Health literacy and health information sources in relation to foodborne and waterborne diseases among adults in Gedeo zone, southern Ethiopia, 2022: A community-based cross-sectional study.

Introduction: Foodborne and waterborne illnesses affect billions of people each year and impose a significant burden on public health globally. To reduce the prevalence of foodborne and waterborne illness in resource-constrained settings like Ethiopia, it is essential to recognize and address the factors that influence health literacy and the sources of health information. We explored health literacy and health information sources regarding foodborne and waterborne illnesses among adults in the Gedeo zone. Methods: A community-based quantitative study was undertaken between March and April 2022 in the Gedeo zone in southern Ethiopia. A semi-structured, pretested, and interviewer-administered questionnaire was used to collect data from 1,175 study participants selected through a systematic sampling technique. Data were entered in Epidata version 4.6 and analyzed in STATA version 14.2. Data were analyzed using descriptive statistics and the Chi-square test, and multivariate logistic regression analysis was used to assess the associations between variables at a significance level of 0.05. Further, a structural equation model or path analysis was also used in the data analysis. Result: 1,107 (about 51% men) study participants were included in the analysis. About 25.5% of the participants had a foodborne or waterborne illness in the last six months before the survey. Family members and/or close friends were the most-used channel of health information (43.3%), and the internet or online sources were the least-used (14.5%). The result of path analysis shows that seeking health information, having adequate health literacy, and foodborne and waterborne literacy were significantly associated with lower incidences of foodborne or waterborne illness. Conclusion: Our findings showed that individuals with a higher level of health literacy and foodborne and waterborne illness literacy had a lower incidence of foodborne and waterborne illness. Similarly, obtaining health information is positively associated with lowering the incidence of foodborne and waterborne illnesses. Importantly, our findings show mass media has the potential to reach a large audience when educating adults about foodborne and waterborne illnesses.

Artificial Intelligence and Machine Learning Based Prediction of Viral Load and CD4 Status of People Living with HIV (PLWH) on Anti-Retroviral Treatment in Gedeo Zone Public Hospitals.

Background: Despite the success made in scaling up HIV treatment activities, there remains a tremendous unmet demand for the monitoring of the disease progression and treatment success, which threatens HIV/AIDS treatment and control. This research presented the assessments of viral load and CD4 classification of adults enrolled in ART care using machine learning algorithms. Methods: We trained, validated, and tested eight machine learning (ML) classifier algorithms with historical data, including demographics, clinical, and laboratory data. Data were extracted from the ART registry database of Yirgacheffe Primary Hospital and Dilla University Referral Hospital. ML classifiers were trained to predict virological failure (viral load >1000 copies/mL) and poor CD4 (CD4 cell count <200 cells/mL). The model predictive performances were evaluated using accuracy, sensitivity, specificity, precision, f1-score, F-beta scores, and AUC. Results: The mean age of the sample participants was 41.6 years (SD = 10.9). The experimental results showed that XGB classifier ranked as the best algorithm for viral load prediction in terms of sensitivity (97%), f1-score (96%), AUC (0.99), accuracy (96%), followed by RF. The GB classifier exhibited a better predictive capability in predicting participants with a CD4 cell count <200 cells/mL. Conclusion: In this study, the XGB and RF models had the highest accuracy and outperformed on various evaluation metrics among the models examined for viral load classification. In the prediction of participants CD4, GB model had the highest accuracy.

Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis.

BACKGROUND: Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12-23 months in Ethiopia. METHODS: A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. RESULTS: Complete basic childhood vaccination among children aged 12-23 months had a significant variation in Ethiopia (Moran's I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region's Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region's (SNNPR) Gedeo and Sidama zones; and the Oromia region's Bale and Guji zones. The second significant cluster was found in the Afar region's zones 1, 4, and 5, as well as the northern Somali region's Siti zone. In the multivariable multilevel analysis, maternal age 20-24, 25-29, 35-39, and 40-44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. CONCLUSION: A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.

Predictors of Mental Health Literacy and Information Seeking Behavior Toward Mental Health Among University Students in Resource-Limited Settings.

Background: This paper investigated mental health literacy level and information seeking behavior, and mental health-related information sources in limited-resource settings, in the case of Ethiopian university students. Methods: A cross-sectional, self-administered web-based survey was conducted among Dilla University students, from 1 January to 29 February 2022, with a total of 780 respondents. We presented descriptive statistics using mean, standard deviations, and proportions. Bivariate and multivariate logistic regression were employed to identify factors associated with mental health literacy and information seeking behavior of students. Further, path analysis was also employed. Results: The result showed 71 (9.1%) respondents had a diagnosed history of mental illness. Overall, 397 (50.9%) respondents were identified as having adequate mental health literacy and 420 (53.8%) sought mental health information. In multivariate analysis, mental health literacy was significantly associated with: being female (AOR = 2.8; 95% CI (1.5-5.4)), higher digital health literacy (AOR=2.8; 95% CI (1.5-5.4), seeking mental health-related information (AOR=1.6; 95% CI: (1.1-2.5)), having family with mental illness, and students in health-related programs (AOR = 2.1; 95% CI (1.0-4.2)). Furthermore, health-related programs, level of mental health literacy, exposure to mental health problems in the family, and were associated with information seeking behavior regarding mental health. Further, path analysis revealed significant positive associations of information seeking behavior and digital health literacy with mental health literacy. Conclusion: The result indicated the status of university students' mental health literacy level and information seeking behavior were low and inadequate. This study suggests the need to improve students' digital health competencies by designing mental health literacy programs by collaboration of different stakeholders, and mental health literacy programs need to optimize access to internet and online resources in the university settings.

Prevalence and Determinants of COVID-19 Vaccine Hesitancy Among the Ethiopian Population: A Systematic Review.

Introduction: Although vaccination is the most effective way to end the COVID-19 pandemic, there are growing concerns that vaccine hesitancy may undermine its effectiveness. In Ethiopia, vaccine hesitancy forms a major challenge to the uptake of COVID-19 vaccines. This systematic review examined the prevalence and determinants of the COVID-19 vaccine hesitancy among the Ethiopian population. Methods: A systematic search of articles was conducted in PubMed, EBSCO, Google Scholar, and Semantic Scholar. Studies that evaluated the prevalence and determinants of COVID-19 vaccine hesitancy in Ethiopia were included. The identified determinants of COVID-19 vaccine hesitancy were analyzed based on the frequency of occurrence in the included studies. Results: The overall COVID-19 vaccine hesitancy level in the Ethiopian population ranged from 14.1% to 68.7%. The high COVID-19 vaccine hesitancy rate observed in this study was due to contextual factors, individual factors, and vaccine-specific factors. Young age, female sex, living in rural areas, lack of adequate information, and lower education are the most common contextual determinants of the COVID-19 vaccine hesitancy. Lack of awareness about the COVID-19 vaccine, low risk of COVID-19, poor adherence to COVID-19 prevention strategies, and negative attitude towards the COVID-19 vaccine are the most frequently reported personal factors. Common vaccine-specific determinants of COVID-19 vaccine hesitation are the side effects of the vaccine and doubts about its effectiveness of the vaccine. Conclusion: Our review showed that COVID-19 vaccine hesitancy remains highly prevalent and varied across regions of Ethiopia, with a wide variety of factors associated with it. Potential interventions on the benefits of vaccination and the adverse effects of vaccine rejection are crucial to enhance COVID-19 vaccine uptake among the Ethiopian population.

Spatial trends and projections of chronic malnutrition among children under 5 years of age in Ethiopia from 2011 to 2019: a geographically weighted regression analysis.

INTRODUCTION: Undernutrition is a serious global health issue, and stunting is a key indicator of children's nutritional status which results from long-term deprivation of basic needs. Ethiopia, the largest and most populous country in Sub-Saharan Africa, has the greatest rate of stunting among children under the age of five, yet the problem is unevenly distributed across the country. Thus, we investigate spatial heterogeneity and explore spatial projection of stunting among under-five children. Further, spatial predictors of stunting were assessed using geospatial regression models. METHODS: The Ethiopia Demographic and Health Surveys (EDHS) data from 2011, 2016, and 2019 were examined using a geostatistical technique that took into account spatial autocorrelation. Ordinary kriging was used to interpolate stunting data, and Kulldorff spatial scan statistics were used to identify spatial clusters with high and low stunting prevalence. In spatial regression modeling, the ordinary least square (OLS) model was employed to investigate spatial predictors of stunting and to examine local spatial variations geographically weighted regression (GWR) and multiscale geographically weighted regression (MGWR) models were employed. RESULTS: Overall, stunting prevalence was decreased from 44.42% [95%, CI: 0.425-0.444] in 2011 to 36.77% [95%, CI: 0.349-0.375] in 2019. Across three waves of EDHS, clusters with a high prevalence of stunting in children under 5 years were consistently observed in northern Ethiopia stretching in Tigray, Amhara, Afar, and Benishangul-Gumuz. Another area of very high stunting incidence was observed in the Southern parts of Ethiopia and the Somali region of Ethiopia. Our spatial regression analysis revealed that the observed geographical variation of under-five stunting significantly correlated with poor sanitation, poor wealth index, inadequate diet, residency, and mothers' education. CONCLUSIONS: In Ethiopia, substantial progress has been made in decreasing stunting among children under the age of 5 years; although disparities varied in some areas and districts between surveys, the pattern generally remained constant over time. These findings suggest a need for region and district-specific policies where priority should be given to children in areas where most likely to exhibit high-risk stunting.

eHealth Literacy and its Associated Factors Among Health Professionals During the COVID-19 Pandemic in Resource-Limited Settings: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has wreaked havoc on health care systems and governments worldwide. Although eHealth literacy is acknowledged as a critical component of public health, it was overlooked during the pandemic. To assist patients and their families, health professionals should be knowledgeable about online health information resources and capable of evaluating relevant online information. In a resource-constrained situation, the level of eHealth literacy among health professionals is not well documented. OBJECTIVE: The aim of this study was to assess the eHealth literacy level and its associated factors among health professionals working in Amhara regional state teaching hospitals, Ethiopia. METHODS: A self-administered questionnaire was used in an institutional-based cross-sectional study design. Descriptive statistics were calculated to describe eHealth literacy statements and key variables using SPSS v.24. Bivariable and multivariable logistic regression models were fit to identify factors related to eHealth literacy. Variables with P<.05 were declared to be statistically significant predictors. RESULTS: A total of 383 participants completed and returned the questionnaire with a response rate of 90.5%. Health professionals demonstrated a moderate level of eHealth literacy (mean 29.21). Most of the professionals were aware of the available health resources located on the internet, and know how to search and locate these resources. However, they lack the ability to distinguish high-quality health resources from low-quality resources. Factors that were significantly associated with eHealth literacy were computer access, computer knowledge, perceived ease of use, and perceived usefulness of eHealth information resources. CONCLUSIONS: It is crucial to provide training and support to health care workers on how to find, interpret, and, most importantly, evaluate the quality of health information found on the internet to improve their eHealth literacy level. Further research is needed to explore the role of eHealth literacy in mitigating pandemics in developing countries.

Determinants of optimal antenatal care visit among pregnant women in Ethiopia: a multilevel analysis of Ethiopian mini demographic health survey 2019 data.

BACKGROUND: Optimal antenatal care (ANC4+) needs to be used throughout pregnancy to reduce pregnancy complications and maternal mortality. The World Health Organization (WHO) recommends eight ANC contacts, while Ethiopia has the lowest coverage of at least four ANC visits. Therefore, this study aimed to identify factors associated with optimal ANC visits among pregnant women in Ethiopia. METHODS: This study is a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). A multilevel logistic regression model is set up to identify factors associated with optimal ANC visits. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to estimate the strength of the association between the outcome and the predictor variables. RESULTS: Overall, 43% of women had optimal ANC visits during their last pregnancy. Higher educated women are 3.99 times more likely (AOR = 3.99; 95% CI: 2.62-6.02) to have optimal ANC visits than women with no formal education. The wealthiest women are 2.09 times more likely (AOR = 2.09; 95% CI: 1.56-2.82) to have optimal ANC visits than women in the poorest quintile. The odds of optimal ANC visit is 42 percent lower in rural women (AOR = 0.58, 95% CI: 0.41-0.83) compared to women living in urban areas. CONCLUSION: Women's educational status, wealth status, mass media exposure, place of residence and region are factors that are significantly associated with optimal ANC visit. These findings help health care programmers and policymakers to introduce appropriate policies and programs to ensure optimal ANC coverage. Priority should be given to addressing economic and educational interventions.

Optimal antenatal care means attending at least four antenatal care visits during pregnancy. In Ethiopia, evidence on factors affecting the use of at least four antenatal care services has not been adequately documented. Using the 2019 Ethiopian Mini Demographic and Health Survey data, this study attempted to uncover factors associated with optimal antenatal care visits among pregnant women in Ethiopia.Data for women aged 15­49 who gave birth five years before the survey and attended antenatal care visits for their last pregnancy were taken from the 2019 Ethiopian Mini Demographic and Health Survey. Accordingly, 3927 women were included in the analysis.Coverage of optimal antenatal care visits is low among pregnant women in Ethiopia. In this study, only 43% of pregnant women received optimal antenatal care. Women's educational status, household wealth status, household size, mass media exposure, place of residence, and administrative region were associated with optimal antenatal care visits.Strategies to increase access and availability of antenatal care services are important, especially for communities in rural areas and disadvantageous regions. Financial assistance that allows mothers from poor families to access antenatal care services can be beneficial. Health promotion programs targeting uneducated mothers are important to raise awareness of the importance of receiving a minimum of four antenatal care services.

Spatial Variations and Determinants of Acute Malnutrition Among Under-Five Children in Ethiopia: Evidence from 2019 Ethiopian Demographic Health Survey.

Background and aims: Childhood acute malnutrition, in the form of wasting defined by a severe weight loss as a result of acute food shortage and/or illness. It is a critical public health problem that needs urgent attention in developing countries, like Ethiopia. Despite its variation between localities, the risk factors and its geospatial variation were not addressed enough across the various corner of the country. Therefore, the current study was undertaken to assess spatial variation and factors associated with acute malnutrition among under-five children in Ethiopia. Methods: A total weighted sample of 4 955 under-five children were included from the 2019 Demographic and Health Survey. Getis-Ord spatial statistical tool used to identify the hot and cold spot areas of severe and acute malnutrition. A multilevel multivariable logistic regression model using was used to examine predictors of acute malnutrition. In the multivariable multilevel analysis, Adjusted Odds Ratio with 95% CI was used to declare significant determinants of acute malnutrition among children. Result: Among 4 955 under-five children, 7% of them were wasted and 1% of them were severely wasted in Ethiopia during the 2019 national demographic survey. The distribution was followed some spatial geo-locations where most parts of Somali were severely affected (RR = 1.46, P37 value <0.001), and the distribution affected few areas of Afar, Gambella, and Benishangul Gumz regions. Factors that significantly associated with childhood wasting were: gender(male)1.9 (1.3-2.7), age (above 36 months) 0.5 (0.2-0.9), wealth index(richest) 0.5 (0.2-0.8), and water source (unimproved source) 1.5 (1.0-2.3). Conclusions: Our finding implies, the distribution of childhood wasting was not random. Regions like Afar, Somali, and pocket areas in Gambella and SNNP should be considered as priority areas nutritional interventions for reducing acute malnutrition. The established socio-demographic and economic characteristics can be also used to develop strategies.

Prevalence and associated factors of caesarian section in Ethiopia: a multilevel analysis of the 2019 Ethiopia Mini Demographic Health Survey.

BACKGROUND: Caesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia. METHODS: Data from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results. RESULT: The prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively. CONCLUSION: Although evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women's age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.

Exploring Spatial Variations and Determinants of Dietary Diversity Among Children in Ethiopia: Spatial and Multilevel Analysis Using EDHS (2011-2016).

INTRODUCTION: Dietary diversity has a significant impact on children's nutritional health. For developing and implementing interventions, it is critical to understand the regional distribution of dietary diversity and underlying factors. However, the application of spatial techniques in dietary studies has not been well documented. The study's goal was to look into the regional variances and factors that influence children's dietary diversity. Further, we have discussed the spatial correlation of dietary diversity with nutritional status. METHODS: Data from the National Demographic and Health Survey were used during analyses. This work evaluated the overall dietary diversity of children aged 6-23 months based on the 2017 WHO and UNICEF classification of minimum dietary diversity (MDD). The Local Anselin Moran's I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariate multilevel logistic regression was used for factor analyses. RESULTS: Overall, only 13.3% (95% CI: 10.2-14.7%) of children in 2011 and 24% (95% CI: 15.5-26.5%) in 2016 achieved MDD. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) in the districts of northern Ethiopia, notably in the Amhara, Tigray, and Afar regions, and clusters of low inadequate dietary diversity (cold spots) in the country's central and western regions. In both studies, the frequency of dietary diversity was significantly higher among older children, those who had media exposure, and mothers and fathers who had received formal education. CONCLUSION: According to our findings, the MDD of children in Ethiopia, as measured by WHO dietary assessment, slightly increased from 2011 to 2016. The dietary diversity of children was distributed non-randomly in different districts across regions of Ethiopia. Localized intervention and preventative methods to improve dietary patterns and culture can be developed using existing socio-demographic factors and districts with a larger distribution of inadequate dietary diversity.

Barriers to the Adoption of Electronic Medical Record System in Ethiopia: A Systematic Review.

BACKGROUND: Electronic medical records (EMRs) can improve the quality of health care and patient safety. Various countries have gone through the local application of EMRs to various health care organizations in national implementation and integration of EMRs. Ethiopia lags far in the back in this regard, as solely some hospitals have implemented EMR. OBJECTIVE: This study aimed to identify barriers to the adoption of EMRs in Ethiopia through a systematic review of the literature. METHODS: PubMed, Semantic Scholar, and Google Scholar have been searched for applicable articles. The search method focuses on peer-reviewed, empirical research conducted in Ethiopia. The ultimate set that met the inclusion standards was 9 studies. The authors extracted, analyzed, and summarized empirical results associated with EMR barriers in these studies. RESULTS: This systematic review identified the following 17 barriers to EMR adoption: absence of EMR training, limited access to computers, insufficient computer literacy, deficiency of EMR knowledge, inadequate technical help, absence of EMR manual, negative attitude to EMR, limited internet access, lack of management support, electric power interruption, absence of perceived system quality, absence of perceived information quality, lack of willingness, the complexity of the system, performance expectancy, effort expectancy, and lack of IT qualification. CONCLUSION: The most common barriers for EMR adoption are absence of EMR training, limited access to a computer, poor computer literacy, poor EMR knowledge, lack of technical support, and absence of an EMR manual. As this study summarizes the available evidence regarding barriers to adopting EMR in Ethiopia, future research will rest on this evidence and specialize in building a proper framework for EMR implementation in Ethiopia.

Factors Associated with Practicing Evidence-Based Medicine Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: A Cross-Sectional Study.

BACKGROUND: Evidence-based medicine (EBM) is an important component of modern medicine and is essential for the provision of high-quality health services. Little is known about the level of EBM use among Ethiopian medical students. This study aimed to assess the factors associated with EBM practice among medical interns in teaching hospitals in northwestern Ethiopia. METHODS: A cross-sectional study was conducted using a random sample of medical interns in teaching hospitals of northwest Ethiopia. Binary logistic regression analysis was used to identify factors associated with EBM practice. The strength of the interaction between variables was calculated using the adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS: Completed questionnaire was obtained from 403 (95.3%) of 423 medical interns. About 48.4% of respondents had a good EBM practice. EBM knowledge (AOR = 1.86, 95% CI = 1.220-2.835), attitude to EBM (AOR = 2.05, 95% CI = 1.318-3.193), ability to appraise evidence (AOR = 2.35, 95% CI = 1.570-3.517), and having sufficient time to search for evidence (AOR = 1.67, 95% CI = 1.065-2.627) were factors significantly associated to EBM practice. CONCLUSION: This study demonstrates that the main factors affecting medical intern's practice of EBM were lack of critical appraisal skill, lack of knowledge needed to practice EBM, negative attitudes toward EBM, and insufficient time to search for evidence. Providing EBM training to the needs of medical interns would overcome the barriers identified in this study, as well as assist medical interns and other clinical staffs to ensure the correct application of EBM in to clinical practice.

Factors Influencing COVID-19 Vaccination Demand and Intent in Resource-Limited Settings: Based on Health Belief Model.

BACKGROUND: Vaccination is, without doubt, one of the most outstanding health interventions in reducing unprecedented damages of coronavirus disease (COVID-19). Globally, several vaccines have been produced to be effective against COVID-19. This survey aimed to assess the demand and intent towards the COVID-19 vaccine among the general population in Ethiopia. Also, factors influencing their demand, intention, and willingness to pay for the COVID-19 vaccine were described, which is poorly understood in resource-limited settings. METHODS: Subjects were 1160 individuals who completed an online questionnaire from February to March 2021. The study used the health belief model (HBM) to evaluate participants' intention to receive and willingness to pay (WTP) regarding the COVID-19 vaccine. Chi-square and binary logistic regression were conducted to identify the prevalence and associated factors of demand and WTP. Multinomial regression was done to examine the intent to receive a vaccine. RESULTS: In total 1116 responses were collected. The results indicated a moderate level of demand and WTP among participants (64.7% and 56.0%, respectively). Further, the researchers examined participants' readiness towards COVID-19 vaccination, where 46.6% of participants had a definite intent, and close to half of the participants are unsure (32.8%) or unwilling (20.7%) to get vaccinated. Among other factors, items under perceived susceptibility and perceived benefits constructs in the HBM have been associated with participants' demand, willingness to vaccinate, and WTP. CONCLUSION: This study demonstrates the usefulness of the HBM model in evaluating the demand, intention, and willingness of participants to pay for COVID-19. Improving public awareness of the vulnerability should be a major point of attention to reduce the barriers, and improve demand and intention for COVID-19. Moreover, public health messages should be tailored to enhance vaccine literacy.

Tracking progress in anthropometric failure among under-five children in Ethiopia: a geospatial and multilevel analysis.

BACKGROUND: Undernutrition is a major public health concern among under-five children in many developing countries. This work evaluated the overall prevalence of under-nutrition by using a composite index of anthropometric failure (CIAF), which helps in the detection of children with multiple anthropometric failures. This research also includes the Spatio-temporal distribution of childhood anthropometric failures across time. METHODS: Secondary data was obtained from the Ethiopian Demographic and Health Survey for the survey 2005, 2011, and 2016 years. Data included 23,864 samples of children between the ages of 0-59 months, which is a nationally representative sample in Ethiopia. Other than descriptive statistics, the multivariate multilevel logistic regression was used to identify associated factors, and Getis-Ord spatial statistical tools were employed to identify high and low hotspots areas of anthropometric failures. RESULT: The prevalence obtained with CIAF in 2005, 2011, and 2016 was, 53.5 %, 51 %, and 46.2 % of children were suffering from under-nutrition respectively. The spatial analysis revealed areas that are at a higher risk of anthropometric failures consistently were found in northern parts of the country, largely in the Amhara, Tigray, and Afar regions. Multilevel logistic regression analysis showed that the risk of anthropometric failure was higher among older children, had low birth weight, had a mother with low BMI, was in a rural area, had mothers and fathers without formal education. CONCLUSIONS: In addition to identifying wasted, stunted, and underweight children, CIAF also identified children with multiple conditions, which are often overlooked in nutritional surveys. As revealed by this composite index, the prevalence of anthropometric failure remains considerably high and its spatial distribution also significantly varied across the regions in the country. The established socio-demographic characteristics and districts with a higher risk of anthropometric failure can be used to develop localized intervention and prevention strategies to improve Ethiopian children's nutritional status and healthcare.