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Melash Belachew Asresie,1 Daniel Tarekegn Worede2 1Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, EthiopiaCorrespondence: Melash Belachew Asresie, Tel +251920774471, Email kalleab1@gmail.comBackground: Risky sexual behavior is defined as engaging in sexual activities that increase the risk of contracting sexually transmitted infections (STIs) and unintended pregnancies, both of which are global public health issues, particularly in low and middle-income countries like Ethiopia. Hence, this study aimed to identify factors associated with risky sexual behaviors among sexually active men in Ethiopia.Methods: We analyzed data on 8, 103 men aged 15– 59 years obtained from the 2016 Ethiopian Demographic and Health Survey. Bivariable and multivariable logistic regression analyses were performed to identify the factors associated with risky sexual behavior. Statistical significance was defined at a 95% confidence interval (CI) with a p-value less than 0.05.Results: Overall, 13.6% (95% CI: 12.8– 14.3) of men were engaged in risky sexual behavior. Men who were married (adjusted odds ratio [AOR]=0.02, 95% CI: 0.01– 0.03) and residing in agrarian-dominated regions (AOR=0.58, 95% CI: 0.44– 0.76) were less likely to engage in risky sexual behavior. On the other hand, men who had alcohol-drinking habits (AOR=1.50, 95% CI: 1.13, 1.99), and initiated sexual activity before the age of 18 (AOR=1.58, 95% CI: 1.26– 1.99), those with primary education (AOR=1.32, 95% CI: 1.01– 1.72) or secondary education (AOR=1.65, 95% CI: 1.20– 2.26), and those who were Muslim (AOR=1.84, 95% CI: 1.32– 2.60) or other religion followers (AOR=2.00, 95% CI: 1.44– 2.76) were more likely to engage in risky sexual behavior.Conclusion: Risky sexual behavior was significantly associated with marital status, geographic location, alcohol consumption, age of first sexual experience, religion, and educational level, which highlights the importance of encouraging men to avoid early sexual activities and to abstain from consuming alcohol. Moreover, a greater emphasis should be placed on initiatives that promote safer sexual behaviors, particularly targeting men living in pastoral regions, unmarried individuals, and Muslim religious followers.Keywords: sexual behavior, men, associated factors, Ethiopia, EDHS

Melash Belachew Asresie,1,* Getasew Tadesse Worku,2,* Yibeltal Alemu Bekele1,* 1Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Health Economics and Health Service Management, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia*These authors contributed equally to this workCorrespondence: Melash Belachew Asresie, P.box:79, Tel +251920774471, Email kalleab1@gmail.comBackground: Human immunodeficiency virus (HIV) testing coverage among men remains low in Ethiopia; the problem of limited HIV testing coverage is worst in rural areas. Therefore, this study aims to identify factors associated with HIV testing uptake among rural men in Ethiopia.Methods: Data from 10,187 rural men was extracted from the 2016 Ethiopian Demography and Health Survey. All analyses were performed using the complex sample analysis procedure to account for the multistage sampling. Bivariable and multivariable regression analyses were performed to identify factors associated with HIV testing uptake. Statistical significance was defined as a 95% Confidence Interval (CI) with a p-value of less than 0.05.Results: Overall, only 40.3% of rural men have ever been tested for HIV. Being aged 31– 44 years (Adjusted Odds Ratio (AOR) =1.12, 95% CI [1.01– 1.42]), living in developed regions (AOR=1.43, 95% CI [1.09– 1.88]), engaging in non-agricultural activities (AOR = 1.27, 95% CI [1.05– 1.52]), being Muslim (AOR = 2.07; 95% CI [1.67– 2.67]), having comprehensive knowledge about HIV (AOR =1.31, 95% CI [1.12– 1.54]), being from a medium (AOR = 0.56, 95% CI [0.47– 0.93]) and rich (AOR = 0.80, 95% CI [0.56– 0.80]) households, attending primary (AOR = 0.21, 95% CI [0.16– 0.28]) and secondary (AOR = 0.35, 95% CI [0.25– 0.35]) school, having their first sexual experience at the age of 17 or younger (AOR = 0.26, 95% CI [0.19– 0.93]), having discriminatory attitudes towards HIV patients (AOR = 0.67, 95% CI: 0.47– 0.93) and having no health insurance coverage (AOR = 0.54, 95% CI [0.42– 0.69]) were significantly associated with HIV testing uptake.Conclusion: HIV testing uptake among rural men was low. Strengthening awareness programmes on HIV and HIV testing, integrating HIV testing with all other healthcare, strengthening partner accompany and HIV testing during pregnancy and delivery, and providing home-based HIV testing may increase HIV testing uptake.Keywords: HIV, testing, rural, men, determinants, Ethiopia

Introduction: High-risk fertility behaviors (HRFB), including short birth intervals, early or late childbearing age, and high parity, are associated with adverse pregnancy outcomes. Understanding the importance of socioeconomic disparity in HRFB and the factors influencing this disparity is essential to improve maternal and child survival, Accordingly, this study investigated socioeconomic inequalities in HRFB over time and its contributing factors., Methods: We included a total weighted sample of 11,163 and 5,527 women aged 15 to 49 years from the 2005 and 2019 Ethiopia Demographic and Health Surveys, respectively. Erreygers Concentration index (ECI) and curve, along with Erreygers normalized decomposition analysis, were used to examine socioeconomic-related inequalities in HFRB and identify contributing factors to these inequalities., Results: The study showed that the concentration curve for HFRB remained above the equality line over time, indicating a disproportionate concentration among socioeconomically disadvantaged individuals. In 2005, the pro-poor ECI was -0.0682; in 2019, it was -0.2634, indicating that pro-poor inequality has widened. Educational status (10% in 2005 and 28% in 2019), place of birth (7% in 2005 and 28% in 2019), religion (16% in 2005 and 4% in 2019), and region (9% in 2005 and 3% in 2019) contributed to the observed pro-poor inequality. In 2019, contraceptive use (12%) and wealth index (15%) emerged as additional factors explaining HRFB inequality., Conclusion: Our findings revealed the disproportional concentration of HRFB among socioeconomically disadvantaged women in Ethiopia, with a widening disparity between 2005 and 2019. Future interventions to address the effect of socioeconomic disadvantage on HRFB should prioritize women with low or no formal education, those who give birth at home, and those who do not use contraceptives., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Asresie 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 and Aims: Despite its prioritization by the World Health Organization, improving access to cervical cancer screening remains a challenge in Ethiopia. Educated individuals, particularly teachers, are viewed as key influencers in promoting healthy lifestyles among youth and can significantly contribute to cervical cancer prevention. However, there is a notable gap in research regarding cervical cancer screening practices among female educators in the studied region. This study aimed to assess the cervical cancer screening practices and associated factors among female school teachers in Bahir Dar, Ethiopia, 2024., Methods: A school-based cross-sectional study was conducted from May 27 to June 28, 2024, involving 561 female school teachers in Bahir Dar City, using a stratified multistage sampling method. Data were gathered through a pretested structured questionnaire, entered in Epi-data version-4.6, and analyzed with SPSS version-23. Bi-variable and multivariable binary logistic regression analyses were performed, considering variables with p values < 0.05 as statistically significant. Multicollinearity was assessed, and the Hosmer-Lemeshow test evaluated the model's fit., Results: The proportion of female school teachers practicing cervical cancer screening was 14.6% (95% CI: 11.57%-17.66%). Significant factors associated with screening included having more than one lifetime sexual partner (AOR = 2.96, 95% CI: 1.48-4.92), a history of gynecological examinations (AOR = 2.59, 95% CI: 1.28-5.23), a fair understanding of cervical cancer (AOR = 2.16, 95% CI: 1.12-4.17), a positive attitude toward screening (AOR = 3.23, 95% CI: 1.65-6.33), and a high perceived susceptibility to cervical cancer (AOR = 2.57, 95% CI: 1.34-4.93)., Conclusions: Cervical cancer screening rates among female school teachers in Bahir Dar City fall short of the HSTP-II target. Independent predictors of screening include having multiple sexual partners, a history of gynecological exams, knowledge of cervical cancer, attitudes toward screening, and perceived susceptibility. To improve these rates, initiatives should focus on raising awareness and fostering positive attitudes among teachers about cervical cancer and health-seeking behavior., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia., Methods: We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05., Results: The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC., Conclusions: There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Asresie, Arora. 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: A negative attitude towards abortion among health care providers providing abortion services could be an obstacle even under a law, which permits abortion on request. Healthcare providers are expected to perform and be change agents of abortion services. However, little information is known about the attitude toward safe abortion among healthcare providers in Ethiopia., Objective: This study aimed to assess health care provider's attitudes towards safe abortion care and its associated factors at the public health facilities of Bahir Dar City, Northwest Ethiopia., Methods: A health facility-based cross-sectional study was employed from March 1 to 30/2021 among 416 health-care providers. The data were collected by computer-based generated simple random sampling technique, entered, coded, and cleaned using Epi data version 4.2 and analyzed using Statistical Package of Social Sciences version 25.0. Bivariate and multivariable logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant., Results: The response rate of the study was 99.3%, and 70.2% [95% CI: 65.6-74.6] of health-care providers had a favorable attitude towards safe abortion care. Multivariable analysis indicated that health care providers who are found in the age group of 25-29, 30-34, and ≥ 35 years [AOR = 3.34, 95% CI = 1.03-10.85], [AOR = 4.58, 95% CI = 1.33- 15.83] and [AOR = 5.30, 95% CI = 1.43-19.66] respectively, male health care providers [AOR = 3.20, 95% CI = 1.55-6.60], midwives [AOR = 6.50, 95% CI = 2.40-17.44], working at hospital [AOR = 4.77, 95% CI = 1.53-14.91], ever trained on safe abortion [AOR = 5.09, 95% CI = 2.29-11.32], practicing of an abortion procedure [AOR = 2.52, 95%, CI = 1.13-5.60], knowledge of abortion [AOR = 7.35, 95% CI = 3.23-16.71], awareness on revised abortion law [AOR = 6.44, 95% CI = 3.15-13.17] and need further legalization of abortion law [AOR = 11.78, 95% CI = 5.52-24.26] were associated with a favorable attitude towards safe abortion care., Conclusions: Healthcare providers who had a favorable attitude toward safe abortion care were relatively high compared to the previous studies. Age, sex, profession, workplace, training, knowledge, and practice-related factors were associated with a favorable attitude toward safe abortion. This study indicated that, a need for intervention to help improve the attitude of healthcare providers toward safe abortion care, especially for those working in the maternity care units., (© 2024. The Author(s).)

Background: Community-based health insurance (CBHI) schemes are crucial for households to avoid financial hardship, improve healthcare quality, and engage in health policies. Household satisfaction is a key indicator for assessing healthcare quality and identifying service gaps. However, research on household satisfaction with CBHI in Ethiopia is limited. Therefore, this study aimed to evaluate household satisfaction and associated factors with CBHI schemes in Ethiopia., Methods: A comprehensive search of relevant literature was conducted using multiple databases, including PubMed, Google Scholar, Africa Journal Online, and Ethiopian Universities' institutional open-access online repositories. The search was carried out between January 25, 2023, and February 28, 2023. Twelve primary studies, including eight published and four unpublished, were identified and included in the analysis with a total sample size of 5311 participants. A protocol with the registration number CRD20531345698 is recorded on the Prospero database. Two authors, DT and MK, independently extracted the required data using a standardized form. The extracted data were then analyzed using STATA version 17 software. Heterogeneity was assessed using the Cochrane Q-test and I 2 tests. Finally, a random-effect model was employed to calculate the overall household satisfaction with CBHI and to determine the associated factors., Results: The meta-analysis showed that the overall household satisfaction with CBHI in Ethiopia was 62.26% (95% CI 53.25-71.21%). The study found regional variations in household satisfaction, with 63.40% in Oromia, 64.01% in Amhara, 49.58% in Addis Ababa, and 66.76% in SNNPs. The study identified several factors associated with household satisfaction and the CBHI scheme, including the availability of drugs (OR 2.13, 95% CI 1.47-2.78), friendly services (OR 3.85, 95% CI 1.60-6.10), affordability of premium (OR 2.80, 95% CI 1.97-3.63), and knowledge/awareness of CBHI (OR 2.52, 95% CI 1.73-3.33)., Conclusions: The study provides valuable insights into household satisfaction with CBHI in Ethiopia, with a considerable proportion of enrolees being satisfied. The finding highlights regional variations in household satisfaction and underscores the need for tailored interventions and monitoring to enhance CBHI sustainability and effectiveness. The results suggest that healthcare providers and policymakers should prioritize the availability of drugs, friendly services, affordable premiums, and education to improve household satisfaction with CBHI schemes., (© 2023. Wuhan University Global Health Institute.)

Background: Immunization has been promoted as a global strategy aimed at improving child survival. The World Health Organization strives to make immunization services available to everyone, everywhere to save over 50 million lives by 2030. Monitoring the change and identifying the factors contributing to the change in immunization coverage over time and across the nations is imperative for continuing global success in increasing immunization coverage. In this study, we examined the changes and factors that contributed to the change in full immunization coverage over time in Ethiopia (2000 to 2019)., Methods: We analyzed data on children aged 12-23 months, extracted from the 2000 and 2019 Ethiopian Demographic and Health Survey (EDHS) datasets. A total of 3,072 weighted samples (2,076 in 2000 and 966 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine change and identify factors that contributed to the change over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05., Results: There was a 29.56% (95% CI: 24.84, 34.28) change in full immunization coverage between the two surveys. It increased from 14.62% (95% CI: 12.43, 17.11) in 2000 to 44.18% (95% CI: 37.19, 51.41) in 2019. The decomposition analysis showed that about 75% of explained change was attributed to the differences in the composition of explanatory variables (the endowment effect). Particularly, women aged 35-49 years (-2.11%), those who attended four or more antenatal care visits (17.06%), individual who had postnatal care visits (16.90%), households with two or more under-five children (2.50%), and those with a history of child mortality (17.80%) were significantly attributed to the change. The rest, 25% of the explained change was attributed to the difference in the effects of explanatory variables (coefficient). The change in the coefficient for women who had experienced child death (-20.40%) was statistically significant to the change in full immunization coverage over time., Conclusion: The finding of this study revealed that there was a statistically significant change in full immunization coverage over time. The majority of the change was attributed to the differences in the composition of explanatory variables such as antenatal care and postnatal care visits, age of the mother, and number of living children in the household. Therefore, strengthening maternal health services utilization may enhance immunization coverage in Ethiopia. Furthermore, the difference in coefficient of mothers with a history of child death had a substantial counteracting effect on the change, emphasizing the importance of raising awareness and delivering vaccine education to them and the larger community., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Asresie 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: Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia., Methods: We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05., Results: The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity., Conclusions: There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Pregnant mothers are a risky population group for COVID-19 and pregnant mothers with COVID-19 are at increased risk of hospitalization, intensive-care unit admission, invasive ventilation support, and maternal mortality. Vaccination is an essential tool in stopping the effect of the pandemic on maternal and child health. However, there are only limited studies in Ethiopia on the intention to take the COVID-19 vaccine among pregnant women. Thus, this study aimed to assess intention to take the COVID-19 vaccine and associated factors among pregnant women in Bahir Dar city, Northwest Ethiopia., Methods: Facility based cross-sectional study was conducted among 590 pregnant women from 23 May to 07 July 2022. The study participants were selected using a systematic sampling technique. Interviewer administrative questionnaire with epicollect5 application was used to collect the data. Both bi-variable and multivariable binary logistic regression analysis was performed. Statistical significance was defined at a 95% CI with a p-value < 0.05., Result: Overall, 19.8% (95% CI: 16.60-23.06%) of pregnant women intend to take the COVID-19 vaccine. Being urban residence (AOR = 3.40, 95% CI: 1.71-6.78), third trimester of gestational age (AOR = 3.11, 95% CI: 1.61-6.03), multipara (AOR = 2.30, 95% CI: 1.33-3.97), knowledge of COVID-19 vaccine (AOR = 2.33, 95% CI: 1.44-3.77) and having good attitude towards COVID-19 vaccine (AOR = 2.68, 95% CI: 1.65-4.33) were significantly associated with intention to take COVID-19 vaccine., Conclusion: In conclusion, the pregnant women's intention to take the COVID-19 vaccine in this study area was very low. It was significantly associated with residency, gestational age, parity, knowledge, and attitude toward the vaccine. Therefore, strengthening interventions that improve knowledge and attitude about the COVID-19 vaccine, predominantly among those primipara mothers and mothers from rural residences, may raise the intention to take it., (© 2023. The Author(s).)

Background: The human papillomavirus vaccine is one of the main preventative measures for cervical cancer. However, global vaccine uptake is low; the problem is particularly acute in low and middle-income countries. The purpose of this study is to assess female preparatory school students' knowledge, attitude, and uptake of the human papillomavirus vaccine and associated factors in Bahir Dar City, Ethiopia., Methods: Institutional-based cross-sectional study was conducted among 633 female preparatory school students in Bahir Dar city from March 1-30, 2021. Participants were selected using the multistage sampling technique. Data were collected using a structured self-administered questionnaire and entered into Epi-data and exported to SPSS for analysis. Binary and multivariable logistic regression analyses were done using an odds ratio with a 95% confidence interval. Finally-value < 0.05 was considered significant in multivariable analysis., Result: The proportion of Human Papillomavirus (HPV) vaccine uptake, knowledge of the vaccine, and respondents' attitudes toward the vaccine were 45.3% (95% CI = 41.6-49.4%), 58.1% (95% CI = 54.4-61.9%), and 16% (95% CI = 13.2-19.5%), respectively. Having a history of sexual contact AOR = 2.80 (95% CI = 1.64-4.76), hearing about HPV infection AOR = 1.59 (95% CI = 1.13-2.24), and having a positive attitude toward HPV vaccine AOR = 1.46 (95% CI = 1.03-2.08) were significantly associated with knowledge about the HPV vaccine. Discussion of reproductive health issues with family AOR = 2.558 (95%CI = 1.800-3.636), and having good knowledge about HPV vaccine AOR = 3.571(95%CI = 2.494-5.113) were associated with a positive attitude toward the HPV vaccine. Good knowledge AOR = 2.36(95%CI = 1.48-3.76) and a positive attitude toward HPV vaccine AOR = 2.87(95%CI = 1.70-4.85) were strongly associated with HPV vaccine utilization., Conclusion: In this study, there was a very low uptake of HPV vaccination among female students, and only a small proportion of them had good knowledge of the HPV vaccine and a favorable attitude toward the HPV vaccine., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Lakneh 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: High-risk fertility behavior is a major public health concern in low and middle-income countries including Ethiopia. Some studies show that the relationship between high-risk fertility behavior and child mortality has analyzed each fertility behavior individually. Yet, there are limited studies that have analyzed outcomes associated with the joint impact of high-risk fertility behaviors. Therefore, the objective of this study was to examine the individual and combined influence of high-risk fertility behavior on under-five mortalities in Ethiopia., Methods: Data from the 2016 Ethiopian Demographic and Health Survey were used analyzed. A total of 10,773 mothers who gave live births were included in the final analysis. Both descriptive and bivariate and multivariate logistic regression analyses were performed using STATA V.14., Results: Overall, 62.1%, 24.0%, and 2.3% of women experienced at least one, two, and three high-risk fertility behaviors, respectively. In the multivariable analysis, under-five mortality was significantly associated with a combination of two or more maternal high-risk fertility behaviors. The odds of under-five mortality among children of women who were engaged in a combination of two high-risk fertility behaviors (AOR = 2.17, 95%CI: 1.52-3.08) and three high-risk fertility behaviors (AOR = 3.69, 95%CI:1.80, 7.55) was higher compared to children of women who have not engaged any high-risk fertility behaviors., Conclusion: This study revealed that a single high-risk fertility behavior was not associated with under-five mortality, yet the presence of two or more maternal high-risk fertility behaviors was an important factor that increased the likelihood of under-five child death. Thus, special emphasis should be given to children of women who engage in a combination of high-risk fertility behaviors. Furthermore, more emphasis should be placed on increasing access to family planning services and raising awareness about high-risk reproductive behaviors among Ethiopian women., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Even though menstruation is a normal biological process, adolescents are facing managing their menstruation when they are at school. It causes girls to miss their class on average three days every month. Studies in some countries showed that the magnitude of menstrual hygiene management problems is higher in rural adolescent girls, but little is known in the Ethiopia context. The objective of this study was to assess and compare menstrual hygiene management practices among rural and urban schoolgirls, Northeast, Ethiopia., Methods: An institution-based comparative cross-sectional study was employed among 1078 schoolgirls (539 urban and 539 rural) from February to March 2020. The participants were selected using a multi-stage sampling technique. A structured self-administrative questionnaire and observational checklist were used for data collection. Bivariate and multivariable logistic regression analysis with a 95% confidence interval was employed. A P- value less than 0.05 was used to declare statistical significance., Results: Overall, the magnitude of good menstrual hygiene practice was 52.9% (95%CI: 50.3%-56.5%), which was 65.9% (95% CI: 62.8%-70.7%) among urban and 39.9% (95% CI: 36.2%-44.6%) among rural schoolgirls. Among urban schoolgirls, the odds of good menstrual hygiene management practice was higher for girls aged below 18 years (AOR = 1.58, 95%CI: 1.05-2.39), learned about menstrual hygiene at school (AOR = 1.89, 95%CI: 1.21-2.97), heard about menstrual hygiene before menarche (AOR = 4.98, 95%CI: 2.71-9.13), and discussed menstrual hygiene with parents (AOR = 2.56, 95%CI: 1.25-5.27). Whereas, the odds of good menstrual hygiene management practice was higher among those who were knowledgeable on menstrual hygiene (AOR = 5.47, 95%CI: 3.68-8.12), those who learned about menstrual hygiene at school (AOR = 1.75, 95%CI: 1.13-2.70), and girls who heard about menstrual hygiene before menarche (AOR = 3.34, 95%CI: 1.44-7.76) in rural schoolgirls., Conclusions: Though the overall menstrual hygiene practice was low, it was relatively better among urban schoolgirls. This calls for more effort to solve these problems and achieve sustainable development goals. Therefore, education and awareness creation on menstrual hygiene for schoolgirls, even before menarche at both settings should be strengthened. Encouraging parent-adolescent discussion on menstrual hygiene would have paramount importance, particularly to urban schoolgirls., Competing Interests: The authors have declared that no competing interests exist.

Background: Implanon discontinuation is unacceptably high in developing countries, including Ethiopia. Furthermore, there is an observed problem of high unintended pregnancy after method discontinuation that strides to program failure. Therefore, the purpose of this study was to assess the level and determinants of Implanon discontinuation among women who used Implanon in Andabet district, public health facilities, North-West Ethiopia, 2017., Methods: Facility-based cross-sectional study design was employed among 537 women from Feb. 03 to April 28, 2017. Study participants were selected using a systematic random sampling technique. A face-to-face interview was employed to collect data. Epi-Info version 7 was used for data entry and SPSS version 20 for analysis. Both descriptive and analytical statistical analysis was computed. On multivariable binary logistic regression, a p value of less than 0.05 was used to declare statistical significance., Results: About 37% of Implanon users have discontinued the method before the intended time. About 86% of them discontinued Implanon before two years of insertion. Women who had no live child (AOR = 2.17, 95% CI: 1.25-3.77), women who did not receive preinsertion counseling (AOR = 1.85, 95% CI: 1.15-2.97), women who developed Implanon-related side effect (AOR = 5.17, 95% CI: 3.18-8.40), and women who did not satisfy by the service provided (AOR = 5.40, 95% CI: 3.04-9.57) had higher odds of Implanon discontinuation. On the other hand, women who received appointment follow-up (AOR = 0.23, 95% CI: 0.13-0.41) had lower odds of Implanon discontinuation., Conclusions: The level of Implanon discontinuation before its intended time was high in the district. Hence, strengthening preinsertion counseling and appointment follow-up as well as improving the clients' level of service satisfaction could increase Implanon's continuation., Competing Interests: We do not have any competing interests., (Copyright © 2021 Gizachew Worku Dagnew et al.)

Background: Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas., Aim: This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia., Methods: For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p -value of less than 0.05 was used as the measure of statistical significance., Results: The prevalence of overweight/obesity among urban reproductive-age women was statistically higher ( p = 21.5%; 95% confidence interval (CI): 18.2-25.1) than the rural women ( p = 3.5%; 95% CI: 2.9%-4.2%). Women who attend secondary or above education, women in the age groups 25-34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women., Conclusions: Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women's overweight/obesity.

Background: Globally, divorce is a common phenomenon in couples' marital life. As a result, many divorced couples and their children face several social, economic, and health problems after dissolution. There is little information on the magnitude and determinants of divorce in developing countries including Ethiopia. Therefore, this study aimed to estimate the prevalence of divorce from the first union and its predictors among reproductive-age women in Ethiopia., Methods: We used the 2016 Ethiopia demographic and health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 11,646 ever-married women were included in the analysis. Bivariate and multivariable logistics regression was done to identify the determinants of divorce from the first marriage. A p-value < 0.05 was used to declare statistical significance., Results: About 25% (95%CI: 23.4% - 26.6%) ever-married women were divorced from their first marital relationship. Women who were married at age < 15 years (AOR = 1.34; 95%CI: 1.07-1.68), urban women (AOR = 1.69; 95%CI: 1.22-2.35), women who did not attend formal education (AOR = 4.36; 95%CI: 3.14-6.05), women who were employed (AOR = 1.51; 95%CI: 1.31-1.73), and being childless (AOR = 1.34; 95%CI: 1.07-1.69) had higher odds of experiencing a divorce. Similarly, women who experienced partner violence, women with no house ownership, and women in the Amhara region had higher odds of divorce from their first marital union. Conversely, women in Oromia, SNNPR, the metropolis, and the pastoral regions had lower odds of divorce from their first marital union., Conclusion: Divorce from the first marriage is high in Ethiopia. Preventing early marriage and partner violence and promoting girls' education would reduce the divorce rate in Ethiopia., Competing Interests: The authors have declared that no competing interests exist.

Background: Women with chronic-energy malnutrition persists in many developing countries, including Ethiopia. To avert this problem identifying the predictor variables for a high magnitude of underweight is paramount. Consequently, this study aimed to assess the factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia., Methods: We used the 2016 Ethiopia demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. A two-stage stratified cluster sampling technique was employed to select Participants. A total of 13,451 reproductive-age group women (age 15-49 years and who were not pregnant and < 2 months of postpartum) were included in the analysis. Both descriptive and analytical analyses were performed. A P-value of less than 0.05 was used to declare statistical significance., Results: About 22.6% (95%CI: 21.5%-23.6%) of reproductive-age women were underweight. The magnitude of underweight is highest in the Afar region (39.6%) and lowest in Addis Ababa city administration (13.5%). Women who lived in the rural area (AOR = 1.59; 95%CI: 1.19-2.12), those who did not attend formal education (AOR = 1.23; 95%CI: 1.01-1.50), unemployed women (AOR = 1.28; 95%CI:1.13-1.44), women who belong to the poorest household wealth index (AOR = 1.42; 95%CI:1.04-1.94), women who were not married (AOR = 1.41; 95%CI: 1.18-2.69), women who lived in Tigray and the pastoral regions have higher odds of underweight. On the other hand, women who lived in southern nations nationalities and people's region, and women whose age group 25-34 years had lower odds of underweight., Conclusions: Chronic-energy malnutrition among reproductive-age women is high in Ethiopia. Improving the food security of rural, never married, and unemployed women would reduce the magnitude of underweight. Moreover, strengthening girls' education, creating employment opportunities for women, and enhancing household income can further reduce the problem of chronic energy malnutrition., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Ethiopia is one of the Sub-Saharan African countries with high unintended pregnancy rate. Every woman in Ethiopia experiences at least one unintended birth. Although there were some studies about contraceptive use among all women in Ethiopia, evidence about contraceptive use among women with no fertility intention was limited. Therefore, this analysis was performed to assess the prevalence of contraceptive use and associated factors among fecund, married reproductive-age women who intended no more children., Methods: We used the 2016 Ethiopian Demography and Health Survey (EDHS) data collected through a two-stage stratified cluster sampling technique. EDHS was a community based, cross-sectional study conducted from January 18, 2016, to June 27, 2016. A total of 2,859 fecund married reproductive age women with no desire to have more children were included in this study. Both descriptive and logistic regression analysis were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance., Results: Contraceptive use among fecund married reproductive-age women who want no more children was 51.1% (95%CI: 47.0-55.24%). Visit by health workers at home (AOR = 1.37, 95%CI: 1.02, 1.83), living in Addis Ababa (AOR = 3.38 95%CI: 1.76, 6.37) and having better wealth index (middle (AOR = 1.76, 95%CI: 1.25, 2.47) and being rich (AOR = 1.96, 95%CI: 1.40, 2.74)) were found positively associated with contraceptive use. On the other hand, living in the Somali region (AOR = 0.10, 95%CI: 0.01, 0.85), and being Muslim (AOR = 0.45, 95%CI: 0.30, 0.67) were found negatively associated with contraceptive use., Conclusion: Contraceptive use among fecund married reproductive-age women with no fertility intention was low compared to their demand. Therefore, to improve contraceptive use, the provision of family planning counseling and information should be strengthened. Further intervention is needed to narrow disparities in contraceptive use among regions and different population groups., Competing Interests: The authors have declared that no competing interests exist.

Background: The postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia., Methods: We used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance., Results: About 23.7% (23.7, 95% CI: 20.7-27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34-3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04-3.10), women who attended 1-3 (AOR = 2.33; 95%CI:1.27-4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43-4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23-2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01-3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13-3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01-1.88) had higher odds of modern contraceptive use., Conclusion: Postpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls' education and encouraging women's participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.

Background: Sexually-transmitted infections are a public health problem in developing countries including Ethiopia. However, there is limited evidence on factors associated with sexually-transmitted infections among men in Ethiopia. Therefore, this analysis was done to fill this gap., Methods: This analysis was done based on the 2016 Ethiopian demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey used two stage-stratified cluster sampling technique. A total of 8849 sexually active men were included in this analysis. Descriptive and analytical analyses were performed. A p-value of less than 0.05 was used to declare statistical significance., Results: Muslim men (AOR = 1.68; 95%CI: 1.02-2.76), men who were not exposed to media (AOR = 1.75; 95%CI: 1.01-3.03) and men who had multiple sexual partners (AOR = 2.29; 95%CI: 1.05-5.01) had higher odds of having a sexually transmitted infection. In addition, men living in Amhara (AOR = 3.31; 95%CI: 1.33-8.22), Oromia (AOR = 4.62; 95%CI: 1.85-11.55), Gambella (AOR = 3.64; 95%CI: 1.27-10.42), and Harari regions (AOR = 4.57; 95%CI: 1.49-14.02) had higher odds of developing sexually transmitted infection. On the other hand, men who believe women are asked to use a condom if she knows he has STIs (AOR = 0.53; 95%CI: 0.33-0.85) had low odds of developing a sexually transmitted infection., Conclusions: Men not exposed to mass media, Muslims and men with multi-sexual partners had higher odds of having sexually transmitted infections. Encouraging monogamous relationships and exposing men to mass media may help to reduce the burden of STIs in Ethiopia., Competing Interests: The authors have declared that no competing interests exist

Background: Institutional delivery is the cornerstone reducing maternal mortality. Community-based behavioral change interventions are increasing institutional delivery in developing countries. Yet, there is a dearth of information on the effect of attending pregnant women's conferences in improving institutional delivery in Ethiopian. Therefore, this study was aimed to assess the effect of attending pregnant women's conference on institutional delivery, Northwest Ethiopia., Methods: Community-based comparative cross-sectional study was conducted in 2017 among 871 women who gave birth within the last 12 months (435: pregnant women's conference attendants and 436: pregnant women's conference non-attendants). Participants were selected by using a multistage-simple random sampling technique and a structured interviewer-administered questionnaire was used for data collection. Both descriptive and logistic regression analyses were performed using SPSS V.23. A P-value less than or equal to 0.05 at 95% confidence interval was set to test statistical significance., Results: Institutional delivery among women who attended pregnant women's conferences was 54.3%, higher compared with 39.9% of women who didn't attend the conference. Likewise, the level of well-preparedness for birth was higher among women who attended the conference (38.9%) compared with their counterparts (25.7%). Being knowledgeable on childbirth (AOR = 1.7, 95%CI: 1.2, 2.8) and postpartum danger signs (AOR = 14.0, 95%CI: 4.6, 40.0), and discussed with partners/families about the place of birth (AOR = 7.7, 95%CI: 3.6, 16.4) were more likely to institutional delivery among women who attended pregnant women's conference. Whereas, among women who didn't attend the pregnant women's conference, being knowledgeable about pregnancy danger signs (AOR = 3.6, 95%CI: 1.6, 8.1) were more likely to institutional delivery. In addition, the nearest health facility within 1 h of walking and well-preparedness for birth and its complication were found positively associated with institutional delivery in both groups., Conclusion: Institutional delivery was low in both groups compared to the national plan, but was higher among women who attended the conference. Similarly, women's knowledge of obstetric danger signs and preparation for birth and its complication was higher among women who attended the conference. Therefore, encouraging women to attend the pregnant women's conference and discuss with their families about the place of delivery should be strengthened.