Geospatial patterns, and individual and community levels factors of cesarean section deliveries in Ethiopia: A spatial and multilevel analysis.

BACKGROUND: Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. METHOD: A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. RESULT: The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24-35: AOR = 1.98, 95% CI (1.3, 3.1), and 35-49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. CONCLUSION: In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions.

Proportional Hazards Model on Attrition and its Predictors in Community Antiretroviral Refill Groups among ART Users in Eastern Ethiopia.

BACKGROUND: The HIV epidemic continues to be a major public health challenge worldwide, particularly in sub-Saharan African countries such as Ethiopia. Community-based antiretroviral refill groups are emerging as a patient-centered approach, but there is limited evidence. Therefore, this study aimed to assess attrition and predictors in community antiretroviral refill groups among ART users in Eastern Ethiopia. METHODS: Institutional-based retrospective cohort study was conducted. Systematic random sampling techniques were used. Data were collected via Kobo Collect and exported to Stata. Statistically significant effects were assumed for a P-value < 0.05 at a confidence interval of 95%. RESULTS: The incidence of attrition in community-based ART refill groups was 6.63 (95% CI: 5.78, 7.48) per 100 person-years. The median duration of months in CAGs from the start till the end of the follow-up period was 9 months (IQR = 24). Thus, recruitment level from health facilities, history of LTFU, and stage IV were statistically significant variables. CONCLUSION: The findings of this study highlight the importance of improving the use of community antiretroviral groups in care. Healthcare programs can ultimately improve health outcomes for individuals living with HIV.

Urban-rural disparities in minimum acceptable diet intake among children aged 6-23 months in Ethiopia: A multivariable Decomposition analysis of Ethiopian demographic and health survey 2019.

Introduction: The achievement of the minimum acceptable diet intake (MAD) stands at 14% among urban and 10% among rural under-five children in Ethiopia. Consequently, identifying the determinants of the urban-rural gap is vital for advancing Sustainable Development Goals (SDGs), fostering healthier communities, and developing evidence-driven approaches to enhance health outcomes and address disparities. Objective: The objective of the study was to decompose the urban-rural disparities in minimum acceptable diet intake in Ethiopia using the Ethiopian Mini-Demographic and Health Survey 2019 data. Method: The study was conducted using the Ethiopian Demographic and Health Survey 2019 report. A total of 1,496 weighted children aged 6-23 months were included using stratified sampling techniques. The main outcome variable minimum acceptable diet was calculated as a combined proportion of minimum dietary diversity and minimum meal frequency. A decomposition analysis was used to analyze the factors associated with the urban-rural discrepancy of minimum acceptable diet intake, and the results were presented using tables and figures. Result: The magnitude of minimum acceptable diet among children aged 6-23 months in Ethiopia was 11.0%. There has been a significant disparity in the intake of minimum acceptable diet between urban and rural under-five children with 14 and 10%, respectively. Endowment factors were responsible for 70.2% of the discrepancy, followed by 45.1% with behavioral coefficients. Educational status of college and above was responsible for narrowing the gap between urban and rural residents by 23.9% (ß = 0.1313, 95% CI: 0.0332-0.245). The number of children in the household and the age of the child between 18 and 23 months were responsible for widening the gap in minimum acceptable diet intake discrepancy between urban and rural residents by 30.7% and 3.36%, respectively (ß = -0.002, 95% CI: -0.003 to -0.0011 and ß = -30.7, 95% CI: -0.025 - -0.0085). From the effect coefficients, the effect of institutional delivery was responsible for 1.99% of the widening of the gap between urban and rural residents in minimum acceptable diet intake (ß = -0.0862, 95% CI: -0.1711 - -0.0012). Conclusion: There is a significant variation between urban and rural residents in minimum acceptable diet. The larger portion of the discrepancy was explained by the endowment effect. Educational status of mothers with college and above, parity, age of child, and place of delivery were the significant factors contributing to the discrepancy of minimum acceptable diet intake between urban and rural residents.

The association between children's exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis.

Background: Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods: A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result: A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion: This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.

Exposure to indoor air pollution and adverse pregnancy outcomes in low and middle-income countries: a systematic review and meta-analysis.

Introduction: Exposure to indoor air pollution such as biomass fuel and particulate matter is a significant cause of adverse pregnancy outcomes. However, there is limited information about the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries. Therefore, this meta-analysis aimed to determine the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries. Methods: International electronic databases such as PubMed, Science Direct, Global Health, African Journals Online, HINARI, Semantic Scholar, and Google and Google Scholar were used to search for relevant articles. The study was conducted according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A random effect model at a 95% confidence interval was used to determine the association between indoor air pollution exposure and adverse pregnancy outcomes using STATA version 14. Funnel plot and Higgs I2 statistics were used to determine the publication bias and heterogeneity of the included studies, respectively. Results: A total of 30 articles with 2,120,228 study participants were included in this meta-analysis. The pooled association between indoor air pollution exposure and at least one adverse pregnancy outcome was 15.5% (95%CI: 12.6-18.5), with significant heterogeneity (I2 = 100%; p < 0.001). Exposure to indoor air pollution increased the risk of small for gestational age by 23.7% (95%CI: 8.2-39.3) followed by low birth weight (17.7%; 95%CI: 12.9-22.5). Exposure to biomass fuel (OR = 1.16; 95%CI: 1.12-1.2), particulate matter (OR = 1.28; 95%CI: 1.25-1.31), and kerosene (OR = 1.38; 95%CI: 1.09-1.66) were factors associated with developing at least one adverse pregnancy outcomes. Conclusions: We found that more than one in seven pregnant women exposed to indoor air pollution had at least one adverse pregnancy outcome. Specifically, exposure to particulate matter, biomass fuel, and kerosene were determinant factors for developing at least one adverse pregnancy outcome. Therefore, urgent comprehensive health intervention should be implemented in the area to reduce adverse pregnancy outcomes.

The burden of health expenditure on household impoverishment in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia, like many low-income countries, faces significant challenges in providing accessible and affordable healthcare to its population. Health expenditure is a critical factor in determining the quality and accessibility of healthcare. However, high health expenditure can also have detrimental effects on households, potentially leading to impoverishment. To the best knowledge of investigators, no similar study has been conducted in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the pooled burden of health expenditure on household impoverishment in Ethiopia. METHODS: This systematic review and meta-analysis used the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Cochrane Library, HINARI, Google Scholar and Epistemonikos electronic databases were searched systematically. Moreover, direct manual searching through google was conducted. The analysis was performed using STATA version 17 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. The trim and fill method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled incidence with a 95% confidence interval of meta-analysis using the random effect model. RESULTS: This systematic review and meta-analysis included a total of 12 studies with a sample size of 66344 participants. The pooled incidence of impoverishment, among households, attributed to health expenditure in Ethiopia was 5.20% (95% CI: 4.30%, 6.20%). Moreover, there was significant heterogeneity between the studies (I2 = 98.25%, P = 0.000). As a result, a random effect model was employed. CONCLUSION: The pooled incidence of impoverishment of households attributed to their health expenditure in Ethiopia was higher than the incidence of impoverishment reported by the world health organization in 2023.

The effect of maternal age on still birth in Africa: A systematic review and meta-analysis.

Background and Aims: Stillbirth is a public health as well as a development problem in low and middle-income countries. The studies that found out maternal age as a factor for the risk of stillbirth reported different findings. This systematic review and meta-analysis is believed to fill the inconclusiveness of these findings. Hence, the aim of this systematic review and meta-analysis is to estimate the pooled effect of advanced maternal age on stillbirth in Africa. Methods: PubMed & HINARY databases and Google Scholar search engine were searched to access the primary studies. The extracted data using Microsoft excel was exported to Stata 15 software for analysis. The presence of heterogeneity was checked using Cochran's Q statistic and the I 2 test. Publication bias was examined by using funnel plot and Egger's test. The pooled effect measure with DerSimonian and Laird method of random-effect model was reported using odds ratio (OR) with respective 95% confidence interval. Results: Totally, 14 articles are included for the systematic review and meta-analysis. The stillbirth reported by the studies ranges from 15 to 146.7 per 1000 births. The overall OR of advanced maternal age (≥35 years) on stillbirth is 1.42 (1.18, 1.71) when compared with the age group of 20-35 years. The cumulative effect of getting pregnant at advanced age on stillbirth was slightly increasing from year to year. Conclusion: Advanced maternal age is a risk factor for stillbirth. Health Information Communication on the risk of getting pregnant at the advanced ages on stillbirth should be well addressed to all women of reproductive age group.

Male involvement in family planning and its association with knowledge and spouse discussion in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to estimate the pooled prevalence of male involvement in family planning (FP) and its association with knowledge and spouse discussion in Ethiopia. DESIGN: Systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. DATA SOURCES: The study was conducted by the articles searched from different databases: (PubMed, Cochrane Library, PsycINFO, HINARI and Google Scholar). ELIGIBILITY CRITERIA FOR SELECTING STUDIES: This research encompassed investigations carried out within married couples in Ethiopia, specifically focusing on studies where male involvement in FP was the primary outcome. The inclusion criteria comprised studies with an observational study design, encompassing both published and unpublished works, conducted in the English language, with no restrictions on data collection and publication year. DATA EXTRACTION AND SYNTHESIS: Following a systematic search of the articles, two independent authors assessed the quality of the studies, and data extraction was conducted using Microsoft Excel. The data analysis was performed by using STATA V.17. The overall level of male involvement in FP in Ethiopia was calculated using DerSimonian and Liard's random-effect model, with a significance level set at a p<0.05. Heterogeneity was examined using the I2 test, and Egger's test was employed to assess publication bias. RESULTS: The pooled prevalence of male involvement in FP in Ethiopia was 59.71% (95% CI (47.68% to 71.73%)). Good knowledge regarding FP (AOR 6.63, 95% CI (2.58 to 17.03)) and spouse discussion on FP (AOR 4.36, 95% CI (2.50 to 7.59)) were significantly associated with male involvement in FP. CONCLUSIONS: The prevalence of male involvement in FP in Ethiopia was low as compared with other literature conducted outside Ethiopia. Both good knowledge and spouse discussion regarding FP were significantly associated with male involvement in FP. So, the government and healthcare providers should focus on interventions that could increase their knowledge through different media. In addition, encouraging couples to have a discussion regarding FP could be a recalled intervention for healthcare providers.

Determinants of unmet need for family planning among currently married reproductive age women at Dewa Chefa District of Oromia special zone, Amhara region, Ethiopia, 2021; a case-control study.

BACKGROUND: Unmet need for family planning is a proportion of women among reproductive age group who want to stop or delay childbearing but are not using any method of contraception. One in ten married women face unmet need for family planning world-wide whereas, one in five women in Africa. Thus, by understanding factors associated with unmet need specific to the study area; the study contributes to planning and intervention of programs, gives additional finding for controversies in earlier studies, and also helps as a baseline for other researchers conducting studies on similar topics. METHODS: A community-based unmatched case-control study was conducted from March 29-April 25, 2021 G.C on 462 currently married reproductive age women (154 cases and 308 controls) in Dewa Chefa District. Currently married reproductive-age women who were fecund, and wanted to limit or delay childbearing but were not using any contraceptive methods were taken as cases and currently married reproductive-age women who were using family planning or did not want to use were taken as controls. A structured and pre-tested questionnaire was used to collect data. Collected data were entered into Epi-data 3.1 and exported to SPSS 23 for analysis. Binary Logistic regression was conducted and variables with p-value < 0.05 were taken as statistically significant. RESULTS: A total of 462 women participated in this study, with 100% response rate. The mean age of the respondents was 27.92 years (with SD of ± 6.3) Age of woman 35-49 [AOR = 6.6 (1.1-39)], having poor knowledge on family planning [AOR = 1.9 (1.1-3.1)], using family planning decided by husband [AOR = 3.8 (2.1-6.9)], using family planning decided together [AOR = 2.3 (1.07-5.1)] and have no support and disapproval of husband for family planning use [AOR = 2.1 (1.08-4)] were factors significantly associated with unmet need. CONCLUSION AND RECOMMENDATIONS: Age of the woman, main decider of family planning use, knowledge about family planning and support and approval of spouse for family planning use were found to have significant association with unmet need for family planning. Thus, family planning providers, District health office, and other concerned bodies should strengthen female empowerment and male involvement in the program with strong couple counseling to reduce unmet need.

Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Informed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia. METHODS: We searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies' quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version. RESULTS: The pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent. CONCLUSION: The appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero .

Gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia.

BACKGROUND: Child psychomotor development and factors affecting it today is the subject of interest of many studies, in particular by the experts involved in the protection and improvement of children's health. There is limited evidence on developmental delay among under-five children in low-income countries like Ethiopia. The aim of this study was to assess gross motor developmental delay and associated factors among under-five children attending public health facilities of Dessie city, Ethiopia. METHODS: Facility based cross sectional study design was used among under-five children attending under-five OPD in public health facilities of Dessie town from July 1, 2020 to August 15, 2021. A total of, 417 under-five children were systematically selected based on their average number of clients in a month. A pretested structured questionnaire was used for data collection, and data was entered into Epi-data 3.1 version and it was exported to STATA version 14 for analysis. Binary logistic regression analysis was used to identify factors associated with the outcome variable. Odds ratio with 95% confidence interval was used to show the strength and direction of association respectively and P-value less than 0.05 is used to declare statistical significance. RESULTS: The overall proportion of gross motor developmental delay among under-five children attending health facilities of Dessie city, Ethiopia was 16.31%, 95% CI: (13.05, 20.19). Increased age of the child [AOR = 0.97, 95% CI: (0.96, 0.99)], increased gestational age during pregnancy [AOR = 0.47, 95% CI: (0.37, 0.65)], being male [AOR = 5.26, 95% CI: (1.76, 15.67)], having history of alcohol intake during pregnancy [AOR = 7.40, 95% CI: (2.36, 23.25)], taking iron during pregnancy [AOR = 0.04, 95% CI: (0.01, 0.15)], facing fetal and/or maternal complication [AOR = 4.98, 95% CI: (1.20, 20.62)], having instrumental delivery [AOR = 9.78, 95% CI: (2.48, 38.60)] were significantly associated with gross motor developmental delay. CONCLUSIONS: The gross motor developmental delay among under-five children was higher as compared to other literatures. This study indicated that, age and sex of the child, iron and alcohol intake during pregnancy, gestational age, mode of delivery and any complication to her and or her neonate were independent variables which showed statistical significant association. The physicians should advise mothers to take iron-folic acid supplement properly and to avoid intake of alcohol during pregnancy. In addition, they should focus on those mothers who faced any complication to her and/or her neonate and better to discourage instrumental delivery unless there are no other options.

Fertility return after hormonal contraceptive discontinuation and associated factors among women attended Family Guidance Association of Ethiopia Dessie model clinic, Northeast Ethiopia: A cross-sectional study.

BACKGROUND: Women who use hormonal contraception face delayed return of fertility upon discontinuation. There was limited evidence of fertility return after hormonal contraceptive discontinuation in the study area. Hence this study assessed fertility return after hormonal contraceptive discontinuation and associated factors among pregnant women attending Family Guidance Association Ethiopia (FGAE) Dessie model clinic, Northeast Ethiopia, 2019. METHODS: A cross-sectional study was conducted on 423 samples selected by using systematic random sampling. Data were collected by face-to-face interview using a pretested and structured questionnaire and reviewing client records. Data were entered using Epi Data version 3.1 and analyzed using SPSS version 23. Both bi-variable and multivariable binary logistic regressions were used to identify predictors of delayed fertility return. Adjusted odds ratio (AOR) along with a 95% Confidence Interval (CI) was used to measure the strength and the direction of the association and statistical significance was declared at a P-value less than 0.05. RESULT: The proportion of fertility return among currently pregnant women after discontinuation of any hormonal contraceptive methods was 88.6% (95% CI; (85.6%-92%)). The proportion of fertility return among Depo-Provera, implant, Intrauterine Contraceptive Device (IUCD), and Oral Contraceptive Pill (OCP) users was 75%, 99.1%, 100%, and 97.8% respectively. Age, (AOR = 5.37, (95% CI; (1.48, 13.6)) and using Depo-Provera (AOR = 4.82, 95% CI; (1.89, 14.2)) had a significant association with delayed fertility return. CONCLUSIONS: The proportion of fertility return among women after discontinuation of any hormonal contraceptive methods was high. Age and using Depo-Provera had a positive association with delayed fertility return. This study recommends a contraceptive counseling approach that addresses concerns about delay in the return of fertility after hormonal contraceptive discontinuation to avoid confusion among family planning users.

Time to postpartum family planning initiation and its predictors among mothers coming for first measles vaccination at Family Guidance Association of Ethiopia, Dessie Model Clinic, Northeast Ethiopia: cox-regression model.

BACKGROUND: Timing of initiation of family planning is an important determinant for the health status of the mother and her child. One-fourths of mothers in developing countries who wanted to space or limit their children were not using family planning methods at right time after delivery. Despite, the existence of many literatures about postpartum family planning, the timing of it is not yet studied. Thus, this study aimed to assess time to postpartum family planning and its predictors among mothers coming for first measles vaccination in Dessie city, Northeast Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted among mothers coming for infant vaccination at Family Guidance Association of Ethiopia, Dessie Model Clinic in Dessie City. A systematic sampling technique was used. The data were entered and analyzed using Epi Data version 3.1 and STATA version 14.0, respectively. Kaplan-Meier and Cox regression model were used to test the time and predictors of postpartum family planning initiation. Adjusted hazard ratio with 95% CI was used to test the strength of association at a p-value of 0.05. RESULTS: The rate of postpartum FP initiation was 0.6% with 95% CI (0.0056, 0.0069). Keeping the effect of confounder constant, age of the women 20-24 [AHR = 2.63, 95% CI (1.65,4.19)], 25-29 [AHR = 3.66, 95% CI (2.35,5.73)], 30-34 [AHR = 2.79, 95% CI (1.75,4.46)], getting family planning counseling [AHR = 1.78, 95% CI (1.26, 2.52)], want more child [AHR = 0.47, 95% CI (0.34, 0.66)], having history of abortion [AHR = 0.54, 95% CI (0.36,0.81)] and wanted last pregnancy [AHR = 0.69, 95% CI (0.49, 0.97) were significantly associated with postpartum family planning initiation. CONCLUSIONS: Age, history of abortion, counseling about family planning, the status of last pregnancy and want more child were significantly associated with postpartum family planning use. Continuous emphasis should be given for health care providers to encourage their counseling services for their customers at different age groups with special attention given for elders.

Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis.

BACKGROUND: Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. METHODS: A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. RESULTS: Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. CONCLUSIONS: Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis.

BACKGROUND: Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD: Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS: Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS: Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.

Induced abortion among female students in higher education institutions in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Female students in institutions of higher education are at higher risk of abortion and its consequences. There is no nationally representative data on induced abortion among students in higher education institutions in Ethiopia. Hence, this study aimed to estimate the pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia. METHODS: This study used a systematic review and meta-analysis of studies conducted from January 1, 2010, to June 30, 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, Google Scholar, CINAHL, and Global Health electronic databases were searched. The analysis was performed using STATA 14 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled prevalence with a 95% confidence interval (CI) of meta-analysis using the random effect model. RESULTS: This systematic review and meta-analysis included a total of 10 studies and 4656 study participants. The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was 5.06% (95%CI: 2.16, 7.96). The rate of induced abortion was 51 per 1000 women. CONCLUSIONS: The pooled prevalence of induced abortion among female students in institutions of higher education in Ethiopia was high. Thus, concerned bodies should design and implement an effective strategy to realize friendly and non-judgmental family planning and comprehensive abortion care service to curb the problem.

Determinants of cervical cancer screening utilization among women attending health facilities of Dessie town, Northeast Ethiopia.

INTRODUCTION: Despite the higher burden of cervical cases, screening programs in highly affected developing countries remained low. This made the disease to be present at an advanced stage which is almost always fatal, causing enormous pain and suffering for the individual and having significant adverse effects on the welfare of their families and community. Thus, this study aimed to assess determinants of cervical cancer screening utilization among women attending health facilities in Dessie Town, Northeast Ethiopia. METHODS: An institution-based unmatched case-control study design was employed on 430 women (146 cases and 284 controls) at selected health facilities of Dessie town, South Wollo Zone, from July 1/2020 to August 30/2020. Cases were selected for all women screened for cervical cancer during the data collection period until the required sample size was attained and using a consecutive sampling technique, every 3 participants from women who come for services other than cervical cancer screening. were included as controls. Pretested and structured questionnaires were used to collect the data. Data were analyzed by SPSS version 25 software. Bivariable and multivariable logistics regression analysis was done. An adjusted odds ratio with 95% CI was estimated to measure the strength of the association. The level of statistical significance was declared at a p-value < 0.05. RESULT: Age group of 35 and more [AOR = 11.52(6.09-21.77)], being a private employee [AOR = 4.67(2.41-9.03)], having symptoms of vaginal bleeding or pelvic pain or postcoital bleeding or vaginal discharge [AOR = 3.08(1.37-6.95)], being recommended by a physician for screening [[AOR = 3.07(1.45-6.49)] and positive attitude towards cervical cancer screening [AOR = 5.3(2.8-10.59)] were determinants of cervical cancer screening. CONCLUSION: Age group of 35 and more, current occupation as a private employee, having symptoms of cervical cancer, being recommended by a physician for screening, and positive attitude towards cervical cancer screening were determinants of cervical cancer screening utilization.

Determinants of wasting among children aged 6-59 months in North-East Ethiopia: a community-based case-control study.

OBJECTIVE: Childhood acute malnutrition, in the form of wasting defined by Weight-for-Height Z-Scores, is a major public health concern. It is one of the main reasons for the death of children in developing countries like Ethiopia. Accordingly, this study aimed to assess determinants of wasting among children aged 6-59 months in Meket district, North Wollo zone, North-East Ethiopia. SETTING: The study was conducted among communities in Meket district, North Wollo zone, North-East Ethiopia. PARTICIPANTS: A total of 327 (109 cases and 218 controls) children aged 6-59 months participated in the study. Children from 6 months to 59 months of age who match the definition of case/wasted/ and control/not wasted were eligible for the study. However, children who had physical deformities which make anthropometric measurements inconvenient were excluded from the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The main outcome measure was wasting. RESULT: The mean ages of the cases and controls were 21.77±11.41 months and 20.13±11.39 months, respectively. Factors that were significantly associated with wasting were: maternal decision making on the use of household money (adjusted odd ratio (AOR)=3.04, 95% CI 1.08 to 7.83), complementary feeding started in a month (AOR=3.02, 95% CI 1.097 to 6.97), food diversity score (AOR=2.64, 95% CI 1.64 to 5.23), frequency of complementary feeding (AOR=6.68, 95% CI 3.6 to 11.25) and history of acute respiratory infections (ARIs) 2 weeks preceding the survey (AOR=3.21, 95% CI 1.07 to 7.86). CONCLUSION: Our result implies that the right time to introduce complementary foods, the frequency of feeding and also the amount of food consumed were some of the crucial factors that needed to be changed in child nutrition to reduce wasting. Furthermore, within the framework of our study, the empowerment of women in the decision-making process and the prevention of ARI should be seen as a necessary benchmark for acute malnutrition.

HIV risk behavior and associated factors among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: HIV risk behavior among people living with HIV/AIDS (PLWHA) is a major public health concern as it increases HIV transmission. In Ethiopia, findings regarding HIV risk behavior have been inconsistent and inconclusive. Therefore, this meta-analysis aimed to estimate the pooled prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia. METHODS: International databases, including Google Scholar, Cochrane library, HINARI, Pub Med, CINAHL, and Global Health were systematically searched to identify articles reporting the prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia. The data were analyzed using STATA/SE version-14. The random-effects model was used to estimate the pooled effects. I-squared statistics and Egger's test were used to assess the heterogeneity and publication bias respectively. RESULTS: A total of 4,137 articles were reviewed and fourteen articles fulfilling the inclusion criteria were included in this meta-analysis. The pooled prevalence of HIV risk behavior in Ethiopia was 34.3%% (95% CI: 28.2, 40.3). Severe heterogeneity was observed between the included research articles (I2 = 96.6, p = 0.000). Alcohol use (OR = 1.9, 95%, CI: [1.6, 2.3]), HIV status non-disclosure (OR = 2.3, 95% CI: [1.3, 4.0]) and perceived stigma (OR = 2.3, 95% CI: [1.3, 4.1]) had a significant association with HIV risk behavior. CONCLUSION: The prevalence of HIV risk behavior among PLWHA in Ethiopia was high. Alcohol use, HIV status non-disclosure, and perceived stigma had a significant association with HIV risk behavior. In addition to promoting access to Antiretroviral Therapy (ART) treatment and improving medication adherence among PLWHA, various intervention programs focusing on the associated factors have to be implemented to tackle high-risk sexual behavior and go forward toward ending the HIV/AIDS pandemic.

Pre-marital sex and its association with peer pressure and watching pornography among young individuals in Ethiopia: a systematic review and meta-analysis.

There is no national representative estimate on pre-marital sex and its association with peer pressure and watching pornography among young individuals in Ethiopia. So, this study aimed to estimate the pooled prevalence of pre-marital sex and its association with peer pressure and watching pornography among young individuals in Ethiopia. A comprehensive search of international databases including CINAHL, Google Scholar, Cochrane Library, PubMed, HINARI, and Global Health was carried out to estimate the pooled prevalence of pre-marital sex and its association with peer pressure and watching pornography among young individuals in Ethiopia. The data were analyzed using STATA/SE version-14. The random-effect model was used to estimate the effect size and I-squared statistics and Egger's test were used to assess the heterogeneity publication bias respectively. A total of thirty-two studies with 18,354 study subjects were included in this meta-analysis. The pooled prevalence of premarital sex among young in Ethiopia was 33.59% [95% CI (29.09, 38.09)]. There was significant heterogeneity among the included articles (I2 = 97.9, p = 0.000). Young individuals who experienced peer pressure were three times more likely to practice premarital sex compared to their counterparts [OR = 2.90, 95%, CI (1.01, 8.31)]. As the crude analysis result indicated, there was a significant association between watching pornography (sex movies) and premarital sexual practice [OR = 3.41, 95% CI (1.99, 5.84)]. However, after doing trim-and-fill analysis, the publication-bias adjusted OR indicates the absence of significant association between watching pornography and premarital sex [OR = 1.23, 95% CI (0.69, 1.76)]. The proportion of premarital sex among young individuals in Ethiopia remains high. Peer pressure had a statistically significant association with premarital sexual practice. However, the publication-bias adjusted OR indicates the absence of a significant association between watching pornography and premarital sex. Peer counseling services, sex education, and behavioral change communications should be strengthened to address factors associated with pre-marital sexual practices.