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Kassahun Alemu Gelaye,1 Getu Debalkie Demissie,2 Tadesse Awoke Ayele,1 Sintayehu Daba Wami,3 Malede Mequanent Sisay,1 Temesgen Yihunie Akalu,1 Destaw Fetene Teshome,1 Haileab Fekadu Wolde1 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Haileab Fekadu Wolde Email haileabfekadu@gmail.comObjective: Ethiopia has the second highest burden of visceral leishmaniasis (VL) next to Sudan. North West Ethiopia alone accounts for 60% of the national burden. Migrant and seasonal farmworkers were the riskiest groups. Good knowledge and attitude on VL is a precursor for successful control of the disease. Therefore, this study was aimed to determine knowledge and attitude towards VL and its associated factors among migrants and seasonal farmworkers in West Gondar zone, Northwest Ethiopia.Methods: A community-based cross-sectional study was conducted from October to November 2018 in Metema and West Armachiho districts. Two-stage cluster sampling was used to select 950 migrant and seasonal farmworkers. A binary logistic regression model was fitted and variables having a P-value< 0.05 were considered to have a significant association with the outcome variable. Odds ratio (OR) with 95% confidence interval (CI) was used as a measure of association. The goodness of fit test was assessed by Hosmer–Lemeshow test.Results: Of the total participants, 33.2% (95% CI=30.2– 36.2) and 30.2% (95% CI=27.4– 33.2) were found to have good knowledge and favorable attitude towards VL, respectively. Factors associated with good knowledge include having health information (AOR=3.2, 95% CI=2.3– 4.4), previous history of VL (AOR=6.8, 95% CI=3.7– 12.8), and higher age (AOR=1.58, 95% CI=1.12– 2.23). Moreover, factors associated with favorable attitude include having health information (AOR=2.8, 95% CI=2.0– 3.9), previous history of VL (AOR=2.3, 95% CI=1.3– 4.1), good knowledge (AOR=2.4, 95% CI=1.7– 3.3), and larger number of visits to the farm area (AOR=2.5, 95% CI=1.5– 4.1).Conclusion: In this study, knowledge and attitude of migrants and seasonal farmworkers towards VL were low. Having health information and previous history of VL had increased the odds of both knowledge and attitude. Tailored interventions for the migrant seasonal farmworkers focusing on knowledge and attitude of VL would be supremely important.Keywords: attitude, knowledge, VL, migrants and seasonal farmworkers, West Gondar

Asaye Tariku Alem,1 Malede Mequanent Sisay,2 Abiy Maru Alemayehu3 1Amhara National Regional Health Bureau, Central Gondar Zone Health Department, Public Health Emergency Management Office, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia; 3Department of Optometry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Malede Mequanent Sisay Tel +251918520611Email maledecsa@gmail.comBackground: Voluntary counseling and testing (VCT) is a vital response to human immunodeficiency virus (HIV) infection among adolescents in sub-Saharan Africa. Determining the status of VCT services is important to link HIV care and antiretroviral therapy.Methods: An institutional cross-sectional study design was conducted among 841 young students at Gondar College of Teachers’ Education. A self-administered questionnaire was used to gather the data. Descriptive statistics were performed. Bivariate and multivariable binary logistic regressions were used to identify factors associated with the use of VCTs. The adjusted odds ratio (AOR) with 95% confidence was used to report statistical significance.Results: The majority (71%) were aware of VCT services. More than one-third (37.8%, 95% CI: 34.6– 41.2) participants had used VCT services. Having peer groups used VCT (AOR=2.04, 95% CI: 1.31– 3.20), having partner (AOR: =1.6, 95% CI: 1.04– 2.45), desiring to have VCT in the future (AOR=3.58, 95% CI: 1.98– 6.50), being aware of VCT (AOR= 1.98, 95% CI: 1.20– 3.34), knew infected/dead individuals with HIV/AIDS (AOR=1.67, 95% CI: 1.07– 2.61), know test sites (AOR=2.01, 95% CI: 1.29– 3.13) were positively associated, whereas being married (AOR=0.36, 95% CI: 0.20– 0.63) and fear of confidentiality (AOR=0.23, 95% CI: 0.10– 0.52) were major barriers to use.Conclusion: Low use of VCTs, which was far away from the 90:90:90 WHO goal, has been noted. The use of VCT services was associated with having peer groups that used VCT, having a partner, wanting to have VCT in the future, knowing the infected/dead individual with HIV/AIDS, fear of confidentiality of results, knowing the test sites, and having awareness of VCT. Efforts are needed to strengthen the health system that also needs to pay attention to education about HIV and VCT.Keywords: youth, VCT utilization, Ethiopia, HIV

Adisu Birhanu Weldesenbet,1 Tadesse Awoke Ayele,2 Malede Mequanent Sisay,2 Biruk Shalmeno Tusa,1 Sewnet Adem Kebede2 1Department of Epidemiology and Biostatistics, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, EthiopiaCorrespondence: Adisu Birhanu Weldesenbet Tel +251968295598Email adisuebi2009@gmail.comBackground: Human immunodeficiency virus (HIV) remains a major global public health issue, particularly in Africa. In resource-limited settings like Ethiopia, regular weight measurement and monitoring is useful in the examination of patient response to antiretroviral therapy and in clinical decision-making. However, there is a paucity of evidence on factors that affect longitudinal weight change. Therefore, the present study was intended to identify predictors of weight change among people living with HIV (PLWH) in West Hararghe, Ethiopia.Methods: An institutional-based retrospective cohort study was conducted among 558 PLWH aged 18 years and above from September 2013 to January 2019 at Chiro Zonal Hospital and Gelemso General Hospital in West Hararghe zone, Ethiopia. Data were entered in Epi info 7 and analyzed in R software. The linear mixed effect regression model was used to identify predictors of longitudinal change in weight. Regression coefficients with their 95% confidence intervals were used to indicate the strength and significance of the association.Results: Weight showed improvement in follow-up periods. In this study, age of respondent (beta=0.136, 95% CI, 0.044:0.227), time since the initiation of antiretroviral therapy (ART) (beta=0.089, 95% CI, 0.075:0.104), primary educational status (beta=2.403, 95% CI, 0.540:4.266), secondary educational status (beta=4.035, 95% CI, 1.666:6.404), tertiary and above educational status (beta=3.444, 95% CI, 0.330:6.558), sex (beta= − 5.514, 95% CI, -7.260:-3.768), ambulatory functional status (beta= − 3.419, 95% CI, − 6.169:-0.668) and baseline CD4 count (≤ 200) (beta=2.205, 95% CI, 0.593, 3.817) were significant predictors of longitudinal weight change.Conclusion: We observed an increment in weight among PLWH who were on ART in Ethiopia. Educational status, time since the beginning of ART, age and having CD4 count above 200 have contributed positively to the change in weight, while ambulatory functional status and being female are negatively associated with longitudinal change in weight. Close monitoring is recommended for patients with ambulatory baseline functional status and for patients with baseline CD4 count ≤ 200.Keywords: weight change, PLWH, ART, linear mixed effect model, Ethiopia

Introduction: Protecting digital health data from unauthorized access, alteration, and destruction is a crucial aspect of healthcare digitalization. Currently, digital security breaches are becoming more common. Healthcare data breaches have compromised over 50 million medical records per year. In Ethiopia, health digitization has grown gradually. However, there is a limitation of study in digital health security. Studying digital health data security helps individuals protect digital data as a baseline and contributes to developing a digital health security policy., Objective: To assess the practice of healthcare professionals in digital health data security among specialized teaching referral hospitals in Amhara Region, Ethiopia., Method: A cross-sectional study design supplemented by a qualitative purposive sampling method was used to measure the digital data security practices of health professionals. The sample size was determined via single population proportion formula. A simple random sampling technique was used for the study participants. Then, self-administered questionnaires were administered. Multivariable logistic analysis was used to identify associated factors using STATA software. For the qualitative study, key informant interviews were used and analyzed using thematic analysis approach via open-code software., Results: Out of the 423 health professionals, 95.0% were involved in the survey. The finding indicates digital health data security practice of health professionals working at specialized teaching hospitals were 45.0%, CI: (40, 50). Health professionals 41-45-year age group (AOR = 0.107), master's degree (AOR = 2.45), postmaster's degree (AOR = 3.87), time to visit the internet for more than two hours (AOR = 2.46), basic computer training (AOR = 2.77), training in digital data security (AOR = 2.14), and knowledge (AOR = 1.76) were associated with the practice of digital health data security. For the qualitative study, three teams were prepared. The findings indicate digital health data security can be improved through training, advanced knowledge and working with digital security., Conclusion: The practice of digital health data security in specialized teaching hospitals in the Amhara region was inadequate. Therefore, it can be improved through enhancing education status, increasing the time needed to visit the internet, providing computer training, and updating health professionals' knowledge toward digital health data security., Competing Interests: Declarations. Ethics approval and consent to participate: The Institutional Review Board (IRB) of the University of Gondar, College of Medicine and Health Science, the institution of the public health ethical review committee, approved the ethical clearance with ref. no/IPH/2013/2014/. To collect further information, a formal letter was then sent from the main executives of specialized teaching hospitals to the concerned unit coordinator. Written consent forms were provided with each questionnaire. The respondents were well informed about the purpose, and appropriate informed written consent was obtained from them. In addition, each method was performed in accordance with the relevant guidelines and regulations of the Helsinki declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Depression is a major public health problem among adult breast cancer patients. Although there are few studies on depression, data were mainly from a single center and the potential risk factors were not exhaustively addressed. Thus, we aimed to investigate the prevalence of depression and risk factors among adult breast cancer patients at two big hospitals in Addis Ababa., Objective: To assess depression and its associated factors among breast cancer patients attending public hospitals in Addis Ababa, Ethiopia, in 2021., Methods: An institution-based cross-sectional study was conducted among adult patients with breast cancer attending at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College from June to July 2021. Simple random sampling was used to obtain a sample size of 318. Data were collected using the standard Patient Health Questionnaire-9, structured questionnaire interviews, and chart reviews. SPSS version 25 was used for analysis; the correlation between independent and dependent variables was evaluated using a logistic regression model. Each analysis regarded a p -value less than 0.05 as statistically significant., Result: The mean age of the participants was 43.1 ± 11.3 years. The prevalence of depression among adult breast cancer patients was 33 (10.6%), and according to the patient health questionnaires (PHQ)-9 score categorization, 116 (37.3%) were minor, 28 (9%) were moderate, and 5 (1.6%) had moderate severity. The duration of diagnosis was <12 months and stage 2 breast cancer was more protective against depression than stage 4 breast cancer. A lower monthly income and poor social support were significantly associated with depression., Conclusion: The prevalence of depression was moderate among adult patients with breast cancer; the stage of cancer, duration of diagnosis, income, and poor social support were significantly associated with depression, emphasizing the value of counseling., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Purpose: Evidence supports that the Health Belief Model (HBM) can explain and predicts certain health behaviors, including participation in cervical cancer (CC) screening. The purpose of this study was to evaluate the psychometric properties of a modified HBM for CC and visual inspection with acetic acid (VIA) in female healthcare professionals in Addis Ababa, Ethiopia, 2020., Methods: Psychometric properties related to CC and VIA were tested using 42-item modified HBM self-administered questionnaire and a cross-sectional study design with simple random sampling. Kaiser-Meyer-Olkin and Bartlett's sphericity test indicated that data sampling adequacy for exploratory factor analysis was 0.792 (χ2 = 3189.95, df = 351, p < .001). Items with cross-loading and factor loadings ≥ 0.5 were retained. Confirmatory factor analysis (CFA) was conducted to determine model fit., Results: The final analysis included 194 women, (mean age 30±4.34). Twelve items with ≤ 0.5 were removed and 30 retained items loaded into 6 factors; (benefits of VIA, perceived seriousness of CC, barrier (fear of negative outcome), self-efficacy, susceptibility to CC, and barriers (health system delivery)) explained 65% of the total variance. Cronbach's alpha for the total instrument was 0.8 and reliability for the 6 subscales was 0.76-0.92. Composite reliability and average variance extracted indicated good internal consistency and convergent validity. CFA identified 6 additional items to be removed with high residual covariance. The final 24 items of the modified HBM had an acceptable model fit (goodness-of-fit index (GFI) = 0.861, adjusted GFI = 0.823, comparative fit index = 0.937, root mean square error of approximation = 0.059)., Conclusion: The modified HBM for CC and VIA with 24 items had adequate psychometric properties and may be used by Ethiopian healthcare professionals for research or clinical purposes. To support external validity the updated 24 items tool is suggested for application in further study in different populations in Ethiopia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Lemlem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Hepatitis B virus (HBV) infection continues to be a major public health issue worldwide. Health information-seeking behavior is critical to obtain information about health, diseases such as the Hepatitis B virus, health risks, and health promotion and it has become a major concern of health policymakers. However, there is little evidence of information-seeking behavior on the Hepatitis B virus in Ethiopia. So, this study aimed to assess Hepatitis B virus information-seeking behavior and its associated factors among pregnant women at teaching and Specialized Hospitals, in Northwest Ethiopia., Methods: An institution-based cross-sectional study was conducted among pregnant women at teaching and specialized hospitals, in Northwest Ethiopia from May 01 to June 01, 2022. A total of 423 participants were selected using a systematic random sampling method. The data was collected through an interview-administered questionnaire by kobo-collect software. Then export into SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were done to identify factors associated with Hepatitis B virus information-seeking behavior., Results: The proportion of information-seeking behavior on the Hepatitis B virus among pregnant women was 40.5% (CI = 35.7, 45.6). Education(diploma and above) [AOR = 3.3, 95% CI (1.31, 8.16)], more than one ANC visit [AOR = 5.99, 95% CI (3.20, 12.31)], smart-phone ownership [AOR = 4.1, 95%CI (1.35, 12.31)], internet access [AOR = 5.1, 95%CI (1.35, 15.60)], perceived susceptibility [AOR = 2.7, 95%CI (1.38, 5.31)], perceived severity [AOR = 3.7, 95%CI (2.06, 6.55)], and self-efficacy [AOR = 1.9, 95%CI (1.03, 3.73)] were factors influencing information seeking on Hepatitis B virus., Conclusion: The overall proportion of information-seeking behavior on HBV among pregnant women was low. To improve information-seeking behavior on HBV among pregnant women we should connect the women to the internet and technology. Creating women's awareness about the Hepatitis B virus severity and their venerability and increasing their antenatal care (ANC) visits, self-efficacy, internet access, and women's education can improve information seeking about the Hepatitis B virus., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Shibabaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women's empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women's empowerment and dietary diversity during pregnancy is limited in Ethiopia., Objective: This study aimed to assess the mediating effects of women's empowerment in the pathway between women's education and dietary diversity during pregnancy in West Shewa zone, Ethiopia., Methods: A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women's empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women's education and empowerment to dietary diversity during pregnancy., Results: From the latent dimensions of women's empowerment produced by factor analyses, pregnant women's education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women's education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women's education and dietary diversity. However, economic dimension was related to neither pregnant women's education nor dietary diversity., Conclusion: This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women's access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.

Background: Considerable proportions of pregnant women are affected by poor nutrition outcomes in Ethiopia. Women's empowerment, on the other hand, is highly recognized as a means to achieve better maternal nutrition outcomes. However, the role of pregnant women's empowerment in nutritional status during pregnancy has not been empirically examined in Ethiopia. This study aimed to address this gap., Objective: To assess the association of individual and composite women's empowerment dimensions with pregnant women's nutrition outcomes in West Shewa Zone, Ethiopia., Methods: A health facility-based cross-sectional study was performed on 1,453 pregnant women living in West Shewa Zone, Ethiopia, in 2021. Exploratory and confirmatory factor analyses were conducted on half of the samples to identify and validate dimensions of pregnant women's empowerment. The associations between pregnant women's empowerment dimensions and anemia status and mid upper arm circumference levels were examined by logistic regressions., Results: Composite pregnant women's empowerment was positively associated with both anemia status and mid-upper-arm circumference level. The odds of not being anemic were higher among pregnant women empowered in economic [adjusted odds ratio (AOR) = 1.7, 95% confidence interval (CI): 1.26, 2.22] and assertiveness (AOR = 1.9, 95% CI: 1.46, 2.38) dimensions than those not empowered in these dimensions. Empowered pregnant women in household decision-making (AOR = 1.6, 95% CI: 1.19, 2.22) and psychological (AOR = 1.4, 95% CI: 1.04, 1.85) dimensions had higher odds of having normal mid-upper-arm circumference measures than those not empowered in the respective dimensions. Communication and time dimensions were not significantly associated with any of the nutrition outcomes., Conclusions: This study suggests that empowered pregnant women are nutritionally better off than their less empowered counterparts. This is also important in child health outcomes. Policies and programs that aim to improve maternal and child health in the study area need to consider interventions that promote the decision-making power, economic, psychological, and assertiveness dimensions of pregnant women., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Etea, Yalew, Sisay and Shiferaw.)

Not all COVID-19 deaths are officially reported, and particularly in low-income and humanitarian settings, the magnitude of reporting gaps remains sparsely characterized. Alternative data sources, including burial site worker reports, satellite imagery of cemeteries, and social media-conducted surveys of infection may offer solutions. By merging these data with independently conducted, representative serological studies within a mathematical modeling framework, we aim to better understand the range of underreporting using examples from three major cities: Addis Ababa (Ethiopia), Aden (Yemen), and Khartoum (Sudan) during 2020. We estimate that 69 to 100%, 0.8 to 8.0%, and 3.0 to 6.0% of COVID-19 deaths were reported in each setting, respectively. In future epidemics, and in settings where vital registration systems are limited, using multiple alternative data sources could provide critically needed, improved estimates of epidemic impact. However, ultimately, these systems are needed to ensure that, in contrast to COVID-19, the impact of future pandemics or other drivers of mortality is reported and understood worldwide.

Background: Post-marketing vaccine safety surveillance aims to monitor and quantify adverse events following immunization in a population, but little is known about their implementation in low- and middle-income countries (LMICs). We aimed to synthesize methodological approaches used to assess adverse events following COVID-19 vaccination in LMICs., Methods: For this systematic review, we searched articles published from 1 December 2019 to 18 February 2022 in main databases, including MEDLINE and Embase. We included all peer-reviewed observational COVID-19 vaccine safety monitoring studies. We excluded randomized controlled trials and case reports. We extracted data using a standardized extraction form. Two authors assessed study quality using the modified Newcastle-Ottawa Quality Assessment Scale. All findings were summarized narratively using frequency tables and figures., Results: Our search found 4254 studies, of which 58 were eligible for analysis. Many of the studies included in this review were conducted in middle-income countries, with 26 studies (45%) in lower-middle-income and 28 (48%) in upper-middle-income countries. More specifically, 14 studies were conducted in the Middle East region, 16 in South Asia, 8 in Latin America, 8 in Europe and Central Asia, and 4 in Africa. Only 3% scored 7-8 points (good quality) on the Newcastle-Ottawa Scale methodological quality assessment, while 10% got 5-6 points (medium). About 15 studies (25.9%) used a cohort study design and the rest were cross-sectional. In half of them (50%), vaccination data were gathered from the participants' self-reporting methods. Seventeen studies (29.3%) used multivariable binary logistic regression and three (5.2%) used survival analyses. Only 12 studies (20.7%) performed model diagnostics and validity checks (e.g., the goodness of fit, identification of outliers, and co-linearity)., Conclusions: Published studies on COVID-19 vaccine safety surveillance in LMICs are limited in number and the methods used do not often address potential confounders. Active surveillance of vaccines in LMICs are needed to advocate vaccination programs. Implementing training programs in pharmacoepidemiology in LMICs is essential.

Background: Unscheduled discontinuation of contraceptives is a public health problem among women of reproductive age. Particularly, it is associated with unwanted pregnancies that lead to maternal and child mortality, but little is known about the spatial distribution of the problem. Therefore, this study aims to assess the spatial distribution and associated factors of unscheduled contraceptive discontinuation in Ethiopia., Method: This study used secondary data from the Ethiopia Demography and Health Survey (EDHS) data of 2005 and 2016. The study population was women who used contraceptives in the preceding 5 years before the survey. A total of 2,327 and 3,858 eligible women were included in the final analysis of the 2005 and 2016 EDHS, respectively. For the spatial analysis, both the 2005 and the 2016 EDHS data were analyzed using ArcGIS version 10.7, while for multilevel regression analysis, the 2016 EDHS data were used. The final model reported an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and a p -value of 0.05 was used to declare statistical significance., Result: This study revealed that unscheduled discontinuation of contraceptives varied geographically, and hotspots were detected in the central, north, and eastern parts of Ethiopia. Moreover, diploma and higher education (AOR = 1.40; 95% CI: 1.01-1.95), urban residence (AOR = 1.37; 95% CI: 1.08-1.72), history of termination of pregnancy (AOR = 1.47; 95% CI: 1.14-1.94), married women (AOR = 10.79; 95% CI: 6.98-16.69), separated/divorced women (AOR = 1.54: 95% CI: 1.07-2.30), -two to four number of children (AOR = 1.46; 95% CI: 1.15-1.84), and involvement in the decision-making process of contraceptive use (AOR = 39.26; 95% CI: 28.84-53.45) were all factors associated with unscheduled discontinuation of contraceptives., Conclusion: This study revealed that unscheduled discontinuation of contraceptive distribution was significantly clustered in the central, north, and eastern parts of Ethiopia, as found in two surveys. The magnitude of this discontinuation increased from 2005 to 2016. The finding underscores that further interventions such as the availability of multiple mixed methods and improvement in women's decision-making ability in the choice of contraceptive methods and utilization are needed in hotspot areas of Ethiopia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Tamirat, Nigatu, Tesema, Sisay and Tessema.)

Background: Estimates of the association between COVID-19 vaccines and myo-/pericarditis risk vary widely across studies due to scarcity of events, especially in age- and sex-stratified analyses. Methods: Population-based cohort study with nested self-controlled risk interval (SCRI) using healthcare data from five European databases. Individuals were followed from 01/01/2020 until end of data availability (31/12/2021 latest). Outcome was first myo-/pericarditis diagnosis. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. Baseline incidence rates (IRs), and vaccine- and dose-specific IRs and rate differences were calculated from the cohort The SCRI calculated calendar time-adjusted IR ratios (IRR), using a 60-day pre-vaccination control period and dose-specific 28-day risk windows. IRRs were pooled using random effects meta-analysis. Findings: Over 35 million individuals (49·2% women, median age 39-49 years) were included, of which 57·4% received at least one COVID-19 vaccine dose. Baseline incidence of myocarditis was low. Myocarditis IRRs were elevated after vaccination in those aged < 30 years, after both Pfizer vaccine doses (IRR = 3·3, 95%CI 1·2-9.4; 7·8, 95%CI 2·6-23·5, respectively) and Moderna vaccine dose 2 (IRR = 6·1, 95%CI 1·1-33·5). An effect of AstraZeneca vaccine dose 2 could not be excluded (IRR = 2·42, 95%CI 0·96-6·07). Pericarditis was not associated with vaccination. Interpretation: mRNA-based COVID-19 vaccines and potentially AstraZeneca are associated with increased myocarditis risk in younger individuals, although absolute incidence remains low. More data on children (≤ 11 years) are needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bots, Riera-Arnau, Belitser, Messina, Aragón, Alsina, Douglas, Durán, García-Poza, Gini, Herings, Huerta, Sisay, Martín-Pérez, Martin, Overbeek, Paoletti, Pallejà-Millán, Schultze, Souverein, Swart, Villalobos, Klungel and Sturkenboom.)

Background: Respiratory distress syndrome (RDS) is caused by a deficiency of a molecule called surfactant. It occurs in newborns born before 37 weeks of gestation. It is a main cause of morbidity and mortality in the early neonatal period. Therefore, this study aims to assess median time to recovery and predictors of preterm neonates with respiratory distress syndrome admitted in University of Gondar comprehensive specialized hospital Northwest Ethiopia 2020., Methods: Institution based retrospective follow up study was conducted on 386 preterm neonates with hyaline membrane disease who were admitted in the neonatal intensive care unit from January, 2016 to December 2018. The data were entered in to EPI info version 7.0 and transferred to Stata version 14.0 for analysis. Both bi-variable and multi variable Weibull parametric model were fitted to identify predictors with 95% confidence interval of hazard ratio (HR) and p-value. P-value less than 0.05 in the multivariable model showed the presence of significant association between covariates and the dependent variable., Results: The overall median length of recovery were 11 day with an interquartile range of (7, 16) neonate-days. Being a product of multiple pregnancy (AHR 1.67; 95%CI (1.25, 2.23)), vaginal mode of delivery (AHR 1.6; 95%CI (1.13, 2.26)), and neonatal hypothermia at admission (AHR 1.6; 95%CI (1.13, 2.26)) were found to be significant predictors of time to recovery., Conclusion: In this study the median time to recovery of preterm neonates with respiratory distress syndrome was slower than the clinical recommendations. Receiving bag and mask ventilation and hypothermia decreased the recovery whereas, vaginal delivery gestational age at birth, being multiple pregnancy, birth weight ≥2000grams were enhance the recovery of preterm neonates with RDS., Competing Interests: The authors declared no potential competing interest with respect to the research, authorship and publication of this article.

Background: COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia., Methods: A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported., Results: The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments., Conclusion: The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Despite decreasing the percentage of women with unmet needs, Ethiopian women still have a higher unmet need for family planning due to different factors. Therefore, addressing the unmet need for FP provides an opportunity for policymakers in all sectors to respond to the expressed fertility preferences of their population. This study aimed to analyze trends and determinants of changes in unmet needs over time among married women of reproductive age in Ethiopia., Methods: The study used data from three consecutive Demographic and Health Surveys conducted in Ethiopia (2005, 2011, and 2016). These nationally representative household surveys cover all Ethiopia region and city administrations with population health and other relevant indicators). The study included a total weighted sample of 8642 in 2005, 10204 in 2011, and 9824 in 2016 in the final analysis. Factors contributing to the change in unmet need rate were examined using logit-based multivariate decomposition analysis., Results: Among married women, unmet needs declined from 33.8% (95% confidence interval (CI):32.8,34.8) in 2005 to 21.0%(95%CI:20.2,21.9) in 2016. In decomposition analysis, the difference in coefficients was responsible for 90% of the overall change in the unmet need rate. In particular, being at the age of 25-49 years, rural place of residence, agrarian regions, and having more than four children were significant predictors of the increase in unmet need rate., Conclusions: Unmet needs among women have shown a remarkable decline over the last decade in Ethiopia. Policy and program interventions better targeting younger, agrarian regions and rural dwellers would help to maintain a declining trend in unmet needs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Azanaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Even though determining the time to anti-retroviral therapy (ART) adverse drug reaction and its predictors is a crucial step to overcome the negative consequences of the adverse drug reaction, there is limited information regarding the time to ART adverse drug reaction and its predictors. Therefore, this study aimed to determine the time to first ART adverse drug reaction and its predictors among adult HIV/AIDS patients on first-line antiretroviral therapy in West Hararghe Zone, Eastern Ethiopia. Methods: An institution-based retrospective cohort study was conducted on 561 HIV/AIDS patients on first-line ART from September 2013-January 2019 at public hospitals in West Hararghe Zone, Eastern Ethiopia. Data were collected using checklists and document reviews, entered using Epi Info and analyzed in R software. A Cox proportional hazard model was fitted to identify predictors of the time to first ART adverse drug reaction. Model adequacy was checked using Cox Snell residuals. An adjusted hazard ratio with its confidence interval was used to show the presence and strength of association at a 95% confidence level. Result: Most (90.74%) ART adverse drug reactions occurred within 1 year of initiation of ART. Overall, 54 patients developed ART adverse drug reactions with an incidence density of 3.5/100 persons-years of observations (95% CI: 2.7-4.6). The initial ART regimen (TDF, 3TC, EFV) [AHR = 0.3, 95% CI 0.1-0.7], fair adherence [AHR = 8.8, 95% CI 3.3-23.2], poor adherence [AHR = 7.8, 95% CI 3.1-19.5], moderate body mass index (BMI) at the baseline [AHR = 4.4, 95% CI 1.8-11.0], severe body mass index [AHR = 2.8, 95% CI 1.1-6.8], World Health Organization (WHO) stage II [AHR = 3.7, 95% CI 1.2-11.3] and WHO stage IV [AHR = 6.3, 95% CI 2.0-19.8] were significant predictors of the time to ART adverse drug reactions. Conclusion: In conclusion, most of the ART adverse drug reactions occurred within 1 year of initiation of ART. The initial ART regimen (TDF, 3TC, EFV), adherence, HIV/AIDS stage, and BMI were risk factors for the time to ART adverse drug reaction. The incidence of the antiretroviral therapy adverse reaction was relatively low with early onset. Close monitoring of clients in clinical stage II and above is required and continuous assessment for improving the detection and management of adverse drug reactions is recommended. Patients with poor adherence need to get continuous counseling to improve their adherence status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Weldesenbet, Tusa, Debele, Sisay and Ayele.)

Background: Unmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey., Methods: This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data's hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics., Results: Overall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country., Conclusions: In this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority., (© 2022. The Author(s).)

Background: Migrant and seasonal farmworkers are at increased risk for occupational fatalities and injuries. Although such employment-related geographical mobility is receiving increasing attention, there is limited evidence about occupational health problems among seasonal farmworkers. Therefore, this study aims to investigate occupational health problems among seasonal and migrant farmworkers in Ethiopia., Methods: A cross-sectional study design was employed from October to December 2019 among seasonal and migrant farmworkers. The study was carried out in two sites of Amhara regional state, northwest Ethiopia. A cluster sampling technique was used to recruit 990 study participants. Bivariable and multivariable binary logistic regression analyses were performed using SPSS version 20 to identify factors associated with injuries. The significance level was obtained at 95% CI and p -value ≤0.05., Results: In this study, the period prevalence of work-related injury among seasonal and migrant farmworkers was 32.5% (95% CI: 29.7, 35.9). Being unemployed before migration (AOR = 2.22, 95% CI: 1.26, 3.91), working for >8 h/day (AOR = 1.62, 95% CI: 1.16, 2.27), stress (AOR = 1.38, 95% CI: 1.02, 1.88) and thermal discomfort (AOR = 1.48, 95% CI: 1.09, 1.98) were the significant risk factors for work-related injury. In addition, nearly two-third (60.9%) of the study participants have shown three or more heat-related illness symptoms. Moreover, the prevalence of work-related stress among seasonal and migrant farmworkers was 67.6% (95% CI: 64.6, 70.7)., Conclusion: Occupational health problems among seasonal and migrant farmworkers in northwest Ethiopia remain a major public health problem. Hence, implementing tailored preventive measures like training on health and safety, and hazard control measures would be supremely important to minimize the risk., Competing Interests: The authors declare that they have no conflicts of interest for this work., (© 2021 Alemu Gelaye et al.)

Objectives: Treatment success rate in patients treated for multidrug-resistant tuberculosis (MDR-TB) is low, but predictors of treatment failure and death have been under-reported. Thus, we aimed to determine the national proportion of treatment success rate in the past 10 years and factors that predict treatment failure and death in patients with MDR-TB in Ethiopia., Setting: A retrospective cohort study with a 10-years follow-up period was conducted in 42 MDR-TB treatment-initiating centres in Ethiopia., Participants: A total of 3395 adult patients with MDR-TB who had final treatment outcome and who were treated under national TB programme were included. Data were collected from clinical charts, registration books and laboratory reports. Competing risk survival analysis model with robust standard errors (SE) was used to determine the predictors of treatment failure and death., Primary and Secondary Outcomes: Treatment outcome was a primary outcome whereas predictors of treatment failure and death were a secondary outcome., Results: The proportion of treatment success was 75.7%, death rate was 12.8%, treatment failure was 1.7% and lost to follow-up was 9.7%. The significant predictors of death were older age (adjusted hazard ratio (AHR)=1.03; 95% CI 1.03 to 1.05; p<0.001), HIV infection (AHR=2.0; 95% CI 1.6 to 2.4; p<0.001) and presence of any grade of anaemia (AHR=1.7; 95% CI 1.4 to 2.0; p<0.001). Unlike the predictors of death, all variables included into multivariable model were not significantly associated with treatment failure., Conclusion: In the past 10 years, although MDR-TB treatment success in Ethiopia has been consistently favourable, the proportion of patients who died is still considerable. Death could be attributed to advanced age, HIV infection and anaemia. Prospective cohort studies are necessary to further explore the potentially modifiable predictors of treatment failure., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: More than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa., Method: Data of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes., Result: The pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes., Conclusion: This study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women's involvement in healthcare decision-making.

Background: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Diabetes and its complications can be reduced by enhancing the attitude of the community. However, there is limited information regarding attitude towards diabetes in northwest Ethiopia. Therefore, this study determined the attitude and associated factors of diabetes mellitus among adult non-diabetic participants in Gondar city., Methods: A community-based cross-sectional study was conducted in Gondar city. Systematic random sampling was employed to select 626 non-diabetic participants. The data were collected using a pre-tested structured questionnaire. Descriptive statistics, processing, and analysis were done using STATA version 14. Both bivariable and multivariable binary logistic regressions were used to identify the associated factors. An adjusted odds ratio with a 95% confidence interval was used to calculate a level of significance., Results: Of 626 participants, 572 (91.37%) study subjects heard about diabetes mellitus. Three hundred and fifteen participants (55.07%) (95% CI: 50.9% - 59.1%) had a favorable attitude towards diabetes mellitus. Having good knowledge about diabetes (adjusted odds ratio = 2.69, 95% CI: 1.88, 3.87), and higher educational status (adjusted odds ratio = 1.69, 95% CI: 1.04, 2.78) were positively associated with a favorable attitude towards diabetes mellitus. Female gender (adjusted odds ratio = 0.68, 95% CI: 0.47, 0.98), on the other hand, had poor attitude towards diabetes mellitus., Conclusion: In this study, a favorable attitude towards diabetes was low among adult non-diabetic participants. Good knowledge, higher educational status, and being male were the factors associated with a favorable attitude towards diabetes., Competing Interests: The authors have declared that no competing interests exist.

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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: More than hundreds and thousands of migrants and seasonal farm workers move from the highlands (relatively low malaria endemicity areas) to the lowlands (higher malaria endemicity areas) for the development of the corridor of the Amhara region during planting, weeding, and harvesting seasons in each year. Seasonal migrant workers are at high risk of malaria infection. Therefore, evidence of their knowledge level and practice in the prevention of malaria during their stay would be important., Objective: The aims of this study was to assess the knowledge and practice of malaria prevention and associated factors among migrants and seasonal farm workers in Northwest Ethiopia., Method: A cross-sectional study was conducted from October to November, 2018 in Metema and West Armacheho districts, northwest Ethiopia. A sample of about 950 migrants and seasonal farm workers were included using two stages of cluster sampling technique. Interview administered structured questionnaire was used. Both bi-variable and multivariable binary logistic regressions were applied to identify predictors of malaria prevention., Result: The overall good knowledge of malaria (those participants who scored more than 60% of correct response for knowledge related questions) was 50.2% with 95% CI (47.0-53.0) and the overall good practice of malaria (those participants who practiced more than 60% for practice related questions) was 27.2% with 95% CI (244.3-29.9). Age (AOR = 0.51(95%CI; 0.33-0.80)), level of education (AOR = 0.55(95%CI; 0.32-0.94)), using mass media as a source of information (AOR = 2.25(95%CI; 1.52-3.32)) and length of stay at the farming site (AOR = 0.59(95%CI; 0.44-0.79)) were significantly associated with knowledge of malaria prevention. Knowledge (AOR = 6.62(95%CI; 4.46-9.83)), attitude (AOR = 2.17(95%CI1.40-3.37), use of mass media (AOR = 1.64(95%CI; 1.30-2.60)) and the length of stay (AOR = 1.93(95%CI; 1.35-2.77)) in the farming area were significantly associated with practice of malaria prevention., Conclusion: The practice of malaria prevention among migrant and seasonal farm workers was low. The programmers and implementers should design tailored malaria intervention programs and strategies for these hard to reach population.

Background: Seasonal migrant farmworkers in Ethiopia are a vulnerable segment of the population facing numerous threats to their mental health. This research aimed to determine the magnitude of common mental disorders (CMDs) and its associated factors among seasonal migrant farmworkers in the northwest of Ethiopia., Methods: A cross-sectional study was conducted. A total of 950 seasonal migrant farmworkers were selected randomly. CMDs were assessed using the self-reporting questionnaire (SRQ-20) and a structured questionnaire was employed to collect the associated characteristics of socio-demographic data. Data were analyzed using descriptive statistics, bivariate, and multivariable binary logistic regression. The adjusted odds ratio (AOR) with a 95% confidence level was used to declare a statistically significant association with CMDs., Results: The prevalence of CMDs was found to be 23.05% (219/950; 95% CI 20.47-25.84) among seasonal migrant farmworkers. The prevalence of psychological stress was 74.53% (708/950; 95% CI 71.65-77.20). Having a daily income below USD 5 (AOR = 1.53, 95% CI: 1.10-2.15), moderate perceived stress (AOR = 3.18, 95% CI: 1.18, 5.36), severe perceived stress (AOR = 16.15, 95% CI: 8.96, 29.11), and heat-related illness (AOR = 1.60, 95% CI: 1.11, 2.30) were associated with a higher likelihood of experiencing CMD. On the other hand, those seasonal migrant farmworkers who migrated for the first time (AOR = 0.38, 95% CI: 0.23-0.65) and those who received health related information (AOR = 0.60, 95% CI: 0.42, 0.85) were less likely to have CMDs., Conclusion: In this study, CMDs were found to be prevalent among seasonal migrant farmworkers. These findings highlight the importance of systematic development of community-based mental health services in combination with rural primary health care centers and an integrated approach to the health care of farmworkers such as screening, early identification, and treatment of CMDs of seasonal migrant farmworkers.

Introduction: Cervical cancer is one of the most common causes of morbidity and mortality among women in developing countries including Ethiopia. Unlike other types of cancers, the grave outcomes of cervical cancer could be prevented if detected at its early stage. However, in Ethiopia, awareness about the disease and the availability of screening and treatment services is limited. This study aims to determine the role of health education on cervical cancer screening uptake in selected health facilities in Addis Ababa., Methods: Two-pronged clustered randomized controlled trial was conducted in 2018 at eight public health centers that provide cervical cancer screening services using visual inspection with acetic acid (VIA) in Addis Ababa, Ethiopia. Each of the eight health centers were randomly assigned to serve as either an intervention or a control center. A two-pronged clustered randomized controlled trial was conducted in eight public health care centers. All the selected facilities provided cervical cancer screening services using visual inspection with acetic acid (VIA). Four health centers were randomly assigned to the intervention and control arms. The study participants were women aged 30-49 years who sought care at maternal and child health clinics but who had never been screened for cervical cancer. In the intervention health centers, all eligible women received one-to-one health education and educational brochures about cervical cancer and cervical cancer screening. In the control health centers, participants received standard care. Baseline data were collected at recruitment and follow-up data were collected two months after the baseline. For the follow-up data collection, participants (both in the intervention and control arms) were interviewed over the phone to check whether they were screened for cervical cancer., Result: From the 2,140 women who participated in the study, 215 (10%) screened for cervical cancer, where 152(71%) were from the intervention health centers. Seventy-four percent of these participants reported that they learned about the benefits of screening from the one-to-one health education or the brochure. Women from the intervention health centers had higher odds of getting screened (AOR = 2.43,95%CI;1.58-2.90) than the controls. Women with the educational status of the first degree and those who have a history of sexually transmitted infections (STIs) had higher odds of getting screened (AOR = 2.03,95%CI;(1.15-2.58) and (AOR = 1.55,95%CI;1.01-2.36), respectively., Conclusion and Recommendation: Providing focused health education supported by printed educational materials increased the uptake of cervical cancer screening services. Integrating one-to-one health education and providing a take-home educational material into the existing maternal and child health services can help increase cervical cancer screening uptake., Competing Interests: NO authors have competing interest.

Juridification of maternal health care is on the rise globally, but little is known about its manifestations in resource constrained settings in sub-Saharan Africa. The Maternal and Perinatal Death Surveillance and Response (MPDSR) system is implemented in Ethiopia to record and review all maternal and perinatal deaths, but underreporting of deaths remains a major implementation challenge. Fear of blame and malpractice litigation among health workers are important factors in underreporting, suggestive of an increased juridification of birth care. By taking MPDSR implementation as an entry point, this article aims to explore the manifestations of juridification of birth care in Ethiopia. Based on multi-sited fieldwork involving interviews, document analysis and observations at different levels of the Ethiopian health system, we explore responses to maternal deaths at various levels of the health system. We found an increasing public notion of maternal deaths being caused by malpractice, and a tendency to perceive the juridical system as the only channel to claim accountability for maternal deaths. Conflicts over legal responsibility for deaths influenced birth care provision. Both health workers and health bureaucrats strived to balance conflicting concerns related to the MPDSR system: reporting all deaths vs revealing failures in service provision. This dilemma encouraged the development of strategies to avoid personalized accountability for deaths. In this context, increased juridification impacted both care and reporting practices. Our study demonstrates the need to create a system that secures legal protection of health professionals reporting maternal deaths as prescribed and provides the public with mechanisms to claim accountability and high-quality birth care services., (© The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Globally, complications of preterm birth are among the most common cause of neonatal mortality. In Ethiopia, the neonatal mortality reduction is not worthy of attention. Hence, this study reviewed the prevalence of preterm birth and factors associated with preterm birth in Ethiopia., Methods: The review protocol of this study has been registered in PROSPERO (CRD42017077356). The PRISMA guideline was followed for this review. Studies that assessed the prevalence and/or associated factors of preterm birth in Ethiopia and published from Jan 01, 2009 to Dec 31, 2019 were considered. Studies were searched from the PubMed and Science Direct among medical electronic databases and Google Scholar. Random-effects model was used for detected heterogeneity among studies. Publication bias and sensitivity analysis were assessed. Pooled estimates with its 95% confidence interval were reported using forest plots. The quality of evidence from the review was assessed using GRADE approach., Results: Twenty-two studies involving a total of 12,279 participants were included. The overall pooled prevalence of preterm birth in Ethiopia was 10.48% (95% CI: 7.98-12.99). Pooled odds ratio showed rural residence (AOR = 2.34, 95% CI: 1.35-4.05), being anemic (AOR = 2.59, 95% CI: 1.85-3.64), < 4 antenatal care visits (AOR = 2.34, 95%CI: 1.73-3.33), pregnancy induced hypertension (AOR = 3.49, 95% CI: 2.45-4.97), prelabor rapture of membrane (AOR = 4.42, 95% CI: 2.28-8.57), antepartum hemorrhage (AOR = 5.02, 95% CI: 2.90-8.68), multiple pregnancies (AOR = 3.89, 95% CI: 2.52-5.99), past adverse birth outcomes (AOR = 3.24, 95% CI: 2.53-4.15) and chronic illness (AOR = 4.89, 95%CI: 3.12-7.66) were associated with increased likelihood of preterm birth. Further, support during pregnancy was associated with reduced occurrence of preterm birth., Conclusion: The pooled national level prevalence of preterm birth in Ethiopia is high. Socio demographic, nutritional, health care, obstetric and gynecologic, chronic illness and medical conditions, behavioral and lifestyle factors are the major associated factors of preterm birth in Ethiopia. This evidence is graded as low grade. Thus, efforts should be intensified to address reported risk factors to relieve the burden of preterm birth in the study setting, Ethiopia.

Objective: This study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade., Design, Setting and Analysis: A nationally representative repeated cross-sectional survey was conducted using 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. Multivariate decomposition logistic regression analysis was employed to identify significant factors that have been contributed to the change in home delivery. Level of statistical significance was declared at a two-sided p value <0.05., Outcome Measure: Trends of home delivery., Participants: A total of 33 482 women were included., Results: Home delivery has been decreased by 21% over the last decade in Ethiopia. In the last decade, 39% of the decrements in home delivery attributed to change in women's compositional characteristics. Antenatal care visits, educational status of the women and husband, birth order, religion, wealth index and distance from a health facility were the main sources of compositional change factors for the change of home delivery. Behavioural changes towards health facility delivery contributed approximately two-thirds of the decline of home delivery in Ethiopia. Antenatal care visits, birth order and religion have significantly contributed to the change of home delivery resulted from behavioural changes towards healthcare facility utilisation over the last decade., Conclusion: Despite the importance of health facility delivery, a significant number of women still deliver at home in Ethiopia. Women's compositional characteristics and behaviour changes were significantly associated with the change in home delivery. Multisectoral educational intervention is needed to change women's attitudes towards home delivery. Antenatal care coverage and healthcare facility coverage should increase thereby to improve healthcare facility based-delivery practice. Further research needs to be done to explore the potential barriers of health facility delivery from a religious perspective., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The key cause of HIV transmission is failure to provide adequate information about HIV/AIDS which is a substantial public health issue in low and middle-income countries. While global health coverage continues, there is still little understanding of HIV/AIDS among women of reproductive age (15-49 years) in Ethiopia. Therefore, the purpose of this study was to identify the determinants of comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia., Methods: A secondary data analysis was employed using the 2016 Ethiopian demographic and health survey data. Data were extracted about comprehensive knowledge of HIV/AIDS among women of reproductive age. We used multi-variable mixed-effect binary logistic regression to identify factors associated with comprehensive knowledge of HIV/AIDS among women of reproductive age. The adjusted odds ratio with 95% confidence interval was used to declare statistical significance., Results: We found that having primary (AOR = 1.75, 95% CI 1.56-1.97),secondary (AOR = 2.74, 95% CI 2.33-3.22), and higher (AOR = 4.07, 95% CI 3.32-4.99) educational statuses, being in highest wealth quintiles; richer (AOR = 1.20, 95% CI 1.01-1.43) and richest (AOR = 1.51, 95% CI 1.22-1.87), knowing the place for HIV test (AOR = 2.13, 95% CI 1.88-2.42), use of traditional contraceptive method (AOR = 1.93,95% CI 1.12-3.35), female household head (AOR = 1.18, 95% CI 1.07-1.31), watching television (AOR = 1.22, 95% CI 1.06-1.41) and own mobile phone (AOR = 1.18, 95% CI 1.05-1.33) were positively associated with comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia., Conclusion: Women with higher education and higher wealth quintiles, knowing the place of HIV test, watching television, a traditional contraceptive method use, having a mobile phone and being in female headed household were positively associated with comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia. Programs working on HIV/AIDS should target women based on the identified factors so as to scale up their comprehensive knowledge towards HIV/AIDS. In this context, the media should actively contribute to raising awareness of HIV/AIDS.

Background: Globally, tuberculosis (TB) is the 10th leading cause of death. Despite no country achieved its target, the world health organization (WHO) proposed a 90-90-90 approach to fastening the end TB strategy. Improvement and progression of TB control need good knowledge and a favorable attitude towards the disease. However, interventions designed don't take migrants and seasonal farmworkers into account. Therefore, this study aimed at estimating the level of knowledge and attitude on Tuberculosis among migrant and seasonal farmworkers in northwest Ethiopia., Methods: Community-based cross-sectional study was conducted in the West Gondar zone from October to November 2018. A two-stage cluster sampling was used to select 949 migrant and seasonal farmworkers. Both bivariate and multivariable logistic regression analyses were performed. A p-value of < 0.05 was used to declare statistical significance. The goodness of fit was checked using Hosmer and Lemeshow test., Results: In this study, (41.8%), (95% CI: 38.73, 45.01) and (50.5%), (95% CI: 47.29, 53.65) of migrants and seasonal farmworkers had good knowledge and a favorable attitude, respectively. The odds of good knowledge among mass media exposed migrants were AOR = 1.42, 95% CI: (1.02, 2.01). Moreover, urban residence and having good knowledge increase the odds of favorable attitude by 1.66, (AOR = 1.7; 95% CI: 1.05, 2.62) and 4.3 (AOR = 4.3, 95%CI: 3.26, 5.75), respectively., Conclusion: In this study, the overall knowledge and attitude of migrant and seasonal farmworkers on TB were low. Family size and mass media exposure significantly affect knowledge of the migrants on TB. On the other hand, the attitude was affected by urban residence, health information, and having good knowledge. Health promotion interventions, focused on TB cause, mode of transmission, prevention, and treatment are important to migrant and seasonal farmworkers to improve the knowledge and attitude of migrants and seasonal farmworkers.

Background: Childhood diarrheal illness is the second leading cause of child mortality in sub-Saharan Africa, including Ethiopia. Epidemiology of diarrhea has long-term implications with respect to medical, social, and economic consequences. Studies hypothesize that there have been regional differences, and this study aimed to examine the spatial variations and identify the determinants of childhood diarrhea in Ethiopia., Methods: Data from the 2016 Demographic and Health Survey of Ethiopia (EDHS), which included 10,337 aged under 5 years were analyzed. The survey was conducted using a two-stage stratified sampling design. The study attempted to detect and test the clustering of diarrhea cases using global Moran's I and LISA. Descriptive statistics followed by mixed-effect logistic regressions were used to identify factors related to the prevalence of diarrhea., Results: Overall, 11.87% of the children experienced childhood diarrheal illness. The study showed that the risk was high in the southern and central parts and low in the eastern and western regions of the country. Children aged 6-12 (AOR = 2.66, [95% CI 2.01, 3.52]), 12-23 (AOR = 2.45, [95% CI 1.89, 3.17]), and 24-35 (AOR = 1.53, [95% CI 1.17, 2.01]) months were more likely to suffer from childhood diarrhea than those aged less than 6 months. Children in Tigray (AOR = 1.69 [95% CI 1.01, 2.83]), Amhara (AOR = 1.80, [95% CI 1.06, 3.06]), SNNPR (AOR = 2.04, [95% CI 1.22, 3.42]), and Gambella (AOR = 2.05, [95% CI 1.22, 3.42]) were at higher risk than those in Addis Ababa. The odds of getting diarrhea decreased by 24% among households with ≥ 3 under-five children compared to those with only one under-five child (AOR = 0.76 [95% CI 0.61, 0.94]). The odds of getting diarrheal illness for the children of employed mothers increased by 19% compared to those children of non-employed mothers (AOR = 1.19 [95% CI 1.03, 1.38])., Conclusions: Childhood diarrheal disease is prevalent among under-five children, particularly in the regions of SNNP, Gambella, Oromia, and Benishangul Gumuz, while the regions are generally making progress in reducing childhood illness. Capacity building programs with the best experience sharing and better home environments can be effective in reducing the incidence of childhood diarrhea in Ethiopia., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Introduction: Human immunodeficiency virus (HIV) infection results in a gradual depletion of immune function, particularly CD4 cells. The CD4 assessment plays a significant role in assessing treatment responses and clinical decision-making for patients on combination antiretroviral therapy (ART) in resource-limited settings. However, new data on CD4 count changes are scarce; the volatility of CD4 counts after initiation of ART over time remains largely uncharacterized. This study aimed to identify the predictors of CD4 changes over time among HIV-infected children who began ART in Amhara, Ethiopia., Methods: A retrospective follow-up study was performed. A total of 983 HIV-infected children who initiated ART in government hospitals in the Amhara region between 2010 and 2016 were included using a simple random sampling technique. Data were extracted using a structured checklist. An exploratory data analysis was carried out to explain individual and average profile plots. The linear mixed model was used to identify the CD4 change count predictors over time. Variables with p value < 0.05 were considered statistically significant in a multivariable linear mixed regression analysis., Results: The mean CD4 count of the participants was 465.1 cells/mm 3 with an average CD4 count increase of 30.06 cells/mm 3 over 6 months from baseline CD4 count and ART initiation. Childhood age ( β = - 0.015; 95% Cl - 0.021, - 0.009), opportunistic infection at ART initiation ( β = - 0.044, 95% CI - 0.085, - 0.004), hemoglobin level ( β = 0.013; 95% CI 0.004, 0.022), and baseline WHO clinical stage II ( β = - 0.046, 95% CI - 0.091, - 0.0003) were significant predictors of CD4 changes over time., Conclusions: The average CD4 count increase was sufficient in HIV patients who began combined antiretroviral therapy over time. The younger age of the infant, the higher baseline level of hemoglobin, the baseline WHO clinical stage II, and opportunistic infections led to changes in CD4 counts. As a result, timely diagnosis and treatment of opportunistic infections will reduce the risk of opportunistic infections., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Introduction: Preterm birth (PTB) complications are the leading cause of death among neonates globally. The reduction in neonatal mortality is not remarkable in Ethiopia. Therefore, this review will assess the magnitude and associated factors of PTB in Ethiopia., Methods and Analysis: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline will be followed during the systematic review. We will include all observational studies published from 1 January 2009 to 31 December 2019 that examined the level and/or associated factors of any type of PTB among live births in Ethiopia. Inclusion criteria will be all live births, PTB defined as delivery before 37 weeks gestation. The primary outcome will be PTB <37 weeks, and secondary outcomes including PTB <34, <32 and <28 weeks will be analysed. PubMed and Science Direct databases as well as Google search engine and Google Scholar will be searched. The pooled prevalence of preterm and effect size of association for associated factors will be analysed using the Stata software V.14. The heterogeneity between studies will be measured by I 2 statistics. A random-effects model will be used to estimate if heterogeneity detected. Publication bias will be assessed using a funnel plot. Subgroup analysis will be sought based on possible characteristics of the studies, specific morbidity (like pre-eclampsia, hypertension), type of PTB (spontaneous or iotrogenic) and quality of study (high-quality or low-risk). Meta-regression will be considered for major covariates (maternal age and maternal body mass index) related to PTB. Forest plots will be used to present the combined estimate with 95% CIs. The quality of evidence of the outcomes will be assessed with the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach., Ethics and Dissemination: No ethical approval is necessary for this systematic review. The findings will be published in a peer-reviewed journal., Prospero Registration Number: CRD42017077356., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Couples HIV Testing & Counselling (CHTC) service is an approach that may enable more people to be reached and tested for HIV. However, little is known about how couples may use this service and what they think about CHTC as an approach to finding out their HIV status. This study aimed to understand how individuals who had ever been in an ongoing heterosexual relationship for 6 months or more intended to use CHTC in Ethiopia and their beliefs about its benefits and potential harms., Methods: Qualitative in-depth interviews were conducted in Addis Ababa, the capital city of Ethiopia, in 2017. Semi-structured interviews were undertaken with individuals who had ever been in an ongoing heterosexual relationship (n = 21) and key-informants (n = 11) including religious leaders, health care providers, and case managers. The interviews were transcribed verbatim, and an inductive thematic analysis was conducted. The data were coded to look for concepts and patterns across the interviews and relevant themes identified which captured key aspects related to the individual's views on undertaking HIV testing with a sexual partner., Results: Most participants regarded CHTC as an important HIV testing approach for people who are in an ongoing heterosexual relationship and expressed the view that there was "nothing like testing together". However, many of the individual participants revealed they would prefer first to get tested alone to find out their own HIV status. They feared the consequences if they were HIV-positive, including accusations of infidelity, relationship break-up, and being exposed in the community. Many also reported being pressured to undertake CHTC before marriage by a third party, including religious institutions. Key informant interviews also discussed the requirements for CHTC before marriage., Conclusion: The findings of this study suggest that people may be concerned about undertaking couples HIV testing without prior individual HIV testing. The intention of many to first test alone has policy and cost implications and underscores the possible harms of the implementation of CHTC in Ethiopia. Future research should examine whether the views identified in this qualitative study are reflected more broadly among couples in the community.

Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4-2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

The Maternal Death Surveillance and Response system (MDSR) was implemented in Ethiopia in 2013 to record and review maternal deaths. The overall aim of the system is to identify and address gaps in order to prevent future death but, to date, around 10% of the expected number of deaths are reported. This article examines practices and reasoning involved in maternal death reporting and review practices in Ethiopia, building on the concept of 'practical norms'. The study is based on multi-sited fieldwork at different levels of the Ethiopian health system including interviews, document analysis and observations, and has documented the politicized nature of MDSR implementation. Death reporting and review are challenged by the fact that maternal mortality is a main indicator of health system performance. Health workers and bureaucrats strive to balance conflicting demands when implementing the MDSR system: to report all deaths; to deliver perceived success in maternal mortality reduction by reporting as few deaths as possible; and to avoid personalized accountability for deaths. Fear of personal and political accountability for maternal deaths strongly influences not only reporting practices but also the care given in the study sites. Health workers report maternal deaths in ways that minimize their number and deflect responsibility for adverse outcomes. They attribute deaths to community and infrastructural factors, which are often beyond their control. The practical norms of how health workers report deaths perpetuate a skewed way of seeing problems and solutions in maternal health. On the basis of our findings, we argue that closer attention to the broader political context is needed to understand the implementation of MDSR and other surveillance systems., (© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Background: Vaccination is one of the cost effective strategies reducing childhood morbidity and mortality. Further improvement of immunization coverage would halt about 1.5 million additional deaths globally. Understanding the level of immunization among children is vital to design appropriate interventions. Therefore, this study aimed to assess full immunization coverage and its determinants among children aged 12-23 months in Ethiopia., Methods: The study was based on secondary data analysis from the 2016 Ethiopia Demographic and Health Survey (EDHS). Information about 1,909 babies aged 12-23 months was extracted from children dataset. Both bivariate and multivariable logistic regression models were utilized to assess the status and factors associated with full immunization. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed. Variables with less than 0.05 p-values in the multivariable logistic regression model were considered as statistically and significantly associated with the outcome variable., Results: The overall full immunization coverage was 38.3% (95% CI: 36.7, 41.2). Rural residence (AOR = 0.60, 95% CI: 0.43, 0.84), employed (AOR = 1.62, 95% CI: 1.31, 2.0), female household head (AOR = 0.58, 95% CI: 0.44, 0.76), wealth index [middle (AOR = 1.44, 95% CI: 1.07, 1.94) and richness (AOR = 1.65, 95% CI: 1.25,2.19)], primary school maternal education (AOR = 1.38,95% CI: 1.07, 1.78), secondary school maternal education (AOR = 2.19, 95% CI: 1.43, 3.36), diploma graduated mothers (AOR = 1.99, 95% CI: 1.09, 3.61), ANC follow ups (AOR = 2.79, 95% CI:2.17 3.59), and delivery at health facilities (AOR = 1.76, 95% CI: 1.36, 2.24) were significantly associated factors with full immunization., Conclusion: Full immunization coverage in Ethiopia was significantly lower than the global target. Female household head and rural dwellings were negatively associated with full immunization. In contrast higher maternal education, employment, middle and rich economic status, ANC follow up, and delivery at health facility were positively associated with full immunization among 12-23 months old children. This suggests that improved health education and service expansion to remote areas are necessary to step immunization access.

Background: Young people in Sub-Saharan Africa are affected by HIV pandemic to a greater extent than elsewhere. Transactional sex among adolescent school girls with older men commonly called "sugar daddies" is one of the major factors fueling the spread of the infection due to the extended sexual network. Thus, this study aimed to assess the magnitude and factors associated with transactional sex among adolescent girls and "sugar daddies" in relation to HIV/AIDS., Methods: Mixed method cross-sectional study was done among 620 female students in Hawassa town, South Ethiopia, from September 2010 to May 2011. A structured questionnaire and in-depth interview check list were used to collect the quantitative and qualitative data, respectively. Survey participants were selected randomly from five preparatory schools whereas ten in-depth interview participants were recruited by a snowball sampling technique from the same schools. Data were entered using Epi-Info and analyzed by SPSS. A descriptive statistics followed by multivariable logistic regression analyses were conducted to identify factors associated with transactional sex with "sugar daddy". Both crude and adjusted odds ratios with 95% confidence interval were reported. We used OpenCode software for coding and categorizing the in-depth interviews and quotes that represent the informants opinion were used to support the quantitative findings., Results: A substantial number of female students, 71(11.5%), reported to have had transactional sex with older men. Most of the respondents who dated "sugar daddies" (93%) had multiple sexual partners concurrently and sequentially, and among them, only 22.7% had consistent condom use. Girls who were in older age group [OR (CI) 6.87 (3.48-13.58)], who had lost both parents [OR (CI) 2.99 (1.14-7.84)], had perceived less economic status [OR: 25.41; 95% CI: 7.80-82.76] and engaged in substance abuse [OR (CO) 5.8 (2.1-15.77)] had higher odds of practicing transactional sex with "sugar daddies". In-depth interviewed participants also revealed that they were involved in transactional sex for monetary while having concurrent and subsequent sexual network with their schoolmates and other young partners., Conclusion: Transactional sex among female students was high, and the sexual network they had with the young men put young people in the network at risk of HIV and other sexually transmitted infections. Therefore, HIV prevention programs shall focus on transactional sex among adolescent school girls to halt transmission of HIV among the generation.

Objective: Postnatal care (PNC) is essential for preventing maternal and newborn deaths; however, it still remains less well recognised in low-income and middle-income countries. This study was aimed to explore geographical patterns and identify the determinants of PNC usage among women aged 15-49 years in Ethiopia., Methods: A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. A total of 7193 women were included in this analysis. We employed spatial scan statistics to detect spatial inequalities of PNC usage among women. A multilevel binary logistic regression model was fitted to identify factors associated with women's PNC., Results: The prevalence of PNC usage among women was 6.9% (95% CI 6.3% to 7.5%). The SaTScan spatial analysis identified three most likely clusters with low rates of PNC use namely southwestern Ethiopia (log likelihood ratio (LLR)=18.07, p<0.0001), southeast Ethiopia (LLR=14.29, p<0.001) and eastern Ethiopia (LLR=10.18, p=0.024). Women with no education (Adjusted Odd Ratio (AOR)=0.55, 95% CI 0.37 to 0.84) and in the poorest wealth quantile (AOR=0.55, 95% CI 0.39 to 0.78) were less likely to use PNC, while women aged 35-49 years (AOR: 1.75, 95% CI 1.01 to 3.04) and with at least four antenatal care (ANC) visits (AOR=2.37, 95% CI 1.71 to 3.29) were more likely to use PNC., Conclusion: PNC usage remains a public health problem and has spatial variations at regional levels in the country. Low prevalence of PNC was detected in the Somali, Oromia, Gambella and Southern Nations, Nationalities, and People's Region (SNNPR) regions. Women with low educational status, old age, being in poorest wealth quantile and history of ANC visits were significantly associated with PNC usage. Hence, it is better to strengthen maternal health programmes that give special emphasis on health promotion with a continuum of care during pregnancy., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Antenatal care (ANC) is special care for pregnant women with the aim of preventing, detecting and treating health problems in both the fetus and mother. Early ANC attendance promotes early detection and treatment of complications which result in proper management during delivery and puerperium. However, the majority of pregnant women in Ethiopia initiate their ANC late. Therefore, this study aimed to assess the prevalence of late initiation of ANC and its associated factors among attendants in Addis Zemen primary hospital., Method: An institution-based cross-sectional study was conducted at Addis Zemen primary hospital from February 7 to June 122,018. The systematic random sampling technique was employed to select 369 pregnant women who attended ANC in the hospital. Data cleaning and analysis was done using SPSS version 25 statistical software. Descriptive statics and bi variable and multivariable logistic regression models were employed to assess the magnitude and factors associated with late initiation of ANC defined as making the first visit after 12 weeks of gestation., Result: This study indicated that 52.5% of the attendants initiated ANC late. The multivariable logistic regression analysis showed that being housewife (Adjusted odds ratio (AOR) = 2.85, 95% CI: 1.36, 5.96), self-employment (AOR = 2.38, 95% CI: 1.12, 5.04), travel expenses (AOR = 1.72, 95% CI: 1.05, 2.81), poor knowledge about ANC (AOR = 2.98, 95% CI: 1.78, 5.01) and unplanned pregnancy (AOR = 2.31, 95% CI: 1.28, 4.16) were significantly associated with late ANC initiation., Conclusion: The prevalence of late ANC initiation remains a major public health issue in Ethiopia. The major factors for being late were found to be poor knowledge, being housewife, and self-employment, travel expenses and unintended pregnancy. District and zonal health offices should work to create awareness about the importance of early initiation of ANC, make the service closer to the community and increase contraceptive utilization.

Background: A delayed initiation of tuberculosis treatment results in high morbidity, mortality, and increased person-to-person transmissions. The aim of this study was to assess treatment delay and its associated factors among adult drug resistant tuberculosis patients in the Amhara Regional State, Ethiopia., Methods: An institution based cross-sectional study was conducted on all adult drug resistant tuberculosis patients who initiated treatment from September 2010 to December 2017. Data were collected from patient charts, registration books, and computer databases using abstraction sheets. The data were entered using Epi-info version 7 and exported to SPSS version 20 for analysis. Summary statistics, like means, medians, and proportions were used to present it. Binary logistic regression was fitted; Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was also computed. Variables with p-value < 0.05 in the multi-variable logistic regression model was declared as significantly associated with treatment delay., Results: The median time to commence treatment after drug resistant tuberculosis diagnosis was 8 (IQR: 3-37) days. Being diagnosed by Line probe assay [AOR = 5.59; 95% CI: 3.48-8.98], Culture [AOR = 5.15; 95% CI: 2.53-10.47], and history of injectable anti-TB drugs [AOR = 2.12; 95% CI: 1.41-3.19] were associated with treatment delays., Conclusion: Treatment delay was long, especially among patients diagnosed by Culture or LPA and those who had a prior history of injectable anti-TB drugs. That suggested that the need for universal accesses to rapid molecular diagnostic tests, such as Gene Xpert and the PMDT team were needed to promptly decide to minimize unnecessary delays.

Background: Prematurity accounts about 1 million neonatal deaths worldwide and the second causes of both neonatal and under five-child mortality. Neonatal mortality accounts for 43% of under-five child mortality in Ethiopia. From this preterm is the second leading cause of death and is steadily increased in low-income countries. Therefore, the aim of this study was to assess time to death and predictors among preterm neonates admitted in University of Gondar comprehensive specialized hospital neonatal intensive care unit North West Ethiopia 2018., Methods: Institution-based retrospective follow-up study was conducted among 516 preterm neonates from January 2016 to March 2018. Data were extracted retrospectively from patients' records using a pretested structured checklist. Descriptive summary statistics like median survival time, Kaplan Meier failure estimation curve and Log-rank test were computed. Bivariate and multivariable Gompertz parametric hazards models were fitted to identify the predictors of mortality. Hazard ratio with a 95% confidence interval was calculated and p-values < 0.05 were considered statistically significant., Results: The proportion of preterm neonatal death in this study was 28.8% (95%CI (25.1, 32.9)). Home delivery (AHR = 2.25, 95% CI (1.03, 4.88)), hyaline membrane disease (AHR =3.21, 95% CI (1.96, 5.25)), gestational age, (AHR = 0.82, 95% CI (0.74, 0.91)), cry immediately at birth (AHR = 1.74, 95% CI (1.19, 2.53)), kangaroo mother care (AHR = 0.24, 95%CI (0.11, 0.52)), presence of jaundice (AHR = 1.62, 95%CI (1.12, 2.54)) and hypoglycemia at admission (AHR = 1.75, 95%CI (1.21, 2.54)) were found to be significant predictors of time to death for preterm neonates., Conclusion: Proportion of preterm neonatal death in this study was high. Home delivery, Jaundice, hypoglycemia, gestational age, cry immediately at birth, kangaroo mother care and hyaline membrane disease were significant predictors of time to death.

Background: Depression is an important public health concern due to its devastating morbidity and mortality among older adults. The aim of this study was to assess the prevalence of depression and associated factors among older adults (age ≥ 60 years) in Ambo Town, Ethiopia, 2016., Methods: A community-based cross-sectional study was conducted among older adults in Ambo town from May to June 2016. Geriatric depression scale item 15 (GDS 15) was used to conduct face-to-face interviews with 800 study participants. Data were entered into Epi Info version 7 and analyzed using SPSS version 20. Descriptive statistics and multivariable logistic regression analysis were employed. Adjusted odds ratio (AOR) with a 95% confidence interval was used to calculate significance., Results: The prevalence of depression was found to be 41.8% [CI = 38.5%, 45.5%]. The multivariable logistic regression model revealed that female sex (AOR = 1.72; 95% CI = 1.12, 2.66), trading (AOR = 2.44; 95% CI =1.32, 4.57), living with children (AOR = 3.19, 95% CI =1.14, 8.93) and retirement (AOR = 3.94, 95% CI = 2.11, 7.35) were associated with depression among older adults., Conclusion: The prevalence of depression among older adult was found to be high. Due emphasis needs to be given to screening and treating depression, especially among older females, retired individuals, adults living with children and merchants.

Objective: Data regarding diabetes retinopathy and associated factors are currently lacking in Ethiopia. The study aims to determine the incidence and determinants of time to diabetes retinopathy among diabetes mellitus patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia., Results: The incidence of diabetes retinopathy is a rapidly growing burden of disease in Ethiopia. The incidence rate of diabetes retinopathy was 2.65 (95% CI 2. 54, 4.05) per 1000 person-years observation. Moreover, 70 (18.57%, 95% CI 14.63, 22.5) DM patients developed diabetes retinopathy. The median time was 74.07 months (with IQR 53.60, 89.88). Male sex (AHR = 1.94, 95% CI = 1.10, 3.39), type 2 DM (AHR = 4.01, 95% CI = 1.34, 12.00), creatinine (AHR = 2.59, 95% CI = 1.91, 3.52), borderline triglyceride (AHR = 2.87, 95% CI 1.33, 6.21) and high triglyceride levels (AHR = 2.59, 95% CI = 1.31, 4.97) were positively correlated factors to diabetes retinopathy occurrence. Multisectoral, population-based approaches are needed to reduce type 2 DM complications.

Objective: This study aimed to estimate the incidence of chronic kidney disease and its predictors among newly diagnosed type 2 diabetes patients attending St. Paul's Hospital, Addis Ababa, Ethiopia., Results: The overall incidence of chronic kidney disease was a major public health issue among type 2 diabetes mellitus patients with 2178 (95% CI 12,801, 21,286) cases per 10,000 patient-months. Moreover, 62(14.25%) patients in the sample experienced chronic kidney disease. Old age [adjusted hazard ratio (AHR) = 1.06, 95%CI 1.03, 1.09], no diabetic retinopathy [AHR = 0.13, 95%CI 0.07-0.24], high density lipoprotein cholesterol ≥ 40 mg/dl [AHR = 0.55, 95%CI 0.31, 0.97] and high body mass index [AHR = 1.17, 95%CI 1.1, 1.25] were common factors for chronic kidney diseases.

Background: Statistics indicate that Ethiopia has made remarkable progress in reducing child mortality. It is however estimated that there is high rate of perinatal mortality although there is scarcity of data due to a lack of vital registration in the country. This study was conducted with the purpose of assessing the determinants and causes of perinatal mortality among babies born from cohorts of pregnant women in three selected districts of North Showa Zone, Oromia Region, Ethiopia. The study used community based data, which is believed to provide more representative and reliable information and also aimed to narrow the data gap on perinatal mortality., Methods: A community based nested case control study was conducted among 4438 (cohorts of) pregnant women. The cohort was followed up between March 2011 to December 2012 in three districts of Oromia region, Ethiopia, until delivery. The World Health Organization verbal autopsy questionnaire for neonatal death was used to collect data. A binary logistic regression model was used to identify determinants of perinatal mortality. Causes of deaths were assigned by a pediatrician and neonatologist. Cases are stillbirths and early neonatal death. Control are live births surviving of the perinatal period' RESULT: A total of 219 newborns (73 cases and 146 controls) were included in the analysis. Perinatal mortality rate was 16.5 per 1000 births. Mothers aged 35 years and above had a higher risk of losing their newborn babies to perinatal deaths than younger mothers [AOR 7.59, (95% CI, 1.91-30.10)]. Babies born to mothers who had a history of neonatal deaths were also more likely to die during the perinatal period than their counterparts [AOR 5.42, (95% CI, 2.27-12.96)]. Preterm births had a higher risk of perinatal death than term babies [AOR 8.58, (95% CI, 2.27-32.38)]. Similarly, male babies were at higher risk than female babies [AOR 5.47, (95% CI, 2.50-11.99)]. Multiple birth babies had a higher chance of dying within the perinatal period than single births [AOR 3.59, (95% CI, 1.20-10.79)]. Home delivery [AOR 0.23, (95% CI, 0.08-0.67)] was found to reduce perinatal deaths. Asphyxia, sepsis and chorioamnionitis were among the leading causes of perinatal deaths., Conclusion: This study reported a lower perinatal mortality rate. The main causes of perinatal death identified were often related to maternal factors. There is still a need for greater focus on these interrelated issues for further intervention.

Objective: This study aimed to assess the incidence and risk factors of treatment failure among HIV/AIDS-infected children who were on antiretroviral therapy (ART) in Amhara National Regional State, Ethiopia., Methods: A retrospective follow-up study was conducted from January 2010 to March 2016. A total of 824 children under the age of 15 who had started ART were included in the study. Data were collected from children's medical charts and ART registration logbook using a standard checklist. A Weibull regression model was used to identify the risk factors of treatment failure. Adjusted HRs (AHRs) with 95% CIs were used to declare statistical significance., Results: The mean (±SD) age of the children was 6.4±3.6 years, with a median (IQR) follow-up of 30.5 (14.6-51.4) months. Sixty-three children (7.7%, 95% CI 5.8 to 9.5) developed treatment failure, 17 (27.0%) of whom were immunological and 46 (73.0%) were clinical failures. The incidence rate of treatment failure was 22.1/10 000 person-months. The cumulative probability of failure was 0.4, with 28 562.5 person-month observations. Lack of disclosure (AHR=4. 4, 95% CI 1.8 to 11.3), opportunistic infections during initiation of ART (AHR=2.3, 95% CI 1.3 to 4.1) and prolonged follow-up (AHR=0.06, 95% CI 0.02 to 0.18) were the main predictors of treatment failure., Conclusion: This study revealed that the incidence of treatment failure remains a significant public health concern in Ethiopia. Undisclosed HIV status to children, the presence of opportunistic infections during initiation of ART and prolonged follow-up were found to be the main predictors of treatment failure. Hence, early detection of treatment failure and further studies on viral monitoring need to be considered., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: The first month of life is the period with the highest risk of dying. Despite knowledge of effective interventions, newborn mortality is high and utilization of health care services remains low in Ethiopia. In settings without universal health coverage, the economy of a household is vulnerable to illness, and out-of-pocket payments may limit families' opportunities to seek health care for newborns. In this paper we explore intra-household resource allocation, focusing on how families prioritize newborn health versus other household needs and their coping strategies for managing these priorities., Methods: A qualitative study was conducted in 2015 in Butajira, Ethiopia, comprising observation, semi-structured interviews, and focus group discussions with household members, health workers, and community members. Household members with hospitalized newborns or who had experienced neonatal death were primary informants., Results: In this predominantly rural and poor district, households struggled to pay out-of-pocket for services such as admission, diagnostics, drugs, and transportation. When newborns fell ill, families made hard choices balancing concerns for newborn health and other household needs. The ability to seek care, obtain services, and follow medical advice depended on the social and economic assets of the household. It was common to borrow money from friends and family, or even to sell a sheep or the harvest, if necessary. In managing household priorities and high costs, families waited before seeking health care, or used cheaper traditional medicines. For poor families with no money or opportunity to borrow, it became impossible to follow medical advice or even seek care in the first place. This had fatal health consequences for the sick newborns., Conclusions: While improving neonatal health is prioritized at policy level in Ethiopia, poor households with sick neonates may prioritize differently. With limited money at hand and high direct health care costs, families balanced conflicting concerns to newborn health and family welfare. We argue that families should not be left in situations where they have to choose between survival of the newborn and economic ruin. Protection against out-of-pocket spending is key as Ethiopia moves towards universal health coverage. A necessary step is to provide prioritized newborn health care services free of charge.