Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach.

The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12-35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers' occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

Health professionals' technology readiness on the acceptance of teleradiology in the Amhara regional state public hospitals, northwest Ethiopia: Using technology readiness acceptance model (TRAM).

BACKGROUND: Considering individual differences caused by personality differences is crucial for end users' technology acceptance. However, previous studies overlooked the influence of users' technology readiness on technology acceptance. This study, therefore, aimed to evaluate the influence of technology readiness on teleradiology acceptance in the Amhara Regional State Public Hospitals using a technology readiness acceptance model. METHODS: An institutional-based cross-sectional mixed study design was conducted in September 2021 among 547 health professionals working at sixteen public hospitals in the Amhara region of northwest Ethiopia. Eight key informants were interviewed to explore organizational-related factors. Face-to-face and Google Meet approaches were used to collect the data. We applied structural equation modeling to investigate the influence of technology readiness on health professionals' teleradiology acceptance using Analysis of Moment Structures Version 23 software. RESULTS: Of the total participants, 70.2% and 85.7% were ready and intended to use teleradiology, respectively. According to technology readiness measuring constructs, optimism and innovativeness positively influenced health professionals' technology acceptance. Perceived ease of use and perceived usefulness showed a statistically positive significant effect on health professionals' intention to use teleradiology. In addition, a statistically significant mediation effect was observed between technology readiness measuring constructs and behavioral intention to use. Furthermore, a shortage of budget, inadequate infrastructure, and users' lack of adequate skills were reported as critical organizational challenges. CONCLUSIONS: We found a higher proportion of readiness and intention to use teleradiology among health professionals. Personality difference measuring constructs and organizational factors played considerable influence on teleradiology acceptance. Therefore, before the actual implementation of teleradiology, ensuring the system's user-friendliness, improving infrastructure, allocating an adequate budget, and availing of capacity-building opportunities are recommended.

Medical students' knowledge and attitude towards tele-education and associated factors at University of Gondar, Ethiopia, 2022: mixed method.

BACKGROUND: Tele-education is the use of ICTs to conduct remote learning. It has been utilized to deliver ongoing training for many years. The world's modern culture is increasingly reliant on the use of information technology to enhance standards of education. However, in order to deploy successful e-learning systems in a developing nation, understanding of user characteristics is required in the creation and usage of e-learning systems. Thus, this study will enable us to understand the user's level of knowledge and attitude towards tele-education. METHODS: An institution-based quantitative cross-sectional study supported by qualitative design was used 397 medical students at University of Gondar from May to June 2022. A pre-tested self-administered structured questionnaires and in-depth interview were used to collect quantitative and qualitative data respectively. Thematic-content analysis was conducted using open-code software for analyzing qualitative data. Quantitative data was entered to Epi-data version 4.6 and exported to SPSS version 25 software for further statistical analysis. Binary logistic regression was conducted. The adjusted odds ratio(AOR) was used to measure the association between the dependent and independent variables. RESULTS: A total of 397 medical students were participated in this study with a response rate of 93.63%. In this study nearly six out of ten 230(57.9%) of study participants had good knowledge towards tele-education. More than half. 211(53.1%) of medical students participated on the study also had a favorable attitude towards tele-education. Factors associated with knowledge about tele-education is training related to ICT (AOR = 2.27 95% CI; (1.13,4.55)), knowledge of medical education digitization (AOR = 3.80 95% CI; (2.12,6.84)), high computer literacy (AOR = 2.82 95% CI; (1.68,4.72)) and favorable attitude towards tele-education (AOR = 3.52 95% CI; (2.12,5.84)). Factors associated with attitude towards tele-education is age group > 21 (AOR = 3.89, 95% CI; (1.33,11.39)) and good knowledge towards tele-education (AOR = 3.42,95%CI;(2.06,5.66)). CONCLUSION: The study revealed that the knowledge of the medical students was good and nearly five out of ten of them had a favorable attitude towards tele-education. The study shows that training related to ICT, knowledge of medical education digitization, high computer literacy and favorable attitude towards tele-education were associated significantly with knowledge of tele-education. In this study age group > 21 and good knowledge towards tele-education of study participants were associated significantly with attitude towards tele-education.

Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: a descriptive phenomenological study.

BACKGROUND: Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists' services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system. METHODS: Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software. RESULTS: Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service. CONCLUSIONS: This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians' ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians' competence through long-term and short-term trainings are recommended to improve the referral consultation practice.

Facilitators and Barriers to the Sustainability of eHealth Solutions in Low- and Middle-Income Countries: Descriptive Exploratory Study.

BACKGROUND: Despite the widely anticipated benefits of eHealth technologies in enhancing health care service delivery, the sustainable usage of eHealth in transitional countries remains low. There is limited evidence supporting the low sustainable adoption of eHealth in low- and middle-income countries. OBJECTIVE: The aim of this study was to explore the facilitators and barriers to the sustainable use of eHealth solutions in low- and middle-income nations. METHODS: A qualitative descriptive exploratory study was conducted in 4 African nations from September to December 2021. A semistructured interview guide was used to collect the data. Data were audio-recorded and transcribed from the local to the English language verbatim, and the audio data were transcribed. On the basis of the information gathered, we assigned codes to the data, searched for conceptual patterns, and created emerging themes. Data were analyzed thematically using OpenCode software. RESULTS: A total of 49 key informant interviews (10 from Tunisia, 15 from Ethiopia, 13 from Ghana, and 11 from Malawi) were conducted. About 40.8% (20/49) of the study participants were between the ages of 26 and 35 years; 73.5% (36/49) of them were male participants; and 71.4% (35/49) of them had a master's degree or higher in their educational background. Additionally, the study participants' work experience ranged from 2 to 35 years. Based on the data we gathered, we identified 5 themes: organizational, technology and technological infrastructure, human factors, economy or funding, and policy and regulations. CONCLUSIONS: This study explores potential facilitators and barriers to long-term eHealth solution implementation. Addressing barriers early in the implementation process can aid in the development of eHealth solutions that will better fulfill the demands of end users. Therefore, focusing on potential challenges would enhance the sustainability of eHealth solutions in low- and middle-income countries.

Willingness to use electronic medical record (EMR) system and its associated factors among health professionals working in Amhara region Private Hospitals 2021, Ethiopia.

INTRODUCTION: Despite the high expectations of electronic medical records as a great prospect for improving performance in healthcare, the level of adoption and utilization, particularly in a developing country, is low. Knowing the willingness to use the electronic medical record system in the private hospital has an impact on the future implementation status and utilization of the electronic medical record in Ethiopia. However, there was no evidence of the status of the willingness to use electronic medical record systems in private hospitals in the Amhara region. This study aimed to assess the willingness to use electronic medical record Systems and its associated factors among health professionals working in Amhara Region Private Hospitals. METHODS: A cross-sectional institutional study was performed among 406 health professionals selected using proportional allocation with a simple random sampling technique in Amhara region private hospitals by using self-administered structured questionnaires. The data were analyzed using SPSS version 20 software. Descriptive statistics and binary logistic regression were performed to estimate the crude and adjusted odds ratios with a 95% Confidence interval. RESULTS: Out of the 406 participants included in the analysis, 307 (75.6%) showed a willingness to use the electronic medical record system. About three hundred twelve (76.8%) health professionals had good knowledge of electronic medical record systems, and 257 (63.3%) had good computer skills in electronic medical record systems. Health professionals who had electronic medical record knowledge (AOR = 1.85, 95% CI (1.004-3.409)), EMR training (3.29, 95% CI (1.353-8.003)), technical support personnel (1.92, 95% CI (1.122-3.305)), supportive supervision (AOR = 1.97, 95% CI (1.072-3.628)), and computer skill on electronic medical record (1.77, 95% CI (1.002-3.148)) were significantly associated with the outcome variable. CONCLUSIONS: This finding shows a good proportion of willingness to use the electronic medical record system. The most significant factors associated with willingness to use the electronic medical record system were a lack of computer skills, computer training, and knowledge of the electronic medical record system.

Knowledge and awareness of health professionals towards telemedicine services in Northwest, Ethiopia.

Background: Understanding telemedicine technology is significantly important for the implementation of a telemedicine system in resource-limited areas. Specifically, in Ethiopia, the doctor-to-patient ratio was 0.003. This has made it difficult to access healthcare services remotely. Therefore, to maximize and facilitate telemedicine adoption, it is critical to have information about health professionals' knowledge and awareness of telemedicine services. This study aimed to determine the Knowledge and Awareness of Health Professionals towards Telemedicine Services in Northwest, Ethiopia. Methods: An institution-based cross-sectional study design was conducted among 423 health professionals working at referral hospitals from 12 February to 20 March 2020. Descriptive statistics, bivariable and multivariable logistic regression analysis were done. To identify associated factors, an odds ratio with a 95% confidence interval (CI) was used. Result: With a response rate of 411 (97.2%), approximately 56.4% of professionals had good knowledge and 57.4% had high awareness of telemedicine services. Information sharing culture [AOR = 3.01, 95% CI: 1.89, 4.80], IT support staff [AOR = 1.87, 95% CI: 1.06, 3.29], internet as a source of information [AOR = 1.80, 95% CI: 1.1, 2.94], awareness [AOR = 1.35, 95% CI: 1.03, 2.40], and being male [AOR = 1.73, 95% CI:1.06], telemedicine training [AOR = 2.33, 95% CI: 1.15, 4.72] and computer accessibility in their hospitals [AOR = 1.54,95% CI: 1.01, 2.35] were significantly associated with respondents' awareness of telemedicine services. Conclusion: More than half of the participants were well-versed in and aware of telemedicine applications. Information sources, having IT support staff, information sharing culture, gender, and awareness were significant for telemedicine service knowledge, and telemedicine training and computer access were significant factors for health professionals' awareness of telemedicine services. As a result, health professionals should receive appropriate and ongoing awareness-raising training on telemedicine systems.

Health professionals' readiness and its associated factors to implement Telemedicine system at private hospitals in Amhara region, Ethiopia 2021.

INTRODUCTION: In resource-limited settings incorporating the Telemedicine system into the healthcare system enhances exchanging valid health information for practicing evidence-based medicine for the diagnosis, treatment, and prevention of diseases. Despite its great importance, the adoption of telemedicine in low-income country settings, like Ethiopia, was lagging and increasingly failed. Assessing the readiness of health professionals before the actual adoption of telemedicine is considered the prominent solution to tackle the problem. However, little is known about Health professionals' telemedicine readiness in this study setting. OBJECTIVE: Accordingly, this study aimed to assess health professionals' readiness and its associated factors to implement a Telemedicine system at private hospitals in North West, Ethiopia. MATERIALS AND METHODS: An institution-based cross-sectional study was conducted from March 3 to April 7, 2021. A total of 423 health professionals working in private hospitals were selected using a simple random sampling technique. Multi-variable logistic regression was fitted to identify determinant factors of health professional readiness after the other covariates were controlled. RESULT: In this study the overall readiness of telemedicine adoption was 65.4% (n = 268) [95% CI:60.1-69.8]. Knowledge (AOR = 2.5;95% CI: [1.4, 4.6]), Attitude (AOR = 3.2;95% CI: [1.6, 6.2]), computer literacy (AOR = 2.2; 95% CI: [1.3, 3.9]), computer training (AOR = 2.1;95% CI: [1.1, 4.1]), Computer skill (AOR = 1.9;95% CI: [1.1, 3.4]), computer access at office (AOR = 2.1;95% CI: [1.1, 3.7]), Internet access at office (AOR = 2.8; 95% CI: [1.6, 5.1]), Own personal computer (AOR = 3.0; 95% CI: [1.5, 5.9]) and work experience (AOR = 3.1; 95% CI: [1.4, 6.7]) were significantly associated with the overall health professionals readiness for the adoption of telemedicine using a cut point of p-value lessthan 0.05. CONCLUSION AND RECOMMENDATION: Around two-thirds of the respondents had a good level of overall readiness for the adoption of telemedicine. The finding implied that less effort is required to improve readiness before the implementation of telemedicine. This findings implied that respondents who had good knowledge and a favorable attitude toward telemedicine were more ready for such technology. Capacity building is needed Enhance computer literacy, and computer skills building their confidence to rise ready for such technology. Building their capacity through training, building good internet connection, and availability of computers, where the necessary measures to improve Telemedicine readiness in this setting. Additionally, further studies are recommended to encompass all types of telemedicine readiness such as organizational readiness, technology readiness, societal readiness, and so on. Additionally, exploring the healthcare provider opinion with qualitative study and extending the proposed study to other implementation settings are recommended to be addressed in future works. The study has a positive impact on the successful implementation and use of telemedicine throughout hospitals at countries level by providing pertinent information about health professionals' preparedness status. Therefore, implementing telemedicine will have a significant contribution to the health system performance improvement in terms of providing quality care, accessibility to health facilities, reduction of costs, and creating a platform for communication between health professionals across different health institutions for providing quality patient care.

Spatio-temporal distribution and associated factors of anaemia among children aged 6-59 months in Ethiopia: a spatial and multilevel analysis based on the EDHS 2005-2016.

OBJECTIVES: Anaemia is a global public health problem with major health and socioeconomic consequences. Though childhood anaemia is a major public health problem in Ethiopia, there is limited evidence on the spatio-temporal variability of childhood anaemia over time in the country. Therefore, this study aimed to assess the spatio-temporal distribution and associated factors of childhood anaemia using the Ethiopian Demographic and Health Survey (EDHS) data from 2005 to 2016. DESIGN: Survey-based cross-sectional study design was employed for the EDHS. SETTING: Data were collected in all nine regions and two city administrations of Ethiopia in 2005, 2011 and 2016. PARTICIPANTS: The source population for this study was all children in Ethiopia aged 6-59 months. A total of 21 302 children aged 6-59 months were included in this study. OUTCOME MEASURE: The outcome variable was child anaemia status. RESULTS: The prevalence of anaemia declined from 53.9% in 2005 to 44.6% in 2011, but it showed an increase in 2016 to 57.6%. The spatial analysis revealed that the spatial distribution of anaemia varied across the regions. The spatial scan statistics analysis indicated a total of 22 clusters (relative risk (RR)=1.5, p<0.01) in 2005, 180 clusters (RR=1.4, p<0.01) in 2011 and 219 clusters (RR=1.4, p<0. 0.01) in 2016, significant primary clusters were identified. The child's age, mother's age, maternal anaemia status, wealth index, birth order, fever, stunting, wasting status and region were significant predictors of childhood anaemia. CONCLUSIONS: In this study, childhood anaemia remains a public health problem. The spatial distribution of childhood anaemia varied significantly across the country. Individual-level and community-level factors were associated with childhood anaemia. Therefore, in regions with a high risk of childhood anaemia, individual-level and community-level factors should be intensified by allocating additional resources and providing appropriate and tailored strategies.

Involvement in family planning service utilization and associated factors among married men at Debre Tabor town, Northwest Ethiopia, 2017.

INTRODUCTION: men´s involvement in family planning (FP) can be either as a user of male contraceptive methods and/or support of the male partners. In some developing countries, levels of communication on this issue is low for decision-making. Unmet need for FP suggested that unwanted pregnancy and unsafe abortion are the main causes of maternal mortality in Ethiopia. Men's involvement in family planning is very important to improve women´s health in particular and reproductive health in general. METHODS: the community based cross-sectional study design was conducted to assess men´s involvement in family planning service and associated factors among married men at Debre Tabor town. A simple random sampling method was used to include 382 married males. Data were collected by face-to-face interview using a structured questionnaire. The data were entered into Epi Info 7 and were analyzed using SPSS version 21 statistical software package. RESULTS: from three hundred and eighty-two participants, 373 participated yielding a 97.6% response rate. The age range of the participants' was from 20 to 65 years, the mean age was 38.6 with the standard deviation of ±7.8. The majority of the participants were Orthodox followers 358 (96%). About 33.2% of them were greater than secondary education level. The magnitude of male involvement in family planning was 254 (68.1%), 370 (99.2%) of the participants had information on different family planning methods. Adjusting all other factors for the final model, educational status AOR = 2.39 [1.084, 5.260], source of information AOR [95%CI] = 1.88 [1.016, 3.485], men's approval AOR [95%CI] = 0.07 [0.036, 0.134], ever used contraceptive AOR [95%CI] = 0.21 [0.064, 0.705] were found to be associated with men's involvement. CONCLUSION: the level of male involvement was moderate, but their actual utilization is low.

Assessment of emergency contraceptives utilization and associated factors among female college students at Debre Tabor town.

BACKGROUND: Unwanted pregnancy is a significant public health problem worldwide. In higher education, students are exposed to the risk of unintended pregnancy, abortion, and its related negative consequences. OBJECTIVE: The objective of this study was to assess the magnitude of emergency contraceptives and factors associated with its utilization among college female students at Debre Tabor Town, Northwest Ethiopia. METHODS: A cross-sectional, institutional-based study was conducted from June to October 2017. A multi-stage stratified sampling technique was applied to select the study participants. Data were cleaned, coded, and entered into Epi info 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression was used to identify the association between the use of emergency contraception and the predictor variables. The P-value less than 0.05 at 95% CI was taken as statistical significance. RESULTS: A total of 821 respondents participated with a response rate of 97.6%. The finding showed that 33.3% of them have used emergency contraceptives following unprotected sex. Female students' knowledge about emergency contraceptive [AOR: 2.3; 95% CI 1.20, 4.25], age with 20-24 years category [AOR: 2.3; 95% CI 1.21, 4.49] and married [AOR: 2.8; 95% CI 1.22, 6.21] and divorced [AOR: 4.9; 95% CI 1.12, 21.08] students were found to be significant predictors of EC utilization. CONCLUSIONS: This study revealed that the level of emergency contraceptive utilization was low. Students' level of knowledge about an emergency contraceptive, age at present, and marital status were found to be the major predictor for emergency contraceptive utilization. Therefore, responsible bodies should develop strategies that enhance the knowledge level of students at the college level on the effective utilization of emergency contraceptive methods.

Spatial distribution of incomplete immunization among under-five children in Ethiopia: evidence from 2005, 2011, and 2016 Ethiopian Demographic and health survey data.

BACKGROUND: An estimate of 2-3 million children under 5 die in the world annually due to vaccine-preventable disease. In Ethiopia, incomplete immunization accounts for nearly 16% of under-five mortality, and there is spatial variation for vaccination of children in Ethiopia. Spatial variation of vaccination can create hotspot of under vaccination and delay control and elimination of vaccine preventable disease. Thus, this study aims to assess the spatial distribution of incomplete immunization among children in Ethiopia from the three consecutive Ethiopia demographic and health survey data. METHOD: A cross-sectional study was employed from Ethiopia demographic and health survey (2005, 2011and 2016) data. In total, 7901mothers who have children aged (12-35) months were included in this study. ArcGIS 10.5 Software was used for global and local statistics analysis and mapping. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of incomplete immunization. GWR version 4 Software was used to model spatial relationships. RESULT: The proportion of incomplete immunization was 74.6% in 2005, 71.4% in 2011, and 55.1% in 2016. The spatial distribution of incomplete immunization was clustered in all the study periods (2005, 2011, and 2016) with global Moran's I of 0.3629, 1.0700, and 0.8796 respectively. Getis-Ord analysis pointed out high-risk regions for incomplete immunization: In 2005, hot spot (high risk) regions were detected in Kefa, Gamogofa, KembataTemibaro, and Hadya zones of SNNPR region, Jimma zone of Oromiya region. Similarly, Kefa, Gamogofa, Kembatatemibaro, Dawuro, and Hadya zones of SNNPR region; Jimma and West Arsi zones of Oromiya region were hot spot regions. In 2016, Afder, Gode, Korahe, Warder Zones of Somali region were hot spot regions. Geographically weighted regression identified different significant variables; being not educated and poor wealth index were the two common for incomplete immunization in different parts of the country in all the three surveys. CONCLUSION: Incomplete immunization was reduced overtime across the study periods. The spatial distribution of incomplete immunization was clustered and High-risk areas were identified in all the study periods. Predictors of incomplete immunization were identified in the three consecutive surveys.

Geographical variations of early age sexual initiation among reproductive-age women in Ethiopia: evidence from EDHS 2016.

BACKGROUND: The early age of sexual initiation contribute a lot for various risks such as mistimed pregnancy followed by insecure termination, developing fistula and contracting sexually transmitted infections which are currently the major public health concerns for low-income countries. Therefore, the purpose of this study was to detect spatial clusters and identify factors associated with an early age sexual initiation of women in the reproductive age group. METHODS: We used a population-based nationwide representative Ethiopian Demographic and Health Survey (EDHS) 2016 data.. A total of 12,033 respondents of reproductive age (15-49 years) women who had at least one event of sexual intercourse was retrieved and included for the analysis. Spatial cluster detection and autocorrelation analysis were also done to explore the patterns of early age sexual initiation. RESULTS: The median age at first sexual intercourse among respondents was 16 (±3.3) years and more than half (66.2%) had their first sexual intercourse before the age of 18 years. The spatial variations of the age of sexual initiation was nonrandom and clustered with a Moran's I = 0.413 (P-value < 0.001). In addition, five significant spatial clusters were also identified. Moreover, the probability of starting sex at an earlier age was associated with the respondent's residence, marital status, educational attainment and wealth index. CONCLUSION: This study found a higher proportion of an early age sexual initiation of women. Respondent's residence, marital status, educational attainment and wealth index were significantly associated with early sexual initiation. The SaTScan analysis identified five statistical significant spatial clusters which indicate that there were geographical variations. Therefore, integrated interventions focusing on the identified high spot clustered areas are recommended to reduce early age sexual initiation.

Factors associated with the preference of institutional delivery after antenatal care attendance in Northwest Ethiopia.

BACKGROUND: Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. METHOD: A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. RESULTS: Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. CONCLUSION: Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.

Spatial variations of women's home delivery after antenatal care visits at lay Gayint District, Northwest Ethiopia.

BACKGROUND: Home delivery is the most frequent childbirth practice in Ethiopia and brings health risks for many mothers and their babies which in turn affecting the whole families. Characterizing the spatial variations and the associated factors of home deliveries after antenatal care visit is necessary to prioritize risks and facilitate geographically based interventions. METHOD: A community-based cross-sectional study design was carried out between February and March 2016. A total of 528 women who had just given birth were interviewed face-to-face using a questionnaire. Geo-referenced data were collected using a handheld global positioning system (GPS). The Bernoulli model was applied using the SatScan ™ software to analyze the purely spatial clusters of home deliveries. ArcGIS version 10.1 was used to visualize clusters of home delivery. RESULTS: The overall proportion of home deliveries was 278(52.7%), and home deliveries had spatial variations. A primary cluster [LLR = 14.54, p < 0.001] was detected in village of Safida Giorgis. Secondary clusters were detected in Checheho [LLR = 9.17, p < 0.05] and ZurAmba [LLR = 8.51, p < 0.05]. Predictors for home delivery included the distance between the health extension worker's and mother's house [AOR = 2.2, 95% CI: 1.1, 4.3], residence [AOR = 3.8, 95% CI: 1.3, 10.9], source of information for ANC [AOR = 0.3, 95% CI: 0.13, 0.7], ANC visits [AOR = 6.1, 95% CI:1.9, 19.3], health education [AOR = 3.4, 95% CI: 1.5, 7.4], decision on place of delivery [AOR = 0.3, 95% CI: 0.1, 0.8], and knowledge on place of delivery [AOR = 0.04, 95% CI: 0.0, 0.1]. CONCLUSION: The proportion of home delivery after ANC visit was decreasing compared to other studies conducted in the region. In addition, spatial variations of home delivery were observed in the study area. Promoting women's education and behavioral change communication at the grass root level, provision of the services both at home and health facilities and improving the quality and capacity of the health providers are some of the recommendations forwarded.

Focused antenatal care utilization and associated factors in Debre Tabor Town, northwest Ethiopia, 2017.

OBJECTIVE: Attending antenatal care helps to reduce the occurrence of maternal morbidity and mortality by providing chances for health promotion and information about danger signs, birth preparedness and where to seek care for pregnancy complications. Therefore identifying factors affecting the utilization of focused ANC service is of supreme importance. RESULTS: A total of 317 mothers who had a history of antenatal care for their last birth during the previous 6 months were included in the study from which 112 (35.3%, 95% CI 30.6, 40.4) of mothers attended focused antenatal care services. Age of mother [AOR = 4.7, 95% CI 1.87, 11.88], Educational status [AOR = 2.5, 95% CI 1.00, 6.19], history of still birth [AOR = 13.1, 95% CI 2.14, 80.20] and planned pregnancy [AOR = 3.7, 95% CI 1.23, 11.12] were found to be major predictors for focused ANC service utilization. Proportion of focused antenatal care was low (35.3%). Age of mother, education, history of stillbirth and planned pregnancy were identified as predictors affecting focused antenatal care service utilization. Encouraging women's educational status, behavioral change communication at grass root level and improving the capacity and quality of ANC service are some of the recommendations forwarded.