Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis.

BACKGROUND: Previous reviews explored the association between maternal use of folic acid and multivitamin supplements and risk of neural tube defect (NTD) in children, with no definitive conclusion. These reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review is to combine the inconsistent data on the effect of prenatal folic acid and/or multivitamin supplementation for the prevention of NTD in offspring. METHODS: Using the PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar reported that the effects of folic acid and/or multivitamin supplementation for the prevention of NTD in offspring were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed. RESULT: Ten SRM with 296,816 study participants were included. The random-effects model analysis from 10 included systematic review and meta-analysis revealed that the pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD globally is found to be 0.43 (95% CI: 0.29, 0.58) (I2 = 93.50%; p ≤0.001). In the subgroup analysis, the pooled effect was found to be 0.23 (0.09, 0.37) in folic acid group, while this estimate is 0.63 (0.53, 0.72) and 0.61 (0.46, 0.75) in groups who took multivitamin. The pooled effect of prevention of NTD was found to be 0.50 (0.34, 0.66) in SRMs aimed at occurrence prevention (primary prevention) group, while this estimate is 0.20 (-0.01, 0.41) among SRMs, which aimed at reoccurrence (secondary) prevention, and 0.61 (0.46, 0.75) among those SRMs aimed to assess the effect folic acid or multivitamin for the prevention of both occurrence and reoccurrence. The pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD was found to be 0.45 (0.03, 0.87) in SRMs of observational studies, while this estimate is 0.43 (0.32, 0.54) among SRMs of randomized controlled trials. CONCLUSION: This umbrella review of systematic review and meta-analysis found that prenatal folic acid and/or multivitamin supplementation was associated with a 57% reduction in NTD. Participants who took folic acid supplementation were associated with a slightly higher (77%) percentage of reduction in NTD compared with those who took multivitamin (37%). Reductions of 80% and 50% were observed for reoccurrence and occurrence prevention of NTD. Reductions of 57% and 55% of NTD have been found in SRM of RCTs and observational studies. This umbrella review revealed that both folic acid and multivitamin were associated with significantly lower levels of NTD in children. Considering the incorporation of those supplements in NTD prevention strategies during the preconception period is recommended. More large-scale prospective cohort and RCTs are needed to understand the protective effect of multivitamins and/or folic acid on NTD risk addressing the molecular mechanisms and to determine the optimal dose, duration, and timing of maternal multivitamin and folic acid intake for best child NTD risk reduction.

Evidence from 2016 Ethiopian demographic and health survey data: association between post health education maternal knowledge and neonatal danger signs.

BACKGROUND: Globally, 4 million infants die in their first 4weeks of life every year; above 8 million infants died before their first year of birthday, and nearly 10 million children died before their 5th birthday. Majority of the deaths were occurred at home because of not receiving health care. In Ethiopia, 120,000 infants died during their first 4 weeks of life. The aim of this study was to assess maternal knowledge about neonatal danger signs and its associations after they had been thought by health professionals in Ethiopia. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey data (EDHS) as a data source. The 2016 EDHS data were collected using a two stage sampling method. All the regions were stratified into urban and rural areas. The study sample taken from the 2016 EDHS data and used in this further analysis was 325. A logistic regression model was used to assess the associations with post health education maternal knowledge on neonatal danger signs. RESULTS: In this study, mothers who had poor knowledge about neonatal danger signs (NDS) were 69.8 % (227) (95 %CI (64.8, 74.8 %). In the final logistic model, wanted no more child ((AOR = 4.15), (95 %CI = 1.12, 15.41)), female child ((AOR = 0.58), (95 %CI = 0.34, 0.98)), primary level maternal education ((AOR = 0.42), (95 %CI = 0.19, 0.92)), secondary level maternal education ((AOR = 0.37), (95 %CI = 0.16, 0.91)), and average size of child ((AOR = 2.64), (95 %CI = 1.26, 5.53)), and small size child ((AOR = 4.53), (95 %CI = 1.52, 13.51)) associated with post health education maternal knowledge about NDS. CONCLUSION: The mothers' knowledge about NDS is poor even they were gave a birth in health facilities. Wanting of additional child, child sex, maternal education and size of child were associated with NDS knowledge. This indicates that the mode of health education provided for mother might not be appropriate and needs protocol changes.

Second dose of measles-containing vaccine coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023.

Background: Measles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023. Methods: A community-based cross-sectional study was conducted among 621 children aged 24-36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association. Results: A total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1-78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43-6.44), first birth order (AOR: 4.45, 95% CI: 1.21-16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62-16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27-5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67-15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15-3.4), and good perception (AOR: 3.6, 95% CI: 2-6.47) about measles vaccination. Conclusion and recommendations: The coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.

Employing advanced supervised machine learning approaches for predicting micronutrient intake status among children aged 6-23 months in Ethiopia.

Background: Although micronutrients (MNs) are important for children's growth and development, their intake has not received enough attention. MN deficiency is a significant public health problem, especially in developing countries like Ethiopia. However, there is a lack of empirical evidence using advanced statistical methods, such as machine learning. Therefore, this study aimed to use advanced supervised algorithms to predict the micronutrient intake status in Ethiopian children aged 6-23 months. Methods: A total weighted of 2,499 children aged 6-23 months from the Ethiopia Demographic and Health Survey 2016 data set were utilized. The data underwent preprocessing, with 80% of the observations used for training and 20% for testing the model. Twelve machine learning algorithms were employed. To select best predictive model, their performance was assessed using different evaluation metrics in Python software. The Boruta algorithm was used to select the most relevant features. Besides, seven data balancing techniques and three hyper parameter tuning methods were employed. To determine the association between independent and targeted feature, association rule mining was conducted using the a priori algorithm in R software. Results: According to the 2016 Ethiopia Demographic and Health Survey, out of 2,499 weighted children aged 12-23 months, 1,728 (69.15%) had MN intake. The random forest, catboost, and light gradient boosting algorithm outperformed in predicting MN intake status among all selected classifiers. Region, wealth index, place of delivery, mothers' occupation, child age, fathers' educational status, desire for more children, access to media exposure, religion, residence, and antenatal care (ANC) follow-up were the top attributes to predict MN intake. Association rule mining was identified the top seven best rules that most frequently associated with MN intake among children aged 6-23 months in Ethiopia. Conclusion: The random forest, catboost, and light gradient boosting algorithm achieved a highest performance and identifying the relevant predictors of MN intake. Therefore, policymakers and healthcare providers can develop targeted interventions to enhance the uptake of micronutrient supplementation among children. Customizing strategies based on identified association rules has the potential to improve child health outcomes and decrease the impact of micronutrient deficiencies in Ethiopia.

Mapping fertility rates at national, sub-national, and local levels in Ethiopia between 2000 and 2019.

Background: Fertility rates are key indicators of population health and demographic change, influencing economic development, healthcare planning, and social policies. Understanding subnational variation in fertility rate is important for effective geographical targeting and policy prioritization. This study aimed to identify geographic variation, trends, and determinants of fertility rates in Ethiopia over the past two decades. Methods: We estimated total fertility rates (TFRs) and age-specific fertility rates (ASFRs) using five nationally representative cross-sectional Demographic and Health Surveys collected in Ethiopia between 2000 and 2019. ASFRs represent the number of live births per 1,000 women aged 15 to 49 during the 3 years before each survey, while TFRs indicate the average number of children a woman would have by the end of her reproductive years, calculated as the sum of ASFRs over five-year intervals. We developed model-based geostatistics by incorporating demographic and healthcare access data with spatial random fields to produce high-resolution fertility rate maps. These results were then aggregated to produce fertility rate estimates at local, sub-national, and national levels in Ethiopia. Results: The national TFR gradually declined from 4.8 live births in 2000 to 4.2 live births in 2019, but it is still above the replacement level of 2.1 children per woman. There were sub-national and local variations in TFR, ranging from 5.7 live births in Somalia and 5.3 Oromia regions to 2.7 live births in Addis Ababa and 3.6 live births Dire Dawa cities. Geographical areas with high TFR were mostly associated with a high proportion of Muslim women and low access to health facilities. Conclusion: Despite a decline in fertility rates among women of reproductive age over the past two decades, marked spatial variation persists at sub-national and local levels in Ethiopia, with demographic factors determining the spatial distribution and rate of decline, highlighting the need for tailored programs and strategies in high-fertility areas to increase access to family planning.