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The impact of breast-feeding on certain childhood respiratory illnesses remains controversial.We sought to examine the effect of exclusive breast-feeding on the early-life upper respiratory tract (URT) and gut microbiome, the URT immune response in infancy, and the risk of common pediatric respiratory diseases.We analyzed data from a birth cohort of healthy infants with prospective ascertainment of breast-feeding patterns and common pediatric pulmonary and atopic outcomes. In a subset of infants, we also characterized the URT and gut microbiome using 16S ribosomal RNA sequencing and measured 9 URT cytokines using magnetic bead-based assays.Of the 1949 infants enrolled, 1495 (76.71%) had 4-year data. In adjusted analyses, exclusive breast-feeding (1) had an inverse dose-response on the ⍺-diversity of the early-life URT and gut microbiome, (2) was positively associated with the URT levels of IFN-α, IFN-γ, and IL-17A in infancy, and (3) had a protective dose-response on the development of a lower respiratory tract infection in infancy, 4-year current asthma, and 4-year ever allergic rhinitis (odds ratio [95% CI] for each 4 weeks of exclusive breast-feeding, 0.95 [0.91-0.99], 0.95 [0.90-0.99], and 0.95 [0.92-0.99], respectively). In exploratory analyses, we also found that the protective association of exclusive breast-feeding on 4-year current asthma was mediated through its impact on the gut microbiome (P = .03).Our results support a protective causal role of exclusive breast-feeding in the risk of developing a lower respiratory tract infection in infancy and asthma and allergic rhinitis in childhood. They also shed light on potential mechanisms of these associations, including the effect of exclusive breast-feeding on the gut microbiome.

Background. Viral hepatitis are considered as the cause of solemn health problem for the human kind, particularly among pregnant women in the 21th century. Therefore, this study is aimed at determining the seroprevalence of HBV and HCV infection among pregnant women attending at Borumeda General Hospital, Dessie, Northeast Ethiopia. Methods. An institution-based cross-sectional study was conducted at Borumeda General Hospital from April to May, 2020. A consecutive total of 124 pregnant women who were attending at the antenatal clinic (ANC) of the hospital were included. A structured questionnaire was used to assess the associated factors and some sociodemographic characteristics. Five milliliters of venous blood was collected from each study participant, and a laboratory test using a rapid HBsAg and anti-HCV kit was done. The data were analyzed using SPSS software version 22. Results. The mean age of the study subjects was 25.81 (±5.967) years. The overall seroprevalence of either HBV or HCV infections among the study participants was 14 (11.3%). HBsAg and anti-HCV were positive among 10 (8.1%) and 4 (3.2%) study participants, respectively. There was no coinfection result between HBV and HCV among pregnant women. Pregnant women who had abortion history [AOR 5.723; 95% CI 1.100-29.785, P value = 0.038] and hospitalization history with IV medication [AOR 6.939; 95% CI 1.017-47.322, P value = 0.048] exhibited statistically significant association with HBV infection. Conclusions. Seroprevalence of HBV and HCV infections among pregnant women was high, and the rate of HBV particularly can be considered in the high endemic category of the WHO classification scheme. Continuous screening of pregnant mothers, provision of hepatitis B vaccine for females at the child-bearing age, and health education to create awareness about HBV and HCV should be implemented.

Whether children and people with asthma and allergic diseases are at increased risk for severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection is unknown.Our aims were to determine the incidence of SARS-CoV-2 infection in households with children and to also determine whether self-reported asthma and/or other allergic diseases are associated with infection and household transmission.For 6 months, biweekly nasal swabs and weekly surveys were conducted within 1394 households (N = 4142 participants) to identify incident SARS-CoV-2 infections from May 2020 to February 2021, which was the pandemic period largely before a vaccine and before the emergence of SARS-CoV-2 variants. Participant and household infection and household transmission probabilities were calculated by using time-to-event analyses, and factors associated with infection and transmission risk were determined by using regression analyses.In all, 147 households (261 participants) tested positive for SARS-CoV-2. The household SARS-CoV-2 infection probability was 25.8%; the participant infection probability was similar for children (14.0% [95% CI = 8.0%-19.6%]), teenagers (12.1% [95% CI = 8.2%-15.9%]), and adults (14.0% [95% CI = 9.5%-18.4%]). Infections were symptomatic in 24.5% of children, 41.2% of teenagers, and 62.5% of adults. Self-reported doctor-diagnosed asthma was not a risk factor for infection (adjusted hazard ratio [aHR] = 1.04 [95% CI = 0.73-1.46]), nor was upper respiratory allergy or eczema. Self-reported doctor-diagnosed food allergy was associated with lower infection risk (aHR = 0.50 [95% CI = 0.32-0.81]); higher body mass index was associated with increased infection risk (aHR per 10-point increase = 1.09 [95% CI = 1.03-1.15]). The household secondary attack rate was 57.7%. Asthma was not associated with household transmission, but transmission was lower in households with food allergy (adjusted odds ratio = 0.43 [95% CI = 0.19-0.96]; P = .04).Asthma does not increase the risk of SARS-CoV-2 infection. Food allergy is associated with lower infection risk, whereas body mass index is associated with increased infection risk. Understanding how these factors modify infection risk may offer new avenues for preventing infection.

Background Millions of people are bitten by venomous snakes annually, causing high mortality and disability, but the true burden of this neglected health issue remains unknown. Since 2015, Médecins Sans Frontières has been treating snakebite patients in a field hospital in north-west Ethiopia. Due to the poor market situation for effective and safe antivenoms for Sub-Saharan Africa, preferred antivenom was not always available, forcing changes in choice of antivenom used. This study describes treatment outcomes and the effectiveness and safety of different antivenoms used. Methodology / Principal findings This retrospective observational study included 781 snakebite patients presenting at the field hospital between 2015 and 2019. Adjusted odds ratios, 95%-CI and p-values were used to compare the treatment outcome of patients treated with Fav-Afrique (n = 149), VacSera (n = 164), and EchiTAb-PLUS-ICP (n = 156) antivenom, and to identify the risk of adverse reactions for each antivenom. Whereas only incidental snakebite cases presented before 2015, after treatment was made available, cases rapidly increased to 1,431 in 2019. Envenomation was mainly attributed to North East African saw-scaled viper (Echis pyramidum) and puff adder (Bitis arietans). Patients treated with VacSera antivenom showed lower chance of uncomplicated treatment outcome (74.4%) compared to Fav-Afrique (93.2%) and EchiTAb-PLUS-ICP (90.4%). VacSera and EchiTAb-PLUS-ICP were associated with 16- and 6-fold adjusted odds of treatment reaction compared to Fav-Afrique, respectively, and VacSera was weakly associated with higher odds of death. Conclusions / Significance Snakebite frequency is grossly underreported unless treatment options are available. Although EchiTAb-PLUS-ICP showed favorable outcomes in this retrospective analysis, prospective randomized trials are needed to evaluate the effectiveness and safety of the most promising antivenoms for Sub-Saharan Africa. Structural investment in sustained production and supply of antivenom is urgently needed.

In this cohort study of hospitalized patients with linked medical record data, we developed International Classification of Diseases (ICD) criteria that accurately identified laboratory-confirmed, severe influenza hospitalizations (positive predictive value [PPV] 80%, 95% confidence interval [CI] 71-87%), which we validated through medical record documentation. These criteria identify patients with clinically important influenza illness outcomes to inform evaluation of preventive and therapeutic interventions and public health policy recommendations.

Background A strong health information system (HIS) is one of the essential building blocks for a resilient health system. The Ministry of Health (MOH) of Ethiopia is working on different initiatives to strengthen the national HIS. Among these is the Capacity-Building and Mentorship Partnership (CBMP) Programme in collaboration with public universities in Ethiopia since November 2017. This study aims to evaluate the outcomes and share experiences of the country in working with universities to strengthen the national HIS. Methods The study employed a mixed-methods approach that included 247 health organizations (health offices and facilities) of CBMP-implementing woredas (districts) and 23 key informant interviews. The programme focused on capacity-building and mentoring facilities and woreda health offices. The status of HIS was measured using a connected woreda checklist before and after the intervention. The checklist consists of items related to HIS infrastructure, data quality and administrative use. The organizations were classified as emerging, candidate or model based on the score. The findings were triangulated with qualitative data collected through key informant interviews. Results The results showed that the overall score of the HIS implementation was 46.3 before and 74.2 after implementation of the programme. The proportion of model organizations increased from 1.2% before to 31.8% after the programme implementation. The health system–university partnership has provided an opportunity for higher education institutions to understand the health system and tune their curricula to address real-world challenges. The partnership brought opportunities to conduct and produce local- and national-level evidence to improve the HIS. Weak ownership, poor responsiveness and poor perceptions of the programme were mentioned as major challenges in programme implementation. Conclusion The overall HIS has shown substantial progress in CBMP implementation woredas. A number of facilities became models in a short period of time after the implementation of the programme. The health system–university partnership was found to be a promising approach to improve the national HIS and to share the on-the-ground experiences with the university academicians. However, weak ownership and poor responsiveness to feedback were the major challenges identified as needing more attention in future programme implementation.

Background Although Ethiopia is endemic to viral hepatitis and HIV, data that could guide population-specific interventions are limited. In this study, we determined the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and assessed their associations with HIV-1 viral load suppression among HIV-1 infected patients on antiretroviral therapy (ART) at Mekelle hospital in northern Ethiopia. Methods Between February and April 2020, blood samples were collected from 439 participants. Samples were screened for HBsAg and anti-HCV on the immunochromatographic test and confirmed using the Enzyme-Linked Immuno-sorbent assay (Beijing Wantai Co. China). HIV-1 viral load was quantified using reverse transcription-polymerase chain reaction (RT-PCR) on the Abbott platform. Binary and multivariable logistic regression was performed to identify potential predictors. Results Overall, 10% (44/439) and 3.6% (16/439) of the participants were coinfected with HBV and HCV, respectively. In a multivariate analysis, being illiterate (AOR = 6.57; 95% CI 1.04–41.6), and having a history of sexually transmitted infections (AOR = 4.44; 95% CI 1.31–15.0) and multiple sexual partners (AOR = 29.9; 95% CI 7.82–114.8) were associated with HBV infection. On the other hand, participants with a history of chronic non-communicable diseases (AOR = 10.6, 95% CI 1.61–70.1), and those reporting a history of sexually transmitted infections (AOR = 5.21, 95% CI 1.39–19.5) were more likely to be infected with HCV. In further analysis, HCV infection status was significantly associated with decreased viral load suppression rate (AOR = 7.14; 95% CI 2.18–23.3) whereas no significant association was observed with the HBV infection. Conclusions The HBV coinfection rate in our study is high and, as per WHO's standard, corresponds to a hyperendemic level. The HCV coinfection rate is also substantially high and urges attention given its influence on the viral load suppression of HIV patients on ART at our study site. Our findings suggest the need to adopt universal screening and vaccination of people with HIV against HBV and screening for HCV at our study site and in Ethiopia at large, which contributes to Ethiopia's progress towards the 2030 global target of reducing the HBV infection.

Background Due to the nutritive and immunologic benefits of breastmilk, children should be exclusively breastfed for the first 6 months of life, even during the corona virus pandemic. However, fear of transmission risk and pandemic-related restrictions could undermine the practice of breastfeeding. This study aimed to assess the knowledge, attitude, and determinants of exclusive breastfeeding (EBF) during COVID-19 among lactating mothers in Mekelle, Tigrai, Ethiopia. Methods A community based cross-sectional study was conducted among 621 lactating mothers living in Mekelle city, Tigrai, from April to June, 2021. Data were collected using an adapted form of a standard KAP questionnaire. Binary logistic regression was used to determine the independent determinants of EBF at a statistical significance of p Results Four hundred (64.4%) mothers exclusively breastfed their children. Infants from female-headed households had twice (AOR 2.21; 95% CI 1.31, 3.71) higher odds of EBF. Higher educational status was associated with higher odds of EBF practice. A unit increase in parity was associated with a 23% increase in the odds of EBF. Mothers who received breastfeeding information had a 73% (AOR 1.73; 95% CI 1.17, 2.56) higher odds of EBF. Moreover, mothers with high knowledge score and positive attitude showed a 74% higher (AOR 1.74; 95% CI 1.20, 2.51) and more than double (AOR 2.35; 95% CI 1.50, 3.70) odds of EBF, respectively. Conclusion About two-thirds of the mothers practiced EBF. Household head, maternal educational, parity, breastfeeding information, knowledge of breastfeeding, and attitude towards EBF were significant determinants of EBF. Our study findings highlighted that programs that enhance women’s participation in education and decision-making could improve EBF practice. Besides, during the COVID-19 pandemic, providing lactating mothers with adequate and up-to-date breastfeeding information could be significant in improving EBF practice.

ObjectiveThe study was aimed to assess the prevalence of depression and anxiety symptoms and their determinant factors among patients with cancer attending follow-up at Hawassa University Comprehensive Specialized Hospital cancer treatment centre, Ethiopia.DesignInstitution-based cross-sectional study design was implemented.SettingPatients with cancer at Hawassa University Comprehensive Specialized Hospital cancer treatment centre from October 2019 to December 2019.ParticipantsRandomly selected 415 patients with cancer who had follow-up at cancer treatment centre.Main outcome measuresAnxiety and depression symptoms were assessed using Hospital Anxiety and Depression Scale.ResultThe prevalence rates of depression and anxiety symptoms were found to be 244 (58.8%) and 249 (60.0%), respectively. Older age (>50 years) (AOR (adjusted OR)=2.24, 95% CI=1.14 to 4.40), being unemployed (AOR=1.96, 95% CI=1.08 to 3.56), advanced stage of cancer such as stage III (AOR=5.37, 95% CI=1.34 to 21.45) and stage IV (AOR=4.55, 95% CI=1.12 to 18.44), comorbid psychotic symptoms (AOR=1.67, 95% CI=1.07 to 2.61) and eating problem in the past 2 weeks (AOR=6.16, 95% CI=1.98 to 19.11) were independent factors significantly associated with depressive symptoms. In addition, cancer stage such as stage II (AOR=3.92, 95% CI=1.07 to 14.36) and stage IV (AOR=5.04, 95% CI=1.44 to 17.59) and comorbid psychotic symptoms (AOR=1.73, 95% CI=1.12 to 2.66) were significantly associated with anxiety symptoms.ConclusionDepression and anxiety symptoms among patients with cancer were considerably high. Age, occupation, cancer stage, comorbid psychotic symptoms and eating problem were determinant factors of depressive symptoms among patients with cancer. Moreover, cancer stage and comorbid psychosis were determinants of anxiety symptoms. Healthcare professionals working in the oncology unity need to conduct routine screening and treatment of depression and anxiety symptoms for patients with cancer.

Background Bacteremia is a major cause of morbidity and mortality worldwide. Children infected with HIV present with patterns of bacteremia that are generally associated with poor prognosis. In Mozambique, data on bacteremia are sparce, with most studies describing the epidemiology of pediatric bacteremia limited to patients near the capital city of Maputo, in the south. Methods We conducted an observational study of HIV-infected and HIV-exposed uninfected children, aged 0-59 months, that were hospitalized with fever between April 1, 2016 and February 28, 2019. A single blood specimen for bacterial culture was collected at admission. Descriptive statistics were used to summarize microorganisms detected and antibiotic susceptibility testing. Results A total of 808 HIV-infected (90%) and HIV-exposed uninfected (10%) children aged 0-59 months were enrolled in our study. The blood culture positivity rate was 12% (95% CI: 9.9%-14.4%). Five organisms accounted for most cases, with Staphylococcus Aureus being most common (37%), followed by Klebsiella spp (11%), Salmonella spp (11%), Escherichia Coli (9%) and Micrococcus (7%). Antibiotic resistance was common. Nearly 70% of Staphylococcus Aureus isolates were methicillin-resistant and roughly 50% of Klebsiella isolates had ESBL production. Conclusion Community-acquired bacteremia was common in HIV-infected and HIV-exposed uninfected children hospitalized in Mozambique with a febrile illness. A high rate of MRSA and ESBL producing organisms has implications for the empiric antibiotic choices utilized in Mozambique. Longitudinal data on the prevalence and antimicrobial resistance patterns of important pathogens are badly needed to guide national policy for drug formulary expansion and antibiotic prescription guidelines.

Background Wheeze and allergic sensitization are the strongest early-life predictors of childhood asthma development; the molecular origins of these early-life phenotypes are poorly understood. Objectives We sought to identify metabolites associated with early-life wheeze, allergic sensitization, and childhood asthma. Methods We conducted a nested case-control study using Environmental influences on Child Health Outcomes Program cohorts for discovery and independent replication. Wheeze and allergic sensitization were defined by number of wheeze episodes and positive specific IgE at age 1 year, respectively. Asthma was defined as physician diagnosis of asthma at age 5 or 6 years. We used untargeted metabolomics, controlling for observed and latent confounding factors, to assess associations between the plasma metabolome and early-life wheeze, allergy, and childhood asthma. Results Eighteen plasma metabolites were associated with first-year wheeze in the discovery cohort (n = 338). Z,Z unconjugated bilirubin (UCB) and its related metabolites exhibited a dose-response relationship with wheeze frequency; UCB levels were 13% (β = 0.87; 95% CI, 0.74-1.02) and 22% (β = 0.78; 95% CI, 0.68-0.91) lower in children with 1 to 3 and 4+ wheeze episodes compared with those who never wheezed, respectively. UCB levels were also associated with childhood asthma (β = 0.82; 95% CI, 0.68-0.98). Similar trends were observed in 2 independent cohorts. UCB was significantly negatively correlated with eicosanoid- and oxidative stress–related metabolites. There were no significant associations between metabolites and allergic sensitization. Conclusions We identified a novel inverse, dose-dependent association between UCB and recurrent wheeze and childhood asthma. Inflammatory lipid mediators and oxidative stress byproducts inversely correlated with UCB, suggesting that UCB modulates pathways critical to the development of early-life recurrent wheeze and childhood asthma.

Background Underweight is one of the largest contributors to child morbidity and mortality and is considered to be the largest contributor to the global burden of diseases in low-and middle-income countries. In Mauritania, where one-fifth of children are underweight, there is a dearth of evidence on socio-economic, sex and geographic disparities in childhood underweight. As a result, this study aimed at investigating the socio-economic, sex and geographic disparities in childhood underweight in Mauritania. Methods Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Mauritania Multiple Indicator Cluster Surveys (MICSs) conducted between 2007 and 2015 were analysed. Childhood underweight was disaggregated by five equity stratifiers: education, wealth, residence, region and sex. In addition, absolute and relative inequality measures, namely difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF) were calculated to understand inequalities from wider perspectives. Corresponding 95% confidence intervals (CIs) were computed to measure statistical significance. Results Substantial absolute and relative socio-economic, sex and geographic disparities in underweight were observed from 2007 to 2015. Children from the poorest households (PAR=−12.66 [95% CI −14.15 to −11.16]), those whose mothers were uneducated (PAF=−9.11 [95% CI −13.41 to −4.81]), those whose mothers were rural residents (R=1.52 [95% CI 1.37 to 1.68]), residents of HodhCharghy (PAF=−66.51 [95% CI −79.25 to −53.76]) and males (D=4.30 [95% CI 2.09 to 6.52]) experienced a higher burden of underweight. Education-related disparities decreased from 2007 to 2015. The urban–rural gap in underweight similarly decreased over time with the different measures showing slightly different reductions. Wealth-driven disparities decreased marginally from 2011 to 2015. The sex-based and regional disparities increased, at least on average, over the 8-y intersurvey period. Conclusions The burden of underweight was significantly higher among children from disadvantaged subpopulations, those with uneducated and poorest/poor mothers, those living in rural areas and those living in HodhCharghy. Special nutrition intervention and efforts focused on these deprived subpopulations are required to reduce childhood morbidity and mortality associated with underweight and help achieve the Sustainable Development Goals.

Introduction. Sexually transmitted infections (STIs) are prevalent in Ethiopia and elsewhere among different population groups particularly among female sex workers (FSWs). Because of their work and their behavior, FSWs are at high risk to acquire STIs. The aim of the study was to assess the seroprevalence and associated factors of HIV, HBV, HCV, and T. pallidum among FSWs in Dessie City, Northeast Ethiopia. Methods. This cross-sectional study was conducted in Dessie City, Amhara Region, Northeastern Ethiopia, from November 2017 to April 2018. A total of 360 FSWs whose age is greater than or equal to 18 years and who are willing to participate were recruited by simple random sampling technique. Interview-based questionnaire was administered, and 5 ml of venous blood from each participant was drawn under aseptic conditions. The rapid test was performed to obtain the result of the four STIs (HIV, T. pallidum, HBV, and HCV). The collected data were entered and analyzed by SPSS version 20.0. From the bivariable analysis, variables having P value < 0.2 were retained into multivariable analysis. From the multivariable analysis, variables with P value < 0.05 were affirmed as statistically associated factors. Adjusted odds ratios and their 95% confidence intervals were used as indicators of the strength of association. Results. Majority of study participants were urban dwellers, 10 (2.8%) respondents were married, 61 (16.9%) have more than two children, and more than half of them were at the age range between 18 and 27 years. Any infection with STIs was 84 (23.3%), whereas 27 (7.5%), 47 (13.1%), 2 (0.6%), and 45 (12.5%) study participants were positive for laboratory test of HIV, HBV, HCV, and T. pallidum, respectively. Marital status, sharing of sharp materials, breakage of condom, number of customers per week, genital discharge, and pain had significant association with any STI. Conclusions. In comparison with different research works in Ethiopia and abroad, the prevalence of any STI, HIV, HBV, and T. pallidum was found to be relatively high. Preventive approach and appropriate treatment of STIs should be developed. Concerned body should work together to alleviate the problem by counseling and recruiting them on other productive job sectors in the country.

BACKGROUND Childhood asthma is a common chronic disease that likely has prenatal origins. Gestational diabetes alters maternal physiology and may influence fetal risk for childhood-onset disease. However, the association between gestational diabetes and child asthma is not well characterized. OBJECTIVE To investigate the association between gestational diabetes and wheeze/asthma at approximately 4 years of age in a racially diverse US cohort. METHODS We studied mother-child dyads enrolled prenatally in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study. Gestational diabetes was determined by medical chart review. At approximately 4 years of age, we assessed child respiratory outcomes including parent report of physician-diagnosed asthma (ever), current wheeze (symptoms within the past 12 months), and current asthma (physician diagnosis and/or medication or symptoms within the past 12 months). We used the modified Poisson regression to assess associations between gestational diabetes and child respiratory outcomes, adjusting for maternal age, race, prenatal smoking, pre-pregnancy body mass index, parity, asthma history, socioeconomic status, and infant sex. RESULTS Among 1107 women, 66% were African American/Black. Six percent (n = 62) had gestational diabetes documented during pregnancy. Gestational diabetes was associated with increased risk of physician-diagnosed asthma (adjusted risk ratio (RR) [95% Confidence Interval]: 2.13 [1.35, 3.38]; prevalence: 14%), current wheeze (RR: 1.85 [1.23, 2.78]; prevalence: 19%), and current asthma (RR: 2.01 [1.30, 3.10]; prevalence: 16%). CONCLUSIONS Gestational diabetes was associated with increased risk of asthma and wheeze outcomes. Additional studies are needed to elucidate modifiable pathways underlying this association.

Background Pneumonia is a leading public health problem in under-five children worldwide and particularly in Africa. Unfortunately, progress in reducing pneumonia related mortality has been slow. The number of children with symptoms of pneumonia taken to health facilities for treatment is low in Ethiopia, and disparities among sub-groups regarding health seeking behavior for pneumonia have not been well explored in the region. This study assessed the trends of inequalities in care seeking behavior for children under five years of age with suspected pneumonia in Ethiopia. Methods Using cross-sectional data from the 2005, 2011 and 2016 Ethiopia Demographic and Health Surveys (DHS) and the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT), this study investigated the inequalities in health seeking behavior for children with suspected pneumonia. Four measures of inequality were calculated: Difference, Ratio, Slope Index of Inequality and Relative Index of Inequality. Results were disaggregated by wealth, education, residence, and sex with computed 95% Uncertainty Intervals for each point estimate to determine significance. Results The percentage of under-five children with symptoms of pneumonia who were taken to a health facility was significantly lower for children in the poorest families, 15.48% (95% UI; 9.77, 23.64) as compared to children in the richest families, 61.72% (95% UI; 45.06, 76.02) in 2011. Substantial absolute (SII = 35.61; 95% UI: 25.31, 45.92) and relative (RII = 4.04%; 95% UI: 2.25, 5.84) economic inequalities were also observed. Both educational and geographic inequalities were observed; (RII = 2.07; 95% UI: 1.08, 3.06) and (D = 28.26; 95% UI: 7.14, 49.37), respectively. Economic inequality decreased from 2011 to 2016. There was no statistically significant difference between male and female under-five children with pneumonia symptoms taken to health facility, in all the studied years. Conclusions Health care seeking behavior for children with pneumonia was lower among the poorest and non-educated families as well as children in rural regions. Policies and strategies need to target subpopulations lagging behind in seeking care for pneumonia treatment as it impedes achievement of key UN sustainable development goals (SDGs).

Childhood wheeze, asthma, and allergic rhinitis are common and likely have prenatal origins. Oxidative stress is associated with respiratory disease, but the association of oxidative stress during the prenatal period with development of respiratory and atopic disease in childhood, particularly beyond the infancy period, is unknown. This study aims to investigate associations between prenatal oxidative stress, measured by maternal urinary FWe prospectively studied Black (n = 717) and White (n = 363) mother-child dyads. We measured FThe prevalence of provider-diagnosed asthma and current wheeze, asthma and allergic rhinitis was 14%, 19%, 15%, and 24%, respectively. Median (IQR) FPrenatal urinary F

Introduction Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal. Materials and methods A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,—the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score. Results A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25–50%), Grade-3 (50–75%), Grade-1 (0–25%), and Grade-4 (75–100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma. Discussion The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one’s family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.

BackgroundIt is unknown whether RSV infection in infancy alters subsequent RSV immune responses.MethodsIn a nested cohort of healthy, term children, peripheral blood mononuclear cells (PBMCs) were collected at ages 2-3 years to examine RSV memory T cell responses among children previously RSV infected during infancy (first year of life) compared to those RSV-uninfected during infancy. The presence vs. absence of infant RSV infection was determined through a combination of RSV molecular and serologic testing. Memory responses were measured in RSV stimulated PBMCs.ResultsCompared to children not infected with RSV during the first year of life, children infected with RSV during infancy had lower memory T cell responses at ages 2-3 years to in vitro stimulation with RSV for most tested type-1 and type-17 markers for a number of memory T cell subsets.ConclusionsRSV infection in infancy has long-term effects on memory T cell responses. This is the first study to show the potential for RSV infection in infancy to have long-term effects on the immune memory irrespective of the severity of the infection. Our results suggest a possible mechanism through which infant RSV infection may result in greater risk of subsequent childhood respiratory viral morbidity, findings also relevant to vaccine development.

Background Undernutrition puts children in a physical and cognitive disadvantage. Animal source foods (ASFs) are important components of nutritious diets and play a significant role in increasing dietary diversity and minimizing the risk of undernutrition among children. Ethiopia still suffers from child undernutrition and there’s no adequate information regarding consumption of ASFs. The objective of this study was to determine the magnitude and determinanats of ASF consumption among children 6–23 months of age. Methodology A total weighted sample of 2861 children drawn from the 2016 Ethiopian demographic and health survey was analyzed using “SVY” command of STATA 14.0. Multivariable logistic regression was used to determine the independent determinants of ASF consumption. The strength of the association was measured by odds ratio and 95% confidence interval and p-value Results Nearly half (46.5%) of the children reported consuming any type of ASF. Religion, child age, number of household assets, number of livestock owned by a household, and ownership of land usable for agriculture were significant determinants of the outcome variable. The odds of ASF consumption were six times, twice, and 70% lower in orthodox children compared to other (catholic, traditional, or others), muslim, and protestant children, respectively. Household ownership of assets and livestock led to an increase in consumption of ASF by 19 and 2%, respectively. Children aged 18–23 months were more likely to consume ASF as compared to the younger age group (6–8 months old children). In the contrary, children from households that own land usable for agriculture were 33% less likely to consume ASFs as compared to those from households that do not own. Conclusions In Ethiopia, only nearly half of children aged 6–23 months consume any type of ASF. The findings of this study imply that ASF consumption can be increased through integrated actions that involve community and religious leaders and programs focused on empowering households’ capability of owning other socioeconomic entities including assets and livestock. This study also may contribute to the growing body of research works on the importance of ASF provision in preventing child undernutrition.

Postnatal exposures, including breastfeeding, may influence asthma development.To investigate the association between breastfeeding duration and child asthma.We studied 2021 mother-child dyads in the ECHO PATHWAYS consortium of prospective pregnancy cohorts (GAPPS, CANDLE, TIDES). Women reported the duration of any and exclusive breastfeeding and child asthma outcomes during follow-up at child age 4 to 6 years. Outcomes included current wheeze (previous 12 months), ever asthma, current asthma (having ≥2 of current wheeze, ever asthma, medication use in past 12-24 months), and strict current asthma (ever asthma with either or both current wheeze and medication use in past 12-24 months). We used multivariable logistic regression to assess associations (odds ratios and 95% confidence intervals) between breastfeeding and asthma outcomes adjusting for potential confounders. We assessed effect modification by mode of delivery, infant sex, and maternal asthma.Among women, 33%, 13%, 9%, and 45% reported 0 to less than 2, 2 to 4, 5 to 6, and more than 6 months of any breastfeeding, respectively. The duration of any breastfeeding had a protective linear trend with ever asthma but no other outcomes. There was a duration-dependent protective association of exclusive breastfeeding and child asthma outcomes (eg, current asthma adjusted odds ratio [95% confidence interval], 0.64 [0.41-1.02], 0.61 [0.38-0.98], and 0.52 (0.31-0.87) for 2to 4 months, 5 to 6 months, and more than 6 months, respectively, compared with2 months). For exclusive breastfeeding, protective associations were stronger in dyads with children born by vaginal vs cesarean delivery although interactions did not reach statistical significance (PLonger duration of exclusive breastfeeding had a protective association with child asthma.

Introduction Evidence suggests that a better understanding of determinants of antenatal care (ANC) utilization is crucial to reducing maternal and child deaths. Little is known about the utilization of ANC services in Guinea. Objective The aim of this study was to explore factors determining utilization of skilled ANC in Guinea. Methods This study focused on a sample of 7812 ever married women. Using multivariate logistic regression, factors associated with the utilization of ANC were identified. The output of the multivariate logistic regression was presented using adjusted odds ratio and the corresponding 95% confidence interval (CI). Results Several factors had significant association with utilization of skilled ANC service in Guinea: having decision-making power (2.21, 95% CI: 1.63, 3.00), employment status (1.86, 95% CI: 1.39, 2.48), media exposure (1.60, 95% CI: 1.26, 2.02), maternal education (2.68, 95% CI: 1.36, 5.28), husband/partner education status (1.66, 95% CI: 1.08, 2.55), household economic status (2.19, 95% CI: 1.40, 3.44), place of residence (0.29, 95% CI: 0.16, 0.50) and ethnicity (0.40, 95% CI: 0.23, 0.69). Conclusions These findings suggest a variety of socio-demographic and economic factors as well as media exposure are associated with women’s use of ANC. Policymakers should implement appropriate measures to address the existing variations and gaps in ANC services utilization among different subgroups of women in Guinea.

BackgroundIn Ethiopia, there is a paucity of studies on inequality in caesarean section using methodologically rigorous and well-established approaches. In this study, we showed extent and the overtime dynamics of inequality in caesarean section in Ethiopia following rigorous methodologies.MethodsThe data for analysis came from Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) to analyze the data. Caesarean delivery was disaggregated by four equity stratifiers, namely education, wealth, residence and regions. Relative and absolute summary measures were calculated for each equity stratifier to capture inequality from different perspectives. 95% Uncertainty Interval was calculated around a point estimate to measure statistical significance.ResultsWe found large socioeconomic and area-based inequalities in use of caesarean section in all study surveys. The inequalities have occurred in favour of socioeconomically advantaged women and those living in urban areas and certain regions such as Addis Ababa. While area-related inequality had generally increased with time, socioeconomic inequality showed fluctuation. Adoption of different measures in the study for the inequality analysis has caused the emergence of mix of patterns in caesarean section inequality over time.ConclusionsIn all the surveys, wealthy and more educated women, and those residing in urban areas had higher chance of obtaining caesarean delivery. Policy makers should work to ensure caesarean section that is in the accepted normal range. More emphasis should be drawn to subpopulation with under use of caesarean section while at the same time, discouraging unjustified use of it.

Background The decrease in the magnitude of stunting over the past 20 years has been slow in Ethiopia. To date, in Ethiopia, the trends in and extent of inequality in stunting have not been investigated using methods suitably developed for disparity studies. This paper investigated both the extent and overtime dynamics of stunting inequality in Ethiopia over the last 17 years. Methods Using the World Health Organization’s Health Equity Assessment Toolkit software, data from the Ethiopia Demographic and Health surveys (EDHS) were analyzed between 2000 and 2016. The inequality analysis consisted of disaggregated rates of stunting using five equity stratifiers (economic status, education, residence, region and sex) and four summary measures (Difference, Population Attributable risk, Ratio and Absolute Concentration Index). A 95% uncertainty interval was constructed around point estimates to measure statistical significance. Results The study showed that both absolute and relative inequalities in stunting exist in all the studied years in Ethiopia. The inequality disfavors children of mothers who are poor, uneducated and living in rural areas and specific regions such as Amhara. The pro-rich (R = 1.2; 1.1, 1.3 in 2000 to R = 1.7; 1.4, 2 in 2016) and pro-educated (R = 1.6; 95%UI = 1.3, 1.9 in 2000 and R = 2.3; 95%UI = 1.5, 3 in 2011) inequalities slightly increased with time. Male children bear a disproportionately higher burden of stunting, and the disparity increased between the first and the last time points (PAR = −1.5 95%UI = −2.5, −0.6 in 2000 and PAR = −2.9 95%UI = −3.9, −1.9) based on complex measures but remained constant with simple measures (R = 1; 95%UI = 0.9, 1.1 in 2000 and R = 1.1 95%UI = 1, 1.2 in 2016). Similarly, both the sub-national regional and residence-related stunting disparities generally widened over time according to some of the inequality measures. Conclusions Stunting appeared to be highly prevalent among certain sub-groups (i.e. poor, uneducated and living in rural regions). The subpopulations experiencing excessively high stunting prevalence should be the focus of policy makers’ attention as they work to achieve the WHO 40% reduction in stunting target by 2025 and the UN Agenda 2030 for Sustainable Development Goals.

Background: African ancestry is associated with a higher prevalence and greater severity of asthma than European ancestries, yet genetic studies of the most common locus associated with childhood-onset asthma, 17q12–21, in African Americans have been inconclusive. The aim of this study was to leverage both the phenotyping of the Children's Respiratory and Environmental Workgroup (CREW) birth cohort consortium, and the reduced linkage disequilibrium in African Americans, to fine map the 17q12–21 locus. Methods: We first did a genetic association study and meta-analysis using 17q12–21 tag single-nucleotide polymorphisms (SNPs) for childhood-onset asthma in 1613 European American and 870 African American children from the CREW consortium. Nine tag SNPs were selected based on linkage disequilibrium patterns at 17q12–21 and their association with asthma, considering the effect allele under an additive model (0, 1, or 2 effect alleles). Results were meta-analysed with publicly available summary data from the EVE consortium (on 4303 European American and 3034 African American individuals) for seven of the nine SNPs of interest. Subsequently, we tested for expression quantitative trait loci (eQTLs) among the SNPs associated with childhood-onset asthma and the expression of 17q12–21 genes in resting peripheral blood mononuclear cells (PBMCs) from 85 African American CREW children and in upper airway epithelial cells from 246 African American CREW children; and in lower airway epithelial cells from 44 European American and 72 African American adults from a case-control study of asthma genetic risk in Chicago (IL, USA). Findings: 17q12–21 SNPs were broadly associated with asthma in European Americans. Only two SNPs (rs2305480 in gasdermin-B [GSDMB] and rs8076131 in ORMDL sphingolipid biosynthesis regulator 3 [ORMDL3]) were associated with asthma in African Americans, at a Bonferroni-corrected threshold of p

Background The occurrence of uterine rupture has dropped significantly in high income countries. It continues, however, to be a major public and clinical health problem in low income countries including Ethiopia. Aim of this study was to assess management outcomes of uterine rupture and associated factors in Yirgalem General and Teaching Hospital in South Ethiopia. Methods Institution-based cross-sectional study was conducted to examine medical records of women with uterine rupture between January 1, 2012, and Decem”ber 31, 2017. Data were collected based on a checklist. Descriptive statistics and logistic regression analyses were performed. Results Incidence of uterine rupture was 345 in 13,500 live births (25.5 in 1000 live births) in the study period. Of these, 331 cases were included. Poor maternal outcome occurred in 224 (67.7%) women. There were 13 (3.7%) maternal deaths and 320 (96.7%) stillbirths. Wound site infection (131; 39.6%) and anemia (129; 39%) were the most common post-operative complications. Prolonged duration of labor (more than 24 h) (adjusted odds ratio (aOR) 3.6; 95% CI 1.7–7.4), women with sepsis on admission (aOR 2.9; 95% CI 1.4–6.1), hemoglobin level Conclusion Poor maternal outcome of uterine rupture was high in the study area as compared to other studies. Proper management of anemia, prompt surgical treatment, proper labor progress monitoring, surgical skills, improved infection prevention, maximizing blood transfusion availability and improving the quality of maternal healthcare all play a significant role in reducing uterine rupture and enhancing the chance of good outcomes.

Background Atopic dermatitis is a common childhood disease, potentially influenced by prenatal nutritional exposures such as polyunsaturated fatty acids (PUFAs). Objective In a racially diverse cohort, we hypothesized that childhood atopic dermatitis would be associated with higher prenatal omega-6 (n-6) and lower omega-3 (n-3) PUFAs. Methods We included mother-child dyads, births 2006 to 2011, enrolled in the University of Tennessee Health Sciences Center Conditions Affecting Neurocognitive Development in Early Childhood cohort. Primary exposures included second trimester plasma n-3 and n-6 PUFA status and the ratio of the two (n-6:n-3). We assessed child current atopic dermatitis symptoms in the previous 12 months at age approximately 4 to 6 years. We investigated the association between PUFA exposures and atopic dermatitis using multivariable logistic regression, adjusting for potential confounders. We assessed for effect modification by maternal prenatal smoking, atopic disease history, and child sex. Results Among 1131 women, 67% were African American and 42% had an atopic disease history; 17% of children had atopic dermatitis. Higher prenatal n-6 PUFAs were associated with increased relative odds of child atopic dermatitis (adjusted odds ratio: 1.25; confidence interval: 1.01-1.54 per interquartile range difference), and interaction models demonstrated that this association was seen in dyads in which the women had a history of atopic disease. Neither prenatal n-3 PUFAs nor n-6:n-3 were associated with child atopic dermatitis. Conclusion In this racially diverse cohort, higher second trimester n-6 PUFAs were associated with atopic dermatitis in children of women with atopy. PUFAs may represent a modifiable risk factor for atopic dermatitis, particularly in individuals with a familial predisposition.

Background Timely initiation of breastfeeding or breastfeeding within 60 min of birth has been shown to be associated with significantly lower risk of infant mortality. The World Health Organization recommends starting breastfeeding within the first hour of birth, yet many women in sub-Saharan Africa do not observe this recommendation. To date, there is limited evidence of timely initiation of breastfeeding for Zimbabwe. Therefore, we undertook this study with the aim of calculating the trend in timely initiation of breastfeeding and to explore the correlates. Methods We used five rounds of Zimbabwe Demographic and Health Survey data conducted between 1999 and 2015. Participants were 15,923 mothers currently breastfeeding or who had a childbirth within five years preceding the surveys. Outcome variable was self-reported timing of timely breastfeeding for singleton births which was categorized as early ( Results Prevalence of timely initiation of breastfeeding was 60.3% (95% Confidence Interval [CI] 57.44, 63.02) in 1999, 66.9% (95% CI 64.32, 69.4) in 2006, 65.8% (95% CI 63.7, 67.8) in 2011 and 58.3% (95% CI 56.3, 60.4) in 2015. It increased by 27 and 22% in 2006 and 2011 compared with that of the 1999 level respectively. We found no socio-economic and gender-based differentials in the prevalence of timely initiation of breastfeeding. Compared with women aged 15–19 years old, women 25–29 and 30–34 years old had higher odds of practicing timely initiation of breastfeeding. The odds of practicing timely initiation of breastfeeding among Muslim women (adjusted odds ratio [aOR] 1.2, 95% CI 1.07, 1.36) was 20% higher when compared with Christian mothers. Women who wanted to have their last child later (aOR 0.89, 95% CI 0.81, 0.97) had 11% lower odd of practicing timely initiation of breastfeeding when compared with women who wanted children then. Conclusions The prevalence of timely initiation of breastfeeding in Zimbabwe was 58.3% in 2015, well over the 50% target recommended by WHO for all countries to attain by 2025.

Background The potential for prenatal antibiotic exposure to influence asthma risk is not clear. We aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. Methods We conducted a population-based cohort study of 84 214 mother–child dyads to examine the association of prenatal antibiotic exposure and childhood asthma using multivariable logistic regression models. Results Sixty-four percent of pregnant women received antibiotics. Prenatal antibiotic exposure was associated dose-dependently with increased odds of childhood asthma (adjusted odds ratio [aOR] for interquartile increase of 2 courses [interquartile range, 0–2], 1.26 [95% confidence interval {CI}, 1.20–1.33]). Among children exposed to at least 1 course in utero, the effect of timing at the first course was moderated by total maternal courses. Among pregnant women receiving a single antibiotic course, timing of exposure had no effect on childhood asthma risk. Among women receiving > 1 course, early exposure of the first course was associated with greater childhood asthma risk. Compared to narrow spectrum–only antibiotic use, broad spectrum–only antibiotic exposure was associated with increased odds of asthma (aOR, 1.14 [95% CI, 1.05–1.24]). There were effect modifications (P Conclusions Increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk. Our study provides important evidence supporting judicious prenatal antibiotic use, particularly timing of use and choice of antibiotics, in preventing subsequent childhood asthma.

Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6–59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7–9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in high-burden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one’s anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non–disease specific approaches to pediatric anemia management and should include improved access to blood culture.

BACKGROUND: Sexual satisfaction is an essential component of overall health related quality of life. However, the epidemiology of sexual satisfaction among Ethiopian women is largely unknown. Hence, the present study was undertaken to investigate the sexual satisfaction and its associated factors among married women.METHODS: Community-based cross-sectional study with mixed approach was conducted from March 1 to April 30, 2019 in Kewot District, Northern Ethiopia on a sample of 397 married women. Quantitative data was collected on a face-to-face interview using a pre-tested questionnaire while qualitative data was collected using in-depth interviews. The new sexual satisfaction scale was used to assess sexual satisfaction of the women. Descriptive statistics and ordinal logistic regression analysis were performed using SPSS version 23.RESULTS: The findings showed that half of the participants (50.4%) expressed moderate sexual satisfaction, and only 39% of the participants reported greatest sexual satisfaction. Poor partner communication (AOR = 0.30, 95% CI; 0.11- 0.79], poor sexual self-esteem (AOR = 0.17, 95% CI; 0.08 - 0.36), absence of social responsibility (AOR = 6.52, 95% CI; 3.32 - 12.80), poor sexual function (AOR = 0.36, 95% CI; 0.21 - 0.61), no previous information about sexuality (AOR = 0.06, 95% CI; 0.00 - 0.62) and perception of sexual talk as taboo (AOR = 7.15, 95% CI; 3.86 - 13.26) were significantly associated with sexual satisfaction.CONCLUSION: Several factors could affect sexual satisfaction of married women. Therefore, development of educational programs, pre-marriage counseling and continuous education should be conducted.

Background Limited studies in Ethiopia showed that infants and young children are at high risk of inadequate intake of energy and nutrients. However, inclusive assessment of both nutrient intakes and their food sources are lacking. We aimed at assessing energy and nutrient intakes and their food sources during religious fasting and non-fasting periods among 6–23 months old children in Northern Ethiopia. Methods Data for this longitudinal study were collected following repeated multiple-pass 24-h dietary recall technique through face-to-face interviews with primary caregivers. Using a two-stage systematic random sampling method, a total of 570 and 551 children participated respectively in the lent fasting and non-fasting periods. Energy and nutrient intakes were estimated and compared with WHO daily requirements. All foods that a child consumed on the day preceding the date of data collection were recorded and processed with database software. Chi-square and t- tests were used to analyze the data. Non-normally distributed data were analyzed using Wilcoxon signed-rank test and statistical significance was set at p Results The overall prevalence of child stunting was 41.4%. Almost all of children (99.6%) consumed grains, roots, and tubers. The inadequacy prevalence of energy, protein and eight selected micronutrients (calcium, iron, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin C) intake were 96.2, 44.9, and 95.5%, respectively. Calcium and zinc were the highest (100%) deficits observed across all age groups. Although consumption of animal source foods (ASFs) was very low (dairy 10.1%, meat 2.3% and eggs 23.6%), there was significantly higher consumption of meat and eggs during the non-fasting compared to fasting period (p Conclusions Inadequate intake of energy and nutrients was common among 6–23 months old children. Cereals were found to be the main sources of many of the nutrients. The consumption of ASFs among 6–23-month-old children was low which was also affected by the religious fasting period. Hence, strengthening social and behavior change communication, supporting rural households to raise poultry and small ruminants is recommended.

Background Plasmodium falciparum is the most serious, genetically most complex and fastest-evolving malaria parasite. Information on genetic diversity of this parasite would guide policy decision and malaria elimination endeavors. This study explored the temporal dynamics of P. falciparum population in two time points in Metehara, east-central Ethiopia. Methods The participants were quantitative real-time polymerase chain reaction-confirmed patients who were recruited for uncomplicated falciparum malaria therapeutic efficacy test in 2015 and 2019. Dry blood spot samples were analysed by the nested PCR to genotype P. falciparum merozoite surface protein (msp1, msp2) and glutamate-rich protein (glurp) genes. Results While msp1, msp2 and glurp genotypes were successfully detected in 26(89.7%), 24(82.8%) and 14(48.3%) of 2015 samples (n = 29); the respective figures for 2019 (n = 41) were 31(68.3%), 39(95.1%), 25(61.0%). In 2015, the frequencies of K1, MAD20 and RO33 allelic families of msp1, and FC27 and IC/3D7 of msp2 were 19(73.1%), 8(30.6%), 14(53.8%), 21(87.5%), 12(50.5%); and in 2019 it was 15(48.4%), 19(61.3%), 15(48.4%), 30(76.9%), 27(69.2%) respectively. MAD20 has shown dominance over both K1 and RO33 in 2019 compared to the proportion in 2015. Similarly, although FC27 remained dominant, there was shifting trend in the frequency of IC/3D7 from 50.5% in 2015 to 69.2% in 2019. The multiplicity of infection (MOI) and expected heterozygosity index (He) in 2015 and 2019 were respectively [1.43 ± 0.84] and [1.15 ± 0.91], 0.3 and 0.03 for msp1. However, there was no significant association between MOI and age or parasitaemia in both time points. Conclusion The lower genetic diversity in P. falciparum population in the two time points and overall declining trend as demonstrated by the lower MOI and He may suggest better progress in malaria control in Metehara. But, the driving force and selective advantage of switching to MAD20 dominance over the other two msp1 allelic families, and the dynamics within msp2 alleles needs further investigation.

Background The roles of systemic and airway-specific epithelial energy metabolism in altering the developmental programming of airway epithelial cells (AECs) in early life are poorly understood. Objective Our aim was to assess carbohydrate metabolism in developing AECs among children with and without wheeze and test the association of infant plasma energy biomarkers with subsequent recurrent wheeze and asthma outcomes. Methods We measured cellular carbohydrate metabolism in live nasal AECs collected at age 2 years from 15 male subjects with and without a history of wheeze and performed a principal component analysis to visually assess clustering of data on AEC metabolism of glycolitic metabolites and simple sugars. Among 237 children with available year 1 plasma samples, we tested the associations of year 1 plasma energy biomarkers and recurrent wheeze and asthma by using generalized estimating equations and logistic regression. Results Children with a history of wheeze had lower utilization of glucose in their nasal AECs than did children with no wheeze. Systemically, a higher plasma glucose concentration at year 1 (within the normal range) was associated with decreased odds of asthma at age 5 years (adjusted odds ratio = 0.56; 95% CI = 0.35-0.90). Insulin concentration, glucose-to-insulin ratio, C-peptide concentration, and leptin concentration at year 1 were associated with recurrent wheeze from age 2 years to age 5 years. Conclusion These results suggest that there is significant energy metabolism dysregulation in early life, which likely affects AEC development. These pertubations of epithelial cell metabolism in infancy may have lasting effects on lung development that could render the airway more susceptible to allergic sensitization.

ObjectiveThis study aimed to analyse the prevalence and factors associated with continuum of maternal healthcare services among women who gave birth in Siyadebirena Wayu district, Central Ethiopia.DesignCommunity-based cross-sectional study.SettingAt eight Kebeles in Central Ethiopia.ParticipantsThe study was done on 614 women aged 15–49 years using interviewer-administered structured questionnaire. Following proportional allocation of the sample, we used simple random sampling technique to select study participants.MethodsBinary logistic regression model was fitted to identify the factors associated with the outcome. Variables with pOutcomeContinuum of maternal healthcare utilisation.ResultsOnly 16.1% (95% CI 13.3% to 19.0%) of the women had used a complete continuum of maternal health services. Variables, such as contraceptive use (AOR 4.95; 95% CI 1.61 to 15.20), autonomy (AOR 4.45; 95% CI 1.69 to 11.60), urban residence (AOR 3.91; 95% CI 1.06 to 14.39), educated women (AOR 5.36; 95% CI 1.15 to 25.06), took less than 30 min to reach a health facility (AOR 3.17; 95% CI 1.38 to 7.25), use public transportation (AOR 2.48; 95% CI 1.12 to 5.52) and good knowledge (AOR 9.88; 95% CI 3.89 to 25.0) were positively associated with continuum of maternal healthcare. In the contrary, women who had third child birth order (AOR 0.22; 95% CI 0.06 to 0.8) was negatively associated.ConclusionsOverall, the level of the continuum of maternal healthcare services utilisation was low compared with the national and global targets. Therefore, programme planners and implementer had better conduct health education to enhance the awareness of women about continuum of maternal healthcare services. Healthcare sector policy-makers and managers shall also scale up healthcare facilities to improve access to maternal healthcare services.

OBJECTIVE: Pregnant women with asthma have increased frequency of respiratory viral infections and exacerbations. Because of these risks, women with asthma may be subject to increased surveillance during pregnancy and may, therefore, be at increased risk of antibiotic receipt. The objective of this study was to assess the relationship between maternal asthma and outpatient prenatal antibiotic prescription fills to inform antibiotic stewardship. METHODS: We included women who delivered a singleton, term, non-low birthweight, and otherwise healthy infant enrolled in the Tennessee Medicaid Program. Maternal asthma and prenatal antibiotic fills were ascertained from healthcare encounters and outpatient pharmacy claims. We examined the association between maternal asthma and prenatal antibiotic fills using modified Poisson regression. RESULTS: Our study population included 168354 pregnant women, 4% of whom had asthma. Women with asthma had an increased risk of filling at least one prenatal antibiotic prescription (adjusted risk ratio [aRR] 1.27, 95% confidence interval [CI] 1.25–1.28) and had an increased number of fills during pregnancy (aRR 1.54, 95% CI 1.51–1.57) compared to women without asthma. Among those who filled at least one antibiotic prescription, women with asthma had earlier first prenatal antibiotic prescription fill and increased likelihood of filling at least one course of broad-spectrum antibiotics during pregnancy (versus narrow-spectrum). CONCLUSIONS: Pregnant women with asthma had more outpatient antibiotic prescription fills than pregnant women without asthma. These findings highlight that pregnant women with asthma disproportionately fill more antibiotic prescriptions during pregnancy, providing data that may inform antibiotic stewardship.

Background: Balneotherapy and hydrotherapy offer interesting treatment alternatives and are commonly used as additional interventions in the management of musculoskeletal disorders and pain management. Therefore, the aim of this study was to assess the effect of balneotherapy on musculoskeletal disorder pain and its perceived improvement among users of hot spring water in Southern Ethiopia. Methods: A single-arm cohort study and convenient sampling method were used to select 1337 study participants from four hot springs in Southern Ethiopia. A structured questionnaire, a physical examination, and laboratory blood tests were used to collect data. Data were entered using Epi data and transferred to SPSS 25 for cleaning and analysis. Descriptive analysis was made. Results: A total of 1279 participants were included in the study, giving a response rate of 96%. The majority of these patients have multiple health problems. Of all, 1137 (88.9%) of the patients were visiting the hot springs for joint pain followed by muscle pain 669 (52.2). Out of all cases of joint pain, 132 (11.6%) were clinically diagnosed with rheumatoid arthritis, and 5.3% were confirmed as having the disease based on a laboratory test. Of the total number of study participants, 1064 (83.2%) reported complete relief from the complaints they had at the start of the bath. Conclusions: Hot spring baths for three and more days have significant therapeutic effects on patients with musculoskeletal disorders, including rheumatoid arthritis. Physicians who are currently working in the area of diagnosis and treatment of patients in government and public facilities of the southern region should consider hot spring bath treatment for those patients with complaints of musculoskeletal pain, nonspecific arthritis, and rheumatoid arthritis. A hot spring bath is beneficial for everyone because it is a natural treatment with few side effects and a low cost.

Introduction African women are affected by cancer at an early age of their productivity. However, the exact prevalence and incidence of cancer, including breast cancer is not known in most sub-Saharan African countries, including Ethiopia because of lack of well-established cancer registry. This study aims to assess the epidemiology of breast cancer at Hawassa University Comprehensive Specialized Hospital (HUCSH), the biggest referral hospital with cancer treatment center serving the southern part of the country. Methods Retrospective review of charts of all patients with a diagnosis of breast cancer between 2013 and 2019 at HUCSH was conducted. A standardized questionnaire was used to collect relevant data that include sociodemographic, symptoms, type of diagnosis, treatment, and outcomes. Data were entered using epidata version 3.1 and analyzed using MS Excel and SPSS version 20. Results Five hundred fifty-nine (18.6%) breast cancer cases were retrieved in 7 years between 2013 and 2019. Of this, 548 (98%) were women. The median ages of the patents were 38 years. Invasive ductal carcinoma was the leading 309 (55.3%) histologic type followed by 185 (33.1%) lobular carcinoma. One hundred seventy-seven (31.7%) were moderately differentiated and 155 (27.7%) were poorly differentiated. Three hundred seventy-two (66.5%) were advanced breast cancer (Stages III and IV). Trends of breast cancer showed the case load is continuously increasing except with a slight reduction of cases in between 2015 and 2016. The majority were advanced breast cancer occurring at an early age by the time diagnosis made. Invasive ductal carcinomas were the predominant one. The trend also showed a continuous increment of cancer case load. Therefore, cancer registration center establishment, community awareness creation, and intensive early detection strategy are mandatory.

Background Animal source foods (ASFs) are rich in high-quality proteins, including essential amino acids and highly bioavailable micronutrients vital for child growth and cognitive development. But, the daily consumption of ASFs among 6–23 months old children is very low in Tigray, Northern Ethiopia. Objective The study aimed to assess the effectiveness of nutrition education intervention to improve the consumption of ASFs among 6–23 months old children from rural communities with strict religious fasting traditions of avoiding intake of ASFs in Northern Ethiopia. Methods A quasi-experimental study was conducted in two food insecure districts namely Samre Seharti (intervention) and Tanqua Abergele (comparison). The mother-child pairs in the intervention group (n = 140) received nutrition education based on the barriers and available resources for optimal consumption of ASFs among children and followed up for nine months. The mother-child pairs in the comparison group (n = 153) received routine nutrition education. The data were collected using a pre-tested structured questionnaire. The baseline and endline data assessment included interviews on socio-demographic and socio-economic status, dietary intake, and child feeding practices. The effectiveness of the intervention was measured using the difference-in-difference (DID) analysis model. Results At endline, the consumption of ASFs among children was 19.5 percentage points higher in the intervention group compared with the comparison group (p = 0.008). In addition, there was a significant increase in egg consumption among children in the intervention group (DID of 16.9, p = 0.012) from the comparison group. No child was consuming meat at baseline in both the intervention and comparison arms and it was very low at endline (5.2% vs. 7.9%). Overall, the proportion of children that consumed eggs in the intervention group was higher than in the comparison group in households that owned sheep and goats (4.8% vs. 21.4%, p = 0.050) and chicken (6.3% vs. 43.8%, p = 0.002) after education interventions. However, no statistically significant difference was observed between cow ownership and milk consumption among children (p>0.05). Conclusions Age-appropriate educational interventions for mothers and owning small livestock in the household can improve the consumption of ASFs and eventually the minimum diet diversity of children in communities with strict religious traditions of avoiding ASFs during the fasting seasons.

IntroductionContemporary literature has revealed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causes acute sialadenitis and related symptoms, such as discomfort, pain, swelling, and secretory dysfunction in salivary glands. The secretory dysfunction is due to SARS-CoV-2 infection-induced xerostomia and other associated clinical courses such as sore tongue, mucosal ulcer, and gingivitis in the oral cavity. Furthermore, it has been reported that COVID-19 causes the development of other oral manifestations.Materials and methodsA prospective clinical follow-up (a prevalent cohort) study was conducted to identify the possible oral manifestations of SARS-CoV-2 infection among patients admitted toat the Eka General Hospital COVID-19 treatment center. Furthermore, the study aimed to calculate the prevalence rate of oral clinical courses in the cohorts. The study consisted of two follow-up phases: Hospital and patient-home-based.ResultsA total of 55 patients (36 males and 19 females) met the inclusion criteria and were followed for 7.5 weeks. The 3.5 weeks hospital-based prospective follow-up study documented an 18% (n = 10) prevalence rate of oral clinical courses among the cohorts. Twelve oral symptoms appeared in these ten patients. The manifested oral symptoms were oral mucosal lesions (n = 6), xerostomia (n = 5), and thickening of saliva (n = 1). The oral mucosal lesions per se consisted of aphthous lesions (n = 3), candidiasis (n = 1), geographic tongue (n = 1), and localized gingivitis (n = 1). The four weeks’ home-based follow-up study disclosed four newly manifested oral symptoms: hemorrhagic crust, bulla, buccal mucositis, and petechiae. These manifestations appeared among six patients (four males and two females) who had not manifested any oral symptoms during the hospital-based follow-up. Accordingly, the overall prevalence of oral clinical courses among patients presented with SARS-CoV-2 is raised from 18% (n = 10) to 29% (n = 16). Similarly, the number of clinical courses increased from 12 to 16 after four additional weeks of follow-up.DiscussionThe study’s findings suggest the importance of initiating oral health care for patients with COVID-19. Therefore, multidisciplinary healthcare approaches should be delivered to assure optimal health outcomes. Accordingly, oral health professionals must be a substantial part of the interdisciplinary approach in caring for patients with COVID-19.

Artículo con numerosos autores, sólo se mencionan el primero, los de la UAM y grupo colectivo, A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of, This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation awarded to S.I.H.

BackgroundThyrotoxicosis is the state of thyroid hormone excess. But, in sub-Saharan Africa (SSA), specifically Northern Ethiopia, scientific evidence about thyrotoxicosis and its cardiac complications like dilated cardiomyopathy is limited. Therefore, this study aimed to explore the thyrotoxicosis presentation and management and identify factors associated with dilated cardiomyopathy in a tertiary hospital in Northern Ethiopia.MethodsAn institution-based cross-sectional study was conducted in Ayder Comprehensive Specialized Hospital from 2017 to 2018. Data from 200 thyrotoxicosis cases were collected using a structured questionnaire. After describing variables, logistic regression was conducted to identify independent predictors of dilated cardiomyopathy. Statistical significance was declared atp ResultsMean age at presentation of thyrotoxicosis was 45 years and females accounted for 89 % of the cases. The most frequent etiology was multinodular toxic goiter (51.5 %). As well, the most common symptoms and signs were palpitation and goiter respectively. Thyroid storm occurred in 6 % of the cases. Out of 89 patients subjected to echocardiography, 35 (39.3 %) of them had dilated cardiomyopathy. And, the odds of dilated cardiomyopathy were higher in patients who had atrial fibrillation (AOR = 15.95, 95 % CI:5.89–38.16,p = 0.001) and tachycardia (AOR = 2.73, 95 % CI:1.04–7.15,p = 0.040). All patients took propylthiouracil and 13.0 % of them experienced its side effects. Concerning β-blockers, propranolol was the most commonly (78.5 % of the cases) used drug followed by atenolol (15.0 %). Six patients underwent surgery.ConclusionsIn developing countries like Ethiopia, patients with thyrotoxicosis have no access to methimazole which is the first-line anti-thyroid drug. Besides, they greatly suffer from dilated cardiomyopathy (due to late presentation) and side effects of propylthiouracil. Therefore, we recommend that patients should get adequate health information about thyrotoxicosis and anti-thyroid drugs including their side effects. Additionally, hospitals and other concerned bodies should also avail of TSH tests and methimazole at an affordable cost. Furthermore, community awareness about iodized salt and iodine-rich foods should be enhanced.

Background Leaving no one behind has been an important marker of the Sustainable Development Goals. Closing the gap in malnutrition between children of different backgrounds aligns well with the tenet of this international agenda. To this end, high-quality evidence of the magnitude and trends of socioeconomic and geographic related existing inequalities in the childhood stunting among Sudanese children emanate from this study help for policy maker and planners to design and implement effective interventions to narrow down inequality. Methods We used the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) for our analysis of stunting inequality. Following standard equity analysis methods recommended by the WHO, we performed the disaggregated analysis of stunting across five equity stratifiers: Wealth, education, residence, sex, and sub-national regions. Then, we summarized stunting inequality through four measures of inequality: Difference, Ratio, Slope Index of Inequality (SII), and Relative Index of Inequality (RII). The point estimates of stunting were accompanied by 95% confidence intervals to measure the statistical significance of the findings. Results In this study, the national average childhood stunting prevalence was increased by 4% from 2010 to 2014. The findings revealed stark inequalities in stunting in all the studied dimensions of inequality. Huge inequality has existed along the wealth quintiles. Simple difference measure for education was increased by four points and simple relative measure decreased by one point for economic status. Conclusions Sex, residence and, geographically related inequalities remain unchanged over time, while economic status and educational inequality had seen a change by some inequality measures over the same time period.

Background. In developing countries, most maternal deaths are related to the lack of accessibility and availability of reproductive health services. In those nations, emergency contraceptive pills are the most commonly used family planning methods to prevent unintended pregnancy. However, women do not use this family planning method for different reasons. Consequently, women expose to unsafe abortion which results in maternal morbidity and mortality. Objective. To assess the knowledge of and utilization of emergency contraceptive and its associated factors among women seeking induced abortion in public hospitals, Eastern Tigray, Ethiopia, 2017. Methods. Hospital-based cross-sectional study was conducted on 380 women, who came for safe termination of pregnancy from April to July 2017. Systematic random sampling technique was used. Pretested structured questionnaire was used to collect data through interview. Data were entered using Epi Info version 7 and exported to SPSS version 20 for analysis. Data were presented using descriptive statistics. Bivariate and multivariate logistic regression was carried out to see if there was significant association between variables at P<0.05 and 95% confidence interval (CI). Result. Out of the total 369 respondents, 149 (40.4%) had the knowledge about emergency contraceptive pills. The magnitude of utilization of emergency contraceptive among respondents was found to be 45 (12.2%). Protestant in religion (AOR = 60.85, CI (5.34–693.29)), previous utilization of any contraceptive method (AOR = 0.13, CI (0.05–0.36)), and women who were not knowledgeable about emergency contraceptive (AOR = 0.030, CI (0.006–0.14)) were significantly associated with the utilization of emergency contraceptive. Conclusion. Most of the women were not knowledgeable about emergency contraceptive and utilization of emergency contraceptive was also very low. In conclusion, religion, knowledge, and previous utilization of emergency contraceptive were associated with the utilization of emergency contraceptive.

Objectives This study aimed to determine the unfavorable outcomes and to assess factors contribute to the unfavorable management outcomes after cesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. Results The unfavorable maternal management outcomes were Adhesion 28 (8.3%), excessive blood loss and blood transfusion 19 (5.6%), cesarean hysterectomy 10 (3%), relaparotomy 5 (1.5%), wound infection and wound dehiscence 23 (6.8%). Unfavorable fetal outcomes were were stillbirth 9 (2.6%), early neonatal death 8 (2.4%), low birth weight 58 (17.2%). women who did not book for Antenatal Care and having a history of previous cesarean delivery were found to be associated with unfavorable maternal outcomes and indications of cesarean delivery as obstructed labor was associated with unfavorable fetal outcomes.

The aim of this study was to evaluate the causes of and contributors to maternal death at Hawassa Referral Comprehensive Specialised Hospital (HRCSH). A health facility–based, maternal death review was used. All maternal deaths that occurred between January 2016 and August 2017 in HRCSH were included. Data were collected using a structured data collection sheet and analysed. Eighty-two maternal deaths that occurred over a 20-month period were reviewed, of which 77 met the inclusion criteria. A total of 8466 births occurred in HRCSH during the study period. The overall facility-based maternal mortality rate (MMR) was 910 deaths per 100,000 live births. The majority of maternal deaths (69 deaths; 89.6%) were due to direct causes, with pregnancy-induced hypertension as the leading direct cause of 33 deaths (42.8%). Eight avoidable factors were identified in this review. Twenty-six patients (33.9%) died as a result of a combination of three or more factors. Patient-oriented and transport/referral factors were the most common avoidable factors, with each contributing to 62 deaths (80.5%). Prenatal patients would benefit from receiving information regarding danger signs that could assist in the early detection of health problems and increase the likelihood that they seek health care.Impact StatementWhat is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting.What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths.What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems. What is already known on this subject? Most maternal deaths are preventable. However, maternal mortality rates remain high despite the presence of multiple measures in the southern part of Ethiopia. There is no adequate information about the maternal death rate in the study setting. What do the results of this study add? Hawassa Referral Comprehensive Specialised Hospital is a regional health centre. This study found that combinations of several factors may be contributing to a high maternal death rate. Most notably, transport, delay management initiation after admission and referral factors account for the majority of maternal deaths. What is the implication of these findings for clinical practice/or further research? Identification of potential problems could assist context-based management of problems. It helps in improving the level of practical skills for the management of pregnancy-related complications like hypertension. It also solves problems in the health services system like access to interventions. It insists on intersectoral collaboration to solve the transportation problems.