Spatial distribution and determinants of tetanus toxoid immunization among pregnant women in Ethiopia using data from Ethiopian demographic and health survey 2016.

INTRODUCTION: Tetanus is a major public health problem caused by clostridium tetani. Although it is vaccine-preventable, the case fatality rate among neonates in areas with poor immunization coverage and limited access to clean deliveries reaches 80-100%. Vaccination of pregnant mothers with the tetanus toxoid (TT) vaccine is the most effective way to protect against neonatal tetanus. This study aimed to examine the spatial distribution and determinants of tetanus toxoid immunization among pregnant mothers using the 2016 EDHS data. METHOD: Secondary analysis of the Ethiopia Demographic and Health Survey 2016 was done to assess the spatial distribution and determinants of tetanus toxoid vaccine among pregnant women in Ethiopia. Spatial autocorrelation analysis and hot spot analysis were used to detect spatial dependency and spatial clustering of the tetanus toxoid vaccine in Ethiopia. Spatial interpolation was used to predict the tetanus toxoid vaccine coverage in unsampled areas. The multilevel binary logistic regression model was fitted to identify factors associated with tetanus toxoid vaccination. An adjusted odds ratio with 95% CI was calculated and used as the measure of association and a p-value less than 0.05 were considered statistically significant. RESULT: From the total of 7043 pregnant women, 42.4% of them have taken at least two doses of tetanus toxoid immunization. Spatial clustering of TT immunization was observed in the Northern, Southwestern and Southwestern parts of Ethiopia. Whereas, low TT coverage was observed in the Eastern and Western parts of the country. Increased ANC visits and the richest economic status favored TT immunization, whereas living in Addis Ababa and Dire Dewa cities decreased the TT immunization coverage. CONCLUSION: The finding of this study reveals that TT immunization had spatial dependency, with the highest immunization coverage observed in the Northern, Southwestern and Southeastern parts of the Country. Thus, geographically targeted interventions should be implemented particularly in the eastern and western parts of the country.

Spatial distribution and associated factors of community based health insurance coverage in Ethiopia: further analysis of Ethiopian demography and health survey, 2019.

BACKGROUND: Community-Based Health Insurance is an emerging concept for providing financial protection against the cost of illness and improving access to quality health services for low-income households excluded from formal insurance and taken as a soft option by many countries. Therefore, exploring the spatial distribution of health insurance is crucial to prioritizing and designing targeted intervention policies in the country. METHODS: A total of 8,663 households aged 15-95 years old were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyze the purely spatial clusters of community based health insurance. ArcGIS version 10.3 was used to visualize the distribution of community-based health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of community-based health insurance coverage. RESULTS: Community based health insurance coverage among households had spatial variations across the country by regions (Moran's I: 0.252, p < 0.0001). Community based health insurance in Amhara (p < 0.0001) and Tigray (p < 0.0001) regions clustered spatially. Age from 15-29 and 30-39 years (Adjusted Odds Ratio 0.46(AOR = 0.46, CI: 0.36,0.60) and 0.77(AOR = 0.77, CI: 0.63,0.96), primary education level 1.57(AOR = 1.57, CI: 1.15,2.15), wealth index of middle and richer (1.71(AOR = 1.71, CI: 1.30,2.24) and 1.79(AOR = 1.79, CI: 1.34,2.41), family size > 5, 0.82(AOR = 0.82, CI: 0.69,0.96),respectively and regions Afar, Oromia, Somali, Benishangul Gumuz, SNNPR, Gambella, Harari, Addis Ababa and Dire Dawa was 0.002(AOR = 0.002, CI: 0.006,0.04), 0.11(AOR = 0.11, CI: 0.06,0.21) 0.02(AOR = 0.02, CI: 0.007,0.04), 0.04(AOR = 0.04, CI: 0.02,0.08), 0.09(AOR = 0.09, CI: 0.05,0.18),0.004(AOR = 0.004,CI:0.02,0.08),0.06(AOR = 0.06,CI:0.03,0.14), 0.07(AOR = 0.07, CI: 0.03,0.16) and 0.03(AOR = 0.03, CI: 0.02,0.07) times less likely utilize community based health insurance than the Amhara region respectively in Ethiopia. CONCLUSION: Community based health insurance coverage among households in Ethiopia was found very low still. The government needs to develop consistent financial and technical support and create awareness for regions with lower health insurance coverage.

Spatial distribution and determinants of newbornsnot receiving postnatal check-up withintwodays after birth in Ethiopia: a spatial and multilevel analysis of EDHS 2016.

BACKGROUND: Accessibility and utilization of postnatal newborn check-ups within 2 days after delivery are critical for a child's survival, growth, and development. However, the service delivery is not yet improved and fluctuates across the geographical locations in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of newborns not received postnatal check-ups within 2 days after birth in Ethiopia. METHODS: A secondary data analysis of the Ethiopia Demographic and Health Survey (EDHS) 2016 was done among live births within 2 years preceding the survey. A multilevel binary logistic regression model was fitted to identify the factors associated with the outcome variable. Adjusted Odds Ratio with 95% (Confidence Interval) was calculated and used as a measure of associations and variables with a p-value < 0.05, were declared as statistically significant. RESULTS: A total of 4036 live newborns in Ethiopia were included in the analysis, of whom half (51.21%) were females. The mean age of the mothers was 33+ SD 1.3, and more than 60 % (61.56%) of the mothers were not educated. The national prevalence of newborns not receiving postnatal check-ups within 2 days after birth was 84.29 (95% CI: 83.10-85.41) with significant spatial variations across the study area. Mothers who had no ANC visits were 58% higher than (AOR = 0.42(0.27-0.66) mothers who had > 4 ANC visits. Mothers who gave birth at home and others were 80% (AOR = 0.02(0.01-0.29) and 25% (AOR = 0.76(0.59-0.99), higher than mothers delivered at hospital. Rural mothers were 1.90 times higher (AOR = 1.90(1.29-2.81) than urban mothers, and mothers live in administrative regions of Afar 66% (AOR = 0.34(0.16-0.69), Oromia 47% (AOR = 0.53(0.30-0.91), Somali 60% (AOR = 0.40 (0.22-0.74),Benishangul 50% (AOR = 0.50 (0.27-0.92), SNNPR 67% (AOR = 0.33(0.19-0.57), Gambela 70% (AOR = 0.30 (0.16-0.56), Harari 56% (AOR = 0.44 (0.25-0.78), and Dire Dawa70% (AOR = 0.30 (0.17-0.54) were higher than Addis Abeba for not receiving postnatal checkup of new born within the first 2 days, respectively. CONCLUSIONS: Low postnatal check-up utilization remains a big challenge in Ethiopia, with significant spatial variations across regional and local levels. Spatial clustering of not receiving postanal check-ups within 2 days was observed in Afar, Oromia, Gambela, Benishangul, SNNPR, Harari, and Dire Dawa regions. Residence, ANC visits, place of delivery, and administrative regions were significantly associated with not receiving postnatal check-ups. Geographically targeted interventions to improve ANC follow-up and institutional delivery should be strengthened.

Prevalence of primary dysmenorrhea, its intensity, impact and associated factors among female students' at Gondar town preparatory school, Northwest Ethiopia.

BACKGROUND: Primary dysmenorrhea is defined as a crampy pain in the lower abdomen before or during the menstrual period in the absence of any pelvic pathology. It is the leading motherhood problem worldwide but there is limited evidence on the prevalence of primary dysmenorrhea in the study area as well in Ethiopia. Researching primary dysmenorrhea helps to focus on the treatment plan. The study aimed to assess the prevalence, intensity, impact, and associated factors of primary dysmenorrhea among female students at Gondar town preparatory school. METHODS: A cross-sectional study design conducted among female students at Gondar town Preparatory School from May 1-10/2017. A total of 459 study participants were used. A simple random sampling technique was used to select study participants. A self-administered structured questionnaire was employed. Epi Info version 7 and SPSS version 20 were used for data entry and analysis respectively. A binary logistic regression model was computed. Variables having a p-value < 0.05 in the multivariate logistic regression model were considered as statistically significant. RESULTS: A total of 459 female students participated in the study with a response rate of 96.29%. The prevalence of primary dysmenorrhea among female students was found to be 64.7% (95% CI; 60.2-69.2%). Around 61% reported moderate intensity of menstrual pain and 50.7% complain about lower abdominal pain. Sixty-five percent of study participants reported that absenteeism from school was the impact of menstrual pain. Having irregular monthly menstrual cycle (AOR = 1.70, 95% CI; 1.02, 2.84) and positive family history of dysmenorrhea (AOR = 5.19, 95% CI: 3.21, 8.37) were significantly associated with primary dysmenorrhea. CONCLUSIONS: The prevalence of primary dysmenorrhea was found to be high. Having an irregular monthly menstrual cycle and a positive family history of dysmenorrhea were determinants of primary dysmenorrhea.

Prevalence of traditional uvulectomy and its associated factors among parents who had less than 6 months of infants in Gondar City, north-west Ethiopia: Mixed study design.

BACKGROUND: Traditional uvulectomy is widely practiced in Africa especially in sub-Saharan countries including Ethiopia. Limited Studies conducted in different times and areas of the world have shown that the prevalence of uvulectomy and its associated factors are varied from country to country. There is limited evidence to determine the prevalence and reasons of malpractice in Ethiopia. Therefore, this study aimed to assess the prevalence of traditional uvulectomy, and its associated factors among parents who had children aged less than 6 months. METHODS: A community-based cross-sectional mixed study design was conducted among 630 participants selected by a systematic sampling technique. Data were collected using a pretested interviewer-administered questionnaire. The collected data were entered into Epi-data, and analyzed by using STATA version 14software. Descriptive statistics were computed and presented using tables, figures and texts. Factors associated with the prevalence of uvulectomy were selected for multiple logistic regressions at the probability value (p-value) of less than 0.2 in the X2- analysis. Statistically significant associated factors were identified at the probability value (p-value) less than 0.05 and adjusted OR (AOR) with a 95% CI. A total of 10 individual depth interviewees and 5 key informants were included using purposive sampling techniques. For the qualitative study, and thematic content analysis was employed to analyze the data, which were transcribed, translated, coded, screened, thematized, analyzed, synthesized, and finally supplemented the quantitative finding. RESULTS: The prevalence of traditional uvulectomy was 84.60% (CI: 81.77%n-87.42%). Being rural residence (adjusted OR = 2.08, CI = 1.06-4.12), mothers aged 30 to 34 years (adjusted OR = 2.9, CI = 1.28-6.60), having no antenatal care visit (adjusted OR = 3.91, CI = 1.33-11.47), having no bad obstetric history (adjusted OR = 2.11, CI = 1.12-3.98), having no postnatal care visit (adjusted OR = 3.88, CI = 1.36-11.12) and mothers' poor attitude (adjusted OR = 3.32, CI = 2.01-5.47) were statistically significant associated factors of traditional uvulectomy. Seeking traditional uvulectomy, lack of information and third-party pressure were the main themes of the qualitative study that support the findings of the quantitative study. CONCLUSION: The prevalence of traditional uvulectomy was high. Being rural residents, mothers aged 30 to 34 years, having no antenatal care visit, having no complications of obstetric history, having no postnatal care visit and mothers with poor attitude were statistically significant associated factors of traditional uvulectomy. Lack of information about uvulectomy and third-party pressure was the reason for seeking traditional uvulectomy.

Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses.

BACKGROUND: Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern. METHODS: Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant. RESULTS: Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood. CONCLUSION: Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.

Major maternal related determinants of non-breastfeeding among mothers in Ethiopia: A multilevel analysis from DHS Ethiopia 2016.

INTRODUCTION: In Ethiopia, the burden of non-breastfeeding is still high despite substantial improvements in breastfeeding. However, the determinants of non-breastfeeding were poorly understood. Therefore, the aim of this study was to identify the maternal -related factors associated with non-breastfeeding. METHODS: An in-depth analysis of data from the Ethiopian Demographic and Health Survey 2016 (EDHS 2016) was used. A total weighted sample of 11,007 children was included in the analysis. Multilevel logistic regression models were fitted to identify factors associated with non-breastfeeding. A p-value < of 0.05 was used to identify factors significantly associated with non-breastfeeding. RESULTS: The prevalence of non-breastfeeding in Ethiopia was 5.28%. The odds of not breastfeeding were 1.5 times higher among women aged 35to 49 years (AOR = 1.5 CI: 1.034, 2.267) than among women aged 15to 24 years. The odds of not breastfeeding were higher among children whose mothers had BMIs of 18.5-24.9 (AOR = 1.6 CI: 1.097, 2.368) and 25-29.9 (AOR = 2.445 CI: 1.36, 4.394) than among women with BMIs of < 18.5. In addition, not breastfeeding was also significantly associated with ANC follow-up, where mothers who had 1-3 ANC follow-up had a 54% decreased odds (AOR = 0.651 CI: 0.46,0.921) compared to mothers who had no ANC follow-up. Demographically, mothers from Somalia region were five times (AOR = 5.485 CI: 1.654, 18.183) and mothers from SNNP region were almost four times (AOR = 3.997 CI: 1.352, 11.809) more likely to not breastfeed than mothers residing in Addis Ababa. CONCLUSIONS: Although breastfeeding practices are gradually improving in Ethiopia, the number of children not breastfed remains high. Individual-level characteristics (women's age, body mass index, and ANC follow-up) and community-level characteristics (geographic region) were statistically significant determinants of non-breastfeeding. Therefore, it is good for the federal minister of Health, planners, policy and decision- makers, and other concerned child health programmers to prioritize both individual and community factors.

Prevalence, spatial distribution and determinants of infant mortality in Ethiopia: Findings from the 2019 Ethiopian Demographic and Health Survey.

INTRODUCTION: Infant mortality declined globally in the last three decades. However, it is still a major public health concern in Ethiopia. The burden of infant mortality varies geographically with the highest rate in Sub-Saharan Africa. Although different kinds of literature are available regarding infant mortality in Ethiopia, an up to date information is needed to design strategies against the problem. Thus, this study aimed to determine the prevalence, show the spatial variations and identify determinants of infant mortality in Ethiopia. METHODS: The prevalence, spatial distribution, and predictors of infant mortality among 5,687 weighted live births were investigated using secondary data from the Ethiopian Demographic and Health Survey 2019. Spatial autocorrelation analysis was used to determine the spatial dependency of infant mortality. The spatial clustering of infant mortality was studied using hotspot analyses. In an unsampled area, ordinary interpolation was employed to forecast infant mortality. A mixed multilevel logistic regression model was used to find determinants of infant mortality. Variables with a p-value less than 0.05 were judged statistically significant and adjusted odds ratios with 95 percent confidence intervals were calculated. RESULT: The prevalence of infant mortality in Ethiopia was 44.5 infant deaths per 1000 live births with significant spatial variations across the country. The highest rate of infant mortality was observed in Eastern, Northwestern, and Southwestern parts of Ethiopia. Maternal age between 15&19 (adjusted odds ratio (AOR) = 2.51, 95% Confidence Interval (CI): 1.37, 4.61) and 45&49(AOR = 5.72, 95% CI: 2.81, 11.67), having no antenatal care follow-up (AOR = 1.71, 95% CI: 1.05, 2.79) and Somali region (AOR = 2.78, 95% CI: 1.05, 7.36) were significantly associated with infant mortality in Ethiopia. CONCLUSION: In Ethiopia, infant mortality was higher than the worldwide objective with significant spatial variations. As a result, policy measures and strategies aimed at lowering infant mortality should be devised and strengthened in clustered areas of the country. Special attention should be also given to infants born to mothers in the age groups of 15-19 and 45-49, infants of mothers with no antenatal care checkups, and infants born to mothers living in the Somali region.

COVID-19 vaccine acceptance rate and its predictors in Ethiopia: A systematic review and meta-analysis.

Coronavirus disease (COVID-19) is a global pandemic caused by the SARS-CoV-2 virus. COVID-19 vaccine is the best strategy for prevention. However, it remained the main challenge. Therefore, this systematic review and meta-analysis aimed to determine the overall pooled estimate of COVID-19 vaccine acceptance and its predictors in Ethiopia. Consequently, we have searched articles from PubMed, EMBASE, Web of Science, Google Scholar, reference lists of included studies, and Ethiopian universities' research repository. The weighted inverse variance random effects model was employed. The quality of studies and the overall variation between studies were checked through Joanna Briggs Institute (JBI) quality appraisal criteria and heterogeneity test (I2), respectively. The funnel plot and Egger's regression test were also conducted. Following that, a total of 14 studies with 6,773 participants were considered in the study and the overall pooled proportion of COVID-19 vaccine acceptance was 51.2% (95% CI: 43.9, 58.5). Having good knowledge (Odds ratio: 2.7; 95% CI: 1.1, 7.1; P. VALUE: 0.00), chronic disease (Odds ratio: 2; 95% CI: 1.3, 3.1), older age (Odds ratio: 1.8; 95% CI: 1.1, 3.0; P. VALUE: 0.02), and secondary education and above (Odds ratio: 3.3; 95% CI: 1.7, 6.7; P. VALUE: 0.00) were significantly associated with the acceptance of COVID-19 vaccine. In conclusion, Having good knowledge, chronic disease, older age, and secondary education and above were significantly associated with COVID-19 vaccine acceptance. Therefore, special attention and a strengthened awareness, education, and training about COVID-19 vaccine benefits had to be given to uneducated segments of the population.

Prevalence and associated factors of double and triple burden of malnutrition among child-mother pairs in Ethiopia: Spatial and survey regression analysis.

BACKGROUND: Evidence on double and triple burdens of malnutrition at household level among child-mother pairs is a key towards addressing the problem of malnutrition. In Ethiopia, studies on double and triple burdens of malnutrition are scarce. Even though there is a study on double burden of malnutrition at national level in Ethiopia, it doesn't assess the triple burdens at all and a few forms of double burden of malnutrition. Therefore, this study aimed to determine the prevalence and associated factors of double and triple burdens of malnutrition among child-mother pairs in Ethiopia. METHODS: A total sample of 7,624 child-mother pairs from Ethiopian Demographic and Health Survey (EDHS) 2016 were included in the study. All analysis were performed considering complex sampling design. Anthropometric measures and hemoglobin levels of children, as well as anthropometric measurements of their mothers, were used to calculate double burden of malnutrition (DBM) and triple burden of malnutrition (TBM). Spatial analysis was applied to detect geographic variation of prevalence of double and triple burdens of malnutrition among EDHS 2016 clusters. Bivariable and multivariable binary survey logistic regression models were used to assess the factors associated with DBM and TBM. RESULTS: The overall weighted prevalence of DBM and TBM respectively were 1.8% (95%CI: 1.38-2.24) and 1.2% (95%CI: 0.83-1.57) among child-mother pairs in Ethiopia. Significant clusters of high prevalence of DBM and TBM were identified. In the adjusted multivariable binary survey logistic regression models, middle household economic status [AOR = 0.23, 95%CI: 0.06, 0.89] as compared to the poor, average birth weight [AOR = 0.26, 95%CI: 0.09, 0.80] as compared to large birth weight and children aged 24-35 months [AOR = 0.19, 95%CI: 0.04,0.95] as compared to 6-12 months were less likely to experience DBM. Average birth weight [AOR = 0.20, 95%CI: 0.05, 0.91] as compared to large birth weight and time to water source <=30 min [AOR = 0.41, 95%CI: 0.19,0.89] as compared to on premise were less likely to experience TBM. CONCLUSION: There is low prevalence of DBM and TBM among child-mother pairs in Ethiopia. Interventions tailored on geographic areas, wealth index, birth weight and child birth could help to control the emerging DBM and TBM at household level among child-mother pairs in Ethiopia.

Spatial variation and determinates of dietary diversity among children aged 6-23 months in Ethiopia: spatial and multilevel analysis using Ethiopian Demography Health Survey (EDHS) 2019.

BACKGROUND: Minimum dietary diversity is the consumption of five or more food groups from the eight World Health Organization recommended food groups. Adequately diversified diet, in terms of amount and composition, is critical for optimal growth, development, and long-term health outcomes in the first 2 years. Understanding the regional variation of dietary diversity and the underlying factors is crucial for developing and implementing interventions. However, the use of spatial approaches in dietary studies has not been widely established. Therefore, this study aimed to explore the spatial patterns and determinates of minimum dietary diversity practice among 6-23 months children in Ethiopia. METHODS: Secondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 1578 children aged 6-23 months was included for this study. The Global Moran's I was estimated to look into the regional variation of dietary diversity and hotspot and cold spot areas. Further, multivariable multilevel logistic regression was used for factor analyses. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. RESULTS: Overall, 87.4% (95% CI: 85.7 to 88.9%) of children in 2019 had inadequate Minimum dietary diversity. We identified statistically significant clusters of high inadequate dietary diversity (hotspots) notably observed in Somali, Afar, Eastern and western Amhara, western Tigray, Benishangul, and Northeastern and western parts of the southern nations, nationality and peoples' regions. Inadequate dietary diversity was significantly higher among young children, uneducated mother, married women, younger mother, no postnatal check, community with higher level of poverty and community level uneducated woman. CONCLUSION: According to the findings of this study inadequate Minimum dietary diversity for children as measured by World Health Organization dietary assessment shows high. Children's dietary diversity was distributed non-randomly in different districts across Ethiopia's regions. The findings of the study provided critical evidence about dietary diversity and associated factors. Hence, policy should focused on improve education status of Mother, boosting economic status of the community, increased maternal continuum of care and focused on young children nutrition may advance dietary diversity.

The Co-Utilization of Oral Rehydration Solution and Zinc for Treating Diarrhea and Its Associated Factors Among Under-Five Children in Ethiopia: Further Analysis of EDHS 2016.

Introduction: Diarrhea causes a loss of body water and salt, which can lead to dehydration and death. The use of oral rehydration salts and zinc together is regarded as an effective treatment for diarrhea in resource-poor settings like Ethiopia. However, studies that examine the co-utilization of oral rehydration solution and zinc in the treatment of diarrhea are limited Ethiopia. Objective: To assess the prevalence and associated factors of oral rehydration solution and zinc co-utilization to treat diarrhea in children under the age of five in Ethiopia, EDHS 2016. Methods: Secondary data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used to investigate the prevalence and factors associated with the co-utilization of ORS and zinc to treat diarrhea in under-five children. A multilevel binary logistic regression model was fitted to identify factors associated with the co-utilization of ORS and zinc. Adjusted odds ratios (AOR) with 95% CI were calculated and used as a measure of associations, and variables having a p-value of less than 0.05 were declared as statistically significant. Results: The national prevalence of ORS and zinc co-utilization was 16.65% (14.66%, 18.84%). Maternal educational status (AOR = 1.45; 95% CI; (1.01, 2.09)), household size (AOR = 1.53; 95% CI; 1.09, 2.16) and distance to health facilities at the community level (AOR = 1.60, 95% CI = 1.02, 2.58) were variables significantly associated with the co-use of ORS and zinc. Conclusion: The co-utilization of ORS and zinc for the management of diarrhea was low in Ethiopia. Education, household size, and distance to health facilities at the community level were significantly associated with the co-utilization of ORS and zinc in Ethiopia.

The effect of gestational age, low birth weight and parity on birth asphyxia among neonates in sub-Saharan Africa: systematic review and meta-analysis: 2021.

BACKGROUND: Despite simple and proven cost-effective measures were available to prevent birth asphyxia; studies suggested that there has been limited progress in preventing birth asphyxia even in healthy full-term neonates. In Sub-Saharan Africa, Inconsistency of magnitude of birth asphyxia and its association gestational age, Low birth Weight and Parity among different studies has been observed through time. OBJECTIVE: This study aimed to estimate the Pooled magnitude of birth asphyxia and its association with gestational age, Low birth Weight and Parity among Neonates in Sub-Saharan Africa. METHOD: PubMed, Cochrane library and Google scholar databases were searched for relevant literatures. In addition, reference lists of included studies were retrieved to obtain birth asphyxia related articles. Appropriate search term was established and used to retrieve studies from databases. Searching was limited to cohort, cross-sectional, and case-control studies conducted in Sub-Saharan africa and published in English language. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. Heterogeneity across the included studies was evaluated by using the inconsistency index (I2) test. Funnel plot and the Egger's regression test were used to test publication bias. A weighted inverse variance random effects- model was used to estimate the pooled prevalence of birth asphyxia among neonates in Sub-Saharan Africa. STATA™ version 11softwarewasused to conduct the meta-analysis. RESULT: A total of 40 studies with 176,334 study participants were included in this systematic review and meta-analysis. The overall pooled magnitude of birth asphyxia in Sub-Saharan Africa was 17.28% (95% CI; (15.5, 19.04). low birth weight (AOR = 2.58(95% CI: 1.36, 4.88)), primigravida (AOR = 1.15 (95% CI: 0.84, 1.46) andMeconium-stained amniotic fluid (AOR = 6(95% CI: 3.69, 9.74)) werevariables significantly associated with the pooled prevalence of birth asphyxia. CONCLUSION: The pooled magnitude of birth asphyxia was found to be high in Sub-Saharan Africa. Low birthweight and Meconium-stained amniotic fluid were variables significantly associated with birth asphyxia in Sub-Saharan Africa. Hence, it is better to develop early detection and management strategies for the affected neonates with low birth weight and born from mothers intrapartum meconium stained amniotic fluid.

Spatial variation and determinants of underweight among children under 5 y of age in Ethiopia: A multilevel and spatial analysis based on data from the 2019 Ethiopian Demographic and Health Survey.

OBJECTIVES: Childhood underweight is a critical public health problem that needs urgent attention in developing countries like Ethiopia. Despite its variation between localities, the determinant factors and its geospatial variation have not been adequately addressed across the various regions of the country. Therefore, the aim of this study was to investigate the spatial variation and determinant factors of underweight among children under 5 y of age in Ethiopia. METHODS: The total weighted samples of 5753 children aged <5 y were included in this study. The data were taken from the 2019 Ethiopian Demographic and Health Survey (EDHS 2019). Arc GIS software was used to analyze geospatial variations to identify the hot- and cold spot areas of underweight in Ethiopia. A multilevel multivariable logistic regression model was used to identify the determinant factors of underweight. Excel, STATA-16, and ArcGIS software were used for the data management and analysis. In the multivariable multilevel analysis, adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to declare significant determinants of underweight among children aged <5 y. RESULTS: Among 5753 children aged <5 y in Ethiopia, 21.3% were underweight during the 2019 EDHS. The distribution showed that there was a geospatial variation of underweight among children aged <5 y in Ethiopia; the Global Moran's index value was 0.36 with P < 0.001. In multivariable multilevel analysis, the significant factors associated with underweight were the sex of the child (aOR, 1.25; 95% CI, 1.09-1.44); age of the child, with the highest odds of being underweight observed in the age group of 24 to 35 mo (aOR, 3.52; 95% CI, 2.60-4.74); wealth index, with poorer children having higher odds of being underweight (aOR, 2.25; 95% CI, 1.58-3.24); and the regions, with the highest odds of underweight was observed in Tigray (aOR, 5.63; 95% CI, 2.79-11.36) and Afar (aOR, 4.71; 95% CI, 2.33-9.51). CONCLUSIONS: Underweight has significant spatial variation in Ethiopia, with spatial clustering in the northern and eastern parts of the country. It is recommended that in regions like Tigray, Afar, and Somali, as well as some areas in Gambella, priority steps be taken to reduce the burden of underweight in children aged <5 y. Thus, nutritional intervention programs should be strengthened and intervention strategies developed, with special emphasis on families with poor wealth index in the hotspot areas.

Study department and gender affects the knowledge and attitude of students towards cardio pulmonary resuscitation procedure at the University of Gondar, northwest Ethiopia, 2019.

Cardiopulmonary Resuscitation (CPR) life-saving procedures, for emergency case purposes, to increase the victim's blood circulation and oxygen for vital organs. The World Health Organization and American Heart Association recommended that CPR learns from schools to increase the rate and reduce mortality. There is no known level of Knowledge and attitude acquisition towards CPR for graduate medical and health science students at the University of Gondar. This study aimed to assess knowledge, attitude, and associated factors towards CPR among final year undergraduate students at the University of Gondar, Northwest Ethiopia. METHODS: An institution-based prospective cross-sectional study was conducted among 422 participants. A simple random sampling technique was used to draw the study participants. A pre-tested self-administered questioner was used to collect the data. Data was entered into Epi-info version7 and analysis by SPSS version20. Descriptive statics of frequency and percentage was done and presented by tables and figures. Logistic regression analysis was done. In bi-variable logistic regression analysis, variables P.V<0.2 were entered to multivariable analysis and statistical significance was declared at P.V<0.05 with 95% Confidence Interval (CI). RESULTS: In this study; more than half of the participants, 58.8% were males. The mean ages were 24.5 ± (SD2.48). The knowledge and attitude levels of the study participant for CPR were [44.1%, 95% CI: (39.3-49.3)], and [45.7%, 95% CI: (41.0-50.5)], respectively. Age ranges from 20-24; [AOR = 1.73 (1.06-2.84)], medical students [AOR = 9.69 (5.06-18.56)], and advance nursing students [AOR = 4.63 (1.71-9.48)] were significantly associated to Knowledge. Male participants [AOR = 2.00 (1.32-3.01)], and age ≥25 years old [AOR = 1.90 (1.27-2.86)] were significantly associated with the attitude of CPR. CONCLUSIONS: The level of knowledge and attitude of this study was not sufficient and favorable. Age and department are associated with knowledge of CPR, in turn, sex and age are also similarly associated with attitude. The authors recommended that CPR should be given an in the common course for all departments by revising their curriculum with up-to-date information, engaged female students to participate in life-saving procedure to adapt and perform at the health care, community, or whatever the causality founds.

Breastfeeding technique and associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia: observational method.

BACKGROUND: The breastfeeding technique is explained positioning, attachment, and suckling during breastfeeding. Ineffective breast feeding technique is one of the factors leading to premature discontinuation of breastfeeding and malnutrition. There is a limited study on the assessments of BFT and associated factors among lactating mothers in the study area. Therefore, the study aimed to assess breastfeeding technique and the associated factors among lactating mothers visiting Gondar town health facilities, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted from February 20 to March 20, 2020. An observational checklist and structured interviewer-administered questionnaire were applied to collect the data. The data were entered into Epi-Data 4.6 version and transferred to analyzed using SPSS version 20. Bi-variable and multivariable logistic regressions were performed to identify the association. The strength of association was identified using odds ratio with a 95% confidence interval (), and a p-value of 0.05 was declare as statistically significant. RESULTS: The proportion of effective BFT was 48% (95%, CI: 43.0-53.0%). The likelihood of applying proper BFT among age group of 18-20 years was 70% lower than (AOR = 0.3; 95% CI: 0.11-0.83) age group > 30 years. The odds of effective BFT in primipara mothers were 49% (AOR = 0.51; 95% CI: 0.32-0.82) lower compared to multiparous mothers. Likewise, the provability of effective BFT was 55% (AOR = 0.45; 95% CI: 0.29-0.70) times lower in women who had no counseling immediately after delivery compared to their counterparts. Moreover, effective breast feeding technique mothers who have breast problem was 78% lower than (AOR = 0.22; 95% CI: 0.07-0.68) mothers who have no breast problem. And mothers who had counselling of BFT during ANC follow up was 55% (AOR = 0.45; 95% CI: 0.29, 0.70) lower than mothers who had no counseling. CONCLUSION: Just under half of the women in the study area applied proper breast feeding technique Younger and primipara mothers poorly performed to effective BFT. But women having counseling during antenatal care follow-up and immediately after delivery and not having breast problems applied BFT effectively. Hence, special emphasis have to give for younger and primipara mothers. Besides, educate the mother for preventing breast problems and working on enhancing counseling at postnatal clinic.

The Prevalence of HIV-Positive Infants Born to HIV-Positive Mothers Attended at the University of Gondar Specialized Hospital Anti-Retroviral Therapy Services, Northwest Ethiopia, 2018.

INTRODUCTION: The human immunodeficiency virus (HIV) attacks the human immune cells and affects their function. It is the highest burden that occurs in a developing country. Ethiopia is one of the top ten countries in the world, which has a high burden of HIV-infected children. Even if the country works hard on the PMCT program, still there is challenging on MTCT reduction. OBJECTIVE: The purpose of this study was to assess the prevalence of HIV-positive infants born to HIV-positive mothers attending anti-retroviral treatment (ART) services at the University of Gondar specialized hospital, Gondar, northwest Ethiopia, 2018. METHODS: A retrospective chart review study was conducted from February to April 2018, among HIV-exposed infants who born to HIV-positive mothers in ART service at the University of Gondar specialized hospital. A systematic sampling method was applied to select study participants. Data were entered into EPI info version 7 statistical software and transferred to SPSS version 20 for analysis. RESULTS: In this study, 239 participants were enrolled, with a 98.8% response rate. The prevalence of HIV-positive infants born to HIV-positive mothers was 5.5% with a 95% CI (3.0-8.5%). Of the mothers, 77.1% were within 25-35 years of age range. Of the total infants, 56.8% were males. From these HIV-positive infants, 13 (5.5%) were born from age ranges of 25-35years old mothers, 9(3.8%) were females, 8(3.4%) were 6-11 months old, 13 (5.5%) were post-term gestation, and 13 (5.5%) were maternal CD4+ less than 350/mm3. CONCLUSION AND RECOMMENDATIONS: The prevalence of HIV-positive infants born to HIV-positive mothers in this study was lower than the previous 10.2%. To reduce such infant HIV infection to zero, it needs proactive action from stakeholders, health professionals, and the community at large.

Maternal HIV infection and preeclampsia increased risk of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017.

INTRODUCTION: Globally, more than 20 million infants are born with low birth weight. The risk of neonatal mortality among low birth weight infants is 25 to 30 times greater than neonates with birth weight ≥ 2500 g. Low birth weight infants are at increased risk of infection, difficulty of feeding, and neurologic problems following birth. So far, the prevalence and factors associated with low birth weight have not been studied in the study area after completion of the time set for millennium development goals. Therefore, the study was aimed at assessing the prevalence and associated factors of low birth weight among newborns delivered at University of Gondar specialized referral hospital, Northwest Ethiopia, 2017. METHODS: Institution-based retrospective cross-sectional study was conducted from April 1 to May 28, 2017. A total of 240 newborns were included in the study. Systematic random sampling technique was used for selecting study participant's medical record charts from delivery registration log book. Data were collected using data extraction tool. Binary logistic regression followed by multivariable regression model was fitted and interpretation was made based on the adjusted odds ratio and p-value of less than 0.05 with corresponding 95% CI. RESULTS: The prevalence of low birth weight was 12.9% (95%CI: 8.94, 17.83%). No history of preeclampsia (AOR = 0.193, 95%CI: 0.0516, 0.723), negative maternal HIV infection (AOR = 0.015, 95%CI: 0.001, 0.277), and being preterm (AOR = 17.6, 95%CI: 5.18, 60.17) were significantly associated with low birth weight. CONCLUSION AND RECOMMENDATIONS: The result of this study highlighted that the burden of low birth weight is a public health concern among babies delivered in University of Gondar specialized referral Hospital. Maternal HIV infection, preeclampsia, and prematurity were associated with low birth weight. Prevention and treatment of Human immunodeficiency virus infection during pregnancy, tackling prematurity and prevention of preeclampsia through strengthening of antenatal care service and other comprehensive strategies are strongly recommended.