Advanced-stage breast cancer diagnosis and its determinants in Ethiopia: a systematic review and meta-analysis.

INTRODUCTION: Worldwide, breast cancer is the primary cause of illness and death. Unless early detected and treated breast cancer is a life-threatening tumor. Advanced-stage presentation is greatly linked with short survival time and increased mortality rates. In Ethiopia nationally summarized evidence on the level of advanced-stage breast cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of advanced-stage breast cancer diagnosis and its determinants in Ethiopia. METHOD: By following PRISMA guidelines, a systematic review and meta-analysis were carried out. To include relevant publications, a broad literature search was conducted in the African Online Journal, PubMed, Google Scholar, and Embase which are published until last search date; June 15, 2023. To prevent further duplication this review was registered in PROSPERO database with ID no of CRD42023435096. To determine the pooled prevalence, a weighted inverse variance random effect model was applied. I2 statistics and the Cochrane Q-test were computed to determine heterogeneity. To evaluate publication bias, a funnel plot, and Egger's regression test were used. RESULT: A total of 924 articles were sought and finally 20 articles were included in this review. The pooled prevalence of advanced-stage breast cancer diagnosis in Ethiopia was 72.56% (95%CI; 68.46-76.65%). Use of traditional medicine as first choice (AOR = 1.32, 95% CI: (1.13-1.55)), delay of > 3 months in seeking care (AOR = 1.24, 95% CI: (1.09-1.41)), diagnosis or health system delay of > 2 months (AOR = 1.27, 95% CI: (1.11-1.46)), rural residence (AOR = 2.04, 95% CI: (1.42 - 2.92)), and chief complaint of a painless breast lump (AOR = 2.67, 95% CI: (1.76-4.06)) were significantly associated to advanced-stage diagnosis. CONCLUSION: In Ethiopia, more than two-thirds of breast cancer cases are diagnosed at an advanced stage. Use of traditional medicine before diagnostic confirmation, delay in seeking care, health system delay, rural residence, and chief complaint of painless breast lump were positively associated with an advanced-stage diagnosis. Policymakers and program designers give great focus to those delays so as to seek and access modern diagnosis and treatment as early as possible specifically focusing on those who are rurally residing.

Anxiety and depression among cancer patients in Ethiopia: a systematic review and meta-analysis.

Introduction: Anxiety and depression are among the common comorbidities of people diagnosed with cancer. However, despite the progress in therapeutic options and outcomes, mental health care and support have lagged behind for cancer patients. Estimating the extent and determinants of mental health disorders among cancer patients is crucial to alert concerned bodies for action. In view of this, we aimed to determine the pooled prevalence and determinants of anxiety and depression among cancer patients in Ethiopia. Methods: Relevant literatures were searched on PubMed, African Journals Online, Hinari, Epistemonikos, Scopus, EMBASE, CINAHL, Cochrane Library, and Gray literature sources. Data were extracted into an Excel spreadsheet and analyzed using STATA 17 statistical software. The random effect model was used to summarize the pooled effect sizes with their respective 95% confidence intervals. The I2 statistics and Egger's regression test in conjunction with the funnel plot were utilized to evaluate heterogeneity and publication bias among included studies respectively. Results: A total of 17 studies with 5,592 participants were considered in this review. The pooled prevalence of anxiety and depression among cancer patients in Ethiopia were 45.10% (95% CI: 36.74, 53.45) and 42.96% (95% CI: 34.98, 50.93), respectively. Primary and above education (OR= 0.76, 95% CI: 0.60, 0.97), poor social support (OR= 2.27, 95% CI: 1.29, 3.98), occupational status (OR= 0.59; 95% CI: 0.43, 0.82), advanced cancer stage (OR= 2.19, 95% CI: 1.38, 3.47), comorbid illness (OR= 1.67; 95% CI: 1.09, 2.58) and poor sleep quality (OR= 11.34, 95% CI: 6.47, 19.89) were significantly associated with depression. Whereas, advanced cancer stage (OR= 1.59, 95% CI: 1.15, 2.20) and poor sleep quality (OR= 12.56, 95% CI: 6.4 1, 24.62) were the factors associated with anxiety. Conclusion: This meta-analysis indicated that a substantial proportion of cancer patients suffer from anxiety and depression in Ethiopia. Educational status, occupational status, social support, cancer stage, comorbid illness and sleep quality were significantly associated with depression. Whereas, anxiety was predicted by cancer stage and sleep quality. Thus, the provision of comprehensive mental health support as a constituent of chronic cancer care is crucial to mitigate the impact and occurrence of anxiety and depression among cancer patients. Besides, families and the community should strengthen social support for cancer patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023468621.

Prevalence and predictors of chronic kidney disease among type 2 diabetic patients worldwide, systematic review and meta-analysis.

BACKGROUND: Diabetes is a complicated, chronic condition that requires ongoing medical attention as well as multiple risk-reduction measures beyond glucose control. The prevalence of chronic kidney disease (CKD) is highly variable in different parts of the world due to various environmental, ethnic, socioeconomic, and rural-urban differences. Diabetes is the leading cause of CKD. This study aimed to estimate the global prevalence of CKD and its associated factors among type 2 diabetes(T2DM) patients, provide scientific evidence for a better understanding of the burden of CKD among diabetes mellitus type 2 patients, and design interventional strategies. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was followed for this review and meta-analysis. The electronic databases (Pub Med, Cochrane Library, Google Scholar, and grey literature) were searched to retrieve articles by using keywords. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of studies. The meta-analysis was conducted using STATA 17 software. The Meta logistic regression was computed to present the pooled prevalence and Odds ratio (OR) of the determinate factors with a 95% confidence interval (CI). RESULTS: In this systematic review and meta-analysis 20 studies were done in 13 different countries. The pooled magnitude of chronic kidney disease among type 2 DM patients was 27% (95% CI 21%, 33%). The prevalence of chronic kidney disease differs across countries, with the maximum in the USA and the lowest in the United Arab Emirates. Patients with CKD have an elevated risk of severe renal and cardiovascular morbidity and mortality. Renin-angiotensin system inhibitors, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and, more recently, non-steroidal mineralocorticoid receptor antagonists are among the medications that have been demonstrated to slow the progression of CKD. In this systematic review and meta-analysis increased age, obesity, having a history of type 2 diabetes mellitus, smoking history, presence of hypertension, and cardiac heart disease were factors significantly associated with the presence of chronic kidney disease among type 2 diabetic patients. CONCLUSIONS: The prevalence of chronic kidney disease among type 2 diabetes mellitus patients was high based on the included 20 articles. The review reported that old age, hypertension, cardiac disease, smoking, obesity, and duration of diabetes mellitus was predictor variable for chronic kidney disease among type 2 diabetic patients. Therefore, in order to lower the morbidity and mortality from chronic kidney disease among type 2 diabetic patients, it is advised to develop both preventive and curative intervention strategies, such as raising awareness, creating a supportive environment, and prescribing appropriate medication at an early stage.

Knowledge of prevention of mother-to-child transmission of HIV among reproductive age women in high HIV/AIDS prevalent countries: A multilevel analysis of recent Demographic and Health Surveys.

BACKGROUND: A lack of enough knowledge about the mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) among reproductive-age women is thought to be a key contributor to new pediatric HIV infections worldwide, and rising HIV-related infant mortality, particularly in resource-limited countries. Knowledge of MTCT of HIV is key to halt the progression of HIV/AIDS. Therefore, this study aimed to assess knowledge of MTCT of HIV and its associated factors among reproductive-age women in high HIV/AIDS prevalent countries. METHODS: A secondary data analysis was performed using 8 HIV/AIDS prevalent countries' Demographic and Health Surveys. A total weighted sample of 97,130 respondents was included in this study. Stata 17 was used for data extraction, coding, and analysis. A multilevel binary logistic regression model was fitted. The odds ratios along with the 95% confidence interval were generated to determine the factors of good knowledge of MTCT of HIV among reproductive-age women. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance. RESULTS: The prevalence of good knowledge of MTCT HIV was 57.89% (95% CI: 57.67,58.29). Mothers aged 25-34 (AOR = 1.37, 95% CI = 1.32, 1.42), 35 and above(AOR = 2.46,95% CI = 1.41, 1.52), mothers' primary education (AOR = 1.32, 95% CI = 1.26, 1.38),), secondary education (AOR = 1.65,95% CI = 1.56, 1.74), higher education (AOR = 1.72,95% CI = 1.58,1.86), exposed to mass media (AOR = 1.12, 95% CI = 1.08,1.16) rich wealth status (AOR = 1.11 (95% CI = 1.06,1.15), talked about MTCT (AOR = 1.70,95% CI = 1.64, 1.76), visited by field worker (AOR = 1.09, 95% CI = 1.03,1.14), health facility visit (AOR = 1.15, 95% CI = 1.11, 1.18), urban dwellers (AOR = 1.09, 95% CI = 1.04,1.14), ever tested for HIV(AOR = 2.18 (95% CI = 2.10,2.27), currently working status (AOR = 1.15, 95% CI = 1.12,1.19) were factors associated with good knowledge of MTCT of HIV/AIDS among reproductive age women. CONCLUSIONS: Overall, the prevalence of good knowledge of MTCT was low in high HIV/AIDS prevalent countries. Maternal age, primary education and above, exposed to media, having higher wealth status, talked about MTCT during ANC visits, being visited by a field worker, visited a health facility, currently working, living in the urban area, and ever been tested for HIV were positively associated with knowledge of MTCT. Health policy and programs should focus on educating mothers, encouraging women to contact health facilities and a well-targeted communications program is required to enhance knowledge of MTCT of HIV.

BabyWASH and diarrhea prevention practices following multimedia educational intervention in hard-to-reach areas of the Afar and Somali regions of Ethiopia: a mixed-method endline evaluation.

BACKGROUND: Water, sanitation, and hygiene (WASH) interventions, which are specifically targeted towards young children-known as "BabyWASH"-reduce exposure to environmental contamination and prevent microbial burden in their play and feeding environments. The purpose of this endline study was to evaluate the effectiveness and potential sustainability of a multimedia educational intervention in influencing key BabyWASH and diarrhea prevention practices in four hard-to-reach woredas (i.e. administrative districts) of the Afar and Somali regions of Ethiopia. METHODS: A mixed-method, comparative cross-sectional study was conducted, which included 457 household surveys, 16 key informant interviews, and 8 focus group discussions. The multimedia educational intervention comprised: broadcasting radio talk shows and radio spot messages, capacity-building training for community health workers and community leaders, community mobilization campaigns, and the distribution of promotional print media materials. Propensity score matching analysis was used to estimate the effect of the multimedia educational intervention on key BabyWASH and diarrhea prevention attitudes and practices, which was then triangulated with qualitative findings. RESULTS: The multimedia intervention had a significant positive impact on good BabyWASH and diarrhea prevention practices, including appropriate practices of child feces disposal (t-test = 5.17; p < 0.001), handwashing with soap or ash (t-test = 8.85; p < 0.001), maintaining separate playgrounds for young children (t-test = 2.83; p < 0.001), washing of child's body, hands, and faces (t-test = 15.78; p < 0.001), and food hygiene practices (t-test = 2.74; p < 0.05). The findings of the qualitative assessment also revealed that the multimedia intervention packages and the approaches used were successful in influencing key BabyWASH and diarrhea prevention behaviors in the intervention implementation woredas. In addition, providing capacity building training to local actors and community leaders and recording radio talk shows and sharing them with community members were recognized as effective intervention implementation strategies. CONCLUSION: The endline evaluation found that the multimedia educational intervention improved awareness, perception, and practice of BabyWASH and diarrhea prevention behaviors in intervention woredas compared to control woredas. Sanitation and hygiene promotion interventions in pastoralist settings can be effective when using locally and contextually appropriate intervention strategies. However, considerations for integrating both behavioral and structural components in WASH interventions is essential.