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Abstract In the field of healthcare, ensuring patient safety is a critical priority that has garnered global recognition as a pressing public health concern. Despite notable progress in medical treatments and diagnostic technologies, patients continue to be at risk of adverse events and harm during the perioperative period. Anesthetists hold a pivotal position in this phase of patient care and have the potential to greatly impact safety and outcomes. This research sought to assess the knowledge, attitudes, and influencing factors of anesthetists concerning patient safety in government referral hospitals situated in Addis Ababa, Ethiopia. Between January and June 2021, a multi-center cross-sectional study was conducted in 13 governmental referral hospitals located in Addis Ababa. Data were collected using a standardized and pre-tested self-administered questionnaire. The collected data was analyzed using Statistical Package for Social Sciences (SPSS) software version 24.0. The variables and their associated factors were examined for their association with logistic regression, and significance was determined at a P-value of less than 0.05. Of the anesthesia professionals surveyed, 238 (86.86%) completed the questionnaire. The study revealed that over half of the participants had good knowledge (56.7%) and a positive attitude (68.9%). Factors significantly associated with patient safety knowledge included having patient safety information during continuing education [AOR = 4.016; 95% CI: (1.99–8.07)] and having a working experience of more than 15 years [AOR = 3.9; 95% CI: (1.23–12.29)]. Additionally, those who received patient safety training [AOR =2.0; 95% CI: (1.2–3.64)] were more likely to have a positive attitude than those who did not receive such training. The study found that a majority of Ethiopian anesthetists hold a favorable view toward patient safety, with 56.7% demonstrating good patient safety knowledge and 68.9% exhibiting a favorable attitude toward patient safety. Work experience, continuous education, patient safety training, and strong knowledge were identified as crucial factors in ensuring patient safety.Therefore, it is recommended that anesthesia professionals participate in educational programs and receive training in patient safety to address these concerns.

IntroductionAlthough late initiation of antenatal care has been linked with adverse pregnancy outcomes, a significant number of pregnant women in resource-limited regions are seeking this care late. There has been a lack of information on the extent and factors influencing late initiation of antenatal care in the African context following the implementation of the new antenatal care model in 2016. Thus, we aimed to determine the pooled prevalence of late antenatal care visit and its determinants among women in Sub-Saharan Africa (SSA) using national surveys conducted after the implementation of new guidelines.MethodsWe analyzed data from the recent demographic and health survey (DHS) conducted in 16 SSA between 2018 and 2022 using a weighted sample of 101,983 women who had antenatal care follow-up during their index pregnancy. A multilevel logistic regression models were fitted and likelihood and deviance values were used for model selection. In the regression model, we used adjusted odds ratios along with their corresponding 95% confidence intervals to determine the factors associated with late antenatal care visit.ResultsThe pooled prevalence of late antenatal care visit among pregnant women in SSA was 53.8% [95% CI: 46.2% - 61.3%], ranging from 27.8% in Liberia to 75.8% in Nigeria. Women's age and education, working status, partner's education, health insurance coverage, birth order, household wealth, age at marriage, decision on health care, residence, and community-level women's illiteracy were the factors associated with late antenatal care visit.ConclusionMore than half of pregnant women in SSA initiated attending antenatal care during late pregnancy, with significant differences seen among countries. These results underscore the necessity for focused interventions to tackle these issues and enhance prompt access to antenatal services for better maternal and child health outcomes in the area. Moreover, creating tailored interventions for younger women, those with multiple previous births, employed women, and those who experienced early marriage to address their specific challenges and obstacles in seeking care is crucial.

Background Sexually transmitted infections (STIs) are a significant global health challenge, demanding attention and intervention. Despite many STIs being manageable, their asymptomatic nature poses a formidable threat to both mental and physical well-being. This silent impact can lead to substantial morbidity and mortality, which is particularly pronounced in East Africa.Objective To investigate the prevalence and factors associated with self-reported STIs among sexually active men in East Africa.Design Cross-sectional study design.Setting 10 East African countries.Participants 66 833 sexually active men.Primary outcome measure Self-reported STI in the 12 months preceding the survey. A multilevel mixed-effects logistic regression model was fitted to identify factors associated with self-reported STIs. An adjusted OR with the corresponding 95% CI was used to estimate the strength of the association, and statistical significance was set at a p value

ABSTRACT Severe hypokalemia can primarily present as a weakness of the limbs, without any other clinical manifestation. A life‐threatening level of decreased serum potassium level can be unusually present with isolated weakness of the limbs and might be misdiagnosed, or the diagnosis may be delayed.

Introduction Application of data science in maternal, newborn, and child health (MNCH) across Africa is variable with limited documentation. Despite efforts to reduce preventable MNCH morbidity and mortality, progress remains slow. Accurate data are crucial for holding countries accountable for tracking progress towards achieving the Sustainable Development Goal 3 targets on MNCH. Data science can improve data availability, quality, healthcare provision and decision-making for MNCH programmes. We aim to map and synthesise data science use cases in MNCH across Africa.Methods and analysis We will develop a conceptual framework encompassing seven domains: (1) infrastructure and systemic challenges, (2) data quality, (3) data governance, regulatory dynamics and policy, (4) technological innovations and digital health, (5) capacity development, human capital and opportunity, (6) collaborative and strategic frameworks and (7) recommendations for implementation and scaling.We will use a scoping review methodology involving literature searches in seven databases, grey literature sources and data extraction from the Digital Health Atlas. Three reviewers will screen articles and extract data. We will synthesise and present data narratively and use tables, figures and maps. Our structured search strategy across academic databases and grey literature sources will find relevant studies on data science in MNCH in Africa.Ethics and dissemination This scoping review does not require formal ethical review and approval because it will not involve collecting primary data. The findings will showcase gaps, opportunities, advances, innovations, implementation and areas needing additional research. They will also propose next steps for integrating data science in MNCH programmes in Africa. The implications of our findings will be examined in relation to possible methods for enhancing data science in MNCH, such as community and clinical settings, monitoring and evaluation. This study will illuminate data science applications in addressing MNCH issues and provide a holistic view of areas where gaps exist and where there are opportunities to leverage and tap into what already exists. The work will be relevant for stakeholders, policymakers and researchers in the MNCH field to inform planning. Findings will be disseminated through peer-reviewed journals, conferences, policy briefs, blogs and social media platforms.

Objective Maternal obesity and gestational diabetes mellitus (GDM) are becoming major public health concerns in developing countries. Understanding their relationship can help in developing contextually appropriate and targeted prevention strategies and interventions to improve maternal and infant health outcomes. This study aimed to determine the association of maternal overweight and obesity with GDM among pregnant women in Ethiopia.Design Case-control study.Setting The study was conducted in selected public hospitals in Addis Ababa, Ethiopia, from 10 March to 30 July 2020.Participants 159 pregnant women with GDM (cases) and 477 pregnant women without GDM (controls).Outcome measures and data analysis Screening and diagnosis of GDM in pregnant women was done by a physician using the 2013 WHO criteria of 1-hour plasma glucose level of 10.0 mmol/L (180 mg/dL) or 2-hour plasma glucose level of 8.5–11.0 mmol/L (153–199 mg/dL) following a 75 g oral glucose load. Overweight and obesity were measured using mid-upper arm circumference (MUAC). Binary logistic regression with bivariate and multivariable models was done to measure the association of overweight and obesity with GDM. Adjusted ORs (AORs) with a 95% CI were computed, and statistical significance was determined at a value of p=0.05.Results GDM was associated with obesity (MUAC≥31) (AOR 2.80; 95% CI 1.58 to 4.90), previous history of caesarean section (AOR 1.91; 95% CI 1.14 to 3.21) and inadequate Minimum Dietary Diversification Score

Background According to the WHO, obstetric fistula (OBF) is an abnormal connection between the genital tract and the urinary tract that occurs as the result of obstetric trauma, typically from prolonged obstructed labour. In 2018, globally, 50 000 and 100 000 cases of OBF are reported each year. The core of activities focused on reducing fistulas depends on a review of the disorder’s knowledge and the features of women at risk of having a lack of understanding. The effect of community-level factors on awareness of OBF was not yet known in Nepal. Therefore, we aimed to investigate the community-level and individual-level factors of awareness of OBF among childbearing-aged women in Nepal.Methods The 2022 Nepal Demographic and Health Survey data were used for this study. It included 14 845 childbearing-aged women. Because of the clustering effects of Demographic and Health Survey data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted OR (AOR) with a 95% CI was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.Results The overall prevalence of awareness of OBF among childbearing women in Nepal was 35.9% (95% CI 35.1%, 36.7%). Educational status (women who attended secondary education (AOR=1.65; 95% CI 1.41, 3.03) and higher education (AOR=4.29; 95% CI 1.14, 36.70)), currently working status (AOR=1.85; 95% CI 1.04, 3.30), birth history (AOR=2.23; 95% CI 1.48, 4.10), media exposure (AOR=1.54; 95% CI 1.07, 3.09) and women’s age from 30 to 39 (AOR=3.38; 95% CI 1.35, 8.93) and 40 to 49 years old (AOR=4.68; 95% CI 1.60, 13.67) at the individual level, as well as urban residence (AOR=1.53; 95% CI 1.99, 2.87) and high community-level media exposure (AOR=2.05; 95% CI 1.67, 2.64) at the community level were statistically significant factors with awareness of OBF.Conclusion Our study revealed that awareness of OBF among childbearing-aged women in Nepal was low (35.9%). The findings of this study will assist policymakers and public health programmers in understanding the magnitude of OBF awareness and the contributory factors. In addition, it will be useful to increasing awareness of OBF in the communities and promoting primary prevention approaches through education and motivation efforts.

Abstract The implications of adding cerium oxide (CeO2) nanoparticles as a fuel additive to a castor oil biodiesel–diesel fuel blend on engine performance and emissions in a single-cylinder four-stroke diesel engine under various speed were examined in the current study. The test fuels used were fossil diesel fuels, B5 blend biodiesel (as 5% biodiesel and 95% diesel), B10 blend biodiesel (as 10% biodiesel and 90% diesel), B15 blend biodiesel (as 15% biodiesel and 85% diesel), B20 blend biodiesel (as 20% biodiesel and 80% diesel), and B25 blend biodiesel (as 25% biodiesel and 75% diesel), with cerium oxide (CeO2) nanoparticle additive (75 ppm). The result of the physio-chemical properties of the oil samples was within the limit of the ASTM standard. The addition of CeO2 nano additive to the biodiesel–diesel blends has demonstrated a significant reduction in emission and increased in engine performance for all biodiesel–diesel blends for the engine operating speed range. From the result B25 have the maximum reduction rate in BSFC and B10 have the minimum reduction rate in BSFC. The average maximum increment of thermal efficiency was 22.2% for B10 with CeO2 inclusion. CO emission increased as engine speed increased. HC emission was reduced for all blend, with and without CeO2 nano additions as speed increased. Maximum NOx emission was seen at the rated speed of 2700 rpm without nano additive and at 2900 rpm with nano additive. CeO2 nano additive reduced the soot opacity by 11.56% for all biodiesel–diesel blends for the engine operating speed range. As the objective of this study the results indicates CeO2 nano additive reduced emissions and improved the performance. So, using sustainable biodiesel–diesel blends made from castor oil with CeO2 nano additive advisable in ideal operating conditions for diesel engines.

Abstract Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value

Key Clinical Message This case report highlights the challenges of diagnosing MSA‐C in resource‐limited settings. MRI findings like the “hot cross bun” sign can be supportive, but the unavailability of advanced tools like seed amplification assay may delay diagnosis. Early diagnosis is crucial for proper symptom management. Abstract Multiple system atrophy is a rare neurodegenerative disorder affecting the pyramidal, autonomic, nigrostriatal, and cerebellar tracts. Multisystem atrophy should be considered in adults with progressive motor or autonomic dysfunctions. Clinical manifestations vary depending on the system, including bradykinesia, tremor, rigidity, cerebellar ataxia, and autonomic failure. Depending on the initial predominant manifestation, multisystem atrophy is classified as Parkinsonian (MSA‐P) and cerebellar (MSA‐C). Our patient presented with progressive loss of balance, rigidity, slurred speech, choking episodes, and loss of morning tumescence for 4 years, suggesting autonomic and cerebellar involvement. He was diagnosed with MSA after 4 years of initial presentation with combinations of magnetic resonant imaging findings and clinical manifestations. Diagnosing multiple system atrophy in such resource‐limited areas is challenging. The unavailability of seed application tests and biomarkers significantly affected the delayed diagnosis.

Abstract Preterm birth is one of the most common obstetric complications in low- and middle-income countries, where access to advanced diagnostic tests and imaging is limited. Therefore, we developed and validated a simplified risk prediction tool to predict preterm birth based on easily applicable and routinely collected characteristics of pregnant women in the primary care setting. We used a logistic regression model to develop a model based on the data collected from 481 pregnant women. Model accuracy was evaluated through discrimination (measured by the area under the Receiver Operating Characteristic curve; AUC) and calibration (via calibration graphs and the Hosmer–Lemeshow goodness of fit test). Internal validation was performed using a bootstrapping technique. A simplified risk score was developed, and the cut-off point was determined using the “Youden index” to classify pregnant women into high or low risk for preterm birth. The incidence of preterm birth was 19.5% (95% CI:16.2, 23.3) of pregnancies. The final prediction model incorporated mid-upper arm circumference, gravidity, history of abortion, antenatal care, comorbidity, intimate partner violence, and anemia as predictors of preeclampsia. The AUC of the model was 0.687 (95% CI: 0.62, 0.75). The calibration plot demonstrated a good calibration with a p-value of 0.713 for the Hosmer–Lemeshow goodness of fit test. The model can identify pregnant women at high risk of preterm birth. It is applicable in daily clinical practice and could contribute to the improvement of the health of women and newborns in primary care settings with limited resources. Healthcare providers in rural areas could use this prediction model to improve clinical decision-making and reduce obstetrics complications.

Abstract The relationship between normal-weight obesity (NWO)—high percent body fat (%BF) in individuals with normal body mass index (BMI)—and cardiometabolic abnormalities has not been explored in Africa. We determined the prevalence of the NWO and evaluated its association with hypertension, elevated blood sugar and dyslipidaemia among adults in Addis Ababa, Ethiopia. A cross-sectional study was conducted among adults 18–64 years (n = 600). Blood pressure, blood glucose, lipid profile, and anthropometric measurements were completed. As a function of skinfold thickness, body density and %BF were estimated using Durnin & Womersley and Siri Equations, respectively. The relationship between the NWO and the outcomes of interest, assessed using adjusted linear and logit models. The age- and sex-standardised prevalence of NWO was 18.9% (95% confidence interval (CI) 15.8, 22.2%). Comparison between normal-weight lean (normal %BF and BMI) and normal-weight obese individuals suggested no difference in systolic blood pressure (β = 2.55; 95% CI − 0.82, 5.92); however, diastolic blood pressure (β = 3.77: 95% CI 1.37, 6.18) and odds of hypertension (adjusted odds ratio (AOR) = 2.46: 95% CI 1.18, 5.13) were significantly raised in the latter. Similarly, adults with NWO had elevated blood glucose (β = 2.30; 95% CI 1.23, 15.66) and increased odds of high blood sugar level (AOR = 1.68; 95% CI 1.05, 2.67). LDL (β = 8.73: 1.56, 15.90), triglyceride (β = 20.99: 0.78, 41.22), total cholesterol (β = 10.47: 1.44, 19.50), and Cholesterol to HDL ratio (β = 0.65: 0.27, 1.04) were also raised among adults with NWO. NWO is common among adults in Addis Ababa and is associated with cardiometabolic derangements.

Abstract Background Spontaneous colon perforation can be classified into stercoral and idiopathic. Stercoral type is associated with chronic constipation, thus it is rare in infants and children. The idiopathic type is sporadic and could occur at any age. Delay in diagnosing or treating idiopathic colon perforation is associated with high mortality and morbidity rates. There are few studies on rectal perforation related to other etiologies or past the neonatal period, and their effect on disease onset and prognosis are unknown. Case presentation We report on a case of 2-year-and-5-month-old Oromo boy who presented with fever, diarrhea, vomiting, and progressive abdominal pain of 5-day duration. The boy underwent an exploratory laparotomy for suspected peritonitis and there was a single perforation of approximately 2.0 cm size in the anterior part of the upper one-third of rectum. The perforated rectum was repaired primarily and sigmoid divided diversion colostomy was carried out. Conclusion It is important to be aware of idiopathic colon perforation in children, a rare but dangerous condition with high mortality and morbidity in cases of delayed diagnosis or management. Pediatricians and surgeons should consider colon perforation as a cause in children who present with abdominal distention and a history of diarrhea for more than 5 days.

This study is the first to determine the levels of heavy metals in commercially important fish species, namely Lates niloticus and Oreochromis niloticus and the potential human health risks associated with their consumption. A total of 120 fish samples were collected from the lower Omo river and Omo delta, with 60 samples from each water source. The fish tissue samples (liver and muscle) were analyzed using a flame atomic absorption spectrometer for nine heavy metals (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn). The human health risk assessment tools used were the target hazard quotient (THQ), the hazard index (HI), and the target cancer risk (TCR). The mean levels of heavy metals detected in the liver and muscle of L. niloticus from the lower Omo river generally occurred in the order Fe > Zn > Pb> Cu > Mn> Cr > Co > Ni and Pb > Cu > Mn > Co > Ni, respectively. The mean levels of metals in the muscle and liver tissues of O. niloticus were in the order Fe > Pb > Zn > Mn > Cu > Cr > Co > Ni and Pb > Zn > Mn > Fe > Cu > Co > Ni, respectively. Similarly, the mean levels of heavy metals detected in the liver and muscle of L. niloticus from Omo delta occurred in the order Fe > Zn > Pb > Cu > Mn > Cr > Co > Ni and Fe > Pb > Zn > Mn > Cu > Co > Cr > Ni, respectively. The mean levels in the muscle and liver tissues of O. niloticus from the Omo delta were in the order Fe > Pb > Zn > Mn > Cu > Cr > Co > Ni and Pb > Fe > Zn > Mn > Co > Cu > Ni, respectively. The study revealed that the THQ values were below 1, indicating that consumption of L. niloticus and O. niloticus from the studied sites does not pose a potential non-carcinogenic health risk. Although the TCR values for Pb in this study were within the tolerable range, it’s mean concentration in the muscle and liver tissues of both fish species from the two water bodies exceeded the permissible limit established by FAO/WHO. This is a warning sign for early intervention, and it emphasizes the need for regular monitoring of freshwater fish. Therefore, it is imperative to investigate the pollution levels and human health risks of heavy metals in fish tissues from lower Omo river and Omo delta for environmental and public health concerns.

Background Low haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin concentration. However, there is limited research on the prevalence and determinants of normal haemoglobin concentration among under-five children in sub-Saharan Africa.Objective To assess determinants of normal haemoglobin concentration among under-five children in SSA.Design Cross-sectional study design using a positive deviance approachSetting 33 SSA countries.Participants 129 408 children aged 6–59 monthsPrimary and secondary outcome measures A multilevel Poisson regression model with robust variance was fitted to identify determinants of normal haemoglobin concentration. An adjusted prevalence ratio with a 95% CI was reported to declare the statistical significance.Result The pooled prevalence of normal haemoglobin concentration among under-five children in SSA was 34.9% (95% CI: 34.6% to 35.1%). High maternal education, middle and rich household wealth, female child, frequent antenatal care visits, non-anaemic mothers, taking anthelmintic drugs and normal nutritional status were associated with increased odds of normal haemoglobin concentration. On the other hand, higher birth order, having fever and diarrhoea, rural residence were associated with lower odds of normal haemoglobin levels.Conclusion According to our finding, only four out of 10 under-five children in SSA had a normal haemoglobin level. This finding proved that anaemia among children in SSA remains a serious public health concern. Therefore, improving maternal education, provision of drugs for an intestinal parasite and early detection and treatment of maternal anaemia, febrile illness and diarrhoeal disease is important.

Objective This study aimed to assess the coutilisation of oral rehydration solution (ORS) and zinc for treating diarrhoea and its associated factors among under-5 children in East Africa.Design Cross-sectional study design. Multilevel Poisson regression analysis with robust variance was fitted to identify predictors of zinc and ORS coutilisation. An adjusted prevalence ratio (aPR) with a 95% CI was reported to declare the statistical significance.Setting Twelve East African countries.Participants 16 850 under-5 children who had diarrhoea were included in the study.Result In East African nations, the coutilisation of ORS and zinc for the treatment of diarrhoea in children under 5 was 53.27% with a 95% CI (52.54% to 54.01%). Children of mothers with primary education (aPR 1.15, 95% CI 1.09 to 1.20), secondary education (aPR 1.08, 95% CI 1.02 to 1.14), higer education (aPR 1.19, 95% CI 1.10 to 1.29), those from maternal age category of 20–24 (aPR 1.14, 95% CI 1.07 to 1.21), age category of 25–29 (aPR 1.13, 95% CI 1.06 to 1.21), age category of 30–34 (aPR 1.09, 95% CI 1.02 to 1.16), those from wealthy households (aPR 1.04, 95% CI 1.01 to 1.09) and those who have a media exposure (aPR 1.04, 95% CI 1.01 to 1.08) were more likely to receive combination.Conclusion Only half of the under-5 children with diarrhoea in East Africa were treated with a combination of ORS and zinc. To increase the use of the suggested combination therapy of ORS with zinc, it is important to empower women through education and prevent teen pregnancy.

Background Globally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a common problem among women in sub-Saharan Africa (SSA), there are limited studies examining the factors contributing to underweight, overweight, and obesity at the SSA level.Objective To determine the factors associated with the DBM, and their relative magnitude, among women of reproductive age in SSA.Design Cross-sectional study design.Setting 33 SSA countries.Participants 240 414 women of reproductive age.Primary and secondary outcome measures A multilevel multinomial logistic regression model was applied to identify factors associated with malnutrition. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association.Results The pooled prevalence of underweight, overweight and obesity among women in SSA were 8.87%, 16.47% and 6.10%, respectively. Women who are from rural residence and smoke cigarettes were more likely to be underweight. Conversely, women between the age of 24–34 and 35–49, who have higher education, belong to a middle and rich household, are ever married, have high parity, use contraceptives, have media exposure and smoke cigarettes were more likely to be overweight and/or obese.Conclusion The findings of our study suggest that certain factors such as residence, education status, wealth, marital status, occupation, cigarette smoking, and contraceptive use have a significant assocation with malnutrition among women. Therefore, it is important for public health programs aimed at preventing the double burden of malnutrition to focus on these factors through comprehensive public awareness and cost-effective operational health interventions.

Objective This study was aimed at assessing the prevalence of herbal drug use among pregnant women with access to modern medicine and associated factors in public health facilities in the west Shewa zone, Oromia regional state, Ethiopia.Design A sequential mixed-method study approach was carried out among pregnant women and other stakeholders.Setting This study was conducted at public health facilities, including 3 public hospitals and 20 health centres, in the west Shewa zone of Ethiopia.Participants A systematically selected sample of 411 pregnant women was participated in the quantitative study. For the qualitative method, focus group discussions and in-depth interviews were conducted among pregnant women attending antenatal care and key informants using an interview guide until data saturation was achieved.Primary outcome For outcome variables, the respondents were asked if they used any herbal medicine during their current pregnancy. It was then recorded as 0=no and 1=yes.Results The prevalence of herbal medicines was found to be 19.7%. The most commonly used herbal medicines were Zingiber officinale, Ocimum gratissimum, Eucalyptus globules, Allium sativum and Rutacha lepensis. Herbal medicine use during pregnancy was significantly associated with older maternal age (adjusted OR (AOR) 2.4, 95% CI 1.2 to 5.1), urban residence (AOR 2.3, 95% CI 1.3 to 3.7) and second trimester of pregnancy (AOR 2.3, 95% CI 1.3 to 4.5).Conclusions In this study, one in five pregnant women uses herbal medicine, which is relatively low. Sociodemographic factors and the duration of pregnancy affected the utilisation of herbal drugs during pregnancy. The most common herbals used by pregnant women were intended to treat minor disorders of pregnancy and medical disorders such as hypertension.

BackgroundBreast cancer is a significant global health issue, responsible for a large number of female cancer deaths. Early detection through breast cancer screening is crucial in reducing mortality rates. However, regions such as Sub-Saharan Africa (SSA) face challenges in identifying breast cancer early, resulting in higher mortality rates and a lower quality of life. Yet, there is a noticeable gap in the literature concerning breast cancer screening. Thus, this study aimed to estimate the pooled prevalence of breast cancer screening and associated factors among women of reproductive age in SSA.MethodsA weighted sample of 80,058 reproductive-age women from recent Demographic and Health Surveys in SSA countries was considered for analysis. A multilevel modified Poisson regression model with robust variance was fitted to identify factors associated with breast cancer screening. Four nested models were fitted, and the model with the lowest deviance value was selected. An adjusted prevalence ratio with the corresponding 95% confidence interval was used to measure the strength of the association. Finally, statistical significance was declared at a p-value < 0.05.ResultThe pooled prevalence of breast cancer screening among reproductive-age women in SSA was 11.35% (95% CI: 11.14%, 11.56%), with variations ranging from 4.95% (95% CI: 4.61%, 5.30%) in Tanzania to 24.70% (95% CI: 24.06%, 25.33%) in Burkina Faso. Age (20-24, 25-29, 30-34, 35-39, 40-44, and 45-49 years), secondary and higher education, wealth index, media exposure, parity, contraceptive use, pregnancy status, breastfeeding status, and visiting a healthcare facility in the last 12 months were identified as significant positive determinants of breast cancer screening. Conversely, being a rural resident and having a primary education level were found to be negative determinants.ConclusionThis study uncovers a low prevalence of breast cancer screening in SSA countries, despite high associated mortality rates. Emphasizing the significance of targeted interventions, it highlights the crucial need to promote education and awareness regarding the benefits of breast cancer screening, particularly in light of the challenges faced by many women in the region.

IntroductionCervical cancer is a major public health problem worldwide, and is mainly caused by human papillomaviruses. More than 90% of cervical cancer cases can be prevented by using a human papilloma vaccine and screening. Despite the ongoing global cervical cancer screening target, uptake remains unacceptably low in sub-Saharan Africa such as Tanzania. Although cervical cancer is the leading cause of mortality in Tanzania, evidence on the individual- and community-level factors associated with cervical cancer screening among women of reproductive age is scarce. Therefore, this study aimed to determine the individual- and community-level factors associated with cervical cancer screening among women of reproductive age in Tanzania.MethodsThis study used data from the 2022 Tanzania Demographic and Health Survey (TDHS). A weighted sample of 15,140 women of reproductive age was included in this study. Given the effect of clustering and binary nature of the outcome variable, we used a multilevel binary logistic regression model. The adjusted odds ratio (AOR) with 95% Confidence Interval (CI) was statistically significant. Moreover, the model with the lowest deviance best suited the data.ResultsThe overall uptake of cervical cancer screening among Tanzanian women was 7.28% (95% confidence interval [CI]: 6.87%, 7.70%). Women's age (25-34, 35-49), women with primary, secondary, and higher educational levels, being employed, a high household wealth index, visiting health facilities in the last 12 months, owning mobile phones, urban residence, and southern highlands, Southern, and Zanzibar administrative zones, were significantly associated with cervical cancer screening.ConclusionCervical cancer screening among women in Tanzania was low. Low uptake underscores the need for increased focus on addressing the coverage of the 2030 Sustainable Development Goals (SDGs). The study would help policymakers create programs that consider education, employment, visiting health facilities, mobile phones, wealth, residence, and administrative zones, which would make women undergo cervical cancer screening. Pointing to women living with low cervical cancer screening could help increase their uptake and achieve the targets of the national and World Health Organization.

IntroductionDespite the Sustainable Development Goal to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, abortion remains one of the top five causes of maternal mortality in low and middle-income countries. However, there is a lack of comprehensive data on the pooled prevalence and determinants of abortion in sub-Saharan Africa (SSA). Therefore, this study aims to investigate the pooled prevalence and determinants of abortion among women of reproductive age in 24 SSA countries using the most recent Demographic and Health Surveys.MethodsThe most recent Demographic and Health Survey (DHS) data from 24 Sub-Saharan African (SSA) countries were analyzed, using a weighted sample of 392,332 women of reproductive age. To address the clustering effects inherent in DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was employed. The results were reported as adjusted odds ratios with 95% confidence intervals to indicate statistical significance. Additionally, the model with the lowest deviance was identified as the best fit for the data.ResultsThe pooled prevalence of abortion in SSA were 6.93% (95%CI: 5.38, 8.48). Older age (AOR = 3.71; 95%CI: 3.46, 3.98), ever married (AOR = 3.87; 95%CI: 3.66, 4.10), being educated (AOR = 1.35; 95%CI: 1.28, 1.44), having formal employment (AOR = 1.19; 95%CI: 1.16, 1.23), traditional contraceptive use (AOR = 1.27; 95%CI: 1.19, 1.36) and media exposure (AOR = 1.37; 95%CI: 1.32, 1.41) found to be a predisposing factors for abortion. While high parity (AOR = 0.72; 95%CI: 0.68, 0.76), rural residence (AOR = 0.87; 95%CI: 0.85, 0.91), and rich (AOR = 0.96; 95%CI: 0.93, 0.99) wealth index were a protective factors.ConclusionThe study found that the pooled prevalence of abortion in Sub-Saharan Africa is 7%. Potential interventions include comprehensive sexual education to inform and empower women, increased access to modern contraceptives to reduce unintended pregnancies, improved healthcare services especially in rural areas, economic empowerment through education and employment opportunities, media campaigns to disseminate information and reduce stigma, and policy development to ensure safe and legal access to abortion services. These interventions aim to improve reproductive health outcomes and reduce unsafe abortions in SSA.

BackgroundCataract, despite being treatable, persists to have a devastating impact on people's health and livelihoods all over the world. In Sub-Saharan Africa (SSA), 1.7 million people are blind and 6.94 million are visually impaired due to cataract. Also, Cataract surgery outcomes remain below the World Health Organization (WHO) recommendations in SSA. Hence, this review aimed to estimate the pooled prevalence and associated factors of poor post-operative visual outcome in SSA.MethodAn intensive literature search was performed from PubMed, Google Scholar, EMBASE, HINARI, Scopus, and Web of Sciences. Data were extracted by using a pre-tested and standardized data extraction format and analyzed by using STATA 17 statistical software. I2 tests to appraise the heterogeneity across the included studies, a random-effect model to estimate the pooled prevalence, and a sub-group analysis to discern the viable source of heterogeneity were executed. Potential publication bias was also assessed by funnel plot, Egger's weighted correlation, and Begg's regression. The odds ratio with its 95% confidence was used to reckon the association between the prevalence and factors.ResultFrom 201 identified studies, 25 articles were included. The pooled prevalence of poor post-operative visual outcome of cataract surgery in SSA was 14.56% (95% CI 11.31, 17.81). The presence of intra-operative complications (AOR = 2.99, 95% CI: 1.79, 4.98) and the presence of post-operative complications (AOR = 3.56, 95% CI: 2.86, 4.43) were statistically significant with the pooled poor post-operative visual outcome. According to the subgroup analysis, the pooled prevalence of poor post-operative visual outcome was found lower in phacoemulsification, with a sub-pooled prevalence of 12.32% (95% CI 7.89, 16.74) compared to incisional with a sub-pooled prevalence of 16.28% (95% CI 10.98, 21.59).ConclusionThis meta-analysis revealed that a substantial proportion of cataract-operated patients had poor post-operative visual outcome. The presence of intra-operative complications and post-operative complications were independent predictors of poor post-operative visual outcome. Therefore, improvement of post-operative visual outcome through decreasing intra-operative complications, managing post-operative complications, and investing in specialized training and equipment for ophthalmic surgeons are pivotal and need significant emphasis.

BackgroundPerinatal mortality is a major global public health concern, especially in sub-Saharan Africa (SSA). Despite perinatal mortality being a major public health concern in SSA, there are very limited studies on the incidence and factors associated with perinatal mortality. Therefore, we aimed to investigate the factors associated with perinatal mortality in SSA.MethodsA secondary data analysis was conducted based on the Demographic and Health Survey (DHS) data of 27 SSA countries. About 314,099 births in the preceding five years of the surveys were considered for the analysis. A multilevel binary logistic regression model was fitted to identify factors associated with perinatal mortality. Deviance (-2Log-Likelihood Ratio (LLR)) was used for model comparison. The Adjusted Odds Ratio (AOR) with the 5% Confidence Interval (CI) of the best-fitted model was used to verify the significant association between factors and perinatal mortality.ResultsThe perinatal mortality rate in sub-Saharan Africa (SSA) was 37.31 per 1,000 births (95% CI: 36.65, 37.98). In the final best-fit model, factors significantly associated with higher perinatal mortality included media exposure (AOR: 1.12, 95% CI: 1.08, 1.17), maternal age ≥ 35 years (AOR: 1.13, 95% CI: 1.06, 1.21), health facility delivery (AOR: 1.10, 95% CI: 1.06, 1.15), having 2-4 births (AOR: 1.35, 95% CI: 1.25, 1.47), five or more births (AOR: 1.69, 95% CI: 1.53, 1.86), residence in West Africa (AOR: 1.30, 95% CI: 1.24, 1.36) or Central Africa (AOR: 1.05, 95% CI: 1.00, 1.11), rural residency (AOR: 1.08, 95% CI: 1.02, 1.13), and difficulty accessing a health facility (AOR: 1.06, 95% CI: 1.02, 1.10). In contrast, factors significantly associated with lower perinatal mortality were a preceding birth interval of 2-4 years (AOR: 0.70, 95% CI: 0.67, 0.74) or five or more years (AOR: 0.91, 95% CI: 0.84, 0.97), Antenatal Care (ANC) visit (AOR: 0.66, 95% CI: 0.63, 0.69), higher education levels (AOR: 0.82, 95% CI: 0.73, 0.93), middle household wealth (AOR: 0.93, 95% CI: 0.88, 0.98), and richer household wealth (AOR: 0.93, 95% CI: 0.87, 0.99).ConclusionPerinatal mortality was a major public health problem in SSA. Maternal socio-demographic, obstetrical, and healthcare-related factors are significantly associated with perinatal mortality. The findings of this study highlighted the need for holistic healthcare interventions targeting enhancing maternal healthcare services to reduce the incidence of perinatal mortality.

BackgroundViolence against women, particularly intimate partner violence, is a significant Concern for public health as well as a violation of the human rights of women especially in low and middle-income countries. However, there was limited evidence how soon an ever-married women experience intimate partner violence in Africa. Therefore, this study aimed to investigate the timing of first intimate partner violence (FIPV) among ever-married women in 30 SSA countries and to identify the risk factors of the timing.MethodsThe present study has utilized 125,731 weighted samples, who participated in the domestic violence module of the survey from Demographic and Health Surveys of 30 SSA countries. The Gompertz gamma shared frailty model was fitted to determine the predictors. For model evaluation, the theta value, Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance were used. The Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported in the multivariable Gompertz gamma shared frailty model to highlight the strength and statistical significance of the associations.ResultOne-third (31.02%) of ever-married women had reported experiencing IPV. The overall incidence rate of FIPV was 57.68 persons per 1000 person-years (95% CI = 50.61-65.76). Age at marriage, age difference, educational status, employment, residence, women's decision-making autonomy, husband who drink alcohol and wealth status were significantly associated with the timing of FIPV.ConclusionThe findings show that ever-married women are at high and increasing risk of violence. Thus, we recommend establishing effective health and legal response services for IPV, strengthening laws governing the sale and purchase of alcohol, empowering women, raising the educational attainment of women, and putting policies in place to combat the culture of societal tolerance for IPV all contribute to the empowerment of women.

BackgroundIntimate Partner Violence (IPV) is a major public health problem worldwide. In developing nations, including Ethiopia, the problem is under-reported and under-estimated. Therefore, this study attempts to assess intimate partner violence and its associated factors among pregnant women receiving antenatal care at public hospitals in Amhara region, Ethiopia.MethodsA health facility-based cross-sectional study design was employed. A sample of 418 pregnant women was selected using random sampling technique from 1st May to 1st June 2021. IPV was measured using the World Health Organization (WHO) Multi-country study of violence against women assessment tool. Data were entered into Epi-data 3.1 and exported into Stata 17 for further analysis. A Bayesian multivariable logistic regression analysis was carried out from the posterior distribution, and an adjusted odds ratio (AOR) with a 95% credible interval (CrI) was used to declare statistically significant variables.ResultsThe prevalence of any IPV among pregnant women was 31.3% [95% CrI 26.6%, 36.1%]. After adjusting a range of covariates, IPV during pregnancy was more likely among women whose husbands used substances [AOR = 4.33: 95% CrI 1.68, 8.95] and household decisions made by husbands only [AOR = 6.45: 95% CI 3.01, 12.64]. Conversely, pregnant women who attended primary [AOR = 0.47: 95% CrI 0.24, 0.81] and secondary [AOR = 0.64: 95% CrI 0.41, 0.92] educational levels, women who had four or more ANC visits antenatal care visits [AOR = 0.43: 95% CrI 0.25, 0.68], and women with no prior history of adverse birth outcomes [AOR = 0.48: 95% CI 0.27, 0.80] were less likely to experience IPV during pregnancy.ConclusionThe study revealed a relatively high prevalence of any IPV among pregnant women, with factors such as substance use by husbands and limited decision-making autonomy associated with increased IPV likelihood. Conversely, women with higher education levels, four and above antenatal care attendance, and no history of adverse birth outcomes showed a reduced likelihood of experiencing IPV during pregnancy. Therefore, targeted interventions to address substance use, empower women in decision-making, and promote education and healthcare access to mitigate IPV risk during pregnancy are recommended.

IntroductionEvidence indicates that postpartum and post-abortion women accept family planning at a higher rate when offered timely at appropriate sites. Therefore, this study explored barriers and enablers of postpartum and post-abortion family planning utilization in primary health care units of Wolaita Zone, Southern Ethiopia, from June 20 to July 25, 2022.MethodsWe used a case study strategy of qualitative research using both the Consolidated Framework for Implementation Research (CFIR) and Gender, Youth, and Social Inclusion (GYSI) frameworks was conducted from June to July 2022. We conducted 41 in-depth and key informant interviews and six focus group discussions. We also used Open Code software version 4.02 for coding and further analysis and applied a framework analysis.ResultsThe analysis of this study identified barriers and enablers of postpartum and post-abortion family planning service uptake in five CFIR domains and four GYSI components. The barriers included misconceptions and sole decision-making by husbands, cultural and religious barriers, and healthcare providers paying less attention to adolescents and husbands, which prevented them from using immediate postpartum and postabortion family planning services. The health facilities were not adequately staffed; there was a shortage and delay of supplies and infrastructure, trained staff turnover, and poor accountability among service providers. The existence of community structure, equal access and legal rights to the service, and having waivered services were enablers for postpartum and post-abortion family planning service uptake.Conclusion and recommendationThe current study identified various barriers and enablers to the uptake of postpartum and post-abortion family planning. Therefore, there is a need for high-impact interventions such as targeting male partners and girls, ensuring infrastructure, supplies, and equipment, building staff capacity, and making decisions jointly.

Background. Delayed cord clamping (DCC) for more than one minute is associated with nutritional and developmental benefits for newborns. However, there is limited evidence regarding the relationship between DCC and outcomes in resource-limited settings. This study aims to assess the effect of the time of cord clamping on serum bilirubin level 24 hours after birth in an Ethiopian Tertiary Care hospital. Methods. A three-arm, single-blind, exploratory randomized controlled trial was conducted between October 2019 and January 2020 targeting healthy, full-term neonates. Study participants were randomly assigned into one of the following intervention groups depending on the timing of cord clamping: immediate cord clamping (

BackgroundAddressing the global challenge of sexually transmitted infections (STIs) is crucial and demands immediate attention. Raising awareness, improving healthcare facilities, and implementing preventive measures are necessary to reduce the spread and mitigate their adverse effects. The treatment seeking behavior of individuals in relation to STIs is an important factor in STI prevention and control. Thus, this study aimed to identify factors associated with STI-related care-seeking behavior among sexually active men in East Africa.MethodsA weighted sample of 3,302 sexually active men from recent Demographic and Health Surveys (DHSs) in East African countries were included for analysis. To accommodate the inherent clustering in DHS data and the binary nature of the dependent variable, we applied a multi-level mixed-effect logistic regression model. The deviance value was used to select the best-fitted model. The strength of the association was estimated using an adjusted odds ratio, along with a 95% confidence interval, and statistical significance was determined at a p-value < 0.05.ResultThe pooled prevalence of STI-related care-seeking behavior among sexually active men in East Africa was 71% (95%CI: 69.76, 72.75). In the multivariable multilevel model, individuals in the age groups of 25-34 (AOR = 1.58, 95%CI: 1.22, 2.04) and 44 years and above (AOR = 1.44, 95%CI: 1.01, 2.02), those who were married (AOR = 1.62, 95%CI: 1.25, 2.11), had 1 (AOR = 1.88, 95%CI: 1.50, 2.35) and ≥2 (AOR = 2.53, 95%CI: 1.89, 3.39) sexual partners excluding their spouse, had ever been tested for HIV (AOR = 1.86, 95%CI: 1.52, 2.28), and had media exposure (AOR = 1.30, 95%CI: 1.04, 1.62) had a positive association with care-seeking behavior for STIs.ConclusionBased on our findings, seven out of ten sexually active men in East Africa exhibit care-seeking behavior for STIs. It is crucial to implement policies and strategies aimed at improving the health-seeking habits of young, unmarried men. Utilizing diverse media platforms to disseminate accurate information and success stories about STI symptoms is pivotal in achieving this goal.

BackgroundTeenage pregnancy remains one of the major reproductive health problems, especially in sub-Saharan African countries. It can lead to maternal and neonatal complications and social consequences. The proportion of teenage pregnancy differs across regions of Ethiopia. Thus, this study aimed to determine the spatial variation in determinants of teenage pregnancy among adolescents aged 15-19 years in Ethiopia using the 2019 Demographic and Health Survey (DHS).MethodsThis study included a total weighted sample of 2165 teenage girls aged 15 to 19 years. A mixed-effect binary logistic regression model was employed to consider the hierarchical nature of the DHS data using STATA version 17. Adjusted odds ratios with 95% confidence intervals are reported, and a p-value less than 0.05 was used to identify significant predictors. The spatial analysis was conducted with ArcGIS version 10.7 and Python 3. To identify factors associated with the hotspots of teenage pregnancy, a multiscale geographically weighted regression (MGWR) was performed. Spatial regression models were compared using adjusted R2, the corrected Akaike information criterion (AICc), and the residual sum of squares (RSS).ResultsThe prevalence of teenage pregnancy among adolescents aged 15 to 19 years was 12.98% (95% CI: 11.6%, 14.5%). It was spatially clustered throughout the country with a significant Moran's I value. Significant hotspot areas were detected in central and southern Afar; northern, central, and western Gambela; northeastern and southern central Oromia; and the eastern Somali region. The MGWR analysis revealed that the significant predictors of spatial variations in teenage pregnancy were being illiterate and being married. Based on the multivariable multilevel analysis, age 17 (AOR = 3.54; 95% CI: 1.60, 7.81), 18 (AOR = 8.21; 95% CI: 3.96, 17.0), 19 (AOR = 15.0; 95% CI: 6.84, 32.9), being literate (AOR = 0.57; 95% CI: 0.35, 0.92), being married (AOR = 22.8; 95% CI: 14.1, 37.0), age of household head (AOR = 0.98; 95% CI: 0.98, 0.99) and residing in the Gambela region (AOR = 3.27; 95% CI: 1.21, 8.86) were significantly associated with teenage pregnancy among adolescents aged 15 to 19.ConclusionTeenage pregnancy is a public health problem in Ethiopia. Policymakers should prioritize addressing early marriage and improving teenage literacy rates, with a focus on the Gambela region and other hotspot areas. It is crucial to implement policies aimed at transforming the traditional practice of early marriage and to take measures to enhance literacy levels and promote awareness about sexual and reproductive health at the family and school levels. This will help ensure that young people have the opportunity to pursue education and make informed decisions about their reproductive health.

Objectives Intimate partner violence (IPV) is a public health challenge but there is evidence that cash and cash ‘plus’ interventions reduce IPV. An increasingly popular design feature of these kind of interventions is the group-based modality for delivering plus activities, however, evidence of the mechanisms through which this modality of delivery impacts IPV is limited. We explore how the group-based modality of delivering plus activities that complemented the Government of Ethiopia’s Productive Safety Net Programme contributed to modifying intermediate outcomes on the pathway to IPV.Design Qualitative study using in-depth interviews and focus group discussions between February and March 2020. Data were analysed using a thematic content and gender lens approach. Findings were interpreted, refined and drafted in collaboration with our local research partners.Setting Amhara and Oromia regions in Ethiopia.Participants In total 115 men and women beneficiaries from the Strengthen PSNP4 Institutions and Resilience (SPIR) programme took part in the study. Fifty-eight were interviewed and 57 took part in 7 focus group discussions.Results We found that Village Economic and Social Associations—through which SPIR activities were delivered—improved financial security and increased economic resilience against income shocks. The group-based delivery of plus activities to couples appeared to enhance individual agency, collective power and social networks, which in turn strengthened social support, gender relations and joint decision-making. Critical reflective dialogues provided a reference group to support the shift away from social norms that condone IPV. Finally, there appeared to be gender differences, with men highlighting the financial benefits and enhanced social status afforded by the groups, whereas women’s accounts focused primarily on strengthened social networks and social capital.Conclusion Our study offers important insights into the mechanisms by which the group-based delivery of plus activities affects intermediate outcomes on the pathway to IPV. It underscores the importance of the modality of delivery in such programmes, and suggests that policy-makers should consider gender-specific needs as men and women might differentially benefit from interventions that enhance social capital to generate gender transformative impacts.

Background For developing countries such as Ethiopia, coffee is a commodity of great economic, social, and environmental importance. No detailed investigations have been performed on the contents of essential and toxic metals in coffee beans and soil in this study area. Methods The levels of essential metals (Na, K, Ca, Zn, Mn, Cu, Co, Cr, Ni) and toxic elements (Pb and Cd) were investigated in coffee beans (coffee growing farmland and coffee washed plants) and soil samples (from farmland) using flame atomic absorption spectrometry (FAAS) and flame emission atomic spectroscopy. We selected six (20%) administrative units (kebele) with purposive sampling techniques based on their coffee production capacity in Dale Woreda for soil testing. After coffee sample preparation in a microwave system with HNO3and H2O2 reagents, the accuracy of the optimized procedure was evaluated by analysing the digest of the spiked samples. Soil samples were abridged with a slight revision of the EPA 3050B acid digesting method. ANOVA was used to determine the significant differences in the mean concentration of metal within coffee beans from farmland at the various sampled sites at the p Na>Ca >Mn>Cu> Ni>Zn. Metal levels were found to be K>Na>Ca >Mn>Cu> Zn>Ni in coffee beans from the washed plants. Co, Cr, Pb and Cd were no detected in all coffee bean samples. Except for calcium, potassium and manganese, the levels of metals in coffee beans from farmland and washed plants were not significantly different at the 95% confidence level within a kebele. Conclusions We observed permitted levels of macro- and trace elements in coffee beans from farmlands and washed plants. Only in the soil samples are cadmium concentrations higher than those permitted for agricultural soil recommended by the WHO and FAO. Overall, there is no health danger linked with the use of coffee beans due to detrimental and trace heavy metals.

BackgroundPrisoners usually need more comprehensive health and social support than the general population. Due to the growing number of prisoners in Ethiopia and limited access to health service, quality of life is a key concern. Compromised health-related quality of life imposes short and long-term consequences on the prisoners, their families, and the healthcare system. In Ethiopia, there are limited studies that investigate health outcomes and health-related quality of life in this particular population. Therefore, this study aimed to assess the magnitude of health-related quality of life and associated factors among prisoners considering the multidimensional nature of health related quality of life.MethodsAn institution-based cross-sectional study was conducted on 1,246 prisoners who were enrolled using simple random sampling. The World Health Organization Quality of Life (WHOQoL-BREF-26) and Patient Health Questionnaire (PHQ-9) tools were used to assess the HRQoL and depression among prisoners, respectively. The relationships between exogenous, mediating, and endogenous variables were identified using structural equation modeling. As the mediation of effects were present, then the direct, indirect, and total effects were determined. General fit indices of the final model were acceptable (x2/df = 1.76, p < 0.001, RMSEA = 0.06, TLI = 0.90, CFI = 0.91, and SRMR = 0.06).ResultThe mean (standard deviation) score of the overall health related quality of life was 53.25 (15.12). Having an underlying medical condition had negative total effect on health related quality of life while visits in prison had positive total effect. Having income-generating work in prison had only a direct positive effect. Whereas, older age, being married, longer duration of imprisonment, and depression all had only a negative direct effect on one or more domains of quality of life (pConclusionInmates in Gondar Prison have very poor and compromised levels of physical and psychological health despite having a modest degree of overall HRQoL. The result of this study is significant for people who work in and research the prison environment because it can assist in recognizing prisoners' health needs and devising treatment procedures that take into consideration physical, psychological, environmental, and social relationship aspects.

Land use and land cover (LULC) change and variability are some of the challenges to present-day water resource management. The purpose of this study was to determine LULC and Normalized Difference Vegetation Index (NDVI) fluctuations in western Ethiopia during the last 20 years. The first part of the study used MODIS LULC data for the change analysis, change detection, and spatial and temporal coverage in the study region. In the second part, the study analyzes the NDVI change and its spatial and temporal coverage. In this study, The Moderate Resolution Imaging Spectroradiometer (MODIS) satellite data were applied to determine LULC and NDVI changes over four different periods. Evergreen broadleaf forests, deciduous broadleaf forests, mixed forests, woody savannas, savannas, grasslands, permanent wetlands, croplands, urban and built-up lands, and water bodies are the LULC in the period of analysis. The overall classification accuracy for the classified image from 2001 to 2020 was 85.4% and the overall kappa statistic was 81.2%. The results indicate a substantial increase in woody savannas, deciduous broadleaf, grasslands, permanent wetlands, and mixed forest areas by 119.6%, 57.7% 45.2%, 37%, and 21.3%, respectively, followed by reductions in croplands, water bodies, savannas, and evergreen broadleaf forest by 90.1%, 19.8%, 13.2%, and 4.8%, respectively, for the catchment between 2001 and 2020. The result also showed that the area’s vegetation cover increased by 64% from 2001 to 2022. This study could provide valuable information for water resource and environmental management as well as policy and decision-making.

Aim To estimate the prevalence of micronutrient deficiencies and anaemia, and their association with body mass index (BMI) categories among Australian adults.Method We analysed data from the 2011–2013 Australian Health Survey from 3539 participants aged 18 years and over (without known pregnancy) with measured weight and height, and nutrient biomarkers. To address complex sampling, survey weights were used when estimating the prevalence of micronutrient deficiencies (vitamin B12 deficiency; serum vitamin B12

Abstract The design of superior biologic therapeutics, including antibodies and engineered proteins, involves optimizing their specific ability to bind to disease-related molecular targets. Previously, we developed and applied the Assisted Design of Antibody and Protein Therapeutics (ADAPT) platform for virtual affinity maturation of antibodies (Vivcharuk et al. in PLoS One 12(7):e0181490, https://doi.org/10.1371/journal.pone.0181490 , 2017). However, ADAPT is limited to point mutations of hot-spot residues in existing CDR loops. In this study, we explore the possibility of wholesale replacement of the entire H3 loop with no restriction to maintain the parental loop length. This complements other currently published studies that sample replacements for the CDR loops L1, L2, L3, H1 and H2. Given the immense sequence space theoretically available to H3, we focused on the virtual grafting of over 5000 human germline-derived H3 sequences from the IGMT/LIGM database increasing the diversity of the sequence space when compared to using crystalized H3 loop sequences. H3 loop conformations are generated and scored to identify optimized H3 sequences. Experimental testing of high-ranking H3 sequences grafted into the framework of the bH1 antibody against human VEGF-A led to the discovery of multiple hits, some of which had similar or better affinities relative to the parental antibody. In over 75% of the tested designs, the re-designed H3 loop contributed favorably to overall binding affinity. The hits also demonstrated good developability attributes such as high thermal stability and no aggregation. Crystal structures of select re-designed H3 variants were solved and indicated that although some deviations from predicted structures were seen in the more solvent accessible regions of the H3 loop, they did not significantly affect predicted affinity scores.

Abstract Non-communicable diseases (NCDs) are increasingly becoming the global cause of premature death encompassing cardiovascular diseases (CVDs), cancer, respiratory diseases and diabetes mellitus. However, cardiometabolic risk factors in the general population, especially among the high-risk groups have rarely been assessed in Ethiopia. The study aimed to assess the prevalence of metabolic syndrome, its components and associated factors among staff in the Ethiopian Public Health Institute (EPHI). An institutional-based cross-section study was conducted from March to June 2018 among EPHI staff members. A total of 450 study participants were involved in the study, and the World Health Organization NCD STEPS survey instrument version 3.1 was used for the assessment. The biochemical parameters were analyzed by using COBAS 6000 analyzer. Statistical package for the social science (SPSS) version 20 was used for data analysis. Both bivariate and multivariate logistic regression analyses were used to identify associated risk factors. p value

Objectives This systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice.Design A mixed-methods systematic review.Data sources Medline, Embase and CINAHL to November 2021.Eligibility criteria Quantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation.Data extraction and synthesis We used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger’s test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis.Results We reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I2 99.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I2 73.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I2 99.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I2 99.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I2 99.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system.Conclusions Our evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.

Mycotoxins can be transferred to breast milk during lactation. Hence, the presence of multiple mycotoxins (aflatoxins B1, B2, G1, G2, and M1, alpha and beta zearalanol, deoxynivalenol, fumonisins B1, B2, B3, and hydrolyzed B1, nivalenol, ochratoxin A, ochratoxin alpha, and zearalenone) in breast milk samples was assessed in our study. Furthermore, the relationship between total fumonisins and pre/post-harvest and the women’s dietary practices was examined. Liquid chromatography coupled with tandem mass spectrometry was used to analyze the 16 mycotoxins. An adjusted censored regression model was fitted to identify predictors of mycotoxins, i.e., total fumonisins. We detected only fumonisin B2 (15% of the samples) and fumonisin B3 (9% of the samples) while fumonisin B1 and nivalenol were detected only in a single breast milk sample. No association between total fumonisins and pre/post-harvest and dietary practices was found (p < 0.05). The overall exposure to mycotoxins was low in the studied women, although fumonisins contamination was not negligible. Moreover, the recorded total fumonisins was not associated with any of the pre/post-harvest and dietary practices. Therefore, to better identify predictors of fumonisin contamination in breast milk, longitudinal studies with food samples in addition to breast milk samples and with larger sample sizes are needed for the future.

IntroductionPerinatal asphyxia continues to be a significant clinical concern around the world as the consequences can be devastating. World Health Organization data indicates perinatal asphyxia is encountered amongst 6-10 newborns per 1000 live full-term birth, and the figures are higher for low and middle-income countries. Nevertheless, studies on the prevalence of asphyxia and the extent of the problem in poorly resourced southern Ethiopian regions are limited. This study aimed to determine the magnitude of perinatal asphyxia and its associated factors.MethodsA retrospective cross-sectional study design was used from March to April 2020. Data was collected from charts of neonates who were admitted to NICU from January 2016 to December 31, 2019.ResultThe review of 311 neonates' medical records revealed that 41.2% of the neonates experienced perinatal asphyxia. Preeclampsia during pregnancy (AOR = 6.2, 95%CI:3.1-12.3), antepartum hemorrhage (AOR = 4.5, 95%CI:2.3-8.6), gestational diabetes mellitus (AOR = 4.2, 95%CI:1.9-9.2), premature rupture of membrane (AOR = 2.5, 95%CI:1.33-4.7) fetal distress (AOR = 3,95%CI:1.3-7.0) and meconium-stained amniotic fluid (AOR = 7.7, 95%CI: 3.1-19.3) were the associated factors.ConclusionSubstantial percentages of neonates encounter perinatal asphyxia, causing significant morbidity and mortality. Focus on early identification and timely treatment of perinatal asphyxia in hospitals should, therefore, be given priority.

Background Cervical cancer (CC) is the 4th most prevalent cancer among females globally. In Ethiopia, around 7,095 new CC cases are diagnosed every year and it is the second common cause of cancer deaths in women. There is limited evidence on survival status as well as about predictors of time to death among CC patients in Ethiopia. Thus, this study investigated the five-year survival status and predictors of time to death among CC patients who had been admitted at Tikur Anbesa specialized Hospital (TASH) from 2014–2019. Methods Facility-based, retrospective-cohort study was conducted at Tikur Anbesa specialized Hospital among 348 patients from June 2014 to June 2019. A systematic random sampling method was employed to select the study participants. Data were extracted from the patient card, and through phone calls. The data was collected using the android version CS-Entry tool. Data was analyzed by SPSS version 23. Kaplan and Meier’s method was used to estimate survival functions and Cox-proportional hazard regression analysis was carried out in order to identify the independent predictors of time to death. Results The overall incidence of death was 31 per 100 person-years of follow up. The median (IQR) follow-up time of the entire cohorts was 18.55 (8.96–49.65) months. The independent predictors for time to death included; age older than 50 years [AHR: 1.4; 95% CI: 1.1–1.9], late stage of CC at diagnosis [AHR: 2.2; 95% CI: 1.7–2.9], No CC treatment [AHR: 2.1; 95% CI: 1.5–3.1] and HIV positive [AHR: 2.3; 95% CI: 1.4–3.8]. Conclusion and recommendation The death rate of CC patients was high. The significant predictors associated with shorten time to death of CC patients were older age, advanced cancer stage at diagnosis, HIV infection and not receiving cancer treatment. Therefore, improving early detection and initiation of treatment for all CC patients is necessary in order to improve patient’s survival status. The government needs to strengthen the routine CC screening programs to address high-risk women such as elderly and HIV positive women in Ethiopia.

Background Although Ethiopia has improved access to health care in recent years, quality of care remains low. Health worker motivation is an important determinant of performance and affects quality of care. Low health care workers motivation can be associated with poor health care quality and client experience, non-attendance, and poor clinical outcome. Objective this study sought to determine the extent and variation of health professionals’ motivation alongside factors associated with motivation. Methods We conducted a facility based cross-sectional study among health extension workers (HEWs) and health care professionals in four regions: Amhara, Oromia, South nations, and nationalities people’s region (SNNPR) and Tigray from April 15 to May 10, 2018. We sampled 401 health system workers: skilled providers including nurses and midwives (n = 110), HEWs (n = 210); and non-patient facing health system staff representing case team leaders, facility and district heads, directors, and officers (n = 81). Participants completed a 30-item Likert scale ranking tool which asked questions across 17 domains. We used exploratory factor analysis to explore latent motivation constructs. Results Of the 397 responses with complete data, 61% (95% CI 56%-66%) self-reported motivation as “very good” or “excellent”. Significant variation in motivation was seen across regions with SNNPR scoring significantly lower on a five-point Likert scale by 0.35 points (P = 0.003). The exploratory factor analysis identified a three-factors: personal and altruistic goals; pride and personal satisfaction; and recognition and support. The personal and altruistic goals factor varied across regions with Oromia and SNNPR being significantly lower by 0.13 (P = 0.018) and 0.12 (P = 0.039) Likert points respectively. The pride and personal satisfaction factor were higher among those aged > = 30 years by 0.14 Likert scale points (P = 0.045) relative to those aged between 19-24years. Conclusions Overall, motivation was high among participants but varied across region, cadre, and age. Workload, leave, and job satisfaction were associated with motivation.

Background Iodine is one of the crucial micronutrients needed by the human body, and is vitally important during pregnancy. This study aimed to determine the relationship between the iodine status of pregnant women and their knowledge, and practices regarding iodized salt. All participants were enrolled in the Butajira nutrition, mental health and pregnancy (BUNMAP) cohort, Butajira, Ethiopia in February-May, 2019. Methods In this cross-sectional study, 152 pregnant women without hypertension or known thyroid disease before or during pregnancy were randomly selected from the BUNMAP mother to child cohort (n = 832). Spot urine samples were collected to estimate the level of urinary iodine concentration (UIC). Salt samples were also collected from their homes. The Sandall-Kolthoff (S-K) method was used to measure the level of iodine in the urine samples, and iodometric titration was used to measure the level of iodine in the salt. Data was entered and cleaned using Epi-info version 3.5.3 and then exported to SPSS version 20 for further analysis. Multivariate logistic regression analysis was performed to identify associations in the collected data. Results The WHO recommended level of iodine for populations of pregnant women is 150–249 F06Dg/L. The median UIC among pregnant women in this study was 151.2 μg/L [interquartile range (IQR) = 85.5–236.2 F06Dg/L], at the low end of this range. About half (49.65%) of the participants were likely to be iodine deficient. There was a significant association between having a formal job (AOR = 2.56; CI = 1.11–5.96) and iodine sufficiency. Based on a cutoff of >15 ppm (mg/kg), 91.7% (95% CI: 87.2–96.2) of the salts collected from the household had adequate iodine content. The median iodine level of the collected salt samples was 34.9 mg/kg (ppm) (IQR = 24.2–44.6 mg/kg). Conclusions The UNICEF 2018 guidelines for adequate iodine nutrition in pregnant women include both a recommended median range of 150–249 μg/L, and an upper limit of 20% on the fraction of the population with UIC below 50 μg/L. Because our study population’s median level is 151.2 μg/L and the percentage of pregnant women with urinary iodine concentration of less than 50 μg/L is 9.7% (14/145), the women received adequate iodine nutrition. The availability of adequately iodized salt in households is more than 90%, as recommended by WHO. In light of previous iodine deficiency in this region of Ethiopia, the salt iodization program promotes the health of babies and mothers.

Mid-upper arm circumference (MUAC) is an age-sensitive anthropometric measurement in infants. However, exact age is difficult to know, particularly in low-income countries. We evaluated the diagnostic accuracy of an age-independent mid-upper arm circumference-to-length (MUAC/L) ratio measurement in detecting wasting among infants aged 1–6 months in Ethiopia. A facility-based diagnostic accuracy study was conducted on 467 in-patient infants aged 1–6 months from March to May 2019. The receiver operating characteristic (ROC) curve was used to evaluate the ability of MUAC/L to detect wasting. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and positive and negative predictive values were calculated. The magnitude of severe wasting was 21⋅6 % and moderate wasting was 13⋅0 %. The area under the ROC curve (AUC) of MUAC/L was 0⋅77 (95 % CI 0⋅73, 0⋅81) for detecting moderate wasting and 0⋅92 (95 % CI 0⋅89, 0⋅94) for detecting severe wasting. MUAC/L had a sensitivity of 91⋅1 % (95 % CI 81⋅3, 94⋅4), a specificity of 84⋅7 % (95 % CI 80⋅6, 88⋅2), a positive likelihood ratio of 5⋅82 (95 % CI 4⋅53, 7⋅48) and a negative likelihood ratio of 0⋅13 (95 % CI 0⋅07, 0⋅22) in total infants. The optimal MUAC/L cut-off was