Prevalence of syphilis and associated factors among female sex workers in Ethiopia: findings from a multilevel analysis of a national bio-behavioral survey.

BACKGROUND: Syphilis is a highly contagious sexually transmitted infection posing a significant public health challenge, especially in developing countries, including sub-Saharan Africa. Female sex workers are exposed to sexually transmitted infections, including syphilis, because of their sexual behavior and limited access to health services. However, data on national syphilis prevalence estimates and the associated factors are scarce in Ethiopia. This, as well as our limited knowledge about the extent of clustering among female sex workers in the country, is a critical gap in information we aimed to fill through this analysis. METHODS: The study was a cross-sectional, bio-behavioral survey conducted among female sex workers in six cities and ten major towns in Ethiopia. Participants were selected using a respondent-driven sampling method. Survey participants provided blood samples for syphilis, HIV, and hepatitis serological testing. Survey data were collected via an interviewer-administered questionnaire. In this analysis, we employed descriptive statistics to summarize data on the study variables. In addition, we used multilevel bivariable and multivariable logistic regression models to examine the association between independent variables and the dependent variable (syphilis prevalence) while accounting for the clustering effect. RESULT: A total of 6085 female sex workers participated in the survey. Their median age [Interquartile Range (IQR) was 25 (8)] years, and a majority (96.1%) were in the 20-24-year-old age group. The prevalence of syphilis among female sex workers in Ethiopia's six cities and ten major towns was 6.2%. Being in the age group of 30-34 (AOR = 2.64; 95% CI = 1.40, 4.98) and 35-59 (AOR = 4.7; 95% CI = 2.5, 8.86), being divorced/widowed (AOR = 1.37; 95% CI = 1.03, 1.82), having no formal education (AOR = 3.38; 95% CI = 2.34, 5.11), primary 1st cycle (grades 1-4) education (AOR = 2.77; 95% CI = 1.79, 4.30), and having primary 2nd cycle (grades 5-8) education (AOR = 1.80; 95% CI = 1.21, 2.69) were significantly associated with syphilis among female sex workers. CONCLUSION: The prevalence of syphilis among female sex workers was high. Being divorced/widowed or in the older age group and having a low level of education were significantly associated with an increased risk of syphilis. The high prevalence and associated factors identified need to be considered in planning comprehensive interventions to control syphilis among female sex workers in Ethiopia.

Gender-based violence and associated factors among female sex workers in Ethiopia. Evidence from The National Bio-behavioral Survey, 2020.

Background: Gender-based violence (GBV) is usually defined as unequal power relations between men and women, which poses a widespread public health problem. The study evaluated the prevalence and factors associated with GBV among female sex workers (FSWs) in Ethiopia. Method: We used cross-sectional bio-behavioral data collected using respondent-driven sampling (RDS) in 2020 from 16 towns in Ethiopia. Descriptive statistics was analyzed to summarize the study population characteristics and prevalence of GBV, and a multilevel logistic regression model was applied to identify associated factors for GBV. A p-value of ≤0.05 was used as a threshold for statistical significance. Result: Of 6,085 participants, 28.1% had experienced GBV during the last 12 months, among which 12.7% and 22.3% experienced physical and sexual violence, respectively. FSWs aged 15-24, and 25-34 than those 35 years or more, had a non-paying than paying partners, had 31-60, 61-90, and over 91 than those had less than 30 paying partners, ever had anal sex than those not, condom failure than those not, mobile female sex workers when compared with those not mobile at different town; 3-5 and ≥ 6 years than those less than 3 years stayed in selling sex, street-based, and multiple places selling sex than those used other venues were significantly associated with GBV. Conclusion: Gender-based violence is a substantial problem among FSWs in Ethiopia, with significant implications for program planning on prevention and response to mitigate the occurrence and impact of GBV among FSWs.

Integrated Community Case Management Utilization Status and Associated Factors Among Caretakers of Sick Children Under the Age of 5 Years in West Shewa, Ethiopia.

Objective: To assess the utilization status and associated factors of integrated community case management (ICCM) of caretakers with <5 years of sick children. Methods: Community-based cross-sectional study was employed with caretakers whose child was sick in the last 3 months before data collection. Bivariate and multivariable logistic regression analyses were employed. Results: About 624 respondents participated in the study; 325 (52.1%) utilized integrated community case management. Caring for children between the ages 24-36 months old, (AOR = 1.26, 95%CI: 0.23, 0.90); women health development army (WHDA) training, (AOR = 5.76, 95%CI: 3.57, 9.30); certified as model family, (AOR = 3.98, 95%CI: 2.45, 6.46); perceived severity, (AOR = 5.29, 95%CI: 2.64, 10.60); awareness of danger sign, (AOR = 2.76, 95%CI: 1.69, 4.50), and awareness of ICCM, (AOR = 5.42, 95%CI: 1.67, 17.58) were associated with ICCM utilization. Conclusion: This study revealed that age of the child, caretakers' awareness of ICCM, awareness of danger signs, illness severity, women's health developmental army training, and graduation as a model family were associated with ICCM utilization. Therefore, it is recommended that promote health education using community-level intervention modalities focusing on common childhood illness symptoms, danger signs, severity, and care-seeking behavior.