Time to complementary feeding initiation and its predictors among children aged 9-23 months in Meket District, Northeast Ethiopia: a Cox Weibull regression.

.Globally and nationally, only 64⋅5 and 49⋅2 % of infants received solid or semi-solid foods, respectively. The available evidence indicates that the time to initiate complementary feeding practices is still poor and varies by region. The aim of the present study was to assess the time to initiation of complementary feeding and its predictors among children aged 9-23 months in Meket District, Amhara Region, Ethiopia. A community-based retrospective cohort study was conducted from June to July 2022 among 459 systematically selected mothers/caregivers with their children from 9 to 23 months of age. The result of descriptive statistics was reported by table, frequency, Kaplan-Meier curve and percent. The proportional hazard model assumption was checked, and a Weibull regression model was used to see the predictors of timely initiation of complementary feeding. An adjusted hazard ratio with a 95 % confidence interval and a P-value of 0⋅05 were used to declare the significant predictors. The median time of complementary feeding initiation was 6 months. Attending primary education (adjusted hazard ration (AHR) 1⋅8; 95 % CI 1⋅16, 2⋅78), occupation of the mother (AHR 1⋅43; 95 % CI 1⋅04, 1⋅95), home delivery (AHR 1⋅61; 95 % CI 1⋅09, 2⋅37) and birth preparedness (AHR 1⋅37; 95 % CI 1⋅03, 1⋅81) were the predictors of time to complementary feeding initiation. The median time to complementary feeding initiation was consistent with the WHO recommendation. Maternal education, maternal employment, place of delivery and birth preparedness were the predictors of time to initiation of complementary feeding. Therefore, working with the education sector, increasing the delivery rate in health facilities, strengthening counselling on birth preparation, increasing maternity leave until 6 months of age and initiating corner feeding should be part of the complementary feeding practices promotion agenda.

Dietary diversity practice and associated factors among adolescents in Ethiopia, systematic review and meta-analysis.

BACKGROUND: Adolescence (10-19 years) is a critical life period for growth and health. An increase in dietary diversity in the food is related to improved nutrient adequacy of the diet. However, studies conducted on dietary diversity practice among adolescents showed non-conclusive and inconsistent findings on the magnitude of the problem. Likewise, there was no meta-analysis conducted in the study area. Hence, this systematic review and meta-analysis were conducted to estimate the pooled prevalence of good dietary diversity practice and its associated factors among adolescents in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. All articles were systematically searched by Google Scholar, PubMed, Hinari, Cochrane Library, Global Health and CINAHL. Meta-analysis was conducted by using STATA 14 software. Forest plots were used to present the pooled prevalence of good dietary diversity practices. A random effect model was used to compute the pooled prevalence; while subgroup analysis was performed to identify the possible source of heterogeneity. Publication bias was assessed by the begg's and egger's test. Moreover, the associated factor of dietary diversity practices was observed. RESULTS: This review involved 7 studies, and 3,950 participants. The pooled prevalence of good dietary diversity practice among adolescents in Ethiopia was 39.24% (95% CI: 30.82, 47.66). Mothers with formal education [AOR = 1.98, (95% CI: 1.65, 2.36)], fathers with formal education [AOR = 2.30, (95% CI: 1.81, 2.93)], Medium wealth index [AOR = 2.75, (95% CI: 1.96, 3.86)] and urban residence [AOR = 2.88, (95% CI: 1.59, 5.22)] were positively associated with good dietary diversity practice. CONCLUSIONS: The pooled prevalence of good dietary diversity practices among adolescents is low. Being urban residents, the medium wealth quintile, mothers' educational status and fathers' educational status were independent factors of good dietary diversity practice among adolescents. Therefore, focused nutritional interventions should be given to rural residents and adolescents from low economic status.

Minimum acceptable diet and its associated factors among children aged 6-23 months in Lalibela, northeast Ethiopia: a community-based cross-sectional study.

The first 2 years of life are a critical window of opportunity for ensuring optimal child growth and development. In Ethiopia, the magnitude of the minimum acceptable diet ranges from 7 to 74⋅6 %. The evidence revealed the variation and unrelated data on the prevalence of minimum acceptable diet. Therefore, the present study aimed to assess the minimum acceptable diet and its associated factors among children aged 6-23 months in Lalibela town administration, northeast Ethiopia. A community-based cross-sectional study was conducted in Lalibela town administration, northeast Ethiopia among 387 mothers/caregivers with children aged 6-23 months from May 1 to 30, 2022. The data were entered by Epidata version 3.1 and analysed by SPSS version 25.0. A multivariable binary logistic regression model was fitted to identify factors associated with minimum acceptable diet. The degrees of association were assessed using an adjusted odds ratio with a 95 % confidence interval and P-value of 0⋅05. The magnitude of minimum acceptable diet in the study area was 16⋅7 % (95 % confidence interval: 12⋅8-20⋅6 %). Sex of child, getting infant and young child feeding counselling at antenatal care, infant feeding practice-related knowledge and childhood illness are the variables that were found to be an independent predictor of minimum acceptable diet. Health facilities should strengthen infant feeding counselling starting from antenatal care visits during pregnancy for the recommended minimum acceptable diet is crucial.

Urban-rural disparity in stunting among Ethiopian children aged 6-59 months old: A multivariate decomposition analysis of 2019 Mini-EDHS.

BACKGROUND: Childhood stunting is still a global public health challenge, including in Ethiopia. Over the past decade, in developing countries, stunting has been characterized by large rural and urban disparities. To design an effective intervention, it is necessary to understand the urban and rural disparities in stunting. OBJECTIVE: To assess the urban-rural disparities in stunting among Ethiopian children aged 6-59 months. METHODS: This study was done based on the data obtained from the 2019 mini-Ethiopian Demographic and Health Survey, conducted by the Central Statistical Agency of Ethiopia and ICF international. The result of descriptive statistics was reported using the mean with standard deviation, frequency, percentages, graphs, and tables. A multivariate decomposition analysis was used to decompose the urban-rural disparity in stunting into two components: one that is explained by residence differences in the level of the determinants (covariate effects), and the other component is explained by differences in the effect of the covariates on the outcome (coefficient effects). The results were robust to the different decomposition weighting schemes. RESULT: The prevalence of stunting among Ethiopian children aged 6-59 months was 37.8% (95% CI: 36.8%, 39.6%). The difference in stunting prevalence between urban and rural residences was high (rural prevalence was 41.5%, while in urban areas it was 25.5%). Endowment and coefficient factors explained the urban-rural disparity in stunting with magnitudes of 35.26% and 64.74%, respectively. Maternal educational status, sex, and age of children were the determinants of the urban-rural disparity in stunting. CONCLUSION AND RECOMMENDATION: There is a significant stunting disparity among urban and rural children in Ethiopia. A larger portion of the urban-rural stunting disparity was explained by coefficient effects (differences in behaviour). Maternal educational status, sex, and age of children were the determinants of the disparity. So, to narrow this disparity, emphasis should be given to both resource distribution and the appropriate utilization of available interventions, including improvement of maternal education and consideration of sex and age differences during child feeding practices.

Individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia: a multi-level analysis.

BACKGROUND: Anemia is still one of the major public health problems in many developing countries including Ethiopia. Thus, this study aimed to assess individual and contextual-level factors associated with iron-folic acid supplement intake during pregnancy in Ethiopia. METHODS: A secondary analysis was done on the 2019 mini-Ethiopian Demographic and Health Survey (EDHS) dataset. A total of 3,927 pregnant women who gave birth five years before the survey were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA/SE version 14.0 to identify individual and contextual-level factors. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to show the strength and direction of the association. The level of statistical significance was declared at a P value less than 0.05. RESULTS: Those primary educated [AOR = 1.83, 95% CI: (1.24, 2.74)], secondary educated [AOR = 2.75, 95% CI: (1.57, 4.824)], women who had greater than 5 living children [AOR = 2.02, 95% CI: (1.25, 3.27)], women who had ANC visit [AOR = 21.26, 95% CI: (13.56, 33.32)] and women who lived in a cluster with high proportion of women had ANC visit [AOR = 1.72, 95% CI: (1.17, 2.54)] and women who lived in Somali [AOR = 0.44 0.73, 95% CI: (0.22, 0.87)] were significantly associated with iron-folic acid intake during pregnancy. CONCLUSIONS: Both individual and contextual-level factors were significantly associated with iron-folic acid intake during pregnancy. From individual-level factors: education status of women, the total numbers of living children, and ANC follow-up are significant and from contextual-level factors: region and living in a high proportion of women who had ANC follow-up were found to have a statistically significant association. Promoting women's education and maternal health services like ANC and intervention targeting the Somali region would be the recalled area of the government.

Covid-19 Vaccine Side Effects and Its Associated Factors Among Healthcare Workers at Dessie Hospital, Ethiopia.

Background: Vaccines are a powerful choice to stop disease outbreaks, including covid-19. However, people are hesitant to take vaccinations due to uncertainty about side effects. So, this study aimed to assess covid-19 vaccine side-effect and its associated factors among healthcare workers in Dessie comprehensive specialized hospital, in Ethiopia. Methods: An institution-based cross-sectional study was conducted at Dessie Comprehensive and Specialized Hospital among 351 vaccinated healthcare workers from April 25 to May 25, 2021. Self-administrated questionnaires were used by consented health workers. Variance inflation factor (VIF) was used to assess the multicollinearity of independent variables. Bivariable and multivariable binary logistic regression were used to identify significant factors of vaccine side effects. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported as the effect size. Statistical significance was considered at p-value <0.05. Results: Overall, of vaccinated healthcare workers, 56.98% (95% CI, 50.86-61.26%) experienced at least one side effect. The majority of the side effects were fever (44.44%), headache (39.03%), fatigue (27.35%), injection site pain (25.93%), and nausea (24.22%). Healthcare workers with (≥10 years) of work experience (AOR: 3.74, 95% CI, 1.32-10.59), Hesitancy to take the first dose of the Covid-19 vaccine (AOR: 3.01, 95% CI, 1.82-4.99), underlying chronic disease (AOR: 14.41, 95% CI, (5.07-40.92)), being on antihypertensive medication (AOR: 0.15; 95% CI (0.02-0.93)), and unsafe perception of vaccine safety (AOR:3.50; 95% CI, 1.43-8.57) were independent factors of Covax vaccine side effect development. Conclusion: Overall, common vaccine side effects were identified in healthcare workers who have taken the Covax vaccine. Healthcare workers with (≥10 years) of work experience, Hesitancy to take the first dose, unsafe perception of vaccine safety, and underlined chronic disease were predictors of vaccine side effect occurrence. So, providing vaccine-related information to the community to be vaccinated is mandatory to reduce hesitancy and flaws regarding vaccine safety.

Comparing the validity of anthropometric measurements in identifying malnutrition status of older age people in Borena district, North Central Ethiopia: a cross_sectional study.

BACKGROUND: Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia. METHODS: A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach's α coefficient and Pearson's correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point. RESULTS: The reliability of BMI, MUAC and CC by Cronbach's alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96-0.99, p < 0.001), 0.94(95% CI, 0.89-0.98, p < 0.001) and 0.96(95% CI, 0.94-0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex. CONCLUSIONS: The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard.

Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis.

Introduction: Globally, anemia among under-five children is a serious public health problem. Even if there are pocket studies here and there, there is limited evidence on the pooled prevalence of anemia among under-five children in Africa. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia. Methods and Analysis. This systematic review and meta-analysis was done following the PRISMA guidelines. A comprehensive search was made in PubMed/MEDLINE, Cochrane Library, HINARI, and Ethiopian Journal of Health Development for studies published since 2009. It was supplemented with Google Scholar search. Study selection, data extraction, and quality of studies were assessed by eight reviewers. The Cochrane Q test and I 2 test statistic were used to test the heterogeneity of studies. A random-effects model of DerSimonian-Laird method was used. Result: A total of 37 articles were included in this systematic review and meta-analysis. The pooled prevalence of anemia among under-five children in Africa was 59% (95% CI: 55, 63). Being female (AOR = 0.71; 95% CI: 0.57, 0.87), maternal education (AOR = 1.47; 95% CI: 1.31, 1.66), residence (AOR = 0.80; 95% CI: 0.67, 0.95), and family size (AOR = 0.93; 95% CI: 0.89, 0.98) were the determinants of anemia among African under-five children. Conclusion and Recommendation. This pooled study revealed that anemia was a severe public health problem. Sex, maternal education, residence, and family size were the determinants of anemia. Therefore, anemia prevention strategy should include sex consideration, educating mothers through youth education, area specific intervention, and encouraging birth spacing.

Optimal complementary feeding practices and associated factors among mothers having children 6 to 23 months, south WOLLO zone, Dessie ZURIA, Ethiopia.

INTRODUCTION: Optimal complementary feeding practice is a child feeding practice that fulfills the minimum dietary diversity, the minimum meal frequency, continuing breastfeeding with complementary feeding, and initiation of complementary feeding from 6 to 8 months. METHOD: A community-based comparative cross-sectional study was conducted on a total of 732 randomly selected mothers having children 6 to 23 months of age from March 10 to April 21 /2021.Data were collected using a pre-tested interviewer-administered questionnaire. Data entry was performed by using Epi data version 3.1 and was exported to Stata version 14.1. Descriptive statistics were done. Multivariable Logistic regression was used to predict the role of independent variables on optimal complementary feeding. Findings with a p-value <0.05 at a 95% confidence interval (CI) were considered statistically significant in the final model. RESULT: The overall proportion of mothers with optimal complementary feeding practice was 18.1% (95% C I 15.3% - 21.0). Only 90 (25.1%, 95% CI = 20.6-29.7) of mothers were found to have optimal complementary feeding practice in NGO supported kebeles but only 37 (10.8%, 95% CI = 7.5-14.1) practiced optimal complementary feeding is not NGO-supported kebeles. Mothers from Kebeles with no NGO support were 46% (AOR = 0.54, 95% CI 0.31, 0.96) less likely to practice optimal complementary feeding. On the other hand, mothers of children aged20-23 months were four times (AOR = 4.47, 95% CI 2.02-9.91) more likely to practice optimal complementary feeding than mothers having children 6-8 months of age. PRACTICE IMPLICATIONS: Different interventions have been implemented by governmental and non-governmental organizations to improve this condition in Dessie Zuria District. But, there is limited data on the extent to which intervention by governmental and non-governmental organizations reduces this improving condition. The aim of this study was to assess the Optimal Complementary Feeding Practice and Associated Factors among Mothers Having Children Aged 6-23 Months, Ethiopia 2021. CONCLUSION: Optimal complementary feeding practices among mothers in NGO-supported kebeles were higher than not supported kebeles. Therefore, strengthening and scaling up the program to not-supported kebeles is recommended to improve the optimal complementary feeding practiced.

Impact of malnutrition on the academic performance of school children in Ethiopia: A systematic review and meta-analysis.

Objective: This study aimed to identify the impact of malnutrition on the academic performance of children in Ethiopia. Method: The protocol of this study is registered in PROSPERO with a registration number CRD42021242269. A comprehensive search of studies from HINARY, MEDLINE (via PubMed), EMBASE, Cochrane Library, SCOPUS, Google Scholar, and Google was conducted. All published and unpublished studies conducted about the effect of any forms of malnutrition on academic performance of elementary school children in Ethiopia using the English language were included. Quality of the articles was assessed using the Joanna Briggs Institute critical appraisal tool. The pooled log odds ratio with 95% confidence interval was determined to identify the effect of malnutrition on academic performance. I-square statistics was applied to check the degree of heterogeneity between studies. The presence of publication or small study bias had been assessed by Funnel plots, Egger's weighted regression test, and Begg's rank correlation test. Result: A total of 10 studies were included in this study. The pooled prevalence of good academic performance among elementary school students in Ethiopia was 58% (95% confidence interval: 48%, 69%). Stunting (odds ratio = 0.48; 95% confidence interval: 0.30, 0.79), underweight (odds ratio = 0.38; 95% confidence interval: 0.27, 0.53), and iodine deficiency (odds ratio = 0.49; 95% confidence interval: 0.31, 0.78) had a significant association with the academic performance. Rural residence (odds ratio = 0.61; 95% confidence interval: 0.44, 0.83), being female (odds ratio = 0.53; 95% confidence interval: 0.37, 0.77), and uneducated parent (odds ratio = 0.51; 95% confidence interval: 0.44, 0.58) were also factors associated with good academic performance of primary school children in Ethiopia. Conclusion: This study concluded that malnutrition in the form of stunting, underweight, and iodine deficiency affected the academic performance of elementary school children in Ethiopia. So, the Ministry of Health worked better to strengthen the nutrition intervention at the critical periods of brain development.

Compliance with standard precaution of infection prevention practice and associated factors among health care workers in Ethiopia: Mixed method study.

Backgrounds and Aims: In developing countries, most infections can be prevented with relatively inexpensive infection prevention methods. However, there is limited information on standard precautions for infection prevention practices among health workers in Ethiopia Therefore, this study aimed to assess the compliance with the standard precaution of infection prevention practice and associated factors among health care workers (HCWs) using a mixed method study. Methods: A hospital-based mixed-methods study design (concurrent mixed method design) was conducted among 378 randomly selected health professionals. Self-administered questionnaire; an in-depth interview and an observational checklist were used to collect the data. The collected data were cleaned and entered into Epi data and analyzed using a static package for social science. Descriptive statistics were conducted and the result was reported using frequency, and percentile. Logistic regression was performed to identify associated factors. Adjusted odds ratios with 95% confidence intervals (CIs) and p < 0.05 were used to explain statistically significant associations. Results: The proportion of standard precaution practice among HCWs at Dessie specialized and comprehensive hospital was 55.6% (put the 95% CI). Age ≤ 25 years (AOR = 0.13, 95% CI: [0.04, 0.42]) and age 31 years above age ≤ 31 years (AOR = 0.06, 95% CI: [0.02, 0.3]), positive attitude toward the standard precaution (AOR: 6.43, 95% CI: [3.47, 11.94]). Access to IP guidelines (AOR: 3.13, 95% CI: [1.61, 6.07]). Training on standard precautions (AOR: 3.61, 95% CI: [1.75, 7.48]) were factors associated with standard precaution practice. Conclusions: In this study, the overall proportion of HCWs' compliance with standard preventive practice was low. HCWs aged 31 years and above, training on standard precaution practice, availability of guidelines in each ward, attitude toward standard precaution practice, knowledge about standard precaution practice, and accessibility of standard precaution supplies were associated with compliance to standard precaution practice. Therefore, the strategies should be designed to fulfill hospitals with supplies, training, and avail guidelines in each ward.

Sleeping duration, physical activity, alcohol drinking and other risk factors as potential attributes of metabolic syndrome in adults in Ethiopia: A hospital-based cross-sectional study.

BACKGROUND: Available evidence showed that metabolic syndrome in the adult population is persistently elevated due to nutrition transition, genetic predisposition, individual-related lifestyle factors, and other environmental risks. However, in developing nations, the burden and scientific evidence on the pattern, and risk exposures for the development of the metabolic syndrome were not adequately investigated. Thus, the study aimed to measure the prevalence of metabolic syndrome and to identify specific risk factors among adult populations who visited Dessie Comprehensive Specialized Hospital, Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among randomly selected 419 adults attending Dessie Comprehensive Specialized Hospital from January 25 to February 29, 2020. We used the WHO STEP-wise approach for non-communicable disease surveillance to assess participants' disease condition. Metabolic syndrome was measured using the harmonized criteria recommended by the International Diabetes Federation Task Force in 2009. Data were explored for missing values, outliers and multicollinearity before presenting the summary statistics and regression results. Multivariable logistic regression was used to disentangle statistically significant predictors of metabolic syndrome expressed using an odds ratio with a 95% of uncertainty interval. All statistical tests were managed using SPSS version 26. A non-linear dose-response analysis was performed to show the relationships between metabolic syndromes with potential risk factors. RESULTS: The overall prevalence of metabolic syndrome among adults was 35.0% (95% CI, (30.5, 39.8)). Women were more affected than men (i.e. 40.3% vs 29.4%). After adjusting for other variables, being female [OR = 1.85; 95% CI (1.01, 3.38)], urban residence [OR = 1.94; 95% CI (1.08, 3.24)], increased age [OR = 18.23; 95% CI (6.66, 49.84)], shorter sleeping durations [OR = 4.62; 95% CI (1.02, 20.98)], sedentary behaviour [OR = 4.05; 95% CI (1.80, 9.11)], obesity [OR = 3.14; 95% CI (1.20, 8.18)] and alcohol drinking [OR = 2.85; 95% CI (1.27,6.39)] were positively associated with the adult metabolic syndrome. Whilst have no formal education [OR = 0.30; 95% CI (0.12, 0.74)] was negatively associated with metabolic syndrome. CONCLUSIONS: The prevalence of adult metabolic syndrome is found to be high. Metabolic syndrome has linear relationships with BMI, physical activity, sleep duration, and level of education. The demographic and behavioural factors are strongly related with the risk of metabolic syndrome. Since most of the factors are modifiable, there should be urgent large-scale community intervention programs focusing on increased physical activity, healthy sleep, weight management, minimize behavioural risk factors, and healthier food interventions targeting a lifecycle approach. The existing policy should be evaluated whether due attention has given to prevention strategies of NCDs.

The role of nutrition-sensitive agriculture combined with behavioral interventions in childhood growth in Ethiopia: An adequacy evaluation study.

Objective: The study aimed to investigate the role of nutrition-sensitive and specific interventions along with nutrition education on child stunting during the first 1000 days in Ethiopia. Methods: An adequacy evaluation study was used to see changes between the baseline and end-line data after following for 1 year. A sample of 170 mother-child pairs who had a 1-year followed up was used to detect differences. We performed structural equation modeling to elucidate changes in feeding behaviors, socioeconomic status, water, sanitation and hygiene on child linear growth. Furthermore, the independent effect of covariates on child linear growth was handled using a general linear model. Results: A total of 170 and 270 mother-child dyads were interviewed at baseline and end-line surveys, respectively. After about 1 year of intervention, the annual rate of stunting prevalence declined from 29.3% (95% confidence interval [CI] = 18.6, 42.7) to 16.4% (95% CI = 10.7, 24.2). There was a significant change in the mean of length-for-age Z-score which changed from -1.18 to -0.45 (P < .034). Adjusting for the different constructs of the health belief model, child sex, age, feeding behaviors, and dietary diversity, one egg consumption per day was responsible for the most significant variability explained (36%) for stunting reduction. Conclusions: Sustainable access to egg consumption for children below 2 years experienced a substantial reduction in childhood stunting. A combination of nutrition-sensitive agricultural and direct nutrition interventions along with behavioral-based education is a sustainable strategy in reducing and preventing child growth from faltering in the early life stages.

Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis.

BACKGROUND: Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. METHODS: The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULTS: The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. CONCLUSIONS: The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women's income, access to health care facilities to increase the frequency of antenatal care utilization.

Preventive Practice and Associated Factors towards COVID-19 among College Students in Amhara Region, Ethiopia: A Cross-Sectional Study.

BACKGROUND: Ethiopia has taken unprecedented preventive measures like closure of higher education institutions to halt the spread of COVID-19. However, still, there is scarce information regarding the knowledge, attitude, and practice (KAP) of students towards COVID-19 pandemic. Thus, this study aimed to assess the KAP and associated factors of preventive measures against COVID-19 among students. METHODS: A cross-sectional study was conducted on 422 students. The sample was proportionally allocated into the randomly selected four colleges, and the students were recruited using a systematic random sampling technique. Variables with p-value < 0.25 in the bivariate logistic regression analysis were entered into the multivariable logistic regression model. RESULTS: This study involved 408 students with response rate of 96.6%. The levels of good knowledge, positive attitude and good practice towards COVID-19 were 69.6%, 56.6% and 65% respectively. After adjusting for covariates, being in the late adolescent age group (16-20), living with > 5 family size, and being single were predictors of knowledge level. Besides, being single, attending diploma (TVET) level trainings, and being year-two students were predictors of attitude levels. Similarly, urban residence, being regular students, and being year-one students were the independent predictors of practice level of students. CONCLUSION: In this study, only two-third of the students had good preventive practice level towards COVID-19, which is below the Organization's recommendation. Thus, the national, regional and local governments should develop effective and inclusive prevention strategies to address students who are at home due to COVID-19 pandemic.

The effect of counseling, antiretroviral therapy and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Human Immunodeficiency Virus (HIV) is continued as a major public health problem, especially in developing countries. Therefore, this study aimed to estimate the effect of counseling, antiretroviral therapy (ART) and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was used during this review. The study included both published and unpublished studies which were conducted in Ethiopia until the end of 2019. Different electronic databases (PubMed, Cochrane library, CINAHL, Global Health, HINARI and Google scholar) were searched. Data were extracted in Microsoft Excel sheet and STATA/SE 14 was used to meta-analysis. I2 and Egger test statistics were used to test heterogeneity and publication bias respectively. RESULTS: Twenty-two articles with 8,873 adult HIV infected peoples were included in this systematic review and meta-analysis. The pooled magnitude of disclosing HIV status to sexual partner was 74.63% [95% CI: (67.79, 81.47)]. Counseled [AOR = 4.96, 95% CI: (2.87, 8.55)], ART initiated [AOR = 4.78, 95% CI: (3.84, 5.94)] and who had a smooth relationship before HIV testing [AOR = 6.82, 95% CI: (3.49, 13.33)] were significantly associated with disclosing HIV status to sexual partner. CONCLUSIONS: Disclosing HIV positive status to sexual partner in Ethiopia was low as the government invested in partner notification. Counseling, ART initiation and smooth relationship before HIV testing were significantly associated with disclosing HIV status to sexual partner. The government needs to strengthen pre and post HIV test counseling even after treatment started to increase disclosing status. REGISTRATION: The protocol of this systematic review and meta-analysis was registered in the PROSPERO with a specific registration number: CRD42020161276; https://clinicaltrials.gov/.

Knowledge and practice of clients on preventive measures of COVID-19 pandemic among governmental health facilities in South Wollo, Ethiopia: A facility-based cross-sectional study.

INTRODUCTION: Coronavirus-19 is a global health challenge and need an immediate action. Thus, understanding client's knowledge about SARS-COV2 causes, roots of transmissions, and prevention strategies are urgently warranted. Although there were global studies reported knowledge and preventive practices of COVID-19, but the information is not representative and inclusive for Ethiopia. Thus, the current study is done to identify the knowledge and the prevention strategies for COVID-19 among clients in South Wollo, Ethiopia. METHODS: An institutional based cross-sectional study was conducted from May 21 to 30, 2020 among clients seeking service in Dessie town health facilities. A total of 81 clients were included from the selected health facilities with simple random sampling technique. We developed measuring tools by adopting from World Health Organization and center for disease prevention recommendation manual for assessing service providers' knowledge and preventive practices. For data entry Epi-data 3.1 version was employed and further data management and analysis was performed using STATA Version 14. Student T-test and one way ANOVA were computed to see the mean difference in knowledge and practice between and among the group. Chi-square test was also done to portray the presence of association between different co-variants with client's knowledge and preventive practices. RESULTS: Findings of the study showed that more than half (56.8%) of the participants had good knowledge about its symptoms, way of spread and prevention of the virus. Furthermore, 65.4% of clients demonstrated five or more preventive practice measures of COVID-19. The mean preventive practice score with standard deviation was (4.75±1.28 from 6 components). In the current study, knowledge had no significant difference among sex, education status, and monthly income. However, COVID-19 transmission knowledge was significantly higher among urban residents. Thus, clients who were knowledgeable about way of transmission and symptoms of COVID-19 had significantly higher COVID-19 preventive practice. CONCLUSION: Our findings revealed that clients' knowledge and preventive practice of COVID-19 were not optimal. Clients with good knowledge and urban residents had practiced better prevention measures of the pandemic, signifying that packages and programs directed in enhancing knowledge about the virus is useful in combating the pandemic and continuing safe practices.

Timely Initiation of Breast Feeding and Associated Factors among Caesarian Section Delivered Mothers in Health Facilities of Dessie City Administration, North Eastern Ethiopia.

OBJECTIVE: To assess the magnitude and associated factors of timely initiation of breastfeeding among cesarean section delivered mothers. METHODS: A health facility-based cross-sectional study was employed among 421 systematically selected mothers from February to June, 2017. Data were collected by a structured questionnaire. Data entry and analysis was done using Epi Data and SPSS version 24. Binary logistic regression was computed to identify factors. Adjusted odds ratio with a 95% confidence interval was used to declare statistical significance. RESULT: The magnitude of timely initiation of breast feeding (among mothers who gave birth by cesarean section was 57%. Counseling during antenatal care (AOR = 3.32; 95% CI: 1.80, 6.13), facility where cesarean section (CS) was performed (AOR = 2.55; 95% CI: 1.57, 4.14), and post-CS counseling (AOR = 6.93; 95% CI: 3.99, 12.02) were factors that contributed for the practice of timely initiation among cesarean section delivered mothers. CONCLUSIONS: The magnitude of TIBF was good. Counseling during ANC, the facility where CS was performed and post-natal advice were factors associated with TIBF. Implementation of baby-friendly hospital initiatives should be strengthened in order to promote timely initiation of breast feeding.

Obesity Indices for Identifying Metabolic Syndrome Among Type Two Diabetes Patients Attending Their Follow-Up in Dessie Referral Hospital, North east Ethiopia.

INTRODUCTION: Worldwide, metabolic syndrome is a common problem among T2DM patients. Even though the International Diabetes Federation recommended waist circumference as a diagnostic tool for metabolic syndrome, the appropriate indices and cut-off point remain controversial. OBJECTIVE: To assess obesity indices in identifying metabolic syndrome among type 2 diabetes mellitus patients in Dessie Referral Hospital, North east Ethiopia. METHODS: A hospital-based cross-sectional study was conducted among 363 consecutively selected T2DM in Dessie Referral Hospital from February to March 2017. Data were collected by interviewer-administered questionnaire. Height, weight, waist circumference, hip circumference, lipid profile, blood glucose levels and blood pressure were taken. Descriptive statistics were computed. Receiver operator characteristic curve analysis with a 95% confidence interval and p-value <0.05 was used to identify the discriminate ability of each index, while the optimal cut point of each index was determined by Youden's index. RESULTS: A total of 330 study participants were included in the study. Based on ATP III definition, the magnitude of metabolic syndrome among T2DM patients was 59.4% (53.6-64.5%). Waist to height ratio (optimal cut point=0.54, AUC=0.85) and waist circumference (optimal cut point= 83 cm, AUC=0.75) were the best predictor of metabolic syndrome for women and men, respectively. For the entire study participant, waist to height ratio (optimal cut point=0.51, AUC=0.79) was the best predictor of metabolic syndrome among type 2 diabetes patients. CONCLUSION AND RECOMMENDATION: Waist to height ratio and waist circumference was the best predictor of metabolic syndrome for women and men, respectively. So, appropriate indices optimal cut-off point should be included to diagnose metabolic syndrome among T2DM.

Determinants of anemia among pregnant mothers attending antenatal care in Dessie town health facilities, northern central Ethiopia, unmatched case -control study.

INTRODUCTION: Anemia affects around 38.2% and 22% of pregnant women at a global and national level respectively. In developing countries, women start pregnancy with already depleted body stores of iron and other vitamins with significant variation of anemia within and between regions. OBJECTIVE: To identify the determinants of anemia among pregnant mothers attending antenatal care in Dessie town health facilities, northern central Ethiopia. METHODS: A health facility based unmatched case control study was conducted among 112 cases and 336 controls from January to March 2016 G.C. The sample size was determined by using Epi Info version 7.1.5.2. Study subjects were selected using consecutive sampling technique. Data were collected using a structured questionnaire, entered using Epi Data version 3.1 and analyzed using SPSS version 20. Bivariable and multivariable logistic regression model was used to see the determinants of anemia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value<0.05 were used to see the significant association. RESULTS: Failure to take dark green leafy vegetables per two weeks (AOR = 5.02, 95% CI: 2.16, 11.71), didn't take chicken per two weeks (AOR = 2.68, 95% CI: 1.22, 5.86), 1st trimester (AOR = 2.07, 95% CI: 1.12, 3.84), 3rd trimester (AOR = 2.96, 95% CI: 1.53, 5.72), HIV infection (AOR = 6.78, 95% CI: 2.28, 20.18) and medication (AOR = 3.57 95% CI: 1.60, 7.98) were positively associated with anemia. CONCLUSIONS: Inadequate intake of dark green leafy vegetables, inadequate consumption of chicken, trimester of the current pregnancy, HIV infection and medication were the determinants of anemia among pregnant women. Therefore, anemia prevention strategy should include promotion of adequate intake of dark green leafy vegetables and chicken, increase meal pattern during the entire pregnancy and strengthen the prevention of mother to child HIV transmission/antenatal care programs.