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Background : Mixed milk feeding is defined as providing formula and/or animal milk along with breast milk to infants under six months old which is prevalent in many countries. However, this practice is generally not recommended as it can reduce the intake of breast milk, depriving the infant of its optimal nutritional and immunological benefits. Unlike formula, breast milk contains complex bioactive constituents that promote intestinal and pancreatic growth and develop mucosal defenses. The aim of this study was to analyze the spatial distribution and predictors of MMF practices in Ethiopia. Methods : This study utilized data from the 2019 Mini-Ethiopian Demographic and Health Survey (MiniEDHS), a nationally representative cross-sectional survey conducted from March to June 2019. The total weighted sample size derived from the data examined in this study amounted to 524 infants. The data analysis used Global Moran's I for spatial autocorrelation and the Getis-Ord Gi * statistic for local cluster analysis to assess the spatial distribution of mixed milk feeding prevalence across Ethiopia's administrative regions and cities. Empirical Bayesian Kriging was used for spatial interpolation to estimate mixed milk feeding prevalence in unsampled areas. The analysis utilized a maximum spatial cluster size threshold of 50% of the population to detect clusters of varying sizes. Ordinary least squares regression analysis identified significant spatial predictors. In geographically weighted regression analysis, the effect of predictor variables on the spatial variation of mixed milk feeding was detected using local coefficients. Results : The overall weighted prevalence of Mixed Milk Feeding (MMF) in Ethiopia was 10.12% (95% CI: 7.8, 13.01). This prevalence shows significant regional variations across the country emphasizing regional disparities in prevalence and distribution. The Global Moran's I statistic was 0.14, with a Z-score of 3.18 and a p-value of < 0.001, indicating a significant spatial clustering of MMF prevalence. Hotspots of mixed milk feeding were identified in Somali, Dire Dawa, and Afar, while cold spots were observed in Amhara, Tigray, Benishangul Gumuz, SNNPR, and parts of Oromia. Household wealth (middle wealth index) and lack of baby postnatal checkups emerged as key influencers of mixed milk feeding practices. Conclusion : The study found significant regional variations in mixed milk feeding practices in Ethiopia. Households with middle wealth index and baby without postnatal check were significant spatial predictors of mixed milk feeding. To reduce mixed milk feeding prevalence, targeted interventions should engage community leaders, enhance breastfeeding education in maternal health services, and integrate counseling into routine healthcare to support informed maternal choices and improve child health outcomes nationwide. [ABSTRACT FROM AUTHOR]

Background: Even if the ideal rate for caesarean section (CS) is considered 10–15%, worldwide CS rates have been steadily increasing, without significant additional benefit to women's health. Its overuse was associated with maternal and fetal complications. Therefore, this study aimed to determine the rate of CS delivery and associated factors among women delivered in health facilities in Ghana. Methods: A cross-sectional study was conducted using the 2022 DHS datasets from Ghana. A total of 5231 weighted samples were included. STATA.16 was used for analysis. A multilevel logistic regression was applied. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors. Result: The prevalence of CS in Ghana was 20.29% [95% CI = 19.23–21.41%]. Age 25-34 [AOR = 1.32, CI: 1.04, 1.68] and 35 + [AOR = 1.57, CI: 1.16, 2.11], primary [AOR = 1.58, CI: 1.21, 2.07], secondary [AOR = 1.36, CI: 1.07, 1.73], and higher [AOR = 2.24, CI: 1.58, 3.17] education, richer [AOR = 1.45, CI: 1.06, 1.99] and richest [AOR = 2.35, CI: 1.63, 3.39] wealth index, employment [AOR = 0.77, CI: 0.64, 0.92], primiparous [AOR = 1.33, CI: 1.07, 1.67], giving first birth after the age of 35 [AOR = 4.58, CI: 1.88, 11.19], multiple pregnancy [AOR = 5.53, CI: 4.02, 7.62], large birth size [AOR = 1.25, CI: 1.06, 1.48], 4–6 kg birth weight [AOR = 2.13, CI: 1.55, 2.92], as well as residing in Volta [AOR = 1.98, 95% CI: 1.22, 3.22] and Bono East [AOR = 2.02, 95% CI: 1.28, 3.19] regions were significant factors associated with CS delivery in Ghana. Conclusion: The rate of CS was higher than previous studies in Ghana and the WHO recommended level, making it a public health concern. Age, education, wealth, employment, parity, age at first birth, pregnancy type, birth size, birth weight, and region were significantly associated with CS. Therefore, strategies aimed at examining guidelines for proper indications and uses of CS may lead to an improvement CS rate. [ABSTRACT FROM AUTHOR]

Background: Breast cancer poses a significant health burden in Ghana and globally, being the primary cause of cancer-related illness and death among women. The World Health Organization has identified clinical breast examination as the gold standard for women in low and middle-income countries. However, the uptake of clinical breast examination remains low in these settings, including Ghana, where the nationwide prevalence and associated factors of this practice have not been determined. Therefore, this study aimed to assess the prevalence and factors associated with clinical breast examination among women of reproductive age in Ghana, using data from 2022 Ghanaian Demographic and Health Survey. Methods: In this study, data from the most recent Ghanaian Demographic Health Survey conducted in 2022 were utilized. The survey used a two-stage stratified sampling technique, and a weighted sample of 15,013 participants was included in the analysis. Descriptive statistics, such as frequencies, percentages, and graphical representations, were utilized to present the study's findings. Multilevel mixed-effects logistic regression analysis was employed to identify factors associated with clinical breast examination. Results: The study found that the prevalence of clinical breast examination was 18.39% (95% CI: 17.8-19.0%). Age group of 45 to 49 (AOR=2.84, 95% CI: 2.13, 3.78), having completed secondary education (AOR=1.70, 95% CI: 1.41, 2.06), having diploma or above education (AOR=3.63, 95% CI: 2.86, 4.61), using modern contraception (AOR=1.12, 95% CI: 1.00, 1.25), having health insurance coverage (AOR=1.53, 95% CI: 1.24, 1.89), listening to the radio at least once per week (AOR=1.35, 95% CI: 1.20, 1.53), reading a newspaper at least once per week (AOR=1.75, 95% CI: 1.39, 2.21), being tested for HIV (AOR=1.92, 95% CI: 1.68, 2.19), undergoing screening for cervical cancer (AOR=6.64, 95% CI: 5.51, 7.99), being currently employed (AOR=1.17, 95% CI: 1.02, 1.34), visiting a health facility within the past 12 months (AOR=1.36, 95% CI: 1.23, 1.51), belonging to the wealthiest wealth categories (AOR=1.70, 95% CI: 1.27, 2.28), being from the North East region (AOR=1.96, 95% CI: 1.19, 3.22) or Oti region (AOR=0.54, 95% CI: 0.34, 0.92), having a greater distance to a health facility (AOR=0.86, 95% CI: 0.75, 0.98), and being from a community with a higher proportion of educated individuals (AOR=1.31, 95% CI: 1.07, 1.61) were significant associated factors of clinical breast examination. Conclusions and recommendations: The study revealed that the magnitude of clinical breast examination among Ghanaian women was low. Age, educational status, modern contraceptives utilization, health insurance coverage, media exposure, HIV testing, cervical cancer screening, occupation, health facility visits, wealth index, and region were significantly associated with clinical breast examination. These findings suggest that public health interventions should prioritize addressing these factors to increase clinical breast examination uptake and promote early detection of breast cancer to improve the survival of women with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Measles is a very contagious illness that can be clinically diagnosed and intervened quickly. It is caused by the measles virus Morbillivirus. The disease has a case fatality rate of 5% to 10% in the sub-Saharan region. Recent information on measles forecasting is limited in this study area. Therefore, this study was aimed to assess the five-year trend and next five-year prediction of measles disease in East Gojjam zone, Amhara National Regional State (ANRS), Ethiopia, 2023. Methods: A descriptive study using case based surveillance data analysis in the East Gojjam zone was conducted. Five-year data (January 1/2018-December 30/2022) was extracted from the WHO database. ARIMA (3, 1, 1) model was used for disease forecasting for the next 5 years of the zone (2023–2027). Results: For the study, 1003 participants in total were enlisted. 12.3% of the subjects were IgM positive. About 59.4% and 1.2% were epidemiologically linked and died subjects, respectively. Many of the cases (54.2%) occurred in the March season and the lowest (1%) in December. For the next five years (2024–2027), it is predicted that the number of cases will rise gradually in fluctuation. Conclusion: The disease had an upward trend over the five-year period, and for the next consecutive years, there will be a consistent increase in the number of cases in the zone. It is recommended that the East Gojjam Zone Health Office and different stakeholders have to monitor and evaluate the vaccination status of target children and vaccination coverage and strengthen the surveillance system in the dry-hot season, which is valuable for disease control. [ABSTRACT FROM AUTHOR]

Background: The implementation of DHIS2 in healthcare systems has transformed data management practices worldwide. However, its specific impact on data quality, availability, and performance in Primary Health Unit (PHU) facilities in Ethiopia remains underexplored. Therefore, we investigated the contribution of DHIS2 to enhancing data quality, availability, and performance within PHU facilities in Ethiopia. Methods: We employed qualitative methods, specifically Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs), to gather insights from stakeholders, including healthcare providers and administrators at PHCUs across Ethiopia. Convenience sampling was used for FGDs, while purposive sampling targeted key informants with relevant expertise. Data were systematically analysed thematically, identifying patterns and themes related to DHIS2's impact on data management within PHUs. This approach offered a comprehensive understanding of the system's effectiveness and the factors influencing its implementation, highlighting both successes and challenges in integrating DHIS2 into healthcare practices. Findings: Participants from various regions reported significant enhancements in the timeliness, completeness, accuracy, and accessibility of health data following the implementation of DHIS2. While some concerns were raised regarding variations in reporting intervals, the consensus indicated marked improvements in data management processes. DHIS2 standardized data collection methods, enabling healthcare providers to input and access data in real-time. This advancement fostered greater accountability and transparency within the healthcare system. Additionally, unexpected benefits arose, including increased digital literacy among staff, equipping them with necessary skills for effective data management, and the creation of job opportunities, particularly for youth. Ultimately, DHIS2 emerged as a pivotal tool for enhancing data quality and promoting health service equity across Ethiopia. Conclusion: DHIS2 has significantly improved data quality and accessibility in Ethiopia, enhancing healthcare management and accountability across facilities. Healthcare providers should continue to leverage its robust features and prioritize ongoing staff training to improve digital literacy and data management skills. Establishing consistent reporting practices and regular audits will further maintain data integrity and foster a culture of accountability within the healthcare system. [ABSTRACT FROM AUTHOR]

Introduction: Growth monitoring and promotion services are strategies to promote child health and reduce child mortality. Even though Ethiopia is attempting different strategies to cope with the low rate of GMP utilization, the problem is still unresolved. Objective: Determine the pooled proportion of GMP utilization and its contributing factors among children less than two years in Ethiopia. Method: The review protocol was registered with PROSPERO, number CRD42023472746. The PRISMA-2020 statement guided the conduct of this review. Electronic databases and grey literature were used. Heterogeneity was evaluated using I2. Subgroup analysis was conducted. The random effect model was used to summarize the pooled effect sizes with their respective 95% CI with STATA version 17. To test the small study effect, the funnel plot and Egger's test were applied. Result: A total of seven (7) studies with 4027 participants were considered in this meta-analysis. The pooled proportion of GMP utilization reported by seven studies was 25.71% (95%CI: 24.39, 27.04). ANC follow-up (AOR = 2.11; 95% CI: 1.47, 2.76), PNC follow-up (AOR = 1.96; 95% CI: 1.44, 2.49), counseling (AOR = 2.88; 95% CI: 2.09, 3.68), maternal education (AOR = 2.89; 95% CI: 1.66, 4.13), paternal education (AOR = 3.78; 95% CI: 2.25, 5.32), family health card (AOR = 2.31; 95% CI: 1.67, 2.96), and mothers good knowledge towards GMP (AOR = 2.90; 95% CI: 1.72, 4.07) variables were positively associated with GMP service utilization. Conclusion and recommendation: The pooled proportion of GMP remains low in Ethiopia. ANC and PNC follow-up, counseling, maternal and paternal education, family health cards, maternal knowledge towards GMP were significantly associated. Findings are essential for evidence-based policy making, intervention, and input for ongoing research. [ABSTRACT FROM AUTHOR]

Introduction: Ethiopia is one of the countries where persistently high neonatal and maternal mortalities are reported. Preterm prelabor rupture of membrane (PPROM) plays an important contribution to these high mortalities. However, there is a paucity of comprehensive evidence about the epidemiology of PPROM in Ethiopia. Therefore, this systematic review was conducted to assess the pooled prevalence and determinants of PPROM among pregnant women in Ethiopia. Methods: A systematic review and meta-analysis were conducted following the PRISMA guideline. Relevant literatures were searched on African Journals Online (AJOL), PubMed, Scopus, Epistemonikos, CINAHL, Cochrane Library and gray literature. All statistical analyses were performed using STATA 17 software. The random effect meta-analysis model was employed to summarize the pooled estimates. Heterogeneity between included studies was evaluated using I2 statistic. Egger's regression test and Begg's correlation test were employed to assess publication bias, in conjunction with funnel plot. Besides, the non-parametric trim-and-fill analysis, sensitivity analysis, subgroup analysis and meta-regression were also performed. Results: A total of 13 original studies with 24,386 participants were considered in this systematic review. The pooled prevalence of PPROM was 6.58% (95% CI: 5.36, 7.79). Urinary tract infection (OR: 3.44; 95% CI: 1.81, 6.53), abnormal vaginal discharge (OR: 4.78; 95% CI: 2.85, 8.01), vaginal bleeding (OR: 2.04; 95% CI: 1.03, 4.06), history of PROM (OR: 4.64; 95% CI: 2.71, 7.95), history of abortion (OR: 3.06; 95% CI: 1.71, 5.46), malnutrition (OR: 5.24; 95% CI: 2.63, 10.44), anemia (OR: 3.97; 95% CI: 2.01, 7.85) and gestational diabetes (OR: 5.08; 95% CI: 1.93, 13.36) were significantly associated with PPROM. Conclusion: This meta-analysis found a high prevalence of PPROM in Ethiopia. Urinary tract infection, abnormal vaginal discharge, vaginal bleeding, history of PROM, history of abortion, malnutrition, anemia and gestational diabetes were risk factors for PPROM. Prevention and control of antenatal infections and malnutrition are highly recommended to reduce the magnitude of PPROM in Ethiopia. Additionally, healthcare providers should emphasize the identified risk factors. Protocol registration number: CRD42024536647. [ABSTRACT FROM AUTHOR]

Background: One of the reasons for the high rates of maternal and child morbidity and mortality in Sub-Saharan Africa is the rising proportion of teenage pregnancy. Preventing teenage pregnancy is critical to meeting sustainable development goal number three which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. To support the achievement of this goal, this study aimed to assess the spatial variation and factors associated with teenage pregnancy in Ethiopia using the recent nationally representative data. Methods: A secondary data analysis of the 2019 Ethiopian mini Demographic and Health Survey was conducted with a total weighted sample of 2211 (unweighted 2100) teenagers. The Bernoulli model was fitted using SaTScan version 9.6 to identify hotspot areas and the geospatial pattern and prediction of teenage pregnancy were mapped using ArcGIS version 10.7. A multilevel logistic regression model was fitted to identify factors associated with teenage pregnancy among teenagers. Adjusted OR with 95% CI was calculated and variables having a p-value less than 0.05 were statistically significant factors of teenage pregnancy. Result: The prevalence of teenage pregnancy among adolescents aged 15–19 years in Ethiopia was 12.89% (95% CI: 11.56%, 14.36%). The SaTScan analysis identified a primary cluster in the Gambella region of Ethiopia (log-likelihood ratio = 14.02, p < 0.001). A high prevalence of teenage pregnancy was observed in Somalia, Afar, Gambella, and the southern part of the Oromia regions of Ethiopia. Age, educational status- primary and secondary, religion- protestant, having television, contraceptive knowledge, household head-female, and region- Small peripheral were significant determinants of teenage pregnancy. Conclusion: The spatial distribution of teenage pregnancy in Ethiopia was nonrandom. Age, educational status, religion, having television, contraceptive knowledge, sex of household head, and region were significant determinants of teenage pregnancy. Therefore, concerned government bodies and other stakeholders should organize periodic educational campaigns and youth-friendly reproductive health services. Collaboration between healthcare professionals, and religious and community leaders could also form a strategic partnership that makes interventions more comprehensive, culturally sensitive, and effective in reducing teenage pregnancy. [ABSTRACT FROM AUTHOR]

Background: While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia. Methods: A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value < 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised. Results: In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran's I = 0.138, p-value <0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors. Conclusion: The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women's knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia. [ABSTRACT FROM AUTHOR]

Introduction: Blood pressure assessment is an essential strategy for early detection and treatment of hypertension and hypotension. Hypertensive disorders of pregnancy (HDP) are major public health problems resulting in a significant burden of perinatal and maternal morbidity and mortality. In Ethiopia, among pregnancies complicated by HDP, 25% end up with perinatal death. Perinatal and maternal mortality related to HDP were found to be higher in Ethiopia compared to high-income and most of the low- and middle-income countries. Despite its importance, there is limited evidence on blood pressure assessment during pregnancy. Therefore, this study aimed to determine the prevalence of blood pressure assessment during pregnancy and its associated factors in Ethiopia. Methods: This study was based on the 2019 Mini Ethiopian Demographic and Health Survey data. A total weighted sample of 2923 women who had a live birth five years before the survey were included and Stata version 16 software was used for statistical analysis. To identify associated factors, a multilevel robust Poisson regression model was fitted since the prevalence of blood pressure assessment was higher than 10%. Variables with p-value < 0.2 in the bi-variable analysis were exported to the multivariable analysis. In the multivariable analysis, the adjusted prevalence ratio with its 95% confidence interval was used to declare a statistically significant association. Results: In Ethiopia, the prevalence of blood pressure assessment during pregnancy was 88.1% (95% CI: 86.9%, 89.2%). In the multivariable multilevel robust Poisson analysis, primary education and secondary education, grand-multiparity, initiation of antenatal care before three months and 3–6 months, four and above antenatal care visits, being counselled by a health professional, being from richer and richest households, residing in Afar and Amhara regions were significantly associated with BP assessment during pregnancy in Ethiopia. Conclusion and recommendations: To reduce the high burden of mortality related to hypertensive disorders of pregnancy in the country, blood pressure assessment should be improved. Therefore, policymakers should design interventions that empower women in terms of education and economy, promoting early initiation of antenatal care visits and prenatal counselling could improve blood pressure assessment. [ABSTRACT FROM AUTHOR]

Background: Despite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections. Methods: A cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors. Result: The overall prevalence of anemia was found to be 45.1% [95% CI: 43.97–46.18%]. Of those 5.05%, 37.97%, and 56.97% were severely, moderately, and mildly anemic, respectively. Education level of primary [AOR = 0.74, 95% CI: 0.62, 0.89], secondary [AOR = 0.81, 95% CI: 0.68, 0.98], and higher [AOR = 0.74, 95% CI: 0.55, 0.99], as well as current contraceptive use [AOR = 0.74, 95% CI: 0.63, 0.87] were negatively associated with anemia. While pregnancy [AOR = 1.51, 95% CI: 1.17, 1.94], breast feeding [AOR = 1.38, 95% CI: 1.17, 1.64], health insurance [AOR = 1.50, 95% CI: 1.25, 1.80], and menstruation within six weeks prior to data collection [AOR = 1.36, 95% CI: 1.20, 1.54] had a significant positive relation with anemia among HIV-infected women in SSA countries. Conclusion: Anemia is a serious public health problem among HIV-infected women in SSA countries. Pregnancy, breast feeding, health insurance, and menstruation within six weeks prior to data collection were significant risk factors. On the other education and current contraceptive use were significant protective factors for anemia among HIV-infected women in SSA countries. Therefore, strategies aimed at early identification of anemia may lead to an improvement in the health of HIV-infected women. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia. Methods: Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237. Results: The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis. Conclusion: Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages. [ABSTRACT FROM AUTHOR]

Introduction: More than two-third of global child death is occurred due to inappropriate feeding practice that happened during early childhood period. Evidence on meal frequency status among infant and young children at national level can be used to design appropriate interventions to improve the recommended feeding frequency. Therefore, this study was aimed to explore the spatial distribution and identify associated factors of inadequate meal frequency among children aged 6–23 months in Ethiopia. Methods: Secondary data analysis was conducted using the 2019 mini Ethiopian Demographic and Health Survey data. A total weighted sample of 1,532 children aged 6–23 months were included. To identify significant factors associated with of inadequate meal frequency, multilevel binary logistic regression model was fitted. Variables with p-value < 0.25 from the bi-variable model were exported to multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significantly associated factors and adjusted odds ratio (AOR) with its 95% confidence interval were reported. Multilevel models were compared using deviance and log-likelihood. Spatial analysis tools were utilized to visualize the distribution of inadequate meal frequency. Bernoulli model was fitted using SaTScan V.9.6 to identify most likely clusters and ArcGIS V.10.8 was used to map the hotspot areas. Ordinary least square and geographic weighted regression models were used and compared using information criteria and adjusted-R2. Local coefficients of factors associated with hotspots of inadequate meal frequency were mapped. Results: The prevalence of inadequate meal frequency was 47.03% (95% CI: 44.54%, 49.53%) in Ethiopia. Age of the child, sex of the household head, timely initiation of breastfeeding, current breastfeeding status, number of antenatal care visit, maternal education, and region were significantly associated with inadequate meal frequency. The spatial distribution of inadequate meal frequency was showed significant variation across Ethiopia (Global Moran's I = 0.164, p-value <0.001). A total of 38 significant clusters were detected through SaTScan analysis, from these the 22 primary clusters were located in Somali and Harari. Conclusion and recommendation: The prevalence of inadequate meal frequency was high in Ethiopia and had significant clustering patter. Significant hotspot clusters were located in Somali, northern Afar, Harari, Amhara, Gambela, and eastern South nation nationalities and peoples' region. Therefore, public health interventions which enhance breastfeeding practice, optimal number of antenatal care visits, educational empowerments should target hotspot areas to decrease inadequate meal frequency practice. [ABSTRACT FROM AUTHOR]

Background: For young adults and adolescents, excessive internet use has become a serious public health concern due to its negative impact on their health. It has been associated with detrimental effects on both physical and mental health. Negative academic outcomes were observed in the students, including missing classes, lower grades, and academic dismissal. Therefore, the purpose of the current study was to identify factors associated with PIU among undergraduate students at the University of Gondar. Method: A cross-sectional study was conducted at the University of Gondar among 1514 undergraduate students from June 1–20, 2022. The study participants were selected using a stratified simple random selection procedure. Using structural equation modeling, the degree of relationship was ascertained. A p-value of less than 0.05 and an adjusted regression coefficient with a 95% confidence interval (CI) were used to interpret the data. Results: In our study, being from non-health departments [β = 0.11, 95% CI: 0.037, 0.181], current alcohol use [β = 0.12, 95% CI: 0.061, 0.187], depressive symptoms [β = 0.23, 95% CI: 0.175, 0.291], insomnia symptoms [β = 0.12, 95% CI: 0.060, 0.196], and ADHD symptoms [β = 0.11, 95% CI: 0.049, 0.166] had a significant positive effect on PIU, while having a history of head injury had a significant negative effect [β = -0.12, 95% CI: -0.226, -0.021] on PIU. Conclusion and recommendation: Factors such as current alcohol use, non-health department type, depressive symptoms, insomnia, and ADHD symptoms were positively associated with PIU. However, a history of head injuries was negatively associated with PIU. Therefore, strategies aimed at the early identification of PIU may lead to an improvement in the psychosocial health of university students. [ABSTRACT FROM AUTHOR]

Introduction: Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. Methods: This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p-value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. Results: The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60–0.87)) were significantly associated with cervical cancer screening. Conclusion: In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya. [ABSTRACT FROM AUTHOR]

Introduction: Anxiety and depression are among the common comorbidities of people diagnosed with cancer. However, despite the progress in therapeutic options and outcomes, mental health care and support have lagged behind for cancer patients. Estimating the extent and determinants of mental health disorders among cancer patients is crucial to alert concerned bodies for action. In view of this, we aimed to determine the pooled prevalence and determinants of anxiety and depression among cancer patients in Ethiopia. Methods: Relevant literatures were searched on PubMed, African Journals Online, Hinari, Epistemonikos, Scopus, EMBASE, CINAHL, Cochrane Library, and Gray literature sources. Data were extracted into an Excel spreadsheet and analyzed using STATA 17 statistical software. The random effect model was used to summarize the pooled effect sizes with their respective 95% confidence intervals. The I² statistics and Egger's regression test in conjunction with the funnel plot were utilized to evaluate heterogeneity and publication bias among included studies respectively. Results: A total of 17 studies with 5,592 participants were considered in this review. The pooled prevalence of anxiety and depression among cancer patients in Ethiopia were 45.10% (95% CI: 36.74, 53.45) and 42.96% (95% CI: 34.98, 50.93), respectively. Primary and above education (OR= 0.76, 95% CI: 0.60, 0.97), poor social support (OR= 2.27, 95% CI: 1.29, 3.98), occupational status (OR= 0.59; 95% CI: 0.43, 0.82), advanced cancer stage (OR= 2.19, 95% CI: 1.38, 3.47), comorbid illness (OR= 1.67; 95% CI: 1.09, 2.58) and poor sleep quality (OR= 11.34, 95% CI: 6.47, 19.89) were significantly associated with depression. Whereas, advanced cancer stage (OR= 1.59, 95% CI: 1.15, 2.20) and poor sleep quality (OR= 12.56, 95% CI: 6.4 1, 24.62) were the factors associated with anxiety. Conclusion: This meta-analysis indicated that a substantial proportion of cancer patients suffer from anxiety and depression in Ethiopia. Educational status, occupational status, social support, cancer stage, comorbid illness and sleep quality were significantly associated with depression. Whereas, anxiety was predicted by cancer stage and sleep quality. Thus, the provision of comprehensive mental health support as a constituent of chronic cancer care is crucial to mitigate the impact and occurrence of anxiety and depression among cancer patients. Besides, families and the community should strengthen social support for cancer patients. [ABSTRACT FROM AUTHOR]

Traditional grazing management practices are central to rangeland productivity and biodiversity. However, the degradation of rangelands and loss of ecosystem services have raised concerns about the future of pastoralism as a form of land use. It is imperative to understand how these practices influence vegetation attributes, e.g., herbaceous species diversity and composition, growth forms (grass, forbs), life form (annuals, perennials), tree metrics (density, canopy cover, and biomass). This study evaluates vegetation shifts under three grazing management practices‐enclosures, open grazing, and browsing lands‐in the Somali pastoral ecosystem of Ethiopia. Enclosures exhibited the highest diversity in herbaceous species, with open grazing lands favoring forbs and annuals. Distinct compositional shifts in herbaceous species were observed across regimes, especially in grass and annuals. Enclosures had three times higher herbage biomass of open grazing and double that of browsing management practice. Conversely, browsing management practices presented optimal wood biomass, density, and canopy cover. The results highlight that a transition to combined enclosure and browsing practices can elevate plant production and diversity, benefiting the Somali rangeland economy. Consequently, dryland restoration should incorporate indigenous knowledge to ensure future rangeland sustainability and biodiversity preservation. [ABSTRACT FROM AUTHOR]

Background: Africa is the most severely affected area, accounting for more than two-thirds of the people living with HIV. In sub-Saharan Africa, more than 85% of new HIV-infected adolescents and 63% of all new HIV infections are accounted for by women. Ethiopia has achieved a 50% incidence rate reduction. However, mortality rate reduction is slow, as the estimated prevalence in 2021 is 0.8%. In sub-Saharan Africa, heterosexual transmission accounts for the majority of HIV infections, and women account for 58% of people living with HIV. Most of these transmissions took place during marriage. Thus, this study aimed to explore the spatial variation of premarital HIV testing across regions of Ethiopia and identify associated factors. Methods: A cross-sectional study design was employed. A total of 10223 weighted samples were taken from individual datasets of the 2016 Ethiopian Demographic and Health Survey. STATA version 14 and ArcGIS version 10.8 software's were used for analysis. A multilevel mixed-effect generalized linear model was fitted, and an adjusted prevalence Ratio with a 95% CI and p-value < 0.05 was used to declare significantly associated factors. Multilevel models were compared using information criteria and log-likelihood. Descriptive and spatial regression analyses (geographical weighted regression and ordinary least squares analysis) were conducted. Models were compared using AICc and adjusted R-squared. The local coefficients of spatial explanatory variables were mapped. Results: In spatial regression analysis, secondary and above education level, richer and above wealth quintile, household media exposure, big problem of distance to health facility, having high risky sexual behaviour and knowing the place of HIV testing were significant explanatory variables for spatial variation of premarital HIV testing among married women. While in the multilevel analysis, age, education level, religion, household media exposure, wealth index, khat chewing, previous history of HIV testing,age at first sex, HIV related knowledge, HIV related stigma, distance to health facility, and community level media exposure were associated with premarital HIV testing among married women. Conclusions and recommendation: Premarital HIV testing had a significant spatial variation across regions of Ethiopia. A statistically significant clustering of premarital HIV testing was observed at Addis Ababa, Dire Dawa, North Tigray and some parts of Afar and Amhara regions. Therefore area based prevention and interventional strategies are required at cold spot areas to halt the role of heterosexual transmission in HIV burden. Moreover, the considering the spatial explanatory variables effect in implementations of these strategies rather than random provision of service would make regional health care delivery systems more cost-effective. [ABSTRACT FROM AUTHOR]

Background: Up to 80% of adults with attention deficit hyperactivity disorder (ADHD) may have a concomitant psychiatric disorder. ADHD and depression, combined with the demands of University life, can pose serious challenges for students. However, there are limited studies conducted on this topic in our country. Therefore, the current study assessed the magnitude, relationship, and determinants of ADHD and depressive symptoms among students at the University of Gondar. Method: An institution-based cross-sectional study was employed among 1514 undergraduate students at the University of Gondar from June 1–20, 2022. A stratified, simple random sampling technique was applied. Structural equation modeling was employed. The degree of relationship was interpreted based on the adjusted regression coefficient with 95% confidence interval (CI) and p-value (<0.05). Result: In our study, 37.6% [CI: 35.2–40.1%] and 20.01% [CI: 18.1–22.1%] of the participants had depressive and ADHD symptoms, respectively. Chronic illness [β = 0.19, CI; 0.09, 0.30], alcohol use [β = 0.10, CI; 0.03, 0.17], social support [β = -0.23, CI; -0.29, -0.17], problematic internet use (PIU) [β = 0.23, CI; 0.18, 0.27], and insomnia [β = 0.24, CI; 0.17, 0.30] had a direct relationship with depressive symptoms. Mother education level [β = -0.09, CI; -0.13, -0.06], birth order [β = -0.09, CI; -0.11, -0.07], chat chewing [β = 0.18, CI; 0.06, 0.30], and depressive symptoms [β = 0.73, CI; 0.62, 0.86] had a direct relationship with ADHD. Chronic illness [β = 0.14, CI; 0.06, 0.22], PIU [β = 0.16, CI; 0.13, 0.21], social support [β = -0.16, CI; -0.22, -0.12], and insomnia [β = 0.17, CI; 0.13, 0.23] had an indirect effect on ADHD. Conclusion and recommendation: The prevalence of ADHD and depressive symptoms was high. Chronic disease, alcohol use, social support, PIU, and insomnia had a direct effect on depressive symptoms and an indirect effect on ADHD. Mother education, birth order, chat chewing, and depressive symptoms had a direct effect on ADHD. Our study provided useful clues for clinical treatment and school-based interventions that aim to improve college students' mental well-being. It is better to design school-based intervention and prevention programs to achieve timely diagnosis and treatment of these disorders among university students. [ABSTRACT FROM AUTHOR]

The epidemiology of fungal infections in Eritrea is unknown. Most cases are under‐reported due to a lack of diagnostics. This study estimates the burden of serious fungal infections and highlights treatment and diagnostic gaps in the country. All publications related to fungal infections were identified by searches using PubMed/Medline and Google Scholar. Where no data were available, data from neighbouring countries, then sub‐Saharan African countries, then other parts of the world were considered for deriving estimates. The Eritrea population was 3,546,427 in 2020. In 2020, HIV/AIDS patients numbered 1400 and TB incidence were 2875. The five‐year adult prevalence of asthma (2016–2020) was 41,390, and the total prevalence estimate of chronic obstructive pulmonary disease (COPD) was 308,328. The annual incidence of cryptococcal meningitis and Pneumocystis jirovecii pneumonia in AIDS patients was estimated at 96 and 205 cases. Oesophageal candidiasis incidence is 715 HIV‐infected patients. Chronic pulmonary aspergillosis prevalence, including post‐tuberculosis cases, was estimated at 1399 (39/100,000). Fungal asthma has a prevalence of 1035 and 1366 in adults. The estimated prevalence of recurrent vulvovaginal candidiasis and tinea capitis is 59,391 and 342,585, respectively. There are no data on candidaemia, but it is estimated at 5/100,000 (177 cases annually). Invasive aspergillosis in leukaemia, lung cancer, COPD and HIV is estimated at 540 cases and fungal keratitis in 514 cases annually. Serious fungal infections are prevalent in Eritrea with approximately 408,164 people (11.5%) affected annually. Studies on fungal diseases to improve diagnosis and treatment are required with the implementation of a national surveillance program. [ABSTRACT FROM AUTHOR]

Abstract: BACKGROUND: The simultaneous treatment of wastewater containing selenite and phenol in batch and continuous systems, inoculated with pellets of Phanerochaete chrysosporium, was evaluated in this study. RESULTS: Synthetic oil refinery wastewater containing 15 mg L−1 selenite and 100–600 mg L−1 phenol was used in batch incubations for 5 days. Orange‐red colored pellets developed during selenite incubations in the presence of up to 400 mg L−1 of phenol, which confirms the formation of elemental selenium with removal efficiencies ranging from 57–78.5% and 75–90.8% for, respectively, phenol and selenite. Continuous experiments in two upflow fungal pelleted bioreactors (30 °C, pH 4.5, hydraulic retention time of 16.7 h) fed the synthetic oil refinery wastewater containing phenol or phenol with selenite were performed for 38 days. The maximum removal efficiency of phenol in the fungal bioreactor was 100% (up to day 26). CONCLUSION: Selenite mass balance showed that the overall maximum removal efficiency of selenite in the presence of phenol was 67.3%. The critical phenol and selenite loading rates of the upflow bioreactors were ∼12 and 4.3 mg L−1 h−1, respectively. © 2017 Society of Chemical Industry [ABSTRACT FROM AUTHOR]

Background: Hospitals usually encounter human, capital, and financial resource constraints which alerts the efficient use of allocated resources more than ever. Health system managers are required to identify inefficient hospitals and the drivers of the inefficiencies. Although there are multiple studies examining the efficiency of public hospitals in East Africa, their findings are often variable and inconsistent. Therefore, this study aimed to review published articles on technical efficiency of public hospitals in East African countries. Methods: A systematic search of published articles on the technical efficiency of public hospitals was employed using Pubmed, Cochrane library, and google scholar and thirteen studies were included to this review. The studies were described in terms of their publication year, sample size, inputs and outputs used in the efficiency analysis, and the technical efficiency levels. Finally, we assessed their quality and estimate the mean technical efficiency using meta-analysis. Results: The technical efficiency score of public hospitals varied across countries in east Africa which ranged from 0.64 ± 0.34 in Tanzania to 0.99 ± 0.03 in Ethiopia. The mean technical efficiency was 0.82 (95% CI = 0.56, 1.07) for primary hospitals and 0.88 (95% CI = 0.82, 0.95) for secondary level hospitals. Technical efficiency of public hospitals was negatively correlated with the number of hospitals (the sample size) and positively correlated with the number of inputs and outputs included in the efficiency analysis. Conclusions: This review revealed that the technical efficiency of public hospitals in east Africa requires an improvement. To enable effective and efficient hospital management and improvement in hospital efficiency, health managers and policymakers must identify the drivers of hospital inefficiency. Systematic reviews on public hospital efficiency, which are currently rare in Africa, should be conducted on a much larger scale in order to create more, and validated information for use in policy-making. Trial registration: This review protocol was registered and approved by the international prospective register of systematic reviews with a Protocol ID: CRD42023444729. [ABSTRACT FROM AUTHOR]

Using new time-series data for the size of the Canadian underground economy, the relationship between unreported and measured GDP in that country is examined. Granger causality tests are conducted, with a proper allowance for the non-stationarity of the data. It is found that there is clear evidence of such causality from measured GDP to 'hidden' output, but only very mild evidence of Granger causality in the reverse direction. This result supports similar evidence for New Zealand reported by the first author, and has several interesting policy implications. [ABSTRACT FROM AUTHOR]

This paper considers the relationship between taxes and the size of the New Zealand underground economy. Previous studies indicate that a positive relationship exists in this and certain other countries, This paper addresses the question: 'Is the response of the underground economy to an increase in taxes the same as its response to a decrease in taxes?' We find that although the effect on the underground economy of an upward movement in the effective tax rate is numerically greater than that of a downward tax movement, this difference is not statistically significant. [ABSTRACT FROM AUTHOR]