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Abstract Background Ensuring the availability of safe drinking water remains a critical challenge in developing countries, including Ethiopia. Therefore, this paper aimed to investigate the prevalence of fecal coliform and E. coli bacteria and, geographical, children availability, and seasonal exposure assessment through a meta-analysis. Methods Two independent review groups extensively searched internet databases for English-language research articles published between 2013 and 2023. This systematic review and meta-analysis followed PRISMA guidelines. The methodological quality of each included study was evaluated using the STROBE guidelines. Publication bias was assessed by visual inspection of a funnel plot and then tested by the Egger regression test, and meta-analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. Subgroup analyses were also conducted to explore heterogeneity. Results Out of 48 potentially relevant studies, only 21 fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of fecal coliform and E. coli was 64% (95% CI: 56.0–71.0%, I 2 = 95.8%) and 54% (95% CI: 45.7–62.3%, I 2 = 94.2%), respectively. Subgroup analysis revealed that the prevalence of fecal coliform bacteria increased during the wet season (70%) compared to the dry season (60%), particularly in households with under-five children (74%) compared to all households (61%), in rural (68%) versus urban (66%) areas, and in regions with high prevalence such as Amhara (71%), Gambela (71%), and Oromia (70%). Similarly, the prevalence of E. coli was higher in households with under-five children (66%) than in all households (46%). Conclusions The analysis highlights the higher prevalence of fecal coliform and E. coli within households drinking water, indicating that these bacteria are a significant public health concern. Moreover, these findings emphasize the critical need for targeted interventions aimed at improving drinking water quality to reduce the risk of fecal contamination and enhance public health outcomes for susceptible groups, including households with under-five children, in particular geographical areas such as the Amhara, Gambela, and Oromia regions, as well as rural areas, at point-of-use, and during the rainy season. Registration This review was registered on PROSPERO (registration ID - CRD42023448812).

ABSTRACT Background Globally, infectious diseases such as pneumonia, diarrhea, and malaria are the leading causes of death for children under 5. Diarrheal disease is a significant public health concern and causes the death of approximately 525,000 children under the age of 5 every year. In Ethiopia, studies revealed that the prevalence of diarrhea among children under 5 years is alarming. However, there has been a shortage of studies regarding the predictors of diarrheal disease in Geshiyaro project implementation sites in Ethiopia. Therefore, this study aimed to fill this gap. Methods A community‐based cross‐sectional study was conducted from June to July 2023. A total of 2937 participants were enrolled in this investigation. Descriptive and multivariate logistic regression analysis was performed using STATA version 16. Results The 2‐week prevalence of diarrhea among children under 5 years was 11.8%. The following factors were significantly associated (p

IntroductionAlthough wastewater-based epidemiology (WBE) successfully functioned as a tool for monitoring the coronavirus disease 2019 (COVID-19) pandemic globally, relatively little is known about its utility in low-income countries. This study aimed to quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater, estimate the number of infected individuals in the catchment areas, and correlate the results with the clinically reported COVID-19 cases in Addis Ababa, Ethiopia.MethodsA total of 323 influent and 33 effluent wastewater samples were collected from three Wastewater Treatment Plants (WWTPs) using a 24-h composite Moore swab sampling method from February to November 2023. The virus was captured using Ceres Nanotrap® Enhancement Reagent 2 and Nanotrap® Microbiome A Particles, and then nucleic acids were extracted using the Qiagen QIAamp Viral RNA Mini Kit. The ThermoFisher TaqPath™ COVID-19 kit was applied to perform real-time reverse transcriptase polymerase chain reaction (qRT-PCR) to quantify the SARS-CoV-2 RNA. Wastewater viral concentrations were normalized using flow rate and number of people served. In the sampling period, spearman correlation was used to compare the SARS-CoV-2 target gene concentration to the reported COVID-19 cases. The numbers of infected individuals under each treatment plant were calculated considering the target genes’ concentration, the flow rate of treatment plants, a gram of feces per person-day, and RNA copies per gram of feces.ResultsSARS-CoV-2 was detected in 94% of untreated wastewater samples. All effluent wastewater samples (n = 22) from the upflow anaerobic sludge blanket (UASB) reactor and membrane bioreactor (MBR) technology were SARS-COV-2 RNA negative. In contrast, two out of 11 effluents from Waste Stabilization Pond were found positive. Positive correlations were observed between the weekly average SARS-CoV-2 concentration and the cumulative weekly reported COVID-19 cases in Addis Ababa. The estimated number of infected people in the Kality Treatment catchment area was 330 times the number of COVID-19 cases reported during the study period in Addis Ababa.DiscussionThis study revealed that SARS-CoV-2 was circulating in the community and confirmed previous reports of more asymptomatic COVID-19 cases in Ethiopia. Additionally, this study provides further evidence of the importance of wastewater-based surveillance in general to monitor infectious diseases in low-income settings.ConclusionWastewater-based surveillance of SARS-CoV-2 can be a useful method for tracking the increment of COVID-19 cases before it spreads widely throughout the community.

Background: Open defecation is a significant global challenge, impacting public health, environmental sanitation, and social well-being, especially in low- and middle-income countries like Ethiopia. It is the second-largest cause of disease burden worldwide by facilitating the spread of germs that cause diarrhea diseases. Studies examining open defecation practices are insufficient, especially in areas implementing Ethiopia’s Geshiyaro project. Therefore, this study aimed to assess the status of open defecation practice and associated factors in the study area. Method: A community-based cross-sectional study was conducted from June to July 2023. The total number of households included in this study was 7995. A structured questionnaire and observational checklist were used to collect data. Descriptive and multivariate logistic regression analyses were performed using STATA version 16. Results: The study found that 16.5% of households practiced open defecation. The following factors were significantly associated with the occurrence of open defecation: residence (AOR = 1.56, 95% CI: 1.26-1.92), education (AOR = 0.59, 95% CI: 0.49-0.72), age (AOR = 0.53, 95% CI: 0.41-0.69), knowledge on diarrhea prevention (AOR = 1.32, 95% CI: 1.17-1.50), marital status (AOR = 1.61, 95% CI: 1.32-1.97), and awareness creation about WASH services (AOR = 1.96, 95% CI: 1.71-2.25). On the other hand, no significant association was observed between the occurrence of open defecation and the household’s income (AOR = 1.07, 95% CI: 0.93-1.23) or the head of household sex (AOR = 0.94, 95% CI: 0.78-1.12). Conclusion: Open defecation remains a critical public health concern in Ethiopia’s Geshiyaro project sites. Various factors influencing this practice have been identified. Targeted interventions are needed to enhance access to safe sanitation facilities and promote awareness of WASH services, aligning with SDG 3 target 3, and SDG 6 target 2.

This study aimed to assess the level of JMP ladders for WASH services. A cross-sectional study was conducted. Forty-four healthcare facilities were enrolled. From each healthcare facility, water samples were collected directly from water storage facilities. In addition to the interview, an observational checklist was used. Descriptive statistics and a chi-square test were conducted to analyze the data. The coverage of advanced and basic drinking water services in healthcare facilities was 4.6 and 70.4%, respectively. However, the healthcare facilities’ access to advanced and basic sanitation services was nil. Similarly, 61.4 and 88.6% of the healthcare facilities had no hygiene and waste disposal services, respectively. While 2.6, 4.5, and 75% of healthcare facilities had advanced, basic, and limited environmental cleaning services, 18.2% lacked environmental cleaning services. Water samples of 15.9, 11.4, and 6.8% of the healthcare facilities were found positive for total coliforms, fecal coliforms, and E. coli, respectively. The WASH services of the healthcare facilities were very low and not on track to achieve the Sustainable Development Goal target. Healthcare facilities could be sources of healthcare-associated infections. Hence, the government and other concerned bodies should take urgent action to improve WASH services. HIGHLIGHTS 4.6 and 70.4% of the healthcare facilities used advanced and basic water services, respectively.; The healthcare facilities’ access to advanced and basic sanitation services was nil.; The majority of the healthcare facilities had no hygiene and waste disposal services.; 18.2% of the healthcare facilities lacked environmental cleaning services.; Bacteria and chemical contaminants contaminated many water samples.;

Abstract Access to basic water, sanitation and hygiene services is the most effective mechanism to reduce many infectious diseases. WASH in schools related to better educational outcomes although adequate water, sanitation, and hygiene services were unavailable to millions of school-age children in Ethiopia. Therefore, it is crucial to assess the level of WASH coverage and identify factors affecting access to basic water, sanitation, and hygiene services. A cross-sectional study was carried out among 82 school facilities. A structured questionnaire and an observational checklist were used to gather the data. Water samples were taken from the schools' water storage. Descriptive and multivariable logistic regression analyses were used to analyze the data. In this study, 74.7%, 61. 3% and 37.3% of the schools had access to basic drinking water, sanitation, and hygiene services, respectively. Additionally, 21.3%, 29.4%, and 30.7% of the schools had access to limited drinking water, sanitation, and hygiene services, respectively. However, 4%, 9.3%, and 32% of the schools lacked water, sanitation, and hygiene services, respectively. We discovered that schools with male heads were 7% less likely to have access to basic hygiene services (AOR = 0.07 with 95% CI 0.01–0.5) than those with female directors. In addition, schools with hygiene and environmental health clubs had an 11.8-fold higher access rate to basic hygiene services (AOR = 11.8 with 95% CI 1.35–104) than schools without such clubs. Besides, schools that conduct WASH lessons at least once a week were 8.63 times more likely to use basic hygiene services (AOR = 8.63; 95% CI 1.18–63.22) than schools that did not. This study offers scientific evidence that could be used for sound decisions to fill the school WASH gaps. This is a unique study in determining the level of WASH coverage and identifying factors affecting access to basic hygiene services. The investigation provides some insights into how access to WASH services can be improved at the grassroots level. Federal and regional governments should implement effective interventions that assist schools to attain Sustainable Development Goal 6 by 2030. School administrators and other partner organizations should take proactive measures to enhance and maintain the WASH services.

Abstract Reducing inequalities in all its forms is one of the key principles of the Sustainable Development Goal (SDG). However, the 2030 SDG Agenda has been a real challenge in addressing inequalities in Water, Sanitation, and Hygiene (WASH) services. There is a disparity in the use of WASH services in Ethiopia. Therefore, this study aimed to identify demographic factors affecting the use of Joint Monitoring Program (JMP) ladders for WASH services. In this study, a total of 5350 households were included. Households having heads with vocational education levels were 2.9 times higher in use of basic drinking-water services ((Adjusted Odds Ratio (AOR) = 2.9 with 95% CI 1.6–5.1) than household having heads who could not read and write. Besides, households living in urban areas were 21.7 times more likely to use basic drinking-water services (AOR = 21.7 with 95% CI 16–30) than in rural parts. Further, households with merchants’ heads were 2.1 times higher to use basic sanitation services (AOR = 2.1 with 95% CI 1.5, 3.1) than households with farmers’ heads. Moreover, households having higher monthly income per head were 2.9 times higher in utilizing basic sanitation services (AOR = 2.9 with 95% CI 2.32–3.58) than the poorest households. Similarly, households with female heads were 1.5 times higher in using the JMP ladder for basic hygiene services (AOR = 1.5 with 95% CI 1.24–1.71) than households with male heads. Additionally, respondents who live in urban areas had 2.8 times higher use of basic hygiene services (AOR = 2.8 with 95% CI 2.26–3.54) than those in rural areas. Many demographic factors that influence the use of the JMP ladders for water, sanitation, and hygiene services were identified. The use of surface water, open defecation practice, unimproved sanitation, and no hygiene services were positively associated with illiteracy. The findings suggest that state authorities should initiate firm WASH policies and strategies to achieve the SDG 6 and 10. Additionally, the government should apply effective WASH interventions that consider demographic disparities.

Objective To determine the associations of WHO/UNICEF Joint Monitoring Program Water, Sanitation and Hygiene (WASH) Service Ladder service levels and sociodemographic factors with diarrhoeal disease among children under 5 years in Bishoftu town, Ethiopia.Design A community-based cross-sectional study.Setting Bishoftu town, Ethiopia, January–February 2022.Participants A total of 1807 mothers with at least one child under 5 years were included. Sociodemographic and WASH variables were collected using a structured questionnaire. 378 drinking water samples were collected.Outcome The response variable was diarrhoeal disease among children under 5 years.Results The 2-week prevalence of diarrhoeal disease among children under 5 years was 14.8%. Illiteracy (adjusted OR 3.15; 95% CI 1.54 to 6.47), occupation (0.35; 0.20 to 0.62), mother’s age (1.63; 1.15 to 2.31), family size (2.38; 1.68 to 3.39), wealth index (5.91; 3.01 to 11.59), residence type (1.98; 1.35 to 2.90), sex of the child (1.62; 1.17 to 2.24), child’s age (3.52; 2.51 to 4.93), breastfeeding status (2.83; 1.74 to 4.59), food storage practice (3.49; 1.74 to 8.26), unimproved drinking water source (8.16; 1.69 to 39.46), limited drinking water service (4.68; 1.47 to 14.95), open defecation practice (5.17; 1.95 to 13.70), unimproved sanitation service (2.74; 1.60 to 4.67), limited sanitation service (1.71; 1.10 to 2.65), no hygiene service (3.43; 1.91 to 6.16) and limited hygiene service (2.13; 1.17 to 3.86) were significantly associated with diarrhoeal disease.Conclusion In this study, diarrhoea among children is a significant health issue. Child’s age, drinking water service, residence type and hygiene service were the largest contributors with respect to the prevalence of diarrhoeal disease. This investigation provides information that could help to inform interventions to reduce childhood diarrhoea. The findings suggest that state authorities should initiate robust WASH strategies to achieve the Sustainable Development Goal 3 agenda.

Abstract Background Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia. Methods The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use. Results The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use (p-value

Background: The consumption of vegetables is increasing in Ethiopia because of their high health benefits. Smallholder farmers who use water from the Akaki River for irrigation meet more than 60% of the vegetable needs of Addis Ababa. However, the Akaki River is severely polluted by anthropogenic impacts. Hence, the intake of vegetables grown in fecally contaminated water can lead to many health problems. Therefore, this study aimed to evaluate microbial contamination of irrigation water and vegetables in Addis Ababa. Methods: This study assessed the quality of water and vegetables collected from the Akaki River. Fresh vegetables, such as Ethiopian kale, lettuce, cabbage, and spinach, were collected from 14 farmlands during the dry and wet seasons. The analysis of E. coli non-E. coli, total coliform (TC), fecal coliform (FC), and total aerobic plate count (TAC) were determined using standard methods. Results: The findings of this study indicated that all fresh vegetables were contaminated with total coliforms, fecal coliforms, and total aerobic plate counts in both dry and wet seasons. The overall mean counts of E. coli and non-E. coli in the water samples were 2.09 and >3.48 log10 CFU 10 mL−1, respectively. The mean counts of TC, FC, and TAC on the sampled vegetables were 3.22, 1.37, and 4.72 in the dry season, and 3.87, 2.57, and 5.09 log10 CFU per gram in the wet season, respectively. Conclusion: The Akaki River has been contaminated with non-E. Coli & E. coli coliforms, and did not meet the WHO guideline criteria for safe irrigation. The microbial contamination of vegetables was found to be high and exceeded the hazard analysis and critical control points for total quality management (HACCPTQM) and International Commission on Microbiological Specifications for Food (ICMSF) limits for safe consumption. Therefore, the local government is responsible for ensuring that farmers can use pollution-reducing irrigation systems and that consumers are aware of the health risks of contaminated vegetables and take appropriate precautions.

Abstract Background Ileoileal knotting is one of the rarest causes of intestinal obstruction. The pathology involves knotting of the ileum around itself, leading to mechanical intestinal obstruction that can rapidly evolve to gangrene. Case presentation Here we will discuss the case of an 18-year-old Oromo girl who presented with sudden onset of severe abdominal pain and signs of generalized peritonitis.Ultrasound examination showed massive peritoneal and cul-de-sac fluid. Explorative laparotomy was done, with a tentative diagnosis of ruptured ovarian cyst. Intraoperative finding was a gangrenous ileoileal knot. The gangrenous segment was resected and ileotransverse anastomosis done. Postoperative course was uneventful, and the patient was discharged improved on the sixth postoperative day. Conclusion We present this case to highlight the diagnostic difficulty that one can face in females of child-bearing age and to create awareness of this rare cause of intestinal obstruction, as morbidity and mortality are very high because of rapid progression to gangrene.

Background: This retrospective study aimed to investigate the physicochemical properties of drinking water sources in Ethiopia and compare the water quality with the health-based target. For this purpose, the water quality database of Ethiopian Public Health Institute (EPHI) from 2010 to 2016 was used. Methods: The concentration and other properties of the water samples were analyzed according to the Standard Methods of Water and Wastewater analysis. Quality control and quality assurance were applied in all stages following our laboratory standard operation procedures (SOPs). Results: The concentration of the selected parameters varied based on the type of water sources. The mean concentration of turbidity was higher in spring water (21.3 NTU) compared to tap (12.6 NTU) and well (3.9 NTU) water sources. The mean concentration of total dissolved solids (TDS), electrical conductivity (EC), sodium (Na+), and sulfate (SO4-2) was found to be higher in spring water sources than tap and well water sources. Comparably, the concentration of hardness, calcium, and magnesium was found to be higher in well water sources than spring and tap water sources. The bivariate analysis indicated that out of 845 analyzed water samples, more than 50% of the samples from Oromia region had turbidity, pH, TDS, hardness, Ca++, K+, and Na+ within an acceptable limit. In addition, the logistic regression analysis showed that water quality parameters were strongly associated with the type of water sources and regional administration at P < 0.05. Conclusion: More than 80% of the samples analyzed from drinking water sources were in agreement with WHO guidelines and national standards. However, the remaining 20% specifically, pH (25%), calcium (20%), hardness (18.1%), TDS (15.5%), and turbidity (13.3%) analyzed from improved water sources did not comply with these recommendations. Due to objectionable or unpleasant taste, people may force to look for alternative unprotected water sources that lead to health concerns.

Background: Ensuring the availability of safe drinking water remains a critical challenge in developing countries, including Ethiopia. Therefore, this paper aimed to investigate the prevalence of fecal coliform and E. coli bacteria and, geographical, children availability, and seasonal exposure assessment through a meta-analysis. Methods: Two independent review groups extensively searched internet databases for English-language research articles published between 2013 and 2023. This systematic review and meta-analysis followed PRISMA guidelines. The methodological quality of each included study was evaluated using the STROBE guidelines. Publication bias was assessed by visual inspection of a funnel plot and then tested by the Egger regression test, and meta-analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. Subgroup analyses were also conducted to explore heterogeneity. Results: Out of 48 potentially relevant studies, only 21 fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of fecal coliform and E. coli was 64% (95% CI: 56.0–71.0%, I2 = 95.8%) and 54% (95% CI: 45.7–62.3%, I2 = 94.2%), respectively. Subgroup analysis revealed that the prevalence of fecal coliform bacteria increased during the wet season (70%) compared to the dry season (60%), particularly in households with under-five children (74%) compared to all households (61%), in rural (68%) versus urban (66%) areas, and in regions with high prevalence such as Amhara (71%), Gambela (71%), and Oromia (70%). Similarly, the prevalence of E. coli was higher in households with under-five children (66%) than in all households (46%). Conclusions: The analysis highlights the higher prevalence of fecal coliform and E. coli within households drinking water, indicating that these bacteria are a significant public health concern. Moreover, these findings emphasize the critical need for targeted interventions aimed at improving drinking water quality to reduce the risk of fecal contamination and enhance public health outcomes for susceptible groups, including households with under-five children, in particular geographical areas such as the Amhara, Gambela, and Oromia regions, as well as rural areas, at point-of-use, and during the rainy season. Registration: This review was registered on PROSPERO (registration ID - CRD42023448812). [ABSTRACT FROM AUTHOR]

Background: Open defecation is a significant global challenge, impacting public health, environmental sanitation, and social well-being, especially in low- and middle-income countries like Ethiopia. It is the second-largest cause of disease burden worldwide by facilitating the spread of germs that cause diarrhea diseases. Studies examining open defecation practices are insufficient, especially in areas implementing Ethiopia's Geshiyaro project. Therefore, this study aimed to assess the status of open defecation practice and associated factors in the study area. Method: A community-based cross-sectional study was conducted from June to July 2023. The total number of households included in this study was 7995. A structured questionnaire and observational checklist were used to collect data. Descriptive and multivariate logistic regression analyses were performed using STATA version 16. Results: The study found that 16.5% of households practiced open defecation. The following factors were significantly associated with the occurrence of open defecation: residence (AOR = 1.56, 95% CI: 1.26-1.92), education (AOR = 0.59, 95% CI: 0.49-0.72), age (AOR = 0.53, 95% CI: 0.41-0.69), knowledge on diarrhea prevention (AOR = 1.32, 95% CI: 1.17-1.50), marital status (AOR = 1.61, 95% CI: 1.32-1.97), and awareness creation about WASH services (AOR = 1.96, 95% CI: 1.71-2.25). On the other hand, no significant association was observed between the occurrence of open defecation and the household's income (AOR = 1.07, 95% CI: 0.93-1.23) or the head of household sex (AOR = 0.94, 95% CI: 0.78-1.12). Conclusion: Open defecation remains a critical public health concern in Ethiopia's Geshiyaro project sites. Various factors influencing this practice have been identified. Targeted interventions are needed to enhance access to safe sanitation facilities and promote awareness of WASH services, aligning with SDG 3 target 3, and SDG 6 target 2. [ABSTRACT FROM AUTHOR]

Introduction: patient satisfaction is an attitude resulting from a person's general orientation towards the total experience of health care. The study was done with the aim of evaluating postoperative patient satisfaction level with the quality of service provided at the surgical wards; determining how much factors related to physicians, nursing, laboratory, and information provision service influence satisfaction level; and determining factors impacting patient satisfaction level. Methods: a hospital-based quantitative cross-sectional study design was conducted in six Addis Ababa City Government tertiary hospitals from November 4th to December 13th, 2022. Patients who had major operations done at the government hospitals from November 21st to December 5th, 2022, were included in the study population. A pre-tested, structured, and Amharic-version questionnaire was used to interview patients. A bivariate and multivariate logistic regression model was used to identify the variables that had an association with the dependent variable. P-values less than 0.05 were considered statistically significant. Results: a total of 287 patients participated in the research, providing a response rate of 95%. Of the total participants, 144 were males (50.8%) and 143 were females (49.5%). The overall patient satisfaction level with surgical ward service is 96.2%. The level of patient satisfaction with nursing services is 94.8%, with physician's services it is 98.6%, with the facility it is 92.3%, and with the provision of information about post-operative complications it is 69.7%. Those who have above-first-degree educational status are less satisfied (66.7%) than patients with other levels of educational status. Only the patients' residency showed a small level of association (r= 0.145, p=0.014) with overall patient satisfaction with surgical ward service among the demographic components. The two variables that are strongly correlated with patient satisfaction are the adequacy of the time ward nurses spent with patients during evaluation and treatment (r = 0.503, p = 0.000) and adequate nurses' response to patients' calls (r = 0.498, p = 0.000). Post-operative patient satisfaction with surgical ward nursing service, physician service, hospital facilities, and the provision of information about post-op complications explain about 40.9 percent of the variation in the overall patient satisfaction with post-op care provided at the surgical ward. Patient satisfaction with nursing service has more significant effect with overall patient satisfaction than the other variables (β = 0.266, p =0.0002). Conclusion: post-operative patients at Addis Ababa City Government Tertiary Hospitals expressed a very high degree of satisfaction with the care they received in the surgical wards. The study also found that patients were generally less satisfied with the information they were given on drugs, side effects, and available treatment options. Another factor identified in the study that caused unhappiness was the unavailability of some pharmacy and laboratory services. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease 2019 (COVID-19) is a novel, primarily respiratory, coronavirus that became a pandemic when it spread to over 210 countries and led to the death of over six million people. There is no definitive treatment for COVID-19, but vaccines have been developed that can help prevent severe illness and death. Studies have investigated the effect of vaccination on disease severity and outcome, and the findings indicate that vaccination is linked to a significant reduction in the risk of hospitalization, intensive care unit (ICU) admission, and disease mortality. However, there is a scarcity of evidence in Africa in general, and no similar study has been conducted in Ethiopia yet. Therefore, the study aimed to assess the effect of vaccination on COVID-19 disease severity and the need for ICU admission among hospitalized patients at a private specialty clinic in Ethiopia. Methods A retrospective cohort study was conducted among 126 patients with COVID-19, 41 vaccinated and 85 unvaccinated, who were hospitalized between September 2021 and May 2022. Data were summarized using frequency (percentage) and median (interquartile range (IQR)). To compare the characteristics of the two groups, Chi-square/Fisher's exact and Mann-Whitney U tests at p-values of ≤ 0.05 were used. To identify the effect of vaccination on COVID-19 disease severity, a marginal structural model (MSM) with an inverse probability weighting (IPW) approach using a robust Poisson regression model was fitted. Adjusted relative risk (ARR) and 95% confidence interval (CI) for ARR were used for interpreting the result. Results The cohort included groups that were comparable in terms of their sociodemographic and clinical characteristics. More than half of the participants were older than 60 years (n = 66, 52.4%), were males (n = 71, 56.3%), and had one or more comorbid illnesses (n = 66, 52.4%). At admission, 85 (67.5%) had severe disease, and 11 (8.7%) progressed after hospitalization and required ICU admission, of which three unvaccinated cases died. From the final model, vaccination was found to be associated with a 62% decreased risk of developing severe COVID-19 disease if infected, compared to not getting vaccinated (ARR = 0.38, 95% CI = 0.23-0.65, p < 0.0001). Conclusions The study's findings support previous reports that vaccinated people are less likely to develop severe COVID-19 disease if later infected with the virus, emphasizing the importance of continuing efforts to promote COVID-19 vaccination not only to safeguard individuals but also to confer community-level immunity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Addis Ababa Regional Health Bureau Ethical Clearance Committee (AARHB-ECC) issued approval (Ref. No. A/A/14044/227). The AARHB-ECC also waived the need for informed consent as the study used secondary data. The anonymity of the participants was maintained by the use of medical record numbers in the research report. No other personal identifiers of the patients were used in the research report. Access to the collected information was limited to the investigators and confidentiality was maintained throughout the project. . Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Belayneh et al.)