Nomogram to predict risk of neonatal mortality among preterm neonates admitted with sepsis at University of Gondar Comprehensive Specialized Hospital: risk prediction model development and validation.

BACKGROUND: Mortality in premature neonates is a global public health problem. In developing countries, nearly 50% of preterm births ends with death. Sepsis is one of the major causes of death in preterm neonates. Risk prediction model for mortality in preterm septic neonates helps for directing the decision making process made by clinicians. OBJECTIVE: We aimed to develop and validate nomogram for the prediction of neonatal mortality. Nomograms are tools which assist the clinical decision making process through early estimation of risks prompting early interventions. METHODS: A three year retrospective follow up study was conducted at University of Gondar Comprehensive Specialized Hospital and a total of 603 preterm neonates with sepsis were included. Data was collected using KoboCollect and analyzed using STATA version 16 and R version 4.2.1. Lasso regression was used to select the most potent predictors and to minimize the problem of overfitting. Nomogram was developed using multivariable binary logistic regression analysis. Model performance was evaluated using discrimination and calibration. Internal model validation was done using bootstrapping. Net benefit of the nomogram was assessed through decision curve analysis (DCA) to assess the clinical relevance of the model. RESULT: The nomogram was developed using nine predictors: gestational age, maternal history of premature rupture of membrane, hypoglycemia, respiratory distress syndrome, perinatal asphyxia, necrotizing enterocolitis, total bilirubin, platelet count and kangaroo-mother care. The model had discriminatory power of 96.7% (95% CI: 95.6, 97.9) and P-value of 0.165 in the calibration test before and after internal validation with brier score of 0.07. Based on the net benefit analysis the nomogram was found better than treat all and treat none conditions. CONCLUSION: The developed nomogram can be used for individualized mortality risk prediction with excellent performance, better net benefit and have been found to be useful in clinical practice with contribution in preterm neonatal mortality reduction by giving better emphasis for those at high risk.

Tools and guidelines to assess the appropriateness of medication and aid deprescribing: An umbrella review.

AIMS: The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIMs), evaluate development and validation methods, and describe evidence levels for medication inclusion. METHODS: Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection and guideline databases from the date of inception to 7 July 2022. Following the initial search, an additional search was conducted to identify an updated versions of tools on 17 July 2023. We analysed the contents of tools and guidelines. RESULTS: From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed and 11 implicit) and nine guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children <18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence. CONCLUSIONS: Tools are available for a diversity of populations. There were discrepancies, with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. In particular, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is urgently needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.

Incidence and Predictors of Major Adverse Drug Reactions Among Human Immunodeficiency Virus-infected Children on Antiretroviral Treatment in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia: A Multicenter Retrospective Follow-up Study.

PURPOSE: Major adverse drug reactions (ADRs) are the leading causes of poor adherence, switching of drugs, morbidity, and mortality. A limited studies was conducted to investigate major ADR in developing countries including Ethiopia, and the purpose of this study was to assess the incidence and predictors of major ADRs among HIV-infected children receiving antiretroviral therapy (ART) in West Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted among 460 children receiving ART from January 1, 2014 to December 31, 2021. A simple random sampling technique was employed, and data were collected using Kobo Toolbox software and then deployed to STATA 14 for analysis. The Kaplan-Meier survival curve and the log-rank test were used to estimate and compare survival times. Both bivariable and multivariable Weibull regression models were fitted to identify predictors. Finally, an adjusted hazards ratio (AHR) with a 95% CI was computed, and variables with P < 0.05 were considered statistically significant predictors of major ADR. FINDINGS: The overall incidence rate of major ADRs was 5.8 (95% CI, 4.6-7.3) per 1000 child months. Being female (AHR, 2.71; 95% CI, 1.52-4.84), tuberculosis (TB)-HIV co-infection (AHR, 2.49; 95% CI, 1.32-4.68), World Health Organization stage (III and IV) (AHR, 2.52; 95% CI, 1.39-4.56), zidovudine-based (AHR, 2.84; 95% CI, 1.11-7.31), and stavudine-based (AHR, 5.96; 95% CI, 1.63-21.84) regimens were found to be significant predictors of major ADRs. IMPLICATIONS: The major ADR incidence rate was high. Health professionals should employ early screening and close follow-up for children with advanced World Health Organization clinical staging, females, those with TB-HIV co-infection, and those receiving stavudine- and zidovudine-based initial regimens to reduce the incidence of major ADRs.

A Bayesian approach to estimate the probability of resistance to bedaquiline in the presence of a genomic variant.

BACKGROUND: Bedaquiline is a core drug for treatment of rifampicin-resistant tuberculosis. Few genomic variants have been statistically associated with bedaquiline resistance. Alternative approaches for determining the genotypic-phenotypic association are needed to guide clinical care. METHODS: Using published phenotype data for variants in Rv0678, atpE, pepQ and Rv1979c genes in 756 Mycobacterium tuberculosis isolates and survey data of the opinion of 33 experts, we applied Bayesian methods to estimate the posterior probability of bedaquiline resistance and corresponding 95% credible intervals. RESULTS: Experts agreed on the role of Rv0678, and atpE, were uncertain about the role of pepQ and Rv1979c variants and overestimated the probability of bedaquiline resistance for most variant types, resulting in lower posterior probabilities compared to prior estimates. The posterior median probability of bedaquiline resistance was low for synonymous mutations in atpE (0.1%) and Rv0678 (3.3%), high for missense mutations in atpE (60.8%) and nonsense mutations in Rv0678 (55.1%), relatively low for missense (31.5%) mutations and frameshift (30.0%) in Rv0678 and low for missense mutations in pepQ (2.6%) and Rv1979c (2.9%), but 95% credible intervals were wide. CONCLUSIONS: Bayesian probability estimates of bedaquiline resistance given the presence of a specific mutation could be useful for clinical decision-making as it presents interpretable probabilities compared to standard odds ratios. For a newly emerging variant, the probability of resistance for the variant type and gene can still be used to guide clinical decision-making. Future studies should investigate the feasibility of using Bayesian probabilities for bedaquiline resistance in clinical practice.

Bedaquiline resistance probability to guide treatment decision making for rifampicin-resistant tuberculosis: insights from a qualitative study.

BACKGROUND: Bedaquiline (BDQ) is a core drug for rifampicin-resistant tuberculosis (RR-TB) treatment. Accurate prediction of a BDQ-resistant phenotype from genomic data is not yet possible. A Bayesian method to predict BDQ resistance probability from next-generation sequencing data has been proposed as an alternative. METHODS: We performed a qualitative study to investigate the decision-making of physicians when facing different levels of BDQ resistance probability. Fourteen semi-structured interviews were conducted with physicians experienced in treating RR-TB, sampled purposefully from eight countries with varying income levels and burden of RR-TB. Five simulated patient scenarios were used as a trigger for discussion. Factors influencing the decision of physicians to prescribe BDQ at macro-, meso- and micro levels were explored using thematic analysis. RESULTS: The perception and interpretation of BDQ resistance probability values varied widely between physicians. The limited availability of other RR-TB drugs and the high cost of BDQ hindered physicians from altering the BDQ-containing regimen and incorporating BDQ resistance probability in their decision-making. The little experience with BDQ susceptibility testing and whole-genome sequencing results, and the discordance between phenotypic susceptibility and resistance probability were other barriers for physicians to interpret the resistance probability estimates. Especially for BDQ resistance probabilities between 25% and 70%, physicians interpreted the resistance probability value dynamically, and other factors such as clinical and bacteriological treatment response, history of exposure to BDQ, and resistance profile were often considered more important than the BDQ probability value for the decision to continue or stop BDQ. In this grey zone, some physicians opted to continue BDQ but added other drugs to strengthen the regimen. CONCLUSIONS: This study highlights the complexity of physicians' decision-making regarding the use of BDQ in RR-TB regimens for different levels of BDQ resistance probability.. Ensuring sufficient access to BDQ and companion drugs, improving knowledge of the genotype-phenotype association for BDQ resistance, availability of a rapid molecular test, building next-generation sequencing capacity, and developing a clinical decision support system incorporating BDQ resistance probability will all be essential to facilitate the implementation of BDQ resistance probability in personalizing treatment for patients with RR-TB.

Mapping BCG vaccination coverage in Ethiopia between 2000 and 2019.

INTRODUCTION: The Bacille-Calmette-Guerin (BCG) vaccination remains the primary strategy to prevent severe disseminated TB in young children, particularly in high TB-burden countries such as Ethiopia. Accurate knowledge of vaccination coverage in small geographical areas is critically important to developing targeted immunization campaigns. Thus, this study aimed to investigate the spatiotemporal distributions and ecological level determinants of BCG vaccination coverage in Ethiopia. METHOD: Bacille-Calmette-Guerin immunization coverage and geographical information data were obtained from five different Demographic and Health Surveys, conducted in Ethiopia between 2000 and 2019. Data for independent variables were obtained from publicly available sources. Bayesian geostatistical models were used to predict the spatial distribution of BCG vaccination coverage in Ethiopia. RESULT: The overall national BCG vaccination coverage between 2000 and 2019 was 65.5%. The BCG vaccine coverage was 53.5% in 2000, 56.9% in 2005, 64.4% in 2011, 79.6% in 2016, and 79.0% in 2019. BCG vaccination coverage increased by 47.6% in Ethiopia from 2000 to 2019, but substantial geographical inequalities in BCG coverage remained at sub-national and local levels. High vaccination coverage was observed in northern, western, and central parts of Ethiopia. Climatic and demographic factors such as temperature, altitude, and population density were positively associated with BCG vaccination coverage. Whereas, healthcare access factors such as distance to health facilities and travel time to the nearest cities were negatively associated with BCG vaccine coverage in Ethiopia. CONCLUSION: Despite substantial progress in national BCG vaccination coverage, marked spatial variation in BCG coverage persists throughout the country at sub-national and local levels. Healthcare access and climatic and demographic factors determined the spatial distribution of BCG vaccination coverage. Maintaining a high level of vaccination coverage across geographical areas is important to prevent TB in Ethiopia.

Prevalence of mental distress and associated factors among university students in Ethiopia: a meta-analysis.

BACKGROUND: Mental distress is an important public health problem and is becoming common health problems among university students. AIMS: This study aimed to provide a pooled prevalence of mental distress and associated factors among university students in Ethiopia. METHOD: We systematically searched PubMed, EMBASE and PsycINFO databases. A further search was performed at Google Scholar search engine for additional studies. All observational studies reporting the prevalence of mental distress and/or associated factors among university students in Ethiopia were included. Pooled prevalence with 95% confidence interval (95% CI) were calculated using random effects and quality effects models. Subgroup and sensitivity analyses were performed. Heterogeneity between studies and evidence of publication bias were assessed. RESULTS: The pooled prevalence of mental distress was 35% (95% CI; 28%-43%). Being female, participating in religious programmes, having close friends, experiencing financial distress, alcohol use, khat use, conflict with friends, lack of interest in their field of study and a family history of mental illness were factors associated with mental distress among students. We found significant heterogeneity, but no evidence of publication bias. CONCLUSIONS: More than one third of university students in Ethiopia have suffered with mental distress. The finding provides evidence that university students are at risk population for mental health problems and suggests the need for early intervention to prevent severe mental illness.

Incidence and Predictors of Anemia Among Children on Antiretroviral Therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2007-2017: A Retrospective Follow-Up Study.

BACKGROUND: Anemia is the most common hematological abnormality among children on antiretroviral therapy. In Ethiopia, as far as our search, there are no studies done on the incidence and predictors of anemia among children on antiretroviral therapy. This study aimed to assess the incidence and predictors of anemia among children on antiretroviral therapy, attending antiretroviral therapy care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from 2007 to 2017. METHODS: A retrospective follow-up study was conducted among 391 children on antiretroviral therapy. Mean survival time for children to be anemia free was estimated. A Log rank test was used to compare survival curves among different independent variables. The Cox regression model was used. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was calculated. P-value ≤0.05 was considered as statically significant. RESULTS: The overall incidence rate of anemia was 10.5 (95% confidence interval (8.6, 12.8)) per 100 child-year. Being severe-immunosuppressed (AHR=2.9, 95% CI: 1.23-6.77), undernutrition (AHR =2.7, 95% CI: 1.5-5), taking zidovudine-based ART regimen (AHR =4, 95% CI: 1.23-12.9), and tuberculosis (AHR =2.1, 95% CI: 1.4-3.3) were independent predictors of anemia among children. CONCLUSION: In this study, the incidence rate of anemia among children on antiretroviral therapy was found to be high. Tuberculosis, zidovudine-based drugs, severe immunosuppression, and undernutrition have remained statically significant predictors of anemia among children on antiretroviral therapy. Children with HIV were the most vulnerable group for anemia, especially in developing countries. Therefore, improving their nutritional status and considering other predictors of anemia were very important for children to reduce the incidence of anemia among children with HIV.

Magnitude of anemia and undernutrition among HIV-infected children who took HAART: a retrospective follow-up study.

BACKGROUND: Human immunodeficiency virus (HIV) is a virus that affects the immune system, the body's natural defence system. It is a virus spreading through certain body fluids that attacks the body's immune system, specifically the Cluster of Differentiation 4 (CD4) T-cells. Anemia is a common manifestation of pediatric HIV infection and is a significant negative predictor of survival. Moreover, undernutrition is the underlying cause of death among 35% of children aged under 5 years, and it has been negatively implicated with antiretroviral therapy (ART) outcomes, particularly in developing countries. The aim of this study was to determine the magnitude of anemia and undernutrition among HIV-infected children within the first year of ART initiation at University of Gondar comprehensive specialized hospital ART clinic. METHODS: Records of 200 children aged <15 years old who were on ART at the University of Gondar comprehensive specialized hospital from 2005 to 2017 were retrospectively reviewed in 2017. Baseline characteristics and one-year flow-up data after ART initiation were extracted from the medical records. Anemic status was determined based on the hemoglobin (Hb) level in accordance with World Health Organization (WHO) guideline. The nutritional status was calculated based on anthropometric measurements. Generalized Estimating Equation (GEE) was fitted to identify factors associated with anemia and undernutrition. Odds ratio with the corresponding 95% Confidence interval (CI) was reported. RESULTS: Of the total children, 75 (37.5%) (95% CI: 30.73-44.27%) were anemic at the baseline of ART initiation. The magnitude of anemia has shown a persistent decline from the baseline to 12th months of ART initiation. At ART initiation, the magnitude of undernutrition was high, 64% (95% CI: 57.3-70.7%). Similarly, the magnitude of undernutrition showed decrement during a one year ART initiation period. Stunting was the most common type of undernutrition at baseline (49.5%), 6 months (44%), 9 months (41%), and 12 months (39%) of ART initiation. Baseline CD4 count, Baseline WHO clinical stage and age at enrollment to the care were significantly associated with anemia within the first year of ART initiation. CONCLUSION: Despite a decline in the first year of ART initiation, anemia and undernutrition were public health problems in HIV-infected children. Hence, for HIV-infected children taking HAART, emphasis should be given to manage anemia and undernutrition within the first year of ART initiation.

Immunological status and virological suppression among HIV-infected adults on highly active antiretroviral therapy.

BACKGROUND: World Health Organization (WHO) recommends that viral load ([VL) is a primary tool that clinicians and researchers have used to monitor patients on antiretroviral therapy (ART), an antiviral drug against retroviruses. Whereas, CD4 cell counts can only be used to monitor clinical response to ART in the absence of VL testing service. Therefore, this study is aimed to assess the level of immunological status and virological suppression, and identify associated factors among human immunodeficiency virus ([HIV)-infected adults who were taking antiretroviral drugs of combination regimen know as highly active antiretroviral therapy (HAART). METHODS: A hospital-based cross-sectional study was conducted at the University of Gondar comprehensive specialized referral hospital from February to April 2018. A total of 323 adult participants on HAART were selected using a systematic random sampling technique and enrolled into the study. Blood samples for viral load determination and CD4 cell count were collected. Binary logistic regression analysis was used to determine factors associated with immunologic status and virological suppression in HIV patients on HAART. Odds ratio with 95% CI was used to measure the strength of association. RESULTS: Virological suppression (VL level < 1000 copies/ml) was found in 82% (95% CI 77.7, 86.1) of study participants, and it has been associated with CD4 cell count between 350 and 499 cells/mm3 (adjusted odds ratio (AOR) = 2.56; 95% CI 1.14, 5.75) and > 499 cells/mm3 (AOR = 7.71; 95% CI 3.48, 17.09) at VL testing and current age > 45 years old (AOR = 5.99; 95% CI 2.12, 16.91). Similarly, favorable immunological status (≥ 400 cells/mm3 for male and ≥ 466 cells/mm3 for female) was observed in 52.9% (95% CI 47.4, 58.8) of the study participants. Baseline CD4 cell count of > 200 cells/mm3, age at enrollment of 26 through 40 years old, and urban residence were significantly associated with favorable immunological status. CONCLUSION: Though the majority of HIV-infected adults who were on HAART had shown viral suppression, the rate of suppression was sub-optimal according to the UNAIDS 90-90-90 target to help end the AIDS pandemic by 2020. Nonetheless, the rate of immunological recovery in the study cohort was low. Hence, early initiation of HAART should be strengthened to achieve good virological suppression and immunological recovery.

Incidence and predictors of tuberculosis occurrence among adults on antiretroviral therapy at Debre Markos referral hospital, Northwest Ethiopia: retrospective follow-up study.

BACKGROUND: In resource limited settings, Tuberculosis (TB) is a major cause of morbidity and mortality among patients on antiretroviral treatment. Ethiopia is one of the 30 high TB burden countries. TB causes burden in healthcare system and challenge the effectiveness of HIV care. This study was to assess incidence and predictors of Tuberculosis among adults on antiretroviral therapy at Debre Markos Referral Hospital, Northwest Ethiopia, 2019. METHODS: Institution based retrospective follow up study was conducted among adults on ART newly enrolled from 2014 to 2018 at Debre Markos Referral Hospital. Simple random sampling technique was used to select patients chart. Data was entered to EPI- INFO version 7.2.2.6 and analyzed using Stata 14.0. Tuberculosis incidence rate was computed and described using frequency tables. Both bivariable and multivariable Cox proportional hazard models was fitted to identify predictors of TB. RESULTS: Out of the 536 patients chart reviewed, 494 patient records were included in the analysis. A total of 62 patients developed new TB cases during the follow up period of 1000.22 Person Years (PY); which gives an overall incidence rate of 6.19 cases per 100 PY (95% CI: 4.83-7.95). The highest rate was seen within the first year of follow up. After adjustment base line Hemoglobin < 10 g/dl (AHR = 5.25; 95% CI: 2.52-10.95), ambulatory/bedridden patients at enrolment (AHR = 2.31; 95% CI: 1.13-4.73), having fair or poor ART adherence (AHR = 3.22; 95% CI: 1.64-6.31) were associated with increased risk of tuberculosis whereas taking Isoniazid Preventive Therapy (IPT) (AHR = 0.33; 95% CI: 0.12-0.85) were protective factors of TB occurrence. CONCLUSION: TB incidence was high among adults on ART especially in the first year of enrollment to ART. Low hemoglobin level, ambulatory or bedridden functional status, non-adherence to ART and IPT usage status were found to be independent predictors. Hence, continuous follow up for ART adherence and provision of IPT has a great importance to reduce the risk of TB.

Prevalence and determinants of mental distress among university students in Ethiopia: a systematic review protocol.

BACKGROUND: Mental distress is an important public health problem and becoming a common health problem among university students. This systematic review and meta-analysis will provide the pooled prevalence of mental distress and identify determinant factors associated with mental distress among university students in Ethiopia. METHOD: A systematic search of PubMed, EMBASE, and PsycINFO databases will be conducted. In addition, we will search grey literature resources such as a database/website of dissertations and theses, WHO websites, and websites of professional bodies. Reference lists of the selected articles will also be searched for additional articles. All observational studies reporting the prevalence of mental distress and/or associated factors among university students in Ethiopia will be included. Pooled prevalence with 95% confidence interval (95% CI) will be calculated using random-effects and quality-effects models. Subgroup and sensitivity analyses will be performed. Heterogeneity between studies and evidence of publication bias will also be assessed. DISCUSSION: The proposed systematic review and meta-analysis will provide a pooled prevalence of mental distress and associated factors to assist policy-makers and programme managers in developing evidence-based mental health promotion and prevention programmes in university/college settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017067223.

Late ART Initiation among adult HIV patients at university of Gondar Hospital, NorthWest Ethiopia.

INTRODUCTION: Late initiation of anti-retroviral therapy (ART) is associated with low immunologic response, increase morbidity, mortality and hospitalization. Therefore, this study aimed to assess the prevalence and factors associated with late ART initiation among adult HIV patients in NorthWest Ethiopia. METHODS: Retrospective cross-sectional study was conducted among 412 HIV patients who started ART between January/2009 and December/2014. Simple random sampling technique was used to select patient records. Data were collected by using pretested and structured extraction tool. Binary logistic regression model was fitted to identify factors associated with late ART initiation. RESULT: A total of 410 participants were included for analysis after excluding 2 participants with incomplete data. The prevalence of late ART initiation was 67.3%. Age between 35-44 years(AOR=3.85; 95%CI:1.68-8.82), duration between testing and enrollment to care<1year (AOR=2.19;95%CI:1.30-3.69), secondary education (AOR=2.59; 95%CI 1.36-4.94), teritary education(AOR=3.28; 95%CI 1.25-8.64), being unmarried(AOR=1.88; 95%CI 1.13-3.03), bedridden and ambulatory patients (AOR=4.68 95%CI:1.49-14.68), other medication use before ART initiation(AOR=2.18; 95%CI 1.07-4.44), starting ART between 2009-2010 (AOR=5.94; 95%CI 2.74-12.87) and 2011-2012(AOR=2.80; 95%CI 1.31-5.96) were significantly associated with late ART initation at p-value <0.05. CONCLUSION: The prevalence of late ART initiation was high. Strengthening the mechanisms of early HIV testing and linkage to care are recommended to initiate treatment earlier.

Magnitude of prelacteal feeding practice and its association with place of birth in Ethiopia: a systematic review and meta-analysis, 2017.

BACKGROUND: Prelacteal feeding is one of the commonest inappropriate child feeding practice which exposes to malnutrition, infection, and neonatal mortality. However, there is no systematic review and meta-analysis that estimates the pooled prevalence of prelacteal feeding and its association with place of birth in Ethiopia. Therefore, this study aimed at investigating the magnitude of prelacteal feeding practice and its association with home delivery in the country. METHODS: Primary studies were accessed through, HINARI and PubMed databases. Additionally, electronics search engines such as Google Scholar, and Google were used. The Joana Briggs Institute quality appraisal checklist was used to appraise the quality of studies. Data were extracted using Microsoft Excel spreadsheet. Heterogeneity between the studies was examined using the I2 heterogeneity test. The DerSimonian and Liard random-effect model was used. The random effects were pooled after conducting subgroup and sensitivity analyses. Publication bias was also checked. RESULTS: A total of 780 primary studies were accessed. However, about 24 studies were included in the qualitative description and quantitative analysis of the prevalence of prelacteal feeding. To examine the association between home delivery and prelacteal feeding practice, only six studies were included. The prevalence of prelacteal feeding ranged from 6.1-75.8%. The pooled prevalence of prelacteal feeding among Ethiopian children was 26.95% (95% CI: 17.76%, 36.14%). The highest prevalence was observed in the Afar region. The pooled odds of prelacteal feeding among women who gave birth at home was increased by 5.16 (95% CI: 3.7, 7.2) folds as compared to those who gave birth at Health institutions. CONCLUSION: Prelacteal feeding practice in Ethiopia was found to be high. Home delivery was strongly associated with prelacteal feeding practice. Therefore, promoting institutional delivery and strengthening of the existing child nutrition strategies are recommended.

Prevalence of anemia and its associated factors among children in Ethiopia: a protocol for systematic review and meta-analysis.

BACKGROUND: Anemia is one of the global public health problems that affect more than one third of the world population. It has been strongly associated with poor growth and development, limited psychomotor development, and poor long-term performance in cognitive, social, and emotional functioning in children. There is not a single national figure about childhood anemia in Ethiopia. There is also inconclusive evidence about factors associated with anemia. Moreover, the present meta-analysis will generate concrete evidence in which the result may urge policy makers and program managers to design appropriate intervention to control childhood anemia. Thus, the aim of this review is to estimate the pooled prevalence and to identify associated factors of anemia among children in Ethiopia. METHOD: Published relevant cross-sectional studies will be searched using comprehensive search strings through PubMed/Medline, SCOPUS, HINARI, EMBASE, Web of Science databases. In addition, Google Scholar and Google will be searched for grey literature.Reference lists and communication with content experts will be used to get additional relevant studies. Two groups of review authors will independently appraise the studies for scientific quality and extract the data using the Joanna Briggs Institute (JBI) tools. The pooled estimate will be determined using random effect model. Heterogeneity between the studies will be assessed using the I2 statistics. Sensitivity and subgroup analysis will be employed in the case of heterogeneity. Publication bias will be assessed by visual inspection of the funnel plot, and using Egger's and Begg's statistical tests. DISCUSSION: Childhood anemia is known to have negative consequences on mental, physical and social development of children. The burden and its associated factors are greatly varied as to the social, economic, and geographical differences of the target population.Therefore, the proposed systematic review will generate evidence about the pooled prevalence of anemia and its associated factors among children in Ethiopia. PROTOCOL REGISTRATION: The protocol was registered at PROSPERO International Prospective Register of Systematic Reviews.(Registration number: CRD42018088223).

Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Anemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia. METHODS: Published articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg's institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression test statistic. RESULTS: Of the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10). CONCLUSION: The pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.

High prevalence of pain among adult HIV-infected patients at University of Gondar Hospital, Northwest Ethiopia.

BACKGROUND: HIV/AIDS are pressing global health problems. Pain is a common symptom reported by patients living with HIV/AIDS. The exact cause of pain in HIV patients has not been thoroughly described, but it may, due to a symptom of HIV itself, result from opportunistic infections, as a side effect of antiretroviral drugs, concurrent neoplasia or other causes. In addition, pain perception of HIV-infected patients is highly variable and may vary based on cultural context and patient demographics. In Ethiopia, there is insufficient evidence on the prevalence and factors associated with HIV-related pain. METHODS: A cross-sectional study was conducted among 422 adult HIV-infected patients at Gondar University Hospital antiretroviral care clinic from March 1 to May 1, 2016. Systematic random sampling was used to select study participants. A pretested interviewer-administered questionnaire and a standardized medical record data abstraction tool were used to collect data. A short form brief pain inventory tool was used to measure the outcome. Bivariate and multivariate logistic regression models were fitted to identify factors associated with pain among adult HIV patients. RESULTS: The prevalence of pain was found to be 51.2% (95% CI: 46.4%-55.9%). Headache (17.9%), abdominal pain (15.6%), and backache (13.3%) were the most common symptoms of study participants. Being female (adjusted odds ratio [aOR]=1.8, 95% CI: 1.1-2.9); regular alcohol intake (aOR=3.3, 95% CI: 1.5-7.2); baseline World Health Organization clinical disease stage: II (aOR=2.5, 95% CI: 1.2-4.9), III (aOR=2, 95%, CI: 1.1-3.6), and IV (aOR=2.4, 95% CI: 1.1-5.3); and the presence of a chronic comorbid condition (aOR=5.9, 95% CI: 2.1-16.7) were significantly associated with pain. CONCLUSION: Adult HIV patients in this sample reported a high level of chronic pain. Healthcare providers should better implement a routine pain assessment among HIV-positive patients to alleviate their suffering.

Factors associated with unintentional injury among the paediatric age population in the hospitals of Amhara National Regional State, Ethiopia.

BACKGROUND: Childhood unintentional injuries cause nearly 875,000 deaths each year. The aim of this study was to assess the prevalence and factors associated with unintentional injury of children presenting to the hospitals of Amhara Regional State, Ethiopia. METHODS: In a hospital-based, cross-sectional study undertaken in one month, from April 1 to 30th 2016, 893 children less than 18 years of age were included. Data were collected using an interviewer-administered questionnaire. Training was given to all data collectors and supervisors. Data was entered into EPI info version 7 and then exported to SPSS version 20, for further analysis. RESULTS: Unintentional injury caused 62% (554) of all injuries in attending children. Several factors affected the likelihood of injuries, namely the age of the child, age of the parents or guardians, sex of the child, and whether the child lived with the parents. Modifiable factors were the child's behaviour, awareness of danger, the child's level of educational, if the child's parent had received adequate injury counselling, and whether a child was left in the care of another child. The source of light in the house, and house floor material were also significant factors at p < 0.05. CONCLUSION: The prevalence of unintentional injury was high. Many of the factors associated with injuries are modifiable and safety issues for children need urgent attention.

Factors associated with unintentional injury among the paediatric age population in the hospitals of Amhara National Regional State, Ethiopia

Background:Childhood unintentional injuries cause nearly 875,000 deaths each year. The aim of this study was to assess the prevalence and factors associated with unintentional injury of children presenting to the hospitals of Amhara Regional State, Ethiopia.Methods:In a hospital-based, cross-sectional study undertaken in one month, from April 1 to 30th 2016,893 children less than 18 years of age were included. Data were collected using an interviewer- administered questionnaire. Training was given to all data collectors and supervisors. Data was entered into EPI info version 7 and then exported to SPSS version 20, for further analysis.Results:Unintentional injury caused 62% (554) of all injuries in attending children. Several factors affected the likelihood of injuries, namely the age of the child, age of the parents or guardians, sex of the child, and whether the child lived with the parents. Modifiable factors were the child's behaviour,awareness of danger, the child's level of educational, if the child's parent had received adequate injury counselling, and whether a child was left in the care of another child. The source of light in the house,and house floor material were also significant factors at p < 0.05.Conclusion:The prevalence of unintentional injury was high. Many of the factors associated with injuries are modifiable and safety issues for children need urgent attention

Prevalence of workplace violence in Northwest Ethiopia: a multivariate analysis.

BACKGROUND: Workplace violence has been acknowledged as a global problem, particularly in the health sector. However, there is scarce data on workplace violence among nurses in Ethiopia. The aim of this study was to assess the prevalence of workplace violence and associated factors among nurses in northwest Ethiopia. METHODS: Hospital based cross-sectional study design was employed in 386 nurses from April 1 - April 30, 2015. Data were collected through the use of self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization and Public Services International. To keep the quality of the data collection training was given to supervisors and data collectors. Piloting was done in Debark hospital two weeks before actual data collection to assess the tool's clarity and make amendments. The proposal was approved by the Institutional Review Board of University of Gondar prior to study commencement and a written consent was obtained from each study participant. RESULTS: The overall prevalence of workplace violence was 26.7 %. Exploratory logistic regression analyses suggested that age, number of staff in the same work shift, working in a male ward, history of workplace violence, and marital status were factors independently associated with workplace violence. CONCLUSION: The prevalence of workplace violence among nurses was high. Creating a prevention strategy involving different stakeholders is recommended.