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

Introduction Zero-dose children refer to a child who has not yet received any childhood vaccines. Globally, zero-dose children are the major public health problem. In sub-Saharan African countries, one among five children do not have access to vaccines. But the efforts to identify the factors contributing to the zero-dose children are not well addressed in Ethiopia.Objectives To assess individual and community-level maternal factors of zero-dose children in Ethiopia using mini-Ethiopian Demographic Health Survey 2019.Methods A secondary analysis of a cross-sectional study was used among a total of 3208 participants. STATA-14 was used for descriptive and multilevel binary logistic regression (mixed effects model) analysis. Model selection was conducted using Akaike information criteria. To identify significant factors for zero-dose children, a p value of

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

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

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