Recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries: a multilevel analysis of the recent demographic and health survey.

INTRODUCTION: Diarrhea is a common public health problem and the third leading cause of death in the world among children under the age of five years. An estimated 2 billion cases and 1.9 million deaths are recorded among children under the age of five years every year. It causes body fluid loss and electrolyte imbalance. Even though, early initiation of recommended homemade fluid is a simple and effective approach to prevent diarrhea-related complications and mortality of children, recommended homemade fluid utilization for the treatment of diarrhea is still low in sub-Saharan African countries. Therefore, this study aimed to assess the magnitude of recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries. METHOD: The most recent Demographic and Health Survey dataset of 21 sub-Saharan African countries from 2015 to 2022 was used for data analysis. A total of 33,341 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results. RESULT: The overall recommended homemade fluid utilization for the treatment of diarrhea among children under five in sub-Saharan African countries was 19.08% (95% CI = 18.66, 19.51), which ranged from 4.34% in Burundi to 72.53% in South Africa. In the multivariable analysis, being an educated mother/caregiver (primary and secondary level) (AOR = 1.15, 95% CI: 1.04, 1.27) and (AOR = 1.30, 95% CI: 1.15, 1.1.47), the primary and secondary level of fathers education (AOR = 1.53, 95% CI: 1.37, 1.71) and (AOR = 1.41, 95% CI: 1.19, 1.1.68), having antenatal care follow-up (AOR = 1.16, 95% CI: 1.01, 1.33), having multiple children (AOR = 1.17, 95% CI: 1.07, 1.28), and being an urban dweller (AOR = 1.15, 95% CI: 1.04, 1.27) were factors associated with recommended homemade fluid utilization. CONCLUSION: The overall recommended homemade fluid utilization for the treatment of diarrhea was low. Individual and community-level variables were associated with recommended homemade fluid utilization for the treatment of diarrhea. Therefore, special consideration should be given to rural dwellers and caregivers who have three and below children. Furthermore, better to strengthen the antenatal care service, mother/caregiver education, and father's education to enhance recommended homemade fluid utilization for the treatment of diarrhea.

Rotavirus vaccine dose-two dropout and its associated factors among children who received rotavirus vaccine dose-one in Sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey.

Rotavirus is the most common cause of diarrhea in children worldwide. In 2016, rotavirus infection resulted in 258 173 300 episodes of diarrhea and 128 500 child deaths in the globe. The study aimed to assess the magnitude of Rotavirus vaccine dose-two dropout and associated factors among children who received rotavirus vaccine dose-one in sub-Saharan African countries. The appended and most recent demographic and health survey (DHS) dataset of 17 sub-Saharan African countries was used for data analysis. A total of 73,396 weighted samples were used. Factors associated with the outcome variable were considered significant if their p-values were ≤ .05 in the multilevel mixed-effect logistic regression model. The overall Rotavirus vaccine dose-two dropouts was 10.77% (95% CI 10.55%, 11.00%), which ranged from 2.77% in Rwanda to 37.67% in Uganda. Being younger, late birth order, having difficulty accessing health facilities, having no media exposure, having no work, having home delivery, having no antenatal follow-up, and having no postnatal checkup were factors significantly associated with the outcome variable. The overall Rotavirus vaccine dose-two dropout was higher in sub-Saharan African countries which implies that vaccine dropout is still a great issue in the region. Special attention should be given to those mothers who are young, who have no work, who give birth at home, who experienced difficulty in accessing health facilities, and late birth orders. Furthermore, targeted interventions should be considered for improving access and utilization of media, antenatal care, and postnatal care services.

Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016.

INTRODUCTION: Tetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data. METHOD: Secondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant. RESULT: From the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage. CONCLUSION: The finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.

Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study.

Introduction: A stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021. Methods: From 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals. Results: A total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3-43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6-47.5) than among unemployed mothers (36.7%) (95% CI: 32.0-41.7). Maternal age [AOR = 2.8, 95% CI: 1.26-6.34] and wealth status [AOR = 0.32, 95% CI: 0.18-0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95-17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12-3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06-0.26] were associated with stunting of preschool children among employed mothers. Conclusion: Stunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers.

Major maternal related determinants of non-breastfeeding among mothers in Ethiopia: A multilevel analysis from DHS Ethiopia 2016.

INTRODUCTION: In Ethiopia, the burden of non-breastfeeding is still high despite substantial improvements in breastfeeding. However, the determinants of non-breastfeeding were poorly understood. Therefore, the aim of this study was to identify the maternal -related factors associated with non-breastfeeding. METHODS: An in-depth analysis of data from the Ethiopian Demographic and Health Survey 2016 (EDHS 2016) was used. A total weighted sample of 11,007 children was included in the analysis. Multilevel logistic regression models were fitted to identify factors associated with non-breastfeeding. A p-value < of 0.05 was used to identify factors significantly associated with non-breastfeeding. RESULTS: The prevalence of non-breastfeeding in Ethiopia was 5.28%. The odds of not breastfeeding were 1.5 times higher among women aged 35to 49 years (AOR = 1.5 CI: 1.034, 2.267) than among women aged 15to 24 years. The odds of not breastfeeding were higher among children whose mothers had BMIs of 18.5-24.9 (AOR = 1.6 CI: 1.097, 2.368) and 25-29.9 (AOR = 2.445 CI: 1.36, 4.394) than among women with BMIs of < 18.5. In addition, not breastfeeding was also significantly associated with ANC follow-up, where mothers who had 1-3 ANC follow-up had a 54% decreased odds (AOR = 0.651 CI: 0.46,0.921) compared to mothers who had no ANC follow-up. Demographically, mothers from Somalia region were five times (AOR = 5.485 CI: 1.654, 18.183) and mothers from SNNP region were almost four times (AOR = 3.997 CI: 1.352, 11.809) more likely to not breastfeed than mothers residing in Addis Ababa. CONCLUSIONS: Although breastfeeding practices are gradually improving in Ethiopia, the number of children not breastfed remains high. Individual-level characteristics (women's age, body mass index, and ANC follow-up) and community-level characteristics (geographic region) were statistically significant determinants of non-breastfeeding. Therefore, it is good for the federal minister of Health, planners, policy and decision- makers, and other concerned child health programmers to prioritize both individual and community factors.

Prevalence, spatial distribution and determinants of infant mortality in Ethiopia: Findings from the 2019 Ethiopian Demographic and Health Survey.

INTRODUCTION: Infant mortality declined globally in the last three decades. However, it is still a major public health concern in Ethiopia. The burden of infant mortality varies geographically with the highest rate in Sub-Saharan Africa. Although different kinds of literature are available regarding infant mortality in Ethiopia, an up to date information is needed to design strategies against the problem. Thus, this study aimed to determine the prevalence, show the spatial variations and identify determinants of infant mortality in Ethiopia. METHODS: The prevalence, spatial distribution, and predictors of infant mortality among 5,687 weighted live births were investigated using secondary data from the Ethiopian Demographic and Health Survey 2019. Spatial autocorrelation analysis was used to determine the spatial dependency of infant mortality. The spatial clustering of infant mortality was studied using hotspot analyses. In an unsampled area, ordinary interpolation was employed to forecast infant mortality. A mixed multilevel logistic regression model was used to find determinants of infant mortality. Variables with a p-value less than 0.05 were judged statistically significant and adjusted odds ratios with 95 percent confidence intervals were calculated. RESULT: The prevalence of infant mortality in Ethiopia was 44.5 infant deaths per 1000 live births with significant spatial variations across the country. The highest rate of infant mortality was observed in Eastern, Northwestern, and Southwestern parts of Ethiopia. Maternal age between 15&19 (adjusted odds ratio (AOR) = 2.51, 95% Confidence Interval (CI): 1.37, 4.61) and 45&49(AOR = 5.72, 95% CI: 2.81, 11.67), having no antenatal care follow-up (AOR = 1.71, 95% CI: 1.05, 2.79) and Somali region (AOR = 2.78, 95% CI: 1.05, 7.36) were significantly associated with infant mortality in Ethiopia. CONCLUSION: In Ethiopia, infant mortality was higher than the worldwide objective with significant spatial variations. As a result, policy measures and strategies aimed at lowering infant mortality should be devised and strengthened in clustered areas of the country. Special attention should be also given to infants born to mothers in the age groups of 15-19 and 45-49, infants of mothers with no antenatal care checkups, and infants born to mothers living in the Somali region.

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

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I2), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P. VALUE: 0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P. VALUE: 0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P. VALUE: 0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Spatial distribution and determinants of newbornsnot receiving postnatal check-up withintwodays after birth in Ethiopia: a spatial and multilevel analysis of EDHS 2016.

BACKGROUND: Accessibility and utilization of postnatal newborn check-ups within 2 days after delivery are critical for a child's survival, growth, and development. However, the service delivery is not yet improved and fluctuates across the geographical locations in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of newborns not received postnatal check-ups within 2 days after birth in Ethiopia. METHODS: A secondary data analysis of the Ethiopia Demographic and Health Survey (EDHS) 2016 was done among live births within 2 years preceding the survey. A multilevel binary logistic regression model was fitted to identify the factors associated with the outcome variable. Adjusted Odds Ratio with 95% (Confidence Interval) was calculated and used as a measure of associations and variables with a p-value < 0.05, were declared as statistically significant. RESULTS: A total of 4036 live newborns in Ethiopia were included in the analysis, of whom half (51.21%) were females. The mean age of the mothers was 33+ SD 1.3, and more than 60 % (61.56%) of the mothers were not educated. The national prevalence of newborns not receiving postnatal check-ups within 2 days after birth was 84.29 (95% CI: 83.10-85.41) with significant spatial variations across the study area. Mothers who had no ANC visits were 58% higher than (AOR = 0.42(0.27-0.66) mothers who had > 4 ANC visits. Mothers who gave birth at home and others were 80% (AOR = 0.02(0.01-0.29) and 25% (AOR = 0.76(0.59-0.99), higher than mothers delivered at hospital. Rural mothers were 1.90 times higher (AOR = 1.90(1.29-2.81) than urban mothers, and mothers live in administrative regions of Afar 66% (AOR = 0.34(0.16-0.69), Oromia 47% (AOR = 0.53(0.30-0.91), Somali 60% (AOR = 0.40 (0.22-0.74),Benishangul 50% (AOR = 0.50 (0.27-0.92), SNNPR 67% (AOR = 0.33(0.19-0.57), Gambela 70% (AOR = 0.30 (0.16-0.56), Harari 56% (AOR = 0.44 (0.25-0.78), and Dire Dawa70% (AOR = 0.30 (0.17-0.54) were higher than Addis Abeba for not receiving postnatal checkup of new born within the first 2 days, respectively. CONCLUSIONS: Low postnatal check-up utilization remains a big challenge in Ethiopia, with significant spatial variations across regional and local levels. Spatial clustering of not receiving postanal check-ups within 2 days was observed in Afar, Oromia, Gambela, Benishangul, SNNPR, Harari, and Dire Dawa regions. Residence, ANC visits, place of delivery, and administrative regions were significantly associated with not receiving postnatal check-ups. Geographically targeted interventions to improve ANC follow-up and institutional delivery should be strengthened.

Spatial distribution and associated factors of community based health insurance coverage in Ethiopia: further analysis of Ethiopian demography and health survey, 2019.

BACKGROUND: Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income households excluded from formal insurance and taken as a soft option by many countries. Therefore, exploring the spatial distribution of health insurance is crucial to prioritizing and designing targeted intervention policies in the country. METHODS: A total of 8,663 households aged 15-95 years old were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of community based health insurance. ArcGIS version 10.3 was used to visualize the distribution of community-based health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of community-based health insurance coverage. RESULTS: Community based health insurance coverage among households had spatial variations across the country by regions (Moran's I: 0.252, p < 0.0001). Community based health insurance in Amhara (p < 0.0001) and Tigray (p < 0.0001) regions clustered spatially. Age from 15-29 and 30-39 years (Adjusted Odds Ratio 0.46(AOR = 0.46, CI: 0.36,0.60) and 0.77(AOR = 0.77, CI: 0.63,0.96), primary education level 1.57(AOR = 1.57, CI: 1.15,2.15), wealth index of middle and richer (1.71(AOR = 1.71, CI: 1.30,2.24) and 1.79(AOR = 1.79, CI: 1.34,2.41), family size > 5, 0.82(AOR = 0.82, CI: 0.69,0.96),respectively and regions Afar, Oromia, Somali, Benishangul Gumuz, SNNPR, Gambella, Harari, Addis Ababa and Dire Dawa was 0.002(AOR = 0.002, CI: 0.006,0.04), 0.11(AOR = 0.11, CI: 0.06,0.21) 0.02(AOR = 0.02, CI: 0.007,0.04), 0.04(AOR = 0.04, CI: 0.02,0.08), 0.09(AOR = 0.09, CI: 0.05,0.18),0.004(AOR = 0.004,CI:0.02,0.08),0.06(AOR = 0.06,CI:0.03,0.14), 0.07(AOR = 0.07, CI: 0.03,0.16) and 0.03(AOR = 0.03, CI: 0.02,0.07) times less likely utilize community based health insurance than the Amhara region respectively in Ethiopia. CONCLUSION: Community based health insurance coverage among households in Ethiopia was found very low still. The government needs to develop consistent financial and technical support and create awareness for regions with lower health insurance coverage.

The Co-Utilization of Oral Rehydration Solution and Zinc for Treating Diarrhea and Its Associated Factors Among Under-Five Children in Ethiopia: Further Analysis of EDHS 2016.

Introduction: Diarrhea causes a loss of body water and salt, which can lead to dehydration and death. The use of oral rehydration salts and zinc together is regarded as an effective treatment for diarrhea in resource-poor settings like Ethiopia. However, studies that examine the co-utilization of oral rehydration solution and zinc in the treatment of diarrhea are limited Ethiopia. Objective: To assess the prevalence and associated factors of oral rehydration solution and zinc co-utilization to treat diarrhea in children under the age of five in Ethiopia, EDHS 2016. Methods: Secondary data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used to investigate the prevalence and factors associated with the co-utilization of ORS and zinc to treat diarrhea in under-five children. A multilevel binary logistic regression model was fitted to identify factors associated with the co-utilization of ORS and zinc. Adjusted odds ratios (AOR) with 95% CI were calculated and used as a measure of associations, and variables having a p-value of less than 0.05 were declared as statistically significant. Results: The national prevalence of ORS and zinc co-utilization was 16.65% (14.66%, 18.84%). Maternal educational status (AOR = 1.45; 95% CI; (1.01, 2.09)), household size (AOR = 1.53; 95% CI; 1.09, 2.16) and distance to health facilities at the community level (AOR = 1.60, 95% CI = 1.02, 2.58) were variables significantly associated with the co-use of ORS and zinc. Conclusion: The co-utilization of ORS and zinc for the management of diarrhea was low in Ethiopia. Education, household size, and distance to health facilities at the community level were significantly associated with the co-utilization of ORS and zinc in Ethiopia.

The effect of gestational age, low birth weight and parity on birth asphyxia among neonates in sub-Saharan Africa: systematic review and meta-analysis: 2021.

BACKGROUND: Despite simple and proven cost-effective measures were available to prevent birth asphyxia; studies suggested that there has been limited progress in preventing birth asphyxia even in healthy full-term neonates. In Sub-Saharan Africa, Inconsistency of magnitude of birth asphyxia and its association gestational age, Low birth Weight and Parity among different studies has been observed through time. OBJECTIVE: This study aimed to estimate the Pooled magnitude of birth asphyxia and its association with gestational age, Low birth Weight and Parity among Neonates in Sub-Saharan Africa. METHOD: PubMed, Cochrane library and Google scholar databases were searched for relevant literatures. In addition, reference lists of included studies were retrieved to obtain birth asphyxia related articles. Appropriate search term was established and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Sub-Saharan africa and published in English language. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Heterogeneity across the included studies was evaluated by using the inconsistency index (I2) test. Funnel plot and the Egger's regression test were used to test publication bias. A weighted inverse variance random effects- model was used to estimate the pooled prevalence of birth asphyxia among neonates in Sub-Saharan Africa. STATA™ version 11softwarewasused to conduct the meta-analysis. RESULT: A total of 40 studies with 176,334 study participants were included in this systematic review and meta-analysis. The overall pooled magnitude of birth asphyxia in Sub-Saharan Africa was 17.28% (95% CI; (15.5, 19.04). low birth weight (AOR = 2.58(95% CI: 1.36, 4.88)), primigravida (AOR = 1.15 (95% CI: 0.84, 1.46) andMeconium-stained amniotic fluid (AOR = 6(95% CI: 3.69, 9.74)) werevariables significantly associated with the pooled prevalence of birth asphyxia. CONCLUSION: The pooled magnitude of birth asphyxia was found to be high in Sub-Saharan Africa. Low birthweight and Meconium-stained amniotic fluid were variables significantly associated with birth asphyxia in Sub-Saharan Africa. Hence, it is better to develop early detection and management strategies for the affected neonates with low birth weight and born from mothers intrapartum meconium stained amniotic fluid.

Spatial variation and determinants of underweight among children under 5 y of age in Ethiopia: A multilevel and spatial analysis based on data from the 2019 Ethiopian Demographic and Health Survey.

OBJECTIVES: Childhood underweight is a critical public health problem that needs urgent attention in developing countries like Ethiopia. Despite its variation between localities, the determinant factors and its geospatial variation have not been adequately addressed across the various regions of the country. Therefore, the aim of this study was to investigate the spatial variation and determinant factors of underweight among children under 5 y of age in Ethiopia. METHODS: The total weighted samples of 5753 children aged <5 y were included in this study. The data were taken from the 2019 Ethiopian Demographic and Health Survey (EDHS 2019). Arc GIS software was used to analyze geospatial variations to identify the hot- and cold spot areas of underweight in Ethiopia. A multilevel multivariable logistic regression model was used to identify the determinant factors of underweight. Excel, STATA-16, and ArcGIS software were used for the data management and analysis. In the multivariable multilevel analysis, adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to declare significant determinants of underweight among children aged <5 y. RESULTS: Among 5753 children aged <5 y in Ethiopia, 21.3% were underweight during the 2019 EDHS. The distribution showed that there was a geospatial variation of underweight among children aged <5 y in Ethiopia; the Global Moran's index value was 0.36 with P < 0.001. In multivariable multilevel analysis, the significant factors associated with underweight were the sex of the child (aOR, 1.25; 95% CI, 1.09-1.44); age of the child, with the highest odds of being underweight observed in the age group of 24 to 35 mo (aOR, 3.52; 95% CI, 2.60-4.74); wealth index, with poorer children having higher odds of being underweight (aOR, 2.25; 95% CI, 1.58-3.24); and the regions, with the highest odds of underweight was observed in Tigray (aOR, 5.63; 95% CI, 2.79-11.36) and Afar (aOR, 4.71; 95% CI, 2.33-9.51). CONCLUSIONS: Underweight has significant spatial variation in Ethiopia, with spatial clustering in the northern and eastern parts of the country. It is recommended that in regions like Tigray, Afar, and Somali, as well as some areas in Gambella, priority steps be taken to reduce the burden of underweight in children aged <5 y. Thus, nutritional intervention programs should be strengthened and intervention strategies developed, with special emphasis on families with poor wealth index in the hotspot areas.

Spatial variation and determinates of dietary diversity among children aged 6-23 months in Ethiopia: spatial and multilevel analysis using Ethiopian Demography Health Survey (EDHS) 2019.

BACKGROUND: Minimum dietary diversity is the consumption of five or more food groups from the eight World Health Organization recommended food groups. Adequately diversified diet, in terms of amount and composition, is critical for optimal growth, development, and long-term health outcomes in the first 2 years. Understanding the regional variation of dietary diversity and the underlying factors is crucial for developing and implementing interventions. However, the use of spatial approaches in dietary studies has not been widely established. Therefore, this study aimed to explore the spatial patterns and determinates of minimum dietary diversity practice among 6-23 months children in Ethiopia. METHODS: Secondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 1578 children aged 6-23 months was included for this study. The Global Moran's I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariable multilevel logistic regression was used for factor analyses. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. RESULTS: Overall, 87.4% (95% CI: 85.7 to 88.9%) of children in 2019 had inadequate Minimum dietary diversity. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) notably observed in Somali, Afar, Eastern and western Amhara, western Tigray, Benishangul, and Northeastern and western parts of the southern nations, nationality and peoples' regions. Inadequate dietary diversity was significantly higher among young children, uneducated mother, married women, younger mother, no postnatal check, community with higher level of poverty and community level uneducated woman. CONCLUSION: According to the findings of this study inadequate Minimum dietary diversity for children as measured by World Health Organization dietary assessment shows high. Children's dietary diversity was distributed non-randomly in different districts across Ethiopia's regions. The findings of the study provided critical evidence about dietary diversity and associated factors. Hence, policy should focused on improve education status of Mother, boosting economic status of the community, increased maternal continuum of care and focused on young children nutrition may advance dietary diversity.

Prevalence and associated factors of double and triple burden of malnutrition among child-mother pairs in Ethiopia: Spatial and survey regression analysis.

BACKGROUND: Evidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn't assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia. METHODS: A total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM. RESULTS: The overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38-2.24) and 1.2% (95%CI: 0.83-1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24-35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6-12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM. CONCLUSION: There is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.

Spatiotemporal distributions of immunization coverage in Ethiopia from 2000 to 2019.

BACKGROUND: Vaccination is the most important mechanism to improve childhood survival. However, immunization coverage is very low and unevenly distributed throughout the country. Therefore, this study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia. METHOD: Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to 2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the national immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages. RESULT: The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for 2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005 and 2019 EDHS. The population density was positively associated with immunization coverage in 2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in 2016. Moreover, mean annual temperature was positively associated with immunization coverage in 2000, 2005 and 2019 EDHSs. Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005, 2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage in all the five EDHSs. CONCLUSION: This study found that immunization coverage in Ethiopia substantially varied across the subnational and local levels. Spatial clustering of low immunization coverage was observed in Southern, Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density, precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers in Ethiopia to design geographically targeted interventions to increase programs to achieve maximum immunization coverage.