Tuberculosis treatment delay and contributing factors within tuberculosis patients in Ethiopia: A systematic review and meta-analysis.

Background: Tuberculosis (TB) is a significant public health disease and a major contributor to illness and death worldwide, including in Ethiopia. There are many information from first source which had inconclusive result in Ethiopia. Therefore, this review aimed to produce pooled evidence on the TB treatment delay and factors associated with it. Methods: The absence of a similar study with a systematic review and meta-analysis was confirmed. Articles from online available and unpublished sources conducted within Ethiopia between 2002 and 2024, were thoroughly screened using electronic sources such as Medline, Embase, Hinari, PubMed, the Cochrane Library, the Web of Science, and Google Scholar. Data analysis was performed using STATA version 14. Heterogeneity was assessed using Inverse of Variance (I2) and Cochrane Q tests. The funnel plot was employed to rule existence of publications subjectively while bias was checked using Egger's statistical method to quantify the bias. Result: Prevalence of TB treatment delay in Ethiopia was 50.42% at 95% (43.21, 57.64). Factors such as knowledge about TB, distance to health facilities less than 10 km, initial contact at a government service providing center for TB, having some educations, having pulmonary Tuberculosis, urban residency, were prtotective towards treatment delay. Female in gender, no chest pain symptom, disease severity with no restriction on daily activity, alcohol drinkers, and unmarried respondents were at higher risk to miss on time tuberculosis treatment. Conclusion and recommendation: The tuberculosis treatment delay in Ethiopia was considerably unexpected and basic personal variables and facility related variables were statistically associated with treatment. Therefore, Ethiopian TB control programs have to recognize and tackle the problem, obstacles, and vulnerability across the continuum patient care taking down and connecting to treatment post-diagnosis. This can be achieved by capacitating both government and non-governmental service provision centers and minimizing unfilled difference across professional awareness and skill, which will contribute further to minimizing delay.

Cost of maternal complications and its associated factors among mothers attending Hawassa public hospitals, Southern Ethiopia.

Background: The cost of maternal complications is considered as an important factor hindering the utilization of maternal health care services. However, information of estimate of spending on maternal complication was lacking. This study was aimed to estimate the cost of maternal complications and associated factors among mother's attending Hawassa public hospitals, Sidama Regional state, Ethiopia. Methods: A cross-sectional study design was conducted among 348 randomly selected mothers attending public hospitals in Hawassa from November 15 to December 15, 2021. Data was coded and entered into Epi Data version 3.1 and exported to STATA version 16.0 for analysis. Simple and multiple linear regression analysis was done. Correlation coefficient along with 95% CI was used to present the finding and p < 0.05 was used to declare statistical significance. Results: This study found that total median cost of maternal complications was 4895.5 (IQR = 3779) ETB. The total median direct medical cost was 1765.5 (IQR = 1649.5) ETB. Number of days absent [(R = 0.028; 95% CI: (0.023, 0.033)], distance from facility [(R = 0.001; 95% CI: (0.000, 0.002)], site of laboratory diagnosis [(R = 0.230; 95% CI: (0.140, 0.320)], number of laboratory test conducted [(R = 0.045; 95% CI: (0.021, 0.069)] were found to be significance predictors of maternal complications costs. Conclusions: Total median cost of maternal complications in current study was high. Respondents' site of diagnosis, number of days missed from work, number of laboratory tests, and distance from hospitals were independent predictors of maternal complications cost. Thus, we will recommend governments to introduce strategies that specifically help mothers with maternal complications.

Determinants of enrollment in community based health insurance program among households in East Wollega Zone, west Ethiopia: Unmatched case-control study.

Background: Ethiopia has launched a community-based health insurance (CBHI) since 2011, which is an innovative financing mechanism to enhance domestic resource mobilization and sustainable health financing. This study assessed determinants of CBHI enrollment among HHs (households) of East Wollega, Ethiopia, 2022. Method and materials: Community based unmatched 1:2 case-control study design was conducted between Jan 7and Feb 5/2022 among 428 HHs (144 cases and 284 controls). Cases were selected from HHs who registered for CBHI and currently using CBHI. Controls were from those who do not registered for CBHI membership. Data collected using a semi-structured, interview administered questionnaire. Multivariable logistic regression with SPSS version 25 was employed for analysis and variables were declared statistical significant association at p-value < 0.05, 95% CI. Result: Data from 428 (144 cases and 284 controls to CBHI) were collected; a response rate of 98.8%. Statistically lower odds of CBHI enrollment was observed among HHs who have poor knowledge [AOR = 0.48 (95% CI:0.27, 0.85)], perceived not respectful care [AOR = 0.44 (95% CI :0.24, 0.81)], unavailability of laboratory services [AOR = 0.37(95% CI:0.21, 0.66)], inappropriate time of premium payment [AOR = 0.31(95% CI:0.18, 0.52)]. In addition, medium wealth status category [AOR = 0.11(95% CI: 0.03, 0.45)]. Higher odd of CBHI enrollment observed among who have formal education [AOR = 2.39(95% CI: 1.28, 4.48)]. Conclusion and recommendation: Educational level, knowledge, time of membership payment, laboratory test availability, perception of respectful care and wealth status were significant determinants of CBHI enrollment status. Hence, the responsible bodies should discuss and decide with community on the appropriate time of premium payment collection, and enhance community education on CBHI benefit package.

Knowledge of periconceptional folic acid supplementation and associated factors among pregnant women attending antenatal care at public health facilities in Hawassa, South Ethiopia.

BACKGROUND: Neural tube closure defect (NTD) such as spinal bifida and anencephaly are serious neurological disabilities that occur when the neural tube does not close completely within 28 days of conception. Even though Folic acid supplementation during and before pregnancy is proved to significantly reduces the risk of NTDs. Currently only 23% of folic acid preventable NTD achieved Worldwide; mainly due to lack of awareness about folic acid supplementation. This study was aimed to assess the knowledge of Folic acid supplementation among pregnant women attending antenatal care at public health facilities in Hawassa Ethiopia. METHODS: Institution based cross-sectional study was employed among 358 pregnant women attending antenatal care. Data were collected using an interviewer-administered structured questionnaire and analyzed using SPSS version 22. The knowledge of Folic acid supplementation was assessed using six multiple-choice questions. The association between the dependent and independent variables were analyzed using Binary Logistic regression model and statistically significant predictors at p-value <.05 at 95% CI. RESULTS: This study indicated that only 7.5% (95% CI, 5.3-10.1) of pregnant women had good knowledge of Folic acid supplementation. The pregnant women who had a history of at least one previous pregnancy loss AOR = 12.64 (95% CI: 4.98, 32.08) and those who had preconception consultation AOR = 11.77 (95% CI: 3.01, 46.07) were more likely to have good knowledge of periconceptional folic acid supplementation as compared to their counterpart. CONCLUSIONS: The knowledge of periconceptional folic acid supplementation among pregnant women was worryingly low in the study area. Alternative and more effective strategies are needed if the population of Ethiopia is to benefit fully from the folic acid prevention of NTDs. Thus, in Ethiopia the future strategies should focus on the possible way to reach the last group through fortification of staple foods with folic acid along with improving women's awareness on folic acid importance in reducing Neural tube defects.

Same-Day ART Initiation and Associated Factors Among People Living with HIV on Lifelong Therapy at Nekemte Specialized Hospital, Western Ethiopia.

Background: The test-and-treat approach recommends early ART initiation (same day). Early ART start has double the benefits as treatment and as prevention. However, there is limited information regarding same-day ART initiation in Ethiopia. Hence, this study aimed to assess the magnitude and factors of same-day ART initiation among people living with HIV (PLHIV) on ART at Nekemte specialized hospital, in Western Ethiopia. Methods: A cross-sectional study was conducted among 483 PLHIV from January 10 to February 15, 2021. Data were collected using an investigator-administered questionnaire. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Variables with P-value <0.25 from bivariable analysis were included in the multivariable analysis. AOR with 95% CI and P-value <0.05 were used to declare statistical significance. Results: A total of 483 study subjects participated and gave a 100% response rate. Two thirds (65%) of them started ART on the same day with a 95% CI [60.2-68.8]. Urban dwellers (AOR = 3.93 (95% 1.96-7.87)), with no OIs (AOR = 4.02 (95% CI: 1.54-10.47)), not screened for TB (AOR = 6.02 (95% CI: 1.71-21.15)), tested via VCT (AOR = 2.32 (95% CI: 1.37-3.26)), who have not used CPT (AOR = 1.88 (95% CI: 1.10-3.23)), who have not used IPT (AOR = 2.36 (95% CI: 1.0-5.57)), who were tested in 2019/20 (AOR = 2.37 (95% CI: 1.08-5.518)), and with BMI ≥25 kg/m2 (AOR = 2.18 (95% CI: 1.05-4.52)) were significantly associated with same-day ART initiation. Conclusion: Two thirds of study subjects initiated ART on the same day as HIV diagnosis. Voluntary testing and immediate referral to HIV care, advocating test-and-treat, and intensive counseling should be strengthened and reinforced for newly diagnosed HIV-positive people. Given that, high attention should be paid to individuals from urban residence, not screened for TB, who have not used CPT and IPT prophylaxis.

Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia.

Introduction: Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021. Methods: A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model. Results: A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption. Conclusion: A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.

HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission.

Background: Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa. Objectives: To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa. Methods: HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses. Result: The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure. Conclusion: The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.

Pretomanid development and its clinical roles in treating tuberculosis.

Tuberculosis (TB) is the leading infectious cause of mortality worldwide. Despite the development of different antituberculosis drugs, managing resistant mycobacteria is still challenging. The discovery of novel drugs and new methods of targeted drug delivery have the potential to improve treatment outcomes, lower the duration of treatment, and reduce adverse events. Following bedaquiline and delamanid, pretomanid is the third medicine approved as part of a novel drug regimen for treating drug-resistant TB. It is a promising drug that has the capacity to shape TB treatment and achieve the End TB strategy set by the World Health Organization. The effectiveness of pretomanid has been reported in different observational and clinical studies. However, long-term safety data in humans are not yet available and the pretomanid-based regimen is recommended under an operational research framework that prohibits its wider and programmatic use. Further research is needed before pretomanid can be celebrated as a promising candidate for the treatment of different categories of TB and specific patients. This review covers the update on pretomanid development and its clinical roles in treating Mycobacterium tuberculosis.

Magnitude of postpartum hemorrhage and associated factors among women who gave birth in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimates the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia. METHODS: Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. The search period for articles was conducted from 15th August 2021 to 15th November 2021. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I2 statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI). Visual assessment of publication bias was assessed using a funnel plot and Egger's test was used to check the significant presence of publication bias. RESULTS: A total of 876 studies were identified from several databases and nine studies fulfilled eligibility criteria and were included in the meta-analysis. The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH. CONCLUSION: In Ethiopia the magnitude of PPH was high, and lack of ANC up follow-up, being multipara, and having a previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage.

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide, particularly in resource-limited countries such as Ethiopia. Findings from a few studies were inconsistent and inconclusive. Therefore, this study aimed to estimate the pooled magnitude of PPH and factors associated with PPH among women who gave birth in Ethiopia.Electronic databases such as Medline, Pub Med, Cochrane library, the Web of Science, and Google Scholar were used to search for articles. Data were extracted using a standardized data extraction checklist and the analyses were conducted using Stata version 14. The Cochrane Q test statistic and I² statistics were used to assessing heterogeneity. To estimate the pooled magnitude of postpartum hemorrhage, a random-effects model was fitted. Association between PPH and independent variables was reported in odds ratio (OR) with 95% confidence interval (CI).The pooled magnitude of PPH in Ethiopia was 11.14% (95% CI 7.21, 15.07). The current meta-analysis revealed that lack of antenatal care follow-up (ANC) (OR = 6.52, 95% CI 2.87, 14.81), being multipara (OR = 1.88, 95% CI 1.25, 2.85), and having the previous history of PPH (OR = 7.59, 95% CI 1.88, 30.55) were found to be significantly associated with PPH.In Ethiopia the magnitude of PPH was high, and lack of ANC follow-up, being multipara, and having the previous history of PPH were risk factors for postpartum hemorrhage. Thus, improving antenatal care follow-up is needed to decrease the magnitude of postpartum hemorrhage.

Perforated duodenal ulcer in the third trimester of pregnancy, with survival of both the mother and neonate, in Ethiopia: a case report.

BACKGROUND: Perforated peptic ulcer disease is a serious complication of peptic ulcer disease (PUD) that presents as acute abdomen. It is very uncommon during pregnancy, but its diagnosis in pregnancy is very challenging in general, and more so in the third trimester. Timely diagnosis and prompt surgical intervention can prevent maternal and fetal mortality, but delayed diagnosis is linked with poor maternal and fetal outcomes. The aim of this case report is to emphasize the need for healthcare professionals to consider the differential diagnosis of perforated PUD when presented with cases of acute abdomen in pregnancy and to involve a multidisciplinary team in management for better feto-maternal outcome. CASE PRESENTATION: A 35-year-old pregnant Ethiopian woman, Gravida 7 and Para 6, presented with a sudden onset of right upper quadrant pain, nausea, and vomiting of 7 hours duration at 36 weeks of gestation. She also had contractions and leakage of liquor of two hours duration. Her abdomen was grossly distended, rigid, and diffusely tender, and showed limited movement with respiration. An upright abdominal X-ray demonstrated air under the diaphragm. She was diagnosed with perforated peptic ulcer disease. Labor was augmented, and a 2.9-kg live male neonate was delivered vaginally. Two hours after delivery, laparoscopic omental patch repair was performed. The patient was discharged 7 days after the omental patch repair surgery in stable condition. CONCLUSIONS: Perforated PUD in pregnancy is a rare occurrence, which may account for the delay in diagnosis and management. Obstetricians should keep a high index of suspicion when a pregnant woman presents with acute abdomen. Care provided by obstetricians should be coupled with care provided by other disciplinary teams, in order to reduce maternal and fetal morbidity and mortality.

Time to recovery from severe acute malnutrition and its predictors among children aged 6-59 months at Asosa general hospital, Northwest Ethiopia. A retrospective follow up study.

BACKGROUND: Severe Acute Malnutrition (SAM) has become a major public health challenge in developing countries including Ethiopia, especially among the underprivileged population. Ethiopia is among the developing countries with the highest burden of acute malnutrition among under-five children. Though, plenty of studies were done on the magnitude of acute malnutrition among under-five children in Ethiopia, there is a limited evidence on time to recovery from SAM and its predictors among children aged 6-59 months in Ethiopia, particularly in the study area. OBJECTIVES: The study was aimed to assess the time to recovery from SAM and its predictors among children aged 6-59 months at Asosa general hospital (AGH), Benishangul Gumuz, Ethiopia. METHODS: A Five years retrospective follow-up study design was employed among 454 children admitted with SAM in AGH from January 2015 to December 2019. The data were extracted from the patient medical records using checklist. The data were coded and entered into Epi-Data 3.1; then exported to STATA/SE-14 for analysis. Proportional Cox regression was performed to identify predictors of recovery time. A proportional hazard assumption was checked. Variables with AHR at 95% CI and P-value less than 0.05 in the multivariable Cox proportional regression was considered as significant predictors of recovery time. FINDINGS: Among the 454 included records of children with SAM, 65.4% (95%CI: 50.1, 69.2) of them were recovered at the end of the follow-up with a median recovery time of 15 IQR(11-18)days. The incidence rate of recovery was 5.28 per 100 child days' observations. Being HIV Negative (AHR = 2.19: 95% CI 1.28, 3.73), Marasmic (AHR = 1.69: 95% CI 1.18, 2.42), and marasmic-kwashiorkor child (AHR = 1.60: 95% CI (1.09, 2.37) independently predicted recovery time. CONCLUSIONS: Though the time to recovery from severe acute malnutrition was in the acceptable range, the proportion of recovery was found to be low in the study area compared to sphere standard. The prognosis of children with severe acute malnutrition was determined by the HIV status of the child and the type of malnutrition experienced. Further strengthening of malnutrition therapeutic centers and routine checkup of the nutritional status of HIV positive children should be emphasized to reduce child mortality and morbidity from under-nutrition.

Incidence and predictors of death from COVID-19 among patients admitted to treatment center of Wollega University Referral Hospital, Western Ethiopia: A retrospective cohort study.

INTRODUCTION: Currently, COVID-19 contributes to mortality and morbidity in developed as well as in developing countries since December 2019. However, there is scarcity of evidence regarding the incidence and predictors of death among patients admitted with COVID-19 in developing country including Ethiopia, where the numbers of deaths are under-reported. Hence, this study aimed to assess the incidence and predictors of death among patients admitted with COVID-19 in Wollega University Referral Hospital (WURH), western Ethiopia. METHODS: An institution based retrospective cohort study design was conducted among 318 patients admitted with COVID-19 in WURH treatment center. Patients who were tested positive for COVID-19 by using rRT-PCR test and admitted with the diagnosis of severe COVID-19 cases from September 30, 2020 to June 10, 2021 were a source population. Epidata version 3.2 was used for data entry, and STATA version 14 for analysis. A Cox proportional hazard regression analysis was used to determine factors associated with mortality from COVID-19. Multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of mortality from COVID-19 at p-value < 0.05. RESULTS: A total of 318 patients were included in final analysis with mean age of 44 (SD±16.7) years and about two third (67.9%) were males. More than half (55.7%) of patients had no comorbidity on admission. The majority, 259 (81.45%) of patients recovered from COVID-19 and 267 (84%) of patients were censored at the end of follow up. The incidence rate of mortality was 14.1 per/1000 (95%CI: 10.7, 18.5) person days observation. Age ≥ 59 years (AHR: 5.76, 95%CI: 2.58, 12.84), low oxygen saturation (AHR: 2.34, 95% CI: (2.34, 4.17), and delayed presentation (AHR: 5.60, 95%CI: 2.97, 10.56) were independent predictors of mortality among COVID-19 patients. CONCLUSION: The mortality rate of COVID-19 pandemic was high in the study area, and most of death was happened during the first 10 days. Being old age, low oxygen saturation and delayed presentation were factors which predict mortality due to COVID-19. Hence, strengthening the health care delivery system to satisfy the need of the patients should get due attention to reduce the incidence of mortality from COVID-19 cases.

First-line virologic-based ART treatment failure and associated factors among adult HIV Positives in Southwest Shoa, Central Ethiopia.

Background: The function of antiretroviral therapy is to enhance immunity and prevent the occurrence of opportunistic infection. But antiretroviral therapy showed a failure to manage infection after a time. Nowadays, an accepted criterion to confirm Antiretroviral therapy (ART) treatment failure is a virologic failure. Regarding this virologic failure, there are no well-addressed findings, especially in this study area. Therefore in this research, the magnitude and factors that contribute for virological ART treatment failure have been identified. Methods: Facilitybased cross-sectional study was conducted on adult patients taking ART. Data entry was conducted using Epi Data Version3 and exported to Stata SE version 14 for analysis. Bivariable logistic regression was used to find covariates significantly associated with firs line ART treatment failure. In this case, variables with P-value ≤ .25 were a candidate for multiple logistic regressions. A backward logistic regression model was used. Finally, variables with P-value ≤ .05 were considered as factors significantly associated with first-line ART treatment failure and the result was presented with a description, graph, and tables. Results: In this study, three hundred and fifty peoples were a candidate for the study and all have been involved. The magnitude of first-line ART treatment failure based on virologic criteria was 20.85%. Greater than three-fourth (84.29%) of study participants have support from somebody. Those patients who have initiated first-line ART with NVP based regimen have 1.83 times more likely to face first-line ART treatment failure as compared with those who have started with Efeverence (EFV) based regimen [AOR = 1.83, 95% CI (1.035, 3.245)]. Patients who have initiated first-line ART at the health center were 3.093 times more likely to face first-line ART treatment failure as compared those who have initiated ART at hospitals [AOR = 3.093, 95% CI (1.101, 8.685)]. Patients who have not developed a common opportunistic infection after ART initiation was 47.3% less likely to encounter first-line ART treatment failure as compared with those who have opportunistic infection [AOR = 0.527, 95% CI (0.289, 0.961)]. Conclusion: Based on virologic criteria, NVP based ART initiation, having history recorded opportunistic infection after ART initiation, being male, Institution where initiate ART, are significantly associated with the occurrences of first-line ART treatment failure. The action has to be directed on those identified factors to maintain the patient stay on First-line ART by concerned stakeholders.

Survival status and predictors of neonatal mortality among neonates admitted to Neonatal Intensive care Unit (NICU) of Wollega University referral hospital (WURH) and Nekemte Specialized hospital, Western Ethiopia: A prospective cohort study.

BACKGROUND: The neonatal period is the most vulnerable time for survival in which children face the highest risk of dying in their lives. Neonatal mortality (NM) remains a global public concern, especially in sub-Saharan African (SSA) countries. Although, better progress has been made in reducing NM before 2016, Ethiopia is currently one of the top ten countries affected by NM. Studies are limited to secondary data extraction in Ethiopia which focus only on survival status during admission, and no study has been conducted in the study area in particular. OBJECTIVE: To assess the survival status and predictors of neonatal mortality among neonates admitted to the NICU of WURH and Nekemte Specialized Hospital, Western Ethiopia. METHODS: An institution-based prospective cohort study was conducted among a cohort of 412 neonates admitted to the NICU of WURH and Nekemte Specialized Hospital from September 1, 2020 to December 30, 2020. All neonates consecutively admitted to the NICU of the two hospitals during the study period were included in the study. Data entry was performed using Epidata version 3.0 and the analysis was performed using STATA version 14. A Kaplan Meier survival curve was constructed to estimate the cumulative survival probability. A cox proportional hazards regression model was used to identify the predictors of NM. Hazard Ratios with 95% CI were computed and all the predictors associated with the outcome variable at p-value ≤ 0.05 in the multivariable cox proportional hazards analysis were declared as a significant predictor of NM. RESULTS: A total of 412 neonates were followed for a median of 27 days with an IQR of 22-28 days. During the follow-up period, a total of 9249 person day observations (PDO) were detected. At the end of follow-up, 15.3% of neonates died with an overall incidence rate of death 6.81/1000 PDO. The median time to death was 10 days, and the highest incidence rate of death was observed during the first week of the neonatal period. The study found that rural residence (AHR = 2.04, 95%CI: 1.14, 3.66), lack of ANC visits (AHR = 7.77, 95%CI: 3.99, 15.11), neonatal hypothermia (AHR = 3.04, 95%CI: 1.36, 6.80), and delayed initiation of breastfeeding (AHR = 2.26, 95% CI: 1.12, 4.56) as independent predictors of NM. However, a decreased number of pregnancies decrease the risk of NM. CONCLUSIONS AND RECOMMENDATIONS: The incidence rate of neonatal death was high particularly in the first week of life in the study area. The study found that lack of ANC visit, neonatal hypothermia, increased number of pregnancies, rural residence, and delayed initiation of breastfeeding positively predicted NM. Therefore, there is a need to encourage programs that enhance ANC visits for pregnant mothers and community-based neonatal survival strategies, particularly for countryside mothers.

Acute respiratory distress syndrome among patients with severe COVID-19 admitted to treatment center of Wollega University Referral Hospital, Western Ethiopia.

BACKGROUND: Acute respiratory distress syndrome is a life-threatening condition that has a significant effect on the occurrence of morbidity and mortality among patients with severe Coronavirus disease 2019 (COVID-19). To the best of researchers' knowledge, there is no Study on ARDS of COVID-19 in Ethiopia. Therefore, this study aimed to identify the prevalence of ARDS and associated factors among severe COVID-19 patients at Wollega University Referral Hospital. METHODS: An institution-based retrospective cross-sectional study was conducted from September 20, 2020, to June 10, 2021. Real-Time Reverse transcription-polymerase Chain Reaction (rRT-PCR) test was used to test Patients for COVID-19. Epi-data version 3.2 was used for data entry, and the final data analysis was through STATA version 14. After checking the assumption P-value<0.25 in the bivariable analysis was used to select a candidate variable for multi-variable analysis, and a p-value of <0.05 was used to declare statistical significance. RESULTS: In this study, the prevalence of ARDS was 32%. Almost all the patients had the clinical feature of cough (93.7%), followed by shortness of breath (79.9%), fever (77.7%), and headache (67%). Age older than 65 years (AOR = 3.35, 95%CI = 1.31, 8.55), male gender (AOR = 5.63, 95%CI = 2.15, 14.77), and low oxygen saturation level (AOR = 4.60, 95%CI = 1.15, 18.35) were the independent predictors of ARDS among severe COVID-19 patients. CONCLUSION: The prevalence of ARDS among patients with severe COVID-19 was high in the study area. Therefore, elders and patients with critical conditions (low oxygen saturation) better to get special attention during COVID-19 case management to enhance good care and monitoring of the patients.

Incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia; A retrospective cohort study, 2021.

Background: Currently, coronavirus disease 2019 (COVID-19) is the leading cause of death and the rate of mortality is rapidly increasing over time. There is a paucity of information regarding the incidence and predictors of mortality among COVID-19 patients from low-income countries, particularly in Ethiopia. Objective: To assess incidence and predictors of mortality among COVID-19 patients admitted to treatment centers in North West Ethiopia. Methods: An institution-based retrospective cohort study was conducted among 552 laboratory-confirmed COVID-19 cases at Debre Markos University and Tibebe Ghion Hospital COVID-19 treatment centers in North West Ethiopia from March 2020 to March 2021. Data were collected from patients' medical records using a structured data extraction tool. Cox-proportional hazards regression models was fitted to identify significant predictors of mortality. Result: The overall mortality rate of COVID-19 was 4.7, (95 % CI: 3.3-6.8) per 1000 person day observations. Older age (AHR: 4.9; 95% CI: 1.8, 13.5), rural residence (AHR: 0.18; 95% CI: 0.05, 0.64), presence of hypertension (AHR: 3.04; 95% CI: 1.18, 7.8), presence of diabetes mellitus (AHR: 8.1; 95% CI: 2.9, 22.4) and cardiovascular disease (AHR: 5.2; 95% CI: (1.69, 16.2) were significantly associated with mortality. Conclusions: The rate of mortality among hospitalized COVID-19 patients in this study was low. COVID-19 patients from urban residences, older patients, and patients with comorbidity have a high risk of death. These high risk groups should be prioritized for COVID-19 vaccinations, and early screening and appropriate intervention should be established on presentation to health facility.

Health professionals' COVID-19 vaccine acceptance and associated factors in Wollega University referral hospital, Western Ethiopia: A cross-sectional study.

BACKGROUND: Health professionals' willingness to accept the COVID-19 vaccine is very important, and evidence suggests that only a limited proportion of health-care workers were ready to accept a COVID-19 vaccine, which is very low when compared with the risk of the disease. This study aimed to assess health professionals' acceptability and associated factors in Wollega University referral hospital, Western Ethiopia. METHODS: An institution-based cross-sectional study was conducted among health-care workers in Wollega University referral hospital from March 26-28, 2021. The data were collected by using a self-administered questionnaire. Epi-data version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the acceptability of the COVID-19 vaccine. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value <.05). RESULTS: A total of 191 health professionals have participated in the study. The study indicates that 65.4% (95% CI: 58.6%, 72.2%) of health professionals had the willingness to receive the COVID-19 vaccine if available. Age of health professionals (AOR = 3.58, 95% CI: 1.38, 8.38), knowledge of the COVID-19 vaccine (AOR = 2.98, 95% CI: 1.22, 7.23), and perception of COVID 19 vaccine (AOR = 5.71, 95% CI: 2.50, 13.00) were significantly associated with vaccine acceptability. CONCLUSIONS AND RECOMMENDATIONS: Nearly, two-thirds of health professionals were willing to accept the COVID-19 vaccine, which is low. In general, continuous communication and health education have to be provided to enhance overall awareness of the COVID-19 vaccine.

Prevalence of asymptomatic malaria and associated factors in Ethiopia: Systematic review and meta-analysis.

Active detection of asymptomatic malaria cases and resolution of associated factors are essential for malaria elimination. There are no nationwide estimates for asymptomatic malaria and associated factors in Ethiopia. Therefore, this study aims to generate comprehensive and conclusive evidence from various studies conducted in Ethiopia. Published articles from various electronic databases such as PubMed, Google Scholar, CINAHL, Scopes, Cochrane Library, the Web of Science, and African Journals Online were accessed. Also, unpublished studies from Addis Ababa digital library were identified. All observational study designs were included in the search. Data were extracted on the Microsoft Excel spreadsheet and analyzed using STATA version 14.1. A random-effects model was fitted to estimate the pooled prevalence of asymptomatic malaria. A meta-regression and subgroup analysis was computed to see heterogeneity. The publication bias was assessed by the funnel plots and Egger's statistical tests. The analysis found that the pooled burden of asymptomatic malaria was 6.7 (95% confidence interval = 4.60, 8.79). The pooled prevalence of Plasmodium falciparum was 3.75 (95% confidence interval = 2.25, 5.18), and that of Plasmodium vivax was 2.22 (95% confidence interval = 1.46, 2.99). Factors such indoor residual spray service (odds ratio = 0.46; 95% confidence interval = 0.26, 0.81), never used insecticide-treated nets (odds ratio = 6.36; 95% confidence interval = 4.01, 10.09), and presence of stagnant water in the vicinity (odds ratio = 3.24; 95% confidence interval = 1.20, 8.71) were found to have a significant association with asymptomatic malaria. This study highlighted that pooled prevalence of asymptomatic malaria is high and varied by population groups. Prevalence of asymptomatic malaria was increased among those who never used insecticide-treated nets and were living near stagnant water by six and three times, respectively. The use of more sensitive diagnostic methods could yield a higher burden of the disease. Furthermore, active case detection is recommended for effective intervention toward elimination.

Internet Addiction and Its Associated Factors Among African High School and University Students: Systematic Review and Meta-Analysis.

Introduction: Internet addiction is characterized by excessive and uncontrolled use of the internet affecting everyday life. Adolescents are the primary risk group for internet addiction. Data on internet addiction is lacking in Africa. Thus, this review aimed to determine the pooled prevalence of internet addiction and its associated factors among high school and university students in Africa. Methods: A comprehensive literature search was conducted using electronic databases (PubMed/MEDLINE, Web of science, Hinari, and Google scholar) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics and small-study effects were checked using Egger's statistical test at a 5% significance level. A sensitivity analysis was performed. A random-effects model was employed to estimate the pooled prevalence and associated factors of internet addiction among students. The primary outcome of measure of this review was the prevalence of internet addiction and the secondary outcome of measures are the factors associated with internet addiction. Results: A total of 5,562 studies were identified among the five databases. Of these, 28 studies from 10 countries with 14,946 high school and university students were included in this review. The overall pooled prevalence of internet addiction among the students was 34.53% [95% Confidence Interval (CI): 26.83, 42.23, I2 = 99.20%]. Male sex [Pooled Odds Ratio (POR) = 1.92, 95% CI:1.43, 2.57 I2 = 0.00], urban residence (POR = 2.32, 95% CI:1.19, 4.53, I2 = 59.39%), and duration of daily internet use for more than 4 h (POR = 2.25, 95% CI:1.20, 4.21, I2 = 0.00%, were significantly associated with internet addiction among adolescents. Conclusion: Almost one-third of university and high school students in Africa are addicted to the internet. Male students, those from urban areas, and those who use the internet for more than 4 h per day have higher odds of internet addiction. Thus, we recommend that health planners and policymakers pay attention to the use of the internet and internet addiction in Africa.

Attitude of health professionals towards COVID-19 vaccination and associated factors among health professionals, Western Ethiopia: A cross-sectional survey.

INTRODUCTION: Even though people of the world were eagerly waiting for the hope of vaccine development, vaccine hesitancy is becoming the top concern in both developed and developing countries. However, there is no adequate evidence regarding the attitude and perception of health professionals towards the COVID 19 vaccine in resource-limited settings like Ethiopia. The aim of this study was to assess health professionals' attitudes and perceptions towards COVID 19 vaccine in Western Ethiopia. METHODS: An institution-based cross-sectional study was conducted among health care workers found in Nekemte town from April 14-21, 2021. A total of 439 health professionals present on duty during the study period was included in the study. The data were collected by using self-administered questionnaire. Epidata version 3.2 was used for data entry, and STATA version 14 was used for data analysis. The binary logistic regression model was employed to determine factors associated with the attitude towards COVID-19 vaccination. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared at a 5% level (p-value < 0.05). RESULT: A total of 431 health professionals participated in the study yielding a response rate of 98.1%. The results indicated that 51.28% (95%CI: 45.12%, 57.34%) of health professionals had a favorable attitude towards COVID-19 vaccination. Having good knowledge about the COVID-19 vaccine (AOR = 0.38, 95%CI: 0.22, 0.64, P-value <0.001) was negatively associated with unfavorable attitude towards COVID-19 vaccine, whereas age less than 30 years (AOR = 2.14, 95%CI:1.25,3.67, P-value <0.001), working in a private clinic (AOR = 7.77, 95% CI: 2.19, 27.58, P-value <0.001) and health center (AOR = 2.45, 95%CI: 1.01, 5.92, P-value = 0.045) were positively associated with unfavorable attitude towards COVID-19 vaccine. CONCLUSION AND RECOMMENDATION: In general, the attitude and perception of health care professionals toward the COVID-19 vaccine in the study area were unsatisfactory. Knowledge about the COVID-19 vaccine, age of health care workers, and place of work are the factors which affects attitude towards COVID-19 vaccine. Thus, we recommend the media outlets and concerned bodies to work to develop trust among the public by disseminating accurate and consistent information about the vaccine.