Maternal near-miss prediction model development among pregnant women in Bahir Dar City administration, northwest Ethiopia: a study protocol.

INTRODUCTION: Maternal near-miss is a condition when a woman nearly died but survived from complications that happened during pregnancy, childbirth or within 42 days after delivery. Maternal near-miss is more prevalent among women in developing nations. Previous studies have identified the impact of different predictor variables on maternal near-miss but shared prognostic predictors are not adequately explored in Ethiopia. It is therefore necessary to build a clinical prediction model for maternal near-misses in Ethiopia. Hence, the aim of this study is to develop and validate a prognostic prediction model, and generate a risk score for maternal near-miss among pregnant women in Bahir Dar City Administration. METHODS AND ANALYSIS: A prospective follow-up study design will be employed among 2110 selected pregnant women in the Bahir Dar City administration from 1 May 2023 to 1 April 2024. At the initial antenatal visit, pregnant women will be systematically selected. Then, they will be followed until 42 days following birth. Data will be collected using structured questionnaires and data extraction sheet. The model will be created using Cox proportional hazard regression analysis. The performance of the model will be assessed based on its capacity for discrimination using c-index and calibration using calibration plot, intercept and slope. The model's internal validity will be evaluated through the bootstrapping method. Ultimately, the model will be illustrated through a nomogram and decision tree, which will be made available to prospective users. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Institutional Review Board of the College of Medicine and Health Sciences, Bahir Dar University (protocol number 704/2023). Findings will be published in peer-reviewed journals and local and international seminars, conferences, symposiums and workshops. Manuscripts will be prepared and published in scientifically reputable journals. In addition, policy briefs will be prepared.

Urban-rural disparities in immunization coverage among children aged 12-23 months in Ethiopia: multivariate decomposition analysis.

BACKGROUND: Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia. METHODS: We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS: The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (ß = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (ß = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (ß = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (ß = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (ß=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (ß=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (ß=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity. CONCLUSIONS: There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.

Contraceptive dynamics among women with disabilities in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Contraceptive dynamics is the use of contraception, unmet need, discontinuation, and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Even though certain studies have been conducted in high-income countries, research is scarce on the degree of contraceptive method mix, unmet needs, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. METHODS: The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (MEDLINE), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health. Grey literature databases will be searched using electronic search engines such as Google Scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. Any type of study design (e.g., randomized controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case-control or nested case-control studies, qualitative, cross-sectional studies) will be included in this scoping review. There will be no restrictions on publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines will be used to report all parts of the protocol and scoping review. DISCUSSION: When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. Despite these facts, they are the most marginalized people on the planet. This is, therefore, critical to map available evidence and identify knowledge gaps on contraceptive dynamics. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

Factors associated with unintended pregnancy in Ethiopia; further analysis of the 2016 Ethiopian demographic health survey data.

BACKGROUND: Unintended pregnancy an important public health problem in Ethiopia. It is associated with adverse physical, mental, social and economic outcomes. Identifying factors associated with unintended pregnancy may help to reduce unintended pregnancy and hence adverse outcomes. There are few studies about the prevalence and associated factors of unintended pregnancy in Ethiopia. But these studies were based on small sample size and fragmented. Therefore, this analysis was done to identify factors associated with unintended pregnancy in Ethiopia based on nationally representative data. METHODS: The study used the 2016 Ethiopian demographic and health survey data. The data was downloaded from The DHS program with permission. A total of 1135 women were included in the final model. Data was weighted to consider disproportionate sampling and non-response. Multivariable logistic regression was used to identify factors associated with unintended pregnancy among women. RESULT: About 30% (95% CI: 25.33-34.39) pregnancies were unintended. Married women (Adjusted odds ratio (AOR); 0.34; 95% CI: (0.01-0.14), woman living in developing regions AOR; 0.14; 95% CI: (0.07-0.27) and women who reported distance was not a big problem to get medical care AOR; 0.59; 95% CI: (0.36-0.99) had lower odds of unintended pregnancy. On the other hand, multiparous AOR; 3.77; 95% CI: (1.71-8.33), grand multiparous AOR; 6.72; 95% CI: (2.74-16.49) women and women who ever used contraceptives AOR; 1.86 95% CI: (1.06-3.26) had higher odds of unintended pregnancy. CONCLUSION: Although high, the magnitude of unintended pregnancy in Ethiopia was lower compared to the global level. Marital status, region, perceived distance to seek medical care, parity and history of contraceptive use were found significant predictors of unintended pregnancy in Ethiopia.

Factors associated with divorce from first union among women in Ethiopia: Further analysis of the 2016 Ethiopia demographic and health survey data.

BACKGROUND: Globally, divorce is a common phenomenon in couples' marital life. As a result, many divorced couples and their children face several social, economic, and health problems after dissolution. There is little information on the magnitude and determinants of divorce in developing countries including Ethiopia. Therefore, this study aimed to estimate the prevalence of divorce from the first union and its predictors among reproductive-age women in Ethiopia. METHODS: We used the 2016 Ethiopia demographic and health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 11,646 ever-married women were included in the analysis. Bivariate and multivariable logistics regression was done to identify the determinants of divorce from the first marriage. A p-value < 0.05 was used to declare statistical significance. RESULTS: About 25% (95%CI: 23.4% - 26.6%) ever-married women were divorced from their first marital relationship. Women who were married at age < 15 years (AOR = 1.34; 95%CI: 1.07-1.68), urban women (AOR = 1.69; 95%CI: 1.22-2.35), women who did not attend formal education (AOR = 4.36; 95%CI: 3.14-6.05), women who were employed (AOR = 1.51; 95%CI: 1.31-1.73), and being childless (AOR = 1.34; 95%CI: 1.07-1.69) had higher odds of experiencing a divorce. Similarly, women who experienced partner violence, women with no house ownership, and women in the Amhara region had higher odds of divorce from their first marital union. Conversely, women in Oromia, SNNPR, the metropolis, and the pastoral regions had lower odds of divorce from their first marital union. CONCLUSION: Divorce from the first marriage is high in Ethiopia. Preventing early marriage and partner violence and promoting girls' education would reduce the divorce rate in Ethiopia.

Factors associated with early long-acting reversible contraceptives discontinuation in Ethiopia: evidence from the 2016 Ethiopian demographic and health survey.

BACKGROUND: Ethiopia is struggling to achieve the 2020 family planning target. But the current contraceptive prevalence uptake is low and dominated by short-acting methods. Contraceptive discontinuation rate is also high. This analysis was done to identify the reasons and factors associated with long-acting and reversible contraceptives (LARC) discontinuation in Ethiopia. METHODS: The unit of analysis was LARC-use episodes in the 5 years preceding the survey, generated from the 2016 Ethiopian Demographic and Health Survey data. A total of 1385 LARC episodes were included. Data analysis was done using STATA 15. The event file generated from the contraceptive calendar was merged to the original data set to identify factors associated with LARC discontinuation. Univariate, bivariate and inferential analyses were done for 12 months LARC discontinuation. RESULT: Approximately 82% of LARC episodes were implants. About 45% of intrauterine device (IUD) and 61% of implant episodes were discontinued by 36 months. Side effects and the desire to become pregnant were the main reasons for discontinuation. Women aged 25-34 (HR = 0.26; 95% CI: 0.20-0.35) and those aged 35-49 (HR = 0.17; 95%CI: 0.11-0.26), women who participated in decision-making partially (HR = 0.53; 95%CI: 0.37-0.78), or fully (HR = 0.55; 95%CI: 0.40-0.74) and primiparous women (HR = 0.53, 95%CI: 0.33-0.86) had a lower hazard of discontinuing LARCs. On the other hand, women who had only primary education (HR = 1.32; 95%CI: 1.02-1.72) and women who were not sure about their fertility intention (HR = 2.11; 95%C: 1.28-3.46) had a higher likelihood of discontinuing these methods. CONCLUSION: Majority of LARC episodes were discontinued early, mainly due to the desire for pregnancy or experience of side effects. Older women, particularly those involved in household decision-making, and primipara were less likely to discontinue LARC. Women with only primary education and those uncertain about their fertility intention had a higher likelihood of discontinuation. Family planning service providers should focus on fertility intention and side effects when counseling women for contraceptive choice. Improving women's participation in household decision-making may decrease LARC discontinuation in Ethiopia.

Contraceptive use among women with no fertility intention in Ethiopia.

INTRODUCTION: Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children. METHODS: We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. RESULTS: Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0-55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use. CONCLUSION: Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups.

Modern contraceptive use and factors associated with use among postpartum women in Ethiopia; further analysis of the 2016 Ethiopia demographic and health survey data.

BACKGROUND: The postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia. METHODS: We used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance. RESULTS: About 23.7% (23.7, 95% CI: 20.7-27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34-3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04-3.10), women who attended 1-3 (AOR = 2.33; 95%CI:1.27-4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43-4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23-2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01-3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13-3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01-1.88) had higher odds of modern contraceptive use. CONCLUSION: Postpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls' education and encouraging women's participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.

Factors associated with sexually transmitted infections among sexually active men in Ethiopia. Further analysis of 2016 Ethiopian demographic and health survey data.

BACKGROUND: Sexually-transmitted infections are a public health problem in developing countries including Ethiopia. However, there is limited evidence on factors associated with sexually-transmitted infections among men in Ethiopia. Therefore, this analysis was done to fill this gap. METHODS: This analysis was done based on the 2016 Ethiopian demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey used two stage-stratified cluster sampling technique. A total of 8849 sexually active men were included in this analysis. Descriptive and analytical analyses were performed. A p-value of less than 0.05 was used to declare statistical significance. RESULTS: Muslim men (AOR = 1.68; 95%CI: 1.02-2.76), men who were not exposed to media (AOR = 1.75; 95%CI: 1.01-3.03) and men who had multiple sexual partners (AOR = 2.29; 95%CI: 1.05-5.01) had higher odds of having a sexually transmitted infection. In addition, men living in Amhara (AOR = 3.31; 95%CI: 1.33-8.22), Oromia (AOR = 4.62; 95%CI: 1.85-11.55), Gambella (AOR = 3.64; 95%CI: 1.27-10.42), and Harari regions (AOR = 4.57; 95%CI: 1.49-14.02) had higher odds of developing sexually transmitted infection. On the other hand, men who believe women are asked to use a condom if she knows he has STIs (AOR = 0.53; 95%CI: 0.33-0.85) had low odds of developing a sexually transmitted infection. CONCLUSIONS: Men not exposed to mass media, Muslims and men with multi-sexual partners had higher odds of having sexually transmitted infections. Encouraging monogamous relationships and exposing men to mass media may help to reduce the burden of STIs in Ethiopia.

Correction: Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey.

[This corrects the article DOI: 10.1371/journal.pone.0227218.].

Factors associated with HIV testing among young females; further analysis of the 2016 Ethiopian demographic and health survey data.

BACKGROUND: HIV counseling and testing are key to control and prevent the spread of the virus and improve the lives of people living with HIV. Although the risk of acquiring the virus is high, only 27% of young Ethiopian women age 15 to 24 years old were tested and counseled for HIV. This coverage is low to achieve the 90-90-90 goal. Identifying factors associated with low utilization of HIV testing and counseling services among young females (aged 15 to 24 years) is important to identify the barriers and improve uptake. Therefore, this analysis was done to identify factors associated with low utilization of HIV counseling and testing services among young Ethiopian women. METHODS: The study used the 2016 Ethiopian demographic and health survey data. The data was downloaded from The DHS program with permission. A total of 2661 young women (aged 15 to 24 years) were included in the final model. Data was weighted to consider disproportionate sampling and non-response. A Complex data management technique was applied to consider the complex sampling technique used in the DHS. Multivariable logistic regression was used to identify factors associated with HIV testing among young women. RESULT: Among sexually active young women, 33.5% (95%CI; 30.1, 37.1) were tested for HIV. Young women who attended primary ((AOR 2.8; (95% CI; 2.0, 3.9)), secondary (AOR 4.7; (95% CI; 3.1, 7.3)) or higher education (AOR; 5.6; 95% CI; 2.6, 12.0), those who had multiple sexual partners (AOR 5.5; 95% (CI; 1.3, 23.3)), young women who ever used alcohol (AOR 1.46; 95% (CI; 1.1, 2.0)) and young women who visited health care facilities (AOR 1.8; (95% CI; 1.4, 2.3)) had higher odds of being tested for HIV. On the other hand, young women from the rural areas had lower odds (AOR 0.5; (95% CI; 0.3, 0.7)) of being tested for HIV. CONCLUSION: HIV testing among sexually active young women in Ethiopia was low. Educational status, place of residence, alcohol intake, number of sexual partners and visiting health facility 12 months before the survey were found significant predictors of HIV testing. Therefore, the Ethiopian government should encourage girls to complete secondary education to improve HIV testing and counseling. Young women should be encouraged to visit health facilities to improve HIV testing service uptake.

Determinants of change in long-acting or permanent contraceptives use in Ethiopia; A multivariate decomposition analysis of data from the Ethiopian demographic and health survey.

BACKGROUND: There has been an increase in the uptake of long-acting or permanent contraceptive methods (LAPMs) in Ethiopia. Identifying the factors associated with this change is important for designing interventions that will further accelerate the uptake. This study was done to identify components of, and factors associated with, changes in the use of LAPMs in Ethiopia. METHODS: Information about 16,336 married or in-union reproductive-age women were extracted from the 2005 and 2016 Ethiopian Demographic and Health Surveys (EDHS). Normalized weighting was used to compensate for disproportionate sampling and non-response in the survey. The two data sets were merged and analyzed using multivariate decomposition analysis. RESULT: From 2005 to 2016, the use of LAPMs increased by 12.0 percentage points. Changes in the characteristics of women (compositional factors) were responsible for nearly 7.0% of the observed difference. Most of the change (92.0%) was attributable to differences in the effects of characteristics. Age, working status, woman's occupation, concordance on the desired number of children between women and their partners, and a visit by health workers in the 12 months before the survey were all significantly associated with the change. CONCLUSION: The contribution of variation in the survey population structure was not significant for the observed change. The change in the use of LAPMs was mainly due to behavioral changes among older, educated and working women, and women visited by health workers.

Modern Contraceptive Use and Associated Factors among Women with Disabilities in Gondar City, Amhara Region, North West Ethiopia: A Cross Sectional Study.

Attention to the sexual reproductive health needs of persons with disabilities is important to ensure the protection and promotion of their human rights, to move forward the international development agenda, and to build a truly inclusive society. The objective of this study was to assess modern contraceptive use and associated factors among women with disabilities in Gondar city, Ethiopia. A community-based cross- sectional study was employed, from 25 June to 05 August 2013. All 280 reproductive age women with disabilities who were found in the town during study period were included. Data were coded, entered and cleaned using EPI INFO statistical software version 3.5.2, and analysed by Software Statistical Packages for Social Sciences version 16. About 18% of participants had ever used modern contraceptive and the contraceptive prevalence rate among study participants and currently married women were 13.1% and 20.2% respectively. One fourth of respondents believed that existing family planning service delivery points were not accessible. The proportion of modern contraceptive use among participants was low. Age, marital status, education, income, and type of disability were significant predictors of modern contraceptive use. Therefore, social behavioural change communication interventions should be designed to improve the awareness of people living with disabilities on modern contraceptives based on the needs and type of disabilities.

Factors associated with long acting and permanent contraceptive methods use in Ethiopia.

BACKGROUND: Long acting and permanent contraceptives methods are more effective, save cost and enable women to control their reproductive lives better. Although the Ethiopian government is promoting its use through various mechanisms, the level of use is low. Therefore, this study was designed to identify factors associated with long acting and permanent contraceptive methods use in Ethiopia. METHODS: Four Ethiopian demographic and health survey data were used to examine trends of long acting and permanent contraceptive methods use. To identify factors associated with long acting and permanent contraceptive methods use, the 2016 Ethiopian demographic and health survey data was used. The data was accessed from the demographic and health survey program data base. Data analysis was done using Stata 15.1. Descriptive analysis was used to describe socio-economic and other variables of the study participants. Data were weighted and design effect was considered during analysis. Multicollinearity was assessed using variance inflation factor. Finally, multinomial logistic regression model was used to identify factors associated with long acting and permanent contraceptive methods use. RESULTS: Long acting and permanent contraceptive methods use increased significantly from 0.6% in 2000 to 11.6% in 2016. The odds of long acting and permanent contraceptive methods use was higher among richer women (AOR 2.6; 95%CI 1.2-5.4), women who were sales workers (AOR 2.1; 95%CI 1.1-3.9) and women whose ideal number of children was high (AOR; 4.2, 95%CI 1.4-13.0). But the odds of long acting and permanent contraceptive methods use was lower among female headed households (AOR 0.2: 95%CI 0.1-0.5) and women who had history of abortion (AOR 0.2: 95%CI 0.1-0.5). CONCLUSION: Long acting and permanent contraceptive methods use increased significantly in Ethiopia. Wealth index, women's occupation, ideal number of children, sex of head of the household and history of abortion were factors associated with long acting and permanent contraceptive methods use in Ethiopia. Improving economic status of women may help improve long acting and permanent contraceptive methods use in Ethiopia.

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey.

BACKGROUND: Antenatal care provides the best opportunity to promote maternal and child health services use. But many Ethiopian mothers deliver at home and fail to attend postnatal care. Therefore, this study was done to identify factors associated with health facility delivery among mothers who attended four or more antenatal care visits. The study was also intended to identify factors associated with postnatal care service use among mothers who delivered at home after four or more antenatal care visits. METHODS: This study used the 2016 Ethiopian Demographic and Health Survey data. Two thousand four hundred fifteen women who attended four or more antenatal care visits were included to identify factors associated with health facility delivery after four or more antenatal care visits. Among them, 1055 mothers delivered at home. These women were included to identify factors associated with postnatal care service use. Stata 15.1 was used to analyze the data. Multivariable logistic regression model was fitted to identify associations between the outcome and predictor variables. RESULTS: Among women who had four or more antenatal care visits, 56% delivered at health facility. Mothers with secondary or higher level of education (AOR = 2.9; 95% CI = 1.6-5.3), urban residents (AOR = 3.4; 95% CI = 1.9-6.1), women with highest wealth quintile (AOR = 2.7; 95% CI = 1.5-4.8), and working women (AOR = 1.6; 95% CI = 1.2-2.3) had higher odds of delivering at health facilities. High birth order (AOR = 0.5; 95% CI = 0.3-0.7) was negatively associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Only the content of care received during antenatal care visits (AOR = 1.40; 95% CI = 1.1-1.8) was significantly associated with postnatal care attendance. CONCLUSION: Women with lower socio-economic status had lower odds of giving birth at health facility even after attending antenatal care. The more antenatal care components a mother received, the higher her probability of delivering at health facility. Similarly, postnatal care attendance was higher among women who had received more antenatal care components.

Birth preparedness and complication readiness among pregnant women in Ethiopia: a systematic review and Meta-analysis.

ᅟ: Birth preparedness and complication readiness is an essential component of safe motherhood programs that promote appropriate utilization of skilled maternal and neonatal care. Preparing for childbirth and its probable complications can reduce delays in seeking care. In Ethiopia, there were limited data on birth preparedness and complication readiness at the national level except a small scale studies conducted.This systemic review and meta-analysis study was conducted to assess the national estimates regarding the status of birth preparedness and complication readiness among pregnant women in Ethiopia. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed during systemic review and meta-anaysis. The databases used to identify studies were; MEDLINE, PubMed, Google scholar, CINAHL, EMBASE and African Journals Online. Appropriate search terms were used to retrieve published studies conducted in Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 14 software. Forest plots were used to present the findings of this meta-analysis. The I2 test statistics and Egger's test were used to test heterogeneity and publication bias respectively. The pooled prevalence with 95% confidence intervals (CI) was computed. Duval and Tweedie nonparametric trim and fill analysis using the random-effect analysis was conducted to account for publication bias and high heterogeneity. RESULT: Thirteen studies and six thousand four hundred ninety three participants were included in this meta-analysis and overall pooled result showed 32% with 95% (25.6, 38.5) of the pregnant women were prepared for birth and its complications. In addition, 51.35% of women save money for birth and emergency case, 38.74% women identified skilled birth attendant, and only 26.33% of pregnant women were aware of danger signs during pregnancy. One fifth (20.59%) of women arranged transportation and 54.85% of women identified the place of birth. Only 8.18%pregnant women identified potential blood donor for emergency cases. CONCLUSION: Low proportions of pregnant women were prepared for childbirth and its complications. The Ministry of health, Regional health bureaus, health facilities and other stakeholders should work to improve birth preparedness and complication readiness among pregnant women in Ethiopia.

The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. METHODS: Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger's test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). RESULT: A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). CONCLUSION: Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.

Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis.

BACKGROUND: Although hypertensive disorders of pregnancy are the leading cause of poor perinatal outcomes in Ethiopia, there is no study that shows the national prevalence. Therefore, the aim of this study was to estimate the national pooled prevalence of hypertensive disorders of pregnancy from studies conducted in different parts of the country. METHODS: Databases; MEDLINE, PubMed, HINARI, EMBASE, Google Scholar and African Journals Online were searched by using different search terms on HDP and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test heterogeneity of studies. Egger's test was used to show the publication bias. The pooled prevalence of HDP and the odds ratio (OR) with 95% confidence interval was presented using forest plots. RESULT: Seventeen studies were included in this review, with a total of 258,602 pregnant women. The overall pooled prevalence of hypertensive disorders of pregnancy in Ethiopia was 6.07% (95% CI: 4.83%, 7.31%). The Subgroup analysis by region and year of study showed a higher prevalence of hypertensive disorders of pregnancy in Southern Nations, Nationalities, and Peoples' Region, 10.13% (95% CI = (8.5, 12.43)), and reduction in the rate of HDP from 1990's to 2010's, 8.54% reducing to 5.71% respectively. The pooled prevalence of pregnancy-induced hypertension (PIH) and preeclampsia/eclampsia alone were 6.29 and 5.47 respectively. Pregnant women ≥ 35 years old are more likely to develop hypertensive disorders of pregnancy, OR = 1.64 (95% CI = (1.18, 2.28)). No statistically significant difference was observed between HDP and younger maternal age (less than 20 years old); OR = 2.92 (95% CI = (0.88, 9.70)). There was no association between hypertensive disorders of pregnancy and number of pregnancy, OR = 1.37 (95% CI = 0.78, 2.41)). CONCLUSIONS: The prevalence of hypertensive disorders of pregnancy is high in Ethiopia. The problem is more common among older pregnant women (> 35 years old). Government and other stakeholders should give due attention to an early screening of hypertension during pregnancy.

Prevalence and determinants of anemia among pregnant women in Ethiopia; a systematic review and meta-analysis.

BACKGROUND: Anemia during pregnancy is one of the most common indirect obstetric cause of maternal mortality in developing countries. It is responsible for poor maternal and fetal outcomes. A limited number of studies were conducted on anemia during pregnancy in Ethiopia, and they present inconsistent findings. Therefore, this review was undertaken to summarize the findings conducted in several parts of the country and present the national level of anemia among pregnant women in Ethiopia. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed for this systematic review and meta-analysis. The databases used were; PUBMED, Cochrane Library, Google Scholar, CINAHL, and African Journals Online. Search terms used were; anemia, pregnancy related anemia and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 14 software. The pooled Meta logistic regression was computed to present the pooled prevalence and relative risks (RRs) of the determinate factors with 95% confidence interval (CI). RESULTS: Twenty studies were included in the meta-analysis with a total of 10, 281 pregnant women. The pooled prevalence of anemia among pregnant women in Ethiopia was 31.66% (95% CI (26.20, 37.11)). Based on the pooled prevalence of the subgroup analysis result, the lowest prevalence of anemia among pregnant women was observed in Amhara region, 15.89% (95% CI (8.82, 22.96)) and the highest prevalence was in Somali region, 56.80% (95% CI (52.76, 60.84)). Primigravid (RR: 0.61 (95% CI: 0.53, 0.71)) and urban women (RR: 0.73 (95% CI: 0.60, 0.88)) were less likely to develop anemia. On the other hand, mothers with short pregnancy interval (RR: 2.14 (95% CI: 1.67, 2.74)) and malaria infection during pregnancy (RR: 1.94 (95% CI: 1.33, 2.82)) had higher risk to develop anemia. CONCLUSIONS: Almost one-third of pregnant women in Ethiopia were anemic. Statistically significant association was observed between anemia during pregnancy and residence, gravidity, pregnancy interval, and malaria infection during pregnancy. Regions with higher anemia prevalence among pregnant women should be given due emphasis. The concerned body should intervene on the identified factors to reduce the high prevalence of anemia among pregnant women.

Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis.

BACKGROUND: Risky sexual practice is a major public health problem in Ethiopia. There are various studies on the prevalence and determinants of risky sexual practice in different regions of the country but there is no study which shows the national estimate of risky sexual practices in Ethiopia. Therefore, this review was conducted to estimate the national pooled prevalence of risky sexual practice and its risk factors in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed to review published and unpublished studies in Ethiopia. The databases used were; PubMed, Google Scholar, CINAHL and African Journals Online. Search terms were; risky sexual behavior, risky sexual practice, unprotected sex, multiple sexual partner, early sexual initiation, and/or Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal. The meta-analysis was conducted using Review Manager software. Descriptive information of studies was presented in narrative form and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were used to test heterogeneity across studies. The pooled estimate prevalence and the odd ratios with 95% confidence intervals were computed by a random effect model. RESULTS: A total of 31 studies with 43,695 participants were included in the meta-analysis. The pooled prevalence of risky sexual practice was 42.80% (95% CI: 35.64%, 49.96%). Being male (OR: 1.69; 95% CI: 1.21, 2.37), substance use (OR: 3.42; 95% CI: 1.41, 8.31), peer pressure (OR: 3.41; 95% CI: 1.69, 6.87) and watching pornography (OR: 3.6; 95% CI: 2.21, 5.86) were factors associated with an increase in risky sexual practices. CONCLUSIONS: The prevalence of risky sexual practices is high in Ethiopia. Being male, substance use, peer pressure and viewing pornographic materials were found to be associated with risky sexual practices. Therefore, life skills training is recommended to reduce peer pressure among individuals. Interventions should be designed to reduce substance use and viewing pornography.