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Background COVID-19 is still threatening the world and has health, social, economic and political crisis. COVID-19 preventive measures are of having paramount importance for the disease mitigation. Governmental and private employees’ compliance with COVID-19preventive measures are highly important in influencing their friends, spouse, families and community at the large to adhere to the preventive measures. Objectives Compliance with COVID-19 preventive measures and associated factors among employees of Seka and Kersa districts, Jimma zone, Ethiopia, 2020. Methods A cross-sectional study was conducted from 4–22 January 2021. A total of 395 employees from randomly selected of public and private institutions were participated in the study. The data were collected using a pre-tested structured tool. The collected data were entered to EPI data manager version 4.6 and exported to Stata version 16.0 for analyses. Descriptive analyses were performed as necessary. Binary and multivariable logistic regression models were fitted to identify determinants of compliance with COVID-19 preventive measures. Adjusted odds ratios with 95% confidence intervals were used to determine the presence and strength of association. Results This study showed that nearly three fourth (74.68%) of employees were compliant with the COVID-19 preventive measures. Being employees of private institution (adjusted β = 3.12; 95% CI 0.31 to 5.94; p = 0.030), having history of chronic illness (adjusted β = 4.06; 95% CI 1.58 to 6.54; p = 0.001), perceived susceptibility to COVID-19 (adjusted β = 0.38; 95% CI 0.16 to 0.61; p = 0.001), self-efficacy to utilize the preventive measures (adjusted β = 0.70; 95% CI 0.54 to 0.86; p

Solomon Berhanu Mogas,1 Temamen Tesfaye,2 Belay Zewde,3 Yonas Tesfaye,4 Ayantu Kebede,1 Mulualem Tadesse,5 Esayas Kebede Gudina,6 Dessalegn Tamiru,7 Lelisa Sena Dadi1 1Department of Epidemiology, Jimma University, Jimma, Oromia Region, Ethiopia; 2School of Nursing and Midwifery, Jimma University, Jimma, Oromia Region, Ethiopia; 3Department of Biomedical Sciences, Jimma University, Jimma, Oromia Region, Ethiopia; 4Department of Psychiatry, Jimma University, Jimma, Oromia Region, Ethiopia; 5School of Medical Laboratory Science, Jimma University, Jimma, Oromia Region, Ethiopia; 6Department of Internal Medicine, Jimma University, Jimma, Oromia Region, Ethiopia; 7Department of Nutrition and Dietetics, Jimma University, Jimma, Oromia Region, EthiopiaCorrespondence: Solomon Berhanu MogasDepartment of Epidemiology, Jimma University, P.O.Box-378, Oromia Region, EthiopiaTel +251913458961Email solo.berhanu@gmail.comBackground: Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia.Methods: A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors. P-value < 0.05 and 95% CI were used on multivariable logistic regression analysis as threshold for significant statistical association.Results: Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02– 1.05), BMI with overweight (AOR=2.52, 95% CI=1.35– 4.71), triglyceride (AOR=1.83, 95% CI=1.29– 2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03– 2.54) were factors significantly associated with HTN.Conclusion: As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population.Keywords: adult, burden, Ethiopia, hypertension, Jimma town, risk, undiagnosed

Background Establishing maternity waiting homes is a key strategy to address the geographic barrier to obstetric care access among women living in rural areas. In Ethiopia, maternity waiting homes have been in use for several years, with a sharp increase in the number of such facilities recently. However, there is little empirical evidence detailing the experiences and challenges faced by women during the implementation of this initiative in Ethiopia. Methods This study used a multiple case study design with qualitative data collection methods, and was conducted from October to November 2016. Data were collected using focus group discussions, in-depth interviews and direct observation of each maternity waiting home. All interviews and focus group discussions were recorded using a digital voice recorder. Data were transcribed and translated into English. The coding process and formation of thematic structure was assisted by Atlas ti7.5 computer software. Results The participants reported that they were satisfied and comfortable with the services at the maternity waiting homes, as were their husbands and community leaders. Facility, social and environmental challenges were identified as common barriers to the utilisation of maternity waiting homes by stakeholders at different levels. Healthcare providers reported common challenges at maternity waiting homes include a lack of basic utilities (water and electric supply), and overcrowding because of a shortage of space and lack of medical supplies. Some women reported that poor transportation services and the distance to facilities hindered the utilisation of maternity waiting homes. Conclusions There are social and facility challenges related to the use of maternity waiting homes in Ethiopia. Policymakers and health managers should work with relevant sectors to mitigate the effect of facility, social and environmental barriers and maximise the use of maternity waiting homes.

Introduction Lack of regional- and local-based cut-off points of lipid profile and/or anthropometric measurements remains one of the challenges in prevention, early detection and control of non-communicable diseases. This study aimed to validate anthropometric-based screening of lipid profiles to develop locally appropriate optimal cut-off points for metabolic syndrome screening. Methods A community-based cross-sectional study was conducted among randomly selected 977 adults in Jimma Town, Ethiopia. Data were collected using structured questionnaire, anthropometric and biochemical measurements. Data were analyzed using SPSS windows version 21 and Kappa statistic was used to validate the agreement between anthropometric measurement and lipid profile. A p-value of

Background This study aimed to assess factors associated with quality of family planning services in the Jimma zone, Ethiopia, 2018. Method Cross-sectional study was conducted at health posts in the Jimma zone from 13 March to 13 April 2018. Logistic regression analysis was used to identify client satisfaction on family planning services and qualitative data were presented by triangulating with quantitative findings. Conclusion Less than 50% of clients were satisfied with family planning services which significantly associated with availability of family planning methods and attending family planning education. Therefore, family planning education and availing different family planning methods is important to improve family planning services at the Jimma zone health posts.

Introduction Early detection of the unrecognized diabetes mellitus (DM) and its risk factors in the community is crucial to minimizing the burden of DM and associated complications. Hence, this study aimed to assess unrecognized DM and its relationship with behavioral characteristics, physical characteristics, and lipid profile among adults in Jimma Town, Southwest Ethiopia. Methods A community-based cross-sectional study was conducted on 915 adults in Jimma Town from June 17 to July 27, 2019. Physical measurements, lipid profile, and blood sugar levels were measured. The collected data were entered and analyzed using Epi Data 3.1 and SPSS version 21, respectively. Multivariable logistic regression was fitted to assess predictors of unrecognized DM where adjusted odds ratio (AOR) with its corresponding 95% confidence interval (CI) was used to assess the strength of association at P-value ≤05. Results The prevalence of unrecognized DM and impaired glucose metabolism (pre-diabetes) were 3.1% (95% CI; 2.0-4.4) and 14.8% (95% CI; 12.5-17.2), respectively. The risk of unrecognized DM was higher among male participants (AOR = 2.94, 95% CI: 1.19, 7.29), age group of 35 years and above (AOR = 3.45, 95% CI: 1.16, 10.27), and high waist circumference (AOR = 4.21, 95% CI: 1.72, 10.33). On the other hand, participants who perform sufficient physical activity (AOR = 0.14, 95% CI: 0.03, 0.58) had low risk of undetected DM. Conclusion The prevalence of unrecognized diabetes mellitus was relatively high. Male sex, advanced age, physical inactivity, and high waist circumference were found to be predictors of unrecognized DM. Thus, awareness needs to be created among the community to practice regular physical activity and maintaining normal body weight. Additionally, screening of DM should be promoted for early detection, prevention, and treatment.

Stroke is one of the most common medical emergencies and the leading cause of preventable death and long-term disability worldwide. A prospective cohort study was conducted at the stroke unit of Jimma university medical center for four consecutive months (from March 10 to July 10, 2017). Of the total 116 study patients, 60 (51.7%) had an ischemic stroke. At 30-day follow-up, 81 (69.8%) patients were alive, 34 (29.3%) were died, and one patient (0.9%) was lost to follow-up. Elevated alanine aminotransferase (ALT) level (AHR: 3.77, 95% CI: 1.34-10.57), diagnosis of stroke clinically alone (AHR: 3.90, 95 CI: 1.49-10.26), brain edema (AHR: 4.28, 95% CI: 1.61-11.37), and National Institute of Health Stroke Scale (NIHSS) ≥ 13 during hospital arrival (AHR: 6.49, 95% CI: 1.90-22.22) were the independent predictors of 30-day mortality. At 60-day follow-up, 68 (58.6%) patients were alive, 46 (39.7%) were died, and 2 (1.7%) were lost to follow-up. Discharge against medical advice (AHR: 6.40, 95% CI: 2.31-17.73) and severe modified Rankin score/mRS (4–5) at discharge (AHR: 3.64, 95% CI: 1.01-13.16) were the independent predictors of 60-day mortality. The median (IQR) length of survival after hospital admission for patients died within 30 and 60 days were 4.65 (2.34–11.80) and 9.3 (3.93–33) days, respectively. Stroke significantly affects the morbidity and mortality in Ethiopia. There is a need to provide better care and future planning for stroke patients as an emergency diagnosis and treatment to minimize mortality and disability., Highlights • Globally stroke is one of the most common medical emergencies and the leading cause of preventable death. • More than 75% of stroke mortality is occur in low and middle-income countries. • Stroke has become a major cause of morbidity, long-term disability and mortality in Ethiopia. • In Ethiopia, resources for stroke care are deficient and majority of the patients are discharged with severe disability. • The paucity of data specific to the Ethiopian setting limits the formulation of an appropriate intervention.

BackgroundRisk of malignancy index (RMI) is scoring system which was introduced to differentiate between benign and malignant ovarian tumor. It incorporates CA-125, ultrasound score and menopausal status for prediction of ovarian malignancies in preoperative period. There is no universal screening method to discriminate between benign and malignant adnexal masses yet. So, this study was conducted to determine the diagnostic accuracy of RMI and determine best cut off value for RMI.MethodsProspective cross-sectional study was carried out among women with ovarian mass admitted to Gynecology ward and operated from September 1, 2019 to June 30, 2020.Data analysis was carried out using SPSS version 26. CA-125 level, menopausal status and ultrasound score were used to calculate RMI. Finally, RMI score was compared to histopathology result used as gold standard.ResultsNinity nine patients were enrolled in this study. Prevalence of benign ovarian tumors were 61.6% (61/99) and that of malignant ovarian tumors were 38.4% (38/99). The mean age for benign tumors was 30±9yrs and the mean age for malignant tumors was 50.6±10.8yrs. Among benign tumors, serous cystadenoma was the most common (36%), followed by dermoid cyst (32.9%), mucinous cyst adenoma (14.8%). The most common malignant ovarian tumor was serous cyst adenocarcinoma (63.2%), followed by mucinous cystadenocarcinoma (23.8%) and dysgerminoma (5.3%). Overall, using RMI score cut off value 220 has good sensitivity (84.2%), specificity (77%), PPV (69.5%), NPV (88.7%) and diagnostic accuracy (79.8%) for discriminating between benign and malignant ovarian tumors.ConclusionFrom this study there were high proportion of women with RMI>=220 in malignant ovarian tumors group. The study shows that there is significant role of RMI in prediction of ovarian malignancy thus helping in deciding which patients need referral to a center where gynecologic oncologists are available. It is good practice to use it in developing countries including our country because of its simplicity, safety and applicability in initial evaluations of patients with adnexal mass.

Eleni Tegodan,1 Gurmesa Tura,2 Ayantu Kebede3 1Addis Ababa, Gulele Sub City, Hidase Health Center, Addis Ababa, Ethiopia; 2Jimma University, Institute of Health, Department of Population and Family Health, Jimma, Ethiopia; 3Jimma University, Institute of Health, Department of Epidemiology, Jimma, EthiopiaCorrespondence: Ayantu Kebede Tel +251910170632Email ayukebede2013@gmail.comBackground: Even though antenatal care (ANC) visits seems to be the key strategy to increase adherence to iron and folic acid supplements during pregnancy, the problem still remains unresolved. Therefore, this study planned to assess adherence to iron and folic acid supplements and associated factors among pregnant mothers attending ANC at Gulele sub-city Government Health Centers in Addis Ababa, Ethiopia, 2019.Methods: An institution-based cross-sectional study design was conducted on 403 pregnant women attending ANC at governmental health centers in Gulele sub city of Addis Ababa from May to June, 2019. The study participants were selected by systematic random sampling techniques, and an interviewer administered questionnaire was used to collect data. Descriptive statistics and logistic regression models were used to analyze the data. The results were considered statistically significant at p-value < 0.05.Results: The proportion of mother’s adherent to iron and folic acid supplements was 62.3% with a 95% CI of 57.5– 67.0. Women who had no formal education (AOR=2.37; 95% CI=1.25– 4.51), poor knowledge about anemia (AOR=1.97; 95% CI=1.24– 3.13), developing any other health problem during current pregnancy (AOR=2.59; 95% CI=1.55– 4.32), attending health information about iron/folic acid supplement (AOR=2.06; 95% CI=1.08– 3.921 and forgetful (AOR=2.23; 95% CI=1.40– 3.56) mothers were more likely to be non-adherent to the supplement compared with their counterparts.Conclusion and Recommendation: The status of maternal adherence was medium compared with other studies, and maternal educational status, knowledge about anemia, exposure to information, experiencing of health problems, and forgetfulness were associated with adherence behavior. This indicates that improving dissemination of information about the supplements and designing a reminder mechanism was needed to improve the adherence status of mothers to the supplement.Keywords: adherence, iron and folic acid supplement, pregnant mother, factors, antenatal care, Ethiopia

Background Sexual and reproductive health and right of adolescents is a global priority as the reproductive choices made by them have a massive impact on their health, wellbeing, education, and economy. Teenage pregnancy is a public health issue and a demographic challenge in Ethiopia. Increasing access to contraceptive services for sexually active adolescents will prevent pregnancies and related complications. However, little is known about the trends in contraceptive use and its determinants among adolescent girls in Ethiopia. Therefore, this study was designed to examine the trends and factors associated with contraceptive use among sexually active girls aged 15–19 years in Ethiopia by using Ethiopian demographic and health survey data. Methods Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data were used. The data was downloaded from the demographic and health survey program database and extracted for sexually active adolescent girls. Data were weighted for analysis and analyzed using SPSS version 21. Descriptive analysis was used to describe the independent variables of the study. A multivariable logistic regression model was used to identify factors associated with contraceptive use and adjusted odds ratios with 95% confidence interval were presented for significant variables. Variables with a p-value less than 0.05 were considered as significantly associated with contraceptive use. Results Contraceptive method use had increased significantly from 6.9% in 2000 to 39.6% in 2016 among sexually active adolescent girls in Ethiopia. The odds of contraceptive use were lower among female adolescents who had no formal education (AOR 0.044; 95% CI 0.008–0.231) and attended primary education (AOR 0.101; 95% CI 0.024–0.414). But the odds were higher among adolescents from a wealthy background (AOR 3.662; 95% CI 1.353–9.913) and those who have visited health facilities and were informed about family planning (AOR 3.115; 95% CI 1.385–7.007). Conclusion There is an increment in the trend of contraceptive use among sexually active female adolescents in Ethiopia between 2000 and 2016. Significant variations in the use of modern contraception by wealth status, educational level and visited a health facility, and being informed about family planning were observed. Improving the economic and educational status of young women, and provision of information may help in improving contraceptive use in Ethiopia., Plain English summary Adolescent contributes up to 16 per cent of the world’s population. Sexual and reproductive health and right of these populations is a global priority. Teenage pregnancy is a public health issue and a demographic challenge in Ethiopia. A contraceptive method is best for sexually active adolescents to prevent pregnancies and its related complications. Data for this study are from the four Ethiopian Demographic and Health Surveys [EDHS] conducted in 2000, 2005, 2011, and 2016. Data for sexually active adolescent girls were extracted from the data set. The trend of contraceptive use among adolescents is increasing from time to time. However, more than three-fifth of the sexually active female adolescents are still not using any type of contraception. There were significant variations in the use of modern contraception by background characteristics of the respondents. In all four rounds of the EDHS, modern contraceptive use was common among adolescents in 18–19 years, who attended secondary and above educational level, lived in urban areas, and was from wealthy family groups.

BACKGROUND፡ Childhood vaccination is considered as one of the most cost-effective public health interventions. With an increasing dropout rate from vaccination, the factors for incomplete vaccination are not well explored. The objective of this study was to identify determinants of incomplete childhood vaccination.METHOD: Community based case-control study was conducted from March 1-30,2018. Cases were children who missed at least one dose of routine vaccine while controls were children who completed all recommended doses. Face-to-face interviews were used to collect data. Multivariable logistic regression was performed in order to identify determinants with 95% CI and a pvalue of

Background Age difference among spouses can be considered as an indicator of the nature of the marital bond, and influences the couple’s fertility expectations. The age difference is one of the features of the traditional African marriage system. However, the likelihood that women use of contraceptives and spousal age differences is not well studied. Thus, this study was to examine the spousal age difference on contraceptive use. Objective This study was aimed to examine spousal age differences and its effect on contraceptive use among sexually active couples in Ethiopia. Methods The related variables for this study were extracted from Ethiopian Demographic and Health Survey 2016 data. IBM SPSS statistics version 20 software was used for analysis. Logistic regression was conducted to see the association between spousal age difference and contraceptive use. All analyses were adjusted for sample weights. Results Out of the 7268 selected women for contraceptive usage questions, one fourth (25.3%) of them were between ages 25 and 29 and in almost all 7061 (98.4%) of them there was spousal age differences, 1555 (21.4%) of them were from poor socioeconomic group. Nearly all 7184 (98.8%) of them knew contraceptive method. However, among those sexually active in the last 4 weeks only two in five (41.2%) were using a contraceptive method. Spousal age difference was found to be significant factor and women older than their spouses were (AOR: 1.771, 95%CI: 1.276, 2.459) more likely and women having spouse’s age difference greater than 10 years were 1.2% (AOR: .988, 95%CI: .848, 1.150) less likely to use contraception compared to those age difference is ten or less than years respectively. Also, women who were living in urban areas (AOR: 1.482, 95%CI: 1.161 to 1.890), current working status (AOR: 1.170; 95%CI: 1.033 to 1.325), from richest economic category (AOR: 2.560; 95%CI: 2.000 to 3.278) husband’s education, couples’ fertility preference (AOR: 1.233; 95%CI: 1.070 to 1.420) were contraception use predictors. Similarly, being Muslim by religion (AOR: .579 95%CI: 0.496 to 0.675) and husband based decision for their health care use were (AOR: .847, CI: .729 to .985) less likely to use contraception. Conclusion and recommendation This study found association between spousal age differences and contraceptive use. Similarly, women’s age, age difference, place of residence, religion, current working status, socioeconomic, husband’s education, living children and current pregnancy, the couples’ fertility preference and who decides on health care use were found to be predictors of contraceptive use. Strengthening strategies for improving women’s educational status, socio-economic and demographic that will help to limit the age differences and improve contraceptive use. Further study, including qualitative is recommended to dig out the why components and better understand this finding.

Background: Sexual and reproductive health and right of young people is a global priority as the reproductive choices made by them have a massive impact on their health and wellbeing, education and economy. Teenage pregnancy is a burning public health issue and a demographic challenge in Ethiopia. The use of contraceptive method is a most effective way for sexually active adolescent to prevent pregnancy and its related complication. However, little is known about the trends in contraceptive use and its determinant among girls aged 15 to 19 in Ethiopia. Therefore, this study was designed to examine the trends and correlates of contraceptive use among sexually active adolescents in Ethiopia by using Ethiopian demographic and health survey data.Methods: Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use among sexually active adolescent girls. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data were used. The data was accessed from the demographic and health survey program data base and data for sexually active adolescent girls were extracted. Data analysis was done using SPSS version 21. Data were weighted for analysis. Descriptive analysis was used to describe independent variables of the study. Multivariable logistic regression model was used to identify factors associated with contraceptive use.Results: Contraceptive method use was increased significantly from 6.9% in 2000 to 39.6% in 2016 among sexually active adolescent girls in Ethiopia. The odds of contraceptive use were lower among female adolescent who had no formal education (AOR= 0.044; 95% CI= 0.008–0.231) and attended primary education (AOR= 0.101; 95% CI= 0.024–0.414). But the odds of contraceptive methods use were higher among adolescents in rich wealth status (AOR= 3.662; 95% CI =1.353–9.913) and those who were told about family planning during their health facility visits (AOR= 3.115; 95% CI= 1.385–7.007)Conclusion: Contraceptive method use was increased significantly among sexually active adolescent girls in Ethiopia in the year 2000 to 2016. Wealth status, educational status and information about family planning during their health facility visits were factors associated with contraceptive use. Improving economic and educational status of young women may help in improving contraceptive use in Ethiopia.

Background Background: Sexual and reproductive health of young people is a global priority. Access to sexual and reproductive health information and services determine the burden of adolescent and unwanted pregnancies. Teenage pregnancy that has profound effects on the health and wellbeing of young women across their life course is a burning public health and a demographic challenge in Ethiopia. Contraceptive use allows girls to postpone motherhood and space births. However, little is known about the trends in contraceptive use and its determinant among girls aged 15 to 19 in Ethiopia. Therefore, this study was designed to examine the trends and correlates of contraceptive use among sexually active adolescents in Ethiopia by using Ethiopian demographic and health survey data. Methods : Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use among sexually active adolescent girls. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data were used. The data was accessed from the demographic and health survey program data base and data for sexually active adolescent girls were extracted. Data analysis was done using SPSS version 21. Data were weighted for analysis. Descriptive analysis was used to describe independent variables of the study. Multivariable logistic regression model was used to identify factors associated with contraceptive use. Results: The analysis of Ethiopian demographic and health survey data indicated that Contraceptive method use were increased significantly from 6.9% in 2000 to 39.6% in 2016. The odds of contraceptive use were lower among female adolescent who had no formal education (AOR: .044; 95%CI: (.008 to 0.231), primary education (AOR:.101; 95%CI: 0.024 to 0.414). But the odds of contraceptive methods use were higher among adolescents of good life standard (rich) (AOR: 3.662; 95%CI: (1.353 to 9.913), and those who were told about family planning during their health facility visit (AOR: 3.115; 95%CI: 1.385 to 7.007) Conclusion: Contraceptive method use were increased significantly among sexually active adolescent girls in Ethiopia in the year 2000 to 2016. Wealth index, education and information about family planning during their health facility visit were factors associated with contraceptive use. Improving economic and educational status of young women may help in improving contraceptive use in Ethiopia.

Background The time spent between referring and receiving health facilities is an important determinant of the outcome of the referred patients/clients especially among women in low income countries due to poor access to early and appropriate referrals. Thus, the aim of this study is to assess the average time spent between referring and service utilization at receiving health facility.Methods A cross-sectional study was employed by using time and motion approach. Structured questionnaire and observation checklist were used for collecting data. SPSS 21 version was used for data analysis and binary and multivariable logistic regression analysis was carried out to identify a variable which has a significant association on the basis of OR, 95% CI and a P value of less than 0.05.Result A total of 266 women were participated in the study with the mean age of the study population is 24.65(± 5.03) years. Majority 223(83.8%) of the participants came for maternal health services and more than half 143(53.8%) of the respondents were self-referrals. Amongst the referred cases the main reason for the referral was for further evaluation and management. Women spent a maximum of 540 minutes on the way to arrive at receiving health facility. Residence and distance were the predictor variables for average time spent. More than two fifth of the women wait more than three hours to get the service at receiving health facility. Residence and distance were the determinant variables for average time spent.Conclusion In general, women wait a maximum of one and half hours to contact health care providers for assessment and more than two fifth of the women wait more than three hours to get the service at receiving health facility. Giving due emphasis to referral system as an integral part of maternal health was essential.

Introduction Lack of regional- and local-based cut-off points of lipid profile and/or anthropometric measurements remains one of the challenges in prevention, early detection and control of non-communicable diseases. This study aimed to validate anthropometric-based screening of lipid profiles to develop locally appropriate optimal cut-off points for metabolic syndrome screening. Methods A community-based cross-sectional study was conducted among randomly selected 977 adults in Jimma Town, Ethiopia. Data were collected using structured questionnaire, anthropometric and biochemical measurements. Data were analyzed using SPSS windows version 21 and Kappa statistic was used to validate the agreement between anthropometric measurement and lipid profile. A p-value of

Alemi Olika Kebede,1 Yonas Terfa Biratu,2 Ayantu Olika Kebede,3 Sena Kitila Belina2 1Population and Family Health Department, Jimma University Institute of Health Science, Jimma, Ethiopia; 2School of Nursing and Midwifery, Jimma University Institute of Health Science, Jimma, Ethiopia; 3Department of Epidemiology, Jimma University Institute of Health, Jimma, EthiopiaCorrespondence: Alemi Olika Kebede Tel +251 910017441Email alemikebede@gmail.comPurpose: Although young people have a right to sexual and reproductive health, they are facing inadequate access to information and services. The Ethiopian government has started implementing policies and strategies to eliminate inequalities in reproductive health service use. However, there are huge disparities in institutional delivery utilization between different age groups. Therefore, this study aimed to explore trends and factors associated with institutional childbirth among young women in Ethiopia.Methods: Ethiopian demographic and health survey data (EDHS) from 2000 to 2016 surveys were used. Data on the most recent births to women aged 15– 24 years that occurred in the 5 years preceding the survey period were extracted. All the four EDHS data were used to examine trends of institutional delivery, whereas determinants for institutional delivery were analyzed from a 2016 dataset by using multivariable logistic regression analysis.Findings: Between 2000 and 2016, the proportion of institutional delivery among young women increased from 6% (95% CI=3.7– 6.5%) to 40.1% (95% CI=30.6– 44.3%). The odds of institutional delivery increased for young women who had attended secondary and above education (AOR=2.68; 95% CI=1.559– 4.607), started ANC visits early (AOR=1.518; 95% CI=1.095– 2.105) and received four or more ANC visits (AOR=1.87; 95% CI=1.370– 2.561). However, the odds were lower among young women who had two (AOR=0.31; 95% CI=0.185– 0.514), and three or more children (AOR=0.62; 95% CI=0.452– 0.849).Conclusion: There is an increase in trend of institutional delivery among young women during the 2000 to 2016 EDHS. Having higher educational levels, early ANC booking, and attending four or more ANC visits were positively associated with institutional delivery. Increased number of children is negatively associated with institutional delivery. Strengthening strategies for improving girls’ education and addressing their socioeconomic and demographic vulnerabilities, and strengthening strategies being implemented for encouraging early and recommended ANC visits is crucial.Keywords: young, youth, institutional delivery, factors, EDHS, Ethiopia

Purpose The purpose of this study is to assess the quality of an integrated community case management service (ICCM) and associated factors at health posts in Ethiopia. Design and methods Institution-based cross-sectional study design was conducted in the health posts of Jimma zone. Data were collected using a structured questionnaire and in-depth interviews. Binary logistic regression was used to identify independent predictors of client satisfaction on services and the qualitative data were presented by triangulating with quantitative findings. Results This study indicated that 80%, 65% and 55% of health extension workers (HEW) correctly assessed cases, classified cases and prescribed drugs of ICCM cases respectively. Some caregivers (40.2%) knew about danger signs which they heard from HEWs (81.9%). More than one-fourth (29.01%) of caregivers reported that their children were exposed to illness like diarrhea (39.1%) in the last two weeks. HEWs have demonstrated to a large number of caregivers (66%) how to give medications. Being a housewife [AOR = 0.17(0.05,0.56)], having a farmer husband[AOR = 3.77(1.09,12.98)] and having a government employed husband [AOR = 5.32(1.03,27.48)] were significantly associated with ICCM services. Conclusions More than half of health extension workers correctly assessed, classified and prescribed drugs for ICCM cases. Some caregivers knew about danger signs which the majority of them heard from health extension workers. Being a housewife and paternal occupation were significantly associated with clients' satisfaction in ICCM services. Practice implications Findings of this study can be used to guide the development of programs to improve integrated community case management service in Ethiopia by informing policymakers and other stakeholders about challenges of ICCM services.

Introduction Early detection of the unrecognized diabetes mellitus (DM) and its risk factors in the community is crucial to minimizing the burden of DM and associated complications. Hence, this study aimed to assess unrecognized DM and its relationship with behavioral characteristics, physical characteristics, and lipid profile among adults in Jimma Town, Southwest Ethiopia. Methods A community-based cross-sectional study was conducted on 915 adults in Jimma Town from June 17 to July 27, 2019. Physical measurements, lipid profile, and blood sugar levels were measured. The collected data were entered and analyzed using Epi Data 3.1 and SPSS version 21, respectively. Multivariable logistic regression was fitted to assess predictors of unrecognized DM where adjusted odds ratio (AOR) with its corresponding 95% confidence interval (CI) was used to assess the strength of association at P-value ≤05. Results The prevalence of unrecognized DM and impaired glucose metabolism (pre-diabetes) were 3.1% (95% CI; 2.0–4.4) and 14.8% (95% CI; 12.5–17.2), respectively. The risk of unrecognized DM was higher among male participants (AOR = 2.94, 95% CI: 1.19, 7.29), age group of 35 years and above (AOR = 3.45, 95% CI: 1.16, 10.27), and high waist circumference (AOR = 4.21, 95% CI: 1.72, 10.33). On the other hand, participants who perform sufficient physical activity (AOR = 0.14, 95% CI: 0.03, 0.58) had low risk of undetected DM. Conclusion The prevalence of unrecognized diabetes mellitus was relatively high. Male sex, advanced age, physical inactivity, and high waist circumference were found to be predictors of unrecognized DM. Thus, awareness needs to be created among the community to practice regular physical activity and maintaining normal body weight. Additionally, screening of DM should be promoted for early detection, prevention, and treatment.

Background: Lack of regional and local based cut off points of lipid profile and/or anthropometric measurement remains one of the challenges in prevention, early detection and control of non-communicable diseases. This study was aimed to validate anthropometric based screening of lipid profile in order to prevent potential predictors of major non-communicable diseases.Methods: Community based cross sectional study was conducted among randomly selected 977 adults in Jimma Town, Ethiopia from July 20 to August 20, 2019. Data were collected using structured questionnaire, anthropometric and biochemical measurements. Data were analyzed using SPSS windows version 20 and Kappa statistic (K) was used to validate the agreement between anthropometric measurement and lipid profile of the study participants. A p-value of < 0.05 was considered statistically significant.Results: Body mass index (BMI) at ≥24.5 was used as screening of dyslipidemia (TG≥150mg/dl) with slight Kappa coefficient of 0.138 (PConclusions: Findings of this study indicated that BMI-based screening of triglyceride was applicable for both sexes than other anthropometric measurements. Waist circumference and Waist to hip ratio-based screening of triglyceride was slightly applicable only for males. However, anthropometric based screening of high-density lipoprotein measurement was not applicable for both sexes. In conclusion, researchers and policy makers need to consider local cut off points to conduct screening nutritional status of the community.

Background The sexual and reproductive health of young people is a global priority. Access to sexual and reproductive health information and services will determine, the burden of adolescent pregnancies and unwanted pregnancies. Teenage pregnancy that has profound effects on the health and wellbeing of young women across their life course is a burning public health and a demographic challenge in Ethiopia. Contraceptive use allows girls to postpone motherhood and space births. However, little is known about the trends in contraceptive use and its determinant among girls aged 15 to 19 in Ethiopia. Therefore, this study was designed to identify factors associated with modern contraceptive methods use among sexually active adolescent girls in Ethiopia. Methods Four Ethiopian demographic and health survey data were used to examine trends of contraceptive methods use among sexually active adolescent girls. To identify factors associated with contraceptive use, the 2016 Ethiopian demographic and health survey data was used. The data was accessed from the demographic and health survey program data base and data for sexually active adolescent girls were extracted. Data analysis was done using SPSS version 21. Data were weighted for analysis. Descriptive analysis was used to describe independent variables of the study participants. And design effect was considered during analysis. Multivariable logistic regression model was used to identify factors associated with contraceptive use. Results Modern contraceptive use increased significantly from 5.9% in 2000 to 39.3% in 2016. The odds of contraceptive use were lower among female adolescent who had no education (AOR: .038; 95%CI: (.007 to 0.216), primary education (AOR: 0.112; 95%CI: 0.026 to 0.483). But the odds of contraceptive methods use were higher among adolescent living in rich wealth status AOR: 5.131; 95%CI: (1.795 to 14.669) and those told about family planning during their health facility visit (A0R: 3.700; 95%CI: 1.517 to 9.020) Conclusion Modern contraceptive use increased significantly among sexually active adolescent girls in Ethiopia. Wealth index, education, told about family planning during their health facility visit and partner occupation were factors associated with contraceptive use. Improving economic and educational status of young women may help improve contraceptive use in Ethiopia.

Food insecurity is a global concern. While it was once characterized mainly as a problem of undernutrition, it is now recognized that a person may be food insecure without experiencing hunger. Numerous studies have demonstrated that food insecurity is strongly related to poor mental health around the world, but the mechanisms that underpin that relationship remain poorly understood. One body of research from nutritional sciences posits that nutrient deficiency impacts brain function, producing symptoms of depression and anxiety. Another body of research from the social sciences posits that the social consequences of having to eat non-preferred foods or obtain food in socially unacceptable ways may compromise mental health through stress. This study was designed to clarify the mechanisms linking food insecurity and mental health using case studies in rural Brazil and urban Ethiopia. Working with samples consisting of about 200 adult household decision-makers (mostly female) recruited between 2015 and 2019 at each site, we tested for nutritional and social mediation of the food insecurity-mental health relationship using multivariable linear regression and mediation analysis. Our analyses found no evidence of mediation in either setting. Moreover, there was no association between nutritional status variables and food insecurity. These findings suggest that food insecurity likely impacts mental health directly through forms of basic needs deprivation, such as worrying about where one's next meal will come from, rather than by acting as a social signal or even by impacting nutritional status. These results underscore the power of basic-needs deprivation for impacting mental health.

Background Stroke is the second-leading global cause of death behind heart disease in 2013 and is a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. It is currently observed to be one of the commonest reasons of admission in many health care setups and becoming an alarming serious public health problem in our country Ethiopia. Despite the high burden of strokes globally, there is insufficient information on the current clinical profile of stroke in low and middle income countries (LMICs) including Ethiopia. So, this study was aimed to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients admitted to stroke unit of Jimma university medical center (JUMC). Methods Prospective observational study design was carried out at stroke unit (SU) of JUMC for 4 consecutive months from March 10–July 10, 2017. A standardized data extraction checklist and patient interview was used to collect data. Data was entered into Epi data version 3.1 and analyzed using SPSS version 20. Multivariable logistic regression was used to identify the predictors of stroke subtypes. Result A total of 116 eligible stroke patients were recruited during the study period. The mean age of the patients was 55.1 ± 14.0 years and males comprised 62.9%. According to world health organization (WHO) criteria of stroke diagnosis, 51.7% of patients had ischemic while 48.3% had hemorrhagic stroke. The most common risk factor identified was hypertension (75.9%) followed by family history (33.6%), alcohol intake (22.4%), smoking (17.2%) and heart failure (17.2%). The most common clinical presentation was headache complained by 75.0% of the patients followed by aphasia 60.3% and hemiparesis 53.4%. Atrial fibrillation was the independent predictor of hemorrhagic stroke (AOR: 0.08, 95% CI: 0.01–0.68). Conclusion The clinical characteristics of stroke in this set up were similar to other low- and middle-resource countries. As stroke is a high priority chronic disease, large-scale public health campaign should be launched focusing on public education regarding stroke risk factors and necessary interventions. Electronic supplementary material The online version of this article (10.1186/s12883-019-1409-0) contains supplementary material, which is available to authorized users.

Background: The global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 periods, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of stroke varies in Ethiopia between regions and over time. The paucity of data has limited research output and consequently the response to this burden in our country. Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variables with P< 0.05 was considered statistically significant. Results: A total of 116 eligible stroke patients were followed with the mean age of 55.1+14.0 years and males comprised of 73 (62.9%) with male: female ratio of 1.70:1. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of in hospital mortality. Among the total, 91 (78.4%) patients discharged alive making in hospital mortality of rate of 25 (21.6%). The median time of in hospital mortality and length of hospital stay after admission of the patients was 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia 11 (44.0%). Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of time to in hospital mortality. Conclusions: The mortality rate of stroke in this set up was comparable with other low- and middle-resource countries. There should be burning need to establish and strengthen the available stroke units which are well-equipped and staffed with intensive health care teams across the country. Additionally, future work must be designed to identify the barriers to improve stroke outcomes and recovery.

Background: Global burden of stroke epidemiology is changing rapidly. Over the 1990–2013 period, there was a significant increase in the absolute number of deaths and incident events of stroke. The burden of ischemic and hemorrhagic stroke varies between regions and over time in Ethiopia. The paucity of data has limited research output and consequently the response to this burden in our country. Methods: Prospective cohort study was carried at stroke unit of Jimma University Medical Center (JUMC) from March 10- July 10, 2017. The outcome of interest was mortality and time to death. Data was analyzed using SPSS version 20. Multivariable Cox regression was used to identify the predictors of in hospital mortality and time to death from hospital arrival. Predictor variables with P< 0.05 were considered statistically significant. Results: A total of 116 eligible stroke patients were followed with the mean age of 55.1+14.0 years and males comprised of 73 (62.9%) with male: female ratio of 1.70:1. Stroke accounted for 16.5 % of total medical admissions and 23.6 % of the total cases of in hospital mortality. A total of 91 (78.4%) of patients were discharged being alive making in hospital mortality of rate of 25 (21.6%). The median time of in hospital mortality after admission and length of hospital stay of the patients was 4.38 days and 9.21 days, respectively. The prominent suspected immediate cause for in hospital mortality was increased intracranial pressure 17 (68.0%) followed by respiratory failure secondary to aspiration pneumonia 11 (44.0%). Brain edema (AHR: 6.27, 95% CI: 2.50-15.76), urine incontinence (AHR: 3.48, 95% CI: 1.48-8.17), National Institute of Health Stroke Scale (NIHSS) >13 during hospital arrival (AHR: 22.58, 95% CI: 2.95-172.56) and diagnosis of stroke clinically alone (AHR: 4.96, 95% CI: 1.96-12.54) were the independent predictors of in hospital mortality. Conclusions: The mortality of stroke in this set up was similar to other low- and middle-resource countries. There should be burning need to establish and strengthen the available stroke units which are well-equipped and staffed with intensive health care teams in different hospitals across the country.

Selection of study participants (DOCX 76 kb)

Data abstraction tool. (DOCX 24 kb)

Hypertension (HTN) is the leading risk factor for mortality due to cardiovascular diseases, it accounts for 7% of global disability adjusted life years. In 2015, it was estimated that around 1.13 billion adults had HTN globally with a high prevalence in low and middle-income countries where the health system is weak to diagnose, treat, and control HTN. Most people with HTN are asymptomatic and go undiagnosed for years. Therefore, the aim of this study was to assess the burden of undiagnosed HTN among adults in urban communities of Southwest Ethiopia.A community-based cross-sectional study involving 915 adults from June 17 to July 27, 2019 was performed. WHO STEPS questionnaire was used to collect data, and the collected data were entered using Epi Data version 3.1and analyzed using SPSS version 20, respectively. Binary logistic regression was used to check for a possible association between outcome and independent factors.Undiagnosed HTN in the study area was 21.2% (194). Age (AOR=1.04, 95% CI=1.02-1.05), BMI with overweight (AOR=2.52, 95% CI=1.35-4.71), triglyceride (AOR=1.83, 95% CI=1.29-2.59), and waist to hip ratio (AOR=1.62, 95% CI=1.03-2.54) were factors significantly associated with HTN.As compared to studies performed before, the risk of undiagnosed HTN in the current study was high. Age, BMI, triglyceride, and waist to hip ratios were found to be the significant factors for it. Preventing the risk factors and screening of HTN should be promoted for early detection, prevention, and treatment of the burden of the disease on the population.