Development and validation of a risk prediction model for lost to follow-up among adults on active antiretroviral therapy in Ethiopia: a retrospective follow-up study.

BACKGROUND: Over 420,000 people have initiated life-saving antiretroviral therapy (ART) in Ethiopia; however, lost-to-follow-up (LTFU) rates continues to be high. A clinical decision tool is needed to identify patients at higher risk for LTFU to provide individualized risk prediction to intervention. Therefore, this study aimed to develop and validate a statistical risk prediction tool that predicts the probability of LTFU among adult clients on ART. METHODS: A retrospective follow-up study was conducted among 432 clients on ART in Gondar Town, northwest, Ethiopia. Prognostic determinates included in the analysis were determined by multivariable logistic regression. The area under the receiver operating characteristic (AUROC) and calibration plot were used to assess the model discriminative ability and predictive accuracy, respectively. Individual risk prediction for LTFU was determined using both regression formula and score chart rule. Youden index value was used to determine the cut-point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA). RESULTS: The incidence of LTFU was 11.19 (95% CI 8.95-13.99) per 100-persons years of observation. Potential prognostic determinants for LTFU were rural residence, not using prophylaxis (either cotrimoxazole or Isoniazid or both), patient on appointment spacing model (ASM), poor drug adherence level, normal Body mass index (BMI), and high viral load (viral copies > 1000 copies/ml). The AUROC was 85.9% (95% CI 82.0-89.6) for the prediction model and the risk score was 81.0% (95% CI 76.7-85.3) which was a good discrimination probability. The maximum sensitivity and specificity of the probability of LTFU using the prediction model were 72.07% and 83.49%, respectively. The calibration plot of the model was good (p-value = 0.350). The DCA indicated that the model provides a higher net benefit following patients based on the risk prediction tool. CONCLUSION: The incidence of LTFU among clients on ART in Gondar town was high (> 3%). The risk prediction model presents an accurate and easily applicable prognostic prediction tool for clients on ART. A prospective follow-up study and external validation of the model is warranted before using the model.

Half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children in Northwest Ethiopia; multi setting historical follow-up study.

BACKGROUND: Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children. METHODS: A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association. RESULTS: A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years' follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure. CONCLUSION: In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children.

Prevalence of childhood Cancer among children attending referral hospitals of outpatient Department in Ethiopia.

INTRODUCTION: Childhood cancer is one of the leading causes of morbidity and mortality in the pediatrics age group. The problem affects both developed and developing countries. A high mortality rate has been observed in low-income counties. Despite its high fatality rate, less attention has been paid to the problem in developing countries, including Ethiopia. For this reason, childhood cancer is not well documented in the study setting. Therefore, we assessed the prevalence of childhood cancer in Ethiopia. METHODS: Institution based cross-sectional study design from January 1, 2019, to March 30, 2019, was conducted in the pediatrics treatment center. A systematic random sampling technique has used to select 1270 children in the pediatric outpatient department. The data were entered using Epi info version 7 and exported to SPSS version 20 for analysis. We checked model fitness for the advanced statistical methods, but it was difficult to proceed with logistic regression model to see the association between dependent and explanatory variables because of the unmet x2 assumption. We presented the results by using tables and figures. RESULTS: From the total 1270 study participants, 1257 were included in the final analysis provided that a 98.97% response rate. Out of these, 10(0.8%) children were diagnosed with cancer. Regarding its types, two each, Acute Lymphocytic Leukemia, Wilms tumor, Hodgkin lymphoma, and one each non-Hodgkin lymphoma, Parotid cancer, Retinoblastoma, and Breast cancer were reported. The prevalence of childhood cancer was 0.9 and 0.7% among male and female children, respectively. CONCLUSIONS: Eight children diagnosed with cancer per 1000 children who visited the pediatric outpatient department. Even though childhood cancers have little attention from policymakers, the prevalence of childhood cancer remains prevalent. Therefore, researchers and policymakers shall give special emphasis to childhood cancer.

Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia.

BACKGROUND: Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. METHODS: A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. RESULTS: A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. CONCLUSIONS: Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.

Prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia.

BACKGROUND: Globally, Gestational Diabetes Mellitus (GDM) is rising, but it is a neglected health threat to mothers and their children in low resource countries. Although, GDM is known in Ethiopia, information regarding it remains scarce by recent diagnostic criteria. Therefore, this study aimed to determine the prevalence of GDM and associated factors among women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia. METHODS: A cross-sectional study was conducted among 1027 pregnant women selected by the systematic random sampling technique. The universal one-step screening and diagnostic strategy was done using a two-hour 75 g oral glucose tolerance test. GDM was diagnosed using updated diagnostic criteria (2017 American Diabetes Association (ADA) or 2013 World Health Organization (WHO) or modified International Association of the Diabetes and Pregnancy Study Groups diagnostic criteria (IADPSG)). Binary logistic regression model was used to identify factors associated with GDM. RESULTS: Of the total 1027 pregnant women, 12.8% (95% CI: 10.8-14.8) were diagnosed with GDM. Overweight and/or obesity (MUAC ≥28 cm) (AOR = 2.25, 95% CI: 1.18-4.26), previous history of GDM (AOR = 5.82, 95% CI: 2.57-13.18), family history of diabetes (AOR = 4.03, 95% CI: 1.57-10.35), low physical activity (AOR = 3.36, 95% CI: 1.60-7.04), inadequate dietary diversity (AOR = 1.9, 95% CI: 1.02-3.53), and antenatal depression (AOR = 4.12, 95% CI: 1.85-9.20) were significantly associated with GDM. CONCLUSIONS: The prevalence of GDM among women attending antenatal care at Gondar town public health facilities was high. Previous history of GDM, antenatal depression, family history of diabetes, low physical activity, overweight and/or obesity and inadequate dietary diversity were significantly associated with GDM. Routine screening of pregnant women and healthy lifestyle are strongly recommended.

Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study.

BACKGROUND: Early initiation of sexual activity affects the sexual and reproductive health of the young population. The youth are at a high risk of risky sexual behaviours, including multiple partners and inconsistent condom use. There has been limited research on the level and determinants of early sexual initiation in Woldia town. Thus, this study aimed to assess the prevalence of early sexual initiation and associated factors among preparatory and high school students in Woldia town, northeast Ethiopia. METHODS: An institution based cross-sectional study was conducted on 723 students selected by the simple random sampling technique on March 7, 2016. A pre-tested and structured self-administered questionnaire was used for data collection. Descriptive statistics, bivariate and multivariable logistic regression were computed. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was calculated to examine the strength of association. In the multivariable analysis, a p-value < 0.05 was considered as statistically significant. RESULT: The prevalence of early sexual initiation among preparatory and high school students in Woldia town was 18.4% (95% CI:15.50,21.30%). Not attending religious programs (AOR = 3.2, 95% CI:1.84,5.44), peer pressure (AOR = 1.9, 95% CI:1.14,3.25), cigarette smoking (AOR = 2.3, 95% CI:1.06,4.85), poor parental monitoring (AOR = 2.8, 95% CI:1.77,4.53), and exposure to pornographic materials (AOR = 2.7, 95% CI:1.68,4.40) were significantly associated with early sexual initiation. CONCLUSION: A large number of students initiated sexual activity at an early age. The practiced is associated with sexual and reproductive health problems. Therefore, raising awareness of students about the risk factors for and implication of early sexual initiation through teachers, religious leaders, and parents is highly recommended.

Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis.

BACKGROUND: Although hypertensive disorders of pregnancy are the leading cause of poor perinatal outcomes in Ethiopia, there is no study that shows the national prevalence. Therefore, the aim of this study was to estimate the national pooled prevalence of hypertensive disorders of pregnancy from studies conducted in different parts of the country. METHODS: Databases; MEDLINE, PubMed, HINARI, EMBASE, Google Scholar and African Journals Online were searched by using different search terms on HDP and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test heterogeneity of studies. Egger's test was used to show the publication bias. The pooled prevalence of HDP and the odds ratio (OR) with 95% confidence interval was presented using forest plots. RESULT: Seventeen studies were included in this review, with a total of 258,602 pregnant women. The overall pooled prevalence of hypertensive disorders of pregnancy in Ethiopia was 6.07% (95% CI: 4.83%, 7.31%). The Subgroup analysis by region and year of study showed a higher prevalence of hypertensive disorders of pregnancy in Southern Nations, Nationalities, and Peoples' Region, 10.13% (95% CI = (8.5, 12.43)), and reduction in the rate of HDP from 1990's to 2010's, 8.54% reducing to 5.71% respectively. The pooled prevalence of pregnancy-induced hypertension (PIH) and preeclampsia/eclampsia alone were 6.29 and 5.47 respectively. Pregnant women ≥ 35 years old are more likely to develop hypertensive disorders of pregnancy, OR = 1.64 (95% CI = (1.18, 2.28)). No statistically significant difference was observed between HDP and younger maternal age (less than 20 years old); OR = 2.92 (95% CI = (0.88, 9.70)). There was no association between hypertensive disorders of pregnancy and number of pregnancy, OR = 1.37 (95% CI = 0.78, 2.41)). CONCLUSIONS: The prevalence of hypertensive disorders of pregnancy is high in Ethiopia. The problem is more common among older pregnant women (> 35 years old). Government and other stakeholders should give due attention to an early screening of hypertension during pregnancy.

The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia. METHODS: Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I2 test statistic and Egger's test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI). RESULT: A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09). CONCLUSION: Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.

Birth preparedness and complication readiness among pregnant women in Ethiopia: a systematic review and Meta-analysis.

ᅟ: Birth preparedness and complication readiness is an essential component of safe motherhood programs that promote appropriate utilization of skilled maternal and neonatal care. Preparing for childbirth and its probable complications can reduce delays in seeking care. In Ethiopia, there were limited data on birth preparedness and complication readiness at the national level except a small scale studies conducted.This systemic review and meta-analysis study was conducted to assess the national estimates regarding the status of birth preparedness and complication readiness among pregnant women in Ethiopia. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed during systemic review and meta-anaysis. The databases used to identify studies were; MEDLINE, PubMed, Google scholar, CINAHL, EMBASE and African Journals Online. Appropriate search terms were used to retrieve published studies conducted in Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for critical appraisal of studies. The meta-analysis was conducted using STATA 14 software. Forest plots were used to present the findings of this meta-analysis. The I2 test statistics and Egger's test were used to test heterogeneity and publication bias respectively. The pooled prevalence with 95% confidence intervals (CI) was computed. Duval and Tweedie nonparametric trim and fill analysis using the random-effect analysis was conducted to account for publication bias and high heterogeneity. RESULT: Thirteen studies and six thousand four hundred ninety three participants were included in this meta-analysis and overall pooled result showed 32% with 95% (25.6, 38.5) of the pregnant women were prepared for birth and its complications. In addition, 51.35% of women save money for birth and emergency case, 38.74% women identified skilled birth attendant, and only 26.33% of pregnant women were aware of danger signs during pregnancy. One fifth (20.59%) of women arranged transportation and 54.85% of women identified the place of birth. Only 8.18%pregnant women identified potential blood donor for emergency cases. CONCLUSION: Low proportions of pregnant women were prepared for childbirth and its complications. The Ministry of health, Regional health bureaus, health facilities and other stakeholders should work to improve birth preparedness and complication readiness among pregnant women in Ethiopia.

Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis.

BACKGROUND: Risky sexual practice is a major public health problem in Ethiopia. There are various studies on the prevalence and determinants of risky sexual practice in different regions of the country but there is no study which shows the national estimate of risky sexual practices in Ethiopia. Therefore, this review was conducted to estimate the national pooled prevalence of risky sexual practice and its risk factors in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed to review published and unpublished studies in Ethiopia. The databases used were; PubMed, Google Scholar, CINAHL and African Journals Online. Search terms were; risky sexual behavior, risky sexual practice, unprotected sex, multiple sexual partner, early sexual initiation, and/or Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal. The meta-analysis was conducted using Review Manager software. Descriptive information of studies was presented in narrative form and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were used to test heterogeneity across studies. The pooled estimate prevalence and the odd ratios with 95% confidence intervals were computed by a random effect model. RESULTS: A total of 31 studies with 43,695 participants were included in the meta-analysis. The pooled prevalence of risky sexual practice was 42.80% (95% CI: 35.64%, 49.96%). Being male (OR: 1.69; 95% CI: 1.21, 2.37), substance use (OR: 3.42; 95% CI: 1.41, 8.31), peer pressure (OR: 3.41; 95% CI: 1.69, 6.87) and watching pornography (OR: 3.6; 95% CI: 2.21, 5.86) were factors associated with an increase in risky sexual practices. CONCLUSIONS: The prevalence of risky sexual practices is high in Ethiopia. Being male, substance use, peer pressure and viewing pornographic materials were found to be associated with risky sexual practices. Therefore, life skills training is recommended to reduce peer pressure among individuals. Interventions should be designed to reduce substance use and viewing pornography.

Time to Treatment Failure and Its Predictors Among Second-Line ART Clients in Amhara Region, Ethiopia: A Retrospective Follow-Up Study.

Background: Second-line antiretroviral treatment failure has become a major public health issue, and the time to treatment failure among second-line ART clients varies globally, and the Sub-Saharan African region having a high rate of second-line ART treatment failures. In addition, after the ART treatment guideline changed there is limited information on Ethiopia. Therefore, this study aimed to assess time to treatment failure and its determinants among second-line ART clients in Amhara Region, Ethiopia. Methods: A multi-centered retrospective follow-up study was conducted. A random sample of 860 people on second-line ART was selected by using a computer-generated simple random sampling technique from January 30, 2016, to January 30, 2021, at the University of Gondar Compressive Specialized Hospital, Felege Hiwot Compressive Specialized Referral Hospital, and Debre Tabor Compressive Specialized Referral Hospital, in Amhara region, Ethiopia. Data was captured using a checklist. Results: A total of 81 (9.4%) ART clients developed second-line treatment failure, with a median follow-up time of 29 months with an interquartile range (IQR: 18, 41]. The risk of second-line treatment failure is higher among patients aged 15 to 30 years (adjusted hazard ratio (AHR) = 2.01, 95% confidence interval (CI): [1.16, 3.48]). Being unable to read and write (AHR = 1.312, 95% CI: [1.068, 1.613]), and poor ART drug adherence (AHR = 3.067, 95% CI: [1.845, 5.099]) were significant predictors of second-line ART treatment failures. Conclusion: In the current study, the time to second-line ART treatment failure was high compared with a previous similar study in Ethiopia. Factors like being younger age, ART clients who are not being able to read and write, and having poor ART drug adherence was significant predictors of second-line ART treatment failure.

Effects of armed conflicts on childhood undernutrition in Africa: a systematic review and meta-analysis.

BACKGROUND: Undernutrition is defined as not consuming enough nutrients and energy to meet one's needs for maintaining good health. It is exacerbated by armed conflict. Individuals cannot stick to jobs because of a lack of safety during conflicts, which has an impact on families' ability to purchase food. However, there is a paucity of evidence on pooled evidence on the impact of armed conflict on childhood undernutrition among children aged 6 to 59 months in Africa. Therefore, this review aimed to examine the effects of armed conflict on the magnitude of undernutrition, particularly stunting, underweight, and wasting among children in Africa. METHODS: A comprehensive literature search was conducted using electronic databases (PubMed, Hinari, and Google Scholar database) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I2 test statistics. Small-study effects were checked using Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence and associated factors of undernutrition among children aged 6-59 months in Africa. RESULTS: Of a total of 585 articles retrieved from the databases, 12 studies met our inclusion criteria. The pooled prevalence of wasting, stunting, and being underweight among conflict-affected African countries was 20.25% (95%CI = 15.08-25.43), 34.18% (95% CI = 26.34-42.02), and 24.00% (95%CI = 16.35-31.65), respectively. The most consistent factors associated with childhood stunting, wasting, and being underweight in Africa were low mother's education, prolonged duration of armed conflict, and rural place of residence. CONCLUSION: The severity of malnutrition crises will be assisted by a better understanding of the variables associated with child malnutrition, which will improve the effectiveness of development and humanitarian responses. We urge that health planners, policymakers, and the general public prioritize children with acute malnutrition in Africa's conflict-affected areas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022367487.

Contraceptive dynamics among women with disabilities in low- and middle-income countries: a scoping review protocol.

INTRODUCTION: Contraceptive dynamics is the use of contraception, unmet need, discontinuation, and/or switching of contraception. Women with disabilities (WWDs) in low- and middle-income countries (LMICs) face a common problem: a low prevalence of contraceptive usage and a high unmet need. Even though certain studies have been conducted in high-income countries, research is scarce on the degree of contraceptive method mix, unmet needs, contraception discontinuation, and switching among WWDs in LMICs. As a result, the scoping review's goal is to investigate, map available evidence, and identify knowledge gaps on contraceptive dynamics within LMICs WWDs. METHODS: The scoping review is guided by the six-stage Arksey and O'Malley methodology framework. Published articles will be retrieved from databases such as PubMed (MEDLINE), the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health. Grey literature databases will be searched using electronic search engines such as Google Scholar, Google, OpenGrey, and Worldcat. In addition, a manual search of reference lists from recognized studies will be conducted, as well as a hand search of the literature. Any type of study design (e.g., randomized controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case-control or nested case-control studies, qualitative, cross-sectional studies) will be included in this scoping review. There will be no restrictions on publication year. Two independent reviewers will screen relevant publications, and data will be charted accordingly. The Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist and reporting guidelines will be used to report all parts of the protocol and scoping review. DISCUSSION: When compared to non-disabled women, WWDs had a lower prevalence of contraceptive usage and a higher unmet need in LMICs. Despite these facts, they are the most marginalized people on the planet. This is, therefore, critical to map available evidence and identify knowledge gaps on contraceptive dynamics. As a result, the findings of this scoping review will be significant in terms of the contraceptive dynamic among WWDs in LMICs. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF), with registration number; DOI/10.17605/OSF.IO/XCKPT.

The psychological impact of COVID-19 pandemic and associated factors among college and university students in Ethiopia: a systematic review and meta-analysis, 2022.

Background: The Corona virus disease 19 (COVID-19) pandemic is a human tragedy that occurred in this era. It poses an unprecedented psychological, social, economic, and health crisis. The mental health and well-being of entire societies are suffering as a result of this crisis, but the suffering is greater in students at all levels of education and must be addressed immediately. Thus, this study was aimed to estimate the pooled prevalence and associated factors of the psychological impact of COVID-19 among higher education students. Methods: The potential studies were searched via PubMed, HINARI, the Cochrane Library, and Google Scholar. Studies were appraised using the Joanna Briggs Institute appraisal checklist. Micro Soft Excel was used to extract the data, which was then exported to Stata version 14 for analysis. Heterogeneity between studies was tested using Cochrane statistics and the I2 test, and small-study effects were checked using Egger's statistical test. A random-effects model was employed to estimate the pooled prevalence of the psychological impact of COVID-19 and its associated factor. Results: After reviewing 227 studies, eight fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of the psychological impact of Corona virus disease 19 among higher education students in Ethiopia, including depression, anxiety, and stress was 43.49% (95% CI: 29.59, 57.40%), 46.27% (95% CI: 32.77, 59.78%), and 31.43% (95% CI: 22.71, 40.15), respectively. Having a medical illness, being an urban resident, living with parents, having relative death due to pandemics, and having a non-health field of study were identified as significant associated factors for the impact of the pandemic in higher education students. Conclusion: The COVID-19 pandemic had a significant psychological impact on college and university students. Depression, anxiety, and stress were the most commonly reported psychological impacts across studies among higher education students. Hence, applying tele-psychotherapy using, smartphones, and social media platforms has an effect on reducing the impact. Programs for preventing and controlling epidemics should be developed by the government and higher education institutions that incorporate mental health interventions and build resilience.

Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021.

BACKGROUND: Diabetic neuropathy is the most common complication in both Type-1 and Type-2 DM patients with more than one half of all patients developing nerve dysfunction in their lifetime. Although, risk prediction model was developed for diabetic neuropathy in developed countries, It is not applicable in clinical practice, due to poor data, methodological problems, inappropriately analyzed and reported. To date, no risk prediction model developed for diabetic neuropathy among DM in Ethiopia, Therefore, this study aimed prediction the risk of diabetic neuropathy among DM patients, used for guiding in clinical decision making for clinicians. OBJECTIVE: Development and validation of risk prediction model for diabetic neuropathy among diabetes mellitus patients at selected referral hospitals, in Amhara regional state Northwest Ethiopia, 2005-2021. METHODS: A retrospective follow up study was conducted with a total of 808 DM patients were enrolled from January 1,2005 to December 30,2021 at two selected referral hospitals in Amhara regional state. Multi-stage sampling techniques were used and the data was collected by checklist from medical records by Kobo collect and exported to STATA version-17 for analysis. Lasso method were used to select predictors and entered to multivariable logistic regression with P-value<0.05 was used for nomogram development. Model performance was assessed by AUC and calibration plot. Internal validation was done through bootstrapping method and decision curve analysis was performed to evaluate net benefit of model. RESULTS: The incidence proportion of diabetic neuropathy among DM patients was 21.29% (95% CI; 18.59, 24.25). In multivariable logistic regression glycemic control, other comorbidities, physical activity, hypertension, alcohol drinking, type of treatment, white blood cells and red blood cells count were statistically significant. Nomogram was developed, has discriminating power AUC; 73.2% (95% CI; 69.0%, 77.3%) and calibration test (P-value = 0.45). It was internally validated by bootstrapping method with discrimination performance 71.7 (95% CI; 67.2%, 75.9%). It had less optimism coefficient (0.015). To make nomogram accessible, mobile based tool were developed. In machine learning, classification and regression tree has discriminating performance of 70.2% (95% CI; 65.8%, 74.6%). The model had high net benefit at different threshold probabilities in both nomogram and classification and regression tree. CONCLUSION: The developed nomogram and decision tree, has good level of accuracy and well calibration, easily individualized prediction of diabetic neuropathy. Both models had added net benefit in clinical practice and to be clinically applicable mobile based tool were developed.

Prognostication of treatment non-compliance among patients with multidrug-resistant tuberculosis in the course of their follow-up: a logistic regression-based machine learning algorithm.

Introduction: Drug compliance is the act of taking medication on schedule or taking medication as prescribed and obeying other medical instructions. It is the most crucial aspect in the treatment of chronic diseases particularly for patients with multidrug-resistant tuberculosis (MDR-TB). Drug non-compliance is the main reason for causing drug resistance and poor treatment outcomes. Hence, developing a risk prediction model by using early obtainable prognostic determinants of non-compliance is vital in averting the existing, unacceptably high level of poor treatment outcomes and reducing drug resistance among MDR-TB patients. Materials and methods: A retrospective follow-up study was conducted on a total of 517 MDR-TB patients in Northwest Ethiopia. A logistic regression-based machine learning algorithm was used to develop a risk score for the prediction of treatment non-compliance among MDR-TB patients in selected referral hospitals of Northwest Ethiopia. The data were incorporated in EpiData version 3.1 and exported to STATA version 16 and R version 4.0.5 software for analysis. A simplified risk prediction model was developed, and its performance was reported. It was also internally validated by using a bootstrapping method. Results: Educational status, registration group (previously treated/new), treatment support, model of care, and khat use were significant prognostic features of treatment non-compliance. The model has a discriminatory power of area under curve (AUC) = 0.79 with a 95% CI of 0.74-0.85 and a calibration test of p-value = 0.5. It was internally validated by using a bootstrapping method, and it has a relatively corrected discriminatory performance of AUC = 0.78 with a 95% CI of 0.73-0.86 and an optimism coefficient of 0.013. Conclusion: Educational status, registration group, treatment supporter, model of care, and khat use are important features that can predict treatment non-compliance of MDR-TB patients. The risk score developed has a satisfactory level of accuracy and good calibration. In addition, it is clinically interpretable and easy to use in clinical practice, because its features are easily ascertainable even at the initial stage of patient enrolment. Hence, it becomes important to reduce poor treatment outcomes and drug resistance.

Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis.

Background: Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation. Methods: This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy. Results: Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers. Conclusion: The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.

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

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

Tenofovir Disoproxil Fumarate-Associated Renal Dysfunction Among Adult People Living with HIV at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2019: A Comparative Retrospective Cohort Study.

BACKGROUND: The use of tenofovir disoproxil fumarate (TDF) has been reported to be a significant contributor to renal dysfunction. However, patients in Ethiopia may be different than in other parts of the world, and findings from such studies may not apply in this setting. OBJECTIVE: This study aimed to assess TDF-associated renal dysfunction among adult people living with HIV (PLHIV) at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. METHODS: This retrospective cohort study included adult PLHIV between January 2015 and June 2019. The Chronic Kidney Disease Epidemiology (CKD-EPI) equation was used to estimate glomerular filtration rate (eGFR). Renal dysfunction was defined as eGFR <60 mL/min/1.73 m2. Data were entered into Epi Info™ 7 and analyzed by using SPSS® software version 20. The Kaplan-Meier method was used to estimate the survival curves. Cox proportional hazards models were used to identify predictors of renal dysfunction using a 95% confidence interval and p-value ≤ 0.05 as a statistical significance. RESULTS: Out of 400 participants, 200 were TDF-based ART groups, and 200 were non-TDF-based ART groups. The incidence of renal dysfunction of TDF and the non-TDF group was 28.31 per 100 person-years (PYs) and 12.53 per 100 PYs, respectively. Adult PLHIV taking TDF-based regimens were 1.70 (adjusted HR = 1.70; 95% CI = 1.02-2.82) times at higher risk of renal dysfunction than non-TDF-based regimens. Age ≥55, diabetes mellitus, concurrent nephrotoxic drug use, and combined use of ritonavir-boosted protease inhibitors were also associated significantly with renal dysfunction. CONCLUSION: The incidence rate of renal dysfunction among TDF users is higher than non-TDF users. Exposure to TDF is a significant risk of renal dysfunction in adult PLHIV. Clinicians should regularly monitor the renal function of adult PLHIV who are taking TDF.

Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia.

BACKGROUND: Maternity continuum of care is a model of integrated components of maternal health service from pregnancy to the post-partum period to improve maternal, neonatal and child health. In Ethiopia, the magnitude of antenatal care, skilled delivery, and post-natal care have shown improvement. However, there is limited evidence of the woman who attends continuing from antenatal care to post-partum care. OBJECTIVE: To assess completion of maternity continuum of care and its associated factors among women, in Motta town and Hulet Eji Enese district, Northwest Ethiopia. METHODS: A community based cross-sectional study with a stratified cluster sampling technique was conducted among 819 women 6week-6month post-partum period in Motta town and Hulet Eji Enese district. The data were collected from March 12, 2019 to April1, 2019 by face to face interviews, using a pretested structured questionnaire. Binary logistic regression (bi-variable and multivariable) model was done. Adjusted odds ratio with respect to 95% confidence interval was employed in the strength and direction of the association between covariates and outcome variable. Besides, a P value<0.05 was used to declare statistical significance. RESULTS: A total of 819 women with100% response rate participated and Completion of maternity continuum of care was found to be 47% (43.2%-50.2%) in the study. Educational attainment of Secondary school and above (adjusted odds ratio(AOR) = 3.5; 1.9-6.3), urban residence (AOR = 4.6; 95%CI 2.5-8.5), women reach to a health facility within 30minute(AOR = 2.1; 95%CI 1.2-3.7), a woman was the primary decision maker for attending maternity continuum of care(AOR = 3.5;95%CI 1.9-6.3), index pregnancy-related complication(AOR = 2.4;95%CI 1.1-5.3), starting antenatal care within second trimester (AOR = 3.4;95%CI 2.1-5.6) and antenatal care visit 3-4 times(AOR = 2.1;95%CI 1.2-3.8) were statistically significant with completion of maternity continuum of care. CONCLUSIONS: The completion of maternity continuum of care is low in the study area. Improving the educational status of women, engaging the rural community, physical accessibility of health facility, woman empowerment for decision making, emphasis on giving care for pregnancy-related complication, and early gestational age antenatal care at least 3 or more visits suggested to increase completion of maternity continuum of care.