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Abstract Background Respiratory tract infection (RTI) has been a predominant health problem worldwide, including Ethiopia. It is one of the major causes of under-five mortality in Ethiopia, accountable for 18% of total deaths. Nationwide studies on the incidence of respiratory infections and maternal risk factors are limited. Hence, this study was aimed to determine the incidence and predictors of respiratory infections among infants aged less than six months in Ethiopia, 2023. Methods This was a retrospective follow up study using data from Performance Monitoring for Action Ethiopia (PMA Ethiopia). A two-stage cluster sampling technique was used to select a total 2,246 eligible study participants from 206 enumeration areas. A Cox proportional hazards regression model was used to identify independent predictors of respiratory tract infection incidence. Hazard ratios with 95% confidence intervals and p value

Abstract Background Undernutrition remains a global challenge and public health concern, despite the presence of policies, programs and interventions. There is substantial evidence that the majority of the rural children under-5 years old have composite index of anthropometric failure than the urban counter parts. Hence, identifying the main contributors of these disparities will help health policy makers, program designers and implementers for the reduction of composite index of anthropometric failures in children under-5 years old in the study areas. Methods The most recent and nationally representative samples of demographic and health surveys of five East African countries data were used for the current study. To appreciate the residence-based differences of composite index of anthropometric failure in under-5 children, the Blinder-Oaxaca decomposition analysis and its extensions were employed to determine the effects of covariates and coefficients. The country specific survey data analysis was performed. Results The current study revealed that the burden of composite index of anthropometric failure (CIAF) in under-5 children were 40.69%, 22.04%, 34.06%, 31.99%, and 33.27% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. The residence-based differences in CIAF were 25.49%, 11.38%, 27%, 22.15%, and 20.55% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. Results of the Blinder-Oaxaca decomposition analysis and its extensions revealed that 100% of the rural–urban children under-5 composite index of anthropometric failure disparity was explained by endowment characteristics (covariate effect). Wealth index, mother’s education, age of child, type of birth, sex of child and birth interval inequality between rural and urban households explains most of the composite index of anthropometric failure disparity in children under-5 years old. Conclusions The residence-based CIAF differences were high in all study countries. The rural–urban CIAF gap is ascribed by household, maternal and child characteristics. This result implies that rural children under-5 is disproportionally disadvantaged with respect to characteristics than their consequences. Through identification of the underlying factors behind the rural–urban CIAF disparities, the result of this study is important in planning effective intervention measures aiming at reducing residence-based inequalities and the population health outcomes. Therefore, should be given for rural children to reduce CIAF by improving house hold wealth index, women education and attentions to older children, and female children.

Abstract Despite growing utilization of family planning in Ethiopia, many pregnancies in rural areas are still unintended and unintended pregnancy remains a major global challenge in public and reproductive health, with devastating impact on women and child health, and the general public. Hence, this study was aimed to determine the prevalence and associated factors of unintended pregnancy in rural women of Ethiopia. This study used a 2016 Ethiopian Demography and Health Survey data. A total weighted samples of 974 reproductive-aged rural women were included in this analysis. Multilevel mixed logistic regression analysis was employed to consider the effect of hierarchal nature of EDHS data using Stata version 14 to determine individual and community level factors. Variables significantly associated with unintended pregnancy were declared at p-value

Abstract Background Equity in COVID-19 vaccine uptake is the heart of managing the ongoing pandemic of COVID-19 disease. However, the evidence of inequality in COVID-19 vaccination in Ethiopia is limited. Therefore, this study investigated the trends of socioeconomic and geographic inequality of COVID-19 vaccine uptake in Ethiopia. Method This study used the Global COVID-19 trends and impact survey as part of the WHO Health Equity Assessment Toolkit software 2021 version. The trends of socioeconomic and geographic inequalities in COVID-19 vaccine uptake between surveys were calculated with a 95% confidence interval (CI). A 95% CI was calculated along with measures of inequality in COVID-19 vaccine uptake and statistical significance was declared if the 95% CI of absolute and relative measures of inequalities does not include 0 and 1 respectively. Result The COVID-19 vaccine uptake in the 45–65 age group significantly increased from 40.04%, 95% CI (32.49, 48.1) to 72.7%, 95%CI (63.7, 80.2) in 05/2021 to 03/2022 respectively. The absolute inequality of COVID-19 vaccine uptake among male vs female respondents was 3.6%, 95% CI (3.9, 11.2) in 08/2021 which was obtained by subtraction of the respecting proportion of vaccines uptakes 32.9% for males minus 29.28% for females and there was a significant more prevalence of vaccine uptake in males than in females. The absolute inequality in COVID-19 vaccine uptake among health workers vs non-health workers was 28.5%, 95% CI (17.8, 37.2), 03/2022 and there was a significantly higher prevalence of vaccine uptake in health workers than non-health workers in each survey. The relative measures of inequality in the ratios of COVID-19 vaccine uptake among urban vs rural was 0.85, 95%CI (0.7, 0.994) in 08/2021 which was obtained by dividing the respecting proportion of vaccine uptakes of urban by rural residents. Conclusion The study showed that the proportion of COVID-19 vaccine uptake in Ethiopia significantly increased from 2021 to 2022 with distinct inequality. The study indicated there is significant absolute and relative inequality in COVID-19 vaccine uptake between health workers and non-health workers, male and female, and urban and rural residents in Ethiopia. Therefore, the effort should be geared towards reducing health workers vs non-health workers, urban vs rural, and gender inequalities in COVID-19 vaccine uptake through health literacy and recommend geographic and equity-oriented policies, to ensure effective pandemic management of COVID-19.

Abstract Introduction The utilization of maternal health services is vital to prevent maternal and child health problems. However, there is limited evidence as to why rural women have lower utilization and educational inequality in maternal health services utilization in Ethiopia. Identifying the causes is the first step to achieving maternal and child health initiatives. Objective The objective of this study was to decompose the urban-rural disparities and educational inequalities in maternal health care utilization in Ethiopia. Methods The study used the 2019 Ethiopian Demography Health Survey. Blinder-Oaxaca decomposition and multivariate decomposition analyses were done on a weighted 3,926.7 women to see the urban-rural differences in maternal health service utilization by using Stata 17.0. For the educational inequality of maternal health service utilization, concentration curve and concentration index were used by using conindex. P value

Abstract Background HIV/AIDS remains a major public health challenge, in Sub-Saharan Africa (SSA). In 2020, 16% of people living with HIV did not know their HIV status in SSA. Understanding the geospatial distribution of HIV infection, awareness status, and transmission knowledge is crucial for designing effective prevention and control strategies to end the HIV/AIDS pandemic by 2030. However, to the best of our literature searching the evidence of geospatial analysis and a machine learning algorithm, specifically a decision tree to decide on a Sustainability Development Goal (SDG), and to establish a clear pathway of HIV awareness status and HIV infection rates in each region of SSA is limited. Therefore, this study aims to determine HIV Infection, awareness status, and transmission knowledge among Adults in SSA using a machine learning approach and geospatial analysis. Methods The study used demographic and health survey data from 2009 to 2019. Machine learning algorithms and geospatial analysis techniques were employed to determine HIV infection, awareness of HIV status, and HIV transmission knowledge. Results The overall prevalence of HIV infection among adults in SSA from 2009 to 2019 is 4.96%. The machine learning algorithm (decision tree) indicates that infected individuals are unaware of their HIV infection, about half of them do not have HIV transmission knowledge, and more of them were found in Southern SSA. The spatial hotspots show that high HIV prevalence, low levels of HIV status awareness, and adequate transmission knowledge are specifically located in the Southern and some Eastern SSA. Conclusion The machine learning algorithm (decision tree) revealed that the risk of HIV infection is high among individuals who are unaware of their HIV status and lack knowledge about HIV transmission in Southern and eastern parts of Sub-Saharan Africa. The spatial analysis revealed the high-risk areas of HIV infection with low HIV status awareness and HIV transmission knowledge were located in Southern and some Eastern SSA countries. Therefore public health strategies should focus on educating individuals about the importance of knowing their HIV status, transmission knowledge, and ensuring accessible testing options in these affected regions to address the observed spatial disparities in HIV infection, HIV status awareness, and HIV transmission knowledge to achieve the 2030 Sustainable Development Goal of ending the HIV/AIDS epidemic in Africa.

Abstract Background Community based health insurance (CBHI) is characterized by voluntary involvement, pooling of health risks and of funds occur within a community. It is becoming increasingly popular way to increase the use of healthcare services in low- and middle-income nations. Understanding the effect of CBHI on the level of health services utilization is a paramount for evidence based decision making. Hence, this study aimed to estimate the pooled effect of CBHI on health services utilization in Ethiopia. Methods Studies were searched from PubMed, Google scholar, Web of Science, Research4life, Science Direct, African Journal Online and national websites for grey literatures. We were adhered to the PRISMA guidelines. Cross sectional and quasi experimental studies were included. Studies were screened, and critically appraised for quality using Joanna Briggs Institute Critical Appraisal tools. The data were extracted using Microsoft excel and exported to STATA 17 and RevMan 5.4.1 for further analysis. Heterogeneity between studies was assessed using Cochran’s Q statistic and quantified with I2. A random-effects model was used to estimate the pooled effect size. Subgroup analysis was done to show variations of the effect sizes across study years. Result A total of 1501 studies were identified, out of which only 14 of them were included in the final meta-analysis. Health services utilization among CBHI members and non-members was 69.1% [95%CI (57.1–81.1%)] versus 50.9% [95%CI (40.6–61.3%)] respectively (difference in the effect was 18.2%). The CBHI members were nearly three folds more likely to utilize health services as compared with their counterparts [OR = 2.54, 95%CI: (1.81, 3.57). On average, CBHI users had 1.14 increased health facility visits as compared to non-insured, mean difference (MD) = 1.14 visits with 95% CI (0.65–1.63). Conclusion The CBHI has a significantly increased health service utilization in Ethiopia. Hence, it will have a great contribution to meet the health for all agenda in resource limited countries.

Abstract Introduction Obstetric fistula is a birth injury that causes the vagina to open abnormally. As a result, women may experience urinary leakage, which can lead to isolation, depression, and a lower quality of life. Due to the scarcity of evidence regarding the average recovery time for obstetric fistula in Ethiopia, Therefore, this study aimed to assess the recovery time for women with obstetric fistula in Ethiopia. Methods Between September and 8 November 2023, published studies were searched using online databases including PubMed, Hinari, Epistemonikos, and Google Scholar. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Study quality was assessed using Egger’s test and a visual inspection of funnel plot symmetry. Statistical analysis was performed using STATA version 17 software. A random-effects model was employed for analysis, and the Cochrane Q-test and I² statistics were used to assess heterogeneity among studies. Result A total of six studies were included in this analysis. The minimum and maximum median survival times were 2.67 and 5.19 weeks, respectively. The pooled median recovery time was 4.05 weeks (95% CI: 2.92, 5.18) based on the random effects model. Heterogeneity among the included studies assessed by the I² statistic was 97.72% (p = 0.000). The p-value for Egger’s regression test (0.017) was significant, indicating evidence of publication bias. Conclusion The findings reveal a pooled median recovery time of 4.05 weeks, with considerable heterogeneity. Although these figures provide valuable insights, the presence of publication bias was evidenced by the asymmetric funnel plot and significant Egger’s test. Efforts to address publication bias are essential to improve future meta- the reliability of the surveys has increased. Registration : The protocol for this systematic review was pre-registered on the International Prospective Register of Systematic Reviews (Registration Number: CRD42023270497).

BackgroundEthiopia faces inadequate minimum dietary diversity (MDD), which significantly contributes to rising death rates and the spread of diseases among children aged 6–23 months. The evidence of socioeconomic and regional inequalities is central to the Sustainable Development Goals (SDGs), and it is especially crucial for guiding the development of local, regional, and national policies and initiatives that address these inequalities in MDD consumption. This will help achieve the SDG target of ending all forms of malnutrition. However, there is limited evidence on socioeconomic and regional inequalities in MDD consumption among children in Ethiopia. Therefore, this study aimed to investigate the socioeconomic and regional inequalities in MDD among children aged 6–23 months in Ethiopia.MethodsThis study utilized nationally representative weighted data comprising 3,145 samples from the 2019 Ethiopia Demographic and Health Survey (EDHS). The concentration index (CIX)was employed to estimate the socioeconomic and regional inequalities in MDD consumption.ResultsThe prevalence of adequate MDD in Ethiopia was 7.11%. The concentration index (CIX) values for MDD by wealth status and region were 0.3 and 0.084, respectively, with a p-value of

BackgroundAntenatal care (ANC) services are essential to reduce maternal and newborn morbidity and mortality rates. However, the trends and socioeconomic inequality of utilizing recommended ANC services has not been well studied in Ethiopia. Therefore, this study aims to investigate the trends and socioeconomic disparities in receiving recommended ANC services among Ethiopian women.MethodsThis study used recent Ethiopian Demographic Health Surveys (EDHS) conducted in 2011, 2016, and 2019. Binary logistic regression model was employed to assess the association between receiving the recommended ANC services and explanatory variables and socioeconomic disparities were estimated through concentration index (CIX) analysis. Moreover, Wagstaff approach was used to decompose the relative CIX to the contribution of explanatory variables for the observed disparities.ResultsThis study found that 37.37% (95%CI: 36.46-38.28%) of mothers utilized the recommended ANC services in Ethiopia. The trend in the coverage of recommended ANC services increased from ~ 30% in 2011 to 44.70% in 2019. Mother's age and education, household wealth status, distance of the nearest health facility, and experiencing domestic abuse (i.e., wife beating) were significantly associated with utilization of recommended ANC services. The relative estimated CIX for wealth index, mothers education, Ethiopian administrative regions, and residence were 0.15 (P ConclusionThe study revealed that Ethiopian women's utilization of recommended ANC services was unequal by their socioeconomic classes, with better off women more likely to utilize the recommended ANC services than worse off women. Hence, the responsible body should improve the access and quality of antenatal care services for underprivileged women in Ethiopia.

BackgroundHuman immunodeficiency virus (HIV) remains the leading cause of global morbidity and mortality. The incidence of HIV is disproportionately higher in Sub-Saharan regions, particularly the Southern African sub-region, which is the most affected region and accounts for 77% of all new HIV infections in the region. Thus, the aim of this study was to identify the determinants of HIV among reproductive-age women in Africa.MethodsThis study was conducted among reproductive-age women in Africa, based on secondary data obtained from the Demographic Health Survey (DHS) conducted between 2010 and 2019. The outcome variable was HIV status, while individual- and community-level variables served as potential predictors. The model fit was assessed using Akaike’s Information Criterion, Bayesian Information Criterion, and − 2 Log likelihood. Then, multilevel mixed-effects analysis was used. Intra-cluster correlation coefficient, median odds ratio, and proportional change in variance were used to measure heterogeneity between clusters.ResultsA total of 292,810 unweighted and 293,773 weighted reproductive-age women in 26 African nations were included in this study. The overall prevalence of HIV among reproductive-age women in Africa was 4.34% (95% CI: 4.2, 4.4%). The highest percentage of HIV was found in Lesotho (23.98%), followed by South Africa (19.12%), and Mozambique (14.67%). However, the lowest HIV prevalence was found in Niger (0.54%), Senegal (0.59%), and Burundi (0.79%). Southern Africa has the highest HIV burden (18.5%), followed by Eastern Africa (6.1%), while Western African countries have the lowest HIV burden. Increasing maternal age, higher maternal education, women who were unemployed, a history of multiple sexual partners, women in a union, community-level educational status, community-level wealth index, African sub-region, and urban residence were found to be independent predictors of HIV infection in Africa.ConclusionThe burden of HIV has remained higher, highlighting the need for targeted public health intervention strategies to prevent the transmission of HIV among key populations.

BackgroundOne of the most common measures of society's health is mortality among neonates. Developing and developed countries still differ significantly in neonatal mortality rates. While there are about 18 neonatal deaths worldwide for every 1,000 live births during the first month of life, less is known about neonatal mortality in developing countries, especially in East Africa. Understanding the extent of mortality during the post-neonatal period and its determinants is crucial for developing appropriate policies and strategies that could help solve the issue. Thus, the aim of this study was to identify the prevalence of post-neonatal mortality in East African countries and the factors that are associated with it.MethodsSecondary data analysis was conducted using data from the most recent Demographic and Health Surveys, which included 11 East African countries between 2014 and 2022. A weighted sample of 225,635 live births had been used in the study. STATA/SE 14 was used for data analysis. The multilevel mixed-effects logistic regression model was applied to determine the factors associated with post-neonatal mortality. In the multilevel logistic regression model, significant factors were deemed to be associated with post-neonatal mortality at p-values

BackgroundAlcohol consumption continues to be a public health problem in Ethiopia. Previous investigations have been conducted on alcohol consumption in Ethiopia; however, these investigations were limited to specific localities, which could not represent the existing alcohol consumption in different parts of Ethiopia. Besides, the spatial variation of alcohol consumption was not well investigated in the previous studies, which could hinder the implementation of effective intervention towards alcohol consumption. Hence, this study aimed to determine the spatial distribution and determinant factors of alcohol consumption in Ethiopia.MethodsSecondary data from the 2016 Ethiopian demographic health survey was used in this study. A total of 44,023 weight samples were included using a stratified two-stage cluster sampling technique. The spatial variation of alcohol consumption was analyzed using ArcGIS version 10.7.1. The statistical significance of alcohol consumption clusters were identified using Kuldorff's SaTScan version 10.2. A multi-level analysis was also conducted to identify factors associated with alcohol consumption using STATA version 14.ResultsIn this study, 33.15% (95%CI: 32.5-33.8) of the study participants consumed alcohol with statistically significant spatial variation across regions of the country. Traditional religion (AOR = 13.7; 95%CI: 2.68-70.3), Regional variations (Amhara region-AOR = 3.56; 95%CI: 1.85-6.8, living in a low proportion of community literacy (AOR = 1.84; 95%CI: 1.1-3.18), cigarette smoking habit (AOR = 15.82; 95%CI: 4.31-58.1), and chewing Khat (AOR = 2.98; 95%CI: 1.22-7.27) were positively linked with alcohol consumption. Hot spot areas of alcohol consumption were found in Tigray, Amhara, and some parts of Oromia regions. The statistical significance of the primary clusters was also observed in Tigray and Amhara regions.ConclusionsWe found that one-third of Ethiopia's population is consuming alcohol. Having a cigarette smoking habit, chewing khat, high proportion of community literacy, and traditional religion were associated factors for alcohol consumption. Therefore, the federal government of Ethiopia, and ministry of health, and other concerned bodies should work in collaboration to decrease the proportion of people consuming alcohol.

Objective This study aimed to determine the prevalence, spatial variation and associated factors of mixed milk feeding practice among mothers with infants aged 0–6 months in Ethiopia.Study design A cross-sectional study design was used.Setting The study was conducted in Ethiopia.Population and participant The study populations were mothers with infants aged 0–6 months and 550 weighted sampled mothers with infants aged 0–6 months were included in the analysis.Outcome variable The primary outcome was mixed milk feeding practice measured by 24-hour recall assessment and the secondary outcome was factors of mixed milk feeding practice.Result The prevalence of mixed milk feeding practice among mothers with infants 0–6 months in Ethiopia was 55.5% with a 95% CI (51, 59). Spatial analysis revealed that mixed milk feeding practice was concentrated in Addis Ababa, Amhara, Oromia and the Southern regions of Ethiopia. Mothers with education had 1.2 times higher odds of engaging in mixed milk feeding compared with those who had no education (AOR=1.2, 95% CI 1.01, 2.3). Mothers from higher wealth index categories exhibited 1.7 times greater odds of mixed milk feeding than those from lower wealth index categories (AOR=1.69, 95% CI 1.3, 1.8). Mothers who delivered in health facilities had a 50% reduced risk of mixed milk feeding compared with those who delivered at home (AOR=0.5, 95% CI 0.3, 0.92). Lastly, the likelihood of mixed milk feeding was 2.6 times higher among mothers in urban administrative regions, while there was a 63% lower risk in less-developed regions compared with developed regions in Ethiopia.Conclusion The study highlights the significant prevalence of mixed milk feeding practice among mothers with infants aged 0–6 months in Ethiopia. Spatial analysis revealed distinct geographical clusters of these practices, particularly in urban areas such as Addis Ababa, Amhara and Oromia. Maternal education, wealth status, place of delivery and regional differences were associated factors of mixed milk feeding. Specifically, mothers who have education and those from wealthier backgrounds were more likely to engage in mixed milk feeding, while those delivering in health facilities had a lower risk.

IntroductionHome birth is described as a delivery that takes place at home without the presence of a skilled birth attendant. In 2017, nearly 295,000 mothers died from various pregnancy and childbirth-related problems, accounting for approximately 810 maternal deaths per day. Therefore, this study aims to investigate the spatial distributions of home birth and associated factors in Ethiopia using the Performance Monitoring for Action Survey (PMAS) 2019) to get information that helps to take geographic-based interventions and can assist health planners and policymakers in developing particular measures to reduce home deliveries.MethodIn PMA-ET 2019, a community-based cross-sectional study was conducted in collaboration with Addis Ababa University, Johns Hopkins University, and the Federal Ministry of Health from September 2019 to December 2019, in Ethiopia. A multi-stage cluster sampling procedure was employed to draw from the stratified 2019 PMAS sample. A weighted total of 5,796 women were included in this study. ArcGIS version 10.7 software was used to visualize the spatial analysis. In addition, STATA version 14 of the statistical software was used for multilevel analysis The Bernoulli model was applied using Kulldorff's SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (−2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value

IntroductionAntimicrobial resistance is a major global public health concern, especially in low-resource settings. In low- and middle-income countries, the existing evidence about antimicrobial resistance in drinking water is inconsistence and not comprehensive. Therefore, this study aimed to estimate the pooled prevalence of antimicrobial resistance profiles of Escherichia coli from drinking water in low- and middle-income countries.MethodsThis study was conducted using comprehensive literature searches using various databases such as PubMed, Scientific Direct, HINARI, and Google Scholar. Data extraction was performed using Microsoft Excel and exported to STATA 14/SE software for analysis. We used the Joanna Briggs Institute’s quality appraisal tool to ensure the quality of the included studies. A random effects model was employed to estimate the pooled prevalence. Publication bias was evaluated using funnel plots and Egger’s regression test. Subgroup and sensitivity analysis were also conducted in this study.ResultsThe study found that the pooled prevalence of Escherichia coli isolates in drinking water was 37.94% (95% CI: 26.73–49.13). The prevalence of multidrug resistance was 43.65% (95% CI: 31.15–56.15). Regarding specific antimicrobials, the pooled resistance levels of Escherichia coli were 54.65% (95% CI: 41.35–67.96) against contrimoxazole, followed by 48.64% (95% CI: −3.6–101) against amoxicillin and 48% (95% CI: −18.1–114.2) against cefuroxime.ConclusionThe findings indicated a significant prevalence of antimicrobial resistance of Escherichia coli isolated from drinking water and its multidrug resistance. To address this issue, it recommends focusing on improving basic hygiene and sanitation practices and enhancing water and wastewater treatment systems.Systematic review registrationIdentifier CRD42024533592.

BackgroundAntenatal care (ANC) is an important component of maternal and child healthcare. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, evidence on whether the WHO recommendations have been followed is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa.MethodThis study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan–Meier (K–M) survival estimate. A Weibull gamma shared frailty model was used to determine the predictors of time to the first ANC visit. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported.ResultThe median time to ANC booking among pregnant women in East Africa was 4 ± 2 months. Maternal education at the primary (AHR = 1.01, 95% CI: 1.02–1.25), secondary (AHR = 1.03, 95% CI: 1.02–1.05), and higher level (AHR = 1.40, 95% CI: 1.30–1.50); husband's education level at the primary (AHR = 1.08, 95% CI: 1.06–1.09), secondary (AHR = 1.12, 95% CI: 1.10–1.13), and higher (AHR = 1.08, 95% CI: 1.07–1.10) levels as compared to with no education; a middle-class wealth status (AHR = 1.66, 95% CI: 1.60–1.70), being rich (AHR: 1.60, 95% CI: 1.56–1.73), high community-level maternal literacy (AHR = 1.05, 95% CI: 1.04–1.06), high community-level poverty (AHR = 0.99, 95% CI: 0.98–0.99), previous Cesarean section (CS) (AHR = 1.35, 95% CI: 1.33–1.39), and unwanted pregnancy (AHR = 0.74, 95% CI: 0.72–0.77) were predictors of the time to ANC booking.ConclusionThe median time to ANC booking among pregnant women in East Africa is longer than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, a better household, community-level wealth index, and previous CS increase the likelihood of an early ANC booking. However, unwanted pregnancy lowers the likelihood of an early ANC booking. Therefore, strengthening systematic efforts to improve women’s and their husbands' educational status, encouraging women's education in the community, providing economic support for women with low wealth status and poor communities, encouraging wanted pregnancy, and providing accessible counseling services for women with unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.

BackgroundMinimum meal frequency (MMF) is a vital indicator of whether a child’s energy needs are being met. Previous studies in Ethiopia on MMF have primarily focused on individual factors, often using basic logistic regression models with limited scope and small sample sizes. In contrast, this study aims to identify the key determinants of MMF among breastfed children aged 6–23 months in Ethiopia, examining both individual and community-level factors through multilevel logistic regression analysis, utilizing nationally representative data.MethodThe study utilized a community-based cross-sectional design with a sample of 1,245 6–23 month breastfed children in Ethiopia, using data from the 2019 Ethiopian Mini Demographic Health Survey. Mixed effect logistic regression was used to identify factors associated with MMF. Adjusted odds ratios (AOR) with 95% confidence intervals were used to assess variable associations, while Intra-cluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were employed to gauge random variation.ResultThe proportion of 6–23-month breastfeeding children with MMF was found to be 55.9% (95% CI: 53.2, 58.6). In mixed effect logistic regression; breastfeeding initiation time within days after birth [AOR = 0.44; 95%CI: (0.24, 0.80)], maternal primary educational level [AOR = 1.46; 95%CI: (1.03, 2.05)], maternal higher level education [AOR = 2.43; 95%CI: (1.22, 4.81)] and children from wealthiest household wealth index [AOR = 2.13; 95%CI: (1.04, 4.33)] were individual-level factors and children from city-based regions [AOR = 1.75; 95%CI: (1.10, 2.77)] was community level factors significantly associated with MMF. The final model indicates that 50.8% of the variation in MMF was explained by combined factors at both individual and community levels and also the variation across clusters remained statistically significant (ICC = 8.1% and variance = 0.29 with p

IntroductionDisparities in access to basic sanitation services between rural and urban households pose significant challenges to public health and human development. Understanding the determinants contributing to this gap is vital for advancing the Sustainable Development Goals (SDGs) and improving environmental and public health through evidence-based interventions.ObjectiveThis study aims to analyze and understand the disparities in access to basic sanitation services between rural and urban households in Ethiopia.MethodsThis study analyzed a sample of 8,663 weighted households, collected using stratified sampling techniques, utilizing the data from the 2019 Ethiopian Demographic and Health Survey (EDHS). The primary outcome was basic sanitation access, defined as access to flush or pour-flush systems, septic tanks, pit latrines, or composting toilets. A multivariable decomposition analysis was conducted to identify factors contributing to rural–urban disparities. Statistically significant variables were determined at a p-value of

Introduction Unintended pregnancy is defined as a pregnancy that is either mistimed (wanted at a later time) or unwanted (not wanted at all). It has been a concerning issue for reproductive health and public health, with significant negative effects on the mother, child, and the public at large. It is a worldwide public health issue that can have a major impact on the health of pregnant women and newborns. Methods The study was conducted using secondary data from IPUMS Multiple Indicator Cluster Surveys round 6. The analysis was based on a data merged from six sub-Saharan Africa countries such as Gambia, Ghana, Lesotho, Malawi, Nigeria, and Sierra Leone. A total weighted sample of 28,027married/in-union reproductive-age women was included in the study. Seven machine learning algorithms were trained and their performance compared in predicting unintended pregnancy. Finally, Shapley Additive exPlanations model explanation technique was used to identify the predictors of unintended pregnancy. Results XGBoost was the top-performing model, achieved the highest area under receiver operating characteristic curve (0.62) and accuracy (65.92%), surpassing all other models. SHAP global feature importance identified top predictors of unintended pregnancy, with women from Malawi, Ghana, and Lesotho, women having primary education and secondary education, with parity of more than three, have higher likelihood of unintended pregnancy. In the other hand, women from Nigeria and Sierra Leone, whose husband/partner has more wives or partners (polygamy relation), and women who owns mobile phone had lower risk of unintended pregnancy. Conclusion These findings highlight the importance of considering contextual factors, such as country-specific sociocultural norms and individual characteristics, in understanding and addressing unintended pregnancies. By strategically addressing the identified predictors, policymakers, and healthcare providers can develop impactful programs that address the root causes of unintended pregnancies, ultimately contributing to improved reproductive health outcomes worldwide.

Background The HIV epidemic continues to be a major public health challenge worldwide, particularly in sub-Saharan African countries such as Ethiopia. Community-based antiretroviral refill groups are emerging as a patient-centered approach, but there is limited evidence. Therefore, this study aimed to assess attrition and predictors in community antiretroviral refill groups among ART users in Eastern Ethiopia. Methods Institutional-based retrospective cohort study was conducted. Systematic random sampling techniques were used. Data were collected via Kobo Collect and exported to Stata. Statistically significant effects were assumed for a P-value

IntroductionThe achievement of the minimum acceptable diet intake (MAD) stands at 14% among urban and 10% among rural under-five children in Ethiopia. Consequently, identifying the determinants of the urban–rural gap is vital for advancing Sustainable Development Goals (SDGs), fostering healthier communities, and developing evidence-driven approaches to enhance health outcomes and address disparities.ObjectiveThe objective of the study was to decompose the urban–rural disparities in minimum acceptable diet intake in Ethiopia using the Ethiopian Mini-Demographic and Health Survey 2019 data.MethodThe study was conducted using the Ethiopian Demographic and Health Survey 2019 report. A total of 1,496 weighted children aged 6–23 months were included using stratified sampling techniques. The main outcome variable minimum acceptable diet was calculated as a combined proportion of minimum dietary diversity and minimum meal frequency. A decomposition analysis was used to analyze the factors associated with the urban–rural discrepancy of minimum acceptable diet intake, and the results were presented using tables and figures.ResultThe magnitude of minimum acceptable diet among children aged 6–23 months in Ethiopia was 11.0%. There has been a significant disparity in the intake of minimum acceptable diet between urban and rural under-five children with 14 and 10%, respectively. Endowment factors were responsible for 70.2% of the discrepancy, followed by 45.1% with behavioral coefficients. Educational status of college and above was responsible for narrowing the gap between urban and rural residents by 23.9% (β = 0.1313, 95% CI: 0.0332–0.245). The number of children in the household and the age of the child between 18 and 23 months were responsible for widening the gap in minimum acceptable diet intake discrepancy between urban and rural residents by 30.7% and 3.36%, respectively (β = −0.002, 95% CI: −0.003 to −0.0011 and β = −30.7, 95% CI: −0.025 – −0.0085). From the effect coefficients, the effect of institutional delivery was responsible for 1.99% of the widening of the gap between urban and rural residents in minimum acceptable diet intake (β = −0.0862, 95% CI: −0.1711 – −0.0012).ConclusionThere is a significant variation between urban and rural residents in minimum acceptable diet. The larger portion of the discrepancy was explained by the endowment effect. Educational status of mothers with college and above, parity, age of child, and place of delivery were the significant factors contributing to the discrepancy of minimum acceptable diet intake between urban and rural residents.

BackgroundIn sub-Saharan Africa, achieving universal health coverage (UHC) and protecting populations from health-related financial hardship remain challenging goals. Subsequently, community-based health insurance (CBHI) has gained interest in low and middle-income countries, such as Ethiopia. However, the rural–urban disparity in CBHI enrollment has not been properly investigated using multivariate decomposition analysis. Therefore, this study aimed to assess the rural–urban disparity of CBHI enrollment in Ethiopia using the Ethiopian Mini Demographic Health Survey 2019 (EMDHS 2019).MethodsThis study used the latest EMDHS 2019 dataset. STATA version 17.0 software was used for analyses. The chi-square test was used to assess the association between CBHI enrollment and the explanatory variables. The rural–urban disparity of CBHI enrollment was assessed using the logit-based multivariate decomposition analysis. A p-value of

Abstract Access to healthcare services is a fundamental human right for every citizen, and it is the responsibility of the nation to guarantee that these services are acceptable, easily accessible, and timely. Barriers to accessing health services may have a detrimental effect on an individual’s physical, and mental health, and overall quality of life. However, access to health care services is a common problem in developing countries. Therefore, this study aimed to investigate spatial distribution and determinants of barriers to healthcare access among female youths in Ethiopia. Secondary data analysis was conducted based on the Demographic and Health Surveys data conducted in Ethiopia. A total weighted sample of 6143 female youths aged 15–24 years old was included in this study. A mixed-effect analysis was employed to identify factors contributing to barriers to healthcare access among youths in Ethiopia. Adjusted Odds Ratio with 95% CI was used to declare the strength and significance of the association. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of barriers to healthcare access. This study revealed that the magnitude of barriers to healthcare access among female youth was 61.3% with 95%CI (60.1 to 62.5) to at least one or more of the four reasons. Age 15–19 years old (AOR = 0.80, 95%CI 0.68 to 0.95), no formal education (AOR = 2.26, CI 1.61, 3.18), primary education (AOR = 2.21, CI 1.66, 2.95), marital status (AOR = 1.43, 95% CI 1.21, 1.70), poor household wealth (AOR = 1.63, 95% CI 1.31, 2.05), no Media exposure (AOR = 1.67, 95%CI 1.41–1.98), reside in rural areas (AOR = 1.63, 95%CI 1.05 to 2.54), and low community media exposure (AOR = 1.45, 95%CI 1.01–2.08) were significantly associated with barriers of health care service. Barriers to healthcare access were significantly and disproportionately concentrated in poor households. A non-random Barrier to healthcare access was observed in Ethiopia. Among the 9 regions, primary clusters were identified in only 4 regions (North Ormiya, Benishangul Gumuz, Gambella, and South Nation Nationality and Peoples regions. A significant proportion of female youths faced barriers to health care access Age, educational status, marital status, rural residency, low economic status, and media exposure were factors associated with barriers to health care access. Therefore, program planners and decision-makers should work on improving the country’s economy to a higher economic level to improve the wealth status of the population, promote media exposure, and increase access to education.

BackgroundAddressing health inequity is a top priority for achieving sustainable development goals. The existing evidences in Ethiopia have shown that there are substantial inequalities in the use of health services among various socioeconomic strata. Therefore, the present study aimed to measure socioeconomic inequalities and the contributing factors in postnatal health checks for newborns in Ethiopia.MethodsWe used a secondary data from the recent 2019 Ethiopia Mini Demographic and Health Survey dataset. The study includes a weighted sample of 2,105 women who gave birth in the 2 years preceding to the survey. The study participants were selected using two stage cluster sampling techniques. The socioeconomic inequality in postnatal health checks for newborns was measured using the Erreygers Normalized Concentration Index (ECI) and illustrated by the concentration curve. A decomposition analysis was done to identify factors contributing to the socioeconomic related inequality in postnatal health checks for newborns in Ethiopia.ResultsThe concentration curve of postnatal health checks for newborns lay below the line of equality, and the Erreygers normalized concentration index was 0.133, with a standard error = 0.0333, and a p value

IntroductionThe World Health Organization recommends that children aged 6–23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6–23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6–23 months in East Africa.MethodThe study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6–23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant.ResultsThe overall prevalence of zero vegetable or fruit consumption among children aged 6–23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries.ConclusionConsidering the high overall prevalence of zero vegetable or fruit consumption among children aged 6–23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

IntroductionExposure to indoor air pollution such as biomass fuel and particulate matter is a significant cause of adverse pregnancy outcomes. However, there is limited information about the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries. Therefore, this meta-analysis aimed to determine the association between indoor air pollution exposure and adverse pregnancy outcomes in low and middle-income countries.MethodsInternational electronic databases such as PubMed, Science Direct, Global Health, African Journals Online, HINARI, Semantic Scholar, and Google and Google Scholar were used to search for relevant articles. The study was conducted according to the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A random effect model at a 95% confidence interval was used to determine the association between indoor air pollution exposure and adverse pregnancy outcomes using STATA version 14. Funnel plot and Higgs I2 statistics were used to determine the publication bias and heterogeneity of the included studies, respectively.ResultsA total of 30 articles with 2,120,228 study participants were included in this meta-analysis. The pooled association between indoor air pollution exposure and at least one adverse pregnancy outcome was 15.5% (95%CI: 12.6–18.5), with significant heterogeneity (I2 = 100%; p < 0.001). Exposure to indoor air pollution increased the risk of small for gestational age by 23.7% (95%CI: 8.2–39.3) followed by low birth weight (17.7%; 95%CI: 12.9–22.5). Exposure to biomass fuel (OR = 1.16; 95%CI: 1.12–1.2), particulate matter (OR = 1.28; 95%CI: 1.25–1.31), and kerosene (OR = 1.38; 95%CI: 1.09–1.66) were factors associated with developing at least one adverse pregnancy outcomes.ConclusionsWe found that more than one in seven pregnant women exposed to indoor air pollution had at least one adverse pregnancy outcome. Specifically, exposure to particulate matter, biomass fuel, and kerosene were determinant factors for developing at least one adverse pregnancy outcome. Therefore, urgent comprehensive health intervention should be implemented in the area to reduce adverse pregnancy outcomes.

BackgroundExposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children.MethodsA comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique.ResultA total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14–1.35) with extreme heterogeneity (I2 = 81%, p

Abstract The development of a post-abortion family plan is an integral part of comprehensive abortion care. In spite of this, it received insufficient attention as a means of breaking the cycle of repeated abortions, unintended pregnancies, and maternal deaths resulting from abortion. Therefore, this study examined post abortion modern contraceptive utilization among Ethiopian women as well as associated factors. The study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 1236 reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of post abortion contraceptive use. Statistical significance was determined using Adjusted Odds Ratio (AOR) with 95% confidence interval. Overall prevalence of post abortion contraceptive use was observed to be 25.6% (95% CI: 23.24, 28.12). Women's age 15–24 (AOR = 2.34; 95% CI: 1.11, 4.93), and 25–34 (AOR = 1.94; 95% CI: 1.27, 2.98), married women (AOR = 2.6; 95% CI: 1.43, 4.96), women who had 1–4 (AOR = 4.13; 95% CI: 1.79, 9.57) and ≥ 5 number of children (AOR = 8.80; 95% CI: 3.30, 13.49), Being in metropolitan region (AOR = 9.14; 95% CI: 1.79, 12.48), women being in urban area (AOR = 1.85; 95% CI: 1.32, 2.24), and community media exposure (AOR = 1.75; 95% CI: 1.11, 3.56) were associated with post abortion modern contraceptive use. Post abortion modern contraceptive use in this study was low. Women age, current marital status, number of living children, residency, community media exposure, and region were significantly associated with post abortion modern contraceptive utilization. Therefore, it is better to provide ongoing health information about post-abortion family planning and its benefits, especially for people who live in rural and small peripheral regions, and public health policymakers should take both individual and community level factors into account when designing family planning programmes.

BackgroundAntenatal care (ANC) remains an invaluable approach to preventive care for ensuring maternal and infant health outcomes. Women in sub-Saharan Africa tend to delay their first antenatal care visits. In Ethiopia, only 20% of women received their first antenatal care during the first trimester of pregnancy. Timely and appropriate antenatal care practices can potentially save the lives of both mothers and children. Understanding socioeconomic inequality in the timing of antenatal care visits and its determinants may contribute to tackling disparities and achieving the sustainable development goals for maternal health.ObjectiveThis study aimed to assess the socioeconomic inequality in the timing of antenatal care visit.MethodSecondary data sourced from the Mini Ethiopian Demographic Health Survey 2019 were used for this study. A total of 2,906 pregnant women were included in the study, and concentration curves were used to show inequality among sociodemographic and economic variables. Decomposition analysis was performed to estimate the contribution of each independent variable to the inequality in the timing of antenatal care visits.ResultThe estimate of early initiation of antenatal care was 63%. The concentration index was 0.18 (P < 0.001). The inequality in the timing of antenatal care visit was more concentrated among the wealthiest pregnant women with a concentration index value of 0.18 (P < 0.001). Based on decomposition analysis results, the wealth index (81.9%.), education status (22.29%), and region (0.0642%) were identified as contributing factors to the inequality in the timing of antenatal care visits among women.ConclusionThe wealth index, educational status, and region were significant contributors to inequality in the early initiation of antenatal care visit. Improving women's wealth and education and narrowing the inequality gap are crucial for improving the health status of women and their children. We should focus on interventions targeted at early antenatal care visit to address the determinants of socioeconomic inequities.

Introduction: Even though breast cancer incidence is lower in Sub-Saharan Africa, its mortality is higher in these countries. However, the impact does not end with diagnosis and treatment; rather many patients struggle with depression which is very common among these patients. This systematic review and meta-analysis helps to provide valuable insights into the overall prevalence of depression and associated factors among breast cancer patients in Sub-Saharan Africa. Method: We searched several databases, including MEDLINE, Embase, Scopus, Hinary, CINHAL and Google Scholar to retrieve relevant literatures from inception up to 15 June 2023. All observational studies, published in English at any time were included, while, letters to editor, review articles, commentaries, interventional and qualitative studies, and, abstracts presented in conferences or seminars were excluded. The results of this systematic review and meta-analysis have been written based on the PRISMA 2020 checklist and the protocol have been registered in PROSPERO database (CRD42023428910). Result: We have included nine articles with 2226 study participants. The result showed that, the pooled prevalence of depression among breast cancer patients in Sub-Saharan Africa was 45.6% (95% CI: 30%–61%) with significant heterogeneity I 2 = 98.9%, (Cochrane) Q

BackgroundSustainable Development Goals 2 target 2.2 aimed to end all forms of malnutrition by 2030. However, the prevalence of inadequate minimum dietary diversity (MDD) is high in Ethiopia and the evidence of trends and determinants of MDD consumption change among children over time is limited. Therefore, this study aimed to determine trends and determinants of MDD consumption change among children aged 6 to 23 months in Ethiopia from 2011-2019 Demographic and Health Survey (DHS) data.MethodThe study used the data on nationally representative weighted samples of 6,971, 7,467, and 3,154 children aged 6-23 months from the 2011, 2016, and 2019 rounds of the DHS. Trend and Multivariate Decomposition analysis was conducted to determine MDD consumption change from 2011-2016, and 2016-2019 into two components: one that was explained by differences in the level of the determinants (endowment), and the other component was explained by differences in the effect of the covariates on the outcome (coefficient effects).ResultThe trends analysis showed that adequate MDD consumption significantly increased from 2% to 10.41% from 2011 to 2016 but decreased from 10.41% to 7.11% from 2016 to 2019 in Ethiopia. The compositional and behavioral change factors like maternal age, occupational status of parents, sex of the household head, wealth index, residence, and sex of child statistically contributed to changes in MDD consumption from 2011 to 2016, and from 2016 to 2019 at p-value ConclusionThe trend of minimum dietary diversity consumption among children aged 6 to 23 months in Ethiopia increased from 2011-2016 and decreased from 2016-2019 in the last decade. The study revealed that the changes in behavioral response and population composition contributed to MDD consumption change among children in Ethiopia. The finding highlights the urgent need for targeted interventions and policies to address the issue of MDD consumption change among young children due to population structure changes like wealth status, residence, and behavioral response related to employment, household head, and sex of the child in Ethiopia. Therefore, efforts should be geared to reduce poverty and improve maternal employment status, particularly for women, by producing equitable economic opportunities.

Background Early neonatal death accounts for a significant number of under-5 mortality worldwide. However, the problem is under-researched and under-reported in low-income and middle-income countries, particularly in Ethiopia. The magnitude of mortality during the early neonatal period and associated factors should be studied for designing appropriate policies, and strategies that could help tackle the problem. Hence, this study aimed to determine the prevalence and identify factors associated with early neonatal mortality in Ethiopia.Methods This study was conducted by using data from Ethiopian Demographic and Health Survey 2016. A total of 10 525 live births were enrolled in the study. A multilevel logistic regression model was used to identify determinants of early neonatal mortality. Adjusted OR (AOR) at a 95% CI was computed to assess the strength and significance of the association between outcome and explanatory variables. Factors with a p

ABSTRACTBackground Even though a few studies have been conducted, the result is inconsistent between studies. The Theory of Planned Behavior (TPB) is a widely used framework for predicting and understanding health behaviors. In the study area, the theory of planned behavior ability to predict breast self-examination among women was not done before. Therefore, this study aimed to determine the efficacy of the Theory of Planned Behavior to predict breast self-examination among women.Methods This study used a systematic review and meta-analysis of studies conducted from 2008 to 2018 globally. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Semantic Scholar, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran’s Q statistics, Funnel plots, and the Egger test respectively. Pooled analysis was conducted using the random-effects model of the DerSimonian–Laird method.Results A total of 5 articles were included in this systematic review and meta-analysis. The overall Pooled Proportion of variance of the Theory of Planned Behavior ability to predict breast self-examination among women was explained at 38% (95%CI: 26.9, 49.1)Conclusions The overall Pooled Proportion of variance explained by the Theory of Planned Behavior ability to predict breast self-examination among women was low as compared to the original assumption of variance explained. While the Theory of Planned Behavior provides a useful framework for understanding health behaviors, it may not fully capture all the complex factors contributing to breast self-examination. Additionally, future studies should consider using alternative measures of variance explained to provide a more comprehensive understanding of the predictive power of the theory of planned behavior.

Abstract Tuberculosis (TB) is major public health concern and Isoniazid Preventive Therapy (IPT) helps to prevent TB development among patients living with human immune deficiency virus (PLWHIV). However, the evidence is limited especially in the study area. Therefore, this study aimed to determine the prevalence and factors associated with TB among IPT users and non-IPT users of PLWHIV in Dessie, Ethiopia. A comparative cross-sectional study was employed for1 month in Dessie. A total of 326 respondents were selected using systematic random sampling. Bivariable and multivariable logistic regression analyses were computed to identify factors associated with Tuberculosis. In multivariable analysis, AOR with 95% CI was used to declare statistically significant variables with TB. The prevalence of TB among non-IPT users was 48.5%, (95% CI 40.8–56.2%), and among IPT users was 8%, (95% CI 5–13%). Cotrimoxazole prophylaxis therapy (CPT) (AOR = 5.835, 95% CI 2.565–13.274), IPT (AOR = 10.359, 95% CI 4.054–26.472), ART adherence (AOR = 30.542, 95% CI 12.871–72.475), and believing that IPT use prevents TB (AOR = 0.093, 95% CI 0.018–0.484) were statistically significant factors. The prevalence of TB was higher among non-IPT users than among IPT users. Therefore, efforts should be strengthened to implement widespread use of IPT among adult PLWHIV.

Background: Childhood stunting is a critical public health agenda that affects physical and cognitive development, leading to long-term health problems. Understanding its wealth related trends and contributing factors is essential for effective prospective interventions. Therefore, this study is aimed to assess the trends of childhood stunting inequality using Ethiopian Demographic Health Surveys (EDHS). Methods: This study employed the three consecutive EDHS datasets collected in 2011, 2016, and 2019. Socioeconomic disparity of stunting among under-five children was estimated through concentration index (CIX). Moreover, Wagstaff approach was used to decompose the relative CIX to assess the contribution of explanatory variables for the overall wealth inequality in childhood stunting. Results: The overall weighted prevalence of childhood stunting in Ethiopia was 40.76% (95%CI: 40.14%, 41.37%). The trend in the magnitude of childhood stunting decreased from 44.52% in 2011 to 37.08% in 2019. The magnitude of childhood stunting was higher (14.30%) among the poorest households than the richest households (4.70%). Moreover, the CIX of wealth inequality decreased from -0.064 in 2011 to -0.089 in 2019. Wealth index(103.38%), place of residence(34.55%), mother's education(26.73%), place of delivery(12.16%) and utilization of recommended antenatal care(12.02%) were high contributor variables in increasing the inequality, whereas administrative regions (-7.15%) and number of under-five children in the household (-4.63%) were variables contributed in the reduction of wealth inequalities in childhood stunting. Conclusion: This study revealed that children in the poorest households were more likely to experience childhood stunting than the children in the richest households. Factors such as wealth index, mothers education, place of residence, place of delivery, number of under-five children in the household were the contributing variables for the childhood stunting inequality. Therefore, the health decision makers better to improve the access and quality of nutritional services for the children in the poorest households in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Undernutrition remains a global challenge and public health concern, despite the presence of policies, programs and interventions. There is substantial evidence that the majority of the rural children under-5 years old have composite index of anthropometric failure than the urban counter parts. Hence, identifying the main contributors of these disparities will help health policy makers, program designers and implementers for the reduction of composite index of anthropometric failures in children under-5 years old in the study areas. Methods: The most recent and nationally representative samples of demographic and health surveys of five East African countries data were used for the current study. To appreciate the residence-based differences of composite index of anthropometric failure in under-5 children, the Blinder-Oaxaca decomposition analysis and its extensions were employed to determine the effects of covariates and coefficients. The country specific survey data analysis was performed. Results: The current study revealed that the burden of composite index of anthropometric failure (CIAF) in under-5 children were 40.69%, 22.04%, 34.06%, 31.99%, and 33.27% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. The residence-based differences in CIAF were 25.49%, 11.38%, 27%, 22.15%, and 20.55% in Ethiopia, Kenya, Rwanda, Uganda, and Tanzania respectively. Results of the Blinder-Oaxaca decomposition analysis and its extensions revealed that 100% of the rural–urban children under-5 composite index of anthropometric failure disparity was explained by endowment characteristics (covariate effect). Wealth index, mother's education, age of child, type of birth, sex of child and birth interval inequality between rural and urban households explains most of the composite index of anthropometric failure disparity in children under-5 years old. Conclusions: The residence-based CIAF differences were high in all study countries. The rural–urban CIAF gap is ascribed by household, maternal and child characteristics. This result implies that rural children under-5 is disproportionally disadvantaged with respect to characteristics than their consequences. Through identification of the underlying factors behind the rural–urban CIAF disparities, the result of this study is important in planning effective intervention measures aiming at reducing residence-based inequalities and the population health outcomes. Therefore, should be given for rural children to reduce CIAF by improving house hold wealth index, women education and attentions to older children, and female children. [ABSTRACT FROM AUTHOR]