Uptake and barriers to cervical cancer screening among human immunodeficiency virus-positive women in Sub Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Cervical cancer is the leading cause of disability and mortality among women in Africa. Despite a significant correlation between HIV/AIDS and cervical cancer, there is unacceptably low coverage of the uptake of cervical cancer screening among human immunodeficiency virus-positive women in Sub-Saharan Africa. Individual primary studies are limited in explaining the patterns of uptake of cervical cancer screening. This review therefore considers the uptake of cervical cancer screening and its barriers among human immunodeficiency virus-positive women in Sub-Saharan Africa. METHODS: We systematically searched articles published until December 31, 2019, from the PubMed, Cochrane Library, POP LINE, Google Scholar, African Journals Online and JURN databases. The quality of the included articles was assessed by using the Newcastle‒Ottawa Scale, and the coverage of uptake of cervical cancer screening was pooled after checking for heterogeneity and publication bias. The random effect model was used, and subgroup analysis estimates were performed by country. RESULTS: Twenty-one studies comprising 20,672 human immunodeficiency virus-positive women were included. Applying a random effect model, the overall cervical cancer screening uptake among this group of women in Sub-Saharan Africa was estimated to be 30% (95% CI: 19, 41, I2 = 100%). The main barriers to uptake of cervical screening include poor knowledge about cervical cancer and screening, low risk perception of cervical cancer, fear of test result and fear of screening as painful, lack of access to screening services, high cost of screening service, and poor partner attitude and acceptance of the service. The perception of an additional burden of having a cervical cancer diagnosis was found to be a unique barrier among this population of women. CONCLUSION: The unacceptably low coverage of uptake of cervical cancer screening would indicate that the need to scale up the opportunities to these groups of women as well. This review revealed that in addition to structural and health care system barriers, sociocultural and personal barriers are powerful barriers in HIV-positive women. For these cohorts of population, a particular obstacle was discovered to be perception of an additional burden of having cervical cancer.

Human Immune Deficiency Virus Serostatus and Associated Factors Among Children of Adult Index Cases in Northern Ethiopia.

INTRODUCTION: Children whose parents with human immunodeficiency virus (HIV) and family of index clients are at high risk of HIV infection. Family testing is an efficient and effective way of identifying children's HIV. The number of children becoming newly infected with HIV remains unacceptably high. This study is to assess human immune deficiency, virus serostatus, and associated factors among children of adult index cases in central Tigrai, Northern Ethiopia, 2019. METHODS: An institution-based cross-sectional study design was conducted to select a total of 454 index cases from February 01 to April 30, 2019. Data were collected from adult clients on antiretroviral treatment who have children using administered questionnaires and data extraction from the hospital antiretroviral register. Simple random sampling was used to select the index cases using the medical record number. Binary logistic regression analysis, odds ratio, and 95% confidence interval were used to determine the strength of association between dependent and independent variables. Statistical significance was declared a P-value <0.05. RESULTS: The prevalence of HIV in children from family index case testing was 8.9% with 95% CI (6.5-11.6). Female index clients [AOR=0.18, 95% CI: 06-0.55], the age of the child [AOR=0.86, 95% CI: 0.76, 0.97], importance of HIV testing [AOR=5.20, 95% CI: 2.2011.96], and discussion HIV testing [AOR=3.22, 95% CI: 1.5-16.84]. Participants who did not discuss HIV were 3.2 more likely have HIV positive child than who discussed with family members. CONCLUSION: The majority of the index clients test their children, but the prevalence rate of HIV in children from family index case testing is high. Strategies should be developed on how to communicate with household members about HIV.

Prevalence of Food Insecurity and Its Associated Factors among Adult People with Human Immunodeficiency Virus in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Food insecurity is the shortage of both the quantity and quality of food and a negative impact on the overall nutritional and health status of people with human immunodeficiency virus (HIV). Ethiopia is intensely affected by food insecurity which is about 87.4% of adult people living with human immuno deficiency virus (HIV) are still facing shortage to have access to safe, sufficient, and nutritious food for themselves and their family. However, there is no concrete scientific evidence established at the national level in Ethiopia. Hence, this review gave special emphasis on adult people with human immunodeficiency virus (HIV) to estimate the pooled prevalence of food insecurity and its associated factor at the national level in Ethiopia. METHODS: Studies were retrieved from selected electronic data bases, including PubMed/Medlin, Cochrane library, Sciences Direct, Google, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled prevalence of food insecurity and its associated factors at 95% confidence interval with odds ratio (OR) using statistical R-software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias was checked using the funnel symmetry test, and heterogeneity was checked using forest plot and inverse variance square (I 2). The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search. RESULT: A total of 650 articles were identified through the initial search of which 20 studies were included in the final review yielding a total sample size of 7,797 adult people with human immunodeficiency virus (HIV). The pooled prevalence of food insecurity was 52% (95% CI, 40%, 63%). Cluster of differentiation 4 (CD4) count < 350 cell/mm3 [AOR = 1.29 (95% CI, 1.08, 1.54)], develop opportunistic infection [AOR = 4.09 (95% CI, 2.47, 6.78)], rural residence [AOR = 1.59 (95% CI, 1.09, 2.34)], and World Health Organization (WHO) clinical stages III and IV [AOR = 1.98 (95% CI, 1.23, 3.19)] was among the significantly associated factors. CONCLUSION: In this review, there was a high prevalence of food insecurity among adult people with human immunodeficiency virus. Therefore, the responsible stockholders should strengthen the system and procedure for early diagnosis of opportunistic infection, under nutrition, screening of underlying problems.

Temporary Hearing Loss and Associated Factors Among Ayka Addis Textile Factory Workers in Oromia Region, Ethiopia: A Cross-Sectional Study.

INTRODUCTION: The development of modern automated machines in industries has considerably decreased the physical burden of workers in addition to increasing the productivity of the industries resulting in noise pollution. Noise exposure above the limit value of 90 dB (A) is known to cause temporary hearing loss among exposed workers. MATERIALS AND METHODS: Institutional-based cross-sectional study design was employed for a total of 406 study participants using a simple random sampling technique from January 15 to April 30, 2019. The data collection methods were observational checklist and a self-administered questionnaire. The collected data were entered into EpiData software version 4.2 and exported to SPSS software version 21 for analysis. Bivariate and multivariable logistic analyses wwere used to identify the associated factors. Statistical significance was declared using a 95% confidence interval and a p-value of less than 0.05. RESULTS: A total of 388 study participants were included in the study with a response rate of 95.6%, of which 254 (65.5%) were females. The overall temporary hearing loss among the textile factory workers was found to be 49% with COR=1.53; 95% CI (1.15-2.03). The workers from the spinning department were 2.38 times more likely to develop temporary hearing loss after exiting from work than workers from the dyeing department (95% CI= (1.16-4.90). Similarly, workers from the knitting department were 3.67 times more likely to develop temporary hearing loss after exiting from work than workers from the dyeing department (95% CI=1.42-9.47). CONCLUSION: The present study demonstrated that the workforce in the spinning and knitting departments of the textile factory had a high prevalence of temporary hearing loss than the workers in dyeing and garment working sections. Therefore, the textile factory should provide hearing protection devices to the workers.

Effect of Maternal Education on Prenatal Adherence of Iron-folic Acid Supplementation in Ethiopia: A Systematic Review and Meta-analysis.

BACKGROUND: Iron-folic acid supplementation is a central preventive measure for maternal anemia, so considering the factors leading to or deterring from adherence is important. This review aims to establish if there is a correlation between increasing maternal education and adherence to iron-folic acid supplementation in Ethiopia. METHODS: An electronic database search was conducted using PubMed, Google Scholar, Cochrane Library and African Journals Online. Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument was used for quality appraisal of the included studies. The extracted data were entered into Microsoft™ Excel sheet and exported to R-software version 3.6.1 for analysis. Maternal education on adherence of iron-folic acid supplementation was analyzed and subgroup analyses of difference between regions and time of study period were conducted. RESULTS: The online search yielded a total of 936 articles, and based on inclusion/exclusion criteria nine were included in this study with a total of 3263 participants. Applying the random effect model, the analysis revealed that the odds of prenatal adherence of iron-folic acid supplementation were 2.89 times higher in mothers with secondary school education and above as compared to those who had not received formal education. CONCLUSION: This review identified that increased maternal education leads to improved adherence of iron-folic acid supplementation amongst women across Ethiopia. This information may inform efforts of government and non-government organizations to encourage maternal education in order to sustained adherence of iron-folic acid supplementation. Further research is required in this critical area at regional, national, and global levels.

Determinants of Uterine Rupture and Its Management Outcomes among Mothers Who Gave Birth at Public Hospitals of Tigrai, North Ethiopia: An Unmatched Case Control Study.

INTRODUCTION: Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai. OBJECTIVE: This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. METHOD: A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. RESULT: Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. CONCLUSION: Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.

Disrespect and Abuse during Childbirth in Ethiopia: A Systematic Review.

BACKGROUND: Disrespect and abuse are recognized for the restricting impact of women from seeking maternal care, psychological humiliations, grievances, and unspoken sufferings on women during childbirth. Individual primary studies are limited in explaining of extent of disrespect and abusive care. Hence, this review considers the synthesis of comprehensive evidence on the extent, contributing factors, and consequences of disrespectful and abusive intrapartum care from the women's and providers' perspectives in Ethiopia. METHODS: Articles had been systematically searched from the databases of PubMed, Cochrane Library, POPLINE, Google Scholar, HINARI, African Journals Online, and WHO Global Health Library. A qualitative and quantitative synthesis was performed using the Bowser and Hill landscape analytical framework. RESULT: Twenty-two studies comprised of the 16 quantitative; 5 qualitative and one mixed studies were included. The most repeatedly dishonored right during facility-based childbirth in Ethiopia was nondignified care, and the least commonly reported abuse was detention in health facilities. These behaviors were contributed by normalization of care, lack of empowerment and education of women, weak health system, and lack of training of providers. Women subjected to disrespectful and abusive behavior distanced themselves from the use of facility-based childbirth-related services and have endured psychological humiliations. CONCLUSION: Disrespectful and abusive care of women during childbirth is repeatedly practiced care in Ethiopia. This result specifically described the contributing factors and their effects as a barrier to the utilization of facility-based childbirth. Therefore, to overcome this alarming problem, health systems and care providers must be responsive to the specific needs of women during childbirth, and implementing policies for standard care of respectful maternity care must be compulsory. In addition, observational, qualitative, and mixed types of studies are required to provide comprehensive evidences on disrespect and abusive behavior during childbirth in Ethiopia.

Knowledge, Attitude, and Practice of High-Risk Age Groups to Coronavirus Disease-19 Prevention and Control in Korem District, Tigray, Ethiopia: Cross-Sectional Study.

BACKGROUND: The emerging of the novel coronavirus in Wuhan, China, since the time declared as a public health emergency of international concern, its impact on the lives of people is negatively substantial. Despite the vulnerability of all ages from the pandemic, evidence showed that elder people are at high-risk for adverse outcomes from coronavirus disease-19. Therefore, this study aimed to assess the knowledge, attitude, and practice of high-risk age groups to coronavirus disease-19 prevention and control in Korem district, Tigray, Ethiopia. METHODS: A community-based cross-sectional study was conducted among high-risk age groups from April 2 to May 9/2020 in Korem district, Tigray, Ethiopia. A total of 422 study participants were selected using a simple random sampling technique. The collected data were entered into Epi-data version 3.1 and exported to SPSS version 22.0 for analysis. Multivariable analysis was done using linear regression after checking collinearity, and a p-value of less than 0.05 was considered significant. RESULTS: A total of 419 study participants were included in the study with a response rate of 99.3%. Overall, about 37.7%, 43.4%, and 52.5% of participants had poor knowledge, negative attitude, and poor practice towards coronavirus disease-19 prevention and control, respectively. Being elder (≥80) years, with no formal education, and having low-income status were among the significantly associated factors. About 76.1% of the respondents did not use hand-rub-based alcohol or sanitizer, and 88.8% did not use any mask in crowding area. CONCLUSION: Generally, the knowledge about coronavirus disease-19 in elders was roughly appropriate but the preventive practices and attitude towards coronavirus disease-19 were found less and inappropriate. Since no proven medicine is invented yet, so maximizing knowledge, increasing behavioral change, and strengthening preventive practices towards coronavirus disease-19 prevention and control is the appropriate solution.

Burden and Determinant of Inadequate Dietary Diversity among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Inadequate dietary diversity intake during pregnancy results in increased risks of negative maternal and perinatal outcomes. About one million neonates die on the first day of life due to inadequate dietary intake during pregnancy as a result of maternal complication and adverse birth outcomes. This review summarizes the burden of inadequate dietary diversity and its determinants among pregnant women at the national level of Ethiopia. METHODS: Studies were retrieved from selected electronic databases, including PubMed, Cochrane Library, and Google Scholar. Random-effects model meta-analysis was used to estimate the pooled burden of inadequate dietary diversity and its determinants at a 95% confidence interval with its respective odds ratio (OR) using statistical R-software version 3.6.1. Moreover, quality appraisal of the included studies, publication bias, and level of heterogeneity were checked with subgroup analysis and sensitivity influential test. The searches were restricted to articles published in the English language only, and Medical Subject Headings (MeSH terms) was used to help expand the search in advanced PubMed search. RESULT: A total of 850 articles were identified through the initial search of which 21 studies were included in the final review yielding a total sample size of 9,230 pregnant women. The pooled prevalence of inadequate dietary diversity was 53% (95% CI: 44%, 62%). Food insecurity [AOR = 2.18, (95% CI: 1.02, 4.63)], family size of greater than four [AOR = 1.46, (95% CI: 1.10, 1.95)], rural residence [AOR = 4.52, (95% CI: 1.02, 20.09)], no formal educational status [AOR = 4.50, (95% CI: 1.02, 20.09)], and a lack of counseling about dietary diversity [AOR = 2.75, (95% CI: 2.17, 3.48)] were among the significantly associated factors for inadequate dietary diversity. CONCLUSION: In this review, there was a high prevalence of inadequate dietary diversity among pregnant women at the national level in Ethiopia. Therefore, strengthening early counseling and diagnosis of dietary intake and undernutrition during the antenatal care period is important.

Maternal and fetal outcomes of cesarean delivery and factors associated with its unfavorable management outcomes; in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017.

OBJECTIVES: This study aimed to determine the unfavorable outcomes and to assess factors contribute to the unfavorable management outcomes after cesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. RESULTS: The unfavorable maternal management outcomes were Adhesion 28 (8.3%), excessive blood loss and blood transfusion 19 (5.6%), cesarean hysterectomy 10 (3%), relaparotomy 5 (1.5%), wound infection and wound dehiscence 23 (6.8%). Unfavorable fetal outcomes were were stillbirth 9 (2.6%), early neonatal death 8 (2.4%), low birth weight 58 (17.2%). women who did not book for Antenatal Care and having a history of previous cesarean delivery were found to be associated with unfavorable maternal outcomes and indications of cesarean delivery as obstructed labor was associated with unfavorable fetal outcomes.