COVID-19 Vaccine Safety Monitoring Studies in Low- and Middle-Income Countries (LMICs)-A Systematic Review of Study Designs and Methods.

BACKGROUND: Post-marketing vaccine safety surveillance aims to monitor and quantify adverse events following immunization in a population, but little is known about their implementation in low- and middle-income countries (LMICs). We aimed to synthesize methodological approaches used to assess adverse events following COVID-19 vaccination in LMICs. METHODS: For this systematic review, we searched articles published from 1 December 2019 to 18 February 2022 in main databases, including MEDLINE and Embase. We included all peer-reviewed observational COVID-19 vaccine safety monitoring studies. We excluded randomized controlled trials and case reports. We extracted data using a standardized extraction form. Two authors assessed study quality using the modified Newcastle-Ottawa Quality Assessment Scale. All findings were summarized narratively using frequency tables and figures. RESULTS: Our search found 4254 studies, of which 58 were eligible for analysis. Many of the studies included in this review were conducted in middle-income countries, with 26 studies (45%) in lower-middle-income and 28 (48%) in upper-middle-income countries. More specifically, 14 studies were conducted in the Middle East region, 16 in South Asia, 8 in Latin America, 8 in Europe and Central Asia, and 4 in Africa. Only 3% scored 7-8 points (good quality) on the Newcastle-Ottawa Scale methodological quality assessment, while 10% got 5-6 points (medium). About 15 studies (25.9%) used a cohort study design and the rest were cross-sectional. In half of them (50%), vaccination data were gathered from the participants' self-reporting methods. Seventeen studies (29.3%) used multivariable binary logistic regression and three (5.2%) used survival analyses. Only 12 studies (20.7%) performed model diagnostics and validity checks (e.g., the goodness of fit, identification of outliers, and co-linearity). CONCLUSIONS: Published studies on COVID-19 vaccine safety surveillance in LMICs are limited in number and the methods used do not often address potential confounders. Active surveillance of vaccines in LMICs are needed to advocate vaccination programs. Implementing training programs in pharmacoepidemiology in LMICs is essential.

Spatial and Multilevel Analysis of Unscheduled Contraceptive Discontinuation in Ethiopia: Further analysis of 2005 and 2016 Ethiopia Demography and Health Surveys.

Background: Unscheduled discontinuation of contraceptives is a public health problem among women of reproductive age. Particularly, it is associated with unwanted pregnancies that lead to maternal and child mortality, but little is known about the spatial distribution of the problem. Therefore, this study aims to assess the spatial distribution and associated factors of unscheduled contraceptive discontinuation in Ethiopia. Method: This study used secondary data from the Ethiopia Demography and Health Survey (EDHS) data of 2005 and 2016. The study population was women who used contraceptives in the preceding 5 years before the survey. A total of 2,327 and 3,858 eligible women were included in the final analysis of the 2005 and 2016 EDHS, respectively. For the spatial analysis, both the 2005 and the 2016 EDHS data were analyzed using ArcGIS version 10.7, while for multilevel regression analysis, the 2016 EDHS data were used. The final model reported an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and a p-value of 0.05 was used to declare statistical significance. Result: This study revealed that unscheduled discontinuation of contraceptives varied geographically, and hotspots were detected in the central, north, and eastern parts of Ethiopia. Moreover, diploma and higher education (AOR = 1.40; 95% CI: 1.01-1.95), urban residence (AOR = 1.37; 95% CI: 1.08-1.72), history of termination of pregnancy (AOR = 1.47; 95% CI: 1.14-1.94), married women (AOR = 10.79; 95% CI: 6.98-16.69), separated/divorced women (AOR = 1.54: 95% CI: 1.07-2.30), -two to four number of children (AOR = 1.46; 95% CI: 1.15-1.84), and involvement in the decision-making process of contraceptive use (AOR = 39.26; 95% CI: 28.84-53.45) were all factors associated with unscheduled discontinuation of contraceptives. Conclusion: This study revealed that unscheduled discontinuation of contraceptive distribution was significantly clustered in the central, north, and eastern parts of Ethiopia, as found in two surveys. The magnitude of this discontinuation increased from 2005 to 2016. The finding underscores that further interventions such as the availability of multiple mixed methods and improvement in women's decision-making ability in the choice of contraceptive methods and utilization are needed in hotspot areas of Ethiopia.

Myocarditis and pericarditis associated with SARS-CoV-2 vaccines: A population-based descriptive cohort and a nested self-controlled risk interval study using electronic health care data from four European countries.

Background: Estimates of the association between COVID-19 vaccines and myo-/pericarditis risk vary widely across studies due to scarcity of events, especially in age- and sex-stratified analyses. Methods: Population-based cohort study with nested self-controlled risk interval (SCRI) using healthcare data from five European databases. Individuals were followed from 01/01/2020 until end of data availability (31/12/2021 latest). Outcome was first myo-/pericarditis diagnosis. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. Baseline incidence rates (IRs), and vaccine- and dose-specific IRs and rate differences were calculated from the cohort The SCRI calculated calendar time-adjusted IR ratios (IRR), using a 60-day pre-vaccination control period and dose-specific 28-day risk windows. IRRs were pooled using random effects meta-analysis. Findings: Over 35 million individuals (49·2% women, median age 39-49 years) were included, of which 57·4% received at least one COVID-19 vaccine dose. Baseline incidence of myocarditis was low. Myocarditis IRRs were elevated after vaccination in those aged < 30 years, after both Pfizer vaccine doses (IRR = 3·3, 95%CI 1·2-9.4; 7·8, 95%CI 2·6-23·5, respectively) and Moderna vaccine dose 2 (IRR = 6·1, 95%CI 1·1-33·5). An effect of AstraZeneca vaccine dose 2 could not be excluded (IRR = 2·42, 95%CI 0·96-6·07). Pericarditis was not associated with vaccination. Interpretation: mRNA-based COVID-19 vaccines and potentially AstraZeneca are associated with increased myocarditis risk in younger individuals, although absolute incidence remains low. More data on children (≤ 11 years) are needed.

Predictors of time to recovery of preterm neonates with respiratory distress syndrome admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit North West Ethiopia.

BACKGROUND: Respiratory distress syndrome (RDS) is caused by a deficiency of a molecule called surfactant. It occurs in newborns born before 37 weeks of gestation. It is a main cause of morbidity and mortality in the early neonatal period. Therefore, this study aims to assess median time to recovery and predictors of preterm neonates with respiratory distress syndrome admitted in University of Gondar comprehensive specialized hospital Northwest Ethiopia 2020. METHODS: Institution based retrospective follow up study was conducted on 386 preterm neonates with hyaline membrane disease who were admitted in the neonatal intensive care unit from January, 2016 to December 2018. The data were entered in to EPI info version 7.0 and transferred to Stata version 14.0 for analysis. Both bi-variable and multi variable Weibull parametric model were fitted to identify predictors with 95% confidence interval of hazard ratio (HR) and p-value. P-value less than 0.05 in the multivariable model showed the presence of significant association between covariates and the dependent variable. RESULTS: The overall median length of recovery were 11 day with an interquartile range of (7, 16) neonate-days. Being a product of multiple pregnancy (AHR 1.67; 95%CI (1.25, 2.23)), vaginal mode of delivery (AHR 1.6; 95%CI (1.13, 2.26)), and neonatal hypothermia at admission (AHR 1.6; 95%CI (1.13, 2.26)) were found to be significant predictors of time to recovery. CONCLUSION: In this study the median time to recovery of preterm neonates with respiratory distress syndrome was slower than the clinical recommendations. Receiving bag and mask ventilation and hypothermia decreased the recovery whereas, vaginal delivery gestational age at birth, being multiple pregnancy, birth weight ≥2000grams were enhance the recovery of preterm neonates with RDS.

Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia.

BACKGROUND: COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia. METHODS: A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported. RESULTS: The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments. CONCLUSION: The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.

Time to First Line Antiretroviral Therapy Adverse Drug Reaction and its Predictors Among Adult HIV/AIDS Patients on Treatment in Eastern Ethiopia.

Background: Even though determining the time to anti-retroviral therapy (ART) adverse drug reaction and its predictors is a crucial step to overcome the negative consequences of the adverse drug reaction, there is limited information regarding the time to ART adverse drug reaction and its predictors. Therefore, this study aimed to determine the time to first ART adverse drug reaction and its predictors among adult HIV/AIDS patients on first-line antiretroviral therapy in West Hararghe Zone, Eastern Ethiopia. Methods: An institution-based retrospective cohort study was conducted on 561 HIV/AIDS patients on first-line ART from September 2013-January 2019 at public hospitals in West Hararghe Zone, Eastern Ethiopia. Data were collected using checklists and document reviews, entered using Epi Info and analyzed in R software. A Cox proportional hazard model was fitted to identify predictors of the time to first ART adverse drug reaction. Model adequacy was checked using Cox Snell residuals. An adjusted hazard ratio with its confidence interval was used to show the presence and strength of association at a 95% confidence level. Result: Most (90.74%) ART adverse drug reactions occurred within 1 year of initiation of ART. Overall, 54 patients developed ART adverse drug reactions with an incidence density of 3.5/100 persons-years of observations (95% CI: 2.7-4.6). The initial ART regimen (TDF, 3TC, EFV) [AHR = 0.3, 95% CI 0.1-0.7], fair adherence [AHR = 8.8, 95% CI 3.3-23.2], poor adherence [AHR = 7.8, 95% CI 3.1-19.5], moderate body mass index (BMI) at the baseline [AHR = 4.4, 95% CI 1.8-11.0], severe body mass index [AHR = 2.8, 95% CI 1.1-6.8], World Health Organization (WHO) stage II [AHR = 3.7, 95% CI 1.2-11.3] and WHO stage IV [AHR = 6.3, 95% CI 2.0-19.8] were significant predictors of the time to ART adverse drug reactions. Conclusion: In conclusion, most of the ART adverse drug reactions occurred within 1 year of initiation of ART. The initial ART regimen (TDF, 3TC, EFV), adherence, HIV/AIDS stage, and BMI were risk factors for the time to ART adverse drug reaction. The incidence of the antiretroviral therapy adverse reaction was relatively low with early onset. Close monitoring of clients in clinical stage II and above is required and continuous assessment for improving the detection and management of adverse drug reactions is recommended. Patients with poor adherence need to get continuous counseling to improve their adherence status.

Spatial distribution and determinant factors of unmet need for family planning among all reproductive-age women in Ethiopia: a multi-level logistic regression modelling approach.

BACKGROUND: Unmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey. METHODS: This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data's hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics. RESULTS: Overall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country. CONCLUSIONS: In this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority.

In general, the unmet need for family planning has been remaining high in developing countries, notably in sub-Saharan Africa. This study aimed to explore geographical disparities of unmet need for family planning among all reproductive-age women in Ethiopia using a 2016 national population-based survey.We used a secondary data analysis of the 2016 Ethiopian demographic health survey. A total of 15,683 women aged 15­49 years were selected using a two-stage stratified sampling process.Overall, the prevalence of unmet need for family planning was 15.2% (95% CI: 14.63, 15.76) in Ethiopia. The spatial analysis of the unmet need for family planning revealed that Northern and Western parts of Oromia, North of Southern Nations and Nationality of People and Gambela regions had high hotspots than the remaining parts of the country.Generally, the findings indicate significant regional variation in the unmet need for family planning among reproductive-age women in Ethiopia, specifically in western parts of the country. Being in low wealth, having a higher number of living children, being in a Married or union relationship, living in rural areas, older age, being in Muslim and Protestant followers were found associated with unmet need for family planning.

Trends of unmet need for family planning among currently married reproductive age women in Ethiopia: A multivariate decomposition analysis.

INTRODUCTION: Despite decreasing the percentage of women with unmet needs, Ethiopian women still have a higher unmet need for family planning due to different factors. Therefore, addressing the unmet need for FP provides an opportunity for policymakers in all sectors to respond to the expressed fertility preferences of their population. This study aimed to analyze trends and determinants of changes in unmet needs over time among married women of reproductive age in Ethiopia. METHODS: The study used data from three consecutive Demographic and Health Surveys conducted in Ethiopia (2005, 2011, and 2016). These nationally representative household surveys cover all Ethiopia region and city administrations with population health and other relevant indicators). The study included a total weighted sample of 8642 in 2005, 10204 in 2011, and 9824 in 2016 in the final analysis. Factors contributing to the change in unmet need rate were examined using logit-based multivariate decomposition analysis. RESULTS: Among married women, unmet needs declined from 33.8% (95% confidence interval (CI):32.8,34.8) in 2005 to 21.0%(95%CI:20.2,21.9) in 2016. In decomposition analysis, the difference in coefficients was responsible for 90% of the overall change in the unmet need rate. In particular, being at the age of 25-49 years, rural place of residence, agrarian regions, and having more than four children were significant predictors of the increase in unmet need rate. CONCLUSIONS: Unmet needs among women have shown a remarkable decline over the last decade in Ethiopia. Policy and program interventions better targeting younger, agrarian regions and rural dwellers would help to maintain a declining trend in unmet needs.

Occupational Health Problems among Seasonal and Migrant Farmworkers in Ethiopia: A Cross-Sectional Study.

BACKGROUND: Migrant and seasonal farmworkers are at increased risk for occupational fatalities and injuries. Although such employment-related geographical mobility is receiving increasing attention, there is limited evidence about occupational health problems among seasonal farmworkers. Therefore, this study aims to investigate occupational health problems among seasonal and migrant farmworkers in Ethiopia. METHODS: A cross-sectional study design was employed from October to December 2019 among seasonal and migrant farmworkers. The study was carried out in two sites of Amhara regional state, northwest Ethiopia. A cluster sampling technique was used to recruit 990 study participants. Bivariable and multivariable binary logistic regression analyses were performed using SPSS version 20 to identify factors associated with injuries. The significance level was obtained at 95% CI and p-value ≤0.05. RESULTS: In this study, the period prevalence of work-related injury among seasonal and migrant farmworkers was 32.5% (95% CI: 29.7, 35.9). Being unemployed before migration (AOR = 2.22, 95% CI: 1.26, 3.91), working for >8 h/day (AOR = 1.62, 95% CI: 1.16, 2.27), stress (AOR = 1.38, 95% CI: 1.02, 1.88) and thermal discomfort (AOR = 1.48, 95% CI: 1.09, 1.98) were the significant risk factors for work-related injury. In addition, nearly two-third (60.9%) of the study participants have shown three or more heat-related illness symptoms. Moreover, the prevalence of work-related stress among seasonal and migrant farmworkers was 67.6% (95% CI: 64.6, 70.7). CONCLUSION: Occupational health problems among seasonal and migrant farmworkers in northwest Ethiopia remain a major public health problem. Hence, implementing tailored preventive measures like training on health and safety, and hazard control measures would be supremely important to minimize the risk.

Determinants of adverse birth outcome in Sub-Saharan Africa: analysis of recent demographic and health surveys.

BACKGROUND: More than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa. METHOD: Data of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes. RESULT: The pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes. CONCLUSION: This study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women's involvement in healthcare decision-making.

Attitude towards diabetes mellitus among adult communities in Gondar city, Ethiopia.

BACKGROUND: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetes and its complications can be reduced by enhancing the attitude of the community. However, there is limited information regarding attitude towards diabetes in northwest Ethiopia. Therefore, this study determined the attitude and associated factors of diabetes mellitus among adult non-diabetic participants in Gondar city. METHODS: A community-based cross-sectional study was conducted in Gondar city. Systematic random sampling was employed to select 626 non-diabetic participants. The data were collected using a pre-tested structured questionnaire. Descriptive statistics, processing, and analysis were done using STATA version 14. Both bivariable and multivariable binary logistic regressions were used to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used to calculate a level of significance. RESULTS: Of 626 participants, 572 (91.37%) study subjects heard about diabetes mellitus. Three hundred and fifteen participants (55.07%) (95% CI: 50.9% - 59.1%) had a favorable attitude towards diabetes mellitus. Having good knowledge about diabetes (adjusted odds ratio = 2.69, 95% CI: 1.88, 3.87), and higher educational status (adjusted odds ratio = 1.69, 95% CI: 1.04, 2.78) were positively associated with a favorable attitude towards diabetes mellitus. Female gender (adjusted odds ratio = 0.68, 95% CI: 0.47, 0.98), on the other hand, had poor attitude towards diabetes mellitus. CONCLUSION: In this study, a favorable attitude towards diabetes was low among adult non-diabetic participants. Good knowledge, higher educational status, and being male were the factors associated with a favorable attitude towards diabetes.

Spatial distribution and factors associated with low birth weight in Ethiopia using data from Ethiopian Demographic and Health Survey 2016: spatial and multilevel analysis.

Objective: This study aimed to assess the spatial distribution, individual and community-level factors associated with low birth weight in Ethiopia. Method: Secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 2110 neonates were included in this study. Spatial autocorrelation analysis was conducted to assess the spatial clustering of LBW. Besides, the spatial scan statistics and ordinary kriging interpolation were done to detect the local level clusters and to assess predicted risk areas, respectively. Furthermore, a multilevel logistic regression model was fitted to determine individual and community-level factors associated with LBW. Finally, most likely clusters with log-likelihood ratio (LLR), relative risk and p value from spatial scan statistics and adjusted OR (AOR) with 95% CI for multilevel logistic regression model were reported. Results: LBW was spatially clustered in Ethiopia. Primary (LLR=11.57; p=0.002) clusters were detected in the Amhara region. Neonates within this spatial window had a 2.66 times higher risk of being LBW babies as compared with those outside the window. Besides, secondary (LLR=11.4; p=0.003; LLR=10.14, p=0.0075) clusters were identified at southwest Oromia, north Oromia, south Afar and southeast Amhara regions. Neonates who were born from severely anaemic (AOR=1.40, 95% CI (1.03 to 2.15)), and uneducated (AOR=1.90, 95% CI (1.23 to 2.93)) mothers, those who were born before 37 weeks of gestation (AOR=5.97, 95% CI (3.26 to 10.95)) and women (AOR=1.41, 95% CI (1.05 to 1.89)), had significantly higher odds of being LBW babies. Conclusion: The high-risk areas of LBW were detected in Afar, Amhara and Oromia regions. Therefore, targeting the policy interventions in those hotspot areas and focusing on the improvement of maternal education, strengthening anaemia control programmes and elimination of modifiable causes of prematurity could be vital for reducing the LBW disparity in Ethiopia.

Common mental disorders among seasonal migrant farmworkers in Northwest Ethiopia.

BACKGROUND: Seasonal migrant farmworkers in Ethiopia are a vulnerable segment of the population facing numerous threats to their mental health. This research aimed to determine the magnitude of common mental disorders (CMDs) and its associated factors among seasonal migrant farmworkers in the northwest of Ethiopia. METHODS: A cross-sectional study was conducted. A total of 950 seasonal migrant farmworkers were selected randomly. CMDs were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect the associated characteristics of socio-demographic data. Data were analyzed using descriptive statistics, bivariate, and multivariable binary logistic regression. The adjusted odds ratio (AOR) with a 95% confidence level was used to declare a statistically significant association with CMDs. RESULTS: The prevalence of CMDs was found to be 23.05% (219/950; 95% CI 20.47-25.84) among seasonal migrant farmworkers. The prevalence of psychological stress was 74.53% (708/950; 95% CI 71.65-77.20). Having a daily income below USD 5 (AOR = 1.53, 95% CI: 1.10-2.15), moderate perceived stress (AOR = 3.18, 95% CI: 1.18, 5.36), severe perceived stress (AOR = 16.15, 95% CI: 8.96, 29.11), and heat-related illness (AOR = 1.60, 95% CI: 1.11, 2.30) were associated with a higher likelihood of experiencing CMD. On the other hand, those seasonal migrant farmworkers who migrated for the first time (AOR = 0.38, 95% CI: 0.23-0.65) and those who received health related information (AOR = 0.60, 95% CI: 0.42, 0.85) were less likely to have CMDs. CONCLUSION: In this study, CMDs were found to be prevalent among seasonal migrant farmworkers. These findings highlight the importance of systematic development of community-based mental health services in combination with rural primary health care centers and an integrated approach to the health care of farmworkers such as screening, early identification, and treatment of CMDs of seasonal migrant farmworkers.

Low practice of malaria prevention among migrants and seasonal farmworkers in Metema and west Armacheho districts, Northwest Ethiopia.

BACKGROUND: More than hundreds and thousands of migrants and seasonal farm workers move from the highlands (relatively low malaria endemicity areas) to the lowlands (higher malaria endemicity areas) for the development of the corridor of the Amhara region during planting, weeding, and harvesting seasons in each year. Seasonal migrant workers are at high risk of malaria infection. Therefore, evidence of their knowledge level and practice in the prevention of malaria during their stay would be important. OBJECTIVE: The aims of this study was to assess the knowledge and practice of malaria prevention and associated factors among migrants and seasonal farm workers in Northwest Ethiopia. METHOD: A cross-sectional study was conducted from October to November, 2018 in Metema and West Armacheho districts, northwest Ethiopia. A sample of about 950 migrants and seasonal farm workers were included using two stages of cluster sampling technique. Interview administered structured questionnaire was used. Both bi-variable and multivariable binary logistic regressions were applied to identify predictors of malaria prevention. RESULT: The overall good knowledge of malaria (those participants who scored more than 60% of correct response for knowledge related questions) was 50.2% with 95% CI (47.0-53.0) and the overall good practice of malaria (those participants who practiced more than 60% for practice related questions) was 27.2% with 95% CI (244.3-29.9). Age (AOR = 0.51(95%CI; 0.33-0.80)), level of education (AOR = 0.55(95%CI; 0.32-0.94)), using mass media as a source of information (AOR = 2.25(95%CI; 1.52-3.32)) and length of stay at the farming site (AOR = 0.59(95%CI; 0.44-0.79)) were significantly associated with knowledge of malaria prevention. Knowledge (AOR = 6.62(95%CI; 4.46-9.83)), attitude (AOR = 2.17(95%CI1.40-3.37), use of mass media (AOR = 1.64(95%CI; 1.30-2.60)) and the length of stay (AOR = 1.93(95%CI; 1.35-2.77)) in the farming area were significantly associated with practice of malaria prevention. CONCLUSION: The practice of malaria prevention among migrant and seasonal farm workers was low. The programmers and implementers should design tailored malaria intervention programs and strategies for these hard to reach population.

Low Knowledge and Attitude Towards Visceral Leishmaniasis Among Migrants and Seasonal Farm Workers in Northwest Ethiopia.

OBJECTIVE: Ethiopia has the second highest burden of visceral leishmaniasis (VL) next to Sudan. North West Ethiopia alone accounts for 60% of the national burden. Migrant and seasonal farmworkers were the riskiest groups. Good knowledge and attitude on VL is a precursor for successful control of the disease. Therefore, this study was aimed to determine knowledge and attitude towards VL and its associated factors among migrants and seasonal farmworkers in West Gondar zone, Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from October to November 2018 in Metema and West Armachiho districts. Two-stage cluster sampling was used to select 950 migrant and seasonal farmworkers. A binary logistic regression model was fitted and variables having a P-value<0.05 were considered to have a significant association with the outcome variable. Odds ratio (OR) with 95% confidence interval (CI) was used as a measure of association. The goodness of fit test was assessed by Hosmer-Lemeshow test. RESULTS: Of the total participants, 33.2% (95% CI=30.2-36.2) and 30.2% (95% CI=27.4-33.2) were found to have good knowledge and favorable attitude towards VL, respectively. Factors associated with good knowledge include having health information (AOR=3.2, 95% CI=2.3-4.4), previous history of VL (AOR=6.8, 95% CI=3.7-12.8), and higher age (AOR=1.58, 95% CI=1.12-2.23). Moreover, factors associated with favorable attitude include having health information (AOR=2.8, 95% CI=2.0-3.9), previous history of VL (AOR=2.3, 95% CI=1.3-4.1), good knowledge (AOR=2.4, 95% CI=1.7-3.3), and larger number of visits to the farm area (AOR=2.5, 95% CI=1.5-4.1). CONCLUSION: In this study, knowledge and attitude of migrants and seasonal farmworkers towards VL were low. Having health information and previous history of VL had increased the odds of both knowledge and attitude. Tailored interventions for the migrant seasonal farmworkers focusing on knowledge and attitude of VL would be supremely important.

Factors Affecting Voluntary HIV/AIDS Counseling and Testing Service Utilization Among Youth in Gondar City, Northwest Ethiopia.

BACKGROUND: Voluntary counseling and testing (VCT) is a vital response to human immunodeficiency virus (HIV) infection among adolescents in sub-Saharan Africa. Determining the status of VCT services is important to link HIV care and antiretroviral therapy. METHODS: An institutional cross-sectional study design was conducted among 841 young students at Gondar College of Teachers' Education. A self-administered questionnaire was used to gather the data. Descriptive statistics were performed. Bivariate and multivariable binary logistic regressions were used to identify factors associated with the use of VCTs. The adjusted odds ratio (AOR) with 95% confidence was used to report statistical significance. RESULTS: The majority (71%) were aware of VCT services. More than one-third (37.8%, 95% CI: 34.6-41.2) participants had used VCT services. Having peer groups used VCT (AOR=2.04, 95% CI: 1.31-3.20), having partner (AOR: =1.6, 95% CI: 1.04-2.45), desiring to have VCT in the future (AOR=3.58, 95% CI: 1.98-6.50), being aware of VCT (AOR= 1.98, 95% CI: 1.20-3.34), knew infected/dead individuals with HIV/AIDS (AOR=1.67, 95% CI: 1.07-2.61), know test sites (AOR=2.01, 95% CI: 1.29-3.13) were positively associated, whereas being married (AOR=0.36, 95% CI: 0.20-0.63) and fear of confidentiality (AOR=0.23, 95% CI: 0.10-0.52) were major barriers to use. CONCLUSION: Low use of VCTs, which was far away from the 90:90:90 WHO goal, has been noted. The use of VCT services was associated with having peer groups that used VCT, having a partner, wanting to have VCT in the future, knowing the infected/dead individual with HIV/AIDS, fear of confidentiality of results, knowing the test sites, and having awareness of VCT. Efforts are needed to strengthen the health system that also needs to pay attention to education about HIV and VCT.

Predictors of Change in Weight Among People Living with HIV on Antiretroviral Treatment in West Hararghe Zone, Ethiopia: A Retrospective Longitudinal Study.

BACKGROUND: Human immunodeficiency virus (HIV) remains a major global public health issue, particularly in Africa. In resource-limited settings like Ethiopia, regular weight measurement and monitoring is useful in the examination of patient response to antiretroviral therapy and in clinical decision-making. However, there is a paucity of evidence on factors that affect longitudinal weight change. Therefore, the present study was intended to identify predictors of weight change among people living with HIV (PLWH) in West Hararghe, Ethiopia. METHODS: An institutional-based retrospective cohort study was conducted among 558 PLWH aged 18 years and above from September 2013 to January 2019 at Chiro Zonal Hospital and Gelemso General Hospital in West Hararghe zone, Ethiopia. Data were entered in Epi info 7 and analyzed in R software. The linear mixed effect regression model was used to identify predictors of longitudinal change in weight. Regression coefficients with their 95% confidence intervals were used to indicate the strength and significance of the association. RESULTS: Weight showed improvement in follow-up periods. In this study, age of respondent (beta=0.136, 95% CI, 0.044:0.227), time since the initiation of antiretroviral therapy (ART) (beta=0.089, 95% CI, 0.075:0.104), primary educational status (beta=2.403, 95% CI, 0.540:4.266), secondary educational status (beta=4.035, 95% CI, 1.666:6.404), tertiary and above educational status (beta=3.444, 95% CI, 0.330:6.558), sex (beta= -5.514, 95% CI, -7.260:-3.768), ambulatory functional status (beta= -3.419, 95% CI, -6.169:-0.668) and baseline CD4 count (≤200) (beta=2.205, 95% CI, 0.593, 3.817) were significant predictors of longitudinal weight change. CONCLUSION: We observed an increment in weight among PLWH who were on ART in Ethiopia. Educational status, time since the beginning of ART, age and having CD4 count above 200 have contributed positively to the change in weight, while ambulatory functional status and being female are negatively associated with longitudinal change in weight. Close monitoring is recommended for patients with ambulatory baseline functional status and for patients with baseline CD4 count ≤200.

Epidemiology of preterm birth in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Globally, complications of preterm birth are among the most common cause of neonatal mortality. In Ethiopia, the neonatal mortality reduction is not worthy of attention. Hence, this study reviewed the prevalence of preterm birth and factors associated with preterm birth in Ethiopia. METHODS: The review protocol of this study has been registered in PROSPERO (CRD42017077356). The PRISMA guideline was followed for this review. Studies that assessed the prevalence and/or associated factors of preterm birth in Ethiopia and published from Jan 01, 2009 to Dec 31, 2019 were considered. Studies were searched from the PubMed and Science Direct among medical electronic databases and Google Scholar. Random-effects model was used for detected heterogeneity among studies. Publication bias and sensitivity analysis were assessed. Pooled estimates with its 95% confidence interval were reported using forest plots. The quality of evidence from the review was assessed using GRADE approach. RESULTS: Twenty-two studies involving a total of 12,279 participants were included. The overall pooled prevalence of preterm birth in Ethiopia was 10.48% (95% CI: 7.98-12.99). Pooled odds ratio showed rural residence (AOR = 2.34, 95% CI: 1.35-4.05), being anemic (AOR = 2.59, 95% CI: 1.85-3.64), < 4 antenatal care visits (AOR = 2.34, 95%CI: 1.73-3.33), pregnancy induced hypertension (AOR = 3.49, 95% CI: 2.45-4.97), prelabor rapture of membrane (AOR = 4.42, 95% CI: 2.28-8.57), antepartum hemorrhage (AOR = 5.02, 95% CI: 2.90-8.68), multiple pregnancies (AOR = 3.89, 95% CI: 2.52-5.99), past adverse birth outcomes (AOR = 3.24, 95% CI: 2.53-4.15) and chronic illness (AOR = 4.89, 95%CI: 3.12-7.66) were associated with increased likelihood of preterm birth. Further, support during pregnancy was associated with reduced occurrence of preterm birth. CONCLUSION: The pooled national level prevalence of preterm birth in Ethiopia is high. Socio demographic, nutritional, health care, obstetric and gynecologic, chronic illness and medical conditions, behavioral and lifestyle factors are the major associated factors of preterm birth in Ethiopia. This evidence is graded as low grade. Thus, efforts should be intensified to address reported risk factors to relieve the burden of preterm birth in the study setting, Ethiopia.

Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys.

OBJECTIVE: This study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade. DESIGN, SETTING AND ANALYSIS: A nationally representative repeated cross-sectional survey was conducted using 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. Multivariate decomposition logistic regression analysis was employed to identify significant factors that have been contributed to the change in home delivery. Level of statistical significance was declared at a two-sided p value <0.05. OUTCOME MEASURE: Trends of home delivery. PARTICIPANTS: A total of 33 482 women were included. RESULTS: Home delivery has been decreased by 21% over the last decade in Ethiopia. In the last decade, 39% of the decrements in home delivery attributed to change in women's compositional characteristics. Antenatal care visits, educational status of the women and husband, birth order, religion, wealth index and distance from a health facility were the main sources of compositional change factors for the change of home delivery. Behavioural changes towards health facility delivery contributed approximately two-thirds of the decline of home delivery in Ethiopia. Antenatal care visits, birth order and religion have significantly contributed to the change of home delivery resulted from behavioural changes towards healthcare facility utilisation over the last decade. CONCLUSION: Despite the importance of health facility delivery, a significant number of women still deliver at home in Ethiopia. Women's compositional characteristics and behaviour changes were significantly associated with the change in home delivery. Multisectoral educational intervention is needed to change women's attitudes towards home delivery. Antenatal care coverage and healthcare facility coverage should increase thereby to improve healthcare facility based-delivery practice. Further research needs to be done to explore the potential barriers of health facility delivery from a religious perspective.

Geographical disparities and determinants of childhood diarrheal illness in Ethiopia: further analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Childhood diarrheal illness is the second leading cause of child mortality in sub-Saharan Africa, including Ethiopia. Epidemiology of diarrhea has long-term implications with respect to medical, social, and economic consequences. Studies hypothesize that there have been regional differences, and this study aimed to examine the spatial variations and identify the determinants of childhood diarrhea in Ethiopia. METHODS: Data from the 2016 Demographic and Health Survey of Ethiopia (EDHS), which included 10,337 aged under 5 years were analyzed. The survey was conducted using a two-stage stratified sampling design. The study attempted to detect and test the clustering of diarrhea cases using global Moran's I and LISA. Descriptive statistics followed by mixed-effect logistic regressions were used to identify factors related to the prevalence of diarrhea. RESULTS: Overall, 11.87% of the children experienced childhood diarrheal illness. The study showed that the risk was high in the southern and central parts and low in the eastern and western regions of the country. Children aged 6-12 (AOR = 2.66, [95% CI 2.01, 3.52]), 12-23 (AOR = 2.45, [95% CI 1.89, 3.17]), and 24-35 (AOR = 1.53, [95% CI 1.17, 2.01]) months were more likely to suffer from childhood diarrhea than those aged less than 6 months. Children in Tigray (AOR = 1.69 [95% CI 1.01, 2.83]), Amhara (AOR = 1.80, [95% CI 1.06, 3.06]), SNNPR (AOR = 2.04, [95% CI 1.22, 3.42]), and Gambella (AOR = 2.05, [95% CI 1.22, 3.42]) were at higher risk than those in Addis Ababa. The odds of getting diarrhea decreased by 24% among households with ≥ 3 under-five children compared to those with only one under-five child (AOR = 0.76 [95% CI 0.61, 0.94]). The odds of getting diarrheal illness for the children of employed mothers increased by 19% compared to those children of non-employed mothers (AOR = 1.19 [95% CI 1.03, 1.38]). CONCLUSIONS: Childhood diarrheal disease is prevalent among under-five children, particularly in the regions of SNNP, Gambella, Oromia, and Benishangul Gumuz, while the regions are generally making progress in reducing childhood illness. Capacity building programs with the best experience sharing and better home environments can be effective in reducing the incidence of childhood diarrhea in Ethiopia.