Spatial distribution and associated factors of cesarean section in Ethiopia using mini EDHS 2019 data: a community based cross-sectional study.

Maternal health is a major public health tricky globally. Cesarean section delivery reduces morbidity and mortality when certain complications occur throughout pregnancy and labor. Cesarean section subjected to the availability and use of essential obstetric services in regional factors in Ethiopia. There was a scarcity of studies that assess the spatial distribution and associated factors of cesarean section. Consequently, this study aimed to assess the spatial variation of cesarean section and associated factors using mini EDHS 2019 national representative data. A community based cross-sectional study was conducted in Ethiopia from March to June 2019. A two-stage stratified sampling design was used to select participants. A Global Moran's I and Getis-Ord Gi* statistic hotspot analysis was used to assess the spatial distribution. Kuldorff's SaTScan was employed to determine the purely statistically significant spatial clusters. A multilevel binary logistic regression model fitted to identify factors. A total of 5753 mothers were included. More than one-fourth of mothers delivered through cesarean section at private health institutions and 54.74% were not educated. The proportion of cesarean section clustered geographically in Ethiopia and hotspot areas were observed in Addis Ababa, Oromia, Tigray, Derie Dewa, Amhara, and SNNR regions. Mothers' age (AOR = 1.07, 95% CI 1.02-1.12), mother's had secondary education (AOR = 2.113, 95% CI 1.414, 3.157), mother's higher education (2.646, 95% CI 1.724, 4.063), Muslim religion followers (AOR = 0.632, 95% CI 0.469, 0.852), poorer (AOR = 1.719, 95% CI 1.057, 2.795), middle wealth index (AOR = 1.769, 95% CI 1.073, 2.918), richer (AOR = 2.041, 95% CI 1.246, 3.344), richest (AOR = 3.510, 95% CI 2.197, 5.607), parity (AOR = 0.825, 95% CI 0.739, 0.921), and multiple pregnancies (AOR = 4.032, 95% CI 2.418, 6.723) were significant factors. Therefore, geographically targeted interventions are essential to reduce maternal and infant mortality with WHO recommendations for those Muslim, poorest and not educated mothers.

Determinants of early initiation of breastfeeding following birth in West Africa: A multilevel analysis using data from multi-country national health surveys.

BACKGROUND: Early initiation of breastfeeding (EIBF), within the first hour of birth, is crucial for promoting exclusive breastfeeding and establishing optimal nursing practices. However, global EIBF rates remain low, with even lower rates observed in Africa. Despite existing research gaps, this study aims to determine the prevalence of EIBF and identify maternal and child-related factors associated with its practice in West Africa. METHODS: This study utilized West African Demographic and Health Survey (DHS) data from 13 countries, including 146,964 children's records. To assess model fit, likelihood test and deviance were used. Similarly, intraclass correlation coefficient, median odds ratio, and proportional change in variance were employed for random effect. A multilevel logistic regression model was used to identify individual- and community-level factors influencing EIBF due to the hierarchical nature of the data. Variables with p-values ≤0.2 in the binary model and <0.05 in the final analysis were considered significantly associated with EIBF. RESULTS: The pooled prevalence of EIBF in West African nations was 50.60% (95% CI; 50.34-50.85%). The highest prevalence rate was observed in Serra Leone (75.33%) and the lowest prevalence was found in Senegal (33.94%). In the multilevel multiple logistic regression model, maternal education (AOR = 1.10, 95% CI, 1.03,1.16), marital status AOR = 1.07, 95% CI, 1.01,1.13), birth weight (AOR = 0.91, CI 0.86,0.96), birth orders (AOR = 1.09, CI 1.03,1.16), and (AOR = 1.11, CI 1.03,1.19), place of residence (AOR = 1.14, CI 1.07,1.21), and mode of delivery type (AOR = 0.26, CI 0.24,0.29) were significantly correlated with EIBF in West Africa. CONCLUSIONS: The incidence of EIBF in West Africa was found to be low. The study emphasizes the need for targeted behavioral change communication programs to address timely breastfeeding initiation, specifically targeting mothers and child characteristics. Factors such as education, delivery mode, marital status, birth weight, birth order, and place of residence were significantly associated with EIBF. Special attention should be given to improving EIBF rates among women undergoing caesarean sections, infants with low birth weight, and primiparous mothers, along with structural improvements in the healthcare sector in West Africa.

Less than one in four mothers get quality intrapartum health care services in Ethiopia.

Intrapartum care is a platform of comprehensive healthcare for pregnant women that is designed to improve birth outcomes for mother and child. However, complications during the intrapartum period continued to be the leading cause of death for women of reproductive age and newborns. Therefore, the aim of this study was to assess the prevalence of quality of intrapartum care and its associated factors among mothers in Ethiopia. A community based cross sectional study was conducted among 4469 mothers who gave birth in the last 2 years. Quality of intrapartum care was analyzed based on the assessment of health facility delivery, skilled birth attendants and early initiations of breast-feeding. Stata version 14 software was used for data cleaning and analysis. A mixed effect multilevel logistic regression was conducted to determine factors associated with quality of intrapartum care. An adjusted odds ratio with 95% confidence interval and a P value of less than or equal to 0.05 was used for the identification of both individual and community level factors. Overall, the prevalence of quality intrapartum care in Ethiopia was 23.8% (95% CI 22.6, 25.13). Primary education (AOR = 1.46, 95% CI = 1.14, 1.88), rich household class (AOR = 1.48, 95% CI = 1.10, 1.98), history of ANC (AOR = 2.91, 95% CI = 2.18, 3.86), perceived distance to the health facility as not a big issue (AOR = 1.63, 95% CI = 1.30, 2.05), urban residence (AOR = 2.97, 95% CI = 1.93, 5.09), Tigray region (AOR = 5.01, 95% CI = 1.25, 20.59), community level poverty (AOR = 0.63, 95% CI = 0.41, 0.97), and having 2-4 children (AOR = 0.74, 95% CI = 0.56, 0.97) were significantly associated with quality of intrapartum care. The finding conclude that less than one in four mothers received good quality intrapartum care. In order to optimize the quality of intrapartum care, the government should empower women through extensive education. It is also recommended for the Ministry of Health to evaluate the health facilities and community health workers to increase coverage of ANC and provide financial assistance to rural residents and the poor household class.

Determinants of podoconiosis among residents of Machakle District East Gojjam Zone Amhara Region Ethiopia.

BACKGROUND: Podoconiosis (endemic non-filarial elephantiasis) is a chronic disease characterized by the development of persistent swelling of plantar foot initially; which progresses to the dorsal foot and lower leg slowly or in a number of acute episodes to reach the knee. About 4 million people are said to be affected by the disease worldwide and it is deemed a serious public health problem in at least 10 African countries including Ethiopia. Therefore this study aimed to identify the determinants of podoconiosis among residence in Machakel district. METHOD: Unmatched case control study design was conducted at Machakel district from August 30 to September 30, 2022. The sample size calculated using Epi-info software yielded 211 controls and 106 cases (317 study participants). Simple random sampling technique was used to select the cases using registration books of the district. Data were entered to Epi info version 7 and exported to SPSS version 22 for statistical analysis. Binary logistic regression was used to identify explanatory variables. RESULT: A total of 312 study participants (104 cases and 208 controls) were included giving a response rate of 98.42%. Bare foot (AOR, 5.83 [95% CI: 2.34-14.50]), female sex (AOR, 4.25 [95% CI: 2.22-8.14]), family history of podoconiosis (AOR: 3.01(95% CI: 1.41-6.42) and age group 41-60 (AOR: 5.05(95% CI: 2.35-10.83), and 61-80 AOR 15.74 95% CI: (5.56-44.55) were determinants of Podoconiosis. CONCLUSION AND RECOMMENDATION: Barefoot, sex, family history of podoconiosis and age were determinants of Podoconiosis. District health office should encourage at risk populations especially older people and individuals with family history of podoconiosis about shoe wearing practice all the time and not to expose their skin and feet.

Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia.

World Health Organization stated that traditional medicine is an important part of health care and countries need to consider integrating it into their primary health care system. Traditional bone setting has a long history in Ethiopia and it enjoys enormous acceptance in the community. However, these methods are raw, there is no standardized training and at the same time, complications are common. Therefore, this research aimed to assess the prevalence of traditional bone setting service utilization and associated factors among people with trauma in Mecha district. Methods A Community- based cross-sectional study design was employed from January 15 to February 15, 2021. A total of 836 participants were selected using a simple random sampling technique. Binary and multiple logistic regressions were employed to assess the association between the independent variables with traditional bone setting service utilization. Results The prevalence of traditional bone setting service utilization was 46.05%. Factors significantly associated with TBS utilization were: Age ≥ 60 years (AOR = 0.13, 95% CI: 0.03- 0.43), rural residence (AOR = 3.63, 95% CI: 1.76 -7.50), occupation (merchant (AOR = 0.21, 95% CI: 0.07 -0.61), and housewife (AOR = 4.12, 95% CI: 1.33 -12.70), type of trauma: dislocation (AOR = 6.40, 95% CI: 3.69-11.10), and strain (AOR = 2.09, 95% CI: 1.05- 4.14)), site of trauma: extremity (AOR = 0.20, 95% CI: 0.11, 0.37), trunk (AOR = 0.08, 95% CI: 0.03-0.22), and shoulder (AOR = 0.20, 95% CI: 0.11-0.37), cause of trauma: fall down and natural deformity (AOR = 9.87, 95% CI: 5.93-16.42) and household annual income greater than > 36,500 (AOR = 2.33, 95% CI: 1.29-4.22). Conclusion The prevalence of traditional bone setting practice is high in the study area, despite recent advancements in the practice of orthopedics and trauma in Ethiopia. Since TBS services are more accepted in society, the integration of TBS into the health care delivery system is recommended.

Awareness and care seeking for long COVID symptoms among Coronavirus disease survivors in Bahir Dar City, Northwest Ethiopia: phenomenological study.

BACKGROUND: Corona Virus Disease (COVID-19) has long-term sequels that persisted for months to years and manifested with a spectrum of signs and symptoms. Presentations of long COVID-19 symptoms are heterogeneous, vary from person to person, and can reach up to over 200 symptoms. Limited studies are conducted on the awareness of long COVID-19. So, this study aimed to explore the awareness about and care seeking for long COVID-19 symptoms among COVID survivors in Bahir Dar City in 2022. METHODS: A qualitative study with a phenomenological design was used. Participants of the study were individuals who survived five months or longer after they tested positive for COVID-19 in Bahir Dar city. Individuals were selected purposively. An in-depth interview guide was prepared and used to collect the data. Open Cod 4.03 software was used for coding and synthesizing. Thematic analysis was used to analyze the transcripts. RESULTS: The themes emerged from the data were awareness, experience of symptoms and their effects, and care practices of long COVID-19. Although only one participant mentioned the common symptoms of long COVID-19 the survivors experienced general, respiratory, cardiac, digestive, neurological, and other symptoms. These symptoms include rash, fatigue fever, cough, palpitations, shortness of breath, chest pain, and abdominal pain, loss of concentration, loss of smell, sleep disorder, depression, joint and muscle pain. These symptoms brought various physical and psychosocial effects. The majority of the respondents described that long COVID-19 symptoms will go off by themselves. To alleviate the problems some of the participants had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification. CONCLUSIONS: The result of this study revealed that participants have a significant deficit of awareness about the common symptoms, risk groups, and communicability of Long COVID. However, they experienced the majority of the common symptoms of Long COVID. To alleviate the problems, they had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification.

Time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital: a retrospective cohort study.

BACKGROUND: Anti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However, information's on the time of initial regimen discontinuation and its predictors are not well studied. OBJECTIVE: This study aimed to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia. METHOD: Institution-based retrospective cohort study was conducted among 418 HIV patients who started HAART from January 1, 2014, to December 31, 2019. Data were collected from the patient chart using a data extraction tool. The Kaplan-Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation. RESULT: A total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking > 1 ART pills/day (AHR = 4.1, 95% CI 3.0-6.5), baseline CD4 count < 100 cells/mm3 (AHR = 2.6, 95% CI 1.5-4.7), 100-199 cells/mm3 (AHR = 2.2, 95% CI 1.2-4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI 1.6-4.3) and stage III (AHR = 2.6, 95% CI 1.4-4.3) and TB infection (AHR = 2.3, 95% CI 1.6-3.5). CONCLUSION: Most of the discontinuation occurred after 1 year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count, and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced and initiation of one ART regimen daily is vital for survival on the initial regimen.

Factors Associated with Human Brucellosis among patients Attending in Ayu Primary Hospital, North Showa, Ethiopia: ACase Control Study.

BACKGROUND: Brucellosis is a disease of domestic and wild animals commonly caused by Brucella species and can be transmitted to humans (zoonosis). Susceptibility to Brucellosis in Humans depends on immune status, routes of infection, size of the inoculums, and to some extent, the species of Brucella. Globally more than 500,000 new cases are reported each year. In sub-Saharan Africa, Brucellosis prevalence is unclear and poorly understood with varying reports from country to country, geographical regions as well as animal factors. METHODS: Facility-based unmatched case-control study was conducted on 167 patients with human brucellosis and 332 controls from February 27/2019 to May 20/2019 in AYU primary hospital, North Showa Zone, Ethiopia. descriptive statistics such as frequency and percentages were used to describe the profile of case and control and analytical statistics such as bivariate and multivariate logistic regression analysis was performed to identify the determinants of human brucellosis. RESULT: A total of 499 participants were included with a response rate of 99.60%. The mean age of participants was 45.46 years with a standard deviation (SD) of ±12.96 years. Human brucellosis had a statistically significant association with raw milk consumptions (AOR 5.75[95%CI 1.97-16.76]), slaughtering of animals at home(AOR 14.81[95%CI 3.63-60.38]), having contact with animal manure(AOR 2.87 [CI 1.08-7.62]), having contact with aborted cattle's fetus (AOR 3.01[95%CI 1.34-9.13]) and knowledge about brucellosis(AOR 0.29 [95%CI 0.08-0.83]. CONCLUSION: Generally in this study knowledge about Human Brucellosis, contact with animal manures, practicing animal slaughtering at home, having contact with animal ruminants, and consuming raw milk were identified as determinants for human brucellosis infection.

Effect of the COVID-19 Pandemic Preparation and Response on Essential Health Services in Primary and Tertiary Healthcare Settings of Amhara Region, Ethiopia.

Countries like Ethiopia have had to make difficult decisions to balance between the demands of the COVID-19 pandemic and maintaining the essential health service delivery. We assessed the effect of preventive COVID-19 measures on essential healthcare services in selected health facilities of Ethiopia. In a comparative cross-sectional study, we analyzed and compared data from seven health facilities over two periods: the pre-COVID-19 period before the first reported COVID-19 case in the country and during the COVID-19 period. Data were summarized using descriptive statistics and the independent t test. During the COVID-19 period the average number of monthly patient visits in the emergency department, pediatrics outpatient, and adult outpatient dropped by 27%, 30%, and 27%, respectively compared with the pre-COVID-19 period. Family planning; institutional delivery; childhood immunization; antenatal care-, hypertension- and diabetic patient follow-up, did not vary significantly between pre-COVID-19 and during COVID-19. Moreover, the monthly average number of tuberculosis (TB) and HIV patients who visited health facilities for drug refill and clinical evaluation did not vary significantly during the two periods. In conclusion, the study highlights that the effect of public restrictions to mitigate the COVID-19 pandemic on essential care systems should be considered.

Determinants of Implanon Discontinuation among Women Who Use Implanon at Bahir Dar Town Health Institutions, Northwest Ethiopia, 2019: A Case-Control Study.

BACKGROUND: Implanon is a long-acting reversible contraceptive method that is 99% effective in preventing unintended pregnancy. Despite its effectiveness, the rate of Implanon discontinuation is high. In Ethiopia, there is limited information about determinants of Implanon discontinuation. Therefore, this study aimed to identify the determinants of Implanon discontinuation among women who used Implanon at Bahir Dar town health institutions. METHODS: We employed an unmatched case-control study to find out the determinants of Implanon discontinuation at Bahir Dar town health institutions from March to June 2019 using the multistage stratified sampling technique to select study participants. Cases were women who had discontinued Implanon before completion of 3 years, and controls were women who had removed Implanon at the date of appointment (3 years). A pretested, structured questionnaire with face-to-face interviews was used. Binary logistic regression was performed to identify determinants of Implanon discontinuation. In the final model, variables with a p value of <0.05 were considered significant at 95% confidence interval and the strength of association was measured using odds ratio. RESULTS: Primary education (AOR = 0.104, 95% CI (0.02-0.48)), secondary education (AOR = 0.48, 95% CI (0.24-0.952)), women who have no child (AOR = 2.04, 95% CI (1.2-3.4)), women who had no discussion with their partner (AOR = 2.2, 95% CI (1.39-3.57)), mass counseling (AOR = 3.5, 95% CI (1.75-7.01)), women who had no counseling about side effects (AOR = 1.7, 95% CI (1.07-2.07)), women who experienced side effects (AOR = 2.2, 95% CI (1.4-3.4)), and purpose of family planning use (AOR = 2.5, 95% CI (1.14-4.8)) were determinants of Implanon discontinuation. CONCLUSION: Implanon discontinuation is attributed by multifactorial involvement. Women's educational status, nulliparity, no counseling, not informed of side effects, and no partner discussion are significant factors. Health sector stakeholders need to tailor counseling services at individual level to bolster family planning utilization until the desired time.

Determinant factors of overweight/obesity among federal ministry civil servants in Addis Ababa, Ethiopia: a call for sector-wise occupational health program.

OBJECTIVE: Civil servants are disposing individuals to sedentary lifestyle and, may lead to overweight and obesity. Thus, the purpose of the study was to identify factors associated with overweight and obesity among employees in Ethiopia ministries. RESULT: Respondents who were age 45 years and above [AOR = 11.56, 95% CI 3.75-35.56], 35-44 years [AOR = 11.17, 95% CI 3.89-32.06] and 25-34 [AOR = 3.08 95% CI 1.07-8.83] were more likely to be overweight/obesity as compared to those who were in age category of 18-24 years. The study also found that ever alcohol consumption [AOR = 2.27, 95% CI 1.23, 4.16] was associated with increased risk of overweight and obesity as compared to non-consumers. Another risk factor was adult who did not practice ten minutes' walk per day, more likely to overweight and obesity [AOR = 11.28, 95% CI 5.96-21.36] as compared to the counter parts. Similarly, participants who did not involve physical activity (sport) [AOR = 2.42% 95% CI 1.36-4.30] were 2.42 times more likely to overweight and obesity as compared to those who had physical activity. Sector-wise occupational health program should be developed in work placed to decrease identified risk factors.

Premarital sexual practice and associated factors among high school youths in Debretabor town, South Gondar zone, North West Ethiopia, 2017.

OBJECTIVE: Premarital sex is voluntary sexual intercourse between unmarried persons. Prevalence and factors associated with premarital sexual practice in the study area are lacking. Thus, the aims of this study were to determine the prevalence and to identify factors associated with premarital sexual practice among Debretabor high school youths. RESULTS: The prevalence of premarital sex among Debretabor town high school youths was 22.5% of which 63.9% of them were males. Among those high school youths, the majority (60.2%) had their first sexual intercourse at the age of 15-19 years. The main reason for initiation of sexual intercourse was due to fell in love which accounts 48.1%, followed by sexual desire 22.2%. Predictors that are risk for premarital sex were youths who did not attend religious education [AOR = 7.4, 95% CI (3.32, 16.43)], having boy or girl friends [AOR = 9.66, 95% CI (4.80, 19.43)], drinking alcohol every day [AOR = 9.43, 95% CI (2.86, 31.14)] and less than twice a week [AOR = 2.52, 95% CI (1.22, 5.21)], watching pornography film [AOR = 5.15, 95% CI (2.56, 10.37)] and youths came from rural residing families [AOR = 0.51, 95% CI (0.27, 0.96)].