Factors associated with the co-utilization of oral rehydration solution and zinc for treating diarrhea among under-five children in 35 sub-saharan Africa countries: a generalized linear mixed effect modeling with robust error variance.

INTRODUCTION: Even though childhood diarrhea is treated with a simple treatment solution, it continues to be one of the leading causes of under-five child mortality and malnutrition globally. In resource-limited settings such as Sub-Saharan Africa (SSA), the combination of oral rehydration salts (ORS) and zinc is regarded as an effective treatment for diarrhea; however, its utilization is very low. The purpose of this study was to determine the proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA. METHODS: The proportion and associated factors of co-utilization of ORS and zinc among under-five children with diarrhea in SSA were determined using secondary data analysis of recent Demographic and Health Surveys (DHS) of 35 SSA countries. The study included a total of 44,341 under-five children with diarrhea in weighted samples. A generalized linear mixed-effects model with robust error variance was used. For the variables included in the final model, adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were estimated. A model with the lowest deviance value were considered as the best-fitted model. RESULT: The pooled proportion of co-utilization of ORS and zinc for the treatment of diarrhea among under five children in SSA countries was 43.58% with a 95% CI (43.15%, 44.01%). Sex of the child, maternal age, residence, maternal educational and employment status, wealth index, media exposure, perceived distance to health facility and insurance coverage were statistically significant determinants of ORS and Zinc co-utilization for treating diarrhea among under five children in SSA. CONCLUSION: Only less than half of under-five children with diarrhea in SSA were treated with a combination of ORS and zinc. Thus, strengthening information dissemination through mass media, and community-level health education programs are important to scale up the utilization of the recommended combination treatment. Furthermore, increasing health insurance coverage, and establishing strategies to address the community with difficulty in accessing health facilities is also crucial in improving the use of the treatment.

Virological failure and its predictors among human immunodeficiency virus infected individuals on second line antiretroviral treatment in North-East Ethiopia, 2021.

INTRODUCTION: Acquired immune deficiency syndrome (AIDS) becomes a manageable chronic disease due to the presence of effective prevention, diagnosis, treatment, and care accesses. Viral load cascade analyses are important to identify gaps in human immunodeficiency virus (HIV)/AIDS treatment and care for quality improvements. OBJECTIVE: Time to Virological Failure and its Predictors among HIV Infected Individuals on Second Line Antiretroviral Treatment (SLART) in North-East Ethiopia, 2021. METHODS: Institution-based retrospective follow-up study was conducted on 474 HIV-infected individuals who were on SLART between September 2016 and April 2020. A universal sampling technique was used to recruit study participants. Data were entered by EpiData-3.3.1 and analyzed by STATA-14. Cox proportional hazard assumptions were checked to determine the effect of predictor variables on virological failure (VF). The study was conducted from February 1 to April 30, 2021. RESULTS: The rate of VF in this study was 15.4% with an incidence rate of 4.93 per 100 person-years. As participants' age and duration of ART use increased by 1 year the hazards of VF was reduced by 2.9% (AHR: 0.971, 95% CI: 0.945, 0.995) and 10.6% (AHR: 0.894, 95% CI: 0.828, 0.963), respectively. The hazards of VF were twice higher among those who were on a non-protease inhibitor-based regimen. Individuals who had a history of making enhanced adherence counseling (EAC) sessions during SLART had three times more risk to develop VF (AHR: 3.374, 95% CI: 1.790, 6.361). CONCLUSION AND RECOMMENDATIONS: The rate of VF among SLART users was high. Keeping SLART users on PI-based regimens may improve virological outcomes in HIV care and treatment. Making EAC sessions effective in promoting better ART adherence might reduce VF.

Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression.

BACKGROUND: Despite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors' knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA. METHODS: Pooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike's and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables. RESULTS: The pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12-1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07-1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01-2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16-1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03-1.06)], higher birth order [APR (95% CI) = 1.31 (1.28-1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13-1.16)] were the predictors of suboptimal birth spacing practice. CONCLUSION: More than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.

Geographical clustering and geographically weighted regression analysis of home delivery and its determinants in developing regions of Ethiopia: a spatial analysis.

BACKGROUND: Nearly three-fourths of pregnant women in Ethiopia give birth at home. However, the spatial pattern and spatial variables linked to home delivery in developing regions of Ethiopia have not yet been discovered. Thus, this study aimed to explore the geographical variation of home delivery and its determinants among women living in emerging (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of Ethiopia, using geographically weighted regression analysis. METHODS: Data were retrieved from the Demographic and Health Survey program's official database ( http://dhsprogram.com ). In this study, a sample of 441 reproductive-age women in Ethiopia's four emerging regions was used. Global and local statistical analyses and mapping were performed using ArcGIS version 10.6. A Bernoulli model was applied to analyze the purely spatial cluster discovery of home delivery. GWR version 4 was used to model spatial regression analysis. RESULTS: The prevalence of home delivery in the emerging regions of Ethiopia was 76.9% (95% CI: 72.7%, 80.6%) and the spatial distribution of home delivery was clustered with global Moran's I = 0.245. Getis-Ord analysis detected high-home birth practice among women in western parts of the Benishangul Gumz region, the Eastern part of the Gambela region, and the Southern and Central parts of the Afar region. Non-attendance of antenatal care, living in a male-headed household, perception of distance to a health facility as a big problem, residing in a rural area, and having a husband with no education significantly influenced home delivery in geographically weighted regression analysis. CONCLUSIONS: More than three-fourths of mothers in the developing regions of Ethiopia gave birth at home, where high-risk locations have been identified and the spatial distribution has been clustered. Thus, strengthening programs targeted to improve antenatal care service utilization and women's empowerment is important in reducing home birth practice in the study area. Besides, supporting the existing health extension programs on community-based health education through home-to-home visits is also crucial in reaching women residing in rural settings.

Prognostic factors of first intimate partner violence among ever-married women in Sub-Saharan Africa: Gompertz gamma shared frailty modeling.

BACKGROUND: Violence against women, particularly intimate partner violence, is a significant Concern for public health as well as a violation of the human rights of women especially in low and middle-income countries. However, there was limited evidence how soon an ever-married women experience intimate partner violence in Africa. Therefore, this study aimed to investigate the timing of first intimate partner violence (FIPV) among ever-married women in 30 SSA countries and to identify the risk factors of the timing. METHODS: The present study has utilized 125,731 weighted samples, who participated in the domestic violence module of the survey from Demographic and Health Surveys of 30 SSA countries. The Gompertz gamma shared frailty model was fitted to determine the predictors. For model evaluation, the theta value, Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance were used. The Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported in the multivariable Gompertz gamma shared frailty model to highlight the strength and statistical significance of the associations. RESULT: One-third (31.02%) of ever-married women had reported experiencing IPV. The overall incidence rate of FIPV was 57.68 persons per 1000 person-years (95% CI = 50.61-65.76). Age at marriage, age difference, educational status, employment, residence, women's decision-making autonomy, husband who drink alcohol and wealth status were significantly associated with the timing of FIPV. CONCLUSION: The findings show that ever-married women are at high and increasing risk of violence. Thus, we recommend establishing effective health and legal response services for IPV, strengthening laws governing the sale and purchase of alcohol, empowering women, raising the educational attainment of women, and putting policies in place to combat the culture of societal tolerance for IPV all contribute to the empowerment of women.

Exploring Barriers to Vitamin A Supplementation Uptake and Program Implementation Among Children Aged 6-59 Months in Ethiopia: A Qualitative Approach.

Background: Children in Ethiopia do not receive the recommended dose of vitamin A supplementation (VAS). Objective: This study aimed to explore the barriers to VAS uptake and program implementation among children aged 6-59 months in Ethiopia. Methods: Data were collected qualitatively using focus group discussions and in-depth interviews. The data were audio-recorded, transcribed, and inductively coded. The results were displayed using thematic analysis and the well-spoken verbatim of the respondents. Results: The barriers to VAS uptake were low parental awareness of the program and low interest or motivation, low promotion of the program among health professionals, an excessive workload for health extension workers, and low professional attention to VAS compared to other health services. Conclusion: Both client-side and supply-side issues posed significant obstacles to the uptake of VAS. It is important to educate mothers about VAS. Health workers should receive refresher training to raise their level of concern about VAS's importance and its schedule. It's crucial to initiate outreach programs for remote communities. The departmentalization of health extension packages will improve service and access.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis.

BACKGROUND: Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries. METHODS: We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software. RESULTS: The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception. CONCLUSIONS: Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

Factors affecting utilization of long-acting reversible contraceptives among sexually active reproductive-age women in the pastoral community of Northeast Ethiopia: A community-based cross-sectional study.

INTRODUCTION: In Ethiopia, only one in ten reproductive-age women use long-acting reversible contraceptives. Evidence on the utilization of these methods and associated factors among sexually active reproductive-age women in the pastoral area of Northeast Ethiopia is limited. Thus, this study aimed to assess the utilization of long-acting reversible contraceptives and associated factors among sexually active reproductive-age women in the pastoral community of Northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from 1 to 30 April 2021 among 572 reproductive-age women selected by a systematic random sampling method. Data were collected using a structured interviewer-administered questionnaire and entered into Epi-info version 7 and then finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the utilization of long-acting reversible contraceptives. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at p-value < 0.05. RESULTS: Overall, the utilization of long-acting reversible contraceptives was (24.3%; 95% confidence interval = 20.9%-28.0%). It was also revealed that being Orthodox (adjusted odds ratio = 4.10; 95% confidence interval = 2.20-7.65) and Protestant (adjusted odds ratio = 7.86; 95% confidence interval = 1.26-18.97) religion followers, attending higher education (adjusted odds ratio = 3.31; 95% confidence interval = 1.37-7.98), and having a husband who attended higher education (adjusted odds ratio = 4.37; 95% confidence interval = 1.98-9.67) were associated with an increased odds of using long-acting reversible contraceptive methods. Besides, having a good (adjusted odds ratio = 6.69; 95% confidence interval = 2.64-16.95) and moderate (adjusted odds ratio = 3.03; 95% confidence interval = 1.06-8.56) knowledge, and positive attitude (adjusted odds ratio = 3.65; 95% confidence interval = 1.90-7.01) toward long-acting reversible contraceptives were also associated with the utilization of these methods. CONCLUSION: Less than one-fourth of sexually active reproductive-age women in the study area were using long-acting reversible contraceptives. Thus, improving women's and husbands' education and women's knowledge and attitude toward long-acting reversible contraceptives is important to scale up the uptake of these contraceptive methods.

Only one in four lactating mothers met the minimum dietary diversity score in the pastoral community, Afar region, Ethiopia: a community-based cross-sectional study.

Maternal dietary feeding practice is one of the proxy indicators of maternal nutrient adequacy and it improves outcomes for both mothers and their offspring. The minimum maternal dietary diversity score of lactating women is defined as when the mother ate at least four and above food groups from the nine food groups 24 h preceding the survey regardless of the portion size. Therefore, the present study aimed to determine the minimum dietary diversity score (MDDS) and its predictors among lactating mothers in the Pastoralist community, Ethiopia. A community-based cross-sectional study design was employed on 360 lactating mothers using a multi-stage sampling technique from 5 January 2020 to 10 February 2020. Data were collected using questionnaires and anthropometry measurements. Data were entered using EPI-data 4.6.02 and exported into SPSS version 25. Statistical significance was declared at P-value <0⋅05 at multivariable logistic regression. Only one in four lactating mothers met the MDDS. The majority of them consumed cereals in the preceding 24 h of data collection. The most important predictors were maternal meal frequency (adjusted odds ratio (AOR) 6⋅26; 95 % confidence interval (CI) (3⋅51, 11⋅15)), antenatal care (ANC) follow-up one to three times and four and above times (AOR: 2⋅58; 95 % CI (1⋅24, 5⋅36), 4⋅77 (1⋅90, 11⋅95), respectively) and secondary paternal education (AOR 2⋅97; 95 % CI (1⋅44, 6⋅11)). The MDDS among lactating mothers was low. Paternal education, maternal meal frequency and ANC follow-up were the significant predictors. Therefore, to improve maternal dietary diversity score emphasis should be given to those predictors.

Nearly one-third of lactating mothers are suffering from undernutrition in pastoral community, Afar region, Ethiopia: Community-based cross-sectional study.

BACKGROUND: Undernutrition is responsible for a significant proportion of maternal and child morbidity and mortality. Lactating women are nutritionally vulnerable groups because this period places a high nutritional demand on the mother and leads to nutritional stress. Poor nutrition during lactation has a significant negative consequence to mothers and children's survival, growth, and development. Therefore this study aimed to assess the nutritional status of lactating mothers and associated factors in pastoral community, Afar region, Ethiopia. METHODS: A community-based cross-sectional study was conducted from January 5/2020 to February 10/2020, in the Abala district. The data were collected from a sample of 366 lactating mothers whose children aged less than 24 months. Data was collected through face-to-face interviews and anthropometric measurements. Study participants were recruited using a systematic sampling technique. Anthropometric measurements (both body mass index and mid-upper arm circumference) were taken from each mother using calibrated equipment and standardized techniques. Data were entered into Epi-data version 4.2 and exported to SPSS version 22 for analysis. Predictor variables with a P-value < 0.25 at bivariable analysis were candidates for the final model. Statistical significance was declared at P-value of < 0.05 in the multivariable logistic regression. RESULT: This study showed that 120(32.8%) and 122(33.3%) surveyed mothers were undernourished using a cut-off body mass index <18.5 kg/m2 and mid-upper arm circumference <23 Centimeter, respectively. Lactating mothers who didn't meet the minimum dietary diversity score were more than five (Adjusted odds ratio (AOR) = 5.103; 95% confidence interval (CI): 2.128, 12.238) times more likely to be undernourished than those who met the minimum dietary diversity score. Mothers with short birth intervals were also more than four (AOR = 4.800; 95% CI: 2.408, 9.567) time more likely to be undernourished. CONCLUSION: Nearly one-third of lactating mothers were undernourished. Undernutrition among lactating mothers was significantly associated with maternal dietary diversity score and birth interval. Health education on proper and adequate maternal dietary feeding practices, and proper family planning utilization during lactation should be emphasized.

Deworming Coverage and its Predictors among Ethiopian Children Aged 24 to 59 Months: Further Analysis of EDHS 2016 Data Set.

Intestinal parasitic infections are the major public health problem globally, mostly in developing countries. World Health Organization recommends deworming to all at-risk people living in endemic areas as a prevention or intervention strategy. Therefore this study aimed to assess the deworming coverage and its predictors among Ethiopian children aged 24-59 months. The study analyzed retrospectively cross-sectional data on a weighted sample of 5,948 children aged 24-59 months nested within 645 clusters after extracting from the Ethiopian Demographic health survey. Bivariable and multivariable logistic regression was employed to assess the association of variables. Predictors at p-value < 0.25 were entered into the multivariable logistic regression model, and statistical significance was declared at P-value < 0.05. In this study, the prevalence of maternal reported deworming supplements among children aged 24-59 months was 15.1%. Predictive variables significantly associated with deworming supplementation include maternal media exposure, maternal control of household healthcare decisions, institutional healthcare delivery, and child vitamin-A supplementation. Having history of a diarrheal disease, maternal and paternal education, and family size were also statistically significant predictors of deworming supplements. Therefore, deworming supplementation among children is low. Maternal education and employment, paternal education, family size, decision-making process, maternal media exposure, place of delivery, vitamin-A supplementation, and a having history of diarrhea were predictors of deworming supplements. Multifaceted interventions aimed at those predictors should be given emphasis.