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BackgroundAlthough Ethiopia has substantial improvements in various health indicators such as maternal and child mortality, the burden of neonatal mortality remains high. Between 2016 and 2019, neonatal mortality increased from 29 deaths per 1,000 live births to 33 deaths per 1,000 live births. This study aimed to explore the spatial patterns and factors contributing to neonatal mortality in Ethiopia.MethodsData from the Ethiopian Demographic and Health Surveys (EDHS) for the years 2000, 2005, 2011, 2016, and 2019 were analyzed. The EDHS sampling design uses a two-stage cluster sampling technique, considering census enumeration areas as primary sampling units and households as secondary sampling units. We used the Spatial Scan analysis in SaTScan and Getis-Ord Gi* statistic in Geographic Information System (GIS), to analyse the spatiotemporal patterns of neonatal mortality. Maternal, newborn and health service-related factors contributing to neonatal mortality were also analyzed using a multilevel logistic regression model. Adjusted Odds Rios (AOR) with corresponding 95% CI were presented as a measure of association and a P-value of 0.05 was used to declare statistical significance.ResultsDuring the initial three consecutive surveys, there was a consistent pattern of hot spot clusters in the Amhara and Benshangul Gumuz regions, along with certain parts of the Oromia region. However, in later surveys, these clusters shifted to the eastern parts of the country, notably including the Somali region. Early initiation of breast feeding was associated with reduced chances of neonatal death (Adjusted Odds Ratio [AOR]) = 0.27; 95% Confidence Interval [CI]: 0.23, 0.32). Neonates born at home (AOR = 1.46; 95% CI: 1.16, 1.82) and male babies had a higher likelihood of mortality during the neonatal period compared to their counterparts (AOR = 1.36; 95% CI: 1.24, 1.51). The odds of neonatal mortality increased with the number of children a mother had ever given birth to (AOR = 1.36; 95% CI: 1.24, 1.51). In contrast, longer birth intervals were associated with a reduced risk of neonatal mortality (AOR = 0.76; 95% CI: 0.68, 0.83).ConclusionThe central southern, central-western, north-western, and northern parts of Ethiopia had most of the neonatal death clusters in the first three rounds of DHS while eastern Ethiopia had the highest neonatal mortality clusters in the latest two surveys. Our results underscore the importance for policymakers and health administrators to reassess intervention approaches and reallocate resources to regions identified as hot spots for neonatal mortality. Enhancing the initiation of breastfeeding within the first hour of birth would improve newborn survival rates. Special attention and care need to be given to babies born of smaller sizes.

BackgroundShort inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region.MethodsA comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings.ResultsA total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals.ConclusionThis review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing.

IntroductionTwin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia.MethodsA hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05.ResultOf 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes.ConclusionThe incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.

Introduction Twin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia. Methods A hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05. Result Of 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes. Conclusion The incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.

When emerging technologies transform an organization’s way of working, explorative business process management (BPM) becomes a new challenge. Although digital innovations can boost process efficacy and business productivity, employees do not necessarily accept the implied work changes. We therefore looked at the increased digitalization efforts during the COVID-19 lockdowns, during which employees were forced to drastically rethink work by heavily depending on technology for communication and almost all business tasks. This global setting allowed us to scrutinize disruptive work changes and how employees can cope with disruptive work adaptations. We also looked into the explorative skillset needed to adapt to these changes. To theorize about an explorative BPM acceptance model, eleven hypotheses were supported based on a solid theoretical foundation. We followed a quantitative research design using partial least squares for structural equation modeling (PLS-SEM) at the university administration settings in two regions, including purposive sampling. Data analysis covered both a measurement model assessment and structural model assessment. Our findings reveal that employees’ perceived work modalities, feeling creative and feeling flexible are more promising features than perceived influence and attitude related to explorative work and skill development. We also offer novel insights into explorative business process management (BPM) skills, and which skills are more productive in uncertain or dynamic working conditions. This research is a learning path for managers struggling with flexible or competitive business environments, and more specifically to facilitate employee willingness.

When emerging technologies transform an organization's way of working, explorative business process management (BPM) becomes a new challenge. Although digital innovations can boost process efficacy and business productivity, employees do not necessarily accept the implied work changes. We therefore looked at the increased digitalization efforts during the COVID-19 lockdowns, during which employees were forced to drastically rethink work by heavily depending on technology for communication and almost all business tasks. This global setting allowed us to scrutinize disruptive work changes and how employees can cope with disruptive work adaptations. We also looked into the explorative skillset needed to adapt to these changes. To theorize about an explorative BPM acceptance model, eleven hypotheses were supported based on a solid theoretical foundation. We followed a quantitative research design using partial least squares for structural equation modeling (PLS-SEM) at the university administration settings in two regions, including purposive sampling. Data analysis covered both a measurement model assessment and structural model assessment. Our findings reveal that employees' perceived work modalities, feeling creative and feeling flexible are more promising features than perceived influence and attitude related to explorative work and skill development. We also offer novel insights into explorative business process management (BPM) skills, and which skills are more productive in uncertain or dynamic working conditions. This research is a learning path for managers struggling with flexible or competitive business environments, and more specifically to facilitate employee willingness.

ObjectivesAlthough tuberculosis (TB) related stigma has a significant impact on the diagnosis, patient adherence with treatment, and recovery from the disease, there is limited evidence from Ethiopia regarding perceived stigma among patient with pulmonary tuberculosis (PTB).The purpose of this study was to assess perceived stigma and associated factors among patient with PTB on treatment in southwest Ethiopia.MethodsInstitution-based cross-sectional study was conducted from April to May 2019 among 410 patient with PTB. Data were collected by using the perceived tuberculosis stigma scale. Epi data v3.1 and SPSSv23 were used for data entry and analysis. Multivariable logistic regression models were fitted to identify factors associated with perceived stigma. Results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).ResultPrevalence of perceived stigma among patient with Pulmonary tuberculosis was 57.1% (95% CI: 52.2, 61.7). Poor social support (AOR = 2.41; 95% CI: 1.06, 5.48), above a month duration of illness (AOR = 2.48; 95% CI: 1.33, 4.64), high perceived stress (AOR = 1.95; 95% CI:1.09, 3.49), current khat use (AOR = 1.88; 95% CI:1.05, 3.37), and presence of depression (AOR = 8.18; 95% CI:4.40, 15.22) were significantly associated with perceived stigma. Patient with HIV co-infection were 5.67 times (AOR = 5.67; 95% CI: 2.32, 13.87) more likely to have Perceived stigma than their counterparts.ConclusionTB related stigma was reported by more than half of the study participant. Stigma reduction measures are needed to lower TB related stigma perceived by the patient, the level of distress associated with it, and to promote the psychological wellbeing of patient with TB.