breastfeeding and its determinants among infants under six months of age in the Gambia. METHODS: It is a secondary data analysis using the 2019-20 Gambia demographic and health survey data. A total of 897 weighted mother-infant paired samples were included in the study. A logistic regression analysis method was employed to declare factors significantly associated with exclusive breastfeeding among infants under six months of age in Gambia. Variables with a p-value of 0.2 were entered into multiple logistic regression analysis, and after controlling other confounding factors, an adjusted odds ratio of 95% CI was applied to identify associated variables. RESULTS: Exclusive breastfeeding was found in 53.63% only among infants under six months of age. Being a rural resident (AOR = 2.14, 95% CI: 1.33, 3.41), reading a newspaper (AOR = 5.62, 95% CI: 1.32, 24.09), and being counseled on breastfeeding by a health professional (AOR = 1.36, 95% CI: 1.01, 1.82) are times more likely to practice exclusive breastfeeding, respectively. On the other hand, a child with a fever (AOR = 0.56, 95% CI: 0.37, 0.84), a child whose age is 2-3 months (AOR = 0.41, 95 CI: 0.28, 0.59), and a child whose age is 4-5 months (AOR = 0.11, 95% CI: 0.07, 0.16) is less likely to be fed exclusively than a 0-1-month-old child. CONCLUSION: Exclusive breastfeeding remains among the public health challenges in the Gambia. Strengthening health professionals' counseling techniques on breastfeeding and infant illnesses, promoting the pros of breastfeeding, and designing timely policies and interventions are urgently needed in the country.

Individual and community level factors associated with medical treatment-seeking behavior for childhood diarrhea among the Gambian mothers: evidence from the Gambian demographic and health survey data, 2019/2020.

INTRODUCTION: In less developed countries, including the Gambia, childhood diarrhea is one of the leading causes of serious illness and death among children. Studies on wider determinants of behaviors in medical treatment seeking for diarrheal illnesses in poor resource settings are limited. However, the challenges are continuing and, there is a gap in research work about it in the Gambia. Therefore, the rationale of this study was to assess the individual and community level factors of medical treatment-seeking behaviors for childhood diarrhea among mothers in the Gambia. METHODS: Data from the 2019-20 Gambia demographic and health survey were used in this study, which was based on secondary data analysis. A total of 1,403 weighted samples of under-five children's mothers were included in the study for diarrhea medical treatment-seeking behaviors. Because of the hierarchical nature of the data, a multi-level logistic regression model was applied to identify individual and community-level factors that may influence mothers' medical treatment-seeking behaviors of diarrhea. Data were analyzed using multilevel logistic regression analysis. In the multivariable multilevel logistic regression analysis, variables were judged significantly linked with medical treatment-seeking behavior of diarrhea if their p-value was less than 0. 05. RESULTS: Medical treatment-seeking behaviors for diarrhea were discovered in 62.24% (95% CI: 59.67,64.74) of mothers of under five children. Being a female child has shown odds of (AOR = 0.79, (CI 95%: (0.62,0.98)) times less treatment-seeking behavior than the counterparts. Moreover, compared to mothers whose children were of average size, those whose children were smaller, and larger than average at birth were more likely to seek out pediatric medical treatment (AOR = 1.53, 95% CI (1.08-2.16), and (AOR = 1.31, 95% CI (1.01,1.169)) respectively. On the other side, mothers who have exposure to listening to the radio, and heard about oral rehydration have shown an odds of (AOR = 1.34, CI 95%, (1.05,1.72)), (AOR = 2.21, CI 95%, (1.14,4.30)), being from the middle, and rich household wealth have also shown (AOR = 2.15, CI 95%, (1.32,3.51)), and (AOR = 1.92, (CI 95%, (1.11,3.32)), a child with cough, and fever (AOR = 1.44, CI 95%, (1.09,1.89)), and (AOR = 1.73, CI 95%, (1.33,2.25)) were individual-level factors that have shown association statistically with the outcome variable. Similarly, regarding community level factors mothers who had a postnatal checkup, and those from the Kerewan region have revealed more odds of (AOR = 1.48, CI 95%, (1.08,2.02)), and (AOR = 2.99, CI 95%, (1.32,6.78)) times significantly with treatment seeking behavior of mothers respectively. CONCLUSION: Diarrhea medical treatment-seeking behavior was found low. Hence, it remains among the top public health challenges in the Gambia. Strengthening mothers' healthcare-seeking behavior and skills on home remedies, and childhood illnesses, advocating mass media exposure, assisting financially disadvantaged mothers, and postnatal checkups after delivery will enhance medical treatment-seeking behavior. Furthermore, coordinating with regional states, and designing timely policies and interventions are highly advisable in the country.

Pooled prevalence and determinants of antenatal care visits in countries with high maternal mortality: A multi-country analysis.

Background: Complications during pregnancy and childbirth are the leading causes of maternal and child deaths and disabilities, particularly in low- and middle-income countries. Timely and frequent antenatal care prevents these burdens by promoting existing disease treatments, vaccination, iron supplementation, and HIV counseling and testing during pregnancy. Many factors could contribute to optimal ANC utilization remaining below targets in countries with high maternal mortality. This study aimed to assess the prevalence and determinants of optimal ANC utilization by using nationally representative surveys of countries with high maternal mortality. Methods: Secondary data analysis was done using recent Demographic and Health Surveys (DHS) data of 27 countries with high maternal mortality. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from the individual record (IR) files of from each of the 27 countries. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) and p-value of ≤0.05 in the multivariable model were used to declare significant factors associated with optimal ANC utilization. Result: The pooled prevalence of optimal ANC utilization in countries with high maternal mortality was 55.66% (95% CI: 47.48-63.85). Several determinants at the individual and community level were significantly associated with optimal ANC utilization. Mothers aged 25-34 years, mothers aged 35-49 years, mothers who had formal education, working mothers, women who are married, had media access, households of middle-wealth quintile, richest household, history of pregnancy termination, female household head, and high community education were positively associated with optimal ANC visits in countries with high maternal mortality, whereas being rural residents, unwanted pregnancy, having birth order 2-5, and birth order >5 were negatively associated. Conclusion and recommendations: Optimal ANC utilization in countries with high maternal mortality was relatively low. Both individual-level factors and community-level factors were significantly associated with ANC utilization. Policymakers, stakeholders, and health professionals should give special attention and intervene by targeting rural residents, uneducated mothers, economically poor women, and other significant factors this study revealed.

Quality of life among patients with the common chronic disease during COVID-19 pandemic in Northwest Ethiopia: A structural equation modelling.

BACKGROUND: Improving Quality of Life (QoL) for patients with chronic diseases is a critical step in controlling disease progression and preventing complications. The COVID-19 pandemic has hampered chronic disease management, lowering patients' quality of life. Thus, we aimed to assess the quality of life and its determinants in patients with common chronic diseases, in Northwest Ethiopia during the COVID-19 pandemic. METHODS: A cross-sectional study was conducted among 1815 randomly selected chronic patients with common chronic diseases. A standardized WHOQOL BREF tool was used, and electronic data collection was employed with the kobo toolbox data collection server. Overall QoL and the domains of Health-Related Quality of life (HRQoL) were determined. Structural equation modelling was done to estimate independent variables' direct and indirect effects. Path coefficients with a 95% confidence interval were reported. RESULTS: About one in third, (33.35%) and 11.43% of the study participants had co-morbid conditions and identified complications, respectively. The mean score of QoL was 56.3 ranging from 14.59 and 98.95. The environmental domain was the most affected domain of HRQoL with a mean score of 52.18. Age, psychological, and environmental domains of HRQoL had a direct positive effect on the overall QoL while the physical and social relationships domains had an indirect positive effect. On the other hand, the number of medications taken, the presence of comorbidity, and complications had a direct negative impact on overall QoL. Furthermore, both rural residency and the presence of complications had an indirect negative effect on overall QoL via the mediator variables of environmental and physical health, respectively. CONCLUSION: The quality of life was compromised in chronic disease patients. During the COVID-19 pandemic, the environmental domain of HRQoL was the most affected. Several socio-demographic and clinical factors had an impact on QoL, either directly or indirectly. These findings highlighted the importance of paying special attention to rural residents, patients with complications, patients taking a higher number of medications, and patients with comorbidity.

Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study.

BACKGROUND: Although there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa. METHODS: We analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children's healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis. RESULT: The overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37-0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49-1.79)], high community level women education [AOR = 1.51, 95% CI (1.39-1.66)], primary education [AOR = 1.62, 95% CI (1.45-1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71-2.32)], working mother [AOR = 1.33, 95% CI (1.20-1.48)], unmarried women [AOR = 1.15, 95% CI (1.04-1.27)], media access [AOR = 1.43, 95% CI (1.20-1.58)], richest [AOR = 1.39, 95% CI (1.29-1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02-1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60-1.95)], age of child 7-23 months [AOR = 1.59, 95% CI (1.39-1.82)], age of child 24-59 months [AOR = 1.24, 95% CI (1.09-1.41)] in comparison with children aged 0-6 months, family size > 10 [AOR = 1.53, 95% CI (1.22-1.92)]. CONCLUSIONS AND RECOMMENDATIONS: The overall prevalence of children's healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.

Prevalence and associated factors of common childhood illnesses in sub-Saharan Africa from 2010 to 2020: a cross-sectional study.

OBJECTIVE: This study aimed to assess the prevalence and determinants of common childhood illnesses in sub-Saharan Africa. DESIGN: Cross-sectional study. SETTING: Sub-Saharan Africa. PARTICIPANTS: Under-5 children. PRIMARY OUTCOME: Common childhood illnesses. METHODS: Secondary data analysis was conducted using data from recent Demographic and Health Survey datasets from 33 sub-Saharan African countries. We used the Kids Record dataset file and we included only children under the age of 5 years. A total weighted sample size of 208 415 from the pooled (appended) data was analysed. STATA V.14.2 software was used to clean, recode and analyse the data. A multilevel binary logistic regression model was fitted, and adjusted OR with a 95% CI and p value of ≤0.05 were used to declare significantly associated factors. To check model fitness and model comparison, intracluster correlation coefficient, median OR, proportional change in variance and deviance (-2 log-likelihood ratio) were used. RESULT: In this study, the prevalence of common childhood illnesses among under-5 children was 50.71% (95% CI: 44.18% to 57.24%) with a large variation between countries which ranged from Sierra Leone (23.26%) to Chad (87.24%). In the multilevel analysis, rural residents, mothers who are currently breast feeding, educated mothers, substandard floor material, high community women education and high community poverty were positively associated with common childhood illnesses in the sub-Saharan African countries. On the other hand, children from older age mothers, children from the richest household and children from large family sizes, and having media access, electricity, a refrigerator and improved toilets were negatively associated. CONCLUSIONS: The prevalence of common illnesses among under-5 children was relatively high in sub-Saharan African countries. Individual-level and community-level factors were associated with the problem. Improving housing conditions, interventions to improve toilets and strengthening the economic status of the family and the communities are recommended to reduce common childhood diseases.

Anaemia and its determinants among reproductive age women (15-49 years) in the Gambia: a multi-level analysis of 2019-20 Gambian Demographic and Health Survey Data.

BACKGROUND: Anaemia is among the top list of the contemporarily public health burden in both developed and developing countries, by affecting mainly women's and children's health. OBJECTIVE: This study aimed to identify the burden of anaemia and its individual and community level factors among women in The Gambia. METHOD: This study was based on an extensive national survey, Gambian Demographic and Health Survey. A total weighted sample of 5,858 reproductive-age women was included. Because of the hierarchical nature of the DHS data, a multi-level logistic regression model was applied to study individual and community-level factors that may influence anaemia. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. RESULT: The overall prevalence of anemia was found 44.28% (95% CI 0.43, 0.46). Current users of contraceptives were (AOR = 0.66, 95% CI: (0.55- 0.79)) and currently pregnant (AOR = 1.44. 95% CI: (1.16, 1.81)) less likely and more likely to develop anaemia compared to their counterparts respectively. In addition to this, living in the region of Brikama (AOR = 0.69, 95% CI: (0.50-0.97)) less likely to be exposed to anemia. From community level factor, high distance to the health facilities (AOR = 1.23,95% CI 1.02-1.48) were associated with anemia. CONCLUSION: The study revealed that the burden of anaemia among reproductive age Gambian women was very high. Anaemia was affected by both individual and community levels of factors. Thus, the burden of anaemia could be significantly reduced if pregnant and contraceptive users' women were monitored and encouraged. Increasing the accessibility of health facilities, community mobilization, and awareness enhancement are also advisable.

Measles second dose vaccine utilization and associated factors among children aged 24-35 months in Sub-Saharan Africa, a multi-level analysis from recent DHS surveys.

BACKGROUND: Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24-35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. METHODS: Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country's KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. RESULT: The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10-62.43%). In the multilevel analysis, mothers aged 25-34 years [AOR = 1.15,95% CI (1.05-1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14-1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13-1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12-1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35-3.24)], PNC visit [AOR = 1.13, 95% CI (1.04-1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04-2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53-0.95)], rural residence [AOR = 0.69, 95% CI (0.57-0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54-0.80)] were found to be negatively associated with MCV2 utilization. CONCLUSIONS AND RECOMMENDATIONS: Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.

Predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia: application of the theory of planned behavior.

BACKGROUND: Cervical cancer is a global public health problem & is the fourth leading cause of cancer morbidity and mortality. Abnormal cervical lesion is common in commercial sex workers and is at a higher risk of developing cervical cancer due to multiple sexual partners besides other factors. Intention is an important predictor of behavior and is an initiative to transform their desire into action. Therefore, this study aimed to assess the predictors of intention to receive cervical cancer screening among commercial sex workers in Gondar city, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from March 27 to May 25, 2021, in Gondar city, northwest Ethiopia. A total of 425 commercial sex workers selected using convenience sampling techniques were included in the study. Linear regression with robust standard errors was carried out to identify predictors of intention to receive cervical cancer screening. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. RESULTS: A total of 393 commercial sex workers participated in the study with a response rate of 92.4%. The mean age of the participants was 27.68 ± 6.62. The median (interquartile range) of intention was 4 (3-4.25). The theory of planned behaviour variables explained 38.51% of the variance in intention to receive cervical cancer screening. Direct subjective norm (ß = 0.09), 95% CI (0.05, 0.13)), direct Attitude (ß = 0.09, 95% CI (0.04, 0.13)), past behaviour (ß = 0.27; 95% CI (0.09, 0.46), and positive HIV status (ß = 0.26; 95% CI (0.06, 0.46) were significant predictors of intention. CONCLUSIONS: Commercial sex workers' intention to undergo cervical cancer screening was high. The theory of planned behavior showed adequate utility in predicting commercial sex workers' intention to receive cervical cancer screening. Participant's attitudes, subjective norm, past behavior, and positive HIV status were important factors affecting their intention to receive cervical cancer screening. Thus, interventions aimed at enhancing commercial sex workers' cervical cancer screening behavior should target creating positive social pressure and attitudinal change towards cervical cancer screening.

Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia.

BACKGROUND: COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia. METHODS: A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported. RESULTS: The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments. CONCLUSION: The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.