Spatial disparity and associated factors of diarrhea among under-five children in Rwanda: a multilevel logistic regression analysis.

BACKGROUND: Diarrhea, defined as three or more loose stool per day, is a major cause of child mortality. Exploring its spatial distribution, prevalence, and influencing factors is crucial for public health decision and targeted interventions. This study aimed to investigate these aspects using 2019 Rwanda demographic health survey data. METHOD: A total 7,978 (weighted) under-five children were included in this study. Spatial clustering (hotspots areas) were mapped using ArcGIS and SaTscan software. A multilevel logistic regression model was fitted to assessed factors associated with diarrhea, reporting significance at p < 0.05 and a 95% confidence interval. RESULTS: diarrheal diseases in Rwanda showed a clustered spatial pattern (Moran's I = 0.126, p = 0.001), with the primary cluster in west and north provinces. Under-five diarrhea prevalence was 14.3% (95% CI: 13.55, 15.08). Factors increasing likelihood included maternal age 15-34 years, child age 7-24 months, while full immunization was protective (aOR = 0.74, 95% CI: 0.56, 0.98). CONCLUSION: Spatial clustering of diarrheal diseases is found in west and north provinces of Rwanda. Being born to a young mother, being a child aged 7-24 months, being fully immunized, being born to a low-educated mother and belonging to a community having low level education are factors associated with diarrheal diseases in Rwanda. Developing interventional plans based on identified clusters and approaching children based on their immunization status, maternal education and age could be cost-effective in reducing diarrheal diseases in Rwanda. Location based intervention could allow for the efficient allocation of resources by focusing on areas with higher prevalence and need.

Time to death and its determinants of under-five children in rural Ethiopia by using shared frailty.

Under-five (U5M) is one of the most significant and sensitive measures of the community's health. Children who live in rural areas are more likely than those who live in urban areas to die before the age of five. Therefore, the study aimed to assess the Survival status of under-five mortality and its determinants in rural Ethiopia. The 2019 Ethiopia Mini Demographic and Health Survey was used in this study as a secondary source (EMDHS). A total of 4426 weighted under-five children were included in the study. To determine survival time and identify predictors of death among children under the age of five, the Cox's gamma shared frailty model and the Kaplan Meier model, respectively, were used. An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) were used to measure the size and direction of the association. The Study showed that in rural Ethiopia, 6.03% of children died before celebrating their first birthday. The median age of under-five mortality in rural Ethiopia was estimated to be 29 Months. The hazard of death among under-five children and those who had given birth to two children in the last five years was 4.99 times less likely to be at risk of dying than those who had given birth to one Child in the previous five years (AHR 4.99, 95% CI 2.97, 8.83). The Study Concluded that under-five mortality remained high in rural Ethiopia. In the final model, the Age of Mothers, Sex of Household, Breastfeeding, Types of Birth, Sex of Child, Educational Level of Mothers, Wealth Index, Child ever born, Marital Status, and Water Source were significant predictors of under-five mortality. Twins and children who are not breastfed should receive additional attention, along with improving water resources for households and mothers income.

Modelling of Hepatitis B Virus vertical transmission dynamics in Ethiopia: a compartmental modelling approach.

BACKGROUND: Hepatitis B (HB) is a virus which causes a potentially fatal liver infection. It is a DNA virus belonging to the Hepadnaviridae virus family. Africa, after Asia, has the second highest number of chronic HBV carriers and is considered a high-endemic region. Ethiopia is classified as a country with a high prevalence of viral hepatitis and with nations that lack a systematic strategy for viral hepatitis surveillance. METHODS: S-I-C-R deterministic model was developed and the numerical simulations were done in "R" statistical and programming software. Fixed population assumption was considered so as to develop a simple model which could predict the HBV vertical transmission for the next 5 decades. RESULTS: The model revealed that significant number of populations will be infected and become carrier till the end the next 49 years even though it has decreasing trend. It was predicted that 271,719 people will die of HBV complications if no intervention will be made on its vertical transmission. The sensitivity analysis result showed that the force of infection has the most important parameter in the vertical transmission dynamics of hepatitis B. Provision of hepatitis B immunoglobulin (HBVIG) and vaccines at the time of delivery could decrease the force of infection by more than half and 51,892 lives will be saved if the intervention is offered for 50% of deliveries in Ethiopia. CONCLUSION: Despite the fact that the incidence of HBV vertical transmission is substantial, it is expected to decline during the next five decades. However, the situation necessitates immediate attention, since it results in thousands of deaths if no action is taken. Offering HBVIG and vaccinations to the 50% of infants can save many lives and reduces the force of infection by more than a half.

The Prevalence and Predictors of Depressive, Anxiety, and Stress Symptoms Among Tepi Town Residents During the COVID-19 Pandemic Lockdown in Ethiopia.

BACKGROUND: As a result of the coronavirus disease 2019 (COVID-19) outbreak, many countries have imposed movement restrictions and implemented lockdowns. However, evidence from a variety of nations showed that the COVID-19 outbreak and its associated quarantine measures triggered a wide range of psychological problems, such as anxiety, depression, and stress in the general population. As a result, the purpose of this study was to determine the prevalence and predictors of depression, anxiety, and stress symptoms among Tepi town residents during the pandemic lockdown. METHODOLOGY: A community-based cross-sectional survey was conducted among residents of Tepi town from September 15 through September 25, 2020, and residents who have lived in Tepi town for at least 6 months were included. We have employed the depression, anxiety, and stress scale 21 (DASS-21) to evaluate depression, anxiety, and stress. The Chi-squared test of association and logistic regression were used to identify factors associated with depression, anxiety, and stress among residents of Tepi town. For all statistical analysis, we used (IBM) SPSS version 25. RESULTS: According to the current study, the prevalence of depression, anxiety, and stress symptoms were 37.7%, 39.0%, and 44.2%, respectively, among residents of Tepi town. Estimated odds of having depression, anxiety, and stress were as follows: for being female 6.315, 4.591, and 3.155; smoking 1.787, 1.883, and 1.787; sleep problem 2.613, 2.254, and 1.721; chewing Khat 2.156, 2.053, and 2.110; quarantine for 14 days 2.251, 1.902, and 1.960; and frequent use of social media 3.126, 1.849, and 3.126 times more likely as compared to their corresponding reference group respectively. The odds of developing depression and anxiety respectively were as follows: for alcohol consumption 2.438 and 1.797 times higher than their corresponding reference group respectively. Those exposed to COVID-19 were 3.870 times more likely to develop depression symptoms. Estimated odds of having anxiety and stress symptoms for fear of COVID-19 were 1.776 and 1.835; social interactions altered were 3.197 and 2.069, moderate levels of hope were 2.687 and 2.849 respectively. The odds ratio for those taking traditional preventive medicine, and having family members infected with COVID-19 were 2.475 and 1.837 times more likely to experience anxiety symptoms respectively. CONCLUSION: In this study, the prevalence of depression, anxiety, and stress symptoms was found to be high among residences in Tepi town. Being female, chewing Khat, smoking, being quarantined for 14 days, frequently using social media, and having sleeping problems were all found to be significantly associated with an increased risk of developing depression, anxiety, and stress symptoms, whereas alcohol consumption and family members infected by COVID-19 were considerably linked to depression and anxiety symptoms. Fear of COVID-19, influence on social interaction and having a moderate level of hope were substantially related to stress and anxiety symptoms, while taking preventive medicine was found to be a significant factor in anxiety symptoms among Tepi town residences. Interventions should be made to improve the mental health of Tepi residents.

Multilevel analysis of factors associated with pregnancy termination in Ethiopia.

Background: Pregnancy termination is a major public health issue that affects maternal mortality around the world. So the study aimed to identify factors that are associated with pregnancy termination in Ethiopia. Methods: Community-based crossectional data came from Ethiopia's Mini Demographic and Health Survey 2019. The current study's sample included women who had their pregnancy terminated (aged 15-49) and had complete information on all factors of interest (N = 8885). The binary logistic regression model investigated the factors that contribute to pregnancy termination in Ethiopia and multilevel logistic regression were used to identify regional variation in Ethiopia. Results: The current study showed that the prevalence of pregnancy termination in Ethiopia was 8.6%. The likelihood of pregnancy termination in uneducated women was 1.5 times (AOR = 1.479, 95% CI = 1.205-1.816) lower than in women who attended elementary school, 1.5 (AOR = 1.476, 95% CI = 1.107-1.969) lower than Secondary attended women and 1.8 times (AOR = 1.755, 95% CI = 1.270-2.427) lower than Higher school attended women. The likelihood of pregnancy termination in rural women was 0.8 times (AOR = 0.753, 95% CI = 0.573-0.990) higher than in urban women. Conclusion: The current study showed that there was regional Variation among women in Ethiopia to terminate the pregnancy. The characteristics of education level, place of residency, marital status and contraceptive knowledge are significant and differ between regions of the country. As a result, increasing contraception use and enhancing women's knowledge are the most effective ways to avert the problem.

Modeling the Transmission Dynamics of COVID-19 Among Five High Burden African Countries.

Background: Today, coronavirus disease-19 has left a permanent dark mark on the history of human beings. The ongoing global pandemic outbreak of COVID-19 has spread to 58 African countries, with over 6.07 million confirmed cases and over 151,412 deaths. The five high burden African countries are South Africa, Morocco, Tunisia, Ethiopia, and Libya, with case fatality rates (CFR) of nearly 0.15%, 0.042%, 0.22%, 0.006%, and 0.086%, respectively. This is why the research aims to adequately understand the transmission dynamics of the virus and its variants in five high-burden African countries. Methods: Our study is a deterministic model, where the population is partitioned into five components on the epidemiological state of the individuals. We presented a year-structured susceptible, infected, mild severs, critical severe, and recover (SIMCR) compartmental model of COVID-19 disease transmission with incidence rate during the pandemic period. Results: The number of susceptible individuals increased by 30,711,930 in South Africa, 5,919,837 in Morocco, 3,485,020 in Tunisia, 7,833,642 in Ethiopia, and 2,145,404 in Libya in the next 3 decades with compare to the unvaccinated population and the number of infected individuals decreased by 30,479,271 in South Africa, 19,809,751 in Morocco, 3,456,406 in Tunisia, 7,761,993 in Ethiopia, and 2,125,038 in Libya. Conclusion: SIMCR model is used to describe the transmission of COVID-19 among five high-burden African countries. For the next 30 years, we will have around 86 million infected individuals and millions of death only in those five African countries. To reduce those problems, vaccination is the best and most effective mechanism. So vaccinating half of the populations in those countries helps to control and reduce the transmission rate of COVID-19 in Africa for the next 30 years. This leads to preventing 17,212,405 people from becoming infected and millions of deaths being reduced in those five high-burden African countries.

Knowledge, Attitude, and Practice of Community towards an Onchocerciasis Elimination Program from South West Ethiopia.

Onchocerciasis is a neglected tropical disease that is prevalent throughout Africa, including developing countries such as Ethiopia. It affects around 37 million people, the majority of whom are from Africa. As a result, the study was designed to look into the community's knowledge, attitude, and practice about the onchocerciasis elimination campaign. Four communities from Gesha town, Southwest Ethiopia, were chosen. The population was selected using a basic random selection procedure, and 312 people were identified for the study based on the eligibility requirements, with 302 (96.79%) of them responding correctly. The data were analyzed using the descriptive method with the SPSS program version 20. It was discovered that the majority of communities (89.4%) are aware of onchocerciasis. They also have a good awareness of the severity, preventability, therapy, and mode of transmission, yet they have certain misunderstandings. The communities attitude towards community directed therapy (CDT) using Ivermectin is positive (68.5%). According to 56% of the community, offering incentives for community drug distributors (CDD) has the potential to make the elimination campaign more successful. Different measures, such as avoiding any activities near the river, are important in the process of eradicating this disease at the community level. As a result, the respondent demonstrates that covering the lower body part lessens the black fly's vulnerability because they may attack below the knee. In general, community awareness and attitude are required to eradicate this disease from the district. In addition, increased stakeholder participation and offering motivating rewards for CDT are required to make the elimination program a success.

Generalized anxiety disorder among mothers attending perinatal services during COVID-19 pandemic: using ordinal logistic regression model.

Background: Generalized anxiety disorder is characterized by excessive and uncontrollable worry about a variety of events. It is critical to ensure a pregnant mother's mental health in order to reduce pregnancy and birth-related problems. The major goal of current study was to identify the factors associated with generalized anxiety disorder among mothers attending perinatal services in the study area during COVID-19 using ordinal logistic regression. Methods: The institution-based cross-sectional study was conducted from July 10th, 2020 to August 10th, 2020 at Kembata Tembaro zone, Southern Ethiopia. The current study included 423 mothers. The GAD-7 scale was used to assess the anxiety level among mothers. An Ordered logit model was used to identify the determinants of GAD. Brant test of the parallel line was utilized to check proportionality assumption. The statistical significance was determined using an adjusted proportional odd ratio with a 95%CI, and a p-value <5%. STATA software version 14 was used to analyze statistical data. Results: Of all 423 mothers attending perinatal service during COVID-19; 134(31.7%), 171(40.4%), 85(20.1%), and 33 (7.8%) had non/minimal to severe generalized anxiety disorder respectively. The results of multivariable proportional odds model (POM) showed that the variables town residents [aPOR = 1.827; 95% CI:1.233-2.708], having alcohol habit [aPOR = 3.437, 95% CI = 1.397-8.454], having occupation [aPOR = 0.509, 95% CI: 0.303-0.857], being health care worker [aPOR = 0.117, 95% CI = 0.044-0.311], having chronic illness [aPOR = 7.685, 95% CI = 3.045-19.39], having family history of anxiety/mood disorder [aPOR = 7.839, 95% CI = 2.656-23.12], fear of contracting COVID-19 [aPOR = 1.704, 95% CI = 1.152-2.521], having moderate social support [aPOR = 0.648, 95% CI = 0.425-0.989], having strong social support [aPOR = 0.495, 95% CI = 0.272-0.901] were significantly associated with generalized anxiety disorder at 5% level of significance. Conclusion: Current findings concluded that the prevalence of GAD among mothers attending perinatal service during COVID-19 was high. The covariates like being town resident, lower-income status, occupation status, having a chronic illness, having a positive family history of anxiety or mood disorder, perceived social support, and fear of the COVID-19 were significantly associated with generalized anxiety disorder among mothers. Mothers who visit perinatal services should be given special consideration to improve health care services and ensure their mental health.

Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia.

BACKGROUND: The maternal mortality rate in poor nations remains unacceptably high. The purpose of this study was to identify factors associated with institutional delivery usage. METHODS: The data came from the Ethiopian mini demographic and health survey, which was conducted in 2019. This study comprised 3978 women of reproductive age who had given birth within the previous 5 years. To uncover significantly linked parameters associated with institutional delivery, we used a multilevel logistic regression model. Statistical significance was declared at p < 0.05, and we assessed the strength of association using adjusted odds ratios with 95% confidence intervals. RESULTS: More than half of the women (53.67%) among 3978 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, women in age group 45-49 (AOR = 2.43, 95% CI: 1.280, 4.591), primary educational level (AOR = 2.21, 95% CI: 1.864, 2.625, secondary and above education level (AOR = 6.37, 95% CI: 4.600, 8.837), being Muslim (AOR = 2.57, 95% CI: 1.245, 2.166), women who visited ANC service four up to seven times (AOR = 2.75, 95% CI: 2.175, 3.473), women visited ANC service eight times and above (AOR = 3.295% CI: 1.685, 6.050), women who reside in middle wealth index (AOR = 1.57, 95% CI: 1.273, 1.950), and rich wealth index (AOR = 3.43, 95% CI: 2.782, 4.225) were more likely to give birth at health institution compared to their counterparts. Furthermore, women being in rural area (AOR = 0.34, 95% CI:- 0.283, 0.474) and protestant women (AOR = 0.1.57, 95% CI: 0.479, 0.852) were less likely to deliver at health institution. CONCLUSIONS: Ethiopia still has a low level of institutionalized delivery. Institutional delivery in Ethiopia should be improved through context-specific and personalized programs, such as educating women and enhancing access to ANC services.