Effect of integrating traditional care with modern healthcare to improve tuberculosis control programs in Ethiopia: a protocol for a cluster-randomized controlled trial.

BACKGROUND: Tuberculosis (TB) remains a major cause of morbidity and mortality in the world, despite being a preventable and curable disease. The World Health Organization (WHO) End-TB Strategy, aligned with the Sustainable Development Goals (SDGs), sets a target of reducing the TB mortality rate by 95%, TB incidence rate by 90%, and catastrophic costs due to TB by 2035, compared with a 2015 level. To achieve these ambitious targets, several interventions have been implemented in the last few years, resulting in major progress toward reducing the burden of TB. However, over one-third of the global TB cases remained undetected and never received treatment. Most of those undetected cases were found in low- and middle-income countries such as Ethiopia. Though several interventions were implemented to increase TB case detection and mitigate catastrophic costs associated with TB, sustaining these interventions in resource-constrained settings remains challenging. Consequently, an alternative method is needed to increase TB case detection while decreasing diagnosis delays and catastrophic costs. Therefore, this study aimed to integrate traditional TB care into modern TB care to improve TB control programs, including early TB case detection, and reduce catastrophic costs in high TB burden settings such as Ethiopia. METHODS: A cluster randomized controlled trial will be conducted in northwest Ethiopia to determine the effectiveness of integrating traditional care with modern TB care. The intervention will be conducted in randomly selected districts in the South Gondar Zone. The control group will be an equal number of districts with usual care. The intervention comprised three key components, which include referral linkage from traditional to modern health care; training of health professionals and traditional care providers in three different rounds to increase their knowledge, attitude, and skills toward the referral systems; and TB screening at traditional health care sites. The primary outcomes of interest will be an increase in case detection rate, and the secondary outcomes of interest will be decreased diagnosis delays and catastrophic costs for TB patients. Data will be collected in both the intervention and control groups on the main outcome of interest and a wide range of independent variables. Generalized linear mixed models will be used to compare the outcome of interest between the trial arms, with adjustment for baseline differences. DISCUSSION: This cluster-randomized controlled trial study will assess the effectiveness of a strategy that integrates traditional healthcare into the modern healthcare system for the control and prevention of TB in northwest Ethiopia, where nearly 90% of the population seeks care from traditional care systems. This trial will provide information on the effectiveness of traditional and modern healthcare integration to improve TB case detection, early diagnosis, and treatment, as well as reduce the catastrophic costs of TB. TRIAL REGISTRATION: ClinicalTrials.gov NCT05236452. Registered on July 22, 2022.

Acceptability of integrating traditional tuberculosis care with modern healthcare services in the Amhara Regional State of Northwest Ethiopia: A qualitative study.

Many people with tuberculosis (TB) rely solely on traditional healthcare services. Integrating traditional healthcare with modern healthcare services can increase access, quality, continuity, consumer satisfaction, and efficiency. However, successful integration of traditional healthcare with modern healthcare services requires stakeholder acceptance. Therefore, this study aimed to explore the acceptability of integrating traditional care with modern TB care in the South Gondar zone, the Amhara Regional State, northwest Ethiopia. Data were collected from patients with TB, traditional healers, religious leaders, healthcare providers, and TB program personnel. Data were collected using in-depth interviews and focus group discussions from January to May 2022. A total of 44 participants were included in the study. The context and perspectives of integration were thematized into the following five major themes: 1) referral linkage, 2) collaboration in awareness creation in the community, 3) collaboration in monitoring and evaluation of integration, 4) maintaining continuity of care and support, and 5) knowledge and skill transfer. Integrating traditional and modern TB care was acceptable to both modern and traditional healthcare providers as well as TB service users. This may be an effective strategy for improving the TB case detection rate by decreasing diagnosis delay, treatment initiation, and catastrophic costs.

Effectiveness of healthcare workers and volunteers training on improving tuberculosis case detection: A systematic review and meta-analysis.

INTRODUCTION: Tuberculosis is the second most common infectious cause of death globally. Low TB case detection remains a major challenge to achieve the global End TB targets. This systematic review and meta-analysis aimed to determine whether training of health professionals and volunteers increase TB case detection. METHODS: We performed a systematic review and meta-analysis of randomized control trials and non-randomized control trials reporting on the effectiveness of health professionals and volunteers training on TB case detection. We searched PubMed, SCOPUS, Cochrane Library, and reference sections of included articles from inception through to 15 February 2021, for studies published in English. Study screening, data extraction, and bias assessments were performed independently by two reviewers with third and fourth reviewers participating to resolve conflicts. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. Meta-analyses were performed with a random effect model to estimate the effectiveness of training intervention on TB case detection. RESULTS: Of the 2015 unique records identified through our search strategies, 2007 records were excluded following the screening, leaving eight studies to be included in the final systematic review and meta-analysis. The results showed that providing training to health professionals and volunteers significantly increased TB case detection (RR: 1.60, 95% CI: 1.53, 1.66). There was not a significant degree of heterogeneity across the included study on the outcome of interest (I2 = 0.00%, p = 0.667). CONCLUSIONS: Providing training to healthcare workers and volunteers can increase TB case detection.

Effectiveness of home visiting on tuberculosis case detection: Systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is a public health agenda globally. Most TB cases are detected using the usual passive method. Starting a decade, cases are detected using an active detection strategy. The home-visiting strategy is one of the active case findings approaches. However, no study shows the pooled effect of home visiting on tuberculosis case detection rate. Thus, we conducted this study to evaluate the effectiveness of home visiting on tuberculosis case detection. METHODS: In this systematic review and meta-analysis, the PRISMA checklist was used to report findings. A systematic comprehensive search was done to address all possible search databases. We used to search databases such as PubMed/MEDLINE, Scopus, and Science Direct to identify relevant articles. Data were extracted by two authors and consistency was checked by two co-authors. Cochrane risk of bias tool was used to assess the quality of studies. Data were extracted using a Microsoft Excel spreadsheet then; data were transferred to Stata version 16 for further analysis. Heterogeneity across studies was checked using the Q statistics (I2). RESULTS: Overall, 4174 articles were found. Two thousand one hundred seventy-five (2175) articles were excluded due to duplications. One thousand nine hundred twenty-four articles were excluded after reviewing titles and abstracts. Seventy-five articles were assessed using their full texts articles and 70 articles were excluded with unclear outcomes and poor methodological quality. Finally, 5 articles were selected for the final analysis. In all studies, the case-notification rate was significantly increased in the intervention arm than the control arm. The pooled effect size was RR: 1.65 (95% CI: 0.92, 2.39). This study showed that there was a significant heterogeneity (I2 = 98.9%, P < 0.001). Visual examination of the funnel plot showed asymmetric distribution. However, the egger's and bigger tests showed there was no significant publication bias ((P = 0.313). CONCLUSION: Home to home visiting is an effective TB case finding method as compared to the usual passive detection methods. The health system should be strengthened home to home visiting to enhance TB case detection. The protocol PROSPERO registration was CRD42021227860.

Determinants of severe acute malnutrition among children aged 6-23 months in bahir dar city public hospitals, Northwest Ethiopia, 2020: a case control study.

BACKGROUND: Severe acute malnutrition is a major problem among developing countries and it is one of the major causes of mortality and morbidity in Ethiopia. The impact is more severe among children aged 6-23 months. Severely malnourished children are nine times more likely to die than healthy children. Identification of the determinants of severe acute malnutrition under the age of two years can significantly reduce the burden of child morbidity and mortality. Therefore, this study was aimed to assess determinants of severe acute malnutrition among children aged 6-23 months at Bahir Dar city public hospitals, Northwest Ethiopia, 2020. METHODS: Institutional-based unmatched case-control study was conducted among a total sample size of 201 children (67 cases and 134 controls) in Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized teaching hospital, from February 2020-March 2020. Children diagnosed with severe acute malnutrition were considered as cases and children with other problems were control groups. The study participants were randomly selected from pediatrics units in the two specialized hospitals. Data were collected using a structured pretested questionnaire through interviews and anthropometric measurements. The data were entered into Epi data version 3.1 and exported to SPSS software version 23 for analysis. Variables with (p < 0.25) in the bivariable analysis were entered into multivariable logistic regression. For multivariable analysis, a backward method was selected with a 95% confidence interval. Statistical significance was declared at P < 0.05. RESULTS: In this study, 67 cases and 134 controls of children with their mothers had participated with an overall response rate of 100%. Family size > 5 [(AOR = 3.89, 95% CI:(1.19, -12.70)], average perceived birth weight [(AOR = 0.048, 95% CI: 0.015, -0.148)] and large perceived birth weight [(AOR = 0.023, 95% CI:(0.002, -0.271)], introduction of complementary feeding before six months [(AOR = 6.21, 95% CI: (1.44, -26.76)] and dietary diversity score < 5 groups [(AOR = 9.20, 95% CI; 3.40, -19.83)were significant factors associated with severe acute malnutrition. CONCLUSION: In this study, dietary diversity, family size, perceived birth weight, and initiation of complementary feeding were significantly associated with severe acute malnutrition. Therefore, emphasis should be given to improving infant and young child feeding practices, especially timely initiation of complementary feeding and dietary diversity.

Parental experiences in neonatal intensive care unit in Ethiopia: a phenomenological study.

INTRODUCTION: Neonatal intensive care unit is important to save the lives of a sick neonate; however, parents are challenged by several stressful conditions during their stay. Therefore, this study aimed to explore the lived experiences of parents in neonatal intensive care units in Ethiopia. METHODS: We used a phenomenological study design. The data were collected using an in-depth interview method from purposively selected parents. In addition, we followed a thematic analysis approach and used Open Code Software Version 4.02 to process the data. RESULTS: In this study, 18 parents were interviewed. The researchers have identified six themes. Parents complained of psychological problems like anxiety, stress, worries, hopelessness, and a state of confusion. In addition, anger, crying, sadness, frustration, dissatisfaction, regret, disappointment, feeling bad, self-blaming, nervousness, disturbance, and lack of self-control were major emotional problems raised by the parents. Parents expressed that health care providers showed indiscipline, lack of commitment, and uncooperative behaviour. Likewise, shortage of medicines, money, and limited time to visit their neonates were the other concerns of many parents. At the same time, parents were provided minimal information and limited cooperation from health care providers. CONCLUSION: Parents whose infants admitted to the NICU were suffered from various psychological and emotional problems. Researchers recommend that health care providers should be supported parents with psycho-emotional problems, strengthen parents-healthcare workers' interaction, and scale up neonatal intensive care unit services to the primary health care centres.KEY MESSAGESParents whose infants admitted to the NICU were suffered from psychological and emotional problems.Poor NICU environment, shortage of equipment, long hospital stay, the presence of pandemic COVID-19, and lack of parental involvement in the care were identified barriers that affected parents' stay.

Social capital and maternal and child health services uptake in low- and middle-income countries: mixed methods systematic review.

BACKGROUND: Social capital has become an important concept in the field of public health, and is associated with improved health services uptake. This study aimed to systematically review the available literature on the role of social capital on the utilization of maternal and child health services in low- and middle-income countries (LMICs). METHODS: Mixed-methods research review and synthesis using three databases PubMed, Scopus, and Science Direct for peer-reviewed literature and Google Scholar and Google search engines for gray literature were performed. Both quantitative and qualitative studies conducted in LMICs, published in English and in grey literature were considered. Prior to inclusion in the review methodological quality was assessed using a standardized critical appraisal instrument. RESULTS: A total of 1,545 studies were identified, of which 13 records were included after exclusions of studies due to duplicates, reading titles, abstracts, and full-text reviews. Of these eligible studies, six studies were included for quantitative synthesis, and seven were included for qualitative synthesis. Of the six quantitative studies, five of them addressed the association between social capital and health facility delivery. Women who lived in communities with higher membership in groups that helps to form intergroup bridging ties had higher odds of using antenatal care services. Synthesized qualitative findings revealed that women received some form of emotional, informational, and instrumental support from their network members. Receiving health information from trusted people and socio-cultural factors influenced the use of maternal and child health services. CONCLUSIONS: Social capital has a great contribution to improve maternal and child health services. Countries aiming at improving maternal and child health services can be benefited from adapting existing context-specific social networks in the community. This review identified limited available evidence examining the role of social capital on maternal and child health services uptake and future studies may be required for an in-depth understanding of how social capital could improve maternal and child health services. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021226923.

Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia.

BACKGROUND: As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education's effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. METHODS: To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. RESULTS: Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (ß = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (ß = - 0.25, p < 0.05), taking aspirin (ß = 0.76, p < 0.05), and having a history of hospitalization (ß = 0.91, p < 0.05). CONCLUSIONS: We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. TRIAL REGISTRATION NUMBER: PACTR201908812642231.

Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia.

BACKGROUND: Health care workers (HCWs) are at an increased risk of acquiring tuberculosis (TB) compared to the general population, because of the frequent face to face contact or potential exposure to TB through shared air or space with infectious patient(s), regardless of economic setting and local TB incidence. Information on the burden of active TB disease among HCWs will help guide control measures, can be utilized to evaluate the effectiveness of TB infection prevention programs in the health care setting, and guide necessary actions. However, data on TB among HCW in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of active TB disease among healthcare workers and support staff in healthcare settings in the Amhara region of Ethiopia. METHODS: A cross-sectional study design was used to recruit a total of 580 randomly selected study participants in the Amhara region. Data were collected over four months in selected hospitals and health centers. Implementation of TB prevention and control measures was evaluated using a standardized checklist. The main outcome indicator was active TB as measured by a laboratory diagnosis using GeneXpert technology. RESULTS: A total of 580 study participants were enrolled. The mean age was 31.3 (±7.8 standard deviation) years, with about two-thirds (65.3%) aged between 18-24 years. A total of 9 (1.6%) MTB cases were detected, 4 (1.4%) in HCWs and 5 (1.7%) in support staff, which did not significantly differ (P = 0.50). About 90% of the participants had not received TB infection prevention and control training ever. More than half (54%) of the study participants worked in poorly ventilated rooms. Triage of coughing patients was not practiced in 32% of the studied facilities (health centers and hospitals). CONCLUSIONS: The magnitude of TB among healthcare workers and support staff in healthcare settings was higher than in the general population (140 per 100000 population). The status of implementation of tuberculosis prevention and control measures indicated missed opportunities. Hence, strict implementation of developed infection control plans of TB in healthcare settings needs to be improved.

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study.

BACKGROUND: Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. METHODS: A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. RESULTS: Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. CONCLUSION: The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

Intestinal parasites and HIV in Ethiopian tuberclosis patients: A systematic review and meta-analysis.

BACKGROUND: The distribution of intestinal parasites among patients with tuberculosis in Ethiopia is not well understood. OBJECTIVE: This systematic review and meta-analysis was designed to determine the pooled national prevalence of intestinal parasites and its association with HIV among patients with tuberculosis in Ethiopia. METHODS: Original articles were searched in PubMed, Google Scholar, EMBASE, World Health Organization's HINARI portal, and supplemented by the hand searching of cross-references. Data were extracted using a standard data extraction checklist. Random-effects model was used to estimate the pooled prevalence of intestinal parasites and odds ratio of the association. The I 2 statistic was utilized to quantify statistical heterogeneity across studies. Funnel plot asymmetry and Egger regression tests were used to check for publication bias. The analysis was done by STATA version 14 for Windows. RESULTS: Of 725 identified studies, 12 articles were eligible for inclusion in the final analysis. The pooled national prevalence of intestinal parasites among patients with tuberculosis in Ethiopia was 36.1% (95% CI, 22.1-50.1; I 2 = 98.7%). Subgroup analysis based on study design indicated that the prevalence of intestinal parasite among case-control studies was 41.69% (95% CI, 28.6-54.8; I 2 = 95.1%). The odds of intestinal parasites among patients with tuberculosis-HIV coinfection was not significantly different compared with patients with tuberculosis without HIV/AIDS (odds ratio = 0.99; 95% CI, 0.7-4.7; P = 0.96). CONCLUSIONS: In Ethiopia, at least 1 out of 3 patients with tuberculosis have an intestinal parasite. These findings suggest a need of more attention on increasing screening tuberculosis patients for intestinal parasites and deworming interventions. (Curr Ther Res Clin Exp. 2020; 81:XXX-XXX).

Common mental illness among epilepsy patients in Bahir Dar city, Ethiopia: A cross-sectional study.

BACKGROUND: Common mental illness has a substantial impact on seizure control and negatively affects the overall quality of life among individuals with epilepsy. However, there is a dearth of studies that examined the associated factors of common mental illness among epilepsy patients in Ethiopia, particularly in the study area. This study aimed to assess the magnitude and factors associated with common mental disorders in epilepsy patients who attended government health institutions in Bahir Dar city, Ethiopia. METHOD: Health institution based cross-sectional study was conducted using a systematic sampling technique among people living with epilepsy in Bahir Dar City Administration. Common mental illness was assessed using a self-reporting questionnaire and a semi-structured questionnaire was employed to collect data on socio-demographic and clinical related characteristics. Data were analyzed using descriptive statistics, univariate logistic regression, and multivariable logistic regression. RESULTS: The magnitude of comorbid common mental illness among people living with epilepsy was found 35.4%. High magnitude of common mental illness was reported among females (39.9%) when compared to males (32.3%). The most prevalent common mental disorders symptoms include being worried, unhappy feeling, trouble thinking clearly, and difficult to enjoy daily activities. Family history of epilepsy, frequent seizures attacks, side effects of antiepileptic drugs, lack of social support and not adherent to antiepileptic drugs were factors associated with common mental illness. CONCLUSIONS: Common mental illness was found to be prevalent among people living with epilepsy. Therefore, it is recommended that great attention should be given to mental illness besides controlling seizure attacks.

A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries.

BACKGROUND: Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa. METHODS: We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger's tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. RESULTS: Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10-4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12-5.74) in Eastern Africa; 4.72 (95% CI: 2.64-6.80) in Western Africa; 4.27 (95% CI: 1.77-6.76) in Northern Africa and 1.46 (95%CI: 0.57-2.34) in southern Africa respectively. CONCLUSION: Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.

Unfinished agenda of the neonates in developing countries: magnitude of neonatal sepsis: systematic review and meta-analysis.

PURPOSE: Neonatal sepsis is the major cause of mortality and morbidity globally, particularly in developing countries. Despite studies revealed the extent of neonatal sepsis in developing countries, the findings were inconclusive. Therefore, the main aim of this study was to determine the pooled prevalence of neonatal sepsis in developing countries. METHODS: We used a systematic review and Meta-analysis study method. The reviewed studies were accessed through an electronic web-based search strategy from the electronic database (PUBMED), advanced google scholar, different journal sites. The data extraction was done by two researchers using a data extraction table and the disparity between data extractors was resolved by the third researcher. The analysis was done using STATA version 11. The I2 test was used to assess heterogeneity across studies. The Funnel plot, Begg's test, and Egger's test were used to check for publication bias. The random-effect model was used to determine the pooled effect size. All studies related to neonatal sepsis which fulfill the inclusion criteria were considered into this study. The quality of each study was checked using the Newcastle-Ottawa Scale and studies graded low score were excluded from the study. RESULTS: At the end, 36 articles fit with our study objectives. Studies conducted in Ethiopia were significant the source of heterogeneity of the study with a coefficient = 90, P-value = 0.025. The overall pooled prevalence of the study was 29.92%. The limitations of this study would be the authors were only used articles reported in the English language, and publication bias. CONCLUSION: The pooled prevalence of neonatal sepsis was found to be high which accounted for a third of the neonates. Despite countries have established possible prevention and treatment mechanisms, neonatal sepsis is the major public health problem in lower and middle-income countries till now.

Prevalence of goiter among children in Ethiopia and associated factors: a systematic review and meta-analysis.

BACKGROUND: The distribution of goiter among children and its risk factors are not well investigated in Ethiopia. Therefore, this systematic review and meta-analysis was designed to determine the pooled prevalence of goiter and its associated factors among children in Ethiopia. METHODS: Electronic web-based searches of PubMed, Google Scholar, EMBASE, and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) were conducted to find primary studies. Relevant data were extracted and descriptive summaries of the studies were presented in tables. The I2 statistic was used to assess heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effects model was used to estimate the pooled prevalence of goiter. Odds ratios (OR) with 95% Confidence Intervals (CI) were also used to determine the association of identified variables with goiter. All statistical analyses were conducted using Stata version 14 software. RESULTS: Our search identified 982 studies, of which, 19 articles were eligible for inclusion in the final meta-analysis. The pooled estimate of goiter among children in Ethiopia was 40.50% (95% CI: 33.6-47.40). The regional distribution of goiter ranged from 44.22 (95% CI: 17.44-71) in Southern Nations Nationalities and Peoples' Region, to 32.79% (95% CI: 19.86-45.73) in Benishangul Gumez region. The prevalence of goiter among female children (44.34%) was higher than among male (32.88%) children. Goiter prevalence was also significantly higher among children who consumed vegetables three or more times per week OR = 1.3 (95% CI: 1.02-1.66); those who had family history of goiter, OR = 2.38 (95% CI: 1.9-2.99); and those whose family stored salt near to fires, OR = 1.4 l (95% CI: 1.1-1.79). CONCLUSION: The prevalence of goiter among children in Ethiopia was high, and endemic according to the WHO criteria. Our findings suggest the need for interventions to improve salt iodization, and for improved health education on appropriate salt storage. In addition, more research may be needed to improve our understanding of foods that increase the risk of goiter among children.

Chewing khat and risky sexual behavior among residents of Bahir Dar City administration, Northwest Ethiopia.

INTRODUCTION: Khat is a well-known natural stimulant and is widely used in Ethiopia, particularly in Bahir Dar city. Khat chewing is linked with risky sexual behaviors. OBJECTIVE: The study was aimed to determine the prevalence of chewing khat and its relation with risky sexual behaviors among residents of Bahir Dar City administration, Northwest Ethiopia. METHODS: A community based cross-sectional study was conducted from January to February, 2016. The data were collected using an interviewer administered structured questionnaire. Logistic regression analysis was applied to assess association between dependent and explanatory variables. RESULTS: The proportion of lifetime and current chewing khat among the study participants were 25.7 and 19.5%, respectively. Males (AOR 5.0; 95% CI 3.0-8.2) than females, merchants (AOR 4.9; 95% CI 2.6-9.3) than government employees, and those with average monthly income of ≥ 3001 Ethiopian birr (AOR 2.4; 95% CI 1.2-4.8) than ≤ 1000 had an increased current chewing khat prevalence. Having lifetime history of chewing khat was significantly associated with ever had sexual intercourse, having extra sexual partners, watching pornographic film and self-reported sexually transmitted infections. CONCLUSION: Chewing khat is associated with increment of having risky sexual behaviors and self-reported sexually transmitted infections. Harm reduction measures are needed to prevent the community from engaging in khat use and risky sexual behaviors.