13 results on '"Alemu, Sisay Mulugeta"'
Search Results
2. Biomedical and public health reviews and meta-analyses in Ethiopia had poor methodological quality: overview of evidence from 1970 to 2018
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Habtewold, Tesfa Dejenie, Alemu, Sisay Mulugeta, Mohammed, Shimels Hussien, Endalamaw, Aklilu, Mohammed, Mohammed Akibu, Teferra, Andreas A., Tura, Abera Kenay, Asefa, Nigus Gebremedhin, and Tegegne, Balewgizie Sileshi
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- 2019
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3. HIV test coverage among pregnant women in Ethiopia: A systematic review and meta-analysis.
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Endalamaw, Aklilu, Geremew, Demeke, Alemu, Sisay Mulugeta, Ambachew, Sintayehu, Tesera, Hiwot, and Habtewold, Tesfa Dejenie
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DIAGNOSIS of HIV infections ,HIV prevention ,ONLINE information services ,PUBLICATION bias ,META-analysis ,CONFIDENCE intervals ,SOCIAL determinants of health ,HEALTH services accessibility ,SYSTEMATIC reviews ,RURAL conditions ,MEDICAL screening ,HEALTH ,INFORMATION resources ,DESCRIPTIVE statistics ,MEDLINE ,METROPOLITAN areas ,DATA analysis software ,VERTICAL transmission (Communicable diseases) ,PREGNANCY - Abstract
Introduction: A human immunodeficiency virus (HIV) test during pregnancy is the gateway to the prevention of mother-to-child transmission (PMTCT) of HIV. Estimating the national uptake of HIV tests among pregnant women is an important course of action. Thus, we pooled the information about the national uptake of HIV tests and determined the significant factors among pregnant women in Ethiopia. Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar databases. We also searched for cross-references to get additional relevant studies, and included cross-sectional, case-control and cohort study studies. We applied a random-effects model meta-analysis to pool the national data of uptake of HIV tests. Galbraith's plot and Egger's regression test were employed to check publication bias, and heterogeneity was assessed using I ² statistics. The protocol registered is found in the PROSPERO database with the registration number CRD42019129166. Results: In total, 22 articles with 13 818 pregnant women study participants were involved. The national uptake of HIV tests among pregnant women was 79.6% (95% CI 73.9–85.4). Living in urban areas (AOR 2.8; 95% CI 1.1–4.6), previous HIV tests (AOR 4.6; 95% CI 1.2–8.0), and comprehensive knowledge on mother-to-child transmission (MTCT) (AOR 2.61; 95% CI 1.5–3.7) and PMTCT of HIV (AOR 2.1; 95% CI 1.5–2.8) were associated with increased practice of HIV tests. Conclusion: This review showed that HIV test coverage among pregnant women was approximately 80% and substantially lower than the national recommendation. Addressing HIV-related health services for rural women and providing health information on MTCT and PMTCT of HIV to increase HIV testing coverage is required. [ABSTRACT FROM AUTHOR]
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- 2021
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4. Higher educational and economic status are key factors for the timely initiation of breastfeeding in Ethiopia: A review and meta‐analysis.
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Habtewold, Tesfa Dejenie, Mohammed, Shimels Hussien, Endalamaw, Aklilu, Mulugeta, Henok, Dessie, Getenet, Berhe, Derbew Fikadu, Birhanu, Mulugeta Molla, Islam, Md. Atiqul, Teferra, Andreas A., Asefa, Nigus Gebremedhin, and Alemu, Sisay Mulugeta
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EDUCATIONAL attainment ,ECONOMIC status ,PUBLICATION bias ,MARITAL status ,INCOME ,ODDS ratio - Abstract
Aim: To investigate the association between initiation of breastfeeding within 1 hour after birth (TIBF) and maternal educational status, paternal educational status, household income, marital status, media exposure and parity in Ethiopia. Methods: We searched PubMed, EMBASE, Web of Science, SCOPUS, CINAHL and WHO Global health library databases. All studies were conducted in Ethiopia and published from 2000 to 2019 were included. To obtain the pooled odds ratio (OR), data were fitted in random‐effects meta‐analysis model. Statistical heterogeneity was quantified using Cochran's Q test, τ2 and I2 statistics. This meta‐analytic review was reported in compliance with the PRISMA statement. Results: Out of 553 studies retrieved, 25 fulfilled our inclusion criteria. High maternal educational status (P <.001), paternal educational status (P =.001) and household income (P =.002), being married (P =.001) and multiparity (P =.01) were significantly associated with TIBF. There was no significant publication bias. Conclusions: Our meta‐analysis showed that TIBF was associated with high educational and economic status, being married and multiparity. This suggests that the meta‐analysis detected small associations that many previous studies in Ethiopia have not been able to show. Our findings can be useful for comparisons with other countries. [ABSTRACT FROM AUTHOR]
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- 2020
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5. Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses.
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Alemu, Sisay Mulugeta, Alemu, Yihun Mulugeta, and Habtewold, Tesfa Dejenie
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COLOSTRUM , *META-analysis , *BREASTFEEDING , *MOTHER-child relationship , *MATERNAL age , *AGE - Abstract
Objective: To investigate whether maternal/caregiver's age, infant age (0-6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.Design: A systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle-Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.Setting: All observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver's age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver's age (OR=1·09; 95 % CI 0·84, 1·41).Conclusions: There was no association between maternal/caregiver's age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum. [ABSTRACT FROM AUTHOR]- Published
- 2019
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6. Evidence on the effect of gender of newborn, antenatal care and postnatal care on breastfeeding practices in Ethiopia: a meta-analysis and meta-regression analysis of observational studies.
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Habtewold, Tesfa Dejenie, Sharew, Nigussie Tadesse, and Alemu, Sisay Mulugeta
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Objectives The aim of this systematic review and metaanalysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia. Design Systematic review and meta-analysis. Data sources To retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018. Eligibility criteria All observational studies including crosssectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies. Data extraction and synthesis Study area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran's Q X2 test, t2 and I2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger's regression test at p value threshold =0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis. Results Of 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I2=90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I2=63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I2=81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I2=93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I2=66.2%). Conclusions In line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison. [ABSTRACT FROM AUTHOR]
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- 2019
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7. Mother’s knowledge on prevention of mother-to-child transmission of HIV, Ethiopia: A cross sectional study.
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Alemu, Yihun Mulugeta, Habtewold, Tesfa Dejenie, and Alemu, Sisay Mulugeta
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HIV infection transmission ,VERTICAL transmission (Communicable diseases) ,HIV prevention ,PUBLIC health ,CROSS-sectional method - Abstract
Objective: To identify proportion of and factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV in pregnant women attending antenatal care in Northern Ethiopia. Methods: A total of 416 pregnant women were interviewed between October 2012 and May 2013. Logistic regression analysis was used to identify factors for comprehensive knowledge on prevention of mother-to-child transmission of HIV. Results: The proportion of pregnant women, who have comprehensive knowledge on prevention of mother-to-child transmission of HIV, was 52%. The odds of having comprehensive knowledge on prevention of mother-to-child transmission of HIV were higher among pregnant women who were younger (16 to 24 years old) (Adjusted Odds Ratio (AOR) = 2.95; 95%CI: 1.20, 7.26), urban residents (AOR = 2.45; 95%CI: 1.39, 4.32), attending secondary education and above (AOR = 4.43; 95%CI: 2.40, 8.20), employed (AOR = 4.99;95%CI: 2.45, 10.16), have five children or more (AOR = 9.34; 95%CI:3.78, 23.07), have favored attitude towards HIV positive living (AOR = 2.53; 95%CI: 1.43, 4.44) and have perceived susceptibility to HIV (AOR = 10.72; 95%CI: 3.90, 29.39). Conclusion: The proportion of women who have comprehensive knowledge on prevention of mother-to-child transmission of HIV in this study setting was low. Measures which will escalate mother’s knowledge on prevention of mother-to-child transmission of HIV should be emphasized. Efforts to improve mother’s knowledge on prevention of mother-to-child transmission of HIV should target women who were older age (> = 35years), rural residents, unemployed, not attending formal education, primigravids, have no favored attitude towards HIV positive living and have not perceived susceptibility to HIV. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study.
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Haile, Yohannes Gebreegziabhere, Alemu, Sisay Mulugeta, and Habtewold, Tesfa Dejenie
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ACADEMIC achievement evaluation , *COLLEGE students , *CONFIDENCE intervals , *EPIDEMIOLOGICAL research , *INSOMNIA , *QUESTIONNAIRES , *RESEARCH funding , *SLEEP , *SLEEP disorders , *LOGISTIC regression analysis , *ACQUISITION of data , *CROSS-sectional method , *DATA analysis software , *DIAGNOSIS ,DEVELOPING countries - Abstract
Introduction. Studies show that 9.4% to 38.2% of university students are suffering from insomnia. However, research data in developing countries is limited. Thus, the aim of the study was to assess insomnia and its temporal association with academic performance. Methods and Materials. Institution based cross-sectional study was conducted with 388 students at Debre Berhan University. Data were collected at the nine colleges. Logistic and linear regression analysis was performed for modeling insomnia and academic performance with a p value threshold of 0.05, respectively. Data were entered using EPI-data version 3.1 and analyzed using SPSS version 20. Results. The prevalence of insomnia was 61.6%. Field of study (p value = 0.01), worshiping frequency (p value = 0.048), marital status (p value = 0.03), and common mental disorder (p value < 0.001) were identified associated factors of insomnia. There was no significant association between insomnia and academic performance (p value = 0.53, β = −0.04). Insomnia explained 1.2% (r2 = 0.012) of the difference in academic performance between students. Conclusions. Nearly 3 out of 5 students had insomnia. We recommended that universities would endorse sleep quality and mental health illness screening programs for students. [ABSTRACT FROM AUTHOR]
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- 2017
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9. Mental and Reproductive Health Correlates of Academic Performance among Debre Berhan University Female Students, Ethiopia: The Case of Premenstrual Dysphoric Disorder.
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Alemu, Sisay Mulugeta, Habtewold, Tesfa Dejenie, and Haile, Yohannes Gebreegziabhere
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ACADEMIC achievement evaluation , *ANALYSIS of variance , *CONFIDENCE intervals , *HUMAN reproduction , *MENSTRUATION , *MENTAL health , *PREMENSTRUAL syndrome , *UNIVERSITIES & colleges , *ACQUISITION of data , *CROSS-sectional method , *DATA analysis software , *SYMPTOMS , *DIAGNOSIS - Abstract
Background. Globally 3 to 8% of reproductive age women are suffering from premenstrual dysphoric disorder (PMDD). Several mental and reproductive health-related factors cause low academic achievement during university education. However, limited data exist in Ethiopia. The aim of the study was to investigate mental and reproductive health correlates of academic performance. Methods. Institution based cross-sectional study was conducted with 667 Debre Berhan University female students from April to June 2015. Academic performance was the outcome variable. Mental and reproductive health characteristics were explanatory variables. Two-way analysis of variance (ANOVA) test of association was applied to examine group difference in academic performance. Result. Among 529 students who participated, 49.3% reported mild premenstrual syndrome (PMS), 36.9% reported moderate/severe PMS, and 13.8% fulfilled PMDD diagnostic criteria. The ANOVA test of association revealed that there was no significant difference in academic performance between students with different level of PMS experience (F-statistic = 0.08, p value = 0.93). Nevertheless, there was a significant difference in academic performance between students with different length of menses (F-statistic = 5.15, p value = 0.006). Conclusion. There was no significant association between PMS experience and academic performance, but on the other hand, the length of menses significantly associated with academic performance. [ABSTRACT FROM AUTHOR]
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- 2017
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10. Sociodemographic, clinical, and psychosocial factors associated with depression among type 2 diabetic outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia: a cross-sectional study.
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Habtewold, Tesfa Dejenie, Alemu, Sisay Mulugeta, and Haile, Yohannes Gebreegziabhere
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PEOPLE with diabetes , *MENTAL depression , *PSYCHOSOCIAL factors , *CROSS-sectional method , *MULTIVARIATE analysis - Abstract
Background: Depression is a common comorbidity among patients with type 2 diabetes. There are several reports supporting a bidirectional association between depression and type 2 diabetes. However, there is limited data from non-western countries. Therefore, the aim of this study was to assess the sociodemographic, clinical, and psychosocial factors associated with co-morbid depression among type 2 diabetic outpatients presenting to Black Lion General Specialized Hospital, Addis Ababa, Ethiopia. Methods: This institution based cross-sectional study design was conducted on a random sample of 276 type 2 diabetic outpatients. Type 2 diabetes patients were evaluated for depression by administering a validated nine-item Patient Health Questionnaire (PHQ-9). Risk factors for depression among type 2 diabetes patients were identified using multiple logistic regression analysis. Result: In total, 264 study participants were interviewed with a response rate of 95.6 %. The prevalence of depression was 44.7 %. In the multivariate analysis, the statistically significant risk factors for depression were monthly family income ≤ 650 (p-value = 0.056; OR = 2.0; 95 % CI = 1.01, 4.2), presence of ≥3 diabetic complications (p-value = 0.03; OR = 3.3; 95 % CI = 1.1, 10.0), diabetic nephropathy (p-value = 0.01; OR = 2.9; 95 % CI = 1.2, 6.7), negative life events (p-value = 0.01; OR = 2.4; 95 % CI = 1.2, 4.5), and poor social support (p-value = 0.001; OR = 2.7; 95 % CI = 1.5, 5.0). Conclusion: This study demonstrated that depression is a common co-morbid health problem with a prevalence rate of 44.7 %. The presence of diabetic complications, low monthly family income, diabetic nephropathy, negative life event, and poor social support were the statistically significant risk factors associated with depression. We presume that the burden of mental health especially depression is high in the population with type 2 diabetes mellitus co-morbidity. Therefore, specific attention is needed to diagnose early and treat promptly. [ABSTRACT FROM AUTHOR]
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- 2016
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11. How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review.
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Alemu SM, Tura AK, do Amaral GSG, Moughalian C, Weitkamp G, Stekelenburg J, and Biesma R
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- Africa South of the Sahara epidemiology, Humans, Infant, Newborn, Patient Acceptance of Health Care, Qualitative Research, Health Facilities, Infant Health
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Background: Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA., Methods: A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review., Results: We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data., Conclusions: The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest F (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)
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- 2022
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12. Evidence on the effect of gender of newborn, antenatal care and postnatal care on breastfeeding practices in Ethiopia: a meta-analysis andmeta-regression analysis of observational studies.
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Habtewold TD, Sharew NT, and Alemu SM
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- Ethiopia, Humans, Infant, Newborn, Regression Analysis, Sex Factors, Breast Feeding statistics & numerical data, Observational Studies as Topic, Postnatal Care statistics & numerical data, Prenatal Care statistics & numerical data
- Abstract
Objectives: The aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia., Design: Systematic review and meta-analysis., Data Sources: To retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018., Eligibility Criteria: All observational studies including cross-sectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies., Data Extraction and Synthesis: Study area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran's Q X
2 test, τ2 and I2 statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger's regression test at p value threshold ≤0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis., Results: Of 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I2 =90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I2 =63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I2 =81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I2 =93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I2 =66.2%)., Conclusions: In line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison., Trial Registration Number: CRD42017056768., 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.)- Published
- 2019
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13. Common mental disorder and its association with academic performance among Debre Berhan University students, Ethiopia.
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Haile YG, Alemu SM, and Habtewold TD
- Abstract
Background: Common mental disorder (CMD) is prevalent in industrialized and non-industrialized countries. The prevalence of CMD among university students was 28.8-44.7% and attributed to several risk factors, such as schooling. The aim of this study was to assess the prevalence and risk factors of CMD. In addition, the association between CMD and academic performance was tested., Methods: Institution based cross-sectional study was conducted with 422 students at Debre Berhan university from March to April 2015. CMD was the primary outcome variable whereas academic performance was the secondary outcome variable. Kessler psychological distress (K10) scale was used to assess CMD. Bivariate and multiple logistic regression analysis were performed for modeling the primary outcome variable; independent samples T test and linear regression analysis were carried out for modeling the secondary outcome variable. The strength of association was interpreted using odds ratio and regression coefficient (β) and decision on statistical significance was made at a p value of 0.05. Data were entered using EPI-data version 3.1 software and analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.01 software., Results: The prevalence of CMD was 63.1%. Field of study (p = 0.008, OR = 0.2, 95% CI 0.04-0.61), worshiping (p = 0.04, OR = 1.8, 95% CI 1.02-3.35), insomnia (p < 0.001, OR = 3.8, 95% CI 2.21-6.57), alcohol drinking (p = 0.006, OR = 2.7, 95% CI 1.33-5.66), and headache (p = 0.02, OR = 2.1, 95% CI 1.10-3.86) were identified risk factors for CMD. The mean cumulative grade point average of students with CMD was lower by 0.02 compared to those without CMD, but not statistically significant (p = 0.70, β = -0.02, 95% CI -0.15 to 0.10). CMD explained only 0.8% (r
2 = 0.008) of the difference in academic performance between students., Conclusions: At least three out of five students fulfilled CMD diagnostic criteria. The statistically significant risk factors were field of study, worshiping, insomnia, alcohol drinking, and headache. Moreover, there was no statistically significant association between CMD and academic performance. Undertaking integrated evidence-based intervention focusing on students with poor sleep quality, poor physical health, and who drink alcohol is essential if the present finding confirmed by a longitudinal study.- Published
- 2017
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