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Patient retention in chronic HIV care is a major challenge following the rapid expansion of combination antiretroviral therapy (cART) in Ethiopia.To describe the proportion of patients who are retained in HIV care and characterize predictors of attrition among HIV-infected adults receiving cART in Addis Ababa.A retrospective analysis was conducted among 836 treatment naïve patients, who started cART between May 2009 and April 2012. Patients were randomly selected from ten health-care facilities, and their current status in HIV care was determined based on routinely available data in the medical records. Patients lost to follow-up (LTFU) were traced by telephone. Kaplan-Meier technique was used to estimate survival probabilities of retention and Cox proportional hazards regression was performed to identify the predictors of attrition.Based on individual patient data from the medical records, nearly 80% (95%CI: 76.7, 82.1) of the patients were retained in care in the first 3 and half years of antiretroviral therapy. After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41%, 88.17%). In the multivariate Cox regression analyses, severe immune deficiency at enrolment in care/or at cART initiation and 'bed-ridden' or 'ambulatory' functional status at the start of cART predicted attrition.Retention in HIV care in Addis Ababa is comparable with or even better than previous findings from other resource-limited as well as EU/USA settings. However, measures to detect and enroll patients in HIV care as early as possible are still necessary.

Birds are vital bioindicators of biodiversity and ecosystem health, but their persistence and ecological roles are under severe threat from human activities in the Lake Tana Basin, Ethiopia. Rapid land and forest degradation driven by agricultural expansion, urbanization, and the rising demand for fuelwood imperil avian community structure and ecosystem functions in this region. However, amidst this ecological challenge, church forests have emerged as crucial sanctuaries. Despite their small size and isolation from each other by mainly agricultural land-use, these church forests provide indispensable ecosystem services and play a pivotal role in preserving biodiversity. Understanding the significance of church forests for avian biodiversity and the factors influencing bird species richness and community composition is paramount. To this end, a comprehensive survey was conducted in 24 church forests between November and December 2018. Data collection involved both point counts utilizing Audiomoth acoustic loggers and transect surveys. The study revealed a total of 131 bird species in the surveyed church forests, including endemic and threatened species. These birds exhibited diverse foraging habits and functional traits. Notably, church forest size and canopy cover were positively associated with species richness, highlighting the importance of preserving and potentially expanding these forested areas. Furthermore, the research identified key factors driving the similarity of bird communities in church forests, notably forest surface area, canopy cover, and altitude. Importantly, resilience metrics demonstrated significant positive relationships with species richness, emphasizing the conservation value of these unique ecosystems. Our study underscores the critical role of church forests in safeguarding avian biodiversity in the Lake Tana Basin, and our findings advocate for conservation efforts aimed at preserving and enhancing the region's church forests, as their continued degradation could jeopardize both ecological and socio-economic potential in this network of remnant forests.

Introduction Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia.Methods Women who gave birth after 28 weeks of gestation and their newborns were included in the analysis. Survival probabilities were estimated for males and females in the neonatal period as well as the 2-year period following birth using Kaplan-Meier curves. HRs and 95% CIs were compared between males and females under 2. Descriptive statistics and χ2 tests were used to determine the sex-disaggregated variation in the birth outcomes of preterm birth, low birth weight (LBW), stillbirth, small for gestational age (SGA) and large for gestational age (LGA).Results The study included a total of 3904 women and child pairs. The neonatal mortality rate for males (3.4%, 95% CI 2.6% to 4.2%) was higher compared with females (1.7%, 95% CI 1.1% to 2.3%). The hazard of death during the first 28 days of life was approximately two times higher for males compared with females (HR 1.99, 95% CI 1.30 to 3.06) but was not significantly different after this period. While there was a non-significant difference between males and females in the proportion of preterm, LBW and LGA births, we found a significantly higher proportion of stillbirth (2.7% vs 1.3%, p=0.003) and SGA (20.5% vs 15.6%, p

Abstract Background Antenatal balanced energy and protein (BEP) supplements have well-documented benefits for pregnancy outcomes. However, considerable practical gaps remain in the effective and cost-effective delivery of antenatal BEP supplements at scale in low- and middle-income countries. Methods A randomized effectiveness study will be conducted in two sub-cities of Addis Ababa, Ethiopia, to evaluate the effectiveness, cost-effectiveness, and implementation of different targeting strategies of antenatal BEP supplements. Pregnant women aged 18 to 49, with a gestational age of 24 weeks or less, and attending antenatal visits in one of the nine study health facilities are eligible for enrollment. In six of the health facilities, participants will be randomized to one of three study arms: control (Arm 1), targeted BEP provision based on baseline nutritional status (Arm 2), and targeted BEP supplementation based on baseline nutritional status and monthly gestational weight gain (GWG) monitoring (Arm 3). In the remaining three facilities, participants will be assigned to universal BEP provision (Arm 4). Participants in Arms 2 and 3 will receive BEP supplements if they have undernutrition at enrollment, as defined by a baseline body mass index less than 18.5 kg/m2 or mid-upper arm circumference less than 23 cm. In Arm 3, in addition to targeting based on baseline undernutrition, regular weight measurements will be used to identify insufficient GWG and inform the initiation of additional BEP supplements. Participants in Arm 4 will receive BEP supplements until the end of pregnancy, regardless of baseline nutritional status or GWG. All participants will receive standard antenatal care, including iron and folic acid supplementation. A total of 5400 pregnant women will be enrolled, with 1350 participants in each arm. Participants will be followed up monthly during their visits to the antenatal facilities until delivery. Maternal and infant health status will be evaluated within 72 h after delivery and at 6 weeks postpartum. The effectiveness and cost-effectiveness of the different BEP targeting strategies in preventing adverse pregnancy outcomes will be compared across arms. Qualitative data will be analyzed to assess the feasibility, acceptability, and implementation of different supplementation strategies. Discussion This study will inform global recommendations and operational guidelines for the effective and cost-effective delivery of antenatal BEP supplements. The targeted approaches have the potential for broader scale-up in Ethiopia and other low-resource settings with a high burden of undernutrition among pregnant women. Trial registration ClinicalTrials.gov registration number: NCT06125860. Registered November 9, 2023.

Abstract Background Despite improvements in food access and nutrition security over the last few decades, malnutrition remains a major public health problem. One of the significant contributors to these problems is affordability of nutritious food. This study aimed to examine the association between perceived food affordability and pre-school children’s diet diversity in Addis Ababa, Ethiopia. Methods Cross-sectional data from 2017 to 18 were used for the analysis. A 24-hour dietary recall assessment was done to assess children’s dietary diversity (DD). We used a modified operational definition of affordability indicator called perceived affordability of dietary diversity (afford-DD) to evaluate the impact of the food environment in terms of affordability at the household level. A sample (n 4,898) of children aged 6–59 months representative of households in Addis Ababa was randomly selected using a multistage sampling procedure including all districts in the city. Mixed-effects linear regression models were used to assess the association between children’s DD and afford-DD. Results The survey revealed that the mean (standard deviation [SD]) of children’s DD was 3.9 [± 1.4] while the mean [SD] of afford-DD was 4.6 [± 2.1]. Overall, 59.8% of children met the minimum dietary diversity (≥ 4 food groups). White roots and tubers were the most commonly consumed food groups regardless of their affordability. Considerable variations were observed between households that reported the food item affordable and not affordable in consumption of Vitamin A rich vegetables and fruits, meat and fish, egg, and dairy. The children’s DD was positively associated with afford-DD after adjusting for maternal education, household wealth status and other relevant confounding. Higher maternal education modified the association between affordability and children’s diet diversity. Conclusions This study suggests higher perceived food affordability was associated with better diet diversity in children. A higher level of maternal education had the potential to mitigate affordability challenges in meeting the children’s dietary diversity needs. Our study emphasizes the need for inclusive food programs and nutrition interventions addressing social differences, intensifying efforts to make nutrient-rich diets affordable for the less privileged, and highlights the potential benefits of targeting maternal education in addressing child dietary diversity.

Abstract Background Ethiopia has committed to ending undernutrition by implementing nutrition intervention strategies, including promoting optimal feeding and care practices. To monitor and evaluate optimal infant feeding practices, it is crucial to have reliable and quality data on infant feeding indicators. Therefore, this study aimed to evaluate the extent to which breastfeeding mothers in Ethiopia have completed the continuum of age-appropriate infant feeding practices and the barriers they face. Methods In this study, a sequential explanatory mixed method design was used. First, using datasets from performance monitoring for action (PMA) in Ethiopia, we estimated the level of the outcome and associated factors. In the quantitative (QUAN) analysis, 1755 mothers of infants were included to generate estimates. A generalized estimating equations logistic regression model was used to identify factors associated with the outcome by accounting for the clustering nature of the data by enumeration area. Then, a qualitative (QUAL) study was conducted with 14 mothers to explore their infant feeding practices using an in-depth interview guide and analyzed using a thematic approach. Results from both quantitative and qualitative data were integrated, described under the identified thematic areas, and interpreted concurrently. Results This study showed that 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Over 8% of mothers did not practice any optimal feeding. Nearly 47% of mothers practiced optimal breastfeeding, and one-fifth of mothers practiced optimal complementary feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was affected by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers. Conclusion The level of a complete continuum of age-appropriate infant feeding practice is low among breastfeeding mothers in Ethiopia. Mothers’ optimal feeding practices in Ethiopia are affected by their level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Therefore, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal infant feeding and design and promote strategies to improve household income or access to diverse food.

Background: Balanced energy protein (BEP) supplementation in pregnant women in low-and middle-income countries may reduce the risk of stillbirth and low birth weight. Objectives: The objective of this study was to assess the adherence to and acceptability of a corn–soy blend (CSB) BEP product among pregnant women in rural Ethiopia. Methods: This formative study was conducted from October to November 2018 among pregnant women in the rural Amhara region of Ethiopia prior to initiation of a clinical effectiveness study (ISRCTN: 15116516). We assessed adherence and acceptability of a micronutrient-fortified CSB BEP supplement among 40 pregnant women during a 4-wk utilization period. Acceptability was assessed using a 7-point Likert-style scale about the hedonic characteristics of the BEP product at 2 wk and 4 wk. Adherence was assessed by weekly monitoring and empty sachet counts for BEP consumption over 4 wk. Results: Adherence to the BEP was, on average, 89% over the month-long pilot. The BEP product was rated favorably (mean Likert score >6 of 7) for the following domains: color, taste, odor, and likeability at mid and endpoints. Women found the product convenient to eat [mean (standard deviation [SD] = 5.9 (1.0))] and filling (mean (SD) = 6.1 (1.5) out of 7). Scores on acceptability and perception of the product remained stable throughout the duration of use. A majority of women (63%) reported consuming the BEP as a snack to supplement meals and splitting the serving over 2 or more sessions (68%). A quarter of respondents reported sharing the supplement with family members. Conclusions: Adherence and acceptability of the CSB BEP product were high among this population in rural Amhara, Ethiopia. This formative data was important to select the final product and shape the counseling and delivery of BEP in the parent study.

BackgroundFood insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95–95-95 HIV treatment target in the local context.MethodsA multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association.ResultsIn this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults.ConclusionThe magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia’s national food and nutrition policy.

BackgroundDespite the significant role of fruit and vegetables (FAVs) in preventing a variety of chronic diseases and their potential to bolster immune responses and slow the progression of HIV infection to AIDS, there is a lack of studies on the dietary intake of FAVs among HIV-infected adults in Africa, including Ethiopia. Hence, this study aimed to investigate the magnitude of FAV intake and estimated consumption among HIV-infected adults receiving antiretroviral therapy (ART) in northcentral Ethiopia.MethodsA multifacility cross-sectional study was conducted on the FAV intake among 865 HIV-infected adults receiving ART. A Poisson regression model with robust variance was used to identify factors associated with FAVs dietary intake.ResultsThe study indicated that 655 (76.34%; 95% CI: 73.38, 79.07) HIV-infected adults reported consuming FAVs less than once per day, with 838 (97.67%, 95% CI: 96.41, 98.49) and 676 (78.79%, 95% CI: 75.92, 81.40) HIV-infected adults reporting consuming fruits and vegetables less than once per day, respectively. The median (IQR) total FAV intake was 271.3 (IQR: 92.5, 439.5) g/day, with the median (IQR) intake of fruits being 248.1 (IQR: 100.0, 400.0) g/day and vegetables being 273.78 (IQR: 82.44, 348.33) g/day, respectively. We found that being divorced (APR = 1.57, 95% CI: 1.16, 2.12), employed as a daily laborer (APR = 2.08, 95% CI: 1.36, 3.20), being employed (APR = 1.77, 95% CI: 1.10, 2.84), merchants (APR = 1.59, 95% CI: 1.03, 2.47), having children as caregivers (APR = 1.61, 95% CI: 1.02, 2.55), an advanced WHO clinical stage (APR = 1.32, 95% CI: 1.32(1.03, 1.69), and receiving ART for more than 8 years (APR = 1.78, 95% CI: 1.18, 2.67) were found to be independent predictors of FAV dietary intake among HIV-infected adults. From the findings, we understood that farmers were less likely to consume FAVs compared to employed individuals, daily laborers, and merchants.ConclusionThe finding indicated a very low level of FAV dietary intake among HIV-infected adults receiving ART, falling well-below the minimum recommendation for physically active adults. Despite living in areas with surplus production and producing these items, farmers are less likely to consume FAV. The study emphasizes the importance of focusing on the early stage of ART treatment for patients and family therapy, including counseling and guidance on consuming healthy diets such as FAVs, to enhance the role of children as caregivers for their families. Additionally, there is a need for comprehensive nutritional counseling to improve FAV consumption, with a particular emphasis on educating individuals about portion size estimation for the consumption of FAVs.

Background: In low-income countries, social norms play a significant role in intrahousehold food allocation practices. These norms can sometimes lead to discrimination against specific groups, posing a public health concern. This study focuses on the social norm surrounding food allocation within households and food taboos affecting adolescent girls in rural Ethiopia. Method: A qualitative study was conducted using vignettes as prompts for 20 focus group discussions and 32 in-depth interviews. The vignettes were tailored to the local context. Participants were chosen purposefully, and data were collected in a comfortable setting. All sessions were recorded and transcribed verbatim. Data analysis was done using Open Code qualitative analysis software with a thematic framework approach. Findings: In the community, adolescent girls were expected to eat after serving the male family members. Those who did not follow this expectation faced sanctions such as being labeled as disrespectful and could even be insulted or beaten by their spouses and siblings. However, there were some exceptions to this rule, such as when girls were giving birth, breastfeeding, sick, or when male family members were traveling. Certain foods were also prohibited for adolescent girls, including spicy foods like chili, animal products such as meat and milk, and nuts. These foods were believed to increase girls' sexual desire, potentially leading them to engage in premarital or extramarital sex. Additionally, eating outside of the house was not considered appropriate behavior for adolescent girls in this community. Conclusion: In many households, social norms dictate that adolescent girls are not given enough food or are denied essential nutrients for their health. It is important to challenge these norms to ensure fair food distribution within households and support the healthy development of adolescent girls.

Cryptosporidium, Shigella, toxin-producing Escherichia coli, and rotavirus were reported to be the most responsible for severe and fatal diarrhea among infants. This study aimed to investigate the presence of these pathogens in infants' drinking water samples and analyzing using water quality determinants in eastern Ethiopia. A molecular (LAMP)-based cross-sectional study design was employed. A total of 410 and 37 water samples were tested from infant point-of-use at household and corresponding water source, respectively, from June 2020 to May, 2021. Cryptosporidium, Shigella, toxin-producing E. coli, and rotavirus were detected in 28.5, 30.0, 26.3, and 32.2%, of water samples tested from infant point-of-use, respectively. About 13.2% of the water samples were positive for all (four) pathogens together. Cryptosporidium, Shigella, toxin-producing E. coli, and rotavirus were detected in 27.0, 32.4, 29.7, and 37.8%, of water samples tested from water sources, respectively. Positive significant correlation was observed between infant point-of-consumption and water sources from which it is drawn toward the presence of each targeted pathogen. Unimproved water source showed a strong significant association with the presence of Cryptosporidium, Shigella and toxin-producing E. coli. Therefore, efforts should be made in development of improved water sources, source protection safety and health education to caretakers of infants. HIGHLIGHTS Highest prevalent agent detected in water samples was rotavirus (32.2%), followed by Shigella (30.0%), Cryptosporadium (28.5%), and toxin-producing E. coli (26.5%).; Positive correlation was observed between drinking water at point-of-use and water sources on presence of pathogens.; Significant association was observed between unimproved water source and presence of Cryptosporidium, Shigella, and toxin-producing E. coli.;

Aim: To determine the magnitude and causes of low vision and blindness in the Gurage zone, central Ethiopia. Methods: A cross sectional study using a multistage cluster sampling technique was [...]

Background: In Ethiopia, domestic animals and their feces are not properly contained. However, the risk of exposure to zoonotic pathogens is not well documented. This study was conducted to assess animal handling practices and the risk of childhood diarrhea among rural households in northwest Ethiopia. Methods: This study was done among 403 randomly selected households. Information on animal handling was collected using a questionnaire and spot-check observation. The occurrence of childhood diarrhea in 14 days prior to the survey was assessed based on the reports of female head of households. Multivariable binary logistic regression analysis was performed to identify the association between animal handling practices and childhood diarrhea. Results: All the female head of households had contact with animal feces when preparing fuel disks and plastering the house components with animal dung. Domestic animals shared a corral within the living space of the humans in 20% of the households. Animals entered the human living quarters and accessed foods in 32% of the households. Moreover, 24% of the children aged 24 to 59 months had diarrhea in a 2-week period prior to the survey. Childhood diarrhea was associated with domestic animals sharing the same house as humans (AOR: 3.3, 95% CI: 1.3, 8.6), presence of animal excreta in child playing areas (AOR: 2.4, 95% CI: 1.2, 4.6), contact of domestic animals with stored foods (AOR: 3.5, 95% CI: 2.0, 5.9), trapped dirt under fingernails of female heads (AOR: 3.7, 95% CI: 1.9, 7.5), open defecation (AOR: 3.24, 95% CI: 1.8, 5.9), and unprotected sources (AOR: 4.2, 95% CI: 1.1, 15.3). Conclusion: Domestic animals and their excreta are not hygienically contained in the area. Animal handling practices including their excreta and the hygiene behavior of female head of households (eg, handwashing and food handling practices) should be improved to prevent childhood diarrhea.

Abstract Background A birth companion is a simple and low-cost intervention that can improve both maternal and newborn health outcomes. The evidence that birth companionship improves labor outcomes and experiences of care has been available for many years. Global and national policies exist in support of birth companions. Many countries including Ethiopia, Kenya, and Nigeria have not yet incorporated birth companions into routine practice in health facilities. This paper presents the protocol for a trial that aims to assess if a package of interventions that addresses known barriers can increase the coverage of birth companions. Methods This two parallel arm cluster randomized controlled trial will evaluate the impact of a targeted intervention package on scale-up of birth companionship at public sector health facilities in Ethiopia (five study sites encompassing 12 facilities), Kenya (two sites encompassing 12 facilities in Murang’a and 12 facilities in Machakos counties), and Nigeria (two sites encompassing 12 facilities in Kano and 12 facilities in Nasarawa states). Baseline and endline assessments at each site will include 744 women who have recently given birth in the quantitative component. We will interview a maximum of 16 birth companions, 48 health care providers, and eight unit managers quarterly for the qualitative component in each country. Discussion Ample evidence supports the contribution of birth companions to positive health outcomes for mothers and newborns. However, limited data are available on effective strategies to improve birth companion coverage and inform scale-up efforts. This trial tests a birth companion intervention package in diverse clinical settings and cultures to identify possible barriers and considerations to increasing uptake of birth companions. Findings from this study may provide valuable evidence for scaling up birth companionship in similar settings. Trial registration Trial is registered with ClinicalTrials.gov with identifier: NCT05565196, first posted 04/10/ 2022.

The study aimed to determine the effects of a game-based training approach on the physical abilities of male youth volleyball players. A two-way mixed design was used. Forty young male volleyball players (age: 15.49±1.36 years old; height: 175.50±0.02 cm; weight: 65.50±1.32 kg; experience: 3.39±1.27 years old) participated in this study. Participants were randomly assigned into two equal study groups, a Traditional Training Group (TTG; n = 20) and a Game-based Training Group (GTG; n = 20). TTG uses a traditional training program in which coaches coach athletes, give individual feedback, and perform technique-focused workouts. GTG follows a 12-week simple volleyball game-based training program. Before and after 12 weeks of training, both groups measured their agility, endurance, power, and speed. A two-way mixed design (2 × 2) ANOVA was used to compare the differences between subjects and repeated measure variables. All coefficients are considered significant at p ≤ .05. As a result, significant differences were found within-subject and between groups in male youth volleyball players’ physical abilities. In conclusion, the 12-week game-based training approach effectively improved the physical performances of male youth volleyball players. To support this notion, an additional study is necessary.

Background Asthma is a public health concern affecting millions of productive age groups. Several studies were conducted on the determinants of asthma in children. However, little is known about the determinants of asthma among adults in Ethiopia. Understanding the determinants of asthma among adults can help reduce its burden. This study was aimed at identifying determinant factors for developing asthma among adults in Tigray hospitals. Methods A facility-based, unmatched case-control study design was conducted from January 1 to April 26, 2019. A total of 698 participants (228 cases and 470 controls) completed their guided interviews using structured and pretested questionnaires by trained data collectors. A modified standard questionnaire from the European Community Respiratory Health Survey II (ECRHS II) was used to collect the data. The case definition was patients having asthma, and the control definition was patients without asthma. Data were entered and cleaned using Epi Data Manager Version 3.1 software and imported to statistical packages for social sciences Version 25 software for analysis. To identify asthma determinants, bivariate and multivariable logistic regression models were fitted. Results The response rate for both cases and controls was 95.9%. The odds of developing asthma was nearly twice higher among those who resided in urban (AOR = 1.68; 95% CI [1.13–2.50]), more than twice higher among those who have income less than 1000 ETB (AOR = 2.3; 95% CI [1.17–4.56]), twice higher among those who had history of skin allergy (AOR = 2.09; 95% CI [1.14–3.86]), over four times higher among those with family history of asthma (AOR = 4.26; 95% CI [2.63–6.91]), three times higher among those having house dust or smoke exposure (AOR = 3.01; 95% CI [1.96–4.64]), over five times higher among those lifetime firewood users (AOR = 5.39; 95% CI [3.34–8.72]), door opening while cooking (AOR = 0.35; 95% CI [0.26–0.55]), nearly two times higher among those having house dampness (AOR = 1.98; 95% CI [1.069–3.68]), over seven times higher among pet owners (AOR = 7.46; 95% CI [4.04–13] and almost twice higher among those who were physically inactive (AOR = 1.75; 95% CI [1.11–2.85]). Conclusion Asthma has been associated with urbanization, low income, a history of allergic diseases, indoor smoke or dust, firewood use, pet ownership, and a sedentary lifestyle. The community should be informed about the known risks and implement preventive steps like opening a door while cooking to lower the risk of asthma.

Objective COVID-19 has negatively impacted mental health of adults globally with increased rates of psychiatric comorbidities. However, network analysis studies to examine comorbidities and correlations between symptoms of different mental disorders are uncommon in low-income countries. This study aimed to investigate the network structure of depression, anxiety and perceived stress among adults in Addis Ababa and identify the most central and bridge symptoms within the depressive-anxiety-perceived symptoms network model.Design Community-based cross-sectional study.Setting This study was carried out on a sample of the general population in Addis Ababa during the first year of the COVID-19 pandemic. A total of 1127 participants were included in this study, of which 747 (66.3%) were females, and the mean age was 36 years.Primary and secondary outcome measures Symptoms of depression, anxiety and stress were measured using the Patient Health Questionnaire, Generalized Anxiety Disorder Scale and the Perceived Stress Scale, respectively.Network analysis was conducted to investigate the network structure. The centrality index expected influence (EI) and bridge EI (1-step) were applied to determine the central and bridge symptoms. Case-dropping procedure was used to examine the network stability.Result The sad mood (EI=1.52) was the most central and bridge symptom in the depression, anxiety and perceived stress network model. Irritability (bridge EI=1.12) and nervousness and stressed (bridge EI=1.33) also served as bridge symptoms. The strongest edge in the network was between nervousness and uncontrollable worry (weight=0.36) in the anxiety community. The network had good stability and accuracy. The network structure was invariant by gender and age based on the network structure invariance test.Conclusions In this study, the sad mood was the core and bridge symptom. This and the other central and bridge symptoms identified in the study should be targeted to prevent mental health disorders and comorbidities among adults.

Background Considerable proportions of pregnant women consume inadequately diversified diets in Ethiopia. On the other hand, women’s empowerment is identified as a means of achieving maternal nutrition improvement. However, evidence on the relationship between multiple dimensions of women’s empowerment and dietary diversity during pregnancy is limited in Ethiopia. Objective This study aimed to assess the mediating effects of women’s empowerment in the pathway between women’s education and dietary diversity during pregnancy in West Shewa zone, Ethiopia. Methods A health facility-based cross-sectional study was conducted among 1,383 pregnant women in 2021. Dietary diversity was measured using the minimum dietary diversity for women (MDD-W) tool. Exploratory and confirmatory factor analyses were employed to identify and validate women’s empowerment dimensions. Structural equation modelling (SEM) was used to examine the pathways linking pregnant women’s education and empowerment to dietary diversity during pregnancy. Results From the latent dimensions of women’s empowerment produced by factor analyses, pregnant women’s education was directly associated with household decision-making power, psychological and time dimensions. In turn, household decision-making power, psychological and time dimensions were associated with dietary diversity during pregnancy. The direct relationship between pregnant women’s education and dietary diversity was insignificant, but the total indirect effect and total effect were significant. Household decision-making power, psychological and time dimensions were significant mediators in the relationship between pregnant women’s education and dietary diversity. However, economic dimension was related to neither pregnant women’s education nor dietary diversity. Conclusion This study highlights pregnant women with better education are more likely to be empowered in household decision-making, psychological and time dimensions; and those empowered pregnant women are more likely to consume more diverse diets, suggesting women’s access to higher education could have a positive indirect effect on consumption of more diverse diets during pregnancy by empowering women in the study area.

BackgroundWith a neonatal mortality rate of 33 per 1,000 live births in 2019, Ethiopia is striving to attain the Sustainable Development Goal target of 12 deaths per 1,000 live births by 2030. A better understanding of the major causes of neonatal mortality is needed to effectively design and implement interventions to achieve this goal. Minimally Invasive Tissue Sampling (MITS), an alternative to conventional autopsy, requires fewer resources and through task-shifting of sample collection from pathologists to nurses, has the potential to support the expansion of pathology-based post-mortem examination and improve mortality data. This paper evaluates the accuracy and adequacy of MITS performed by nurses at a tertiary and general hospital and in the home of the deceased.MethodsNurses in a tertiary and general hospital in Ethiopia were trained in MITS sample collection on neonatal deaths and stillbirths using standardized protocols. MITS sample collection was performed by both pathologists and nurses in the tertiary hospital and by nurses in the general hospital and home-setting. Agreement in the performance of MITS between pathologists and nurses was calculated for samples collected at the tertiary hospital. Samples collected by nurses in the general hospital and home-setting were evaluated for technical adequacy using preestablished criteria.ResultsOne hundred thirty-nine MITS were done: 125 in hospitals and 14 inside homes. There was a perfect or almost perfect agreement between the pathologists and the nurses in the tertiary hospital using Gwet's agreement interpretation criteria. The adequacy of MITS samples collected by nurses in the general hospital was more than 72% when compared to the preset criteria. The adequacy of the MITS sampling yield ranged from 87% to 91% on liveborn neonatal deaths and 76% for the liver, right and left lungs and 55% for brain tissues in stillbirths.ConclusionsThis study demonstrated that task-shifting MITS sample collection to nurses can be achieved with comparable accuracy and adequacy as pathologists. Our study showed that with standardized training and supportive supervision MITS sample collection can be conducted by nurses in a tertiary, general hospital and, at the home of the deceased. Future studies should validate and expand on this work by evaluating task-shifting of MITS sample collection to nurses within community settings and with larger sample sizes.

BackgroundLength of hospital stay (LOS) is one of the essential indicators for evaluating the efficiency and the quality-of-care service delivered. predicting LOS is critical for resource allocation, decision-making, lowering neonatal morbidity and death, enhancing clinical outcomes and parent counseling. In addition, extended hospital stays (long LOS_NICU) place a burden on the healthcare systems decreasing bed turnover rates as well as their financial stand and the mental stress on families. In Ethiopia, there is limited evidence on the determinant factors that influence on LOS.ObjectivesTo determine factors affecting neonatal intensive care unit length of stay for all preterm newborns who were discharged alive.MethodThe study used a secondary data source, was collected for the Study of Illness in Preterm (SIP) infants project. The research study was a multicenter, cross-sectional, observational clinical study that took place in five Ethiopia hospitals from July 1, 2016, to May 31, 2018. The predictors of LOS were determined using Fine-Gray's competing risk analysis.ResultsFor this study 3,511 preterm infants admitted to the NICU were analyzed. About 28.8% of the preterm infants died during their time in neonatal care while 66.6% were discharged alive. At the end of the study 4.6% babies were still in the NICU. The overall median LOS (death or discharge) was 7 days, with an interquartile range of 8 days. The cumulative incidence of discharge rose with increasing in gestational age and birth weight, on the contrary, the rate of discharge was decreased by 45.7% with the development of RDS (SDH ratio: 0.543), by 75.9% with the development of apnea (SDH ratio: 0.241), by 36.2% with sepsis, and by 43.6% with pneumonia (SDH ratio: 0.564).ConclusionsPreterm newborns with a low gestational age and birth weight have a greater probability of having a prolonged LOS. Complications of the medical conditions RDS, apnea, sepsis, pneumonia, anemia, asphyxia, and NEC substantially raise LOS considerably.

Abstract Background Psychiatric patients have two to three-fold higher risk of cardiovascular morbidity and mortality as compared to the general population. Despite the high rate of cardiovascular disease, about 80% of patients with psychiatric disorders have fewer opportunities for cardiovascular disease screening. Early detection of subclinical cardiovascular disease using an electrocardiogram can improve the clinical outcomes of these patients. However, in Ethiopia, no previous study had been conducted on electrocardiogram abnormalities and associated factors among psychiatric patients. Hence, this study aimed to assess the electrocardiogram abnormalities and associated factors among psychiatric patients attending follow-up at Jimma Medical Center, Jimma, Ethiopia. Methods An institution-based cross-sectional study was carried out among psychiatric patients attending Jimma Medical Center Psychiatry Clinic from October 14 to December 10, 2021. An interviewer-administered structured questionnaire was used to collect socio-demographic data, behavioral factors, disease-related and medication-related data. Anthropometry and blood pressure were measured following the standard protocols. A resting 12 lead ECG was recorded according to the standard recording protocol of the Minnesota code. Data were entered into Epi data version 4.6 and exported to SPSS version 25. Results of the descriptive analysis were summarized by frequencies, means, and proportions, and presented by using tables and figures. Bivariable and multivariable logistic regressions were performed. p value 10 years [AOR = 4.25: 95% CI 1.72–10.49] were significantly associated with ECG abnormalities. Conclusions In the present study, six out of ten respondents had ECG abnormalities. Age of the respondents, treatment with antipsychotics, having schizophrenia, polytherapy and illness duration of > 10 years were significant predictors of ECG abnormalities. Routine ECG investigation should be performed in the psychiatry treatment setting and further studies are recommended to delineate factors affecting ECG abnormalities.

Abstract Background The functional survival time of long-lasting insecticidal nets (LLINs), which varies across different field contexts, is critical for the successful prevention of malaria transmission. However, there is limited data on LLIN durability in field settings in Ethiopia. Methods A three-year longitudinal study was conducted to monitor attrition, physical integrity, and bio-efficacy and residual chemical concentration of LLINs in four regions in Ethiopia. World Health Organization (WHO) guidelines were used to determine sample size, measure physical integrity, and calculate attrition rates, and functional survival time. Yearly bio-efficacy testing was done on randomly selected LLINs. An excel tool developed by vector works project was used to calculate the median functional survival time of the LLINs. Predictors of functional survival were identified by fitting binary and multivariate cox proportional hazards model. Results A total of 3,396 LLINs were included in the analysis. A total of 3,396 LLINs were included in the analysis. By the end of 36 months, the proportion of LLINs functionally surviving was 12.9% [95% confidence interval (CI) 10.5, 15.6], the rates of attrition due to physical damage and repurposing were 48.8% [95% confidence interval (CI) 45.0, 52.6] and 13.8% [95% confidence interval (CI) 11.6, 14.6], respectively. The estimated median functional survival time was 19 months (95%CI 17, 21). Factors associated with shorter functional survival time include being in a low malaria transmission setting [Adjusted Hazards Ratio (AHR) (95%CI) 1.77 (1.22, 2.55)], rural locations [AHR (95%CI) 1.83 (1.17, 2.84)], and in a room where cooking occurs [AHR (95%CI) 1.28 (1.05, 1.55)]. Bioassay tests revealed that 95.3% (95%CI 86.4, 98.5) of the LLINs met the WHO criteria of bio-efficacy after 24 months of distribution. Conclusion The LLIN survival time was shorter than the expected three years due to high attrition rates and rapid loss of physical integrity. National malaria programmes may consider, procuring more durable LLINs, educating communities on how to prevent damage of LLINs, and revising the current three-year LLIN distribution schedule to ensure sufficient protection is provided by LLINs against malaria transmission. While this paper contributes to the understanding of determinants impacting functional survival, further research is needed to understand factors for the rapid attrition rates and loss of physical integrity of LLINs in field settings.

Background Varied HIV prevention interventions involving multiple strategies has been instrumental in the effort to contain and lessen the prevalence of HIV around the globe. However, female sex workers (FSWs) often face stigma and discriminatory challenges, resulting in lower access to the HIV prevention initiatives. This study has aimed to assess the effect of one of the HIV service delivery models, the Drop-in Centers (DICs), which is designed to overcome the service uptake barriers of FSWs. Method A quasi-experimental study design was employed. A respondent-driven sampling technique was used to recruit 1,366 FSWs from January to June 2020. A propensity score matching technique was used to balance the potential confounders between FSWs who had access to DICs and those who had never accessed DICs. Comparisons of the effect of DIC on the outcome of interest was made using a logit regression model at a 5% level of significance. Results A total of 1,366 FSWs took part in the study. The analysis estimated the average treatment effects of access to DICs on four key outcomes: ever-testing to know HIV status, finding HIV-positive FSWs, awareness of HIV-positive status, and consistent condom use. A significant effect of DIC was seen at a 95% confidence interval on each outcome. Access to DIC produced a 7.58% increase in the probability of testing to know HIV status (P < 0.001), a 7.02% increment in finding HIV-positive FSWs (P = 0.003), an increase of 6.93% in awareness of HIV status among HIV positive FSWs (P = 0.001), and a 4.39% rise in consistent condom use (P = 0.01). Conclusions Ensuring access of FSWs to DICs has led to an upsurge in HIV testing among FSWs, raising HIV status awareness among those who are HIV positive, and encouraged consistent condom use. To provide effective HIV prevention services, particularly to those FSWs living with HIV, it is essential to strengthen the services provided in DICs and expand the centers. This will ensure that the entire network of FSWs is reached with appropriate HIV prevention services.

Objective The study intended to assess the pooled prevalence of vitamin D deficiency (VDD) and its associated factors among patients with type 2 diabetes mellitus (T2DM).Design The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were employed to plan and conduct this systematic review and meta-analysis.Data sources PubMed, Medline, Google Scholar, Web of Science, Science Direct and the Worldwide Science database were searched from their inception to 31 January 2023.Methods Data were extracted using a standardised data extraction format prepared in Microsoft Excel. The inverse variance (I2) test was used to evaluate the presence of heterogeneity across the included studies. To identify the possible source of heterogeneity, subgroup analysis was carried out. Funnel plot symmetry, Begg’s and Egger’s tests were used to evaluate the existence of publication bias. In addition, factors associated with VDD among patients with T2DM were examined. All statistical analyses were carried out with STATA V.14 software.Results A total of 54 studies with 38 016 study participants were included in the study. The pooled prevalence of VDD among patients with T2DM was found to be 64.2% (95% CI 60.6% to 67.8%) with a substantial level of heterogeneity (I2=98.2%; p

PURPOSEThere are limited data on the association between delay in breast cancer diagnosis after breast symptom recognition and survival, particularly in sub-Saharan Africa. The recently launched Global Breast Cancer Initiative by WHO includes measuring delay as the core indicator for quality of breast cancer care. Herein, we examined the association between delay in breast cancer diagnosis with overall survival among women in Addis Ababa, Ethiopia.MATERIALS AND METHODSA total of 439 women diagnosed with breast cancer from January 1, 2017, to June 30, 2018, in Addis Ababa were followed for survival to the end of 2019. Survival rates were estimated using the Kaplan-Meier method. The association between delay in diagnosis (>3 months after symptom recognition) and overall survival was computed using the multivariable Cox regression model after adjusting for demographic and clinical factors.RESULTSNearly 70% (303/439) of women with breast cancer were delayed in diagnosis of their cancer. During a median follow-up period of 25.1 months, 2-year overall survival rate was 73.5% (95% CI, 68.0 to 78.2) in women with diagnosis delay compared with 79.1% (95% CI, 71.2 to 85.1) in those women without diagnosis delay. In the multivariable Cox regression model, the risk of death was 73% higher (hazard ratio, 1.73; 95% CI, 1.09 to 2.74) in women with diagnosis delay compared with those without diagnosis delay.CONCLUSIONDelay in diagnostic confirmation of breast cancer after recognition of breast symptoms was negatively associated with overall survival in Addis Ababa, Ethiopia, underscoring the need to increase awareness about the importance of prompt presentation for clinical evaluation and referral for diagnostic confirmation to mitigate the undue high burden of the disease.

Background In patriarchal societies, female caregivers decide on food allocation within a family based on prevailing gender and age norms, which may lead to inequality that does not favor young adolescent girls. This study evaluated the effect of a community-based social norm intervention involving female caregivers in West Hararghe, Ethiopia. The intervention was engaging female caregivers along with other adult influential community members to deliberate and act on food allocation social norms in a process referred to as Social Analysis and Action (SAA). Method We used data from a large quasi-experimental study to compare family eating practices between those who participated in the Social Analyses and Action intervention and those who did not. The respondents were female caregivers in households with young adolescent girls (ages 13 and 14 years). The study’s outcome was the practice of family eating together from the same dish. The difference in difference (DID) analysis with the mixed effect logistic regression model was used to examine the effect of the intervention. Result The results showed improved family eating practices in both groups, but the improvement was greater in the intervention group. The DID analysis showed an 11.99 percentage points greater improvement in the intervention arm than in the control arm. The mixed-effect regression produced an adjusted odds ratio of 2.08 (95% CI [1.06–4.09]) after controlling selected covariates, p-value 0.033. Conclusions The involvement of influential adult community members significantly improves the family practice of eating together in households where adolescent girls are present in our study. The intervention has great potential to minimize household food allocation inequalities and thus improve the nutritional status of young adolescents. Further studies are necessary to evaluate the effectiveness of the intervention in different social norm contexts to formulate policy and guidelines for scale-up.

The study was conducted to investigate the breeding season, sex ratio, size at maturation, fecundity and condition factor of African catfish Clarias gariepinus in Lake Koka. A total of 754 fish specimens were collected from October 2020 to August 2021. Total length and weight were measured and sexes were identified and gonad maturity levels were recorded. The sex ratio of African catfish in different size classes was similar to that of a hypothetical 1:1 ratio. The length at first maturity (L50) was 51.8 cm in total length. The mean Fulton’s condition factor of female African catfish ranged from 0.65 ± 0.05 – 0.71 ± 0.14, while the males ranged from 0.62 ± 0.04 – 0.7 ± 0.11. The Fulton’s condition factor was significantly higher in August for females than in the rest of the sampling months. The highest ripe gonads were recorded in the rainy season and the lowest was in the dry season, with the percentage of ripe gonads being 27.5%, while the males showed similarly extended maturity patterns among seasons. Fisheries management for African catfish should therefore take into account the estimated L50 value and the main breeding season to sustain the fishery and benefits the fishermen.

Background: Clinical practice is the means by which nursing students learn to apply the theory, facilitating integration of theoretical knowledge and practical skill in the clinical setting which becomes arts and science of profession. This correlation of theory and practice, and the building of meaningful experience, take place during clinical practice in the health care service. Even though, nursing students need to have clinical competency during practical setting, there were little available evidences regarding to their competency status in Ethiopia. Therefore, this study was aimed to assess magnitude of clinical competency and its predictors among undergraduate nursing students studying in universities of Southern regional state of Ethiopia in 2021 G C. Methods: Multi-centered institutional based cross-sectional study was conducted among 414 undergraduate nursing students studying in eight universities of Southern regional state of Ethiopia in 2021 academic year. Systematic random sampling technique after proportional allocation to each selected university was used to select the study participants. Data were collected using pretested structured questionnaire by face to face interview after written informed consent was obtained from each participant. Data were cleaned, coded and entered into Epidata version 3.01 and analyzed using statistical package for social science (SPSS) software version 26. Descriptive statistic for all variables and bi-variable and multi-variables logistic regression analysis to identify factors associated with clinical competency was computed and expressed in odds ratio. The result was presented in the form of text, tables and figures and those variables with P-value of

The Afar region is characterized by an arid and semi-arid climate with erratic rainfall and is prone to frequent droughts despite being endowed with fresh and saline water bodies along the Awash River Basin. Lake Hertale is one of those fresh water bodies located in the middle of the Awash River Valley. The lake's fishery is presumed not to have been exploited before. The study attempted to describe some physico-chemical parameters, fish species composition, estimate production potential which are relevant to develop a lake fishery with the prospect of contributing to food and nutrition security. The nutrient and chlorphyl-a measurements indicated eutrophic state but with apparently comparative low primary biomass. Conductivity, dissolved oxygen and temperature were within the optimal range for warm water species along with slightly alkaline pH. It was found that Lake Hertale is home to four important fish species, namely, Nile Tilapia (Oreochromis niloticus), barbs (Lebobarbus intermidus), African catfish (Clarias gariepinus) and Common carp (Cyprinus carpio), Nile crocodiles, several species of birds and hippopotamus. Labeobarbus constituted 56%, followed by Nile tilapia with 31% of the total population. The African Catfish constituted only 9% of the catch. The mean lengths of African Catfish and Labeobarbus were 47.2 and 38 cm respectively. The mean lengths of Nile tilapia and Common carp were 22.8 and 21.7 cm respectively. The fish production potential of the lake was estimated from 94.3 to 238 tons per year, with an average production of 145.7 tons per year. The estimate production potential can support up to 21 to 28 fishers, with an average number of 25 fishermen to sustainably utilize the lake's fishery potential. Lake Hertale and other adjacent lakes in the Afar region of Ethiopia can complement to the fight against hunger and malnutrition. Besides, through appropriate fishery development intervention, it is possible to create employment for the predominantly pastoralist Afar community.

Malt Barley has a great contribution to food security and farm income in Debark district. Despite the contribution, there was a loss in Malt Barley production due to improper post-harvest handling at the farm level. Thus, this study assessed the extent of post-harvest loss in Malt Barley at different stages at the farm level and the factor affecting post-harvest loss of Malt Barley in Debark district. Three-stage purposive and simple random sampling techniques were applied to draw 223 samples. Tobit model was used to analyse factors affecting post-harvest loss at the farm level. The study result shows that post-harvest loss at the farm level was estimated to be 12.68%. The result from the Tobit model revealed that post-harvest loss was significantly influenced by variables such as family labour, education level, land allocated for Malt Barley, access to frequency of extension contact, storage facility, and volume of Malt Barley production. Therefore, expansion of adult and basic education for farmers, increasing the frequency of extension contact, the introduction of a harvesting machine, and proper storage facilities are expected to minimize post-harvest losses of Malt Barley at the farm level.

Abstract Sedentary time is associated with increased risks of detrimental health outcomes. Prolonged sedentary time associates with cardiometabolic risk factors and increased mortality regardless of physical activity. Therefore, the purpose of this study was to examine the associations of sedentary time and cardiometabolic risk factors among university employees in Eastern Ethiopia. A cross-sectional study was conducted among 1200 participants. Data were collected using the World Health Organization STEPS survey instrument, and sedentary behavior questionnaire in hour per day. Sedentary time is the time spent for any duration (minutes per day or hours per day) by considering a local context. Study participants were asked how many minutes or hours they spent in sedentary time at work, their leisure time and in transportation. Finally, the total sedentary time was calculated by the sum of the individual spent in sedentary time at work, leisure, and transportation. Cardiometabolic risk factors were assessed with blood samples analysis and anthropometric measurements. The associations between sedentary time and cardiometabolic risk factors were examined using linear regression models. An adjusted coefficient (β) with the 95% confidence interval (CI) was used to report the results. p value

Abstract Stunting is a public health issue of global concern. Despite, poor sanitation, diarrhea, parasitic infections, and environmental enteric dysfunction (EED) are associated with stunting, their link is poorly understood and has not been investigated in Ethiopia. This study was conducted to assess the associations of stunting with sanitation, enteric infections, and EED among children aged 24–59 months in rural northwest Ethiopia. A community-based cross-sectional study was conducted among 224 randomly selected children aged 24–59 months in rural areas of the east Dembiya district. We collected information on household food insecurity and dietary diversity using pre-tested questionnaires adopted from the food and nutrition technical assistance (FANTA) project. We used height-for-age-z score (HAZ) to define stunting. We also used the data collected to measure the environmental exposures of children to intestinal parasitic infections and fecal biomarkers of EED. A multivariable binary logistic regression model was used to assess the association of stunting with sanitation, enteric infections, and EED. Of the 224 children, 33% (95% CI 27, 39%) were stunted. Stunting in children was significantly associated with poor dietary intake (AOR 3.0, 95% CI 1.2, 7.3), open defecation practice (AOR 3.0, 95% CI 1.2, 7.9), presence of animal excreta in the living environment (AOR 3.4, 95% CI 1.2, 9.9), E. coli contamination of drinking water (AOR 4.2, 95% CI 1.1, 15.3), diarrheal disease incidence (AOR 3.4, 95% CI 1.5, 7.7), intestinal parasites in children (AOR 3.3, 95% CI 1.3, 8.8), and higher EED disease activity scores (AOR 2.9, 95% CI 1.2, 6.7). One-third of the children in the study area were stunted and this high prevalence of stunting was associated with poor dietary intake, poor hygiene and sanitation conditions, enteric infections, and EED. Thus, stunting can be prevented by improving sanitation and hygienic conditions to prevent repeated enteric infections in children and by promoting dietary diversity of children.

In this numerical study, ducted and flipped Ahmed model is used to study aerodynamic characteristics of ducted models and how ducting would contribute to the energy consumption reduction effort from aerodynamic resistance. Three-dimensional, incompressible, and steady governing equations were solved by commercial software PHOENICS (version 2018) with extended k-ε turbulent model proposed by Chen-Kim (1987). The study can be considered as a steppingstone to bring a new approach to design aerodynamically efficient vehicle by ducting target vehicles. To investigate the feasibility of the ducting for aerodynamic energy efficiency improvement, fundamental study has been conducted numerically on a simple body before applying to appropriate vehicle model. It is observed from the study that ducting a cross-sectional area of 9.6% of a model would reduce over 19% of the pressure drag at a speed of 100 km/h, to the contrary the increase in skin friction drag is noted although its significance to the total drag is very less compared to pressure drag. Therefore, study of air duct and its effect on aerodynamic performance is expected to contribute to improvement of electric vehicle aerodynamic performance. [ABSTRACT FROM AUTHOR]

Plain Language Summary Adverse birth outcomes are a major public health problem and a big challenge in Ethiopia, particularly in the study area. They encompass stillbirth, neonatal death, and neonatal illness within 28 days after birth. Globally, about 4 million babies die within the first month of birth annually with more than 3 million stillbirths. Of these, about 99% of newborn deaths and 98% of stillbirths occur in developing countries. As a solution to overcome those problems, a continuum of care in maternal health services is a core strategy. Therefore, this study was planned to determine how effective continuum of care in maternal health service is in reducing perinatal death and factors contributing to the adverse birth outcomes. In this study, 2198 pregnant women were recruited and followed for 11 months. The health condition of women was frequently assessed and recorded during pregnancy, childbirth and the period until 42 days after childbirth, as well as the health condition of the babies until 28 days after the birth, the package of maternal health services received, and adverse birth outcomes. Among the 2198 pregnant women enrolled in the study, 248 women encountered adverse birth outcomes (52 had stillbirths, 58 had neonatal death and 138 had neonatal illness). Risk factors of adverse birth outcomes were a poor household wealth index quintile, pregnancy-related maternal complications, offensive odor amniotic fluid, and history of stillbirth. On the other hand, protective interventions against adverse birth outcomes were receiving iron supplementation during pregnancy, initiating breastfeeding within 1 h, and immunizing the newborn. Moreover, completions of continuum of care in maternal health services via time and space dimensions reduced perinatal death. In conclusion, neonatal and perinatal deaths were high in the study areas. Completions of continuum of care in maternal health services via time and space dimensions reduced perinatal death, neonatal death, and stillbirth. The results of this study can inform national health policymakers, maternal and child programmers, and other stakeholders to prioritize and strengthen protective intervention and continuum of care in maternal health services.

Abstract Background Obstructive sleep apnea is a syndrome characterized by recurrent partial, or complete upper airway collapse during sleep. Although obstructive sleep apnea is common in type 2 diabetes mellitus, the majority of patients remain undiagnosed because of the prohibitive cost of the test and paucity of the sleep clinic, especially in developing nations. The study aimed to assess high-risk obstructive sleep apnea and its associated factors among type 2 diabetes mellitus patients at Wolkite University Specialized Hospital. Methods A Hospital-based comparative cross-sectional study was employed from October 15 to December 5, 2021, among 204 participants. Data collection was done by semi-structured interviewer-administered questionnaires. Data was entered into the Epi data version 4.6 and exported to SPSS version 25.0 for analysis. Independent t-test and chi-square test were used to compare continuous and categorical variables accordingly. Binary and multiple logistic regression analysis was used to assess factors associated with high-risk obstructive sleep apnea. Statistical significance was set at P-value

Objectives To explore the reasons for unintended pregnancy and effective prevention measures from the perspectives of women and healthcare providers in Addis Ababa, Ethiopia.Design Phenomenological qualitative study.Setting and participants This study was conducted at three public health facilities found in Addis Ababa, Ethiopia. Women with unintended pregnancies and healthcare providers currently working in maternal health services were purposively recruited for in-depth interviews. Twenty in-depth interviews were conducted until data saturation was achieved. Data were analysed using thematic analysis.Results Seven themes emerged from the transcribed interview data. These include: Personal characteristics (negligence; lower pregnancy expectation), family influence (fear of family), sociocultural and economic influence (stigma and discrimination), healthcare provider influence (disrespectful and abusive approach; disregard for women’s contraceptive choice), preconception thoughts and behaviours (unprotected early sexual practice; myths and misunderstanding), lack of access to quality family planning services (lack of trained contraceptive counsellor, inappropriate contraceptive use), and preventive strategies for unintended pregnancy (comprehensive sexual education; sexual and reproductive health and rights service integration)Conclusions This study identified multilevel reasons for unintended pregnancy from the perspective of the participants. Participants shared their views on preventive measures for unintended pregnancy, including comprehensive sexual education, service integration and male-inclusive contraceptive counselling. This study highlights the need to improve sexual and reproductive health services by shedding light on the viewpoints and experiences of women and healthcare providers.

Objectives The objective of this study was to determine the level of home-based optimal newborn care practice and associated factors among mothers in Ethiopia.Design A community-based longitudinal panel survey design.Setting, participants and outcomes We used data from the Performance Monitoring for Action Ethiopia panel survey (2019–2021). A total of 860 mothers of neonates were included in the analysis. A generalised estimating equation logistic regression model was used to identify factors associated with home-based optimal newborn care practice and to account for the clustering nature of the data by enumeration area. An OR with 95% CI was used to measure the association between exposure and outcome variables.Results The level of home-based optimal newborn care practice was 8.7% with 95% uncertainty interval ranging from 6% to 11%. After adjusting the effect of potential confounding factors, area of residence remained statistically significantly associated with mothers’ optimal newborn care practice. The chance of home-based optimal newborn care practice was 69% times lower among mothers from rural areas compared with those in urban areas (adjusted OR=0.31, 95% CI=0.15, 0.61).Conclusion The findings of this study showed that the level of home-based optimal newborn care practice was very low in Ethiopia. Also, home-based optimal newborn care practice was lower among mothers from rural areas in the nation. Therefore, health planners and healthcare providers, including health extension workers, should give priority attention to mothers from rural areas to improve their optimal newborn care practice by considering their context-specific factors or barriers.

BackgroundBoth hypertension (HTN) and diabetes are public health concerns in low- and middle-income countries, particularly in sub-Saharan African countries. The co-occurrence of HTN and diabetes is associated with an increased risk of mortality, morbidity, and reduced productivity in the working force. In Ethiopia, there is limited evidence on the co-occurrence of HTN and type 2 diabetes (T2DM). Therefore, this study was conducted to assess the co-occurrence of HTN and T2DM and their associated factors among Haramaya University employees in Eastern Ethiopia.MethodsA cross-sectional survey was conducted among 1,200 employees at Haramaya University using a simple random sampling technique from December 2018 to February 2019. Demographic and behavioral factors were collected on a semi-structured questionnaire, followed by measurement of anthropometry and blood pressure. Blood glucose and lipid profile measurements were performed by collecting 6 ml of venous blood samples after 8 h of overnight fasting. Data were entered into EpiData 3.1 version and analyzed using Stata 16 software. Bivariable and multivariable logistic regressions were applied to observe the association between independent variables with co-occurrence of HPN and T2DM using odds ratio, 95% confidence interval (CI), and p-values of ≤ 0.05 were considered statistically significant.ResultsThe prevalence of HTN and T2DM was 27.3 and 7.4%, respectively. The co-occurrence of HTN and T2DM was 3.8%. The study found that being older (AOR = 3.97; 95 % CI: 1.80–8.74), khat chewing (AOR = 2.76; 95 % CI: 1.23–6.18), body mass index ≥ 25 kg/m2 (AOR = 5.11; 95 % CI: 2.06–12.66), and sedentary behavior ≥8 h per day (AOR = 6.44; 95 % CI: 2.89–14.34) were statistically associated with co-occurrence of HTN and T2DM. On the other hand, consuming fruits and vegetables (AOR = 0.10; 95 % CI: 0.04–0.22) and a higher level of education (AOR = 0.39; 95% CI: 0.17–0.89) were negatively statistically associated with the co-occurrence of HTN and T2DM.ConclusionThe co-occurrence of HTN and T2DM was prevalent among the study participants. This may create a substantial load on the healthcare system as an end result of increased demand for healthcare services. Therefore, rigorous efforts are needed to develop strategies for screening employees to tackle the alarming increase in HTN and T2DM in university employees.

IntroductionAdverse pregnancy outcomes are a personal and social crisis caused by easily preventable pregnancy-related problems. Despite that, studies on the effectiveness of adherence to the continuity of antenatal care (ANC) services are scarce. Therefore, this study aims to determine the effectiveness of the continuity of ANC services and the determinants of adverse pregnancy outcomes.MethodsA prospective follow-up study design was conducted from March 2020 to January 2021 in Northwest Ethiopia among randomly selected study subjects. Data were collected by trained data collectors using pre-tested structured questionnaires and analyzed using STATA Software version 14. A multilevel regression model was used to identify determinant factors, whereas the propensity score matching (PSM) model was used to look at the effectiveness of adherence to ANC services on adverse pregnancy outcomes.ResultsAmong 2,198 study participants, 26.8% had adverse pregnancy outcomes, with 95% CI: 24.9–28.7 [abortion (6.1%; 95% CI: 5.1–7.1), low birth weight (11.5%; 95% CI: 10.2–12.9), and preterm birth (10.9; 95% CI: 9.6–12.3)]. Determinant factors were iron-folic acid supplementation (AOR = 0.52; 95% CI: 0.41, 0.68), delayed initiation of ANC visits at 4–6 months (AOR = 0.5; 95% CI: 0.32, 0.8), initiation of ANC visits after 6 months (AOR = 0.2; 95% CI: 0.06, 0.66), received four ANC visits (AOR = 0.36; 95% CI: 0.24, 0.49), an average time of rupture of the amniotic membrane of between 1 and 12 h (AOR = 0.66; 95% CI: 0.45, 0.97), and pregnancy-related problems (AOR = 1.89; 95% CI: 1.24, 2.9). As a treatment effect, completion of a continuum of visit-based ANC (ATET; β = −0.1, 95% CI: −0.15, −0.05), and continuum of care via space dimension (ATET; β = −0.11, 95% CI: −0.15, −0.07) were statistically significant on the reduction of adverse pregnancy outcomes.ConclusionIn the study area, the rate of adverse pregnancy outcomes was high. Even though adherence to the continuity of ANC services via time and space dimensions is effective in the prevention of adverse pregnancy outcomes, programmatically important factors were also detected. Therefore, key strategies for promoting the uptake of antenatal services and strengthening iron-folic acid supplementation are strongly recommended.

Background: Sustainable Development Goals −3 (SDG – 3) were to ensure healthy live and promote well-being by reducing global maternal and neonatal deaths. These were to be implemented through the concept of continuum of care in maternal health program framework to improve health outcomes. There is a paucity of published evidences; as such, this review is designed to assess the effectiveness of the concept of continuum of care in maternal and neonatal health services on the reduction of maternal and neonatal mortality. Methods: A search was conducted using the key words; maternal and neonatal, health services, continuum of care, maternal and neonatal mortality. Search focused on PubMed, Cochrane, MEDLINE and Google Scholar. Extractions of articles were done based on predetermine criteria. Data were compiled, and screened, entered and analysis was done using STATA 13 and Rev. Man. software. Effects of the intervention package were determined and the result was interpreted in random effect RR with 95%CI. The publication bias was determined by using funnel plot, Egger and Bagger test, heterogeneity, and sensitivity test. Results: A total of 4685 articles were retrieved of these 20 articles reviewed. Articles on 631,975 live births (LBs) were analyzed. Results showed the distribution as follows; 23,126 newborns died within 28 days resulting [NMR = 35/1000LBs among the intervention group whereas NMR = 39/1000LBs among the control group]. The pooled effect of the intervention was significantly reduced neonatal mortality (RR = 0.84; 95%CI: 0.77–0.91). Similarly, 1268 women died during the pregnancy period up to 42 days after childbirth that resulted [MMR = 330/100,000LBs among the intervention group whereas MMR = 460/100,000LBs among the control group]. The pooled effect of the intervention was not a statistically significant association with maternal mortality (RR = 0.64; 95%CI: 0.41–1.00). Conclusion: Adoption of continuum of care concepts in maternal health services reduced maternal and neonatal mortality. We recommend strengthening and effective implementation of a continuum of care in maternal health services to improve maternal and neonatal health care outcomes.

BackgroundConsiderable proportions of pregnant women are affected by poor nutrition outcomes in Ethiopia. Women's empowerment, on the other hand, is highly recognized as a means to achieve better maternal nutrition outcomes. However, the role of pregnant women's empowerment in nutritional status during pregnancy has not been empirically examined in Ethiopia. This study aimed to address this gap.ObjectiveTo assess the association of individual and composite women's empowerment dimensions with pregnant women's nutrition outcomes in West Shewa Zone, Ethiopia.MethodsA health facility-based cross-sectional study was performed on 1,453 pregnant women living in West Shewa Zone, Ethiopia, in 2021. Exploratory and confirmatory factor analyses were conducted on half of the samples to identify and validate dimensions of pregnant women's empowerment. The associations between pregnant women's empowerment dimensions and anemia status and mid upper arm circumference levels were examined by logistic regressions.ResultsComposite pregnant women's empowerment was positively associated with both anemia status and mid-upper-arm circumference level. The odds of not being anemic were higher among pregnant women empowered in economic [adjusted odds ratio (AOR) = 1.7, 95% confidence interval (CI): 1.26, 2.22] and assertiveness (AOR = 1.9, 95% CI: 1.46, 2.38) dimensions than those not empowered in these dimensions. Empowered pregnant women in household decision-making (AOR = 1.6, 95% CI: 1.19, 2.22) and psychological (AOR = 1.4, 95% CI: 1.04, 1.85) dimensions had higher odds of having normal mid-upper-arm circumference measures than those not empowered in the respective dimensions. Communication and time dimensions were not significantly associated with any of the nutrition outcomes.ConclusionsThis study suggests that empowered pregnant women are nutritionally better off than their less empowered counterparts. This is also important in child health outcomes. Policies and programs that aim to improve maternal and child health in the study area need to consider interventions that promote the decision-making power, economic, psychological, and assertiveness dimensions of pregnant women.