What is the effect of mobile phone text message reminders on medication adherence among adult type 2 diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Globally, type 2 diabetes has become increasing. As little is known about the effect of educational intervention on this population, this systematic review and meta-analysis evaluated the effectiveness of mobile phone text message reminders versus usual care to improve medication adherence among type 2 diabetes mellitus patients. METHODS: PubMed, Google Scholar, Cochrane Library, Scopus, and African Journals Online, were searched. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: A total of 9 trials with 1,121 participants were included in the review. The pooled estimated impact of mobile phone text message reminders on medication adherence was (SMD: 0.36; 95%CI; 0.14, 0.59) compared to usual care groups among patients with type 2 diabetes mellitus. In addition, subgroup analyses revealed greater medication adherence levels in those studies with intervention durations of more than six months and with self-report/refill adherence scale measurement (SMD: 0.21; 95%CI: 0.02, 0.40) and (SMD: 0.45; 95%CI: 0.22, 0.68), respectively. CONCLUSION: Mobile phone text messages can potentially lead to improved medication adherence levels in patients with Type 2 diabetes despite heterogeneity across the studies. Therefore, mobile phone text messaging when delivered in addition to usual care, have the potential to produce significant improvements in medication adherence.

Prevalence and determinants of early onset neonatal sepsis at two selected public referral hospitals in the Northwest Ethiopia: a cross-sectional study.

INTRODUCTION: Globally, neonatal mortality is decreasing, and road maps such as the Early Newborn Action Plan set ambitious targets for 2030. Despite this, deaths in the first weeks of life continue to rise as a percentage of total child mortality. Neonatal sepsis with early onset continues to be a significant cause of death and illness. The majority of sepsis-related deaths occur in developing nations, where the prevalence and causes of newborn sepsis are yet unknown. As a result, the goal of this study was to determine the prevalence of early-onset sepsis and identify determinant factors. METHODS: A cross-sectional study was conducted on 368 study participants in referral hospitals of East and West Gojjam Zones from March 1st to April 30th, 2019. Study participants were selected at random using lottery method. Face-to-face interviews with index mothers for maternal variables and neonatal record review for neonatal variables were used to collect data using a structured pretested questionnaire. Data were entered into Epidata 3.1 and then exported to STATA/SE software version 14. Finally, the logistic regression model was used for analysis. Statistical significance was declared at P < 0.05 after multivariable logistic regression. RESULTS: A total of 368 newborns and their index mothers took part in this study. The mean age of the newborns was 4.69 days (± 1.93SD). Early-onset neonatal sepsis was seen in 34% of the babies. Nulliparity (AOR: 3.3, 95% CI: 1.1-9.5), duration of labor > 18 h after rupture of membranes (AOR: 11.3, 95% CI: 3.0-41.8), gestational age of 32-37 weeks (AOR: 3.2, 95% CI: 1.2-8.5), and neonates who require resuscitation at birth (AOR: 4, 95% CI: 1.4 -11.8) were all found to be significantly associated with early-onset neonatal sepsis. CONCLUSION AND RECOMMENDATION: Early-onset neonatal sepsis was found to be high in this study. Early-onset neonatal sepsis was found to be associated with maternal, obstetric, and neonatal variables. Comprehensive prevention strategies that target the identified risk factors should be implemented right away.

Mapping age- and sex-specific HIV prevalence in adults in sub-Saharan Africa, 2000-2018.

BACKGROUND: Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15-59 years across SSA. METHODS: We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. RESULTS: We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. CONCLUSIONS: As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Immunological Treatment Failure Among Adult Patients Receiving Highly Active Antiretroviral Therapy in East Africa: A Systematic Review and Meta-Analysis.

BACKGROUND: Minimizing antiretroviral treatment failure is crucial for improving patient health and for maintaining long-term access to care in low-income settings such as eastern Africa. To develop interventions to support adherence, policymakers must understand the extent and scope of treatment failure in their programs. However, estimates of treatment failure in eastern Africa have been variable and inconclusive. OBJECTIVE: This systematic review and meta-analysis sought to determine the pooled prevalence of immunological failure among adults receiving antiretroviral therapy in eastern Africa. METHODS: We performed a systematic search of the PubMed, Google Scholar, Excerpta Medica Database, and the World Health Organization's Hinari portal (which includes the Scopus, African Index Medicus, and African Journals Online databases) databases. Unpublished studies were also accessed from conference websites and university repositories. We used Stata version 14 for data analysis. The Cochrane Q test and I 2 test statistic were used to test for heterogeneity across the studies. Due to high levels of heterogeneity, a random effects model was used to estimate the pooled prevalence of immunological failure. Begg and Egger tests of the intercept in the random effects model were used to check for publication bias. RESULTS: After removing duplicates, 25 articles remained for assessment and screening. After quality screening, 15 articles were deemed eligible and incorporated into the final analysis. The average pooled estimate of immunological treatment failure prevalence was found to be 21.89% (95% CI, 15.14-28.64). In the subgroup analysis conducted by geographic region, the pooled prevalence of immunological treatment failure in Ethiopia was 15.2% (95% CI, 12.27-18.13) while in Tanzania it was 53.93% (95% CI, 48.14-59.73). Neither the results of Egger test or Begg tests suggested publication bias; however, on visual examination, the funnel plot appeared asymmetric. The large heterogeneity across the studies could be explained by study country. CONCLUSION: Immunological treatment failure among patients receiving antiretroviral therapy in eastern Africa was high, and greater than previously reported. The relatively low rates of treatment failure found in Ethiopia suggest that its health extension program should be studied as a model for improving adherence in the region. (Curr Ther Res Clin Exp. 2021; 82:XXX-XXX) © 2021 Elsevier HS Journals, Inc.

Prevalence of diabetic peripheral neuropathy in Africa: a systematic review and meta-analysis.

BACKGROUND: Diabetes mellitus (DM) is a global health care problem that can impose a substantial economic burden. Diabetic peripheral neuropathy (DPN) is a common microvascular complication of DM that increases the potential for morbidity and disability due to ulceration and amputation. Though there is a significant amount of variation in the primary studies on DM regarding the prevalence of DPN in Africa. Hence, this study was aimed to estimate the overall prevalence of DPN in DM patients in Africa. METHODS: PubMed, Scopus, Google Scholar, African Journals OnLine, WHO African Library, and the Cochrane Review were systematically searched online to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was followed. Heterogeneity across the included studies was evaluated by the inconsistency index (I2). Publication bias was examined by funnel plot and Egger's regression test. The random-effect model was fitted to estimate the pooled prevalence of diabetic peripheral neuropathy among patients in Africa. The meta-analysis was performed using the STATA™ Version 14 software. RESULTS: Twenty-three studies which includes 269,691 participants were included in the meta-analysis. The overall pooled prevalence of diabetic peripheral neuropathy was 46% (95% CI:36.21-55.78%). Based on the subgroup analysis, the highest prevalence of diabetic peripheral neuropathy in DM patients was reported in West Africa at 49.4% (95% CI: 32.74, 66.06). CONCLUSION: This study revealed that the overall prevalence of diabetic peripheral neuropathy is relatively high in Africa. Hence, DPN needs situation-based interventions and preventive strategies, which are specific to the country. Further meta-analysis is needed to identify associated factors for the occurrence of diabetic peripheral neuropathy.

Preeclampsia management modalities and perinatal death: a retrospective study in Woldia general hospital.

BACKGROUND: Hypertensive disorders of pregnancy are among the most common causes of perinatal death. The disorders are highly linked to multiple factors that make prediction and prevention challenging. Early diagnosis and proper management play a crucial role in the wellbeing and life of the women and her baby. In this study, we aimed to assess the association between different management options of preeclampsia and perinatal death at a public hospital in Ethiopia. METHODS: A document review was conducted on 241 preeclamptic patients' medical files who have been admitted and delivered in Woldia General Hospital from 2011 to 2016. The study was conducted from August 8 - September 10, 2017 in the aforementioned public hospital in Woldia town, Ethiopia. Associations were tested using Pearson chi squared test and binary logistic regression with a p-value < 0.05 considered significant. RESULT: In this study, nearly 20 every 100 neonates from preeclamptic women has been died and the figure was higher (76.59% Vs 23.4%) among neonates from severe preeclamptic women than mild preeclamptic women (p = 0.01). More than two thirds of the patients (69.3%) received magnesium sulfate to prevent convulsion. Perinatal death among women with diastolic blood pressures greater than 110 mmHg at admission was nearly 3 times (Adjusted Odds Ratio (AOR) = 2.824; 95% Confidence Interval (CI) (1.154-6.038)) higher compared to women with diastolic blood pressures below 110 mmHg. CONCLUSION: In the 5-year period, the magnitude of perinatal death among inpatient preeclamptic women was remarkably high and of which stillbirths exceeded pre-discharge early neonatal death. Utilization of magnesium sulfate tended to increase across years. Maternal diastolic blood pressure at admission was significantly associated with perinatal death.

Prevalence and associated factors of birth asphyxia among live births at Debre Tabor General Hospital, North Central Ethiopia.

BACKGROUND: More than one third of the neonatal deaths at Neonatal Intensive Care Unit (NICU) in Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from the maternity ward in the hospital. Concerns have also been raised regarding delayed intrapartum decisions for emergency obstetrics action in the hospital. However, there has been no recent scientific evidence about the exact burden of birth asphyxia and its specific determinants among live births at maternity ward of DTGH. Moreover, the public health importance of delivery time and professional mix of labor attendants haven't been addressed in the prior studies. METHODS: Hospital based cross sectional study was conducted on a sample of 582 mother newborn dyads at maternity ward. Every other mother newborn dyad was included from December 2019 to March 2020. Pre-tested structured questionnaire and checklist were used for data collection. The collected data were processed and entered into Epidata version 4.2 and exported to Stata version 14. Binary logistic regressions were fitted and statistical significance was declared at p less than 0.05 with 95% CI. RESULTS: The prevalence of birth asphyxia was 28.35% [95% CI: 26.51, 35.24%]. From the final model, fetal mal-presentation (AOR = 6.96: 3.16, 15.30), premature rupture of fetal membranes (AOR = 6.30, 95% CI: 2.45, 16.22), meconium stained amniotic fluid (AOR = 7.15: 3.07, 16.66), vacuum delivery (AOR =6.21: 2.62, 14.73), night time delivery (AOR = 6.01: 2.82, 12.79) and labor attendance by medical interns alone (AOR = 3.32:1.13, 9.78) were positively associated with birth asphyxia at 95% CI. CONCLUSIONS: The prevalence of birth asphyxia has remained a problem of public health importance in the study setting. Therefore, the existing efforts of emergency obstetric and newborn care should be strengthened to prevent birth asphyxia from the complications of fetal mal-presentation, premature rupture of fetal membranes, meconium stained amniotic fluid and vacuum delivery. Moreover, night time deliveries and professional mixes of labor and/delivery care providers should be given more due emphasis.

Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Globally, PUs are recognized as one of the five most frequent causes of harm to clients. With millions affected globally, the national pooled prevalence of pressure ulcers in Ethiopia remains unknown. Hence, this review and meta-analysis aimed to determine the prevalence of pressure ulcers among hospitalized clients in Ethiopia. METHODS: Studies were retrieved through search engines in PubMed, Scopus, WHO Afro Library, Google Scholar, Africa Journals Online, and Web of Science. Heterogeneity between-studies were checked using the I2 test. A funnel plot and Egger's regression test was used to assess the presence of publication bias. The random-effect model was fitted to estimate summary effects and 95% confidence intervals (CIs) across studies. The analyses were performed using STATA™ Version 14 software. RESULTS: The pooled prevalence of pressure ulcer in Ethiopia was assessed using seven studies involving a total of 1881 participants. The pooled prevalence of pressure ulcers in Ethiopia was 11.7% (95% CI: 7.28, 16.13). The subgroup analysis showed that the estimated magnitude of pressure ulcers was 15.89% (95% CI: 13.32, 18.46); among studies, their sample size was greater than or equal to 250. CONCLUSION: The current review reported that the pooled prevalence of pressure ulcers in Ethiopia was relatively high. Hence, policymaker and healthcare providers should give attention to reduce the magnitude of pressure ulcers. Furthermore, further a meta-analysis study could be conducted to identify individual and health care service-related factors related to the occurrence of pressure ulcers.

The global burden of pressure ulcers among patients with spinal cord injury: a systematic review and meta-analysis.

BACKGROUND: Pressure ulcers (PU), one of the common challenging public health problems affecting patient with spinal cord injury. PUs occurs over bony areas of the body where pressure and tissue distortion is greatest. It has a significant impact to the patient and health care system. Moreover, it has psychological, physical, social burden and decrease the quality of life (QoL) of patients. Despite its serious complications, limited evidence is available on the global magnitude of pressure ulcers among patient with spinal cord injury. Hence, this review and meta-analysis aimed to estimate the global magnitude of pressure ulcers among patient with spinal cord injury. METHODS: PubMed, Scopus, Google Scholar, African Journals Online, PsycINFO, and Web of Science were systematically searched to retrieve related articles. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was followed. DerSimonian and Laird random-effects model was applied to obtain the pooled effect size. To investigate heterogeneity across the included studies, I2 test was employed. Publication bias was examined using funnel plot and Egger's regression test statistic. Sensitivity analysis was deployed to see the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software. RESULTS: A total of 24 studies which comprises of 600,078 participants were included in this study. The global pooled magnitude of pressure ulcers among patients with spinal cord injury was 32.36% (95% CI (28.21, 36.51%)). Based on the subgroup analysis, the highest magnitude of pressure ulcer was observed in Africa 41.19% (95% CI: 31.70, 52.18). CONCLUSION: This systematic review and meta-analysis revealed that about one in three patients with spinal cord injury had pressure ulcers. This implies that the overall global magnitude of pressure ulcer is relatively high. Therefore, policy maker and other concerned body should be design country context- specific preventive strategies to reduce the burden of pressure ulcers in patients with spinal cord injury.

Surgical site infection and its associated factors in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Despite being a preventable complication of surgical procedures, surgical site infections (SSIs) continue to threaten public health with significant impacts on the patients and the health-care human and financial resources. With millions affected globally, there is significant variation in the primary studies on the prevalence of SSIs in Ethiopia. Therefore, this study aimed to estimate the pooled prevalence of SSI and its associated factors among postoperative patients in Ethiopia. METHODS: PubMed, Scopus, Psyinfo, African Journals Online, and Google Scholar were searched for studies that looked at SSI in postoperative patients. A funnel plot and Egger's regression test were used to determine publication bias. The I2 statistic was used to check heterogeneity between the studies. DerSimonian and Laird random-effects model was applied to estimate the pooled effect size, odds ratios (ORs), and 95% confidence interval (CIs) across studies. The subgroup analysis was conducted by region, sample size, and year of publication. Sensitivity analysis was deployed to determine the effect of a single study on the overall estimation. Analysis was done using STATA™ Version 14 software. RESULT: A total of 24 studies with 13,136 study participants were included in this study. The estimated pooled prevalence of SSI in Ethiopia was 12.3% (95% CI: 10.19, 14.42). Duration of surgery > 1 h (AOR = 1.78; 95% CI: 1.08-2.94), diabetes mellitus (AOR = 3.25; 95% CI: 1.51-6.99), American Society of Anaesthesiologists score > 1 (AOR = 2.51; 95% CI: 1.07-5.91), previous surgery (AOR = 2.5; 95% CI: 1.77-3.53), clean-contaminated wound (AOR = 2.15; 95% CI: 1.52-3.04), and preoperative hospital stay > 7 day (AOR = 5.76; 95% CI: 1.15-28.86), were significantly associated with SSI. CONCLUSION: The prevalence of SSI among postoperative patients in Ethiopia remains high with a pooled prevalence of 12.3% in 24 extracted studies. Therefore, situation based interventions and region context-specific preventive strategies should be developed to reduce the prevalence of SSI among postoperative patients.

Dyslipidemia among adult HIV patients on antiretroviral therapy and its association with age and body mass index in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. METHOD: We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. RESULT: Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. CONCLUSION: The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. TRIAL REGISTRATION: Protocol registered with PROSPERO (CRD42023440125).

The effectiveness of short mobile phone text message reminders compared to usual care on medication adherence in patients with hypertension: a systematic review protocol.

BACKGROUND: Poor adherence to long-term medication increases the risk of morbidity and mortality and decreases the quality of life of patients with hypertension. One strategy to improve treatment adherence is to use a short text message reminder. Although evidence indicates that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice needs to be better documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. This systematic review aimed to evaluate the effectiveness of short mobile phone text message reminders versus usual/standard care for medication adherence in patients with hypertension. METHODS: This review will include and summarize evidence from randomized controlled trials. Adults (age > 18 years) with hypertension. The comparator group received either the usual care or standard care. It encompasses standard medical care for patients not participating in a structured and supervised intervention program such as a telemedicine program. We will include studies that assess the effectiveness of short mobile phone text message reminders in improving medication adherence in patients with hypertension compared to usual care. We will search the following databases: PubMed, EMBASE, CINAHL, SCOPUS, Web of Science, Cochrane Library Central Register of Controlled Trials, and Cochrane Library. We will include studies published in English. Furthermore, we will consider studies published from the inception of the database until April 20, 2024. At least two reviewers will independently conduct study selection, data extraction, and quality assessment. A third reviewer will determine and resolve discrepancies. We will conduct a quality assessment using the ROBIS 2 critical appraisal checklist. At least two independent reviewers will crosscheck the data synthesis. DISCUSSION: We expect this review to provide current evidence for future studies and clinical practice concerning the impact of mobile phone text message reminders on medication adherence issues. We will publish our results in a peer-reviewed journal for publication. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023391236.

Incidence of tuberculosis and its predictors among under-five children with severe acute malnutrition in North Shoa, Amhara region, Ethiopia: a retrospective follow-up study.

Introduction: Although tuberculosis (TB) is one of the significant public health challenges in severely malnourished children throughout the globe, it is a severe issue for countries such as Ethiopia, with significant resource limitations. Few studies have examined the incidence of tuberculosis and its predictors among children under five years of age with severe acute malnutrition in developing countries, and there is a paucity of data. This study aimed to estimate the incidence of tuberculosis and its predictors among under-five children with severe acute malnutrition (SAM) in North Shoa, Amhara region, Ethiopia. Methods: An institution-based retrospective follow-up study was conducted between January 20, 2017, and June 20, 2019. The sample size was calculated using STATA, which yields a total of 345 charts that were selected with systematic random sampling. Data entry was performed using Epi-data version 4.2 and analyzed with STATA 14. Kaplan-Meier survival curves were computed. Cox proportional hazard models were fitted to detect the determinants of tuberculosis. The hazard ratio with a 95% confidence interval was subsequently calculated. Variables with p-values < 0.05 were considered statistically significant. Results: The incidence rate of tuberculosis among children under five years of age with SAM was 4.6 per 100 person-day observations (95% CI: 3.29, 8.9). Predictors of TB were a history of contact with known TB cases [AHR: 1.4 (95% CI: 1.00, 2.8], HIV/AIDS [AHR: 3.71 (95% CI: 2.10, 8.71)], baseline pneumonia [AHR: 2.10 (1.76,12)], not supplying zinc at baseline [AHR: 3.1 (1.91, 4.70)], and failed appetite taste at the diagnosis of SAM [AHR: 2.4 (1.35, 3.82)]. Conclusions: In this study, the incidence rate of TB was high. Not supplying zinc at baseline, failed appetite taste at the diagnosis of SAM, history of contact with known TB cases, and baseline pneumonia were significant predictors of TB. Prioritizing regular TB screenings, nutritional support, and zinc supplementation for under-five children with SAM should be implemented to reduce the risk of TB.

The Effect of Estrogen Receptor Status on Survival in Breast Cancer Patients in Ethiopia. Retrospective Cohort Study.

Background: There is wide global variance in survival from breast cancer, both in developed and developing country. However, the effect of estrogen receptor status has not been widely evaluated in Ethiopia where the incidence of breast cancer is rapidly increasing. Hence, the current study aimed to determine the effect of estrogen receptor status on the overall survival of breast cancer patients who were treated at Black Lion Specialized Hospital, Ethiopia. Methods: In this institution-based retrospective cohort study a total of 368 study participants were included with a one-to-one ratio of estrogen receptor negative to estrogen receptor positive. The main outcome of interest for this study was death due to breast cancer. The authors compared the women with estrogen receptor-positive and estrogen receptor-negative breast cancer for overall survival rate using log rank test. The incidence density rate of mortality was calculated for each exposed and non-exposed variable. The effect of estrogen receptor status on breast cancer mortality was estimated using the Cox proportional hazards model. Results: The incidence density rate of mortality among breast cancer patients for estrogen receptor positive were found to be 5.48 (95% CI=3.94-7.64) per 1,000 person years observation; while for estrogen negative receptor status the mortality rate was found to be 10.47 (95% CI=8.19-13.37) per 1,000 person years observation. In the Cox regression analysis after ful adjustments for confounder variables, the mortality event risk was 32% higher among estrogen receptor negative (HR=1.32; 95% CI=1.08-2.91) as compared to estrogen receptor positive breast cancer patients. Conclusion: We have found that the incidence density rate of mortality among breast cancer patients was significantly higher in the estrogen receptor negative groups. Therefore, clinicians should give careful attention to the impact of estrogen receptor negative status on the overall outcome of clients.

Incidence and predictors of loss to follow-up among adult HIV-infected patients taking antiretroviral therapy at North Shewa zone public Hospitals, Northeast Ethiopia: A retrospective follow-up study.

Background: Patients who are lost to follow-up while on treatment compromise their own health and the long-term success of antiretroviral therapy (ART) programs. Besides, loss to follow-up (LTFU) increases HIV-related morbidity and mortality. Therefore, this study aimed to determine the incidence of LTFU and its predictors among adult HIV positive patients on anti-retroviral therapy at North Shoa zone public hospitals, Northeast Ethiopia. Methods: A retrospective follow up study of 517 people living with HIV/AIDS and attending an ART clinic between 2015 and 2020 was conducted at North Shewa zone, public hospitals. Kaplan-Meier failure function together with log rank test was used to compare failure function. Multivariable Cox proportion hazards regression model was used to determine predictors of LTFU. Result: The incidence density rate of lost to follow up among HIV positive adult on ART was found to be 8.9 per 100 adult years observation (95%CI; 7.45, 10.68). In multivariable cox proportional regression analysis, WHO clinical stage-IV (AHR = 1.50; 95% CI: 1.08, 3.75), comorbidity disease (AHR = 0.54; 95% CI; 0.30, 0.97), body mass index less than 18kg/m2 (AHR = 1.60; 95% CI; 1.02, 2.51), cotrimoxazole preventive therapy (AHR = 1.57; 95% CI;1.09, 2.53), and a low CD4 count (AHR = 1.66; 95% CI; 1.29, 3.49) were found to be a significant predictors of lost to follow up. Conclusion: The current study showed that the incidence rate of loss to ART follow-up was high. Body mass index score less than 18kg/m2, advanced WHO clinical stage, CD4<200cell/mm3, had comorbidity disease, and cotrimoxazole therapy were a significant predictors of lost to ART follow up. Therefore, appropriate mitigation measures in the at-risk group need to be instigated to advance retention rate.

Determinants of neonatal mortality among preterm births in Black Lion Specialized Hospital, Addis Ababa, Ethiopia: a case-cohort study.

BACKGROUND: Preterm neonatal death is a global burden in both developed and developing countries. In Ethiopia, it is the first and fourth cause of newborn and under-5 deaths, respectively. From 2015 to present, the government of Ethiopia showed its effort to improve the survival of neonates, mainly preterm births, through the inclusion of high-impact life-saving neonatal interventions. Despite these efforts, the cause of preterm neonatal death is still not reduced as expected. Therefore, this study aimed to identify determinants of preterm neonatal mortality. METHODS: An institution-based retrospective case-cohort study was conducted among a cohort of preterm neonates who were born between March 2013 and February 2018. A total of 170 cases were considered when the neonates died during the retrospective follow-up period, which was confirmed by reviewing a medical death certificate. Controls were 404 randomly selected charts of neonates who survived the neonatal period. Data were collected from patient charts using a data extraction tool, entered using EpiData V.3.1 and analysed using STATA V.14. Finally, a multivariate logistic regression analysis was performed, and goodness of fit of the final model was tested using the likelihood ratio test. Statistical significance was declared at a p value of ≤0.05. RESULTS: In this study, the overall incidence rate of mortality was 39.1 (95% CI: 33.6 to 45.4) per 1000 neonate-days. Maternal diabetes mellitus (adjusted OR (AOR): 2.3 (95% CI: 1.4 to 3.6)), neonatal sepsis (AOR: 1.6 (95% CI: 1.1 to 2.4)), respiratory distress (AOR: 1.5 (95% CI: 1.1 to 2.3)), extreme prematurity (AOR: 2.9 (95% CI: 1.61 to 5.11)), low Apgar score (AOR: 3.1 (95% CI: 1.79 to 5.05)) and premature rupture of membranes (AOR: 2.3 (95% CI: 1.8 to 3.5)) were found to be predictors. CONCLUSION: In this study, the overall incidence was found to be high. Premature rupture of membranes, maternal diabetes mellitus, sepsis, respiratory distress, extreme prematurity and low Apgar score were found to be predictors of neonatal mortality. Therefore, it should be better to give special attention to patients with significantly associated factors.

Risk Factors of Birth Asphyxia among Newborns at Debre Markos Comprehensive Specialized Referral Hospital, Northwest Ethiopia: Unmatched Case-Control Study.

Background: Despite a global decline in under-five deaths, the neonatal mortality rate remains slow in developing countries and birth asphyxia remains the third cause of neonatal deaths. Globally, neonatal deaths accounts for 45% of under-five deaths, birth asphyxia causes 23-40% of neonatal deaths in Ethiopia. There is limited data on risk factors of asphyxia in Ethiopia, particularly in the study area. Therefore, this study aimed to identify the risk factors of birth asphyxia among newborns. Methods: This research followed a hospital-based unmatched case-control study design at Debre Markos comprehensive specialized referral hospital, Northwest Ethiopia, among 372 newborns (124 cases and 248 controls). Data were collected by interviewing index mothers and chart review using a pre-tested questionnaire. Then it was entered in Epi-data version 3.1 and transferred to STATA version 14.0 for analysis. Bivariate and multiple variable logistic regression were carried out to the possible risk factors. Finally, statistical significance was declared using adjusted odds ratio with 95% CI and p-value <0.05. Results: Prolonged labor >12, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, noncephalic presentation, comorbidity, birthweight<2500grams were found to be significant factors of birth asphyxia. Conclusion: In this study, Prolonged labor >12 hours, meconium-stained amniotic fluid, assisted vaginal delivery, gestational age < 37 weeks, non-cephalic presentation comorbidity, fetal distress, birthweight<2500grams were found to be risk factors of birth asphyxia were risk factors of birth asphyxia. Therefore, to reduce neonatal mortality associated with birth asphyxia, attention should be given to holistic pregnancy, labor and delivery care, and post-natal care. Moreover, interventions aimed at reducing birth asphyxia should target the identified factors.

National burden of intestinal parasitic infections and its determinants among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis.

Objectives: The aim of this systematic review and meta-analysis is designed to assess the pooled prevalence and determine risk factors of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia. Methods: International databases: PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were systematically searched. Publication bias was determined using the funnel plot and Egger's regression tests. Heterogeneity between the studies included in this review was checked by I 2 statistic. The DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Sub-group, meta-regression, and sensitivity analysis were conducted. Overall, meta-analysis was done using Stata version 14 statistical software. Results: Twenty-seven studies with 8946 individuals were included, the estimated pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy was 40.24% (95% confidence interval = 33.8-46.6). Based on sub-group analysis, the highest prevalence was observed in the Tigray region 45.7% (95% confidence interval = 7.9-83.5), followed by Oromia region 42.2% (95% confidence interval = 28.8-55.6). Availability of latrine (odds ratio = 26.6, 95% confidence interval = 2.8-15.8), presence of animals at home (odds ratio = 2.7, 95% confidence interval = 1.2-5.8), and source of drinking water (odds ratio = 3.2, 95% confidence interval = 1.3-7.5) were significantly associated with intestinal parasitic infections. Conclusion: These findings indicated that the prevalence of intestinal parasites among people living with HIV/AIDS was high in Ethiopia.

Time to occurrence of necrotizing enterocolitis and its predictors among low birth weight neonates admitted at neonatal intensive care unit of felege hiwot compressive specialized hospital BahirDar, Ethiopia, 2021: A retrospective follow-up study.

Background: Globally, the incidence of necrotizing enterocolitis (NEC) varies between 6 and 15% of all neonates admitted to the neonatal intensive care unit (NICU). Though necrotizing enterocolitis is a multifactorial and life-threatening disease, low birth prematurity is the single cause. Therefore, determining the time to presentation and its predictors of necrotizing enterocolitis were the main goals of this investigation. Materials and methods: An institution-based retrospective follow-up study was conducted among 747 low birth weight (LBW) neonates admitted to the neonatal intensive care unit of Felege Hiwot comprehensive specialized Hospital from 1 January 2017 to 30 December 2019. The sample size was calculated by using the STATA package. Data were entered into Epi data version 3.1 and exported to STATA version 14 for analysis. The log-rank test and the Kaplan-Meier estimator were used to display the survival probability and differences between groups. At a significance threshold of 5%, Cox proportional hazard regression was performed to determine the net independent predictors of necrotizing enterocolitis. Result: The overall incidence rate was 0.86 per 1,000 person-days (95% CI: 0.67, 1.14) with a 6.8% (95% i: 5.2, 8.9) proportion of necrotizing enterocolitis among low birth weight neonates. Preeclampsia [adjusted hazard ratio (AHR);1.92 (95% CI: 1.03-3.58)], premature rapture of membrane [AHR; 2.36 (95%, CI: 1.19-4.69)], perinatal asphyxia [AHR; 4.05 (95%, CI: 2.04-8.60)], gestational age between 28 and 32 weeks [AHR; 3.59 (95% CI: 1.01-8.83)], and birth weigh less than 1,000 g [AHR; 5.45 (95% CI: 3.84-9.12) were the independent predictors of necrotizing enterocolitis. Conclusion: Within the first 1-7 days of a newborn's life, necrotizing enterocolitis was most common. It was discovered that preeclampsia, premature rupture of membrane, perinatal asphyxia, gestational age of 28-32 weeks, and birth weight less than 1,000 g were predictors of its occurrence.

Prevalence of Leucopenia and Associated Factors before and after Initiation of ART among HIV-Infected Patients, North East Ethiopia: Cross-Sectional Study.

BACKGROUND: Leucopenia is the commonest hematological abnormaly that occurs in patients with human immune deficiency virus (HIV) infection. The magnitude and related factors of leucopenia during the time of ART are not characterized in Ethiopia. This study aimed to assess the prevalence of leucopenia before and after the initiation of ART among HIV patients attending Debre Berhan Referral Hospital (DBRH), North East Ethiopia. METHODS: A cross-sectional study was conducted from September to December 2020 in DBRH, North-East Ethiopia. A total of 272 patients on ART were selected by simple random sampling techniques. Socio-demographic and clinical characteristics of the study participants were collected by standard questionnaires. Measurements of leucocyte count and CD4 counts were made by Sysmex XT 2000i hematology analyzer and BD FACS count CD4 analyzer, respectively. Statistical analysis of data was done by SPSS version 23. Logistic regression was done and a P-value<0.05 was taken as statistically significant. RESULTS: The prevalence of leucopenia, neutropenia, and lymphopenia were 20.9%, 7.0%, and 6.6% before initiation of ART and 15.4%, 1.1, and 4.4% after initiation of ART, respectively. There was a significant difference in total white blood cell count, absolute neutrophil count, and total lymphocyte count between patients on ART and ART naïve patients. HIV patients whose cluster of differentiation (CD4) counts were <200 cells/µL and patients on a zidovudine (AZT)-based regimen were more likely to have leucopenia than HIV patients whose CD4 counts were ≥ 200 cells/µL and on a tenofovir (TDF)-based regimen. CONCLUSION: In this study, the prevalence of leucopenia, neutropenia, and lymphopenia has shown a significant decrement after the initiation of ART. HIV patients with low CD4 count and on an AZT-based regimen are more likely to have leucopenia, neutropenia, and lymphopenia. Based on our findings, we recommend that the health care professional routinely investigate and should treat leucopenia.