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Background: Neural tube defects (NTDs) are complex multifactorial disorders in the neurulation of the brain and spinal cord that develop in humans between 21 and 28 days of conception. Neonates with NTDs may experience morbidity and mortality, with severe social and economic consequences. Therefore, the aim of this systematic review and meta-analysis is to assess the pooled prevalence and determinants for neural tube defects among newborns in Ethiopia. Methods: The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42023407095). We systematically searched the databases PubMed, Science Direct, Cochrane Library, Google Scholar and Research Gate. Grey literature was searched on Google. Heterogeneity among studies was assessed using the I2 test statistic and the Cochran Q test statistic. A random effects model was used to estimate the birth prevalence of neural tube defects. Result: Twenty-five articles were included in the meta-analysis to estimate the prevalence and determinants of neural tube defects in Ethiopia. A total of 611,354 newborns were included in the analysis. The pooled birth prevalence of neural tube defects was 83.40 (95% CI: 60.78, 106.02) per 10,000 births. The highest and lowest prevalence rates were 130.9 (95% CI: 113.52, 148.29) in Tigray and 28.60 (95% CI: 18.70, 38.50) per 10,000 births in Amhara regional states. Women's intake of folic acid supplements and planned pregnancy were identified as protective factors for NTDs, while stillbirth history, use of any drugs during pregnancy, exposure to radiation, and pesticides during pregnancy were risk factors for neural tube defects. Conclusion: The pooled birth prevalence of neural tube defects in Ethiopia was found to be high. Effective prevention interventions, especially focusing on periconceptional folic acid supplementation as well as folate fortification, should be prioritized alongside nutrition education, maternal health care, and environmental safety measures. [ABSTRACT FROM AUTHOR]

Background: Visceral leishmaniasis (VL) is an important public health problem, which mainly affects the poor rural dwelling communities in Low- and Middle-Income Countries. However, little is known about the health and economic burdens of this disease in East Africa, including Ethiopia. The aim of this study was to assess the household level economic burden of VL among affected communities in Tigray, Northern Ethiopia. Methods: Between April and August 2020, a cross-sectional household survey was conducted on 96 patients who had been treated for VL within 12 months prior to the survey, in six districts of Tigray. Data on households' health seeking behavior, direct and indirect costs and coping strategies were collected using a structured questionnaire and the responses were analyzed using SPSS software. Results: Most (82%) of the patients surveyed were males and the majority (74%) of them were between 16 and 30 years of age. The education level of participants was very low: over 33% had not received any form of education; 48% of patients were farmers dependent on subsistence agriculture and about 32% were daily laborers. Just under half of household families (46%) resided in "poor houses" with structures made from entirely local materials. Forty-one percent of patients from the surveyed households had traveled 48 to 72 kilometers to reach VL treatment hospitals. The median total household cost for one VL episode was estimated to be US$ 214. This is equated to 18% of the mean total annual household income or 72.5% of annual per capita income of the study population. More than 80% of the households surveyed incurred catastrophic costs of VL, where this is defined as exceeding 10% of annual household income. The median delay between the onset of symptoms and arrival at a care provider hospital was 37 days; once the patient arrived at hospital, the median delay during diagnosis was 3 days. Direct and indirect costs represented 44% and 56% of the total costs incurred, respectively. To cope with VL treatment costs, 43% of the households used more than one coping strategy: 48% took out loans, 43% sold livestock and 31% of households mobilized cash savings. Conclusions: VL in Tigray is concentrated among young males with low educational background and mostly engaged in subsistence economic activities. Despite the free diagnostic and treatment provisions that were available at public hospitals at the time of the study, our work shows that the household economic burden of the disease had significant impact among VL-affected communities in Tigray. Initiating community awareness towards prevention, early treatment seeking and decentralization of VL treatment centers are strongly recommended. In addition, we recommend efforts to reduce household treatment costs through transport and food provisions for patients (and their accompanying carers where possible) or through cash reimbursement for patients who complete treatment at public hospitals, in order to reduce the barriers to seeking treatment for this life-threatening disease. Author summary: Visceral leishmaniasis (VL) is a vector-born parasitic disease which predominantly affect poor communities in isolated regions and is closely linked with extreme poverty. VL is life-threatening when left untreated and has important socio-economic impacts. In this study we examined the economic burden of VL among households in Tigray, northern Ethiopia. Our findings indicate that the economic burden of VL as a percent of household income is extremely expensive, with a large proportion representing catastrophic health costs. The economic impact of VL is not only limited to high cost of treatment, but also time lost during treatment-seeking periods and hospital stays. VL diagnostics and drugs are being provided free of charge to patients treated at public hospitals, an important policy measure in Ethiopia. Nevertheless, the economic impact of the disease is still very challenging to households. Therefore, VL transmission needs to be blocked by implementing efficient prevention strategies, mainly through outreach case-detections and community awareness campaigns to alleviate the economic burden of households from VL endemic communities. In the absence of effective prevention, the other feasible way is through decentralization of VL care centers to enable patients get care services nearby without spending much time and transportation costs. [ABSTRACT FROM AUTHOR]

Background: The Tigray region of Ethiopia, which has been affected by civil war from 2020 to 2022, is facing an increase in tuberculosis in the damaged health system. Our study employed mathematical modeling to predict the incidence of tuberculosis and its trends during the war and in the post-conflict setting of Tigray, Northern Ethiopia. Methods: We predicted the incidence of tuberculosis from 2020 to 2025 in Tigray using the SEIRD model in the context of the recent war and compared it with its counterfactual trend in the absence of war. The counterfactual trend was forecasted using an autoregressive integrated moving average (ARIMA) model for stationary time-series data. We performed rolling origin cross-validation for ARIMA and sensitivity analysis for the SEIRD model. The initial tuberculosis data and model parameters were obtained from the Institute for Health Metrics and Evaluation and the literature, respectively. Results: Between 2000 and 2017, the incidence of tuberculosis in Tigray decreased at an annual rate of 3.0%. Shortly before the war, the incidence of tuberculosis in the region was 178 per 100,000 people. In a counterfactual scenario where there was no war, the incidence was projected to decrease to 144.3 in 2022 and 126.3 in 2025. However, owing to the war and siege, the SEIRD-projected incidence of tuberculosis would have increased to 965.5 (95% CI: 958.5– 972.7) in 2022 and 372.4 (95% CI: 367.7– 376.6) in 2025. Over 800 cases of tuberculosis per 100,000 people were attributed to the war in 2022. In the postwar period, the incidence is projected to decrease by 30% by 2023. Conclusion: The Tigray War reversed a two-decade decline in tuberculosis cases, causing a five-fold increase compared to the no-war scenario. Urgent interventions are needed to support tuberculosis prevention, testing, and treatment, particularly in key and vulnerable populations. [ABSTRACT FROM AUTHOR]

Objective: This study seeks to examine the impact of war on maternal mortality following an exacerbation in the dynamics of inequality in maternal health caused by the continuing conflict. Design: Community‐based cross‐sectional study. Setting: Tigray region of Northern Ethiopia, between November 2020 and May 2022. Population: This study surveyed a total of 189 087 households from six of the seven zones of Tigray in 121 tabiyas from 31 districts selected. A multistage cluster sampling technique was used to select the districts and tabiyas. Methods: The study was conducted in two phases. In the first phase, reproductive‐age deaths that occurred during the study period were screened. In the second phase, verbal autopsies were conducted at the screened households. Main Outcome Measures: Maternal mortality ratio level and cause‐specific mortality. Results: The results of the study showed that the maternal mortality ratio was 840 (95% CI 739–914) per 100 000 live births. Haemorrhage, 107 (42.8%), pregnancy‐induced hypertension, 21 (8.4%), and accidents, 14 (5.6%), were the main causes of mortality. Additionally, 203 (81.2%) of the mothers died outside of a health facility. Conclusions: This study has shown a higher maternal mortality ratio following the dynamics of the Tigray war, as compared with the pre‐war level of 186/100 000. Furthermore, potentially many of the pregnancy‐related deaths could have been prevented with access to preventive and emergency services. Given the destruction and looting of many facilities, the restoration and improvement of the Tigray health system must take precedence. [ABSTRACT FROM AUTHOR]