Global prevalence of intimate partner violence during the COVID-19 pandemic among women: systematic review and meta-analysis.

BACKGROUND: During the coronavirus pandemic, people faced strict preventive measures, including staying at home and maintaining social distance, which led to increasing rates of intimate partner violence. Women have been facing dual health emergencies, including COVID-19 and domestic violence. Despite this, there is a lack of representative data on intimate partner violence during the COVID-19 pandemic and inconsistent findings. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to develop the systematic review and meta-analysis. All English-language studies conducted between 31 December 2019 and May 15/2022 were extracted from databases such as PubMed/Medline, CINAHL, and Google Scholar. The quality of the articles was assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The I2 was used to assess heterogeneity among studies. Publication bias was assessed using funnel plot inspection and Egger's test. A random effect model was used for the analysis using RevMan and STATA 14 software. RESULT: A total of 5065 studies were retrieved, and 14 studies were included in the final meta-analysis. The pooled prevalence of intimate partner violence was 31% (95% CI: 22, 40). Subgroup analysis based on region showed that the highest prevalence of intimate partner violence was in developing regions (33, 95% CI: 23.0, 43.0) compared to developed regions (14, 95% CI: 11.0, 17.0). Subgroup analysis based on country showed that Uganda had the highest prevalence of IPV 68% (95% CI: 62.0, 72.0), and the lowest was in the USA 10% (95% CI: 7.0, 15.0). CONCLUSION: Nearly one in three women experienced intimate partner violence during the COVID-19 pandemic. Subgroup analysis based on region showed that the highest prevalence of intimate partner violence was in developing regions (33%). All forms of intimate partner violence (physical, sexual, emotional, and economic) were prevalent. Thus, available interventions should be implemented to alleviate women's intimate partner violence during the COVID-19 pandemic and similar emerging and remerging pandemics, particularly in developing countries. TRIAL REGISTRATION: PROSPERO registration number: CRD42022334613 .

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.

Individual and community-level determinants of non-use of contraceptive among women with no fertility desire in Ethiopia: a multilevel mixed-effect analysis.

BACKGROUND: In Ethiopia, about two-third of women in the reproductive-age do not use any method of contraception. Moreover, evidence on non-use of contraceptives among women who do not have future fertility desires are limited. Therefore, this study intended to identify both individual and community-level determinants of non-use of contraceptives among this group in Ethiopia using a multilevel mixed effect analysis. METHODS: Data retrieved from the demographic and health survey program official database website ( http://dhsprogram.com ) were used in this study. The suvey was conducting using a multistage cluster sampling technique and a weighted sample of 4398 reproductive-age women with no fertility desire was used in this study. Four models were fitted using a multilevel multivariable logistic regression to identify determinants of non-use of contraceptives and model with the lowest Akaike's Information Criterion was selected as a best fitted model. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. RESULTS: Overall, 65.3% [95% CI (63.9%, 66.7%)] of women with no fertility desire were not using any contraceptive method. Living in large central [AOR (95% CI) 0.45 (0.31, 0.67)] and metropolitan regions [AOR (95% CI) 0.39 (0.22, 0.68)] and being from household with middle [AOR (95% CI) 0.65 (0.42, 0.93)] and rich wealth index [AOR (95% CI) 0.67 (0.44, 0.98)] were negatively associated with non-use of contraceptives. Besides, being from a community with high women illiteracy [AOR (95% CI) 1.38 (1.15, 1.67)], being Muslim [AOR (95% CI) 1.86 (1.22, 2.85)], having history of pregnancy termination [AOR (95% CI) 1.59 (1.10, 2.31)], having a husband who desire to have more children [AOR (95% CI) 1.46 (1.02, 2.09)] were the positive determinants of non-utilization of contraceptives. CONCLUSION: Nearly two-third of reproductive-age women with no fertility desire in Ethiopia do not use any contraceptive method. Awareness creation interventions on the benefits of contraceptives targeting Muslim religion followers and improving women education and their economic empowerment at household level may decrease the proportion of non-use of contraceptives at a national level.

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.

Geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia: a spatial and geographically weighted regression analysis.

BACKGROUND: Maintaining and effectively utilizing maternal continuum of care could save an estimated 860,000 additional mothers and newborn lives each year. In Ethiopia, the number of maternal and neonatal deaths occurred during pregnancy, childbirth, and the postpartum period was very high. It is indisputable that area-based heterogeneity of zero utilization for a standard maternal continuum of care is critical to improve maternal and child health interventions. However, none of the previous studies explored the spatial distribution of zero utilization for maternal continuum of care. Hence, this study was aimed to explore geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia. METHODS: A total of 4178 women who gave birth five years preceding the 2016 Ethiopian demographic and health survey were included. ArcGIS version 10.7, SaT Scan version 9.6, and GWR version 4.0 Software was used to handle mapping, hotspot, ordinary least square, Bernoulli model analysis, and to model spatial relationships. Finally, a statistical decision was made at a p-value< 0.05 and at 95% confidence interval. MAIN FINDINGS: The proportion of mothers who had zero utilization of a standard maternal continuum of care was 48.8% (95% CI: 47.3-50.4). Hot spot (high risk) regions for zero utilization of maternal continuum of care was detected in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of Oromia region. Respondents who had poor wealth index, uneducated mothers, and mothers who declared distance as a big problem could increase zero utilization of maternal continuum of care by 0.24, 0.27, and 0.1 times. CONCLUSION: Five women out of ten could not utilize any components of a standard maternal continuum of care. Hot spot (high risk) areas was detected in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of Oromia region. Poor wealth index, uneducated mothers, and mothers who declare distance as a big problem were factors significantly associated with zero utilization of maternal continuum of care. Thus, geographical based intervention could be held to curve the high prevalence of zero utilization of maternal continuum of care.

Determinants of malaria among under-five children in Ethiopia: Bayesian multilevel analysis.

BACKGROUND: In Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children. However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia. METHODS: We retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria. RESULTS: In this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31-0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17-0.88)], have radio [AOR 0.41, (95% CI, 0.19-0.78)], have television [AOR 0.19, (95% CI, 0.01-0.89)] and altitude [AOR 0.05, (95% CI, 0.01-0.13)] were the predictors of malaria among under-five children. CONCLUSIONS: The study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.

Predictors of neonatal mortality among neonates admitted to NICU at Dubti General hospital, Northeast Ethiopia.

Background: In Ethiopia, despite various strategies and interventions being implemented, the rate of neonatal mortality remains high. Despite numerous published articles in Ethiopia, there is a lack of sufficient data regarding the time to death and its predictors in neonatal mortality, especially in pastoral communities like the Afar region. Therefore, this study aims to evaluate neonatal mortality and its predictors among neonates admitted to the neonatal intensive care unit at Dubti General Hospital, Northeast Ethiopia. Method: We conducted a facility-based retrospective follow-up study, involving a sample of 479 neonates admitted to the neonatal intensive care unit at Dubti General Hospital. Data entry was performed using Epi-Data version 4.6, and subsequent analysis was carried out using STATA version 14.1. To identify predictors of neonatal mortality, we applied the Cox-proportional hazard model. Results: Out of the total, 87 neonates (18.16 %) passed away. The overall incidence of neonatal mortality was 27.2 deaths per 1000 neonate-days spent in the neonatal intensive care unit, with a 95 % confidence interval of [21.8, 34.2]. Appearance, pulse, grimace, activity, and respiration score less than or equal to 5 [AHR = 0.33, 95%CI: 0.07, 0.62], respiratory distress syndrome [AHR = 3.22, 95%CI: 1.71, 6.07], Neonatal hypothermia [AHR = 3.12, 95%CI: 1.31, 7.42]. No initiation of breastfeeding [AHR = 3.68, 95%CI: 1.44, 9.36], no antenatal care visits [AHR = 0.25, 95%CI: 0.13, 0.48] and maternal birth related complication [AHR = 2.71, 95%CI: 2.43, 11.14] are predictors. Conclusion: The mortality rate was notably high, with several factors identified as independent predictors of newborn death, including Appearance, pulse, grimace, activity, and respiration, respiratory distress syndrome, hypothermia, initiation of breastfeeding, antenatal care visits, and maternal birth-related complications. There is a pressing need for intensified programming efforts aimed at improving child survival within healthcare facilities, particularly addressing neonatal complications. Enhancing prenatal care during pregnancy and early detection and treatment of intrapartum disorders are recommended strategies for enhancing newborn health outcomes.

Intimate Partner Violence and its associated factors among pregnant women receiving antenatal care. A Bayesian analysis approach.

BACKGROUND: Intimate Partner Violence (IPV) is a major public health problem worldwide. In developing nations, including Ethiopia, the problem is under-reported and under-estimated. Therefore, this study attempts to assess intimate partner violence and its associated factors among pregnant women receiving antenatal care at public hospitals in Amhara region, Ethiopia. METHODS: A health facility-based cross-sectional study design was employed. A sample of 418 pregnant women was selected using random sampling technique from 1st May to 1st June 2021. IPV was measured using the World Health Organization (WHO) Multi-country study of violence against women assessment tool. Data were entered into Epi-data 3.1 and exported into Stata 17 for further analysis. A Bayesian multivariable logistic regression analysis was carried out from the posterior distribution, and an adjusted odds ratio (AOR) with a 95% credible interval (CrI) was used to declare statistically significant variables. RESULTS: The prevalence of any IPV among pregnant women was 31.3% [95% CrI 26.6%, 36.1%]. After adjusting a range of covariates, IPV during pregnancy was more likely among women whose husbands used substances [AOR = 4.33: 95% CrI 1.68, 8.95] and household decisions made by husbands only [AOR = 6.45: 95% CI 3.01, 12.64]. Conversely, pregnant women who attended primary [AOR = 0.47: 95% CrI 0.24, 0.81] and secondary [AOR = 0.64: 95% CrI 0.41, 0.92] educational levels, women who had four or more ANC visits antenatal care visits [AOR = 0.43: 95% CrI 0.25, 0.68], and women with no prior history of adverse birth outcomes [AOR = 0.48: 95% CI 0.27, 0.80] were less likely to experience IPV during pregnancy. CONCLUSION: The study revealed a relatively high prevalence of any IPV among pregnant women, with factors such as substance use by husbands and limited decision-making autonomy associated with increased IPV likelihood. Conversely, women with higher education levels, four and above antenatal care attendance, and no history of adverse birth outcomes showed a reduced likelihood of experiencing IPV during pregnancy. Therefore, targeted interventions to address substance use, empower women in decision-making, and promote education and healthcare access to mitigate IPV risk during pregnancy are recommended.

Women's desire to limit child-bearing and its associated factors in rural Ethiopia: A multilevel analysis.

Introduction: Ethiopia ranks twelfth globally and second in Africa by population size. High fertility rates, especially in rural areas, contribute to rapid population growth, impacting the country's economy. The decision of women to control the number of children they have is a crucial factor influencing population growth and contributing to elevated health risks for both women and children.Objective: the purpose of this study was to assess women desire to limit childbearing and its associated factor among rural women in Ethiopia. Methods: A cross-sectional survey dataset of Ethiopian demographic and health survey 2016 was used for this study. A total of 12,019 rural women were included in the study. A multilevel binary logistic regression was used to identify the predictors of women's desire to limit childbearing. The adjusted odds ratio with respective 95 % confidence interval was used to declare statistically significant variables. Result: In rural Ethiopia, 33.04 % of women had a desired to limit their childbearing. Women in the age group of 25-34 years (AOR = 1.61, 95 % CI = 1.28,2.13), 35-49 years (AOR = 4.96, 95 % CI = 3.64, 6.65), had no children (AOR = 0.06, 95 % CI = 0.04, 0.09), having children 1-3 (AOR = 0.29, 95 % CI = 0.23, 0.36), married (AOR = 0.45, 95 % CI = 0.27, 0.75), living in small peripherals region (AOR = 0.33,95 % CI = 0.24, 0.45) and community level poverty (AOR = 0.72, 95 % CI = 0.57, 0.89) were significant predictors of women's desire to limit the number of children they bear. Conclusion: In rural Ethiopia, there is a limited inclination to control childbearing. Older women and those with higher number of children express a stronger desire to limit childbearing. Conversely, married women, from smaller peripheral regions and those residing in areas with a higher community poverty rate are less likely to have a desire to limit childbearing. Thus, promoting education on the advantages of smaller family sizes and offering family planning services could be crucial in fostering women's willingness to limit their childbearing.

Determinants of tobacco use among pregnant women in sub-Saharan Africa. A multilevel mixed-effect logistic regression model.

INTRODUCTION: Although it is known that maternal tobacco use during pregnancy substantially declined in higher-income countries, information on the magnitude and determinants of tobacco use among pregnant women in sub-Saharan Africa (SSA) remains limited. Establishing evidence on maternal tobacco during pregnancy is crucial for guiding targeted interventions in SSA. This study aimed to determine the overall prevalence of tobacco use and its determinants among pregnant women in SSA countries. METHODS: The study used data from Demographic and Health Surveys conducted in 33 countries across SSA from 2010 and 2021. Our analysis included a total weighted sample of 40,291 pregnant women. A multilevel logistic regression model was used to identify factors associated with maternal tobacco use during pregnancy. The measure of association between explanatory variables and the outcome was reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: The pooled prevalence of tobacco use among pregnant women in SSA was 1.76% (95% CI: 1.41, 2.12). Our findings showed that pregnant women in the age groups of 25-34 years (AOR 1.44; 95% CI: 1.14, 1.82) and 35+ years (AOR 2.18; 95% CI: 1.68, 2.83) had higher odds of tobacco use during pregnancy. Pregnant women who attained primary education (AOR 0.57; 95% CI: 0.46, 0.70) and secondary or higher education (AOR 0.39; 95% CI: 0.30, 0.53) were associated with lower odds of tobacco use. Similarly, pregnant women who resided in households with a high wealth index (AOR 0.36; 95% CI: 0.55 0.90) and those with media exposure (AOR 0.81; 95% CI: 0.67, 0.99) were less likely to use tobacco during pregnancy. CONCLUSION: This study revealed that the overall prevalence of maternal tobacco use during pregnancy was relatively low in SSA, but some countries exhibited higher estimates. To address this, it is crucial to implement targeted smoking prevention and cessation strategies, particularly for young pregnant women, those facing socioeconomic disadvantages, and those with lower educational status.

A systematic review and meta-analysis of sexually transmitted infection prevention practices among Ethiopian young people.

Objective: Approximately 178.5 million new cases of treatable sexually transmitted infections are thought to be diagnosed each year among young people worldwide who are between the ages of 15 and 24 years. The results regarding sexually transmitted infection prevention studies in Ethiopia are not consistent. Therefore, the objective of this systematic review and meta-analysis was to determine the pooled prevalence of sexually transmitted infection prevention methods among young people in Ethiopia. Methods: The systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Between 5 January and 18 May 2022, published studies were searched using online databases such as PubMed, CINAHL, African Online Journal, and Google Scholar. The quality of the study was evaluated using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. A random-effects model was used for the statistical analysis using STATA version 14 software. Results: A total of 3331 studies were searched, and five studies with a total of 1925 participants were included in the final meta-analysis. The pooled prevalence of preventive practice toward sexually transmitted infections was 54% (95% confidence interval: 44, 64). According to a subgroup analysis based on regional state, the prevalence was highest in the southern region, at 66% (95% CI: 59, 73), and lowest in the Amhara region, at 42% (95% confidence interval: 38, 45). Institution-based studies had high heterogeneity, according to a subgroup analysis based on study setting (I 2 = 95.39%, p value 0.001). Conclusion: Almost one in every two young people is engaged in preventive practices. This is lower than the World Health Organization global health sector strategy target (70%) for sexually transmitted infections. A subgroup analysis based on regional state and study setting showed a variation in the prevalence of preventive practices and significant heterogeneity among the regions.

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.

Preventive practices toward sexually transmitted infections and their determinants among young people in Ethiopia: A protocol for systematic review and meta-analysis.

BACKGROUND: Globally, the estimated annual number of new cases of curable sexually transmitted infections occurring among young people aged 15-24 years is approximately 178.5 million. There are fragmented and inconsistent findings on preventive practices for sexually transmitted infections. Thus, this systematic review and meta-analysis protocol aimed to estimate the pooled prevalence of preventive practices of sexually transmitted infections and identify its determinants among young people in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) will be used to develop the review protocol. Online databases such as PubMed, CINAHL, Scopus, Google, and Google Scholar will be used to search published and unpublished studies. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument will be used to assess the quality of the study. Statistical heterogeneity will be checked using the Cochran Q test and I2 statistics. Subgroup analysis and meta-regression will be performed to identify the sources of heterogeneity. The statistical analysis will be performed using STATA version 14 software. A random-effects model will be performed to estimate the pooled prevalence and identify determinants of preventive practices of sexually transmitted infections. DISCUSSION: Young people have a high unmet need for sexual and reproductive health services and poor preventive practices toward sexually transmitted infections. Although there are studies on preventive practices for sexually transmitted infections, there is no study finding on the pooled prevalence of preventive practices for sexually transmitted infections and its determinants among young people in Ethiopia. Thus, this systematic review and meta-analysis protocol will help to develop appropriate strategies.

Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a protocol for a systematic review and meta-analysis.

INTRODUCTION: Respiratory rehabilitation is the use of exercise, education, and behavioural interventions to alleviate symptoms and improve quality of life. Recent studies highlight that respiratory rehabilitation is effective and safe for patients with COVID-19. We aim to evaluate the effectiveness and feasibility of respiratory telerehabilitation on patients infected with COVID-19 by conducting a systematic review and meta-analysis. METHODS AND ANALYSIS: PubMed, Web of Science, Science Direct, Physiotherapy Evidence Database, Google Scholar and Cochrane Library databases will be searched from inception to the end of November 2021. Randomised controlled trials investigating the effectiveness of telerehabilitation in the management of COVID-19 will be included. The primary outcomes will be functional capacity, cardiopulmonary exercise tests and quality of life. Secondary outcomes will include anxiety/depression level, sleep quality, mortality rate, completion rate, reason for withdrawal, adverse events, service satisfaction, cost-effectiveness and other potential factors. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. Review Manager V.5.4 (Cochrane Collaboration) software will be used for statistical analysis. Heterogeneity will be analysed using I² statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables. ETHICS AND DISSEMINATION: Ethical approval is not required because this systematic review and meta-analysis is based on previously published data. Final result will be published in peer-reviewed journal and presented at relevant conferences and events. PROSPERO REGISTRATION NUMBER: CRD42021287975.

Male involvement in family planning use and its determinants in Ethiopia: a systematic review and meta-analysis protocol.

BACKGROUND: The need to include males who require joint spousal decisions is critical in achieving key reproductive health indicators. Low involvement of males in family planning use is one of the contributing factors for low contraceptive use in Ethiopia. Despite this, there are inconsistent findings on the prevalence and determinants of male involvement in family planning use in Ethiopia. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of male involvement in family planning use and its determinants in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be used to develop the protocol. The online databases PubMed, CINAHL, Google Scholar, and unpublished gray literature will be searched to retrieve available articles from April 10 to August 11, 2021. The two authors will conduct selection of studies, data extraction, and quality assessment. The quality of the studies will be assessed using the Joanna Briggs Institute checklist. The chi-squared test and I-squared statistic will be used to examine heterogeneity among studies. Sources of heterogeneity will be investigated using subgroup analysis and meta-regression based on regions and residence (urban and rural). Publication bias will be examined by observation using funnel plots and statistically by Begg's and Egger's tests. A random-effects model will be used to estimate the pooled prevalence and its determinants of male involvement in family planning use. DISCUSSION: The role of males in family planning and participation in contraceptive use improves women's uptake and continuity of family planning use. Although there are studies on male involvement in family planning use, there are no synthesis research findings on the pooled prevalence of male involvement in family planning use and its determinants in Ethiopia. Therefore, the findings from this systematic review and meta-analysis will help the national health sector transformational plane emphasize the pooled prevalence and its determinants that drive low male involvement in family planning use in Ethiopia.

Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a systematic review and meta-analysis.

OBJECTIVES: To determine the pooled effectiveness and feasibility of telerehabilitation in patients with COVID-19. DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: PubMed, CINAHL, Science Direct, PEDro, Google Scholar and Cochrane Library databases were systematically searched to the end of March 2022. ELIGIBILITY CRITERIA AND OUTCOMES: RCTs investigating the effects of telerehabilitation in the management of patients with COVID-19 were included. The outcomes of interest were functional capacity, cardiopulmonary exercise tests, quality of life and other variables where data are available. DATA EXTRACTION AND SYNTHESIS: Two reviewers screened, extracted data and performed methodological quality assessment independently. The revised Cochrane Risk of Bias tool was used to assess the risk of bias. Review Manager V.5.4 and Stata V.14.0 software were used for statistical analysis. Mean difference (MD) with 95% CI and the corresponding p value were used to determine the treatment effect between groups. A fixed-effect model was used for all variables as no significant heterogeneity was observed. RESULTS: Four studies with 334 patients with COVID-19 were included. The pooled result of telerehabilitation showed statistically significant improvement on 6-minute walking test (MD 75.50; 95% CI 54.69 to 96.30; p=0.48), 30-second sit-to-stand test (MD 1.76; 95% CI 1.47 to 2.04; p=0.30), Borg Scale (MD 2.49; 95% CI 2.16 to 2.83; p=0.28) and level of dyspnoea (MD 6.26; 95% CI 5.42 to 7.10; p=0.66). The overall treatment completion rate was 88.46%, and the most common reason for withdrawal after randomisation was lost to follow-up or uncooperativeness. CONCLUSIONS: The findings showed that telerehabilitation interventions could improve functional capacity and exercise perception among patients affected by COVID-19 and can be implemented with a high completion rate and minimal adverse events. However, more studies are required to investigate the effects on cardiopulmonary function, quality of life, anxiety, depression and other variables. PROSPERO REGISTRATION NUMBER: CRD42021287975.

Women's decisions regarding family planning use and its determinants in Ethiopia: A systematic review and meta-analysis protocol.

BACKGROUND: Low use of contraceptives has many consequences. Despite this effect, less emphasis is given to women's decision-making on family planning use in Ethiopia. Although there are studies conducted in different parts of the country on women's decision-making regarding family planning use, there are inconsistent findings and a lack of national representative data. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of women's decision-making regarding family planning use and its determinants in Ethiopia. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed to develop the review protocol. All observational studies will be retrieved using Medical Subject Heading (MeSH) terms or keywords from the online databases PubMed, CINAHL, Google Scholar, African Journal online, and gray literature. The quality of the studies will be critically assessed using the Joanna Briggs Institute checklist. Heterogeneity among studies will be examined using I-squared statistics. Funnel plots and Egger's test will be used to examine publication bias. The meta-analysis will be performed using STATA version 14 software. Statistical significance will be determined at 95% CI. DISCUSSION: Improving women's autonomy in decision-making on reproductive health services, including contraceptive use, has a substantial advantage. There are studies on women's decision-making in family planning use; however, there are inconsistent findings. Therefore, this review protocol aims to determine the pooled prevalence of women's decision-making regarding family planning use and its determinants in Ethiopia. The findings from this systematic review and meta-analysis will help inform policy makers to develop appropriate interventions to improve women's decision making regarding family planning use.

Multidisciplinary Rehabilitation for People with Parkinson's Disease: A Systematic Review and Meta-Analysis.

Introduction: Guidelines endorse to implement an integrated and multidisciplinary team approach in the management of people with Parkinson's disease (PD). However, there is no net and clear finding that shows the supremacy of multidisciplinary team interventions over conventional interventions for people with PD. Therefore, we perform a systematic review and meta-analysis to determine the supremacy of multidisciplinary interventions for people with PD. Methods: A systematic review and meta-analysis of randomized controlled trials were conducted. PubMed, Physiotherapy Evidence Database, Cochrane Library, and Google Scholar were searched from inception until May 2021. Randomized controlled trials comparing multidisciplinary intervention with conventional physiotherapy were included. The outcome measures were gait balance, disability status, quality of life, and depression level. The PEDro scale was used to systematically appraise methodological quality. Two reviewers screened, extracted, and performed a quality assessment of included studies independently. Review Manager V.5.4 (Cochrane Collaboration) software was used for statistical analysis. Heterogeneity was analyzed using I2 statistics, and a standardized mean difference with 95% CI and Pvalue was used to calculate the treatment effect for outcome variables. Results: A total of 6 studies with 1260 participants were included. The average PEDro methodological quality score was 6.67. No statistically significant difference between multidisciplinary and conventional rehabilitation on functional capacity (SMD: 0.69; 95% CI: -0.13, 1.51; P=0.10), disability status (SMD: 0.65; 95% CI: -0.16, 1.46; P=0.11), and quality of life (SMD: 0.28; 95% CI: -0.31, 0.59; P=0.08) was found. However, there is a statistically significant improvement in caregivers' anxiety levels in the multidisciplinary group (SMD: 0.39; 95% CI 0.06, 1.73; P=0.02). Conclusion: This systematic review and meta-analysis show no significant difference between multidisciplinary and conventional rehabilitation on functionality, disability, and quality of life. Caregivers' anxiety levels show improvement following multidisciplinary interventions. However, large-scale studies with long-term follow-up were required for concrete and clinical recommendations.

Married women's decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey.

INTRODUCTION: Women's decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women's decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women's decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model. METHODS: The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15-49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women's decision-making autonomy on contraceptive use. Akaike's information criterion was used to select the best-fitted model. RESULTS: Overall, 21.6% (95% confidence interval = 20.3%-22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67-3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52-3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36-4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32-3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34-3.87) were positively associated with women's decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29-0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12-0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23-0.87) were negatively associated with women's independent decision on contraceptive use. CONCLUSION: Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women's age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women's decision-making autonomy on contraceptive use. The government should promote women's autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

Under-nutrition and its determinants among school-aged children in northwest Ethiopia.

Background: Malnutrition among children has lifelong implications, its outcomes not only cover the whole life but also transfer from one generation to another generation. Most studies conducted before focused on undernutrition in pregnant mothers and children less than 5 years of age, whereas school-age children are often omitted from health and nutrition surveys or surveillance. In Northwest Ethiopia, particularly in the study area, the community levels nutritional status of school-age is not well studied and documented. Therefore, this study aimed to assess the prevalence and determinants of the under-nutritional status of school-age children in Gondar Zuria District, Northwest Ethiopia. Methods: A community-based cross-sectional study design was employed with 364 respondents from January to April 2020. Data entered using Epi Data software version 3.1. Standard deviation scores were obtained by the world health organization Anthro Plus software to determine the nutritional status of children, and further analysis was done by using STATA version 14 software. Adjusted odds ratio with its corresponding 95 % confidence interval was used to declare statistically significant variables. Results: The prevalence of overall under-nutrition was 71.98% (95%, CI: 67%-76%) from which, 43.13% (95%, CI: 38%-48%) were stunted, 40.93% (95%, CI: 35%-46%) were under-weight, and 35.44% (95%, CI: 30%-40%) were wasted. Child age [AOR = 0.30, 95% CI (0.13-0.68)], food insecurity [AOR = 2.24, 95% CI (1.03-4.83)], good knowledge of mother/care giver [AOR = 0.40, 95% CI (0.17-0.92)], having larger family size (Tzioumis and Adair, 2014; Wolde et al., 2015; Mohammed et al., 2019) [6-8] [AOR = 2.92, 95% CI (1.29-6.58)], and unprotected drinking water sources [AOR = 2.84, 95% CI (1.00-8.06)] were the predictors of under-nutrition. Conclusion: According to the world health organization cut-offs, the prevalence of overall under-nutrition in the study area was very high. Child age, food insecurity, knowledge of mother/caregiver, having a larger family size, and unprotected drinking water sources were the predictors of under-nutrition. The district offices should give attention to the improvement of the food security status of the community, and give priority to the availability and accessibility of drinking water sources, particularly pipe water sources. Special attention to older age groups of children is important to control the prevalence of under-nutrition.