Multilevel and geographically weighted regression analysis of factors associated with full immunization among children aged 12-23 months in Ethiopia.

Immunization is the process of building immunity or resistance to an infectious disease, typically through administering a vaccine. It is one of the most effective strategies for lowering child morbidity and death. It protects against more than 20 potentially fatal diseases, increasing longevity and health. Despite progress, Ethiopia failed to meet its vaccination coverage target. The magnitude of full immunization is different across areas. Therefore, conducting geographically weighted regression to identify the local factors and multilevel analysis to investigate and identify factors associated with full immunization coverage among children aged 12-23 months is necessary. The study was conducted using the 2019 Ethiopian Mini Demographic Health Survey dataset. A sample of 1028 weighted children aged 12-23 months were included in the analysis. Descriptive statistics were used to describe variables. For the spatial analysis, Arc-GIS version 10.8 statistical software was used. Spatial regression (geographically weighted regression) was done to identify factors associated with the proportion of full immunization, and model comparison was based on adjusted R2 and Akaike Information Criteria (AICc). Multilevel mixed-effect binary logistic regression models were fitted to identify factors associated with full immunization. The fitted models were compared based on log-likelihood, deviance, median odds ratio, and Proportional Change in Variance. Finally, statistically significant factors were reported using an adjusted odd ratio (AOR) with a 95% Confidence Interval for fixed effect. All variables with a p-value less than 0.05 in the final model were considered statistically significant factors. In Ethiopia, the overall full immunization coverage among children aged 12-23 months was 40.58%, with spatial variation across regions in Ethiopia. The significant spatial distribution of full immunization coverage among children aged 12-23 months was detected in northern Tigray, Addis Ababa, central Oromia, and southeastern Amhara regions. The proportion of rural residents,the proportion of women aged 35-44 years,  the proportion of women who had ANC 4 and above andthe proportion of women who had PNC were local factors associated with the proportion of full immunization among children aged 12-23 months. Rural residence [AOR 0.27 (95% CI 0.10, 0.70)], family size 4 and above[AOR 0.41 (95% CI 0.17, 0.96)], never breastfeed [AOR 0.026(95% CI 0.003, 0.21)], 1-3 times ANC visit [AOR 0.45 (95% CI 0.23, 0.86)], being from Oromia region [AOR 0.23 (95% CI 0.05, 0.97)], Eastern pastoralist region [AOR 0.09 (95% CI 0.023, 0.35)], age 35-44 years [(AOR 6 (95% CI 1.57, 22.9)], and PNC [AOR 2.40 (95% CI 1.24, 4.8)] were significant factors associated with fully immunization in multilevel mixed effect analysis. Full immunization coverage in Ethiopia is below the global target with significant geographical variation. The high proportion of rural residents, the high proportion of women who had ANC 4 and above, mothers who had a high proportion of PNC, and the high proportion women age 35-44 years were local geographical factors for the proportion of full immunization among children age 12-23 months in Ethiopia. Women who had PNC, ANC visits four or more times, and increased maternal age were positively associated, whereas larger family size, no breastfeeding, rural residence, and being from Oromia and eastern pastoralist region were negatively associated with full immunization. Strengthening maternal and child health services, focusing on rural areas and low-coverage regions, is essential to increase immunization coverage in Ethiopia.

Measles second dose vaccine uptake and its associated factors among children aged 24-35 months in Northwest Ethiopia, 2022.

Measles is a major public health problem in under-five children, leading to lifelong complications. Therefore, the study aimed to assess the magnitude of measles second-dose vaccine uptake and its determinants among children aged 24-35 months in Northwest Ethiopia. A community-based cross-sectional study was conducted among 418 children aged 24-35 months in Northwest Ethiopia between January 2022 and February 2022. A simple random sampling technique was used to access study subjects. A binary logistic regression model was employed. An adjusted odd ratio with a 95% confidence interval (CI) and a p-value < 0.05 was used to declare significant predictors of measles second dose vaccine uptake. The magnitude of the measles second dose vaccine uptake among children aged 24-35 months was 41.39%. Postnatal care visits (AOR: 4.78, CI 1.49, 15.34), child vaccination status of other scheduled vaccines (AOR: 3.88, CI 2.23, 6.73), awareness of the measles second dose vaccine and its schedule (AOR: 8.924, CI 5.27, 15.09), and distance from the vaccination center (AOR: 0.21, CI 0.06, 0.77) were significantly associated with measles second dose vaccine uptake. The uptake of measles second dose vaccine in the study area was low. Therefore, health workers and other partners should initiate awareness creation programs for mothers/caretaker to improve the uptake of measles second dose vaccine.

Iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia: a multilevel complex data analysis of 2019 Ethiopian mini demographic and health survey data.

Background: Iron and folic acid deficiency is a worldwide public health concern, particularly in low and middle-income countries. In Ethiopia, adherence to iron and folic acid supplements is still very low. Despite the fact that a number of studies on IFA supplementation have been conducted in Ethiopia, they do not indicate a nationwide problem and do not use advanced models to demonstrate clustering effects. The purpose of this study was to assess the level of non-adherence to iron folic acid supplementation and predictors among pregnant women in Ethiopia. Objective: To assess iron folic acid supplementation adherence level and its associated factors among pregnant women in Ethiopia using data from the 2019 Mini-Ethiopian demographic health survey. Methods: The Mini Ethiopian Demographic and Health Survey 2019 data were obtained from the official database website of the Demographic and Health Survey program (http://dhsprogram.com). The analysis included a sample of 2,356 weighted study participants. A multivariable multilevel mixed-effects logistic regression model was used Variables with p-values less than 5%) was reported as statistically significant variables in the multivariable analysis. Results: The proportion of mothers who did not adhere to iron and folic acid supplements was 81.03% (95 %CI, 79.39, and 82.56). Birth interval less than 2 years [AOR: 2.03; 95% CI: 1.12, 3.66], women ever born less than six children [AOR: 1.99; 95% CI: 1.09, 3.64], starting ANC visit during first trimester [AOR: 2.74; 95 %CI: 1.03, 7.30], region [AOR = 0.24; 95% CI: 0.10], and having a high no ANC visit in the community [AOR = 1.77; 95% CI: 1.08, 2.88] were statistically significant factors. There was Intra-Custer Correlation (ICC = 17.72%), indicating that 17.72% variability in non-adherence levels was due to clusters. Conclusion and recommendation: In Ethiopia, nearly four out of every five pregnant women did not receive iron folic acid supplementation for the recommended periods. Birth intervals, number of children, timing of ANC visits, region, and community level no ANC service were significant factors for non-adherence IFAS. As a result, the community, govern metal and non-governmental sectors enacting on health should focus on reducing non-adherence through tailored interventions on factors that influence it.

Tinea capitis among schoolchildren in Ethiopia: A systematic review and meta analysis.

BACKGROUND: Tinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among schoolchildren particularly in developing countries. Due to the presence of significant variability among the previous studies, this study was conducted to provide a pooled prevalence and associated factors of tinea capitis in Ethiopian schoolchildren. METHOD: We conducted a systematic search in five major databases for articles similar to our topic. This review included school-based cross-sectional studies that were reported in English and conducted from 2006 through 2022. The data were extracted using Microsoft Excel and further analysis was done using StataTM Version 17.0 statistical software. Forest plots were used to assess the presence of heterogeneity with 95% confidence intervals. A random effects meta- analysis model was used to pool primary estimates. To declare the presence or absence of association, 95% confidence interval with odds ratio was used. RESULTS: Fourteen studies with a total of 9465 schoolchildren were included. The pooled prevalence was 29.03% (95%CI: 15.37-42.71). There was observed heterogeneity, which could be explained by publication bias (P = 0.04). Family history of tinea capitis (OR: 9.18, 95%CI: 3.5-24.02), under the age of 10 years (OR: 1.65, 95%CI: 1.17-2.33) were factors increasing the development of tinea capitis among schoolchildren and schoolchildren who had hair wash at least once a week (OR: 0.31, 95%CI: 0.24-0.42) was significantly associated with reduced risk for tinea capitis. CONCLUSION: One of the most prevalent childhood health condition in Ethiopia is tinea capitis, which affects over one in every four schoolchildren. Schoolchildren who had family history of tinea capitis and under the age of 10 years were the identified risk factors but they had hair wash at least once a week was the protective factor of tinea capitis among schoolchildren. Clinical and public engagement activities are needed to overcome the burden of the disease.

A meta-analysis on burden of postpartum depression and its predictors among lactating women in East African countries from 1998 up to 2018.

Objective: Postpartum depression is a common mental illness that affects lactating women. This not only makes daily activities difficult for them, but it also affects child's future lives. There is little evidence of about postpartum depression and its factors in East African countries, which piqued the authors' interest in conducting a study on this matter for future decision- and policy-making. Methods: The protocol for Preferred Reporting Items for Systematic Reviews and Meta-Analyses was followed. To identify published articles, all major databases such as PubMed/MEDLINE, WHOLIS, Cochrane Library, Embase, PsycINFO, ScienceDirect, Web of Science, and reference lists were used. In addition, shelves, author contact, Google and Google Scholar were also used to identify unpublished studies. Joanna Briggs Institute-Meta-Analysis of Statistical Assessment and Review Instrument was used for critical appraisal of studies. STATA software version 14 was used for the analysis. The random-effect model was used to estimate postpartum depression with 95% confidence interval, while subgroup analysis and meta-regression were used to identify potential sources of heterogeneity and associated factors, respectively. Furthermore, Egger's test and trim-and-fill analysis were used to check for publication bias. Results: Postpartum depression was found in 24% of lactating women in East African countries (95% confidence interval: 17.79-30.20). Postpartum depression was associated with being married (odds ratio = 2; 95% confidence interval: 1.05-3.81), domestic violence (odds ratio = 6.34; 95% confidence interval: 4:11-9.78), a lack of support (odds ratio = 6.59; 95% confidence interval: 1.98-21.89), and a lack of empowerment (odds ratio = 2.79; 95% confidence interval: 1.12-6.92). Conclusion: In East Africa, the prevalence of postpartum depression among lactating women is high and rising, as per global postpartum depression estimates. Therefore, the primary focus should be on women's domestic violence prevention mechanisms. Existing national policies and development agendas must prioritize strategies for women's support and empowerment. Future research into the relationship between marriage and postpartum depression is required.

Spatial exploration of non-resilience to food insecurity, its association with COVID-19 and household coping strategies in East Gojjam districts, Northwest Ethiopia, 2020.

The coronavirus disease-2019 (COVID-19) pandemic has posed a significant multifaceted threat to the global community. Ethiopia, as a Sub-Saharan African country, is suffering from chronic food insecurity, and the emergence of such a pandemic will exacerbate the situation. As a result, this study investigated the spatial variation of non-resilience to food insecurity, its relationship with COVID-19, and household coping strategies to become resilient in the long run among households in the East Gojjam Zone of Northwest Ethiopia. From September 22 to December 24, 2020, an agro-ecological-based cross-sectional study of 3532 households was conducted to assess the spatial distribution and associated factors of non-resilience to household food insecurity. The enumeration areas (EAs) and households were chosen using a multistage sampling technique. Data were gathered using a semi-structured questionnaire and checklist using an Android device loaded with an Open Data Kit (ODK) template. Binary logistic regression was used to identify the specific factors associated with household non-resilience to food insecurity. A thematic analysis was conducted to investigate the opportunities and challenges of resilience for household food insecurity. Nearly two-thirds (62.5%) of the households were farmers, 67.9% lived in rural areas, and nearly three-quarters (73.8%) earned less than or equal to ETB 2100 per month. Males headed more than four-fifths of the households (81.7%). We found that nearly two-thirds of the households (60.02%), 95% CI 58.40, 61.64) were food insecure. After bivariate logistic regression, we found that households who were divorced (AOR = 2.54 (1.65, 3.87)), daily laborers (AOR = 2.37 (1.15, 4.87)), government employees (AOR = 2.06 (1.05, 4.05)), residents of highland and hot areas (AOR = 11.5 (5.37, 16.77)) and lowland areas (AOR = 1.35 (1.02, 3.15)) were frustrated by COVID-19 (AOR = 1.23 (1.02, 1.50)) and price inflation (1.89 (AOR = 1.42, 2.56))) were at higher odds of being non-resilient to household food insecurity at a 95% confidence level. Geospatial hot spot analysis revealed that Kurar kebele (the lowest government administrative unit) in Dejen District and Debre Markos town were the red-hotspot areas of household non-resilience to food insecurity. Less than a quarter of the households attempted to cope with food insecurity by adjusting their food consumption, while more than 60% of the households chose none of the coping strategies tested. According to the thematic analysis, the degree of poverty (lack of asset ownership), the COVID-19 pandemic, farm decreased variety, and low crop productivity were identified as challenges to coping with the hardship of resilience to food insecurity. During the COVID-19 pandemic and public emergency, the proportion of households that were unprepared for food insecurity reached its peak. It was recognized that a segment of the population with low economic capacity was more vulnerable to food insecurity and less resilient. Tough developmental gains will be undermined in this case. As a result, each responsible body and stakeholder should develop and implement solid corrective plans for the local context.

Practice of Sunlight Exposure of Infants and Associated Factors Among Infant Coupled Mothers at Dejen District, Amhara Region, Northwest Ethiopia 2021.

Introduction: Currently, nutritional rickets has become a concern of many nutrition experts in many countries. Sunlight is the best and most reliable Source of vitamin D. Since, there is scarce information regarding infant sunlight exposure practice and the determinant factors. Hence, this study aimed to assess mothers' infant sunlight exposure, practice level, and associated factors. Methods: A community-based cross-sectional study was conducted on 884 mothers from March 20 to April 4, 2017. Through the multi-stage simple random sampling method, the study areas had selected. The data were collected using a structured and pre-tested questionnaire and were entered into Epidata version 3.1 and exported to SPSS version 20 for analysis. The strength of association was measured using binary logistic regression at a 95% CI odds ratio. Finally, P < .05% was declared statistically significant. Results: From 884 infant coupled mothers, 866 were recruited in the study with a response rate of 97.9%. Only 44% of mothers had good practice of infant sunlight exposure. In multivariate analyses; Knowledge status (AOR = 1.4, 95% CI: 1.0-1.9), Attitude status (AOR = 1.4, 95% CI: 1.1-1.9), mothers age group (AOR = 8.6, 95% CI: 5.1-14.4), mothers educational status (AOR = 5.2, 95% CI: 1.6-16.9), delivery at health facility (AOR = 1.5, 95% CI: 1.0-2.1), and friend influence (AOR = 1.6, 95% CI: 1.2-2.1) were significantly associated with maternal exposure status of their infants to sunlight. Conclusion: This finding showed that the majority of the mothers did not expose their infants to sunlight appropriately. The mother's knowledge, attitude, educational status, institutional delivery, and friend influence were the significant factors and needs to work on these.

Time to lost to follow-up and its predictors among adult patients receiving antiretroviral therapy retrospective follow-up study Amhara Northwest Ethiopia.

Antiretroviral therapy lowers viral load only when people living with HIV maintain their treatment retention. Lost to follow-up is the persistent major challenge to the success of ART program in low-resource settings including Ethiopia. The purpose of this study is to estimate time to lost to follow-up and its predictors in antiretroviral therapies amongst adult patients. Among registered HIV patients, 542 samples were included. Data cleaning and analysis were done using Stata/SE version 14 software. In multivariable Cox regression, a p-value < 0.05 at 95% confidence interval with corresponding adjusted hazards ratio (AHR) were statistically significant predictors. In this study, the median time to lost to follow-up is 77 months. The incidence density of lost to follow-up was 13.45 (95% CI: 11.78, 15.34) per 100 person-years. Antiretroviral therapy drug adherence [AHR: 3.04 (95% CI: 2.18, 4.24)], last functional status [AHR: 2.74 (95% CI: 2.04, 3.67)], and INH prophylaxis [AHR: 1.65 (95% CI: 1.07, 2.56) were significant predictors for time to lost to follow-up. The median time to lost was 77 months and incidence of lost to follow-up was high. Health care providers should be focused on HIV counseling and proper case management focused on identified risks.

A systematic review and meta-analysis of women's satisfaction with skilled delivery care and the associated factors in Ethiopia.

Evidence of variation in maternity health service practices has increased the government's interest in quantifying and advancing the quality of institutional delivery care in the developing world, including Ethiopia. Therefore, we conducted a systematic review and meta-analysis to update and provide more representative data on women's satisfaction with skilled delivery care and the associated factors in Ethiopia. This systematic review and meta-analysis followed the Preferred Reporting Items 2015 guideline. We searched PubMed/Medline, SCOPUS, Embase, Web of Science, and Google Scholar electronic databases for all 36 included studies. The pooled prevalence of women's satisfaction with skilled delivery care and the associated factors were estimated using a random-effects model. Subgroup analysis and meta-regression were performed to identify the source of heterogeneity. Furthermore, publication bias was checked using eggers and funnel plots. All statistical analyses were performed using STATA version 14.0 software. The pooled prevalence of women's satisfaction with skilled delivery care was 67.31 with 95% confidence interval (60.18-74.44). Wanted pregnancy (adjusted odds ratio = 2.86, 95% confidence interval: (2.24-3.64)), having a plan to deliver at a health facility (adjusted odds ratio = 2.09, 95% confidence interval: (1.42-3.09)), access to ambulance service (adjusted odds ratio = 1.52, 95% confidence interval: (1.00-2.31)), waiting time < 15 min (adjusted odds ratio = 3.66, 95% confidence interval: (2.51-5.33)), privacy assured (adjusted odds ratio = 3.94, 95% confidence interval: (2.23-6.94)), short duration of labour < 12 hr (adjusted odds ratio = 2.55, 95% confidence interval: (1.58-4.12)), proper labour pain management (adjusted odds ratio = 3.01, 95% confidence interval: (1.46-6.22)), and normal newborn outcome (adjusted odds ratio = 3.94, 95% confidence interval: (2.17-7.15)) were associated with women's satisfaction. Almost two-thirds of women were satisfied with skilled delivery care. In comparison, the remaining one-third were not satisfied with the care. The quality of intrapartum care, unwanted pregnancy, lack of ambulance services, prolonged duration of labour, poor labour pain management, and complicated newborn outcome were factors affecting women's satisfaction with skilled delivery care in Ethiopia. Therefore, strategies need to be developed to increase the satisfaction level by considering the abovementioned factors during routine delivery care.

Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia.

INTRODUCTION: tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students. METHODS: a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association. RESULTS: the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking. CONCLUSION: the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.

Adherence status to iron with folic acid supplementation and associated factors among pregnant women receiving antenatal care at public health facilities in Northwest Ethiopia.

INTRODUCTION: Iron and folic acid deficiency is among the most frequent nutrient inadequacies in the world, affecting expected two billion people, and causing nearly a million deaths. The adherence rate to iron with folic acid supplements remains very low in Ethiopia. Therefore, this study aimed to assess adherence status to iron with folic acid supplementation and associated factors among pregnant women receiving antenatal care at public health facilities in Northwest Ethiopia. METHODS: A facility-based cross-sectional study was conducted among pregnant women at public health facilities in the Debay Tilat Gen district from 27 February 2018 to 27 March 2018. Systematic random sampling was used to select pregnant women. Data were entered into Epidata version 3.1 and analysis was performed using SPSS version 20. Binary logistic regression was used to predict the association of the dependent variable with independent variables. Variables that showed association at a p-value of less than 0.25 in the bivariable analysis were a candidate for multivariable analysis. Finally, variables at a p-value less than 0.05 with corresponding 95% confidence interval declared statistically significant factors of iron with folic acid supplementations. RESULTS: A total of 400 participants were included in the study. The mean (± standard deviation) age of study participants was 26.64 (±4.37 standard deviation) years. This study revealed that about 52.8% of pregnant women attending antenatal care clinics were adherent to iron with folic acid supplementation. Counseling on iron with folic acid supplementations (adjusted odd ratio = 2.53, 95% confidence interval = 1.37-4.66; p-value < 0.003), having current anemia (adjusted odd ratio = 4.21, 95% confidence interval = 1.77-9.94; p-value < 0.001), and good knowledge of iron with folic acid supplementations (adjusted odd ratio = 2.1, 95% confidence interval = 1.29-3.44; p-value < 0.003) showed statistically significant associations with adherence to iron with folic acid supplementation. CONCLUSION: This study revealed that more than half of pregnant women were adherent to iron with folic acid supplementation. Knowledge of iron with folic acid supplementations, current anemia, and being counseled were factors associated with pregnant women's adherence to iron with folic acid supplementation. Therefore, counseling and awareness creation should be strengthened by health institutions.

Impact of cesarean section on timely initiation of breastfeeding in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Timely initiation of breastfeeding is feeding of breast milk within one hour of birth, however, three in five babies were not breastfed in the first hour of birth globally. There is evidence that cesarean section is the major constraint for this low prevalence, but the impact of cesarean section on timely initiation of breastfeeding in Ethiopia is limited. Therefore, this meta-analysis aimed to provide evidence for policy makers, health professionals and program implementers. METHODS: This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Electronic bibliographic databases such as PubMed/Medline, EMBASE, PsycINFO, CINHAL, Scopus, Google Scholar, Science Direct and Cochrane Library were used to search relevant studies and was conducted up to February 2021. Random effects model meta-analysis was applied to estimate the pooled impact of cesarean section on timely initiation of breastfeeding with 95% confidence intervals (CI). I2 statistical test and, funnel plot and Egger's test were used to check heterogeneity and publication bias across included studies respectively. RESULTS: According to meta-analysis of 17 studies, the pooled estimate of timely initiation of breastfeeding among women who had cesarean section in Ethiopia was 40.1% (95% CI 33.29, 46.92). The meta-analysis of 29,919 study participants showed that cesarean section was associated with a 79% lower odds of timely initiation of breastfeeding compared with vaginal birth (OR 0.21; 95% CI 0.16, 0.28). CONCLUSIONS: In Ethiopia, almost only one-third of mothers who gave birth by cesarean section initiate breastfeeding within one hour of birth, much lower than the pooled prevalence among general population. Special health promotion, intervention and healthcare provider support during immediate or early skin to skin contact, and having focused breastfeeding guidelines for post-operative patient and trained health professionals should be considered for mothers who give birth through cesarean section.

Estimation of rainwater harvesting potential for emergency water demand in the era of COVID-19. The case of Dilla town, Southern, Ethiopia.

Safe and adequate quantity of water is crucial for the implementation of infection prevention and control measures during the prevention of COVID-19. Rainwater harvesting could be an optional water source to fulfill or support the emergency water demand in areas where there is abundant rainfall. The study aimed to assess the rainwater harvesting potential and storage requirements for households and selected institutions and to determine its adequacy to satisfy the emergency water demand for the prevention of COVID-19 in Dilla town, Southern Ethiopia. Rainwater harvesting potential for households and selected institutions were quantified using 17 years' worth of rainfall data from the Ethiopian Meteorology Agency. To address the rainfall variability, we computed the confidence limits of monthly harvest-able rainwater potential using confidence intervals about the mean as well as confidence intervals using Coefficient of Variation (COV) of monthly rainfall. The storage requirements were also estimated by considering the driest and west seasons and months. The average annual rainfall in Dilla town was 1464 mm. Households with a roof area of 40 and 100 m2 have the potential to harvest 7.2-39.66 m3 and 19.11-105.35 m3 of rainwater respectively. Similarly, the rainwater harvesting potential for the selected institutions was in the range of 34524.5-190374.5, 4070.8-14964.8 , 1140.4-6288.6, 4561.7-25154.3, 5605.8-14152.8 , and 402.4-2219.1 m3 of rainwater for colleges, vocational schools, secondary schools, primary schools, Dilla University Referral Hospital and health centers respectively. These institutional rainwater harvesting potentials can address, 24-132.2, 222.4 -817.8, 59.4-327.3, 34.6-190.9, 94.5-238.5, and 28.2-155.7 % of the colleges, vocational schools, secondary schools, primary schools, Dilla University referral hospital, and, health centers emergency water demand respectively. Rainwater can be an alternative water source for the town in the prevention and control of COVID-19. Further applied researches must be conducted that can address the rainwater quality and treatment for ease of use.

Incidence and Predictors of Pre-Eclampsia Among Pregnant Women Attending Antenatal Care at Debre Markos Referral Hospital, North West Ethiopia: Prospective Cohort Study.

BACKGROUND: Pre-eclampsia is a pregnancy-induced hypertension that occurs after 20 weeks of gestation. It is the leading cause of maternal and perinatal morbidity and mortality globally, but it is higher in developing countries. In Ethiopia, conducting research on the incidence and predictors of pre-eclampsia is crucial due to the paucity of information. METHODS: A prospective cohort study was undertaken using 242 pregnant women between November 1, 2018 and March 30, 2019 at Debre Markos Referral Hospital. All eligible women who fulfilled the inclusion criteria were included in this study. Data were entered into the epic-data Version 4.2 and analyzed using the STATA Version 14.0 software. The Cox-proportional hazard regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Pre-eclampsia free survival time was estimated using the Kaplan-Meier survival curve. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of pre-eclampsia. RESULTS: The overall incidence rate of pre-eclampsia was 3.35 per 100 person-years. Having a pre-existing history of diabetes mellitus [AHR=2.7 (95% CI=1.43-8.81)], having a history of multiple pregnancy [AHR=3.4 (95% CI=2.8-6.9)] and being ≥35 years old age [AHR=2.5 (95% CI=1.42-3.54)] were the significant predictors of pre-eclampsia. CONCLUSION: The incidence of pre-eclampsia was high in this study. Having (pre-existing diabetes and multiple pregnancy) and being ≥35 years old age were the significant predictors of pre-eclampsia. Inspiring pregnant women's health-seeking behavior should provide a chance to diagnose pre-eclampsia early to prevent the medical complication of pre-eclampsia.

Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. METHODS: This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger's test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. RESULTS: Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation's adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. CONCLUSIONS: More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.

Determinants of chronic energy deficiency among adults living with HIV in Shebel Berenta District, East Gojjam, Amhara region, North West Ethiopia, 2017: case control study.

OBJECTIVE: To assess determinants of chronic energy deficiency in adults living with HIV in Shebel Berenta District Anti-Retroviral Therapy (ART) site health centers, East Gojjam, Amhara region, Ethiopia, 2017. An institutional based unmatched case control study design was employed and simple random sampling was used to select the desired sample size for both cases and controls. Data were entered to Epi-Data 3.1, exported to SPSS version 20 for analysis. Binary logistic regression was used to identify the determinants of chronic energy malnutrition among Human Immune Deficiency Virus positive adult patients. RESULTS: A total of 473 (118 cases and 355 controls) People Living with Human Immune Deficiency Virus (PLHIV) adult patients were participated. PLHIV who started ART at world health organization (WHO) clinical stage I (AOR: 0.285, CI 0.10, 0.81), rural residents (AOR: 0.38, CI 0.17, 0.83), had family size ≤ 3 (AOR: 0.114, CI 0.03, 0.48) and changed their feeding style (AOR: 0.075, CI 0.038, 0.150) decreased the risk of chronic energy deficiency. However, the baseline CD4 cell < 200/mm3 (AOR: 13.398; CI 4.83, 37.19), monthly family income ≤ 500 Ethiopia Birr (AOR: 6.9, CI 1.07, 44.62) and interrupted treatment (AOR: 2.28, CI 1.02, 5.09) were increasing the risk of chronic energy deficiency. Therefore; the government and partners should focus on the above determinants to improve the nutritional status of the clients.

Prevalence of hypertension and its associated factors among adults in Debre Markos Town, Northwest Ethiopia: community based cross-sectional study.

OBJECTIVE: To assess the prevalence and associated factors of hypertension among adults in Debre Markos town, Northwest Ethiopia. A community based cross sectional study design was employed. Systematic random sampling was used to select 456 study participants. Analysis was performed using SPSS version 20. Binary logistic regression was fitted to show the association between dependent variable and independent variables. RESULT: A total of 57 (12.5%) individuals had hypertension in Debre Markos town. Being female [AOR 3.78, 95% CI 1.56, 9.147], consuming animal source fat [AOR 6.28, 95% CI 2.63, 14.99], family history of hypertension [AOR 4.88, 95% CI 1.99, 12.015], age greater than 50 years [AOR 3.31, 95% CI 1.00, 10.99], body mass index ≥ 25 kg/m2 [AOR 4.70, 95% CI 1.99, 11.06], excess salt consumption [AOR 6.49, 95% CI 2.83,14.89] and alcohol consumers [AOR 3.19, 95% CI 1.13, 8.99] were found to be statistically significant factors associated with hypertension. The prevalence of hypertension in Debre Markos town is still a public health problem. Being female sex, consuming animal source fat, family history of hypertension, excess salt consumption age greater than 50 years and body mass index > 25 kg/m2 were significant factors of hypertension. Therefore, health sectors should take actions to tackle these modifiable risk factors.

Uptake of minimum acceptable diet among children aged 6-23 months in orthodox religion followers during fasting season in rural area, DEMBECHA, north West Ethiopia.

BACKGROUND: Under-nutrition is the cause for poor physical and mental development and has more burden among infants and young children aged between 6 and 23 months. Cultural practices like not providing animal source foods for infants and young child aged between 6 and 23 months were barrier for practicing proper children feeding. The aim of this study was to assess minimum acceptable diet and associated factors among children aged between 6 and 23 months in Orthodox religion during fasting season in rural area, Dembecha, Ethiopia. METHODS: A community-based cross-sectional study was conducted to assess Minimum Acceptable diet.Random sampling technique was applied to select 506 study participants. Interview was used to collect data on Practice of minimum acceptable diet, minimum dietary diversity, minimum meal frequency and related factors among children aged between 6 and 23 months from mothers / caregivers. RESULT: About 8.6% of infants and young children aged between 6 and 23 months received minimum acceptable diet. Education status of mother(AOR = 0.22,95%CI:0.1, 0.48), involvement of mother in decision making (AOR = 0.22,95%CI:0.10,0.48), birth order of index children (AOR = 0.36,95%CI:0.14,0. 94), knowledge on feeding frequency (AOR = 0.3,95% CI:0.16,0.58), and institutional delivery (AOR = 5.13, 95%CI: 1.26, 20.80) were significantly associated with minimum acceptable diet. CONCLUSION: Minimum acceptable diet practice was low. Educational status of mother, involvement of mother in decision making, knowledge on feeding frequency and institutional delivery were significantly associated with minimum acceptable diet. This indicates that nutrition education and counseling related to infant and young child feeding practice is not addressed for all mothers. Strengthening mothers' education on acceptable child feed practice, and working with religion leaders to increase knowledge of mothers on child feed practice are recommended.

Prelacteal feeding and associated factors in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Prelacteal feeding can be defined as giving any solid or liquid foods other than breast milk during the first three days after birth. It affects timely initiation of breastfeeding and exclusive breastfeeding practices. Even though the issue was investigated in Ethiopia, fragmented and inconsistent findings were reported. Therefore, the main objective of this meta-analysis was to estimate the pooled prevalence of prelacteal feeding and associated factors in Ethiopia. METHODS: The preferred reporting items for systematic reviews and meta-analyses guideline was followed. Articles were systematically searched through different searching mechanisms. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument adapted for cross-sectional study design was used for quality assessment of each individual study. The total of 28 studies were included and analyzed. The random effect model was used to estimate the pooled prevalence; subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. Both Egger's, and Begg's test were used to check publication bias. The effects between associated factor variables, and prelacteal feeding practices were tested. RESULTS: A total of 492 studies were retrieved and 28 studies were included in the meta-analysis. The pooled prevalence of prelacteal feeding practice in Ethiopia was 25.29% (95% Confidence Interval [CI] 17.43, 33.15) with severe heterogeneity (I2 = 99.7, p < 0.001) and no publication bias. Antenatal care (Odds Ratio [OR] 0.25, 95% CI 0.09, 0.69), counselling on infant feeding (OR 0.37, 95% CI 0.22, 0.63), timely initiation of breastfeeding (OR 0.28, 95% CI 0.21, 0.38) and an urban residence (OR 0.47, 95% CI 0.26, 0.86) had lower odds, while home birth had higher odds (OR 3.93, 95% CI 2.17, 7.10) of prelacteal feeding in Ethiopia. CONCLUSIONS: In Ethiopia, one in four children were given prelacteal foods. Mothers who gave birth at home are more prone to give prelacteal foods. Whereas, antenatal care, timely initiation of breastfeeding, counseling on infant feeding and an urban residence decreases prelacteal feeding practices in Ethiopia. Therefore, the government and health institutions should focus to increase maternal health service utilization and promote infant and young child feeding practices according to the guideline.

Prevalence of anemia and its associated factors in human immuno deficiency virus infected adult individuals in Ethiopia. A systematic review and meta-analysis.

BACKGROUND: Anemia is a common hematologic disorder among human Immunodeficiency virus (HIV) infected adult Individuals. However, there is no concrete scientific evidence established at national level in Ethiopia. Hence, this review gave special emphasis on Ethiopian HIV infected adult individuals to estimate pooled prevalence of anemia and its associated factors at national level. METHODS: Studies were retrieved through search engines in PUBMED/Medline, Cochrane Library, and the web of science, Google and Google scholar following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of the included studies. Random effects meta-analysis was used to estimate the pooled prevalence of anemia and associated factors at 95% Confidence interval with its respective odds ratio (OR). Meta regression was also carried out to identify the factors. Moreover, Sub-group analysis, begs and egger test followed by trim-and-fill analysis were employed to assess heterogeneity and publication bias respectively. RESULT: A total of 532 articles were identified through searching of which 20 studies were included in the final review with a total sample size of 8079 HIV infected adult individuals. The pooled prevalence of anemia was 31.00% (95% CI: 23.94, 38.02). Cluster of Differentiation 4 (CD4) count <= 200 cells/µl with OR = 3.01 (95% CI: 1.87, 4.84), World Health Organization (WHO) clinical stage III&IV with OR = 2.5 (95% CI: 1.29, 4.84), opportunistic infections (OIs) with OR = 1.76 (95% CI: 1.07, 2.89) and body mass index (BMI) < 18.5 kg/M2 with OR = 1.55 ((95% CI: 1. 28, 1.88) were the associated factors. CONCLUSION: This review demonstrates high prevalence of anemia among HIV infected adults. Low CD4 count, WHO clinical stage III&IV, OIs and low level of BMI were found to have significant association with the occurrence of anemia. Therefore, the responsible stockholders including anti retro viral treatment (ART) clinics should strengthen the system and procedures for the early diagnosis of opportunistic infection and screening of underlying problems. There should be also early screening for OIs and under nutrition with strict and frequent monitoring of HIV infected individuals CD4 count.