Effectiveness of trained religious leaders' engagement in maternal health education on improving maternal health service utilizations: Protocol of cluster randomized controlled trial in Hadiya Zone, Southern Ethiopia.

BACKGROUND: Despite the many supply- and demand-side interventions aimed at increasing uptake of maternal health service utilizations, the maternal and new-born health service utilizations remains low. Religious leaders have the power to inhibit or facilitate effective adoption of maternal health service utilizations to promote maternal health. However, evidence on the roles of religious leaders in promoting maternal health in developing world is not fully known. Therefore this cluster-randomized trial is designed to evaluate the effects of trained religious leaders' engagement in maternal health education in improving maternal health service utilization and knowledge of obstetric danger signs. METHODS: A community based cluster randomized control trial in which the study kebeles are randomly assigned into intervention and control groups will be conducted. The sample size is calculated using stata software. Three hundred six pregnant mothers will be enrolled in each group. A baseline study will be conducted before the intervention and post-intervention evaluation will be conducted after four months of intervention. Religious leaders will be selected and trained to lead participatory sessions on maternal health. Data on maternal health service utilizations, knowledge about obstetric danger signs, attitude towards skilled delivery service utilization and perception of pregnancy risk will be collected from a repeated cross sectional household survey. Effect of intervention will be assessed using multivariable logistic regression with generalized estimating equation model. Data will be analyzed using STATA software. For qualitative study, coded transcripts will be further analyzed and summarized in narratives for each theme and sub-themes. DISCUSSION: This is one of the first trials to evaluate the effectiveness of trained religious leaders' engagement in maternal health education and will provide much needed evidence to policy makers about aspects of functionality and the religious leaders engagement required as they scale-up this programme in Ethiopia.

Community's knowledge, perceptions and preventive practices on Onchocerciasis in Jimma zone, Ethiopia, formative mixed study.

BACKGROUND: In Ethiopia, Onchocerciasis is a prevalent neglected tropical disease, currently targeted for elimination with mass drug administration and community behavioral changes towards sustained control and eventual elimination. This study aimed to elucidate the awareness, perceptions and practices of endemic communities in Jimma Zone, Ethiopia. METHODS AND MATERIALS: Community-based cross-sectional study triangulated with qualitative method was conducted from October-November, 2021. A multistage sampling was employed and data were collected using a pre-tested interviewer-administered structured questionnaire. Logistic regression was used to identify the predictors of comprehensive knowledge and preventive practice. Adjusted odds ratios were calculated at 95% confidence interval (CI) and considered significant with a p-value of <0.05. Kruskal-Whallis and Mann-whitney tests were used to compare median risk perception score by socio-demographic factors. Qualitative data were collected through focus group discussions and key informant interviews and transcribed verbatim. Then the data were coded, categorized, and themes were developed. RESULT: The overall prevalence of adequate comprehensive knowledge was 48.8% (95% CI: 44.9, 52.3), high risk perception was 18.7% (95%CI15.9, 21.4) and preventive practice was 46.9%(95%CI:(43.3,50.4). High risk perception[AOR = 1.95 95%CI: (1.32, 2.89] was statistically significant with comprehensive knowledge, likewise knowledge of mode of transmission [AOR = 2.64 95% CI: (1.44, 4.85)], knowledge of consequences [AOR = 2.12 95%CI: (1.21, 3.72)] and knowledge of preventive measures [AOR = 15.65,95%CI:(10.1, 24.2)] were statistically significant with preventive practice. The median risk perception was varied significantly between the groups by educational status, study district and age category. Qualitative evidence showed that there were great community knowledge gap about the disease. CONCLUSION: Community knowledge, perceptions, and practices are unacceptably low. Risk perception was significantly associated with comprehensive knowledge, likewise knowledge of mode of transmission, consequences and preventive measures were significantly associated with preventive practice. This implies knowledge is a key component of effective prevention strategies as it is a necessary condition for the behavior change.

Pregnancy Risk Perception, Knowledge of Obstetric Danger Signs and Attitude Towards Skilled Delivery Service Utilization Among Pregnant Mothers in a Rural Setting in South Ethiopia: A Community-Based Cross-Sectional Study.

Background: Poor pregnancy risk perception, ignorance of obstetric risk symptoms, and attitudes toward institutional delivery services are factors that prevent pregnant women from choosing to receive emergency obstetric treatment. Objective: To assess pregnancy risk perception, attitude towards skilled delivery service, and knowledge of obstetric danger signs and associated factors among pregnant mothers. Methods: A cross-sectional community-based study design was used. The 668 pregnant women who participated in this study were chosen using a multi-stage sampling methodology. Data were gathered using a pretested questionnaire that was presented by an interviewer. To find independent factors, logistic regression analysis was used. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated. Results: Pregnancy risk perception was shown to have a lower mean score (23) overall. Only 40.9% of the study participants had high pregnancy risk perception. Over 50% (337) of respondents had a positive attitude towards skilled delivery service utilization. In all categories of obstetric danger signs, only 153 respondents (or 22.9%) knew what the obstetric danger signs were. Maternal age (AOR = 1.966, CI: 1.185-3.261), maternal education (AOR = 1.965, 1.002-3.854), and parity (AOR = 0.534, CI: 0.305-0.933) were factors affecting knowledge of obstetric danger signs. Pregnancy risk Perception (AOR = 14.7, CI: 9.849-22.235) and parity (AOR = 2.27, CI: 1.381-3.733) were significantly associated with attitudes on the use of skilled delivery services. Conclusion: This study found that pregnant women in rural locations had poor levels of knowledge of obstetric danger sign, attitude toward using skilled delivery services, and perception of pregnancy risk. The knowledge of obstetric danger indicators among pregnant women was considerably affected by the mother's age, education, and parity. The perception of pregnancy risk and parity were found to be substantially associated with attitudes towards skilled delivery services.

Structural, programmatic, and sociocultural intersectionality of gender influencing access-uptake of reproductive, maternal, and child health services in developing regions of Ethiopia: A qualitative study.

BACKGROUND: Gender remains a critical social factor in reproductive, maternal, and child health and family planning (RMNCH/FP) care. However, its intersectionality with other social determinants of the RMNCH remains poorly documented. This study aimed to explore the influence of gender intersectionality on the access uptake of RMNCH/FP in Developing Regional States (DRS) in Ethiopia. METHODS: We conducted a qualitative study to explore the intersectionality of gender with other social and structural factors and its influence on RMNCH/FP use in 20 selected districts in four DRS of Ethiopia. We conducted 20 Focus Group Discussions (FGDs) and 32 in-depth and key informant interviews (IDIs/KIIs) among men and women of reproductive age who were purposively selected from communities and organizations in different settings. Audio-recorded data were transcribed verbatim and analyzed thematically. FINDINGS: Women in the DRS were responsible for the children and families' health care and information, and household chores, whereas men mainly engaged in income generation, decision making, and resource control. Women who were overburdened with household chores were not involved in decision-making, and resource control was less likely to incur transport expenses and use RMNCH/FP services. FP was less utilized than antenatal, child, and delivery services in the DRS,as it was mainly affected by the sociocultural, structural, and programmatic intersectionality of gender. The women-focused RMNCH/FP education initiatives that followed the deployment of female frontline health extension workers (HEWs) created a high demand for FP among women. Nonetheless, the unmet need for FP worsened as a result of the RMNCH/FP initiatives that strategically marginalized men, who often have resource control and decision-making virtues that emanate from the sociocultural, religious, and structural positions they assumed. CONCLUSIONS: Structural, sociocultural, religious, and programmatic intersectionality of gender shaped access to and use of RMNCH/FP services. Men's dominance in resource control and decision-making in sociocultural-religious affairs intersected with their poor engagement in health empowerment initiatives that mainly engaged women set the key barrier to RMNCH/FP uptake. Improved access to and uptake of RMNCH would best result from gender-responsive strategies established through a systemic understanding of intersectional gender inequalities and through increased participation of men in RMNCH programs in the DRS of Ethiopia.

Nonpharmaceutical interventions reduce the incidence and mortality of COVID-19: A study based on the survey from the International COVID-19 Research Network (ICRN).

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19.

Menstrual abnormality, maternal illiteracy, and household factors as main predictors of anemia among adolescent girls in Ethiopia: Systematic review and meta-analysis.

BACKGROUND: Adolescent girls are more likely to develop anemia as a result of physical and physiological changes that place a greater strain on their nutritional needs. Primary studies, on the other hand, may not be sufficient to provide a complete picture of anemia in adolescent girls and its major risk factors. OBJECTIVE: The study aimed to describe the pooled prevalence of adolescent girls' anemia and the factors that contribute. METHODS: We conducted a systematic review of observational studies using the databases CINAHL (EBSCO), PubMed, Science Direct, Cochrane Library, and Google Scholar. The Newcastle-Ottawa Scale was used to assess the quality of the articles, and studies of fair to good quality were included. We pooled anemia prevalence among adolescents and odds ratio estimates for risk factors. Subgroup analysis employing sample size and study setup was computed to determine the source of heterogeneity, and the I2 test was used to identify the existence or absence of substantial heterogeneity during subgroup analysis. The pooled prevalence of adolescent girls' anemia was calculated using a random-effects meta-analysis model. RESULTS: The overall pooled prevalence of anemia among adolescent girls in Ethiopia was 23.03% (95% confidence interval: 17.07, 28.98). Low dietary diversity (odds ratio: 1.56; 95% confidence interval: 1.05, 2.32), illiterate mothers (odds ratio: 1.45; 95% confidence interval: 1.13, 1.86), household size greater than five (odds ratio: 1.65; 95% confidence interval: 1.14, 2.38), food-insecure households (odds ratio: 1.48; 95% confidence interval: 1.21, 1.82), and menstrual blood flow more than 5 days (odds ratio: 6.21; 95% confidence interval: 1.67, 23.12) were the identified factors associated with anemia among adolescent girls. CONCLUSION: The pooled prevalence of anemia among adolescent girls in Ethiopia was moderately high. Therefore, to combat the burden of anemia among adolescent girls offering nutritional education is crucial. Iron supplementation is also recommended for adolescent females who have a menstrual cycle that lasts longer than 5 days.

Exploration of barriers to postnatal care service utilization in Debre Libanos District, Ethiopia: A descriptive qualitative study.

Background: In Ethiopia, postnatal care (PNC) service utilization was low although many interventions had been implemented. Previous studies showed community-/caregiver-related barriers to PNC service utilization, but limited evidence was available on the health facilities and health care provider-related barriers. Therefore, the study was aimed at exploring both community and health care provider-related barriers to PNC service utilization. Methods: A descriptive qualitative study was conducted at Debre Libanos District, Ethiopia, from 11 March to 7 April 2019. A purposive sampling technique was used to recruit study participants among recently delivered women (<2 months), health care providers, and community members. A total of five in-depth interviews, 12 key informant interviews, and four FGDs were conducted. Data were audio-recorded, transcribed verbatim, and translated, and inductive thematic analysis was used to analyze the data using the atlas ti.7.1 software. Results: A total of 51 participants were involved in the study. The findings were organized into two major themes: (1) Community/caregiver-related barriers to PNC service utilization: lack of awareness about PNC, its importance, and schedules; lack of awareness about postnatal danger signs, sociocultural and religious beliefs, topographical and transportation problems, non-functionality of the health developmental armies (HDA); (2) health facility and health care provider-related barriers to PNC service utilization: poor supportive supervision and monitoring, lack of health extension workers' (HEW) commitment, lack of an organized system to notify delivery to HEW, shortage of HEWs, the residence of the HEWs, closure of health posts (HP) on working hours, and non-functionality of HPs. Conclusions: The study findings underscore the need to develop different strategies and take actions. Therefore, the health centers and district health offices should have to assign the required number of HEWs at HPs, regularly supervise and monitor HEWs, and develop an organized system to facilitate early notification of delivery to HEWs. The HEWs should have to live near the HP, re-organize HDAs, create awareness of maternal and newborn danger signs, and conduct social and behavioral change communications to increase the health-seeking behavior of community members for utilizing PNC services.

A mixed-methods study on health learning materials utilization for COVID-19 risk communication and community engagement among health workers in Arsi Zone, Ethiopia: Implication for response to pandemic.

BACKGROUND: Risk communication and community engagement are among the key strategies used in response to pandemics. Effective risk communication and community engagement can be achieved when assisted by health learning materials. However, their utilization was not known in Ethiopia. Therefore, the present study aimed to assess the utilization of COVID-19 health learning materials (HLMs), and explore barriers and facilitating factors. METHODS: A sequential explanatory mixed-methods study consisting of two phases was carried out. The first phase was a cross-sectional survey to assess the utilization of COVID-19 HLMs and their predictors. In this phase, a multistage sampling technique was used to select 530 health workers. A self-administered structured questionnaire was used for data collection. Epi-data manager version 4.6.0.2 and STATA version 16 were used for data entry and analyses, respectively. Descriptive analyses were carried out as necessary. Ordinal logistic regression analyses were done to identify the predictors of COVID-19 HLMs utilization. Phase two is a qualitative study to explore enablers and barriers to COVID-19 HLMs utilization. A judgmental sampling technique was used and 14 key informants were recruited. The collected data were uploaded into Atlas ti version 7.0.71. An inductive process of thematic analysis was employed and the data were coded, categorized, and thematized. RESULTS: Findings showed that out of the total 530 respondents, 210(39.6%), 117(22.1%), and 203(38.3%) of them never use COVID-19 HLMs, use sometimes, and always, respectively. Health workers' perceived quality of COVID-19 HLMs [AOR = 6.44 (95% CI: 4.18-9.94)], health workers' perceived usefulness of COVID-19 HLMs [AOR = 2.82 (95% CI: 1.88-4.22)], working facility [AOR = 1.83 (95% CI: 1.07-3.14)], educational level of the respondents [AOR = 1.73 (95% CI: 1.11-2.72)] and availability of COVID-19 HLMs [AOR = 1.45(95% CI: 1.01-2.08)] had statistically significant association with the utilization status of COVID-19 HLMs. Findings from the qualitative study showed that materials-related factors, and structure and health workers-related factors had influence on HLMs utilization. CONCLUSIONS: In this study, we found that only a few of the respondents were regularly utilizing COVID-19 HLMs. Perceived quality, usefulness, and availability of HLMs, and health workers' educational status and working facility determined the level of COVID-19 HLMs utilization. There is a need for giving due attention to HLMs, evaluating their quality, availing them to health facilities, and providing training for health workers.

Predictors of uncircumcised primary school girls' intention to genital cutting in South Ethiopia: Application of theory of planned behavior.

BACKGROUND: Female genital cutting (FGC) is still among the most common harmful traditional practices, especially in Africa and Asia. Despite the existence of rich evidence on the prevalence of FGC, information about the primary target audiences' (girls') intention toward FGC is limited. Therefore, this study aimed to identify the predictors of primary school girls' behavioral intention toward female genital cutting. METHODS: An institution-based cross-sectional study was conducted from May 08 to 28, 2019 in Dunna district, South Ethiopia. A two-stage sampling technique was used to select 354 uncircumcised female students. A self-administered pre-tested structured questionnaire was used for data collection. Data were entered into Epi data manager version 4.0.2 and exported to STATA version 16.0. Descriptive analyses such as frequency, percentage, mean and standard deviation were performed as necessary. Univariable and multivariable linear regression analyses were conducted to identify predictors of primary school girls' intention to experience FGC. RESULTS: The mean age of the respondents was 13.09±1.69 years with an age range of 10 to 18 years. Of the 354 respondents, 156 (44.1%) intended to experience FGC. The model accounted for 76.58% of the variance in primary school girls' intention to experience FGC. Among socio-demographic characteristics, mothers' educational level of ≤8 grade (ß = 1.95, p<0.001) and the age of the respondents (ß = -0.23, p = 0.036) predicted primary school girls' intention toward FGC. Among the constructs of the theory of planned behavior (TPB), direct perceived behavioral control (ß = 0.47, p = 0.015), indirect perceived behavioral controls (ß = 0.05, p = 0.002), and direct subjective norms (ß = 0.18, p = 0.039) predicted primary school girls' intention to experience FGC. CONCLUSIONS: In this study, we found that primary school girls' intention toward FGC was high. The educational level of mothers and the age of the respondents had a great influence on primary school girls' intention to experience FGC. Perceived lack of power and social pressure also predicted primary school girls' intention to engage in genital cutting. The findings suggest that FGC is mainly performed by the decision of the parents irrespective of the girls' preferences. Therefore, behavioral change communication interventions such as media campaigns, peer education and community dialogue guided by the TPB for empowering girls to confront FGC and reducing the influence of referents need to be focused.

Students' figurative communication of malaria messages, belief, norms, and practices in Oromia, Ethiopia: A qualitative content analysis approach.

BACKGROUND: School engagement is an emerging strategy and proven potent vehicles for social and behavioral change communication (SBCC) intervention to prevent and control malaria. Little was known about the figurative speeches used in the malaria messages disseminated and communicated by school students. Therefore, this study evaluated the figurative speeches used in the poems to convey messages related to malarial perceptions, beliefs, norms and practices to prevent and control malaria. METHODS: A qualitative content analysis was conducted to explore the figurative speeches used in malaria messages conveyed in poems produced by primary school students. Twenty poems were purposively selected from twenty schools across rural villages in five districts of Jimma Zone. Data were analyzed using ATLAS.ti version 7.1.4 software. The figurative speeches were presented using central themes and categories supported with quotations. RESULTS: The predominantly used figurative speeches were simile, metaphor, personification and hyperbole. Simile was used to express the nature of anopheles mosquito, and sign and symptoms of malaria. The metaphor was used to express malaria, severity/seriousness of malaria and Insecticide-Treated Net (ITN); and also to express the relationship between persons ITN malpractice and its effect on their health. Personification was used to express the nature of anopheles mosquito and malaria. Finally, hyperbole was used to express nature of anopheles mosquito, severity of malaria and exaggerated effect of ITN and Indoor Residual Spraying (IRS). CONCLUSIONS: The students conveyed messages related to malarial perceptions, beliefs, norms and practices of the local community to prevent and control malaria through different types of figurative speeches. Therefore, conceptualizing the local norms, beliefs, values, perception and practices, and expressing in different figurative speeches to convey messages and convince the local community might be important to bring the desired or intended behavioral change.

What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study.

OBJECTIVE: Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020. SETTING: This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance. RESULTS: A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42). CONCLUSION: Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.

Development and validation of preconception care improvement scale (PCIS) in a resource-limited setting.

BACKGROUND: Preconception care helps to close the gaps in a continuum of care. It is of paramount importance to reduce maternal and child adverse pregnancy outcomes, increase the utilization of services such as antenatal care, skilled delivery care, and post-natal care, and improve the lives of future generations. Therefore, a validated instrument is required. The purpose of this study was to develop and validate the preconception care improvement scale (PCIS) in a resource-limited setting. METHODS: A mixed-method study was carried out from 02, March to 10, April 2019 in Manna district, Oromia region, Ethiopia to test the reliability and validity of the scale. Items were generated from literatures review, in-depth interviews with different individuals, and focused group discussions with women of reproductive age groups. A pretested structured questionnaire was used and a survey was conducted among 623 pregnant women in the district. The collected data were entered into EPI-data version 3.1 software and exported to SPSS version 23 software and data were analyzed for internal consistency and validity using reliability analysis and factor analysis. RESULTS: The PCIS has 17 items loaded into six factors: Substance-related behaviors, screening for common non-communicable and infectious diseases, micronutrient supplementation and vaccination, seeking advice, decision and readiness for conception, and screening for sexually transmitted diseases. Factor analysis accounted for 67.51% of the observed variance. The internal consistency (Cronbach's alpha) of the scale was 0.776. Diversified participants of the qualitative study and experts' discussions assured the face and content validity of the scale. Factor loading indicated the convergent validity of the scale. Three of the PCIS subscale scores had a positive and significant association with the practice of preconception care and antenatal care visits, which confirmed the predictive validity of the scale. CONCLUSION: The PCIS exhibited good reliability, face validity, content validity, convergent validity, and predictive validity. Thus, the scale is valid and helps to improve preconception care, especially in resource-limited settings.

The global case fatality rate of coronavirus disease 2019 by continents and national income: A meta-analysis.

The aim of this study is to provide a more accurate representation of COVID-19's case fatality rate (CFR) by performing meta-analyses by continents and income, and by comparing the result with pooled estimates. We used multiple worldwide data sources on COVID-19 for every country reporting COVID-19 cases. On the basis of data, we performed random and fixed meta-analyses for CFR of COVID-19 by continents and income according to each individual calendar date. CFR was estimated based on the different geographical regions and levels of income using three models: pooled estimates, fixed- and random-model. In Asia, all three types of CFR initially remained approximately between 2.0% and 3.0%. In the case of pooled estimates and the fixed model results, CFR increased to 4.0%, by then gradually decreasing, while in the case of random-model, CFR remained under 2.0%. Similarly, in Europe, initially, the two types of CFR peaked at 9.0% and 10.0%, respectively. The random-model results showed an increase near 5.0%. In high-income countries, pooled estimates and fixed-model showed gradually increasing trends with a final pooled estimates and random-model reached about 8.0% and 4.0%, respectively. In middle-income, the pooled estimates and fixed-model have gradually increased reaching up to 4.5%. in low-income countries, CFRs remained similar between 1.5% and 3.0%. Our study emphasizes that COVID-19 CFR is not a fixed or static value. Rather, it is a dynamic estimate that changes with time, population, socioeconomic factors, and the mitigatory efforts of individual countries.

Helmet wearing behavior where people often ride motorcycle in Ethiopia: A cross-sectional study.

BACKGROUND: Road traffic accidents are a major global concern that affects all people regardless of their age, sex, wealth, and ethnicity. Injuries and deaths due to motorcycles are increasing, especially in developing countries. Wearing helmet is effective in reducing deaths and injuries caused by motorcycle accidents. OBJECTIVES: To assess the magnitude of helmet wearing behavior and its determinants among motorcycle riders in Sawula and Bulky towns, Gofa zone, Southern Ethiopia. METHODS: A community-based cross-sectional study was conducted from April, 15 to May 25, 2020, among 422 motorcycle drivers in Sawula and Bulky towns, where people often drive motorcycles. A stratified sampling technique was used to recruit sampled drivers in a face-to-face interview. Data were entered into EPI-data version 3.1 software and exported to SPSS version 23 software to manage analysis. Descriptive analyses such as frequency, percentage, mean and standard deviation were performed as necessary. Logistic regression models were fitted to identify the predictors of helmet wearing behavior. Adjusted odds ratios (AOR) with 95% confidence interval (CI) were used to determine the magnitude and strength of the association. RESULTS: A total of 403 motorcycle drivers participated in the study which gave a 95.5% response rate. Among 403 motorcycle riders, only 12.4% (95% CI, 9.2 to 15.6%) wore helmets while driving motorcycles. Having license [AOR 3.51(95% C.I 1.56-7.89)], driving distance >10Km [AOR 2.53(95% C.I 1.08-5.91)], History of exposure to accident [AOR 2.71(95% C.I 1.32-5.55)], driving experience of ≥10 years [AOR 2.98 (95% C.I 1.25-7.09)] and high perceived susceptibility to accident [AOR 3.10(95% C.I 1.29-7.46)] had statistically significant association with helmet wearing compared to their counterparts. CONCLUSIONS: This study found that helmet-wearing behavior was very low. Having a license, driving distance, exposure to accidents, driving experience, and accident risk perception were determinants of helmet wearing behavior. These determinants imply the need for interventions that focus on behavioral change communications such as awareness creation campaigns and mandatory helmet wearing laws.

A survey on women's awareness of iron and folic acid intake during preconception period and its associated factors in Manna District, Oromia region, Southwest Ethiopia.

AIM: This study aimed to assess pregnant women's awareness of iron and folic acid intake during the preconception period and associated factors. DESIGN: A cross-sectional study. METHODS: This study was conducted on 636 pregnant women in Manna District, Oromia region, Southwest Ethiopia. Women's awareness of iron and folic acid intake during the preconception period was measured using a pre-tested structured questionnaire. Descriptive, binary and multivariable logistic regression analyses were carried out. RESULTS: Of the total of 623 participants, 6.7% of them had an awareness of iron and folic acid intake during preconception period. Women's husband who had formal education, women who had ≥four ANC visits and women who were at distance of <30 min from the nearest health facility were significant predictors of pregnant women's awareness iron and folic acid intake during the preconception period. CONCLUSIONS: Women's awareness of iron and folic acid intake during the preconception period was very low. Husband educational status, frequency of ANC visits and distance from health facility were predictors of women's awareness of iron and folic acid intake during the preconception period.

Monkeypox: Immune response, vaccination and preventive efforts.

Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.

Response to self-care practice messages among patients with diabetes mellitus visiting Jimma University medical center facility based cross sectional design application of extended parallel process model.

OBJECTIVE: To determine response to self-care practice message among patients with diabetes in Jimma University Medical center based on the Extended Parallel Process Model. DESIGN: A facility-based cross-sectional study was conducted. SETTING: Jimma University Medical Center is found in Jimma town. PARTICIPANTS: A total of 343 patients with diabetes participated in the study; making a response rate of 93.9%. All patients with diabetes who were 18 years and above and who were on follow up and registered were included in the study and those with Gestational DM were excluded. DATA ANALYSIS: Multivariable logistic regression analysis. RESULT: Responsive respondents scored high in self-care practice score as compared to other respondents. educational status, information sources, knowledge, and preferred message appeals were independent predictors of controlling the danger of diabetes. CONCLUSION: There is a significant gap in controlling the danger of diabetes. Variables like the level of education, knowledge of diabetes mellitus, information sources, and message appeals were independent predictors of controlling the danger of diabetes. Designing message having higher efficacy while maintaining the level of threat is the best that fits the existing audience's message processing to bring about desired diabetic self-care Practice.

Acceptability of peer learning and education approach on malaria prevention (PLEA-malaria) through primary schools communities in rural Ethiopia: peer educators' perspectives.

BACKGROUND: Evidence on peer educators' experiences of implementing the school-based educational interventions on malaria prevention would be used as inputs for malaria eliminating efforts. This study explored the acceptability of the school-based peer-learning and education approach on malaria prevention (PLEA-malaria) among peer educators in Ethiopia. METHODS: This process evaluation study was aimed to examine the success of the school-based PLEA-malaria that was implemented in 75 primary schools in Jimma from 2017 to 2019. A mixed research method was employed to collect post-intervention data from 404 peer educators and key stakeholders. Data were collected using a structured questionnaire and interview guide. Multivariable linear regression modelling was performed using SPSS software version 26.0. Atlas ti 7.5 for windows was used to analyse the qualitative data. The result was presented by triangulating the findings of the qualitative and quantitative methods. RESULTS: The mean score (M, range = R) of acceptability of PLEA-malaria was (M = 20.20, R = 6-30). The regression modelling showed that age; (ß = 0.264, 95% CI 0.266 to 0.632), GPA; (ß = 0.106, 95% CI 0.008 to 0.074), parental readiness for malaria education; (ß = 0.184, 95% CI 0.711 to 2.130), frequency of peer education; (ß = 0.232, 95% CI 1.087 to 2.514) and team spirit; (ß = 0.141, 95% CI 0.027 to 0.177) were positively associated with the acceptability while this relationship was negative for the number of ITN in the household; (ß = - 0.111, 95% CI - 1.182 to -0.13) and frequency of parent-student communication; (ß = - 0.149, 95% CI - 1.201 to - 0.293). The qualitative study identified facilitators of PLEA-malaria (e.g. team formation process, outcome efficacy, presence of schools' structures, schools priority, and support) and barriers (e.g. low commitments, threat appraisal, response efficacy, and PLEA-malaria implementation gaps). CONCLUSION: The results suggested that the acceptability of the school-based PLEA-malaria was higher implying the strategy is promising in promoting malaria prevention in primary schools. Considering factors related to personal, access to malaria preventive services, school system, and social support in education and behaviour change interventions would be important to improve the acceptability. The relationship about how an improvement in the level of acceptability would in turn influences malaria preventive behaviours among the students should be investigated.

Acceptability and feasibility of the school-engaged social and behavior change communication approach on malaria prevention in Ethiopia: implications for engagement, empowerment, and retention (EER) of education sectors in malaria elimination efforts.

BACKGROUND: Evidence on process outcomes such as acceptability, and feasibility of behavior change communication interventions are important in program evaluation to understand how, and why such a program works. However; documented evidence on the issue is not available as far as the social and behavior change communication (SBCC) on malaria is concerned. Enrolling the frontline providers this study measured the acceptability and feasibility of the school-engaged SBCC strategy on malaria prevention in malaria-endemic settings of Ethiopia. METHODS: A school-engaged SBCC strategy involving various communication and capacity-building interventions aimed to advance malaria preventive practices in primary schools in Jimma were implemented from 2017 to 2019. A cross-sectional study was conducted with 205 key stakeholders at the end of the intervention. Both acceptability and feasibility were measured using standardized tools. Data were collected using a structured questionnaire and filled by the study participants. The SPSS version 26 was used to analyze the data. Multivariate general linear modeling was performed to identify the predictors of acceptability and feasibility of the program. P-value < 5% was considered to decide statistical significance. RESULTS: The result showed the mean scores (M, range = R) of acceptability and feasibility of the program were (M = 25.63, R = 6 to 30) and (M = 19.35, R = 5 to 25) respectively. The multivariate linear modeling showed acceptability was affected by self-efficacy; (ß = 0.438, P < 0.001), community support; (ß = 0.417, P < 0.001), school climate; (ß = - 0.16; P = 0.003), perceived malaria threat; (ß = 0.40, P < 0.001) and knowledge; (ß = 0.229, P = 0.013). Similarly, feasibility was influenced by self-efficacy; (ß = 0.352, P < 0.001), community support; (ß = 0.591, P < 0.001), school climate; (ß = - 0.099, P-value < 0.030) and perceived malaria threat; (ß = 0.172, P = 0.002). CONCLUSION: With a considerably high level of acceptability, the school-engaged SBCC strategy to enhance malaria preventive practices seems feasible. The SBCC strategy targeting personal factors such as malaria threat perceptions, knowledge and skills on the program, and contextual factors that include school social climate and community support would be fruitful to facilitate the implementation of the program. The result implicates the benefit of intensifying such a strategy to engage, empower, and retain the education sectors in malaria elimination efforts and beyond.

Primary school students' poetic malaria messages from Jimma zone, Oromia, Ethiopia: a qualitative content analysis.

BACKGROUND: The engagement of schools in malaria control is an emerging strategy. Little is known about the involvement of students in the development of malaria messages. This study evaluated the message content of primary school students' malaria poems. METHODS: A qualitative content analysis was conducted to explore malaria messages conveyed in poems produced by students. Twenty poems were purposively selected from twenty schools across rural villages in five districts of the Jimma Zone. Data were analyzed using Atlas.ti version 7.1.4 software. The message contents were quantified in terms of frequency, and including metaphors, presented using central themes, categories, and supportive quotations. RESULTS: A total of 602 malarial contents were generated, and organized into 21 categories under five central themes. 1) Malaria-related knowledge (causation and modes of transmission, mosquito breeding and biting behavior, signs and symptoms, care for insecticide-treated nets (ITNs), and prevention methods), 2) Perceived threats from malaria, 3)The effectiveness of prevention methods (i.e., related to the adaption of ITNs, environmental cleaning, indoor residual spray (IRS), treatment for fever, and drug adherence practices), 4) Misconceptions, beliefs, and malpractices regarding the cause of malaria and drug use) and 5) Direct calls to the adopt ITN, IRS, clean surroundings, treatment, and drug use. The most commonly conveyed message contents were about the severity of malaria, distinguishable signs and symptoms, calls for community participation for malaria elimination, knowledge of preventive methods, and effectiveness of ITN use. Metaphoric expressions (war and death) were used to convey messages about the severity and the need to manage the prognosis of malaria through the active ITN use, which itself was metaphorically represented as 'a trap' to mosquitoes. CONCLUSIONS: The poetic analysis indicated that the students developed and disseminated rich malarial messages, especially on malarial knowledge, and perceptions, beliefs, norms and practices of the local community to prevent and control malaria. Therefore, primary school students can be a source of information and would effectively communicate knowledge, perceptions, and promote malaria related practices, particularly in rural settings.