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Abstract Introduction Nowadays, food safety is regarded as one of the most critical global public health issues. Edible oil, a key ingredient in food processing, is widely used and consumed in every Ethiopian household. However, its safety is often overlooked. Currently, edible oil is produced in Ethiopia from small-scale operations to large industrial levels, as well as imported from other countries. Objective This study aimed to determine the levels of heavy metals and essential minerals in edible vegetable oils produced and marketed in Gondar City, Northwest Ethiopia. Methods A laboratory-based cross-sectional study was conducted from May to July 2021 in Gondar City. Seventeen edible oil samples were collected using simple random sampling techniques. Heavy metal content was determined using an atomic absorption spectrophotometer with the standard procedures and techniques after microwave digestion. The efficiency and validity of the method used were evaluated by determining the limit of detection (LOD), the limit of quantification (LOQ), accuracy, and precision. The collected data were entered into Microsoft Excel and transported to Stata for analysis. Result A total of seventeen vegetable oil samples were analyzed. The accuracy of the method was evaluated by recovery studies, which ranged from 81 to 115%, and the relative standard deviations were found to be below 15%. The concentrations of Zn, Cu, Fe, Cd, and Pb were in the range of 0.07 to 0.8 mg/l, 0.002 to 0.06 mg/l, 0.01 to 0.8 mg/l, 0.08 to 0.18 mg/l, and 0.003 to 0.27 mg/l, respectively. In general, the lead and cadmium content was higher than other metals in some of the investigated edible vegetable oils. Most values fell within the permissible quality limits for edibility as prescribed by the World Health Organization (WHO) and the National Agency for Food and Drug Administration and Control (NAFDAC). However, the levels of Pb and Cd exceeded the reference levels in some locally produced vegetable oils. Conclusion To address the exceeded levels of heavy metals, it is imperative to implement more careful handling, processing of raw materials, and filtering practices. Producers and marketers should take the necessary precautions to prevent contamination. Strict regulatory control from responsible bodies and stakeholders is recommended to ensure the safety and metal contents of vegetable oils originating from the study area.

IntroductionGenerating quality data for decision-making at all levels of a health system is a global imperative. The assessment of the Ethiopian National Health Information System revealed that health information system resources, data management, dissemination, and their use were rated as “not adequate” among the six major components of the health system. Health extension workers are the frontline health workforce where baseline health data are generated in the Ethiopian health system. However, the data collected, compiled, and reported by health extension workers are unreliable and of low quality. Despite huge problems in data management practices, there is a lack of sound evidence on how to overcome these health data management challenges, particularly among health extension workers. Thus, this study aimed to assess data management practices and their associated factors among health extension workers in the Central Gondar Zone.MethodAn institution-based cross-sectional study was conducted among 383 health extension workers. A simple random sampling method was used to select districts, all health extension workers were surveyed in the selected districts, and a structured self-administered questionnaire was used for data collection. The data was entered using EpiData version 4.6 and analyzed using STATA, version 16. Bivariable and multivariable binary logistic regression analyses were executed. An odds ratio with a 95% confidence interval and a p-value of

Abstract Cooking and heating using solid fuels, such as dung, wood, agricultural residues, grass, straw, charcoal, and coal, is a main source of household air pollution. This indoor combustion encompasses a diversity of health detrimental pollutants, especially for people from low-income countries like Ethiopia since solid fuels are accessible easily at a lesser cost. Limited studies done showing factors affecting in choosing fuel type and no study, which revealed spatial heterogeneity of solid fuel used based on such nationally representative data. Therefore, this study, aimed at investigating spatial variation and determinants of solid fuel use in Ethiopia. This study was done using the data from the Ethiopian Demographic and Health Survey 2016, a national representative sample (16,650) households were included. Spatial and Multi-level logistic regression analysis was done by considering the DHS data hierarchal nature. Variables in the final model with a p-value

Abstract Introduction Health systems around the world are struggling with the massive numbers of people with mental disorders who require professional care. The treatment gap for mental disorders is high all over the world, with between 76 and 85% of people in low- and middle-income countries with severe mental disorders receiving no treatment for their mental health conditions. Tele-psychiatry is used as an alternative solution to the problem of limited mental health services and effective Tele-psychiatry service use may be achievable if mental health providers have a good attitude towards it. Objective To assess the attitude of mental healthcare providers toward Tele-psychiatry services and associated factors at public referral hospitals in Addis Ababa city, Ethiopia, 2022. Method A Multicenter institution-based cross-sectional study was conducted among 413 mental health professionals working in public referral hospitals in Addis Ababa city, from May 04 to June 10, 2022. Data were collected by using a structured and self-administered questionnaire prepared by reviewing previous related studies. Epi Data version 3.1 and Stata version 14 were used for data entry and analysis respectively. Bivariate and multivariable logistic regression analyses were used to identify factors associated with attitudes toward Tele-psychiatry services. A statistical significance was declared at p-value

Abstract Background Tele-education is the use of ICTs to conduct remote learning. It has been utilized to deliver ongoing training for many years. The world’s modern culture is increasingly reliant on the use of information technology to enhance standards of education. However, in order to deploy successful e-learning systems in a developing nation, understanding of user characteristics is required in the creation and usage of e-learning systems. Thus, this study will enable us to understand the user’s level of knowledge and attitude towards tele-education. Methods An institution-based quantitative cross-sectional study supported by qualitative design was used 397 medical students at University of Gondar from May to June 2022. A pre-tested self-administered structured questionnaires and in-depth interview were used to collect quantitative and qualitative data respectively. Thematic-content analysis was conducted using open-code software for analyzing qualitative data. Quantitative data was entered to Epi-data version 4.6 and exported to SPSS version 25 software for further statistical analysis. Binary logistic regression was conducted. The adjusted odds ratio(AOR) was used to measure the association between the dependent and independent variables. Results A total of 397 medical students were participated in this study with a response rate of 93.63%. In this study nearly six out of ten 230(57.9%) of study participants had good knowledge towards tele-education. More than half. 211(53.1%) of medical students participated on the study also had a favorable attitude towards tele-education. Factors associated with knowledge about tele-education is training related to ICT (AOR = 2.27 95% CI; (1.13,4.55)), knowledge of medical education digitization (AOR = 3.80 95% CI; (2.12,6.84)), high computer literacy (AOR = 2.82 95% CI; (1.68,4.72)) and favorable attitude towards tele-education (AOR = 3.52 95% CI; (2.12,5.84)). Factors associated with attitude towards tele-education is age group > 21 (AOR = 3.89, 95% CI; (1.33,11.39)) and good knowledge towards tele-education (AOR = 3.42,95%CI;(2.06,5.66)). Conclusion The study revealed that the knowledge of the medical students was good and nearly five out of ten of them had a favorable attitude towards tele-education. The study shows that training related to ICT, knowledge of medical education digitization, high computer literacy and favorable attitude towards tele-education were associated significantly with knowledge of tele-education. In this study age group > 21 and good knowledge towards tele-education of study participants were associated significantly with attitude towards tele-education.

Abstract Background Treatment with effective antiretroviral therapy (ART) reduces viral load as well as HIV-related morbidity and mortality in HIV-positive patients. Despite the expanded availability of antiretroviral therapy around the world, virological failure remains a serious problem for HIV-positive patients. Thus, Machine learning predictive algorithms have the potential to improve the quality of care and predict the needs of HIV patients by analyzing huge amounts of data, and enhancing prediction capabilities. This study used different machine learning classification algorithms to predict the features that cause virological failure in HIV-positive patients. Method An institution-based secondary data was used to conduct patients who were on antiretroviral therapy at the University of Gondar Comprehensive and Specialized Hospital from January 2020 to May 2022. Patients’ data were extracted from the electronic database using a structured checklist and imported into Python version three software for data pre-processing and analysis. Then, seven supervised classification machine-learning algorithms for model development were trained. The performances of the predictive models were evaluated using accuracy, sensitivity, specificity, precision, f1-score, and AUC. Association rule mining was used to generate the best rule for the association between independent features and the target feature. Result Out of 5264 study participants, 1893 (35.06%) males and 3371 (64.04%) females were included. The random forest classifier (sensitivity = 1.00, precision = 0.987, f1-score = 0.993, AUC = 0.9989) outperformed in predicting virological failure among all selected classifiers. Random forest feature importance and association rules identified the top eight predictors (Male, younger age, longer duration on ART, not taking CPT, not taking TPT, secondary educational status, TDF-3TC-EFV, and low CD4 counts) of virological failure based on the importance ranking, and the CD-4 count was recognized as the most important predictor feature. Conclusion The random forest classifier outperformed in predicting and identifying the relevant predictors of virological failure. The results of this study could be very helpful to health professionals in determining the optimal virological outcome.

Abstracts Background Tele-pharmacy is a subset of telemedicine in which pharmacies use telecommunication technology to provide patient care. Tele-pharmacy can improve pharmaceutical care service delivery by reducing medication errors, improving access to health professionals and facilities in remote and rural areas, and minimizing adverse drug events. However, there is limited evidence regarding future pharmacists' knowledge and perceptions of the Tele-pharmacy system in Ethiopia. As a result, this study aimed to assess tele-Pharmacy perception, knowledge and associated factors among pharmacy students in Northwest Ethiopia. Methods An institutional-based cross-sectional study was conducted among 376 pharmacy students in Northwest Ethiopia between July 15 and August 27, 2022. A pre-tested self-administered questionnaire was used to collect data. The data were entered using Epi info version 7.0 and analyzed using SPSS version 25. Descriptive statistics, bivariable and multivariable logistic regression analysis were used to describe pharmacy students' knowledge and perceptions of Tele-pharmacy and identify associated factors. An adjusted odds ratio (OR) and a p-value with a 95% confidence interval (CI) were calculated to declare statistical significance. Results From a total of 352 participants, about 32.4% with [95% CI (27%-37%)] and 48.6% with [95% CI (43%—54%)] had good knowledge and a positive perception toward Tele-pharmacy, respectively. Being age group of 26–30 (AOR = 0.35, 95% CI: 0.17–0.68), being male (AOR = 2.38, 95% CI: 1.26–4.49), Having a CPGA of > 3.5 (AOR = 2.28, 95% CI: 1.24–4.19), Taking basic computer training (AOR = 2.00, 95% CI: 1.17–3.39), Management support (AOR = 1.84, 95% CI: 1.06–3.19) were found to be significantly associated with pharmacy students' knowledge of Tele-pharmacy. Similarly, having access to electronic devices (AOR = 3.80, 95% CI: 1.81–7.97), training related to pharmacy information systems (AOR = 6.66, 95% CI: 3.34–13.29), availability of guidelines (AOR = 2.99, 95% CI: 1.62–5.50) were found to be significantly associated with pharmacy students' perceptions of Tele-pharmacy. Conclusion This study found that pharmacy students have limited knowledge and perceptions of the Tele-pharmacy system. A continuing Tele-pharmacy training package, incorporating pharmacy information system guidelines as part of their education, and providing managerial support could be recommended to improve pharmacy students' knowledge and perception of Tele-pharmacy.

Abstract Introduction Sexually transmitted infections (STIs) are the major public health problem globally, affecting millions of people every day. The burden is high in the Sub-Saharan region, including Ethiopia. Besides, there is little evidence on the distribution of STIs across Ethiopian regions. Hence, having a better understanding of the infections is of great importance to lessen their burden on society. Therefore, this article aimed to assess predictors of STIs using machine learning techniques and their geographic distribution across Ethiopian regions. Assessing the predictors of STIs and their spatial distribution could help policymakers to understand the problems better and design interventions accordingly. Methods A community-based cross-sectional study was conducted from January 18, 2016, to June 27, 2016, using the 2016 Ethiopian Demography and Health Survey (EDHS) dataset. We applied spatial autocorrelation analysis using Global Moran’s I statistics to detect latent STI clusters. Spatial scan statics was done to identify local significant clusters based on the Bernoulli model using the SaTScan™ for spatial distribution and Supervised machine learning models such as C5.0 Decision tree, Random Forest, Support Vector Machine, Naïve Bayes, and Logistic regression were applied to the 2016 EDHS dataset for STI prediction and their performances were analyzed. Association rules were done using an unsupervised machine learning algorithm. Results The spatial distribution of STI in Ethiopia was clustered across the country with a global Moran’s index = 0.06 and p value = 0.04. The Random Forest algorithm was best for STI prediction with 69.48% balanced accuracy and 68.50% area under the curve. The random forest model showed that region, wealth, age category, educational level, age at first sex, working status, marital status, media access, alcohol drinking, chat chewing, and sex of the respondent were the top 11 predictors of STI in Ethiopia. Conclusion Applying random forest machine learning algorithm for STI prediction in Ethiopia is the proposed model to identify the predictors of STIs.

Abstract Background Globally, 38% of contraceptive users discontinue the use of a method within the first twelve months. In Ethiopia, about 35% of contraceptive users also discontinue within twelve months. Discontinuation reduces contraceptive coverage, family planning program effectiveness and contributes to undesired fertility. Hence understanding potential predictors of contraceptive discontinuation is crucial to reducing its undesired outcomes. Predicting the risk of discontinuing contraceptives is also used as an early-warning system to notify family planning programs. Thus, this study could enable to predict and determine the predictors for contraceptive discontinuation in Ethiopia. Methodology Secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey. Eight machine learning algorithms were employed on a total sample of 5885 women and evaluated using performance metrics to predict and identify important predictors of discontinuation through python software. Feature importance method was used to select top predictors of contraceptive discontinuation. Finally, association rule mining was applied to discover the relationship between contraceptive discontinuation and its top predictors by using R statistical software. Result Random forest was the best predictive model with 68% accuracy which identified the top predictors of contraceptive discontinuation. Association rule mining identified women's age, women’s education level, family size, husband’s desire for children, husband’s education level, and women’s fertility preference as predictors most frequently associated with contraceptive discontinuation. Conclusion Results have shown that machine learning algorithms can accurately predict the discontinuation status of contraceptives, making them potentially valuable as decision-support tools for the relevant stakeholders. Through association rule mining analysis of a large dataset, our findings also revealed previously unknown patterns and relationships between contraceptive discontinuation and numerous predictors.

Objective To assess the awareness and readiness of mental healthcare providers to implement telemental health services and the associated factors at public referral hospitals in Addis Ababa City, Ethiopia.Study design A cross-sectional study was conducted among mental health professionals working at public referral hospitals in Addis Ababa City from 4 May to 10 June 2022.Participants A total of 413 (55.7% male and 44.3% female) health professionals participated in the study. The study participants were selected using a simple random sampling technique. All mental healthcare providers working at public referral hospitals in Addis Ababa City were considered as the source population. Mental healthcare providers who meet the inclusion criteria were considered the study population. Having a minimum diploma qualification and 6 months or more of work experience and giving written consent were considered the inclusion criteria.Outcome measure The main outcome measure was awareness and readiness to implement telemental health services.Result A total of 413 participants were enrolled, with a response rate of 90.6%. The prevalence of good awareness towards telemental health services was 41% (95% CI 37%, 47%). Being female (adjusted OR (AOR)=0.34; 95% CI 0.15, 0.76), having poor information technology support (AOR=0.32; 95% CI 0.11, 0.99) and having electronic health technology experience (AOR=1.21; 95% CI 1.1, 2.44) were significantly associated with awareness of telemental health services, whereas computer access at the workplace (AOR=0.04; 95% CI 0.003, 0.55) and awareness (AOR=4.34; 95% CI 1.02, 18.48) and attitude (AOR=1.01; 95% CI 1.03, 2.19) towards telemental health services were the variables that showed statistically significant association with readiness of mental healthcare providers for telemental health services.Conclusion Although majority of healthcare providers in this survey were prepared to implement telemental health services, there was typically little awareness among mental healthcare providers.

Abstract Background Nearly three-fourths of pregnant women in Ethiopia give birth at home. However, the spatial pattern and spatial variables linked to home delivery in developing regions of Ethiopia have not yet been discovered. Thus, this study aimed to explore the geographical variation of home delivery and its determinants among women living in emerging (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of Ethiopia, using geographically weighted regression analysis. Methods Data were retrieved from the Demographic and Health Survey program's official database ( http://dhsprogram.com ). In this study, a sample of 441 reproductive-age women in Ethiopia's four emerging regions was used. Global and local statistical analyses and mapping were performed using ArcGIS version 10.6. A Bernoulli model was applied to analyze the purely spatial cluster discovery of home delivery. GWR version 4 was used to model spatial regression analysis. Results The prevalence of home delivery in the emerging regions of Ethiopia was 76.9% (95% CI: 72.7%, 80.6%) and the spatial distribution of home delivery was clustered with global Moran’s I = 0.245. Getis-Ord analysis detected high-home birth practice among women in western parts of the Benishangul Gumz region, the Eastern part of the Gambela region, and the Southern and Central parts of the Afar region. Non-attendance of antenatal care, living in a male-headed household, perception of distance to a health facility as a big problem, residing in a rural area, and having a husband with no education significantly influenced home delivery in geographically weighted regression analysis. Conclusions More than three-fourths of mothers in the developing regions of Ethiopia gave birth at home, where high-risk locations have been identified and the spatial distribution has been clustered. Thus, strengthening programs targeted to improve antenatal care service utilization and women’s empowerment is important in reducing home birth practice in the study area. Besides, supporting the existing health extension programs on community-based health education through home-to-home visits is also crucial in reaching women residing in rural settings.

Abstract Background Inadequate micronutrients in the diet and vitamin A deficiency are worldwide public health problems. In developing regions, many preschool children are undernourished, become blind every year and died before the age of 23 months. This study was aimed to explore the spatial distribution of vitamin A rich foods intake among children aged 6–23 months and identify associated factors in Ethiopia. Methods Ethiopian Mini Demographic and Health Survey 2019 dataset with a total 1407 children aged 6–23 months was used. Data management and processing were done using STATA version 15 software and Microsoft Office Excel. ArcMap version 10.7 software was used for mapping and spatial visualization of the distribution. Spatial scan statistics was performed using SaTScan version 9.5 software for Bernoulli-based model. Multilevel mixed effect logistic regression model was employed to identify associated factors. Results Overall, 38.99% (95% CI: 36.46–41.62) of children aged 6– 23 months took vitamin A rich foods. Poor intake of vitamin A rich foods was significantly clustered Dire Dawa city, Somali and Harari regions of Ethiopia. Children aged 6–23 months lived in the primary cluster were 70% (RR = 1.70, P-value

Objectives Personal health record systems allow users to manage their health information in a confidential manner. However, there is little evidence about healthcare providers’ intentions to use such technologies in resource-limited settings. Therefore, this study aimed to assess predicting healthcare providers’ acceptance of electronic personal health record systems.Methods An institutional-based cross-sectional study was conducted from 19 July to 23 August 2022 at teaching hospitals in the Amhara regional state of Ethiopia. A total of 638 health professionals participated in the study. Simple random sampling techniques were used to select the study participants. Structural equation modelling analysis was employed using AMOS V.26 software.Result Perceived ease of use had a significant effect on the intention to use electronic personal health records (β=0. 377, p

Introduction The lack of local side effect profiles for vaccines could hinder vaccination uptake. Since all COVID-19 vaccines are brand-new medications, it is crucial to keep track of any safety related concern. Objective This study is aimed to investigate post-vaccination side effects of COVID-19 vaccines and associated factors in Bahir Dar city. Method An institutional-based cross-sectional study was conducted among vaccinated clients. A simple random and a systematic random sampling method were used to select the health facilities and the participants, respectively. Bi-variable and multivariable binary logistic regression analyses were executed with odds ratio at 95% confidence intervals at p

Abstract Background Respecting patients’ confidentiality is an ethical and legal responsibility for health professionals and the cornerstone of care excellence. This study aims to assess health professionals’ knowledge, attitudes, and associated factors towards patients’ confidentiality in a resource-limited setting. Methods Institutional based cross-sectional study was conducted among 423 health professionals. Stratified sampling methods were used to select the participants, and a structured self-administer questionnaire was used for data collection. The data was entered using Epi-data version 4.6 and analyzed using SPSS, version 25. Bi-variable and multivariable binary logistic regression analyses were used to measure the association between the dependent and independent variables. Odds ratio with 95% confidence intervals and P value was calculated to determine the strength of association and to evaluate statistical significance. Result Out of 410 participants, about 59.8% with [95% CI (54.8–68.8%)] and 49.5% with [95% CI (44.5–54.5%)] had good knowledge and favorable attitude towards patents confidentiality respectively. Being male (AOR = 1.63, 95% CI [1.03–2.59]), taking training on medical ethics (AOR = 1.73, 95% CI = [1.11–2.70]), facing ethical dilemmas (AOR = 3.07, 95% CI [1.07–8.79]) were significantly associated factors for health professional knowledge towards patients’ confidentiality. Likewise, taking training on medical ethics (AOR = 2.30, 95% CI [1.42–3.72]), having direct contact with the patients (AOR = 3.06, 95% CI [1.12–8.34]), visiting more patient (AOR = 4.38, 95% CI [2.46–7.80]), and facing ethical dilemma (AOR = 3.56, 95% CI [1.23–10.26]) were significant factors associated with attitude of health professionals towards patient confidentiality. Conclusion The findings of this study revealed that health professionals have a limited attitude towards patient confidentiality but have relatively good knowledge. Providing a continuing medical ethics training package for health workers before joining the hospital and in between the working time could be recommended to enhance health professionals’ knowledge and attitude towards patient confidentiality.

Abstract Background Maintaining and effectively utilizing maternal continuum of care could save an estimated 860,000 additional mothers and newborn lives each year. In Ethiopia, the number of maternal and neonatal deaths occurred during pregnancy, childbirth, and the postpartum period was very high. It is indisputable that area-based heterogeneity of zero utilization for a standard maternal continuum of care is critical to improve maternal and child health interventions. However, none of the previous studies explored the spatial distribution of zero utilization for maternal continuum of care. Hence, this study was aimed to explore geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia. Methods A total of 4178 women who gave birth five years preceding the 2016 Ethiopian demographic and health survey were included. ArcGIS version 10.7, SaT Scan version 9.6, and GWR version 4.0 Software was used to handle mapping, hotspot, ordinary least square, Bernoulli model analysis, and to model spatial relationships. Finally, a statistical decision was made at a p-value

IntroductionElectronic personal health record (e-PHR) system enables individuals to access their health information and manage it themselves. It helps patient engagement management of health information that is accessed and shared with their healthcare providers using the platform. This improves individual healthcare through the exchange of health information between patients and healthcare providers. However, less is known about e-PHRs among healthcare professionals.ObjectiveTherefore, this study aimed to assess Health professionals' Knowledge and attitude and its associated factors toward e-PHR at the teaching hospital in northwest Ethiopia.MethodsAn institution-based cross-sectional study design was used to determine healthcare professionals' knowledge and attitude and their associated factors toward e-PHR systems in teaching hospitals of Amhara regional state, Ethiopia, from 20 July to 20 August 2022. Pretested structured self-administered questionnaires were used to collect the data. Descriptive statistic was computed based on sociodemographic and other variables presented in the form of table graphs and texts. Bivariable and multivariable logistic analyses were performed with an adjusted odds ratio (AOR) and 95% CI to identify predictor variables.ResultOf the total study participants, 57% were males and nearly half of the respondents had a bachelor's degree. Out of 402 participants, ~65.7% [61–70%] and 55.5% [50–60%] had good knowledge and favorable attitude toward e-PHR systems, respectively. Having a social media account 4.3 [AOR = 4.3, 95% CI (2.3–7.9)], having a smartphone 4.4 [AOR = 4.4, 95% CI (2.2–8.6)], digital literacy 8.8 [(AOR = 8.8, 95% CI (4.6–15.9)], being male 2.7 [AOR = 2.7, 95% CI (1.4–5.0)], and perceived usefulness 4.5 [(AOR = 4.5, 95% CI (2.5–8.5)] were positively associated with knowledge toward e-PHR systems. Similarly, having a personal computer 1.9 [AOR = 1.9, 95% CI (1.1–3.5)], computer training 3.9 [AOR = 3.9, 95% CI (1.8–8.3)], computer skill 19.8 [AOR = 19.8, 95% CI (10.7–36.9)], and Internet access 6.0 [AOR = 6.0, 95% CI (3.0–12.0)] were predictors for attitude toward e-PHR systems.ConclusionThe findings from the study showed that healthcare professionals have good knowledge and a favorable attitude toward e-PHRs. Providing comprehensive basic computer training to improve healthcare professionals' expectation on the usefulness of e-PHR systems has a paramount contribution to the advancement of their knowledge and attitude toward successfully implementing e-PHRs.

BackgroundThe strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. ObjectiveThis study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. MethodsWe developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. ResultsAfter reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups

Introduction: Health information utilization is a global approach to improving the healthcare service quality. However, health information utilization has been challenging in developing countries due to health professionals having limited access to appropriate data. Objective: Therefore this study aimed to assess health information utilization and associated factors among health professionals in North Gondar Zone Hospitals. Methods: An institution-based cross-sectional survey study was conducted among 335 health professionals from June 1 to July 3, 2022. The data were analyzed using SPSS version 26 software. Data was collected using pretested interviewer-administered questionnaires. Data were entered with epi data 4.6 versions and cleaned and analyzed using SPSS version 26. Bi-variable and multivariable logistic regression was carried out to see the effect of explanatory variables on the outcome variable. The strength of the association between the dependent and independent variables was assessed using the odds ratio, and statistical significance was determined using a p-value of less than 0.05. Results: A total of 327 study subjects participated in this study with a 97.6% response rate. About 64%(95%; CI = 58.4, 68.8) of the participants had good health information utilization. Discuss feedback at a meeting (AOR = 2.65, 95% CI = 1.31–5.39), collect and store data using HMIS tools was (AOR = 2.13, 95% CI = 1.10–4.10), and respondents who had check data quality (AOR = 4.54, 95% CI = 2.31, 8.92) were found to be the significant factors associated with health information utilization. Conclusion: Overall, this study finding showed that the level of health information utilization was moderate. The following points are forwarded to improve health information utilization such as; discuss feedback, check data quality, and use HMIS tools.

Background: Nursing care practice in most developing countries is challenged due to a lack of effective methods, physical limitations, and a shortage of nurses’ professionals to provide nursing care for patients. But there is no evidence about awareness and knowledge of telenursing care. So, this study aimed to fill the evidence gap regarding telenursing awareness or knowledge among nurses in resource limited settings. Method: An institution-based cross-sectional study was conducted among 422 nurses at a specialized teaching referral hospital from May 16 to July 18, 2022. A simple random sampling technique was applied to select study participants. Descriptive statistics were done through a table and a bar graph. A binary logistic regression analysis was done, and 95% confidence intervals with a P-value of less than 0.05 were employed to identify factors associated with telenursing awareness and knowledge. Result: Four hundred fifteen (415) nurses were included for analysis, with a response rate of 98.5%. Among study participants, 49.4% and 45.8% of them had good awareness and knowledge toward telenursing care, respectively. Educational level, job experience, source of information, digital training, internet access, and computer training were factors associated with a nurse's awareness of telenursing care. Moreover, nurses' awareness, social media use, experience contacting clients or patients online, source of information, research, digital training, and computer training were factors associated with nurses' knowledge of telenursing care. Conclusion: and recommendation: Overall, nurses' awareness and knowledge about telenursing care were low. Considering factors and the user's preference could inform the implementation strategy for improving nurses' awareness and knowledge regarding telenursing care for future acceptance, use, and implantation.

Background: Cancer is one of the major non-communicable diseases that impose an enormous burden both in low and middle-income countries. A cancer patient’s chance of survival is mainly determined by the time to treatment initiation, and when it is delayed, there is a lower chance of survival. Therefore, the objective of this study was to assess the magnitude of delayed cancer treatment initiation and its associated factors among patients at the oncology units of Northwest Amhara referral hospitals. Methods: An institution-based cross-sectional study was conducted among 423 cancer patients enrolled in treatment between April 3, 2018, and August 13, 2021, at Northwest Amhara referral hospital oncology units. A systematic random sampling technique was applied to select study participants. The data was analyzed with Stata 14.1. A binary logistic regression model was fitted to identify factors associated with delayed cancer treatment initiation at a p-value

BackgroundBillions of people have faced the problem of accessing appropriate sanitation services. This study aimed to explore the spatial distribution of households' access to sanitation services and identify associated factors in Ethiopia.MethodsThe 2019 Ethiopian Mini Demographic and Health Survey data was used with a total of 6261 weighted samples. A cross-sectional study design with a two-stage cluster sampling technique was used. Global Moran's I statistic measure, Getis-Ord Gi*, and the ordinary Kriging Gaussian interpolation were used for spatial autocorrelation, hot spot analysis, and interpolation of unsampled areas, respectively. A purely spatial Bernoulli-based model was employed to determine the geographical locations of the most likely clusters. A multilevel logistic regression model was used, and predictors with a P value of less than 0.05 with a 95% CI were considered significant factors.ResultsOverall, 19.7% of households had access to improved sanitation services in Ethiopia. Poor sanitation service access was significantly clustered, with hotspots of poor access identified in the South Nations Nationality and People's Region (SNNPR), Oromia, Amhara, and Benishangul Gumuz regions. A total of 275 significant clusters were identified. Households in the circled area were more vulnerable to poor sanitation service access. Rural households, on-premises water access, media exposure, and rich wealth status were statistically significant factors for access to sanitation services.ConclusionsAccess to sanitation services among households in Ethiopia is insufficient. The majority of the households had no access to sanitation services. Stakeholders are recommended to raise household members' awareness of sanitation services, give priority to the hotspot areas, and encourage poor households to have access to toilet facilities. Household members recommended using the available sanitation service and keeping the sanitation service clean. Households are recommended to construct clean shared sanitation facilities.

IntroductionElectronic health has the potential benefit to the health system by improving health service quality efficiency effectiveness and reducing the cost of care. Having good e-health literacy level is considered essential for improving healthcare delivery and quality of care as well as empowers caregivers and patients to influence control care decisions. Many studies have done on eHealth literacy and its determinants among adults, however, inconsistent findings from those studies were found. Therefore, this study was conducted to determine the pooled magnitude of eHealth literacy and to identify associated factors among adults in Ethiopia through systematic review and meta-analysis.MethodSearch of PubMed, Scopus, and web of science, and Google Scholar was conducted to find out relevant articles published from January 2028 to 2022. The Newcastle-Ottawa scale tool was used to assess the quality of included studies. Two reviewers extracted the data independently by using standard extraction formats and exported in to Stata version11 for meta-analysis. The degree of heterogeneity between studies was measured using I2 statistics. The publication bias between studies also checked by using egger test. The pooled magnitude of eHealth literacy was performed using fixed effect model.ResultAfter go through 138 studies, five studies with total participants of 1758 were included in this systematic review and Meta-analysis. The pooled estimate of eHealth literacy in Ethiopia was found 59.39% (95%CI: 47.10-71.68). Perceived usefulness (AOR = 2.46; 95% CI: 1.36, 3.12),educational status(AOR = 2.28; 95% CI: 1.11, 4.68), internet access (AOR = 2.35; 95% CI: 1.67, 3.30), knowledge on electronic health information sources(AOR = 2.60; 95% CI: 1.78, 3.78), electronic health information sources utilization (AOR = 2.55; 95%CI: 1.85, 3.52), gender (AOR = 1.82; 95% CI: 1.38, 2.41) were identified significant predictors of e-health literacy.Conclusion and recommendationThis systematic review and meta-analysis found that more than half of study participants were eHealth literate. This finding recommends that creating awareness about importance of eHealth usefulness and capacity building to enhance and encouraging to use electronic sources and availability of internet has para amount to solution to increase eHealth literacy level of study participants.

Introduction: The burden of diabetes mellitus is increasing in Africa. Wearables have a proven track record of combating chronic diseases. However, little is known about patients’ intentions to use such technologies in resource-limited settings. Therefore, this study aimed to assess DM patients' intentions to use wearable health devices and its predictors in Ethiopia. Methods: An institutional-based cross-sectional study was conducted among 924 diabetes mellitus patients from May 19 to June 23, 2022, at referral hospitals in the Amhara regional state of Ethiopia. An interviewer-administered questionnaire was used to collect the data using the Kobo Collect app. A systematic random sampling technique was used to select the study participants. Descriptive statistics were done using SPSS version 25 software and presented using tables and pie charts. Structural equation modeling analysis with SPSS AMOS version 26 software was employed to identify predictors associated with the intention to use wearable health devices in Ethiopia. Results: A total of 883 diabetes mellitus patients, with a 95.56% response rate, participated in the study. The proportion of intention to use wearable health devices was 47.1%, 95% CI (43.7–50.5). Effort expectancy (β = 0.543, P

Abstract Background There is limited national representative evidence on determinants of women’s acceptance of wife-beating especially; community level factors are not investigated in Ethiopia. Thus, this study aimed to assess individual and community-level factors associated with acceptance of wife beating among reproductive age women in Ethiopia. Methods Secondary data analysis was done on 2016 Ethiopian Demographic and Health Survey data. A total of 15,683 weighted reproductive age group women were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by Stata version 14.0 to identify individual and community-level factors. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association. Statistical significance was declared at p value less than 0.05 at the final model. Result Individual-level factors significantly associated with acceptance of wife-beating among women were; being Muslim follower [AOR = 1.3, 95% CI = (1.1, 1.5)], Being married [AOR = 1.3, 95% CI = (1.1, 1.6)], attending primary, secondary and higher education [AOR = 0.8, 95% CI = (0.7, 0.9)], [AOR = 0.4, 95% CI = (0.3, 0.5)], [AOR = 0.3, 95% CI (0.2, 0.4)] respectively. From community level factors, living in Somali [AOR = 0.2 95% CI = (0.1, 0.3)], Addis Ababa [AOR = 0.3, 95%CI = (0.2, 0.5)] and Dire Dawa [AOR = 0.5, 95% CI = (0.3, 0.7)] were 80%, 70% and 50% less likely accept wife-beating when compare to women who live in Tigray region, respectively. Live in high proportion of poor community [AOR = 1.2, 95% CI = (1.1, 1.3)], live in low proportion of television exposure communities [AOR = 1.4, 95% CI = (1.2, 2.2)] were significantly associated with acceptance of wife-beating among women in Ethiopia. Conclusion Educational status, religion, marital status, region, community-level wealth, and community level of television exposure had a statistical association with women’s acceptance of wife-beating. Improving educational coverage, community-level of media exposure, community-level wealth status and providing community-friendly interventions are important to reduce the acceptance of wife-beating among women in Ethiopia.

Abstract In the situation of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. To date, the overall effect of antenatal care (ANC) follow up on essential newborn practice have not been estimated in East Africa. Therefore, this study aims to identify the effect of ANC follow up on essential newborn care practice in East Africa. We reported this review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched articles using PubMed, Cochrane library, African journal online (AJOL), and HINARI electronic databases as well as Google/Google scholar search engines. Heterogeneity and publication bias between studies were assessed using I2 test statistics and Egger’s significance test. Forest plots were used to present the findings. In this review, 27 studies containing 34,440 study participants were included. The pooled estimate of essential newborn care practice was 38% (95% CI 30.10–45.89) in the study area. Women who had one or more antenatal care follow up were about 3.71 times more likely practiced essential newborn care compared to women who had no ANC follow up [OR 3.71, 95% CI 2.35, 5.88]. Similarly, women who had four or more ANC follow up were 2.11 times more likely practiced essential newborn care compared to women who had less than four ANC follow up (OR 2.11, 95% CI 1.33, 3.35). Our study showed that the practice of ENBC was low in East Africa. Accordingly, those women who had more antenatal follow up were more likely practiced Essential newborn care. Thus, to improve the practice of essential newborn care more emphasis should be given on increasing antenatal care follow up of pregnant women in East Africa.

Abstract Background Worldwide, pneumonia is the third leading cause of death in under 5 years children. Ethiopia is ranked 4th out of 15 countries having the highest burdens of the death rate among under-five children due to pneumonia. Regardless of this fact, efforts to identify determinants of pneumonia have been limited yet in Amhara region. This study was aimed to identify predictors of community-acquired childhood pneumonia among 2–59 months old children in the Amhara region, Ethiopia. Methods Facility-based case–control study was conducted in the Amhara region from June 4 to July 15, 2018, among 28 health centers distributed across the region. The total sample size used was 888 (296 cases and 592 controls) children whose age were 2–59 months. At first, multistage sampling technique was employed. Data were collected on a face-to-face interview. Epi data v. 4.6 for data entry and statistical packages for social sciences version 23 for data analysis were used. Multivariable logistic regression analyses were used to test the associations between the study variables at P-value

Abstract Background An estimate of 2–3 million children under 5 die in the world annually due to vaccine-preventable disease. In Ethiopia, incomplete immunization accounts for nearly 16% of under-five mortality, and there is spatial variation for vaccination of children in Ethiopia. Spatial variation of vaccination can create hotspot of under vaccination and delay control and elimination of vaccine preventable disease. Thus, this study aims to assess the spatial distribution of incomplete immunization among children in Ethiopia from the three consecutive Ethiopia demographic and health survey data. Method A cross-sectional study was employed from Ethiopia demographic and health survey (2005, 2011and 2016) data. In total, 7901mothers who have children aged (12–35) months were included in this study. ArcGIS 10.5 Software was used for global and local statistics analysis and mapping. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of incomplete immunization. GWR version 4 Software was used to model spatial relationships. Result The proportion of incomplete immunization was 74.6% in 2005, 71.4% in 2011, and 55.1% in 2016. The spatial distribution of incomplete immunization was clustered in all the study periods (2005, 2011, and 2016) with global Moran’s I of 0.3629, 1.0700, and 0.8796 respectively. Getis-Ord analysis pointed out high-risk regions for incomplete immunization: In 2005, hot spot (high risk) regions were detected in Kefa, Gamogofa, KembataTemibaro, and Hadya zones of SNNPR region, Jimma zone of Oromiya region. Similarly, Kefa, Gamogofa, Kembatatemibaro, Dawuro, and Hadya zones of SNNPR region; Jimma and West Arsi zones of Oromiya region were hot spot regions. In 2016, Afder, Gode, Korahe, Warder Zones of Somali region were hot spot regions. Geographically weighted regression identified different significant variables; being not educated and poor wealth index were the two common for incomplete immunization in different parts of the country in all the three surveys. Conclusion Incomplete immunization was reduced overtime across the study periods. The spatial distribution of incomplete immunization was clustered and High-risk areas were identified in all the study periods. Predictors of incomplete immunization were identified in the three consecutive surveys.

BackgroundHIV risk behavior among people living with HIV/AIDS (PLWHA) is a major public health concern as it increases HIV transmission. In Ethiopia, findings regarding HIV risk behavior have been inconsistent and inconclusive. Therefore, this meta-analysis aimed to estimate the pooled prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia.MethodsInternational databases, including Google Scholar, Cochrane library, HINARI, Pub Med, CINAHL, and Global Health were systematically searched to identify articles reporting the prevalence of HIV risk behavior and associated factors among PLWHA in Ethiopia. The data were analyzed using STATA/SE version-14. The random-effects model was used to estimate the pooled effects. I-squared statistics and Egger's test were used to assess the heterogeneity and publication bias respectively.ResultsA total of 4,137 articles were reviewed and fourteen articles fulfilling the inclusion criteria were included in this meta-analysis. The pooled prevalence of HIV risk behavior in Ethiopia was 34.3%% (95% CI: 28.2, 40.3). Severe heterogeneity was observed between the included research articles (I2 = 96.6, p = 0.000). Alcohol use (OR = 1.9, 95%, CI: [1.6, 2.3]), HIV status non-disclosure (OR = 2.3, 95% CI: [1.3, 4.0]) and perceived stigma (OR = 2.3, 95% CI: [1.3, 4.1]) had a significant association with HIV risk behavior.ConclusionThe prevalence of HIV risk behavior among PLWHA in Ethiopia was high. Alcohol use, HIV status non-disclosure, and perceived stigma had a significant association with HIV risk behavior. In addition to promoting access to Antiretroviral Therapy (ART) treatment and improving medication adherence among PLWHA, various intervention programs focusing on the associated factors have to be implemented to tackle high-risk sexual behavior and go forward toward ending the HIV/AIDS pandemic.

BackgroundUnder-five mortality (U5M) is one of the most important and sensitive indicators of the health status of the community. Despite there having been a substantial reduction in U5M since 1990, its rate is still high in Sub-Saharan African countries. Thus, this study aimed to assess time to under-five mortality and its predictors in rural Ethiopia.MethodsThis study utilized a secondary analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS). A total of 9,807 weighted under-five children selected at different stages were included in the analysis. The Kaplan-Meier and Cox's-gamma shared frailty models were used to estimate survival time and to identify predictors of under-five mortality, respectively. An adjusted Hazard Ratio (AHR) along with a 95% Confidence Interval (CI) was used to measure the effect size and direction of the association.ResultsThe study indicated that 6.69% (95% CI: 6.13, 7.30) of children died before celebrating their fifth birthday in rural Ethiopia. Of all the deaths, the median time to death was 27 months. After controlling the effect of cluster and other confounding factors, female sex (AHR = 0.62, 95% CI: 0.52, 0.75), ever born greater than five children (AHR = 1.40, 95% CI: 1.07, 1.83), very large size at birth (AHR = 1.33, 95% CI: 1.03 1.71), very small size at birth (AHR = 1.41, 95% CI: 1.10, 1.82), twin pregnancy (AHR = 3.5, 95% CI: 2.47, 4.88), not ever breastfeeding (AHR = 11.29, 95% CI: 9.03, 14.12), unimproved latrine (AHR = 3.44, 95% CI: 1.91, 6.17), covered by health insurance (AHR = 0.29, 95% CI: 0.12, 0.70) were predictors of under-five mortality.ConclusionsStill under-five mortality was high in rural Ethiopia as compared to the global under-five mortality rate. In the final model, sex of a child, the total number of children ever born, children's size at birth, type of pregnancy, breastfeeding, type of toilet, and being covered by health insurance were significant predictors of under-five mortality. Further emphasis should be given to twin and not breastfeeding children, as well as households' better encouraging membership of community health insurance and utilization of improved latrines.

Background: Among currently available technologies, only the Internet has the potential to deliver universal access to up-to-date health care information. This study aimed to assess the status of Internet utilization to access health information and its associated factors among university students in Ethiopia. Methods: A facility-based cross-sectional study was conducted among 845 undergraduate students selected by Stratified multi-stage sampling from 19 randomly chosen departments of Addis Ababa University. A pretested structured interviewer-administered questionnaire was used to collect the data. The data were entered into EPI Info version 7 and exported to the SPSS version 23 for analysis. A binary logistic regression analysis was conducted to assess the association between the study and outcome variables. Result: Almost all 761 (98.8%) university students have used the Internet. Among these, the overall proportion of Internet use for health information was 59.1% (95% CI: 55.5–62.7). Respondents with good eHealth literacy (AOR = 1.656, 95% CI: (1.143, 2.397), student's field of study (AOR = 0.025, 95% CI: (0.007, 0.087), year of study (AOR = 1.609, 95% CI: (1.130, 2.290), and owning computer device (AOR = 2.314, 95% CI: (1.392, 3.844) were found to be significantly associated with utilization of Internet for health information. Conclusion: This study confirms that nearly two-thirds of undergraduate university students use the Internet to access health information. eHealth literacy, the field of study, year of study, and ownership of electronic devices were significant predictors for Internet use for accessing health information. As a result, it is recommended that university students in Ethiopia have access to electronic devices and that eHealth literacy be promoted to use the Internet as a source of health information effectively.

Background: Universal health coverage demands universal access to health information. However, in developing nations, a lack of health information continues to be a significant obstacle to evidence-based health care. As a result, the objective of this study was to determine the pooled level of health information seekers in Ethiopia and its associated factors. Methods: Studies were found using search engines in Medline, PubMed, Scopus, EMBASE, and African journal online (AJOL), HINARI, Science direct, and web-science, all following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA). The study was performed using STATA version 11 software. The index of heterogeneity (I2) was used to assess heterogeneity amongst the included papers. A visual inspection of the funnel plot and Egger's regression test were used to search for potential publication bias. The pooled effect size of each study is estimated using a random-effect model meta-analysis with a 95% confidence interval. Results: Eight out of the 197 assessed studies met the inclusion criteria and were included in the systematic review and meta-analysis. The estimated prevalence of health information seekers in Ethiopia was 50.45% (95% CI: 39.68–61.23). According to the subgroup analysis, health information seekers accounted for 52.48% in the Amhara area, 57.45% among health professionals, and 53.77% in studies conducted after 2015. Furthermore, having computer and internet access and being computer literate were significant associations with health information seeking in Ethiopia. Conclusion: The overall pooled prevalence of health information seekers in Ethiopia was relatively low. Having computer and internet access and being computer literate was a positive association with health information seeking. As a result, offering computer and internet access and a training package on basic computer skills could be recommended to raise the overall number of health information seekers in Ethiopia.

Background In Ethiopia, nearly one-third of people living with human immunodeficiency viruses do not adhere to antiretroviral therapy. Moreover, information regarding non-adherence and its associated factors among adults on first-line antiretroviral therapy in Northeast Ethiopia is limited. Therefore, this study aimed to assess the level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in North Shewa Zone, Amhara Regional State, Ethiopia. Methods A facility-based cross-sectional study was conducted on 326 participants selected by systematic random sampling technique from the five randomly selected public health facilities. Data were collected using the questionnaire adapted from the studies conducted previously and the collected data were entered into Epi data version 3.1 and exported to Stata version 14 for further analysis. Multivariable logistic regression analysis was done and an adjusted odds ratio with its corresponding 95% confidence interval was used to declare a statistical significance. Results The overall prevalence of non-adherence was 17.4% [95% CI: (12.8%, 21.2%)]. Patients with no formal education [AOR (95% CI) = 5.57 (1.97, 15.88)], those who did not use memory aids to take their medications [AOR (95% CI) = 3.01 (1.27, 7.11)], travel more than 10 kilometers to visit the nearby antiretroviral therapy clinics [AOR (95% CI) = 2.42 (1.22, 25.86)], those who used substance [AOR (95% CI) = 3.57 (1.86, 28.69)], and patients whose medication time interfered with their daily routine activities [AOR (95% CI) = 15.46 (4.41, 54.28) had higher odds of having non-adherence to first-line antiretroviral therapy compared to their counter groups. Conclusion The level of non-adherence to first-line antiretroviral therapy was 17.4%, higher compared to WHO’s recommendation. Hence, patients counseling focused on avoiding substance use, use memory aids, and adjusting working time with medication schedule are very crucial. Furthermore, the ministry of health and the regional health bureau with other stakeholders should expand antiretroviral therapy service delivery at health facilities that are close to the community to address distance barriers.

BackgroundIntestinal parasitosis is a major public health problem that affects the health of primary school children in low- and middle-income countries where water, sanitation, and hygiene (WASH) conditions are deficient. Since there is a paucity of information on the prevalence and associated factors of this problem among primary school children in Dessie City in Ethiopia, this study was designed to address these gaps.MethodsA school-based cross-sectional study was conducted among 407 stratified-sampled primary school children in five primary schools at Dessie City from April to June 2018. Data were collected using a pretested structured questionnaire, an observation checklist and laboratory analysis of stool samples. Stool specimen from each study participant was collected using clean, properly labeled and leak-proof stool cup. A portion of stool from each study participant collected sample was processed using saline wet mount technique and examined by microscope. The remaining specimens were preserved with 10% formalin and transported to Dessie Comprehensive Specialized Hospital laboratory to be processed by using formol-ether concentration technique. Then, slide smears were prepared from each processed stool specimen and finally, it was microscopically examined with 10x as well as 40x objectives for the presence or absence of intestinal parasites. Factors significantly associated with intestinal parasitosis were determined using binary logistic regression model at 95% CI (confidence interval). Thus, bivariate (COR [crude odds ratio]) and multivariable (AOR [adjusted odds ratio]) logistic regression analyses were carried out. From the multivariable analysis, variables having a p-value of less than 0.05 were declared as factors significantly associated with intestinal parasitosis among primary school children.Main findingsThe overall prevalence of intestinal parasitosis was found to be 16.0% (95% CI: 12.5-19.4%), of these, 50.8% were positive for protozoa, 32.2% for helminth infections and 16.9% for double co-infections. Entamoeba histolytica was the most prevalent parasite (29.2%), followed by Giardia lamblia (21.5%), Ascaris lumbricoides (18.5%), Hymenolepis nana (9.2%) and Enterobius vermicularis (4.6%). Prevalence rates were similar among government (16.3%) and private (15.7%) school children. Water consumption was less than 5 liters per capita per day in 4 of the 5 schools. Thirty-eight (9.3%) of primary school students reported that they practiced open defecation. About two-thirds (285, 70.0%) said they always washed their hands after defecation. Mother's education (illiterate) (AOR = 3.3; 95% CI: 1.20-9.37), father's education (illiterate) (AOR = 3.9; 95% CI: 1.40-10.82), fathers who could read and write (AOR = 3.3; 95% CI: 1.25-7.86), handwashing before meal (sometimes) (AOR = 2.2; 95% CI: 1.11-4.17) and poor knowledge of WASH (AOR = 9.3; 95% CI: 2.17-16.70) were statistically associated with presence of intestinal parasitic infections.ConclusionWe concluded that the prevalence of intestinal parasitosis in the study area among Grades 4-8 primary school children had public health significance. Factors significantly associated with intestinal parasitosis among primary school children's were illiterate mothers and fathers, irregular handwashing of children before meals, and poor knowledge of WASH. Health education to improve students' WASH knowledge and mass deworming for parasites are recommended as preventive measures; and improvements to the quality of WASH facilities in primary schools are strongly recommended to support these measures.

BackgroundMalnutrition among under-five children is a common public health problem and it is one of the main cause for the mortality of under-five children in developing countries, including Ethiopia. Therefore, lack of evidence about geographic heterogeneity and predictors of under-nutrition hinders for evidence-based decision-making process for the prevention and control programs of under-nutrition in Ethiopia. Thus, this study aimed to address this gap.MethodsThe data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2016. A total of 9,384 under-five children nested in 645 clusters were included with a stratified two-stage cluster sampling. ArcGIS version 10.5 software was used for global, local and ordinary least square analysis and mapping. The spatial autocorrelation (Global Moran's I) statistic was held in order to assess the pattern of wasting, stunting, and underweight whether it was dispersed, clustered, or randomly distributed. In addition, a Bernoulli model was used to analyze the purely spatial cluster detection of under-nutrition indicators through SaTScan version 9.6 software. Geographically weighted regression (GWR) version 4.0 software was used to model spatial relationships in the GWR analysis. Finally, a statistical decision was made at p-valueMain findingsChildhood under-nutrition showed geographical variations at zonal levels in Ethiopia. Accordingly, Somali region (Afder, Gode, Korahe, Warder Zones), Afar region (Zone 2), Tigray region (Southern Zone), and Amhara region (Waghmira Zones) for wasting, Amhara region (West Gojam, Awi, South Gondar, and Waghmira Zones) for stunting and Amhara region (South Wollo, North Wollo, Awi, South Gondar, and Waghmira zones), Afar region (Zone 2), Tigray region (Eastern Zone, North Western Zone, Central Zone, Southern Zone, and Mekele Special Zones), and Benshangul region (Metekel and Assosa Zones) for underweight were detected as hot spot (high risk) regions. In GWR analysis, had unimproved toilet facility for stunting, wasting and underweight, father had primary education for stunting and wasting, father had secondary education for stunting and underweight, mothers age 35-49 years for wasting and underweight, having female children for stunting, having children eight and above for wasting, and mother had primary education for underweight were significant predictors at (pConclusionsOur study showed that the spatial distribution of under-nutrition was clustered and high-risk areas were identified in all forms of under-nutrition indicators. Predictors of under-nutrition were identified in all forms of under-nutrition indicators. Thus, geographic-based nutritional interventions mainly mobilizing additional resources could be held to reduce the burden of childhood under-nutrition in hot spot areas. In addition, improving sanitation and hygiene practice, improving the life style of the community, and promotion of parent education in the identified hot spot zones for under-nutrition should be more emphasized.

Background. Studies conducted to date in Ethiopia did not explore the spatial distribution, individual-level, and community-level factors affecting women’s nonautonomy on decision to use contraceptives. Hence, this study aimed to assess the spatial distribution of women’s nonautonomy on decision regarding contraceptive utilization and its determinants in Ethiopia. Methods. Data were accessed from the Demographic Health Survey program official database website (https://dhsprogram.com). A weighted sample of 3,668 married reproductive-age women currently using contraceptives was included in this analysis. Bayesian multilevel logistic regression models were fitted to identify the determinants of women’s nonautonomy on contraceptive utilization. Adjusted odds ratio with 95% credible interval was used to select variables that have a significant effect on nonautonomy on contraceptive utilization. Results. A high proportion of women with nonautonomy on decision regarding contraceptive utilization was found in northern parts of Southern Nations, Nationalities, and People’s Region, Southern parts of Oromia, and Benishangul-Gumuz regions of the country. Overall, 2876 (78.40% (95% CI: 77.0%, 79.7%)) women were nonautonomous on decision regarding contraceptive utilization. In the final model, age from 35–49 (AOR (95% CI) = 0.63 (0.54, 0.72)), living in the richer households (AOR (95% CI) = 0.12 (0.03, 0.26)), being married at 18 years or above (AOR (95% CI) = 0.33 (0.19, 0.57)), and residing in an rural areas (AOR (95% CI) = 1.34 (1.01, 1.71)) and metropolitan regions (AOR (95% CI) = 0.71(0.54, 0.91)) were associated with women’s nonautonomy on decision regarding contraceptive utilization. Conclusions. In Ethiopia, the spatial distribution of women’s nonautonomy on decision about contraceptive utilization was nonrandom. More than three-fourths of married reproductive-age women in Ethiopia are nonautonomous on decision regarding contraceptive utilization. Region, residence, current age, age at marriage, and wealth index were statistically associated with women’s nonautonomy on decision regarding contraceptive utilization.