Suboptimal micronutrient intake among children aged 6 to 23 months in Ethiopia: Further analysis of the demographic and health survey.

BACKGROUND: The recommended essential micronutrient such as food rich in vitamin-A or iron, multiple micronutrient powder or iron supplement, routine daily consumption of iodine, and vitamin-A supplement are deficient among children in Ethiopia. This has been a significant public health problem despite the government efforts. Although few studies have examined the micronutrient intake among children, they are limited in scope and methodological measurements. Analyzing the micronutrient intake among children across all regions and leveraging all essential micronutrient elements are crucial for generating improved evidence to better inform policy. Thus, we examined the micronutrient intake among children aged 6 to 23 months in Ethiopia. METHODS: We used data from the Ethiopian Demographic and Health Survey. A two-stage stratified sampling technique was employed, and 1392 children aged 6 to 23 months were included in our analysis. We conducted a multilevel mixed-effect binary logistic regression analysis to identify determinants of micronutrient intake. In the final model, we used a p-value of less than 0.05 and Adjusted Odds Ratio (AOR) with their 95% confidence interval (CI). RESULTS: We found that only 27.6% (95% CI: 26.8-31.6) of children aged 6 to 23 months were received the recommended micronutrients in Ethiopia. We identified that maternal educational status (Educated mothers (AOR = 2.09, 95%CI:1.23-3.58)), health facility delivery (AOR = 2.14, 95%CI:1.42-2.98), household wealth status (middle quantile (AOR = 1.80, 95%CI:1.01-3.21)), children's age (12 to 23 months age (AOR = 2.36, 95% CI: 1.33-4.21)), and mother's exposure to media (AOR = 1.70, 95%CI: 1.42-2.04) were increased micronutrient intake, whereas residing in the rural communities (AOR = 0.27, 95%CI: 0.21-0.34) decreased micronutrient intake. CONCLUSIONS: Nearly three-fourths of children aged 6 to 23 months did not receive the recommended essential micronutrients in Ethiopia. Therefore, there is a need to broaden strategies aimed at enhancing the intake by improving information and knowledge dissemination among mothers during facility visits and through media channels.

Household- and community-level factors of zero vegetable or fruit consumption among children aged 6-23 months in East Africa.

Introduction: The World Health Organization recommends that children aged 6-23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Method: The study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6-23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant. Results: The overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries. Conclusion: Considering the high overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

Spatial distribution and determinants of Early sexual initiation in Ethiopia.

INTRODUCTION: Early sexual initiation has negative health, social, and economic consequences for both women and future generations. The trend of early sexual initiation is increasing globally, leading to higher rates of sexually transmitted diseases and unplanned pregnancies. Ethiopia has been challenged various disasters that makes women vulnerable and position them at heightened risk of early sexual initiation in the last four years. The spatial patterns and factors of early sexual initiation in the post-conflict-post pandemic settings is not well understood. Hence this research aimed at mapping Spatial Patterns and identifying determinant factors in the Post-COVID-Post-Conflict Settings. METHODS: The study was conducted on secondary data from the PMA 2021 cross-sectional survey which conducted nationally from November 2021 to January 2022 which is in the post pandemic and post-war period. Total weighted sample of 6,036 reproductive age women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Multilevel logistic regression model was used to estimate the effects of independent variables on early sexual initiation at individual and community level factors. Adjusted odds ratio with the 95% confidence interval was reported to declare the strength and statistical significance of the association. RESULT: The spatial distribution of early sexual initiation was clustered in Ethiopia with a global Moran's I index value of 0.09 and Z-score 6.01 (p-value < 0.001).Significant hotspots were detected in East Gojjam zone of Amhara region, Bale, Arsi, West Hararge, East Wellega and Horo Gudru Wellega zones of Oromia region. The odds of having early sexual initiation was higher in women with primary education (AOR = 1.23, 95%CI: 1.03, 1.47), secondary or above education (AOR = 4.36, 95%CI: 3.49, 5.44), Women aged 26 to 25 (AOR = 1.91, 95%CI: 1.61, 2.26), women aged 36 to 49(AOR = 1.51, 95%CI: 1.24, 1.84). However, there was a significant lower likelihood of early sexual initiation in rural resident women (AOR = 0.53, 95%CI: 0.35, 0.81) and women living in 5 to 7 family size (AOR = 0.79, 95%CI: 0.68, 0.92), and more than 7 members (AOR = 0.63, 95%CI: 0.49, 0.81). CONCLUSIONS: The spatial distribution of early sexual initiation was clustered in Ethiopia. Interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas. Policies and interventions targeted to this problem may also take the identified associated factors into account for better results.

Exposure to indoor air pollution and adverse pregnancy outcomes in low and middle-income countries: a systematic review and meta-analysis.

Introduction: Exposure to indoor air pollution such as biomass fuel and particulate matter is a significant cause of adverse pregnancy outcomes. However, there is limited information about the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries. Therefore, this meta-analysis aimed to determine the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries. Methods: International electronic databases such as PubMed, Science Direct, Global Health, African Journals Online, HINARI, Semantic Scholar, and Google and Google Scholar were used to search for relevant articles. The study was conducted according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A random effect model at a 95% confidence interval was used to determine the association between indoor air pollution exposure and adverse pregnancy outcomes using STATA version 14. Funnel plot and Higgs I2 statistics were used to determine the publication bias and heterogeneity of the included studies, respectively. Results: A total of 30 articles with 2,120,228 study participants were included in this meta-analysis. The pooled association between indoor air pollution exposure and at least one adverse pregnancy outcome was 15.5% (95%CI: 12.6-18.5), with significant heterogeneity (I2 = 100%; p < 0.001). Exposure to indoor air pollution increased the risk of small for gestational age by 23.7% (95%CI: 8.2-39.3) followed by low birth weight (17.7%; 95%CI: 12.9-22.5). Exposure to biomass fuel (OR = 1.16; 95%CI: 1.12-1.2), particulate matter (OR = 1.28; 95%CI: 1.25-1.31), and kerosene (OR = 1.38; 95%CI: 1.09-1.66) were factors associated with developing at least one adverse pregnancy outcomes. Conclusions: We found that more than one in seven pregnant women exposed to indoor air pollution had at least one adverse pregnancy outcome. Specifically, exposure to particulate matter, biomass fuel, and kerosene were determinant factors for developing at least one adverse pregnancy outcome. Therefore, urgent comprehensive health intervention should be implemented in the area to reduce adverse pregnancy outcomes.

Measuring socioeconomic inequalities in postnatal health checks for newborns in Ethiopia: a decomposition analysis.

Background: Addressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial inequalities in the use of health services among various socioeconomic strata. Therefore, the present study aimed to measure socioeconomic inequalities and the contributing factors in postnatal health checks for newborns in Ethiopia. Methods: We used a secondary data from the recent 2019 Ethiopia Mini Demographic and Health Survey dataset. The study includes a weighted sample of 2,105 women who gave birth in the 2 years preceding to the survey. The study participants were selected using two stage cluster sampling techniques. The socioeconomic inequality in postnatal health checks for newborns was measured using the Erreygers Normalized Concentration Index (ECI) and illustrated by the concentration curve. A decomposition analysis was done to identify factors contributing to the socioeconomic related inequality in postnatal health checks for newborns in Ethiopia. Results: The concentration curve of postnatal health checks for newborns lay below the line of equality, and the Erreygers normalized concentration index was 0.133, with a standard error = 0.0333, and a p value <0.001; indicating that the postnatal health check for newborns was disproportionately concentrated among newborns with higher socioeconomic status. The decomposition analysis reported that antenatal care (ANC) visit (59.22%), household wealth index (34.43%), and educational level of the mother (8.58%) were the major contributors to the pro-rich socioeconomic inequalities in postnatal health checks for newborns. Conclusion: The finding revealed that there is a pro-rich inequality in postnatal health checks for newborns in Ethiopia. To reduce the observed socioeconomic health inequality, the government needs to improve ANC visits, implement strategies to access health service for economically disadvantaged groups, and increase educational attainment among women.

The association between children's exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis.

Background: Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods: A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result: A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion: This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.

The burden of health expenditure on household impoverishment in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia, like many low-income countries, faces significant challenges in providing accessible and affordable healthcare to its population. Health expenditure is a critical factor in determining the quality and accessibility of healthcare. However, high health expenditure can also have detrimental effects on households, potentially leading to impoverishment. To the best knowledge of investigators, no similar study has been conducted in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the pooled burden of health expenditure on household impoverishment in Ethiopia. METHODS: This systematic review and meta-analysis used the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Cochrane Library, HINARI, Google Scholar and Epistemonikos electronic databases were searched systematically. Moreover, direct manual searching through google was conducted. The analysis was performed using STATA version 17 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. The trim and fill method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled incidence with a 95% confidence interval of meta-analysis using the random effect model. RESULTS: This systematic review and meta-analysis included a total of 12 studies with a sample size of 66344 participants. The pooled incidence of impoverishment, among households, attributed to health expenditure in Ethiopia was 5.20% (95% CI: 4.30%, 6.20%). Moreover, there was significant heterogeneity between the studies (I2 = 98.25%, P = 0.000). As a result, a random effect model was employed. CONCLUSION: The pooled incidence of impoverishment of households attributed to their health expenditure in Ethiopia was higher than the incidence of impoverishment reported by the world health organization in 2023.

Client satisfaction and contributing factors towards sexual and reproductive health services delivery system among youth at Family Guidance Association of north Ethiopia (FGAE) clinics, 2023: mixed method study.

BACKGROUND: The Family Guidance Association of Ethiopia (FGAE) operates as a non-governmental organization dedicated to offering family planning and reproductive health services to the Ethiopian population. The gap in the study regarding client satisfaction and contributing factors towards sexual and reproductive health services for youth at FGAE clinics highlights the need for a comprehensive investigation to fill this void. By conducting a mixed-method study, this research aims to provide a holistic understanding of the factors influencing client satisfaction in the delivery of sexual and reproductive health services to youth at FGAE clinics. The added value of this study lies in its potential to offer valuable insights and recommendations for improving service delivery systems and enhancing client satisfaction levels, ultimately contributing to the overall well-being and health outcomes of youth in North Ethiopia. Therefore study aimed to asses Client Satisfaction and Contributing Factors towards in sexual and reproductive health services delivery system among youth at Family Guidance Association of North Ethiopia (FGAE) Clinics, 2023. METHOD: The study was conducted within the clinics of the Family Guidance Association of Ethiopia (FGAE), spanning Dessie, Kombolcha, and Woldia city administrations, involving a participant cohort of 416 clients. Facility-based concurrent type mixed method study design both quantitative and qualitative techniques were applied. Quantitative research employed a simple random sampling technique and conversely, the qualitative study utilized a heterogeneous type of purposive sampling strategy to recruit participants The collected data underwent a rigorous process of entry, cleaning, and coding using Epi-Data 4.6 software, followed by analysis in STATA V17. Descriptive statistics and binary logistic regression were employed to highlight the impact of independent variables on the dependent variable. A more comprehensive examination was provided through multivariable logistic regression. Crude and adjusted odds ratios, along with a 95% confidence interval, were computed, with significance set at a p-value ≤ 0.05. RESULT: Nearly more than half of the clients 194 (47.8%) came to receive family planning services followed by maternal and child health 107 (26.4%). Sixty patients (14.8%) didn't receive all the services they wanted or came for. Half of the participants 30 (50%) raised the unavailability of the service as a reason for not taking the service followed by not having enough time in the clinic 12 (20%). About 65.52% (60.74-70.00%) of the participants were satisfied with the Sexual and Reproductive Health services provided by the clinics of FGAE in northeast Ethiopia. Clients in the age group of 25-34 (AOR = 2.04; 95%CI: 1.11-3.72). Clients who had primary and secondary education (AOR = 2.49; 95%CI: 1.03-6.02) and (AOR = 3.05; 95%CI: 1.25-7.49) respectively. Clients who responded that physicians show respect (AOR = 5.59; 95%CI: 1.89-16.49). clients who received an explanation about the side effects of the utilized methods and follow-up dates (AOR = 4.59;95%CI:1.68-12.53) and (AOR = 2.89;95%CI:1.53-5.49) respectively. CONCLUSION: The proportion of client satisfaction with Client Satisfaction in the Services delivery system at Family Guidance Association of Ethiopia (FGAE) Clinics was low as compared to the previous study. Age group 25-34 years, primary and secondary education, showing respect, explaining side-effects and follow-up visits were significant associated factors of client service satisfaction. Enhancing service delivery at Family Guidance Association of Ethiopia (FGAE) Clinics by targeting specific areas identified in the study. Strategies should focus on improving communication regarding side effects, ensuring respectful interactions, and prioritizing follow-up visits, particularly for clients aged 25-34 with primary and secondary education backgrounds.

Virological Suppression and its Predictors Among HIV/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis.

Background: Achieving viral load suppression is crucial for the prevention of complications and deaths related to HIV infection. Ethiopia has embraced the worldwide 95-95-95 target, but there is no national representative information regarding virological suppression. Therefore, this review aims to determine the pooled virological suppression rate and identify the pooled effect of contributing factors of viral suppression for HIV-positive patients on antiretroviral therapy in Ethiopia. Methods: We systematically searched websites and databases, including online repositories, to obtain primary studies. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale appraisal checklist. Publication bias was checked using Egger's regression test, the heterogeneity of the studies was assessed using I2 statistics and Q statistics, and a sensitivity analysis was performed to identify any outlier results in the included studies. The Der Simonian Laird random-effects model was used to estimate the overall proportion of viral suppression, and STATA 17 statistical software was used for all types of analysis. Results: A total of 21 eligible articles primarily conducted in Ethiopia using HIV program data were used for this quantitative synthesis. The overall pooled virological suppression rate was 71% (95% CI, 64%-77%). The pooled effects of poor adherence to ART (adjusted odds ratio [AOR], 0.33; 95% CI, 0.28-0.40), body mass index (18.5-24.9 kg/m2; AOR, 1.8; 95% CI, 1.37-2.36), disclosure (AOR, 1.41; 95% CI, 1.05-1.89), absence of opportunistic infection (AOR, 1.68; 95% CI, 1.43-1.97), and high baseline viral load count (AOR, 0.65; 95% CI, 0.52-0.81) were identified as significant predictors of viral suppression. Conclusions: The overall pooled percentage of virological suppression was low compared with the global target of viral suppression and the Ethiopian Public Health Institute report. Poor adherence, normal body mass index, disclosure, absence of opportunistic infection, and high baseline viral load count were factors contributing to viral suppression in Ethiopia. Responsible stakeholders should maximize their efforts to achieve the global target of virological suppression by addressing significant predictors.

Socioeconomic inequality in timing of ANC visit among pregnant women in Ethiopia, 2019.

Background: Antenatal care (ANC) remains an invaluable approach to preventive care for ensuring maternal and infant health outcomes. Women in sub-Saharan Africa tend to delay their first antenatal care visits. In Ethiopia, only 20% of women received their first antenatal care during the first trimester of pregnancy. Timely and appropriate antenatal care practices can potentially save the lives of both mothers and children. Understanding socioeconomic inequality in the timing of antenatal care visits and its determinants may contribute to tackling disparities and achieving the sustainable development goals for maternal health. Objective: This study aimed to assess the socioeconomic inequality in the timing of antenatal care visit. Method: Secondary data sourced from the Mini Ethiopian Demographic Health Survey 2019 were used for this study. A total of 2,906 pregnant women were included in the study, and concentration curves were used to show inequality among sociodemographic and economic variables. Decomposition analysis was performed to estimate the contribution of each independent variable to the inequality in the timing of antenatal care visits. Result: The estimate of early initiation of antenatal care was 63%. The concentration index was 0.18 (P < 0.001). The inequality in the timing of antenatal care visit was more concentrated among the wealthiest pregnant women with a concentration index value of 0.18 (P < 0.001). Based on decomposition analysis results, the wealth index (81.9%.), education status (22.29%), and region (0.0642%) were identified as contributing factors to the inequality in the timing of antenatal care visits among women. Conclusion: The wealth index, educational status, and region were significant contributors to inequality in the early initiation of antenatal care visit. Improving women's wealth and education and narrowing the inequality gap are crucial for improving the health status of women and their children. We should focus on interventions targeted at early antenatal care visit to address the determinants of socioeconomic inequities.

Factors influencing delay in malaria treatment seeking at selected public health facilities in South Gonder, Ethiopia.

Early and prompt treatment-seeking for malaria is necessary to reduce the progression of the disease to its severe forms and the associated mortality. Various studies have indicated that treatments sought for malaria were not always within the recommended timeframe. Therefore, this study aims to assess factors influencing delay in malaria treatment seeking at public health facilities in South Gonder, Ethiopia. An unmatched case-control study was conducted among 322 individuals, comprising 161 cases and 161 controls, who were randomly selected malaria patients visiting public health facilities in South Gonder District, Ethiopia, from May 20/2022 to June 25/2022. An interviewer-administered questionnaire was used to collect data, which were subsequently cleaned and entered into Epi data. Descriptive statistics were performed, and variables with a p-value of ≤ 0.25 from the bivariate analysis were included in a multivariable logistic regression model. Significant variables with a p-value of < 0.05 were retained in the multivariable model. Patients who were unable to read and write [AOR = 3.47 (1.01-11.9)], fear of side effects of malaria treatment drugs [AOR = 1.89 (1.04-3.42)], lack of access to health education malaria disease and its treatment [AOR = 1.93 (1.02-3.65)], lack of transportation access [AOR = 4.70 (1.73-12.7)], not membership of community-based health insurance [AOR = 2.5 (1.3-4.82)] and lack of confidence on malaria care health facility providing [AOR = 2.14 (1.06-4.29)], were found to be determinants of treatment-seeking delay among malaria patients. In Summary, this study revealed significant associations between delays in seeking malaria treatment and factors such as educational status (those who were unable to read and write), malaria drug side effects, health education on malaria, transportation access, CBHI membership, and confidence in health malaria care. it is recommended that targeted interventions and awareness campaigns be implemented to address these determinants, promoting prompt and effective malaria treatment-seeking behavior in the studied population.

Prevalence and associated factors of depression among breast cancer patients in Sub-Saharan Africa: A systematic review and meta-analysis.

Introduction: Even though breast cancer incidence is lower in Sub-Saharan Africa, its mortality is higher in these countries. However, the impact does not end with diagnosis and treatment; rather many patients struggle with depression which is very common among these patients. This systematic review and meta-analysis helps to provide valuable insights into the overall prevalence of depression and associated factors among breast cancer patients in Sub-Saharan Africa. Method: We searched several databases, including MEDLINE, Embase, Scopus, Hinary, CINHAL and Google Scholar to retrieve relevant literatures from inception up to 15 June 2023. All observational studies, published in English at any time were included, while, letters to editor, review articles, commentaries, interventional and qualitative studies, and, abstracts presented in conferences or seminars were excluded. The results of this systematic review and meta-analysis have been written based on the PRISMA 2020 checklist and the protocol have been registered in PROSPERO database (CRD42023428910). Result: We have included nine articles with 2226 study participants. The result showed that, the pooled prevalence of depression among breast cancer patients in Sub-Saharan Africa was 45.6% (95% CI: 30%-61%) with significant heterogeneity I2 = 98.9%, (Cochrane) Q < 0.0001. There was no single study effect and publication bias but substantial heterogeneity was observed. In addition, there has been a publication bias with eggers test (p < 0.0033). However, there were no studies imputed after trim and fill analysis. From the factors, breast cancer patients who had poor financial support were 1.47 (95% CI: 1.02-2.13) times more at risk of developing depression than their counterparts. Conclusion: The prevalence of depression among breast cancer patients in Sub-Saharan Africa countries were higher than other regions. Thus, Emphasis should be given on developing financial assistance programs designed to cover the medical costs and improving the health care infrastructure.

Trends of socioeconomic and geographic inequalities in severe wasting among under-five children in Ethiopia from 2000 to 2019: using the WHO Health Equity Assessment Toolkit.

Severe wasting is the deadliest form of wasting caused by a lack of nutritious food and repeated attacks of illness. The World Health Assembly has agreed to reduce severe wasting to less than 5% and 3% by the end of 2025 and 2030. Significant disparities were observed worldwide in progress towards the goal. However, limited evidence of disparity in severe wasting was available in Ethiopia. Therefore, this study aimed to assess trends in socioeconomic and geographic inequalities in severe wasting among under-five children in Ethiopia between 2000 and 2019. The trend in socioeconomic and geographic inequality was assessed using the World Health Organization Health Equity Assessment Toolkit, employing both absolute and relative measures of inequality. Difference (D), ratio (R), slope index inequality (SII), relative concentration index (RCI), and population attributable ratio (PAR) were utilized to assess disparity across wealth, education, residence, and subnational regions. The 95% uncertainty interval (UI) was used to declare the significant change in inequality through time. The proportion of severe wasting increased from 3.8% to 4.7% between 2000 to 2005 and dropped to 2.9% in 2011 to remain constant until 2016. However, the proportion of severe wasting significantly declined to 1.1% in 2019. As indicated by RCI, significant fluctuation in wealth-related inequality was observed in all five survey years but a significant change in wealth-related inequality was observed in 2005 and 2019. Whereas the education-related inequality in RCI of severe wasting steadily increased from -8.8% in 2005 to -24.3% in 2019. And the change was significantly widened from 2011 to 2019. On the other hand, residence-related inequality of severe wasting was observed in 2000 in ratio, difference and PAR summary measures but disappeared in 2019. Between 2000 and 2016, regional inequalities in severe wasting fluctuated between 8.7 in 2005 to 5.9 in 2016 taking the difference as a measure of inequality. Overall, Wealth-related inequality has significantly widened over time with under five children from the richest households being less affected by severe wasting. Education-related inequality was not changed with under five children whose mothers had not attended formal education highly affected by severe wasting. Regional disparity in severe wasting is also exhibited in Ethiopia in all-round surveys with children from Addis Ababa being least affected whereas children from Somalia were highly affected by severe wasting. However, no significant disparity in the type of residence in severe wasting was revealed in Ethiopia. Therefore, special attention should be paid to under-five children living in the poorest households, whose mothers did not attend formal education and children living in Somalia region.

Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Informed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia. METHODS: We searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies' quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version. RESULTS: The pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent. CONCLUSION: The appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero .

Spatial distribution and determinants of barriers of health care access among female youths in Ethiopia, a mixed effect and spatial analysis.

Access to healthcare services is a fundamental human right for every citizen, and it is the responsibility of the nation to guarantee that these services are acceptable, easily accessible, and timely. Barriers to accessing health services may have a detrimental effect on an individual's physical, and mental health, and overall quality of life. However, access to health care services is a common problem in developing countries. Therefore, this study aimed to investigate spatial distribution and determinants of barriers to healthcare access among female youths in Ethiopia. Secondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 6143 female youths aged 15-24 years old was included in this study. A mixed-effect analysis was employed to identify factors contributing to barriers to healthcare access among youths in Ethiopia. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of barriers to healthcare access. This study revealed that the magnitude of barriers to healthcare access among female youth was 61.3% with 95%CI (60.1 to 62.5) to at least one or more of the four reasons. Age 15-19 years old (AOR = 0.80, 95%CI 0.68 to 0.95), no formal education (AOR = 2.26, CI 1.61, 3.18), primary education (AOR = 2.21, CI 1.66, 2.95), marital status (AOR = 1.43, 95% CI 1.21, 1.70), poor household wealth (AOR = 1.63, 95% CI 1.31, 2.05), no Media exposure (AOR = 1.67, 95%CI 1.41-1.98), reside in rural areas (AOR = 1.63, 95%CI 1.05 to 2.54), and low community media exposure (AOR = 1.45, 95%CI 1.01-2.08) were significantly associated with barriers of health care service. Barriers to healthcare access were significantly and disproportionately concentrated in poor households. A non-random Barrier to healthcare access was observed in Ethiopia. Among the 9 regions, primary clusters were identified in only 4 regions (North Ormiya, Benishangul Gumuz, Gambella, and South Nation Nationality and Peoples regions. A significant proportion of female youths faced barriers to health care access Age, educational status, marital status, rural residency, low economic status, and media exposure were factors associated with barriers to health care access. Therefore, program planners and decision-makers should work on improving the country's economy to a higher economic level to improve the wealth status of the population, promote media exposure, and increase access to education.

Postpartum long-acting reversible contraceptives use in sub-Saharan Africa. Evidence from recent demographic and health surveys data.

BACKGROUND: In developing countries, most women want to avoid pregnancy for two years after giving birth. However, 70% do not use contraceptives during this time. Unintended pregnancies may occur for couples who delay contraceptive use during the postpartum period. The most effective form of contraceptive methods for postpartum women is long-acting reversible contraceptive (LARC). Therefore, this study aimed to assess long-acting reversible contraceptive use and associated factors among postpartum women in Sub-Saharan Africa. METHODS: Secondary data analysis was performed using the recent Demographic and Health Surveys (DHS). Stata version 14 was used to analyze the data. A multilevel mixed-effect logistic regression model was used to identify factors associated with long-acting reversible contraceptive use. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with long-acting reversible contraceptives. RESULTS: The magnitude of long-acting reversible contraceptive use among postpartum women was 12.6% (95% CI: 12.3, 12.8). Women primary (aOR = 1.51; 95% CI: 1.41, 1.63) and secondary education (aOR = 1.62; 95% CI: 1.32, 1.71), media exposure (aOR = 1.73; 95% CI: 1.51, 1.85), place of delivery (aOR = 1.54; 95% CI: 1.43, 1.67), number of ANC visit; 1-3 (aOR = 2.62; 95% CI: 2.31, 2.83) and ≥4 (aOR = 3.22; 95% CI: 2.93, 3.57), received PNC (aOR = 1.34; 95%CI: 1.13, 1.58), and income level; low middle income (aOR = 2.41; 95% CI: 2.11, 2.88) and upper middle income (aOR = 1.83; 95% CI: 1.56, 1.24) were significantly associated with long-acting reversible contractive use. CONCLUSION: Nearly one in 10 postpartum women used long-acting reversible contraceptives. Hence, we suggest that the concerned bodies should promote family planning messages in mass media and give the well-documented benefits of postpartum long-acting contraceptive use. Promote the integration of postpartum LARC methods into maternal health care services and give better attention to postpartum women living in low-income countries and uneducated women.

Spatial distribution, magnitude, and predictors of high fertility status among reproductive age women in Ethiopia: Further analysis of 2016 Ethiopia Demographic and Health Survey.

BACKGROUND: Women's health and welfare, as well as the survival of their children, are adversely affected by high fertility rates in developing countries. The fertility rate in Ethiopia has been high for a long time, with some pockets still showing poor improvement. Thus, the current study is aimed to assess the spatial distribution and its predictors of high fertility status in Ethiopia. METHODS: Secondary data analysis was used using the 2016 Ethiopian Demographic and Health Survey (EDHS). The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of high fertility status. ArcGIS version 10.8 was used to visualize the distribution of high fertility status across the country. Mixed-effect logistic regression analysis was also used to identify the predictors of high fertility. RESULT: High fertility among reproductive-age women had spatial variation across the country. In this study, a higher proportion of fertility occurred in Somali region, Southeastern part of Oromia region, and Northeastern part of SNNPR. About 45.33% (confidence interval: (44.32, 46.33) of reproductive-age women had high fertility. Education; no formal (aOR: 13.12, 95% CI: 9.27, 18.58) and primary (aOR: 5.51, 95% CI: 3.88, 7.79), religion; Muslim (aOR: 1.52, 95% CI: 1.28, 1.81) and Protestant (aOR: 1.48, 95% CI: 1.23, 1.78), age at first birth (aOR: 2.94, 95% CI: 2.61, 3.31), age at first sex (aOR: 1.70, 95% CI: 1.49, 1.93), rural resident (aOR: 3.76, 95% CI: 2.85, 4.94) were predictors of high fertility in Ethiopia. CONCLUSION: The spatial pattern of high fertility status in Ethiopia is clustered. Hotspot areas of a problem were located in Somali, Central Afar, Northeastern part of SNNPR, and Southeastern part of Oromia region. Therefore, designing a hotspot area-based interventional plan could help to reduce high fertility. Moreover, much is needed to be done among rural residents, reducing early sexual initiations and early age at first birth, and enhancing women's education. All the concerned bodies including the kebele administration, religious leaders, and community leaders should be in a position to ensure the practicability of the legal age of marriage.

Prevalence and predictors of post-abortion modern contraceptive utilization among reproductive age women in Ethiopia.

The development of a post-abortion family plan is an integral part of comprehensive abortion care. In spite of this, it received insufficient attention as a means of breaking the cycle of repeated abortions, unintended pregnancies, and maternal deaths resulting from abortion. Therefore, this study examined post abortion modern contraceptive utilization among Ethiopian women as well as associated factors. The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of post abortion contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. Overall prevalence of post abortion contraceptive use was observed to be 25.6% (95% CI: 23.24, 28.12). Women's age 15-24 (AOR = 2.34; 95% CI: 1.11, 4.93), and 25-34 (AOR = 1.94; 95% CI: 1.27, 2.98), married women (AOR = 2.6; 95% CI: 1.43, 4.96), women who had 1-4 (AOR = 4.13; 95% CI: 1.79, 9.57) and ≥ 5 number of children (AOR = 8.80; 95% CI: 3.30, 13.49), Being in metropolitan region (AOR = 9.14; 95% CI: 1.79, 12.48), women being in urban area (AOR = 1.85; 95% CI: 1.32, 2.24), and community media exposure (AOR = 1.75; 95% CI: 1.11, 3.56) were associated with post abortion modern contraceptive use. Post abortion modern contraceptive use in this study was low. Women age, current marital status, number of living children, residency, community media exposure, and region were significantly associated with post abortion modern contraceptive utilization. Therefore, it is better to provide ongoing health information about post-abortion family planning and its benefits, especially for people who live in rural and small peripheral regions, and public health policymakers should take both individual and community level factors into account when designing family planning programmes.

Prevalence and determinants of early neonatal mortality in Ethiopia: findings from the Ethiopian Demographic and Health Survey 2016.

BACKGROUND: Early neonatal death accounts for a significant number of under-5 mortality worldwide. However, the problem is under-researched and under-reported in low-income and middle-income countries, particularly in Ethiopia. The magnitude of mortality during the early neonatal period and associated factors should be studied for designing appropriate policies, and strategies that could help tackle the problem. Hence, this study aimed to determine the prevalence and identify factors associated with early neonatal mortality in Ethiopia. METHODS: This study was conducted by using data from Ethiopian Demographic and Health Survey 2016. A total of 10 525 live births were enrolled in the study. A multilevel logistic regression model was used to identify determinants of early neonatal mortality. Adjusted OR (AOR) at a 95% CI was computed to assess the strength and significance of the association between outcome and explanatory variables. Factors with a p<0.05 were declared statistically significant. RESULTS: The national prevalence of early neonatal mortality in Ethiopia was 41.8 (95% CI 38.1 to 45.8) early neonatal deaths per 1000 live births. The extreme ages of pregnancy (under 20 years (AOR 2.7, 95% CI 1.3 to 5.5) and above 35 years (AOR 2.4, 95% CI 1.5 to 4)), home delivery (AOR 2.4, 95% CI 1.3 to 4.3), low birth weight (AOR 3.3, 95% CI 1.4 to 8.2) and multiple pregnancies (AOR 5.3, 95% CI 4.1 to 9.9) were significantly associated early neonatal mortality. CONCLUSIONS: This study revealed a higher prevalence of early neonatal mortality as compared with prevalence in other low-income and middle-income countries. Thus, it is determined to be essential to design maternal and child health policies and initiatives with a priority on the prevention of early neonatal deaths. Emphasis should be given to babies born to mothers at extreme ages of pregnancy, to those born of multiple pregnancies delivered at home and to low birthweight babies.

Early Postnatal Home Visit Coverage by Health Extension Workers and Associated Factors Among Postpartum Women in Gidan District, Northeast Ethiopia.

Objectives: To determine the coverage and associated factors of early postnatal home visits (PNHVs) by health extension workers (HEWs) among postpartum women in Gidan district, Northeast Ethiopia. Methods: A community-based, cross-sectional study was conducted between 30 March and 29 April 2021 in the Gidan district, Northeast Ethiopia. A multistage sampling technique was employed to select 767 postpartum women participants. Interviewer-administered questionnaires were used to collect the data. A binary logistic regression model was fitted to identify factors associated with early PNHVs by HEWs. Results: The coverage of early postnatal home visits was 15.13% [95% confidence interval (CI): 12.75, 17.87]. Women's education, institutional delivery, time to reach health posts, and participation in pregnant women forums were significantly associated with early PNHVs by HEWs. Conclusion: In the current study, the coverage of early postnatal home visits by HEWs remains low in the study area. The concerned bodies should consider interventions that promote women's education and institutional delivery, and more efforts should be made to improve community-based participation and links with HEWs.