Association between pregnancy intention and completion of newborn and infant continuum of care in Sub-Saharan Africa: systematic review and meta-analysis.

BACKGROUND: The newborn and infant continuum of care such as essential newborn care, early initiation and exclusive breastfeeding, and immunisation are highly recommended for improving the quality of life and survival of infants. However, newborn and infant mortality remains high across Sub-Saharan African countries. While unintended pregnancies are associated with adverse newborn and infant health outcomes, there is inconclusive evidence on whether pregnancy intention influences newborn and infant continuum of care completion. Therefore, this review aimed to pool findings reported in the literature on the association between pregnancy intention and newborn and infant health care across the continuum of care in Sub-Saharan Africa. METHODS: We searched MEDLINE Complete, EMBASE, CINAHL Complete, and Global Health databases for studies potentially eligible for this systematic review and meta-analysis. Two researchers independently screened the identified articles by abstract and title, and then full-text using Covidence. We used the Newcastle-Ottawa Scale to assess the quality of the included studies. The Cochran's Q test and I2 were executed to detect and quantify the presence of statistical heterogeneity in the studies. Meta-analysis was done for each outcome when more than one original study reported relevant data, using Stata statistical software version 18. RESULTS: Eleven studies were included from a total of 235 articles identified by the search. The odds of completing essential newborn care (pooled odds ratio: 3.04, 95% CI: 1.56, 5.90), early initiation of breastfeeding (pooled odds ratio: 1.30, 95% CI: 1.13, 1.52), exclusive breastfeeding (pooled odds ratio: 2.21, 95% CI: 1.68, 2.89), and being fully immunised (pooled odds ratio: 2.73, 95% CI: 1.16, 6.40) were higher among infants born to women with intended pregnancies as compared to women with unintended pregnancies. CONCLUSION: Intended pregnancy was positively associated with essential newborn care completion, early initiation and exclusive breastfeeding, and full immunisation of infants in SSA countries. Thus, policy-makers and stakeholders should strengthen the provision of quality family planning services to prevent unintended pregnancy. Furthermore, follow-up of women with unintended pregnancies is needed to increase women's opportunity to access essential newborn health care services that further reduce the risk of newborn and infant morbidity and mortality. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42023409148.

Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Infectious diseases remain the leading causes of death in low and middle-income countries including Ethiopia. The existence of emerging, re-emerging, and drug-resistant infectious agents maximizes the importance of infection prevention and control. Healthcare workers are the key actors in the prevention and control of infection. As a result assessing the knowledge, attitude, and practice of healthcare workers toward infection prevention and control is very critical in the prevention and control of infectious diseases. Therefore, this systematic review and meta-analysis aimed to assess the knowledge, attitude, and practice of healthcare providers toward infection prevention in Ethiopia. METHOD: PubMed, Scopus, SEMANTIC SCHOLAR, Google Scholar, and Addis Ababa University Digital Library were systematically searched for relevant literature until November 18/2023. The quality of the included studies was assessed using the Joanna Briggs Institute quality appraisal tool. Data were abstracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11. A random-effects model was used to estimate the pooled prevalence. Heterogeneity among reported studies was assessed by Forest plot, Cochran's Q-statistics, and I2 test. Publication bias was checked using funnel plots, and Egger's regression test. In addition, sub-group and sensitivity analyses were conducted. RESULT: A total of 7,681 articles were retrieved of which 19 studies with 5,650 healthcare workers were included in this systematic review and meta-analysis. About 74.5% (95% CI, 65.88, 83.12), 66.71% (95% CI 55.15, 78.28), and 55.2% (95% CI 48.22, 62.18) of healthcare workers were knowledgeable, had positive attitudes, and good standard of practice on infection prevention respectively. CONCLUSION: Despite acceptable knowledge and attitude, about half of the healthcare workers have unsafe infection prevention and control practices in Ethiopia. Hence, serious attention should be given to healthcare workers' application of infection prevention standards in their working environment.

Association between preconception care and family planning and previous adverse birth outcomes in Ethiopia: systematic review and meta-analysis.

OBJECTIVES: Inconsistent findings on the associations of preconception care with the utilisation of family planning and previous adverse birth outcomes have not been systematically reviewed in Ethiopia. Thus, this review aims to estimate the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes in Ethiopia. DESIGN: Systematic review and meta-analysis of observational studies. DATA SOURCES: MEDLINE Complete, CINAHL Complete, Scopus and Global Health were searched from inception to 28 July 2023. ELIGIBILITY CRITERIA: Observational studies that reported preconception care as an outcome variable and the use of family planning before pregnancy or previous adverse birth outcomes as exposure variables were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently conducted study screening, data extraction and quality assessment. A fixed-effects model was used to determine the pooled association of preconception care with the utilisation of family planning and previous adverse birth outcomes. RESULTS: Eight studies involving a total of 3829 participants were included in the review. The pooled meta-analysis found that women with a history of family planning use had a higher likelihood of using preconception care (OR 2.09, 95% CI 1.74 to 2.52) than those women who did not use family planning before their current pregnancy. Likewise, the pooled meta-analysis found that women with prior adverse birth outcomes had a higher chance of using preconception care (OR 3.38, 95% CI 1.06 to 10.74) than women with no history of prior adverse birth outcomes. CONCLUSION: This review indicated that utilisation of preconception care had a positive association with previous use of family planning and prior adverse birth outcomes. Thus, policymakers and other relevant stakeholders should strengthen the integration of preconception care with family planning and other maternal healthcare services. PROSPERO REGISTRATION NUMBER: CRD42023443855.

Child sexual abuse and its determinants among children in Addis Ababa Ethiopia: Systematic review and meta-analysis.

Child sexual abuse is a significant public health concern and a breach of basic human rights affecting millions of children each year globally. It is typically not reported by victims, hence it remains usually concealed. Except for single studies with varying reports, there is no national studies conducted on child sexual abuse in Ethiopia. Therefore, this review determined the pooled magnitude and determinants of sexual abuse among children in Ethiopia. Potential articles were searched from PubMed, Science Direct, Scopus, and Web of science using relevant searching key terms. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to evaluate the quality of all selected articles. Data were analyzed using STATA Version 14 software. Publication bias was checked using Egger's test and funnel plot. Cochran's chi-squared test and I2 values were used to assess heterogeneity. A random-effects model was applied during meta-analysis. The pooled prevalence of sexual abuse among 5,979 children in Ethiopia was 41.15% (95% CI: 24.44, 57.86). Sex of children (OR: 2.14, 95%CI: 1.12, 4.06), smoking (OR: 4.48, 95%CI: 1.26, 76.79), khat chewing (OR: 3.68, 95%CI: 1.62, 21.93), and alcohol use (OR: 4.77, 95%CI: 2.22, 10.25) were the determinants of child sexual abuse. The main perpetrators of sexual abuse against children were neighbors, boy/girlfriends, family members, school teachers, and stranger person. Child sexual abuse commonly took place in the victim's or perpetrator's home, school, and neighbor's home. This review revealed that the magnitude of child sexual abuse in Ethiopia was relatively high and multiple factors determined the likelihood of sexual violence against children. Thus, policy-makers and concerned stakeholders should strengthen comprehensive sexual and reproductive health education to reduce the magnitude and consequences of child sexual abuse. Moreover, support with special attention should be given to children with mental illness and physical disabilities.

Sleep disturbance and its associated factors among pregnant women in Ethiopia: systematic review and meta-analysis.

INTRODUCTION: Globally, sleep disturbance is the foremost public health issue among pregnant women which might have undesirable birth outcome including neurocognitive impairment, preterm birth, low birth weight, and neonatal morbidity and mortality. In Ethiopia, inconsistent findings have been reported on the prevalence of sleep disturbance among pregnant women. Therefore, this review aims to estimate the pooled prevalence sleep disturbance and its associated factors among pregnant women in Ethiopia. METHODS: This systematic review and meta-analysis of observational studies was designed according to the PRISMA guideline. A systematic search of literature was conducted in PubMed, Scopus, Web of science, and Google Scholar using relevant searching key terms. The Newcastle-Ottawa scale was used to evaluate the quality of all selected articles. Data were analyzed using STATA Version 14 software. Publication bias was checked using Egger's test and funnel plot. Cochran's chi-squared test and I2 values were used to assess heterogeneity. A fixed-effects model was applied during meta-analysis. RESULTS: In this review, six studies were included after reviewing 17,100 articles. The pooled prevalence of sleep disturbance among pregnant women in Ethiopia was 50.43% (95%CI: 39.34-61.52). Third trimester pregnancy AOR = 4.03; 95% CI: 2.84,5.71), multigravidity (AOR = 1.99; 95% CI: 1.54, 2.59), unplanned pregnancy (AOR = 2.56; 95% CI: 1.52,4.31), depression (AOR = 3.57; 95% CI: 2.04, 6.27), stress (AOR = 2.77; 95% CI: 1.57, 4.88), anxiety (AOR = 3.69; 95% CI: 1.42, 9.59) and poor sleep hygiene (AOR = 2.49; 95% CI: 1.56, 3.99) and were statistically associated with sleep disturbance among pregnant women. CONCLUSION: This review revealed that the magnitude of sleep disturbance among pregnant woman in Ethiopia was relatively high and multiple factors determined the likelihood of having a disturbed sleep-awake pattern. Thus, the implementation of interventions for sleep disturbance after screening pregnant women is needed. Moreover, public health interventions targeted on the prevention of unintended pregnancy and depression during pregnancy should be implemented.

Magnitude of Spousal Violence and Associated Factors among Midlife Women in Ethiopia.

Background: Intimate partner violence is the most common form of gender-based violence and has enormous maternal health consequences. There is limited evidence concerning the magnitude and determinants of intimate partner violence amongst midlife women. Thus, this study aimed to determine the extent of and the factors contributing to spousal violence amongst midlife Ethiopian women. Methods: The 2016 Ethiopia Demographic and Health Survey (EDHS) data were examined, and a sample of 1628 ever-married midlife women was included. The analysis was performed using SPSS version 20. Bivariate and multivariable logistic regression analysis was conducted to examine the determinants of intimate partner violence. All statistical significance was declared at p value < 0.05. Results: The prevalence of spousal violence among midlife women in Ethiopia was 31.8%. Age of women, divorced, and working status were significantly associated with spousal violence. The likelihood of spousal violence is increase among midlife women who had no formal education, less decision-making power in household, and had partner who had drinking habit. Conclusion: This study showed that nearly one-thirds of midlife Ethiopian women have experienced spousal violence in their lifetime. Empowering midlife women by giving them decision-making tools and educating them to deal with, and prevent spousal violence may be effective strategies in reducing this problem.

Impact of COVID-19 pandemic on utilization of essential maternal healthcare services in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has a significant challenge for countries to maintain the provision of essential maternity services. Many women could experience difficulties in accessing maternal healthcare due to transport problems, anxiety, and fear of infection. A reduction in the utilization of maternity services has been suggested as a possible cause of worsened maternal health outcomes. Thus, this study aimed to determine the impact of the COVID-19 pandemic on the utilization of maternal healthcare services in Ethiopia. METHODS: Searching of articles was conducted from PubMed, Science Direct, Cochrane Library, Web of Science, Scopus, and Google scholar. The quality of studies was evaluated using the Newcastle-Ottawa scale. Inspection of the Funnel plot and Egger's test were used to evaluate the evidence of publication bias. Heterogeneity was evaluated using Cochran's Q statistic and quantified by I2. A random-effects model was used to determine pooled estimates using STATA 14. RESULTS: After reviewing 41,188 articles, 21 studies were included in this systematic review and meta-analysis. The pooled reduction was 26.62% (95% CI: 13.86, 39.37) for family planning, 19.30% (95% CI: 15.85, 22.76) for antenatal care, 12.82% (95% CI: 7.29, 18.34) for institutional delivery, 17.82% (95% CI: 8.32, 27.32) for postnatal care, and 19.39% (95% CI: 11.29, 27.49) for abortion care. This study also demonstrated that maternal perception of poor quality of care and fear of infection, lack of transport, cultural events, diversion of resources, lack of essential drugs, and lack of personal protective equipment and sanitizer were identified as the main challenges faced during the pandemic. CONCLUSION: This study revealed that the utilization of maternal healthcare services in Ethiopia significantly decreased during the COVID-19 pandemic. Government measures, health facility-related barriers, and maternal-related factors were identified as challenges faced during the pandemic. Thus, service providers, policy-makers, and other relevant stakeholders should prioritize maternity care as an essential core healthcare service. Besides, increasing awareness of women through mass media, and making maternity services more accessible and equitable would likely increase the utilization of maternal healthcare services. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021293681.

Intimate partner violence and associated factors among HIV positive women attending antiretroviral therapy clinics in Gondar city, Northwest Ethiopia.

INTRODUCTION: Intimate partner violence against women is a behavior within an intimate relationship that causes sexual, physical, or psychological harm to the women. It occurs among all socioeconomic, religious, and cultural groups in all settings, and affects the health of women, families, and the community at large. Determining the magnitude and determinants of intimate partner violence against HIV positive women could help to design preventive and control strategies. However, there is a dearth of information regarding the magnitude and determinants of intimate partner violence against HIV positive women in Ethiopia. Thus, this study aimed to assess the magnitude and associated factors of intimate partner violence against HIV positive women in Gondar city, Northwest Ethiopia. METHOD: A facility-based cross-sectional study was carried out from February to May 2021 in selected public health facilities of Gondar city among 626 HIV positive women. A systematic random sampling technique was used to select study participants. Data were analyzed using Statistical Package of Social Science (SPSS) version 20 software. Bivariable and Multivariable logistic regression models were done. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to identify determinants of intimate partner violence. Statistical significance was considered at a p value < 0.05. RESULTS: The overall prevalence of intimate partner violence against HIV positive women within the last 12 months was 64.2% (95% CI 60.4, 68.2). Physical violence was the most common type (54.8%), followed by sexual (51.1%) and emotional (48.9%) violence. Intimate partner violence among HIV positive women was associated with women's age 19-24 (AOR = 0.13, 95% CI 0.02, 0.79), monthly income of 500-2500 (AOR = 6.5, 95% CI 1.72, 25.0), urban residence (AOR = 0.35, 95% CI 0.13, 0.91), partner drink alcohol (AOR = 2.14, 95% CI 1.42, 4.06), and a husband with no multiple sexual partners (AOR = 0.75, 95% CI 0.34, 0.94). CONCLUSION: The result of this study revealed that intimate partner violence against HIV positive women was found to be high. Thus, protective measures that could increase the community's and women's awareness about the consequences of various forms of violence, and women empowerment are paramount. Priorities in programs of gender-based violence prevention should involve women from rural residences, older age, and males who consume alcohol.

Predictors of successful vaginal birth after a cesarean section in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: The rates of successful vaginal birth after previous cesarean section (VBAC) have been increasing with minimal complication. Successful vaginal birth after cesarean section improves maternal and fetal outcomes by shortening the length of hospital stay, avoiding abdominal surgery, decreasing the risk of infections and hemorrhage, and decreasing injury of the bladder and bowel. Despite a few single studies stating different predictors of successful VBAC, there is a lack of nationwide data to show the determinants of successful VBAC. Thus, this meta-analysis aimed to determine the predictors of successful VBAC in Ethiopia. METHODS: A systematic literature search was performed from PubMed, Web of Sciences, EMBASE, CINAHL, and Google scholar until July 25, 2022. The quality of included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist. The analysis was executed using Stata 14 statistical software. Heterogeneity was evaluated statistically using Cochran's Q-statistic and quantified by the I2 value. A random-effects model was used to estimate the determinants of successful vaginal birth after a cesarean section if substantial heterogeneity was detected across included studies; otherwise, a fixed-effects model was used. RESULTS: Women living in rural residence (AOR: 2.14; 95% CI: 1.01, 4.52), history of previous spontaneous vaginal delivery (AOR: 2.92; 95% CI: 2.02, 4.23), previous successful vaginal birth after previous cesarean section (AOR: 5.29; 95% CI: 2.20, 12.69), history of stillbirth (AOR: 1.57; 95% CI: 1.20, 2.04), cervical dilation of ≥ 4 cm at admission (AOR: 2.14; 95% CI: 1.27, 3.61), spontaneous ruptured membranes at admission (AOR: 1.32; 95% CI: 1.17, 1.48) were independent determinants of successful vaginal birth after previous cesarean section. CONCLUSION: The results of this meta-analysis showed that successful VBAC was influenced by past and present obstetric conditions and other predictors. Thus, it is recommended that obstetric care providers should emphasize those factors that lead to successful vaginal birth during counseling and optimal selection of women for the trial of labour after cesarean section. SYSTEMATIC REVIEW AND META-ANALYSIS REGISTRATION: PROSPERO CRD42022329567.

Prevalence and associated factors of sexual violence experienced by housemaids in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Housemaids often experience different types of sexual violence by different perpetrators. Sexual violence against housemaids remains usually concealed as victims cannot report such offenses. Except for fragmented studies with varying reports, there is no national prevalence studies conducted on sexual violence among housemaids in Ethiopia. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence and associated factors of sexual violence amongst housemaids in Ethiopia. METHODS: A systematic search of PubMed, Embase, Science Direct, HINARI, Scopus, Cochrane Library, and Google Scholar was conducted using relevant search terms. Data were extracted using the Joanna Briggs Institute (JBI) tool. The quality of all selected articles was evaluated using JBI critical appraisal checklist. Data analysis was performed using STATA Version 14 statistical software. Egger's test and funnel plot were used to evaluate publication bias. Heterogeneity was assessed using Cochran's chi-squared test and quantified by I2 values. A random-effects model was applied during meta-analysis if heterogeneity was exhibited; otherwise, a fixed-effects model was used. RESULTS: After reviewing 37,849 articles, 8 studies involving 3,324 housemaids were included for this systematic review and meta-analysis. The pooled prevalence of life time sexual violence among housemaids in Ethiopia was 46.26% (95% CI: 24.69, 67.84). The pooled prevalence was 55.43% (95% CI: 26.38, 84.47) for sexual harassment, 39.03% (95% CI: 14.55, 63.52) for attempted rape, and 18.85% (95% CI: 7.51, 30.19) for rape. Sexual violence is more likely among housemaid who previously lived rural residence (AOR = 2.25; 95% CI: 1.41, 3.60), drinks alcohol (AOR = 2.79 95% CI: 1.02, 4.56), and employer alcohol consumption (AOR = 6.01; 95% CI: 1.10, 32.96). CONCLUSION: This study revealed that the prevalence of sexual violence against housemaids in Ethiopia is high. Of the forms of sexual violence against housemaids, sexual harassment is high. Male employers are the vast majority of perpetrators of their housemaids. Thus, concerned stakeholders should develop and implement interventions that could empower housemaids in their struggle toward the elimination of sexual violence, create awareness for men, control and monitor the implementation of legislation and policies, and prompt punishment of the perpetrators. Systematic review and meta-analysis registration PROSPERO CRD42021160511.

Sexual violence is the most common form of gender-based violence and has been a persistent problem in public health. Housemaids are the most vulnerable groups for any of the forms of sexual violence, as they face the greatest obstacles to gaining protection and necessary services. The sexual activity of domestic workers differs from that of the general population. Housemaids are more likely to be coerced into having sex and to have had sex before age 15 as compared to other young women. Housemaids often experience sexual violence by a person unknown to the victim, employers and male members of the household, brokers, or other intermediary persons. Sexual violence against housemaids remains usually concealed as victims cannot report such offenses. The most common reason for not reporting such violence was a lack of awareness of where to and for whom to report, a low level of education, and a fear of losing their work as they have few or no options for other work.In Ethiopia, the national prevalence of sexual violence among housemaids is not investigated. Also, forms and determinants of sexual violence and identification of perpetrators have not been well described. Thus, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of sexual violence amongst housemaids in Ethiopia. This systematic review and meta-analysis revealed that nearly half of housemaids experienced at least one form of sexual violence by different perpetrators. Of the forms of sexual violence against housemaids, sexual harassment is high. Male employers are the vast majority of perpetrators of their housemaids. Thus, concerned stakeholders should develop and implement interventions that could empower housemaids in their struggle toward the elimination of sexual violence, create awareness for men, and prompt punishment of the perpetrators.

COVID-19 vaccine acceptance and its associated factors in Ethiopia: A systematic review and meta-analysis.

Background: COVID-19 vaccination is considered as an effective intervention for controlling the burden of the pandemic. However, vaccine hesitation is increasing and hindering efforts targeting to reduce the burden of the COVID-19 disease. Hence, determining COVID-19 vaccine acceptance and identifying determinants that would hinder people to vaccinate against COVID-19 is crucial to effectively improve COVID-19 vaccine uptake. In Ethiopia, the pooled proportion of COVID-19 vaccine acceptance and its determinants is not well known. Thus, the aim of this study is to estimate the pooled proportion of COVID-19 vaccine acceptance and its determinants in Ethiopia. Methods: A systematic search of articles was conducted from PubMed, Scopus, Web of Science, MEDLINE, CINAHL, Science Direct and Cochrane Library. Data were extracted using a data extraction tool which was adapted from the Joanna Briggs Institute. The quality of each included primary studies was evaluated using the Newcastle-Ottawa scale tool. Data analysis was performed using STATA 14. Heterogeneity in studies was assessed using Cochrane Q and I2 test. Publication bias was assessed using visual inspection of funnel plots and Egger's test. A random effects model was applied to determine the pooled estimates if heterogeneity was exhibited; otherwise, a fixed-effects model was used. Results: A total of 14 studies involving 6373 participants were included for the final analysis. The pooled proportion of COVID-19 vaccine acceptance in Ethiopia was 56.02% (95% CI: 47.84, 64.20). The likelihood of COVID-19 vaccine acceptance was higher among participants who had history of chronic disease (AOR = 1.33, 95% CI: 1.09, 2.97), good knowledge (AOR = 2.13, 95% CI: 1.59, 4.97), positive attitude (AOR = 2.23, 95% CI: 1.21, 4.66), good COVID-19 preventive practice (AOR = 1.97, 95% CI: 1.82, 2.12), and high perceived seriousness of COVID-19 (AOR = 3.21, 95% CI: 2.32, 5.98). Conclusion: More than half participants were willing to accept COVID-19 vaccine. Thus, awareness creation battles about the efficacy and safety of the COVID-19 vaccine should be provided to the community. Besides, policy-makers, health planners and other stakeholders should encourage COVID-19 vaccine uptake behaviors by providing trusted information.Systematic review and meta-analysis registration: PROSPERO CRD42021264708.

Rational Drug Use Evaluation Based on World Health Organization Core Drug Use Indicators in Ethiopia: A Systematic Review.

BACKGROUND: Rational use of medicines plays a vital role in avoiding preventable adverse drug effects, maximizing therapeutic outcomes with promoting patient adherence, and minimizing the cost of drug therapy. Irrational use of drugs is often observed in countries with weak health care systems. No review has been done that systematically expresses rational drug use practice based on the three WHO core drug use indicators in Ethiopia. Thus, this study was aimed to review systematically the prescribing, health-facility, and patient-care indicators based on WHO core drug use indicators in Ethiopia. METHODS: A systematic article search was conducted in different electronic databases including PubMed/ MEDLINE, the Cochrane Library, EMBASE, Web of Science, POPLINE, the Global Health, and Google scholar. Quality assessment was conducted using Newcastle-Ottawa quality assessment scale. Studies were synthesized and grouped in to prescribing, patient care and health facility indicators. RESULTS: From a total of 6239 articles, 21 studies were found suitable for the review. The highest average number of drugs per encounter was 2.5 while the lowest was 0.98. The percentage of generic drug use was ranged from 70.5% to 100%. The highest percentage of encounters with an antibiotic was 85%. The lowest percentage of drugs prescribed from essential drugs list was 81.4%. The highest percentage of drugs actually dispensed and adequately labeled was 96.16% and 96.25%, respectively. CONCLUSION: This study showed that the practice of rational drug use varied across region of the country. The average number of drugs per prescription, percentage of drugs encounter with antibiotics, drugs prescribed by their generic name, average consultation time, average dispensing time, percentage of drugs adequately labeled, and availability of essential drugs showed deviation from the standard recommended by WHO. Thus, provision of regular training for prescribers and pharmacists, and ensuring the availability of essential drugs should be encouraged.

Routine health information utilization and associated factors among health care workers in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Utilization of routine health information plays a vital role for the effectiveness of routine and programed decisions. A proper utilization of routine health information helps to make decisions based on evidence. Considerable studies have been done on the utilization of routine health information among health workers in Ethiopia, but inconsistent findings were reported. Thus, this study was conducted to determine the pooled utilization of routine health information and to identify associated factors among health workers in Ethiopia. METHODS: Search of PubMed, HINARI, Global Health, Scopus, EMBASE, web of science, and Google Scholar was conducted to identify relevant studies from October 24, 2020 to November 18, 2020. The Newcastle-Ottawa scale tool was used to assess the quality of included studies. Two reviewers extracted the data independently using a standardized data extraction format and exported to STATA software version 11 for meta-analysis. Heterogeneity among studies was checked using Cochrane Q and I2 test statistics. The pooled estimate of utilization of routine health information was executed using a random effect model. RESULTS: After reviewing 22924 studies, 10 studies involving 4054 health workers were included for this review and meta-analysis. The pooled estimate of routine health information utilization among health workers in Ethiopia was 57.42% (95% CI: 41.48, 73.36). Supportive supervision (AOR = 2.25; 95% CI: 1.80, 2.82), regular feedback (AOR = 2.86; 95% CI: 1.60, 5.12), availability of standard guideline (AOR = 2.53; 95% CI: 1.80, 3.58), data management knowledge (AOR = 3.04; 95% CI: 1.75, 5.29) and training on health information (AOR = 3.45; 95% CI: 1.96, 6.07) were identified factors associated with utilization of routine health information. CONCLUSION: This systematic review and meta-analysis found that more than two-fifth of health workers did not use their routine health information. This study suggests the need to conduct regular supportive supervision, provision of training and capacity building, mentoring on competence of routine health information tasks, and strengthening regular feedback at all health facilities. In addition, improving the accessibility and availability of standard set of indicators is important to scale-up information use.

Knowledge and Associated Factors of Postpartum Contraceptive Use Among Women in the Extended Postpartum Period in Gondar City, Northwest Ethiopia.

BACKGROUND: The choice of a postpartum contraceptive method and the timing of its initiation depend on the woman's knowledge regarding postpartum contraceptives use. Also, women's perception towards family planning is reliant on good knowledge and has a great influence on their attitudes and practices. There is limited information on the knowledge and associated factors of postpartum contraceptive use among women. Therefore, the aim of this study was to assess the knowledge and associated factors of postpartum contraceptive use among women in the extended postpartum period. METHODS: An institutional-based cross-sectional study was conducted from November 5, 2018 to December 5, 2018 among postpartum women in six health institutions in Gondar city, northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariable and multivariable logistic regression models were fitted to identify the determinants of knowledge of postpartum contraceptive use. Adjusted odds ratio (AOR) with their 95% confidence intervals (CI) were calculated. P-values less than 0.05 were considered to indicate statistical significance. RESULTS: Out of 403 participants, 299 (74.2%) had good knowledge on postpartum contraceptive use. Being urban residents (AOR=2.95, 95% CI=1.34-6.48), previous modern contraceptives use (AOR=5.15, 95% CI=1.16-22.88), health facility delivery (AOR=4.10, 95% CI=1.20-13.98), and counseling about family planning during PNC (AOR=3.80; 95% CI=1.52-9.51) were significantly associated with good knowledge. CONCLUSION: This study showed that the knowledge of women regarding postpartum contraceptives was relatively low. Therefore, increasing institutional delivery service and counseling about family planning during the postpartum period should get more focus to address the knowledge gap of postpartum mothers.

Lost to Follow-up and Predictors Among HIV-Exposed Infants in Northwest Ethiopia.

INTRODUCTION: Even though advancement in mother-to-child HIV transmission prevention services is observed, many infants are lost to follow-up and could not access the full package of mother-to-child HIV transmission prevention services as a result. This is one of the obstacles to the effectiveness of the program. Therefore, determining the magnitude of lost to follow-up and its predictors is important among HIV-exposed infants. METHOD: This institution-based retrospective cohort study was conducted from August 2013 to June 2018 at the University of Gondar Comprehensive Specialized Hospital. We retrieved charts of 423 child-mother pairs through a simple random sampling technique. Data collectors extracted data by using a data extraction tool adapted from the Ethiopian Federal Ministry of Health HIV-exposed infant follow-up form. Bivariable and multivariable Cox regression models were fitted to identify predictors of lost to follow-up. RESULT: A total of 402 child-mother pairs were included in the study. Of the study participants, 6.0% were lost to follow-up for more than 3 months before the declaration of their HIV status. Born from rural residence mother (AHR = 3.5; 95% CI 1.549-7.894), infants whose mothers have three and more children (AHR = 3; 95% CI 1.284-6.963), and low birth weight infants (AHR = 3.2; 95% CI 1.055-9.450) were independent predictors of lost to follow-up among HIV-exposed infants. CONCLUSION: Significant numbers of infants were unable to access full HIV diagnosis and care services as a result of loss to follow-up. Special consideration for mothers having large numbers of children, rural residence, and low birth weight infants could be an important intervention to decrease lost to follow-up.

Factors associated with early resumption of sexual intercourse among women during extended postpartum period in Northwest Ethiopia: a cross sectional study.

BACKGROUND: Postpartum sexual health and practice need to be integrated in the current maternal healthcare services to address sexual health problems. However, postpartum sexual practice has received little attention, and was not often discussed by healthcare providers during prenatal and postnatal care. Thus, this study was aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in Gondar city, Northwest Ethiopia. METHODS: A community based cross-sectional study was conducted from January 20 to February 20, 2020. A systematic random sampling technique was used to select 634 postpartum women. A pretested, structured and interviewer-administered questionnaire was used to collect data. Data were entered into Epi Info 7.2.2 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regressions analysis were done. Variables with p- value of < 0.05 were considered as statistically significant. RESULTS: The magnitude of early resumption of sexual intercourse after childbirth was found to be 26.9% (95% CI: 23.2, 30.8). Urban resident (AOR = 6.12, 95% CI: 2.41, 15.66), parity of one (AOR = 2.26, 95% CI: 1.66, 7.78), husband demand (AOR = 2.66, 95% CI: 1.72, 4.11), postnatal care (AOR = 1.45, 95% CI: 1.06, 2.18) and use of family planning (AOR = 2.72, 95% CI: 1.51, 3.43) were factors significantly associated with early resumption of sexual intercourse. CONCLUSION: The study found that more than one fourth of women had resumed sexual intercourse within six weeks of following childbirth. The finding of this study suggests the need of integrating discussions of postpartum sexual activity into routine prenatal, intrapartum and postnatal care with collaborative effort of policy makers, program planners, health care providers and other stakeholders. Moreover, spousal communication on postpartum sexual activity should be encouraged.

Knowledge, Attitude, and Associated Factors towards Safe Abortion among Private College Female Students in Gondar City, Northwest Ethiopia: A Cross-Sectional Study.

BACKGROUND: Women die from complications of unsafe abortion in developing countries because most have little knowledge about how to safely access to abortion care. Studies on knowledge, attitude, and associated factors towards safe abortion are limited in general and particularly among private college students. Therefore, the aim of this study was to assess knowledge, attitude, and associated factors towards safe abortion among private college female students in Gondar City, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from April 30, 2019, to May 30, 2019, among private college students in the Gondar town. Data were collected from 633 female students using self-administered questionnaires by a simple random sampling technique. Bivariable and multivariable logistic regression analyses were performed to identify association of dependent and independent variables using SPSS, version 20. RESULTS: A total of 633 respondents participated in this study with the response rate of 97.7%. The majority (433 (68.4%)) of students had good knowledge about safe abortion. Older age (AOR = 2.79, 95% CI: 1.16, 7.29), urban residence (AOR = 2.42, 95% CI: 1.26, 4.35), family education (AOR = 3.18, 95% CI: 1.32, 7.06), and ever having heard about safe abortion (AOR = 4.36, 95% CI: 1.89, 10.83) were factors associated with knowledge of students on safe abortion. Regarding attitude, 361 (57%) of students had favorable attitude towards safe abortion. Age (AOR = 6.58, 95% CI: 2.71, 11.21) and urban residence (AOR = 1.51, 95% CI: 1.09, 2.21) were factors significantly associated with attitude towards safe abortion. CONCLUSION: More than half of the participants have good knowledge and attitude towards safe abortion, but still a significant proportion of students have poor knowledge and unfavorable attitude. Information, education, and communication programs on youth reproductive health should be provided to address topics on safe abortion for students. Forums and panel discussions on safe abortion need to be undertaken especially, among youths and students who come from rural area.

Breast self-examination practice and associated factors among female healthcare workers in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Breast cancer is common global public health problem. It is the principal cause of cancer related death. In Ethiopia, study findings regarding prevalence and associated factors of BSE among female healthcare workers have been inconsistently reported and highly variable. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of breast self-examination practice and determinants in Ethiopia. METHODS: A systematic search of PubMed, Medline, EMBASE, Global Health, Google Scholar, CINAHL and Scopus from April 2, 2020 to April 24, 2020. Data were extracted from articles included in the review using a data extraction tool which was adapted from the Joanna Briggs Institute. the quality of each included article was evaluated using the Newcastle-Ottawa scale. Data analysis was done using STATA 11. The Cochrane Q and I2 test were used to assess heterogeneity between the studies; and publication bias was assessed using funnel plots and Egger's test. A random effects meta-analysis was computed to determine the pooled prevalence of breast self-examination. The determinants for breast self-examination were examined. Forest plots were used to present the prevalence and odds ratio with 95% confidence interval. RESULTS: After reviewing 9605 studies, 12 studies involving 4129 female healthcare workers were included for this review and meta-analysis. The pooled prevalence of breast self-examination practice among healthcare workers in Ethiopia was 56.31% (95% CI: 44.37, 68.25). The subgroup analysis further revealed that the higher breast self-examination practice was observed among other healthcare workers, 58.60% (95% CI: 43.31, 73.90). Good knowledge (AOR = 3.02; 95% CI: 1.24, 7.35), positive attitude (AOR = 2.73; 95% CI: 1.95, 4.13) and family history of breast cancer (AOR = 3.21; 95% CI: 1.22, 6.52) were significantly associated with breast self-examination practice among healthcare workers. CONCLUSION: This meta-analysis found that nearly half of the female healthcare workers were not performed breast self-examination. The finding of this study suggests the need of strengthening early diagnosis of breast cancer and control strategies with a collaborative effort of policymakers and other concerned stakeholders.

Prevalence and associated factors of contraceptive discontinuation among reproductive-age women in Ethiopia: using 2016 Nationwide Survey Data.

BACKGROUND: Contraceptive discontinuation for reasons other than the desire for pregnancy is associated with mistimed and unwanted pregnancies, unwanted births and unsafe abortions which has increased risks of maternal morbidity and mortality. However, research on the identification of factors that are associated with contraceptive discontinuation in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of contraceptive discontinuation and associated factors among reproductive-age women in Ethiopia, using recent national survey data. METHODS: A population-based cross-sectional study was conducted using secondary data analysis from of 2016, Ethiopian Demographic Health Survey. A total of 10,871 reproductive-age women were included. The analysis was performed using SPSS version 20 statistical package. Bivariate and multivariate logistic regression analysis was conducted to examine significant factors of contraceptive discontinuation, and statistical significance was declared at p-value < 0.05. RESULTS: The prevalence of discontinuation for all contraceptives methods among reproductive-age women was 32.2% (95% C.I 31.2, 33.1). Rural residence (AOR = 1.94, 95% C.I 1.65, 2.28), women with no formal education (AOR = 1.68, 95% C.I 1.30, 2.17), women having no children (AOR = 1.95, 95% C.I 1.19, 3.58), husband desire for children (AOR = 2.57, 95% C.I 2.03, 3.26), women self-decision when using a contraceptive (AOR = 0.54, 95% C.I 0.38, 0.77), joint decision when using a contraceptive (AOR = 0.38, 95% C.I 0.29, 0.48), didn't discuss about FP with healthcare worker (AOR = 1.28, 95% C.I 1.06, 1.54) and didn't get information about side effects (AOR = 2.01, 95% C.I 1.59, 2.52) were factors significantly associated with contraceptives discontinuation. CONCLUSION: The prevalence of contraceptive discontinuation among reproductive-age women was high and multiple factors determined it. Thus, counseling on side effects, availability of other contraceptive methods, and partner involvement in decision-making process by health care providers are strongly recommended. In addition, women empowerment should be promoted so that women are able to liberally decide on when and how many children they wish to have.

Early sexual debut and associated factors among students in Ethiopia: A systematic review and meta-analysis.

Students with early sexual debut are exposed to risky sexual behaviours. For effective intervention on early sexual debut and its consequences, determination of its magnitude and identifications of associated factors is important. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence and the associated factors of early sexual debut among students in Ethiopia. Relevant articles were identified through databases such as PubMed, Global Health, HINARI, Google advance search, Scopus, and EMBASE from March 10th to April 3rd. The data was extracted using a standardized data extraction form and exported to STATA 11 for analysis. The overall pooled prevalence of early sexual debut among students was estimated using a randomeffects meta-analysis. Presence of association was determined using an odds ratio with a corresponding 95% CI. A total of 9 studies with 4,217 participants were involved in this meta-analysis. The estimated pooled prevalence of early sexual debut among students in Ethiopia was 27.53% (95% CI: 20.52, 34.54). Being female (OR: 3.64, 95% CI: 1.67, 5.61), watching pornography (OR: 3.8, 95% CI: 2.10, 5.50) and having boyfriend or girlfriend (OR: 2.72, 95% CI: 1.24, 5.96) were found to be significantly associated with early sexual debut. More than one fourth of students practiced early sexual debut. The finding suggests the need of strengthening prevention strategies, effective intervention, and programs in educational institutions to reduce early sexual debut and its consequences. Furthermore, special attention should be given to female students and students who watch pornography.