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Alemayehu Digssie Gebremariam,1 Sofonyas Abebaw Tiruneh,2 Melaku Tadege Engidaw,1 Desalegn Tesfa,3 Melkalem Mamuye Azanaw,2 Getachew Yideg Yitbarek,4 Getnet Asmare5 1Department of Public Health (Human Nutrition), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Public Health (Epidemiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 3Department of Public Health (Reproductive Health), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 4Department of Biomedical Science (Medical Physiology), College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 5Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Sofonyas Abebaw Tiruneh Email zephab2@gmail.comBackground: Early neonatal death is the death of a live-born baby within the first seven days of life, which is 73% of all postnatal deaths in the globe. This study aimed to develop and validate a prognostic clinical risk tool for the prediction of early neonatal death.Methods: A prospective follow-up study was conducted among 393 neonates at Debre Tabor Referral hospital, Northwest Ethiopia. Multivariable logistic regression model was employed to identify potential prognostic determinants for early neonatal mortality. Area under receiver operating characteristics curve (AUROC) was used to check the model discrimination probability using ‘pROC’ R-package. Model calibration plot was checked using ‘givitiR’ R-package. Finally, a risk score prediction tool was developed for ease of applicability. Decision curve analysis was done for cost-benefit analysis and to check the clinical impact of the model.Results: Overall, 15.27% (95% CI: 12.03– 19.18) of neonates had the event of death during the follow-up period. Maternal undernutrition, antenatal follow-up less than four times, birth asphyxia, low birth weight, and not exclusive breastfeeding were the prognostic predictors of early neonatal mortality. The AUROC for the reduced model was 88.7% (95% CI: 83.8– 93.6%), which had good discriminative probability. The AUROC of the simplified risk score algorithm was 87.8% (95% CI, 82.7– 92.9%). The sensitivity and specificity of the risk score tool was 70% and 89%, respectively. The true prediction accuracy of the risk score tool to predict early neonatal mortality was 86%, and the false prediction probability was 13%.Conclusion: We developed an early neonatal death prediction tool using easily available maternal and neonatal characteristics for resource-limited settings. This risk prediction using risk score is an easily applicable tool to identify neonates at a higher risk of having early neonatal mortality. This risk score tool would offer an opportunity to reduce early neonatal mortality, thus improving the overall early neonatal death in a resource-limited setting.Keywords: prediction model, risk score, neonate, decision curve, Ethiopia

Malnutrition is more prevalent among children with cerebral palsy and a major factor for child morbidity and mortality in children with different co-morbidity, especially in Sub-Saharan Africa: The main aim of this systematic review and meta-analysis was to estimate the burden of malnutrition among children with cerebral palsy in Sub-Saharan Africa. We searched PubMed, Web of Science, Google Scholar, Research Gate, and institutional repositories for papers that reported the proportion of malnutrition among children with cerebral palsy that were published between December 2010 and September 2023. Data were retrieved using the standardized JBI data extraction checklist through Microsoft Excel, and then exported to STATA 17 for further analysis. DerSimonian and Laird's estimator was used to calculate the pooled effect size in the random-effects model. Statistics such as the Cochran Q test and I2 test were employed to measure heterogeneity. Egger's test and the funnel plot were used to look for publication bias. This systematic review and meta-analysis used 16 studies from Sub-Saharan Africa to estimate the proportion of malnutrition among 2,120 children with cerebral palsy. The pooled proportion of malnutrition among children with cerebral palsy in Sub-Saharan Africa by using random-effects model analysis was found to be 59.7% (95% CI; 49.8-69.6). The proportion of malnutrition was also estimated by sample sizes categorized as ≤ 120 and > 120, and the proportion of malnutrition was found to be 54.0 (95% CI: 44.7-63.3) and 64.5 (95% CI: 50.5-78.5). Moreover, the proportion of malnutrition was estimated by accounting for the difference in the year of publication. In this regard, the study classified before ≤ 2017 and > 2017, and the proportion of malnutrition was found to be 53.7 (95% CI: 38.0-69.3) and 62.5 (95% CI: 49.7-75.3) in Sub-Saharan Africa respectively. Malnutrition among children with cerebral in Sub-Saharan Africa was found to be very high. Hence, enhancing and developing strategic guidelines for malnutrition screening, prevention, and nutritional support are crucial among children with cerebral palsy. Furthermore, systematic review, randomized control trials, and qualitative studies are recommended to understand the burden more among children with cerebral palsy in the continent., (© 2024. The Author(s).)

Introduction: Preterm birth remains the most significant clinical and public health encounter. Preterm infant outcomes pose key evidence for clinicians and policymakers and are extensively used to set clinical and policy verdicts to improve services. It is necessary to conduct the outcomes of neonates frequently, as it varies from place to place and even from time to time in a similar place. There is limited literature in Ethiopia about preterm neonates' outcomes and their predictors., Objective: This study aimed to assess the neonatal outcomes of preterm neonates and their predictors in South Gondar zone public hospitals, Northwest Ethiopia, 2021., Methods: A prospective observational study was employed on 462 preterm neonates in South Gondar Zone Public Hospitals. The data were entered into Epidata 4.6 and analyzed using STATA version 16/MP software. A parametric log-normal survival model was used to identify possible predictors for preterm neonate death. Statistical significance was declared at a P -value less than 0.05., Result: The overall preterm survival rate was 71.1% (95% CI: 66.7, 75.1). Thirty-six percent of preterm neonates were diagnosed with sepsis. One-fourth of the neonates had respiratory distress syndrome. Gestational age greater than 34 weeks (β = 1.04; 95% CI: 0.53, 1.56), respiratory distress syndrome (β = 0.85; 95% CI: 0.49, 1.22), body mass index (β = -1.34; 95% CI: -1.87, -0.80), non-union marital status (β = -0.71; 95% CI: -1.34, -0.09), multiple pregnancies (β = -0.66; 95% CI: -0.99-0.32), multiparous (β = 0.35; 95% CI: 0.01, 0.69), hypothermia (β = -1.19; 95% CI: -1.76, -0.62), Kangaroo Mother Care (β = -1.9; 95% CI: -2.34, -1.41) and non-cephalic presentation (β = -1.23; 95% CI: -1.99,-0.46) were significant predictors., Conclusion: In this study, the preterm survival rate was low. Gestational age greater than 34 weeks, no respiratory distress syndrome, and multiparous mothers were positively associated with the survival of preterm neonates. Though, high pre-pregnancy maternal body mass index, non-union marital status of mothers, multiple pregnancies, hypothermia, Kangaroo mother care is not given, and non-cephalic presentation were negatively associated. A significant focus should be given to implementing WHO recommendations on preventing and caring for preterm births., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Introduction: Although Ethiopia has implemented the Option B+ program over the past 7 years, loss to follow-up among HIV-positive women remains a major problem for antiretroviral therapy (ART) treatment. This study was conducted to investigate the number of women who dropped out of follow-up after the Option B+ program., Methods: A retrospective follow-up study was conducted among 403 pregnant and lactating women between June 2013 and December 2019 at health facilities in Northwest Ethiopia. The Cox proportional hazards regression model was used to identify predictors of loss to follow-up. The results were reported as hazard ratios with 95% confidence intervals (CIs) at a significance level of p  = 0.05., Results: The overall incidence rate of loss to follow-up was 9.4 per 1,000 person-months of observation (95% CI: 7.40-11.90). According to the multivariable Cox regression, rural residency [adjusted hazard ratio (AHR): 2.30; 95% CI: 1.08-4.88], being a Muslim religion follower (AHR: 2.44; 95% CI: 1.23-4.81), having no baseline viral load measurement (AHR: 4.21; 95% CI: 2.23-7.96), being on ART before enrolment (AHR: 0.30; 95% CI: 0.15-0.62), having drug side effects (AHR:1.82; 95% CI: 1.01-3.33), same-day ART initiation (AHR: 3.23; 95% CI: 1.53-6.84), and having suboptimal adherence level (AHR: 3.96; 95% CI: 2.18-7.19) were significant predictors of loss to follow-up., Conclusion: The incidence of loss to follow-up is lower as compared to evidence from most African countries but slightly higher than the WHO target. It is better to strengthen and expand viral load measurements for all women and to pay attention to women residing in rural areas with fair or poor adherence levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Azanaw, Baraki and Yenit.)

Background: The Corona virus disease 19 (COVID-19) pandemic is a human tragedy that occurred in this era. It poses an unprecedented psychological, social, economic, and health crisis. The mental health and well-being of entire societies are suffering as a result of this crisis, but the suffering is greater in students at all levels of education and must be addressed immediately. Thus, this study was aimed to estimate the pooled prevalence and associated factors of the psychological impact of COVID-19 among higher education students., Methods: The potential studies were searched via PubMed, HINARI, the Cochrane Library, and Google Scholar. Studies were appraised using the Joanna Briggs Institute appraisal checklist. Micro Soft Excel was used to extract the data, which was then exported to Stata version 14 for analysis. Heterogeneity between studies was tested using Cochrane statistics and the I 2 test, and small-study effects were checked using Egger's statistical test. A random-effects model was employed to estimate the pooled prevalence of the psychological impact of COVID-19 and its associated factor., Results: After reviewing 227 studies, eight fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of the psychological impact of Corona virus disease 19 among higher education students in Ethiopia, including depression, anxiety, and stress was 43.49% (95% CI: 29.59, 57.40%), 46.27% (95% CI: 32.77, 59.78%), and 31.43% (95% CI: 22.71, 40.15), respectively. Having a medical illness, being an urban resident, living with parents, having relative death due to pandemics, and having a non-health field of study were identified as significant associated factors for the impact of the pandemic in higher education students., Conclusion: The COVID-19 pandemic had a significant psychological impact on college and university students. Depression, anxiety, and stress were the most commonly reported psychological impacts across studies among higher education students. Hence, applying tele-psychotherapy using, smartphones, and social media platforms has an effect on reducing the impact. Programs for preventing and controlling epidemics should be developed by the government and higher education institutions that incorporate mental health interventions and build resilience., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Anteneh, Dessie, Azanaw, Anley, Melese, Feleke, Abebe and Muche.)

Introduction: Transactional sex is casual sex between two people to receive material incentives in exchange for sexual favors. Transactional sex is associated with negative consequences, which increase the risk of sexually transmitted diseases, including HIV/AIDS, unintended pregnancy, unsafe abortion, and physiological trauma. In Sub-Saharan Africa, several primary studies have been conducted in various countries to examine the prevalence and associated factors of transactional sex among women. These studies had great discrepancies and inconsistent results. Hence, this systematic review and meta-analysis aimed to synthesize the pooled prevalence of the practice of transactional sex among women and its associated factors in Sub-Saharan Africa., Method: Data source: PubMed, Google Scholar, HINARI, the Cochrane Library, and grey literature were searched from March 6 to April 24, 2022, and included studies conducted from 2000 to 2022. The pooled prevalence of transactional sex and associated factors was estimated using Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic, a funnel plot, and Egger's test were used to check for heterogeneity and publication bias, respectively. A subgroup analysis was done based on the study years, source of data, sample sizes, and geographical location., Results: The pooled prevalence of transactional sex among women in Sub-Saharan Africa was 12.55% (9.59%-15.52%). Early sexual debut (OR = 2.58, 95% CI: 1.56, 4.27), substance abuse (OR = 4.62, 95% CI: 2.62, 8.08), history of sexual experience (OR = 4.87, 95% CI: 2.37, 10.02), physical violence abuse (OR = 6.70, 95% CI: 3.32, 13.53), orphanhood (OR = 2.10, 95% CI: 1.27, 3.47), and sexual violence abuse (OR = 3.76, 95% CI: 1.08, 13.05) were significantly associated with transactional sex., Conclusion: The prevalence of transactional sex among women in sub-Saharan Africa was high. Alcohol consumption, substance abuse, early sex debuts, having a history of sexual experiences, physical violence, and sexual violence increased the practice of transactional sex., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Mihretie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Hepatitis B (HB) is a virus which causes a potentially fatal liver infection. It is a DNA virus belonging to the Hepadnaviridae virus family. Africa, after Asia, has the second highest number of chronic HBV carriers and is considered a high-endemic region. Ethiopia is classified as a country with a high prevalence of viral hepatitis and with nations that lack a systematic strategy for viral hepatitis surveillance., Methods: S-I-C-R deterministic model was developed and the numerical simulations were done in "R" statistical and programming software. Fixed population assumption was considered so as to develop a simple model which could predict the HBV vertical transmission for the next 5 decades., Results: The model revealed that significant number of populations will be infected and become carrier till the end the next 49 years even though it has decreasing trend. It was predicted that 271,719 people will die of HBV complications if no intervention will be made on its vertical transmission. The sensitivity analysis result showed that the force of infection has the most important parameter in the vertical transmission dynamics of hepatitis B. Provision of hepatitis B immunoglobulin (HBVIG) and vaccines at the time of delivery could decrease the force of infection by more than half and 51,892 lives will be saved if the intervention is offered for 50% of deliveries in Ethiopia., Conclusion: Despite the fact that the incidence of HBV vertical transmission is substantial, it is expected to decline during the next five decades. However, the situation necessitates immediate attention, since it results in thousands of deaths if no action is taken. Offering HBVIG and vaccinations to the 50% of infants can save many lives and reduces the force of infection by more than a half., (© 2023. The Author(s).)

Background: Undernutrition is defined as not consuming enough nutrients and energy to meet one's needs for maintaining good health. It is exacerbated by armed conflict. Individuals cannot stick to jobs because of a lack of safety during conflicts, which has an impact on families' ability to purchase food. However, there is a paucity of evidence on pooled evidence on the impact of armed conflict on childhood undernutrition among children aged 6 to 59 months in Africa. Therefore, this review aimed to examine the effects of armed conflict on the magnitude of undernutrition, particularly stunting, underweight, and wasting among children in Africa., Methods: A comprehensive literature search was conducted using electronic databases (PubMed, Hinari, and Google Scholar database) to locate potential studies. Heterogeneity between studies was checked using Cochrane Q test statistics and I 2 test statistics. Small-study effects were checked using Egger's statistical test at a 5% significance level. A random-effects model was employed to estimate the pooled prevalence and associated factors of undernutrition among children aged 6-59 months in Africa., Results: Of a total of 585 articles retrieved from the databases, 12 studies met our inclusion criteria. The pooled prevalence of wasting, stunting, and being underweight among conflict-affected African countries was 20.25% (95%CI = 15.08-25.43), 34.18% (95% CI = 26.34-42.02), and 24.00% (95%CI = 16.35-31.65), respectively. The most consistent factors associated with childhood stunting, wasting, and being underweight in Africa were low mother's education, prolonged duration of armed conflict, and rural place of residence., Conclusion: The severity of malnutrition crises will be assisted by a better understanding of the variables associated with child malnutrition, which will improve the effectiveness of development and humanitarian responses. We urge that health planners, policymakers, and the general public prioritize children with acute malnutrition in Africa's conflict-affected areas., Systematic Review Registration: PROSPERO CRD42022367487., (© 2023. The Author(s).)

Background: Even though the total fertility rate (TFR) has decreased significantly over the past decades in many countries, it has remained stable in sub-Saharan African (SSA) countries. However, there is variation among the sub-regions and inhabitants of SSA. Therefore, this study aimed to conduct a meta-analysis of demographic and health surveys (DHS) to estimate the pooled level of TFR in SSA and to depict sub-regional and inhabitant differences., Methods: The data source for this study was the standard Demographic and Health Survey datasets of 33 sub-Saharan African countries, accessed through www.meaasuredhs.com between 2010 and 2018. The point estimate of the total fertility rate with its corresponding standard error in each sub-Saharan African country was estimated using the DHS.rates R package. Using the point estimate of the TFR with the standard error of each country, the pooled estimate of the TFR was generated by the metan STATA command., Results: The study comprised 1,324,466 live births in total. The pooled estimate of sub-Saharan Africa's overall fertility rate was five children per woman (95% CI: 4.63-5.37). Consequently, the pooled estimate of total fertility for people living in urban and rural areas was 3.90 (95% CI: 3.60-4.21) and 5.82 (95% CI: 5.43-6.21) children per woman, respectively. In sub-group analysis, the pooled estimates of the TFR for the East African, Central African, Southern African, and West African regions, respectively, were 4.74, 5.59, 3.18, and 5.38 children per woman. Total fertility rates were greater in low-income nations (5.45), lower-middle-income countries (4.70), and high-middle-income countries (3.80)., Conclusions: SSA has a relatively high total fertility rate. The regions of West and Central Africa have the highest overall fertility rate. The fertility rate is higher in countries with a large rural population and low income. Strategies should be developed to address this public health concern, especially in rural Central and Western Africa., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Tesfa, Tiruneh, Gebremariam, Azanaw, Engidaw, Kefale, Abebe, Dessalegn and Tiruneh.)

Objective: Undernutrition contributes to decreased physical and cognitive functional status, higher healthcare consumption, premature institutionalisation and increased mortality. So, the objective of this study was to determine the pooled prevalence and factors associated with undernutrition among older adults in Ethiopia., Design: Systematic review and meta-analysis was used. Articles that presented original data on undernutrition using body mass index (BMI) were included. We made an inclusive literature search from PubMed, Medline and Google Scholar. The I 2 test was used to examine the heterogeneity of the studies considered in this meta-analysis. Stata software V.14 and METANDI command were used., Setting: Studies conducted in Ethiopia were included., Participants: Eight independent studies were eligible and enrolled for final analysis., Outcome: Prevalence and determinants of undernutrition. A selection of publications, data extraction and reported results for the review was designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines., Results: A total of eight unique studies were enrolled for final analysis. The pooled prevalence of undernutrition was 20.53% (95% CI 17.39% to 23.67%). The study revealed that males had lesser odds of being undernutrition with AOR 0.17 (95% CI 0.15 to 0.20). Older adults in the age range of 65-74 years were less likely to be undernourished as compared with those whose age was above 85 years with Adjusted Odds Ratio (AOR) 022 (95% CI 0.22 to 0.25). Older adults who were depressed had higher odds of undernutrition as compared with their counterparts with AOR 1.27 (95% CI 1.19 to 1.37). However, older adults from households with poor wealth indexes were two times more likely to be undernourished as compared with those who were from rich households., Conclusion: The burden of undernutrition in Ethiopia is significant. The limitation of the current study was that all included studies were observational, mainly cross-sectional., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Evidence suggests that couples frequently dispute regarding the desirability of pregnancy, as well as whether or not to employ family planning measures. There are numerous unmet needs owing to partner or family objections, according to a scares study that illustrates women's independent decision-making capacity on whether or not to use a contraceptive. As a result, the purpose of this study was to analyze women's independent decision-making power and determinants of not using contraceptives., Methods: Reproductive age group women aged (15-49 years) currently married who are not pregnant and are currently not using family planning preceding five years the survey was included from the individual record (IR file) file using standard demographic and health survey datasets of Ethiopia. Using multilevel logistic regression models, we investigated the relationship between several independent factors and women's independent decision-making not to use contraception. The adjusted odds ratios were evaluated using 95% confidence intervals., Results: A total of 5,598 currently married women were included in this study. Individual level factors significantly associated with women independent decision making on not to use contraceptive were female-led households (AOR = 2.11; 95% CI = 1.60-2.78), being orthodox ( AOR = 1.84; 95% CI = 1.39-2.44 ) and protestant ( AOR = 1.62; 95% CI = 1.17-2.23), and belonging to more than one union (AOR = 1.48; 95% CI = 1.12-1.95). Whereas, low community education (AOR = 1.19; 95%= 1.00-1.49) and regions: in Tigray (AOR = 2.19; 95%CI = 1.51-3.16), Afar (AOR = 1.74; 95% CI = 1.14-2.64), Amhara (AOR = 2.45; 95% CI = 1.71-3.500), South Nations Nationality (AOR = 1.87; 95% CI = 1.32-2.65), Gambela (AOR = 2.58; 95% CI = 1.73-3.84), Hareri (AOR = 3.93; 95% CI = 2.62-5.88), and Dre DDewa (AOR = 1.66; 95% CI = 1.12-2.45) were community-level factors., Conclusion: Women's independent decision-making power not to use contraceptives was low and greatly affected by both individual and community-level factors. Therefore, it is necessary to develop policies and create programs that promote women's empowerment by incorporating their partners in each region of the nation to encourage women's independent decision-making authority to use or not to use a contraceptive., (© 2022. The Author(s).)

Background: Overweight /obesity is a global public health concern. It is higher among women than men in most continents of the world. This study aimed to determine the spatiotemporal distribution and determinants of changes in overweight/obesity over time among urban women in Ethiopia., Methods: We used data from three consecutive Demographic and Health Surveys in Ethiopia (2005, 2011, and 2016). The total weighted sample of 1112 in 2005, 3569 in 2011, and 3071 in 2016 urban women were included in the analysis. The primary outcome measure of this study was the spatiotemporal distribution and trends over time in overweight/obesity. Factors contributing to change in overweight/obesity were examined using a logit-based multivariate decomposition analysis., Results: Overweight/obesity increased from 14.2% in 2005 to 21% in 2016. Approximately 61.3% of the overall increase in overweight/obesity among urban women was due to the difference in coefficient (difference in the effect of characteristics) across the surveys. Changes in the composition of women aged 25-49 years (β = 0.012, 95% CI 0.008, 0.015), married women (β = 0.010, 95% CI 0.006, 0.014), women with formal education (primary: β = 0.007, 95% CI 0.003, 0.011, higher education: β = 0.014, 95% CI 0.006, 0.022), women with formal employment (β = 0.006, 95% CI 0.001, 0.011), and women with informal employment (β = - 0.002, 95% CI - 0.003, - 0.0004) were factors contributing to the change in overweight/obesity from 2005 to 2016. The risk difference (RD) in women's overweight/obesity significantly varied across regions in urban Ethiopia. Furthermore, a high proportion of overweight/obesity was found mainly in Tigray, Oromia, Amhara, and Addis Ababa., Conclusions: The rate of overweight/obesity among women in urban Ethiopia has shown a significant increase over the last 11 years. This rate change was due to changes in the composition of women's age, educational status, marital status, and employment status. Therefore, program interventions should be targeted at older (> 25 years), educated, married, Addis Ababa residents, and formally employed women., (© 2022. The Author(s).)

Background: Stroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia., Methods: For this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05., Results: Of the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01-1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97-23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21-6.48), hypertension (AOR=0.51, 95% CI:0.31-0.85), and past stroke (AOR = 3.54, 95% CI:0.93-13.49) were found to be independent determinants of the stroke subtype., Conclusion: Age, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ayehu, Yitbarek, Zewdie, Amsalu, Abie, Atlaw, Agegnehu, Admasu, Azanaw, Amare and Emiru.)

According to the global burden of disease 5.5 million deaths were attributable to stroke. The stroke mortality rate is estimated to be seven times higher in low-income countries compared to high-income countries. The main aim of the study was to assess the 28 days case fatality rate and its determinants among admitted stroke patients in public referral hospitals, in Northwest Ethiopia. A hospital-based prospective cohort study was conducted from December 2020 to June 2021. The study population was 554 stroke patients. Based on Akakian Information Criteria, the Gompertz model was fitted to predict the hazard of death. The study included admitted stroke patients who were treated in the general medical ward and neurology ward. The mean age of the participants was 61 ± 12.85 years and 53.25% of the patients were female. The 28-days case fatality rate of stroke was 27.08%. The results from Gompertz parametric baseline hazard distribution revealed that female sex adjusted hazard rate (AHR = 0.27, 95% CI:0.18-0.42), absence of a family history of chronic disease (AHR = 0.50, 95%CI:0.29-0.87), good GCS score (AHR = 0.21, 95% CI:0.09-0.50) and the absence of complication during hospital admission (AHR = 0.16, 95% CI:0.08-0.29) were factors which decrease hazard of 28 days case fatality rate. While, hemorrhagic stroke sub-type (AHR = 1.38, 95% CI:1.04-3.19), time from symptom onset to hospital arrival (AHR = 1.49, 95% CI:1.57-2 .71), time from confirmation of the diagnosis to initiation of treatment (AHR = 1.03, 95% CI:1.01-1.04), a respiratory rate greater than 20 (AHR = 7.21, 95% CI:3.48-14.9), and increase in NIHSS score (AHR = 1.16, 95% CI:1.10-1.23) were factors increasing hazard of 28 days case fatality rate of stroke. At 28-days follow-up, more than one-fourth of the patients have died. The establishment of separate stroke centers and a network of local and regional stroke centers with expertise in early stroke evaluation and management may address challenges., Competing Interests: The authors have declared that no competing interests exist.

Background: Birth asphyxia leads to profound systemic and neurological sequela to decrease blood flow or oxygen to the fetus followed by lethal progressive or irreversible life-long pathologies. In low resource setting countries, birth asphyxia remains a critical condition. This study aimed to develop and validate prognostic risk scores to forecast birth asphyxia using maternal and neonatal characteristics in south Gondar zone hospitals., Methods: Prospective cohorts of 404 pregnant women were included in the model in south Gondar Zone Hospitals, Northwest Ethiopia. To recognize potential prognostic determinants for birth asphyxia, multivariable logistic regression was applied. The model discrimination probability was checked using the receiver operating characteristic curve (AUROC) and the model calibration plot was assessed using the 'givitiR' R-package. To check the clinical importance of the model, a cost-benefit analysis was done through a decision curve and the model was internally validated using bootstrapping. Lastly, a risk score prediction measurement was established for simple application., Results: Of 404, 108 (26.73%) (95% CI: 22.6-31.3) newborns were exposed to birth asphyxia during the follow-up time. Premature rupture of membrane, meconium aspiration syndrome, malpresentation, prolonged labor, Preterm, and tight nuchal was the significant prognostic predictors of birth asphyxia. The AUROC curve for birth asphyxia was 88.6% (95% CI: 84.6-92.2%), which indicated that the tool identified the newborns at risk for birth asphyxia very well. The AUROC of the simplified risk score algorithm, was 87.9 (95% CI, 84.0- 91.7%) and the risk score value of 2 was selected as the optimal cut-off value, with a sensitivity of 78.87%, a specificity of 83.26%, a positive predictive value of 63.23%, and a negative predictive value of 91.52%., Conclusions: We established birth asphyxia prediction tools by applying non-sophisticated maternal and neonatal characteristics for resource scares countries. The driven score has very good discriminative ability and prediction performance. This risk score tool would allow reducing neonatal morbidity and mortality related to birth asphyxia. Consequently, it will improve the overall neonatal health / under-five child health in low-income countries., (© 2022. The Author(s).)

Introduction: Despite decreasing the percentage of women with unmet needs, Ethiopian women still have a higher unmet need for family planning due to different factors. Therefore, addressing the unmet need for FP provides an opportunity for policymakers in all sectors to respond to the expressed fertility preferences of their population. This study aimed to analyze trends and determinants of changes in unmet needs over time among married women of reproductive age in Ethiopia., Methods: The study used data from three consecutive Demographic and Health Surveys conducted in Ethiopia (2005, 2011, and 2016). These nationally representative household surveys cover all Ethiopia region and city administrations with population health and other relevant indicators). The study included a total weighted sample of 8642 in 2005, 10204 in 2011, and 9824 in 2016 in the final analysis. Factors contributing to the change in unmet need rate were examined using logit-based multivariate decomposition analysis., Results: Among married women, unmet needs declined from 33.8% (95% confidence interval (CI):32.8,34.8) in 2005 to 21.0%(95%CI:20.2,21.9) in 2016. In decomposition analysis, the difference in coefficients was responsible for 90% of the overall change in the unmet need rate. In particular, being at the age of 25-49 years, rural place of residence, agrarian regions, and having more than four children were significant predictors of the increase in unmet need rate., Conclusions: Unmet needs among women have shown a remarkable decline over the last decade in Ethiopia. Policy and program interventions better targeting younger, agrarian regions and rural dwellers would help to maintain a declining trend in unmet needs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Azanaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Unmet need for family planning has been remaining high in developing countries than developed countries, notably in sub-Saharan Africa. Data on unmet needs can help countries set service priorities. This study aimed to explore the geographical disparities of unmet need among reproductive-age women in Ethiopia using a 2016 national population-based survey., Methods: This study was based on the nationally representative 2016 Ethiopian Demographic and Health Survey data. We used a total weighted sample of 15,683 reproductive-aged women. A multi-level logistic regression analysis was used to account for the Demographic Health Survey data's hierarchal nature. In the multivariable multi-level analysis, those variables with a p-value < 0.05 were significantly associated with unmet needs. Spatial autocorrelation techniques were used to explore the clustering tendencies of unmet needss using Getis-Ord Gi* statistics., Results: Overall, 15.2% (95% Confidence Interval (CI): 14.63, 15.76) of women of the reproductive age group in Ethiopia had an unmet need for family planning in 2016. In multivariable multilevel logistic regression analysis; individual-level variables such as being married (Adjusted odds ratio (AOR) = 25.7,95% CI: 11.50,60.42), lowest wealth status (AOR = 1.43,95% CI:1.14,1.79), having five or more children (AOR = 1.98, 95% CI:1.62,2.41), being a follower of Muslim religion (AOR = 1.35,95% CI:1.03,1.76) and protestant religion (AOR = 0.73,95% CI: 0.53,0.99) than orthodox Christian followers were statistically associated factors with unmet need. Among community-level variables; being in rural residency (AOR = 1.37, 95% CI: 1.01, 1.93), belong to the Oromia region (AOR = 1.53, 95%CI: 1.10, 2.11) and Somali region (AOR = 0.37, 95% CI: 0.22, 0.61) were significantly associated unmet need. The spatial analysis of unmet need among all women revealed that Oromia, Southern Nations, and Nationality of People and Gambela regions had high hotspots than other parts of the country., Conclusions: In this study, the prevalence of unmet needs was high. Significant regional unmet need variation was indicated among reproductive-age women in Ethiopia, specifically in western parts of the country. Wealth status, number of children, marital status, residence, and religion were the most important associated factors with unmet needs. Addressing unmet needs targeted rural residents with low socioeconomic status, and western regions should be given top priority., (© 2022. The Author(s).)

Introduction: Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia has implemented community-based health insurance in piloted regions of the country. The scheme aims to improve the utilization of healthcare services by removing financial barriers. There is a dearth of literature regarding the effect of the insurance scheme on the utilization of healthcare services., Methods: A community-based comparative cross-sectional study was conducted in the south Gondar Zone. Six hundred fifty-eight participants were selected using a systematic random sampling method. Data were entered into EPI data version 4.4.1 and exported to SPSS version 25 for analysis. Binary logistic regression was used to measure the association of factors with the outcome variable. The result of the final model was expressed in terms of Adjusted Odd Ratios (AOR) and 95% CI., Result: Two hundred twenty-three (67.8%) and 111 (33.7%) of the respondents reported that their family members went to health institutions within three months among CBHI users and non-users respectively. The presence of under-five children (AOR = 2, 95% CI = 1.6-2.4), CBHI scheme membership times (AOR = 3, 95% CI = 2.6-3.4), household wealth index rich (AOR = 4, 95% CI = 2.3-6.3), household wealth index medium (AOR = 3, 95% CI = 1.8-5.8) and presence of chronic illness (AOR = 0.5, 95% CI = 0.2-0.8) was associated with health care service utilization. Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled., Conclusion and Recommendation: Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled. Therefore, health sector leaders and managers in the study area should strengthen their efforts for increasing the enrollment of the community into CBHI., Competing Interests: The authors have declared that no competing interests exist.

Background: Worldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia., Methods: Nationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value < 0.05., Results: The weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 - 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR = 7.03, 95% CI: 4.40-11.24), breastfed within one hour after birth (AHR = 0.41, 95% CI: 0.28-0.61), preceding birth interval 18-23 months (AHR = 1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR = 2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR = 1.70, 95% CI: 1.01-2.87) were statistically significant factors for time to under-five death., Conclusion: Even though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality., (© 2022. The Author(s).)

Background: Even though treatment failure is higher among TB and HIV infected children in a resource-limited setting, there is no prior evidence in general and in the study area in particular. Hence, this study was aimed at determining the half-life time prediction of developing first-line antiretroviral treatment failure and its risk factors among TB and HIV co-infected children., Methods: A historical follow-up study was employed among 239 TB and HIV co-infected children from January 2010-December 2020. The data was entered into Epi data version 4.2.2 and exported to STATA 14.0 Software for analysis. The Kaplan-Meier plot was used to estimate the half-life time to develop treatment failure. The required assumption was fulfilled for each predictor variable. Additionally, those variables having a p-value ≤0.25 in the bivariable analysis were fitted into a multivariable Cox-proportional hazards regression model. P-value, < 0.05 was used to declare a significant association., Results: A total of 239 TB and HIV co-infected children were involved in this study. The overall half-life time to develop first treatment failure was found to be 101 months, with a total of 1027.8 years' follow-up period. The incidence rate and proportion of developing first-line treatment failure were 5.5 per 100 PPY (Person-Year) [CI (confidence interval): 3.7, 6.9] 100 PPY and 23.8% (CI; 18.8, 29.7) respectively. Factors such as hemoglobin 10 mg/dl [AHR (Adjusted Hazard Ratio): 3.2 (95% CI: 1.30, 7.73), severe acute malnutrition [AHR: 3.8 (95% CI: 1.51, 79.65), World Health Organization stage IV [AHR: 2.4 (95% CI: 1.15, 4.93)], and cotrimoxazole prophylaxis non user [AHR: 2.3 (95% CI: 1.14, 4.47)] were found to be a risk factor to develop treatment failure., Conclusion: In this study, the half-life time to develop first-line treatment failure was found to be very low. In addition, the incidence was found to be very high. The presence of hemoglobin 10 mg/dl, severe acute malnutrition, World Health Organization stage, and non-use of cotrimoxazole prophylaxis were discovered to be risk factors for treatment failure. Further prospective cohort and qualitative studies should be conducted to improve the quality of care in paediatric ART clinics to reduce the incidence or burden of first line treatment failure among TB and HIV co-infected children., (© 2022. The Author(s).)

Background: Different evidence suggested that couples often disagree about the desirability of pregnancy and the use of contraceptives. Increased women's decision-making on contraceptives is identified as a key solution that can change the prevailing fertility and contraceptive utilization pattern in SSA. Therefore, this study aimed to determine determinants of contraceptive decision-making among married women in Sub-Saharan Africa., Methods: The data source of this study was the standard demographic and health survey datasets of 33 Sub-Saharan Africa countries. Reproductive age group women aged (15-49 years) currently married who are not pregnant and are current users of contraceptive preceding three years the survey was included from the individual record (IR file) file between 2010 and 2018. Since the outcome variable is composed of polychotomous categorical having multiple-choice, the Multinomial logistic regression (MNLR) model was applied., Results: A total of 76,516 married women were included in this study. Maternal age 20-35 and 36-49 years were more likely to had decision making on contraceptive use in both women-only and joint (women and husband/partner category (referance = husband/partner) (RRR = 1.2; 95% CI = 1.05-1.41, RRR = 1.18; 1.04-1.33 and RRR = 1.38; 95% CI = 1.17-1.61, RRR = 1.27; 1.11-1.47)] respectively. Married women with higher education were more likely to decide by women-only category on contraceptive use (referance = husband/partner) (RRR = 1.26; 95% CI = 1.06-1.49). Women only decision-making to use contraceptives relative to the husband/partner only decreases by a factor of 0.86 (95% CI = 0.80-0.93) among rural than urban residences. Women only or joint decision making to use contraceptives was 1.25 and 1.35 times more likely relative to husband/partner decision making respectively among women who had work than that of had no work. The relative risk of women's decision to use family planning relative to husband increased among couples who had a marital duration of ≥ 10 years (RRR = 1.14; 95% CI = 1.06-1.22). But it has no significant effect on joint decision making. Respondents found in the richest wealth index category increase the relative risk of joint decision-making relative to husband/partner (RRR = 1.33; 95% CI = 1.20-1.47) compared to the poorest category., Conclusions: Decision-making to use contraceptives among married women varies greatly by socio-demographic characteristics. The finding of this study showed that women's age, women educational status, residence, duration of the marriage, family economy, and country income were significantly associated with contraceptive decision-making. Therefore to promote ideal family planning decision making, there is a need to formulate policies and design programs that target women's socio-demographic characteristics and modern contraceptive interventions should be promoted by considering empowering women on decision making., (© 2022. The Author(s).)

Objectives: The objectives of this study were to assess the prevalence and determinants of undernutrition among older adults aged 65 years in the south Gondar Zone, Ethiopia, in 2020., Design: A community-based cross-sectional study., Setting: The study was conducted from 1 October to 15 December 2020, in the South Gondar Zone, Ethiopia. Study participants were selected by systematic random sampling. A pretested and structured questionnaire adapted from different literature was used to collect data. Anthropometric measurements were taken following the standard procedure., Participants: A total of 290 older adults aged greater than or equal to 65 years of age were included in the study., Data Analysis: Descriptive and summary statistics were employed. Multiple logistic regression was fitted to identify determinants of undernutrition. ORs and their 95% CIs were computed to determine the level of significance., Outcome Measures: Undernutrition was assessed by using Body Mass Index and Mini Nutritional Assessment (MNA) tool., Results: The prevalence of undernutrition was 27.6% (95% CI 22.4 to 32.8), and 2.1% (95% CI 0.7 to 3.8) of the study participants were overweight. Based on the MNA tool, 29.7% (95% CI 24.5 to 35.2) of the study participants were undernourished and 61.7% (95% CI 55.5 to 67.2) were at risk of undernourishment. Rural residence adjusted OR (aOR)=10.3 (95% CI 3.6 to 29.4), inability to read and write aOR=3.5 (95% CI 1.6 to 7.6), decrease in food intake aOR=13.5 (95% CI 6.1 to 29.5) and household monthly income of less than US$35.6 aOR=4.3 (95% CI 1.9 to 9.4) were significantly and independently associated with undernutrition., Conclusion: The level of undernutrition among older adults in the study area was high, making it an important public health burden. The determinants of undernutrition were a place of residence, educational status, food intake and monthly income., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: In resource-limited settings, the mortality rate among tuberculosis and human Immunodeficiency virus co-infected children is higher. However, there is no adequate evidence in Ethiopia in general and in the study area in particular. Hence, this study aims to estimate lifetime survival and predictors of mortality among TB with HIV co-infected children after test and treat strategies launched in Northwest Ethiopia Hospitals, 2021., Methods: Institution-based historical follow-up study was conducted in Northwest Ethiopia Hospitals among 227 Tuberculosis and Human Immunodeficiency Virus co-infected children from March 1, 2014, to January 12, 2021. The data were entered into Epi info-7 and then exported to STATA version 14 for analysis. The log-rank test was used to estimate the curve difference of the predictor variables. Bivariable cox-proportional hazard models were employed for each predictor variable. Additionally, those variables having a p-value < 0.25 in bivariate analysis were fitted into a multivariable cox-proportional hazards model. P-value < 0.05 was used to declare significance associated with the dependent variable., Results: From a total of 227 TB and HIV co-infected children, 39 died during the follow-up period. The overall mortality rate was 3.7 (95% CI (confidence interval): 2.9-4.7) per 100 person-years with a total of 1063.2-year observations. Cotrimoxazole preventive therapy (CPT) non-users [Adjusted Hazarded Ratio (AHR) = 3.8 (95% CI: 1.64-8.86)], presence of treatment failure [AHR = 3.0 (95% CI: 1.14-78.17)], and Cluster of differentiation 4(CD4) count below threshold [AHR = 2.7 (95% CI: 1.21-6.45)] were significant predictors of mortality., Conclusion: In this study, the mortality rate among TB and HIV co-infected children was found to be very high. The risk of mortality among TB and HIV co-infected children was associated with treatment failure, CD4 count below the threshold, and cotrimoxazole preventive therapy non-users. Further research should conduct to assess and improve the quality of ART service in Northwest Ethiopia Hospitals., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Childhood overweight and/or obesity become a significant public health problem in the 21 st century. It is a double burden next to undernutrition and has a dramatic rise in low- and middle-income countries. This study aimed to determine the prevalence of overweight and/or obesity and its determinants among under-five children in East African Countries., Methods: Data were retrieved from the recent nationally representative demographic and health survey datasets from eleven East African Countries. A total of 89,091 weighted numbers of under-five children participated. Statistical analysis was performed using the R (Brms R-package) software. Multivariable mixed-effects logistic regression analysis using the Bayesian approach was employed to identify the factors affecting overweight and/or obesity among under-five children., Results: Overall, 4.59% (95% CI, 4.45-4.73) of under-five children in East African Countries were overweight and/or obese. Under-five children overweight and/or obesity was highest in Comoros and lowest in Burundi. Under-five children aged older than two years (Adjusted odds ratio (AOR) = 0.65, 95% credible interval (CrI), 0.57-0.73), females (AOR = 0.84, 95% CrI:, 0.75-0.94), under-five children live from rich household wealth status (AOR = 1.25, 95% CrI, 1.06-1.49), under-five children living in Malawi (AOR = 2.60, 95% CrI, 1.49-4.51), Mozambique (AOR = 5.26, 95% CrI, 3.52-7.79), Rwanda (AOR = 5.63, 95% CrI, 3.46-9.08), Tanzania (AOR = 2.15, 95% CrI, 1.47-3.12), and Uganda (AOR = 2.62, 95% CrI, 1.71-3.99) were a significant determinant for under-five overweight and/or obesity., Conclusion: Overweight and/or obesity among under-five children become a problem in low and middle-income countries. Older under-five children, male sex, children who live in rich household wealth, and children who live in a country in Malawi, Mozambique, Ruanda, Tanzania, and Uganda were significantly affected by overweight and/or obesity. Therefore, in these countries, responsible stakeholders shall give primary attention to curve the alarming increase in overweight and/or obesity among under-five children., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Background: Substantial global progress has been made in reducing under-five mortality since 1990, yet progress is insufficient to meet the sustainable development goal of 2030 which calls for ending preventable child deaths. There are disproportional survivals among children in the world. Therefore, the study aimed to assess the Survival status of under-five mortality and determinants in Sub-Saharan African Countries using the recent DHS data., Methods: The data was retrieved from the birth record file from the standard Demographic and Health Survey dataset of Sub-Saharan Africa countries. Countries that have at least one survey between 2010 and 2018 were retrieved. Parametric shared frailty survival analysis was employed., Results: A total of 27,221 (7.35%) children were died before celebrating their fifth birthday. Children at an early age were at higher risk of dying and then decrease proportionally with increased age. The risk of death among rich and middle family were lowered by 18 and 8% (AHR =0.82, 95% CI: 0.77-0.87) and (AHR = 0.92, 95% CI: 0.87-0.97) respectively, the hazard of death were 11, 19, 17, 90 and 55% (AHR = 1.06, 95% CI: 1.00-1.12), (AHR = 1.11,95%CI:1.04-1.19), (AHR = 1.17, 95% CI:1.12-1.23), (AHR = 1.90, 95%CI: 1.78-2.04) and (AHR = 1.55, 95% CI:1.47-1.63) higher than among children in rural, use unimproved water, delivered at home, born less than 18 months and between 18 and 23 months birth intervals respectively. The hazard of death was 7% among females and low birth weights (AHR = 0.93, 95%CI: 0.90 - 0.97) and (AHR = 0.93 95%CI: 0.89-0.97) respectively. There was also a significant association between multiple births and birth orders (AHR = 2.11, 95%CI: 2.51 - 2.90), (AHR = 3.01, 95%CI: 2.85-3.19) respectively., Conclusions: Death rate among under-five children was higher at an early age then decreases as age advanced. Wealth status, residence, water source, place of delivery, sex of the child, plurality, birth size, preceding birth interval, and birth order were the most predictor variables. The health care program should be designed to encourage a healthy family structure. The health care providers should intervene in the community to inspire maternal health services., (© 2021. The Author(s).)

Background: The coronavirus (COVID-19) pandemic was reported from Wuhan, China, on December 31, 2019, and the pandemic was spread to more than 212 countries in the globe. This meta-analysis aimed to assess the pooled incidence of COVID-19 complications and to identify the association between the incidence of complications and age., Methods: Comprehensive databases, PubMed, Hinari, and Google Scholar, were used to locate potential articles for this review. Data were extracted using Microsoft Excel and imported to the STATA/MP version 16.0 software for analysis. Heterogeneity between studies was assessed using the Cochrane Q test statistics and I 2 test, and small study effect was checked using Egger's statistical test at 5% significant level. Sensitivity analysis was checked. A random-effects model was conducted to estimate the pooled incidence of COVID-19 complications. Univariate meta-regression was conducted to identify the association between the mean ages with each complication., Results: From the total of 1237 studies, 12 studies were included with a total of 3064 COVID-19 patients. The most complications were acute respiratory distress syndrome (30.93%, 95%CI 21.3-40.6%) followed by acute liver injury (22.8%, 95%CI 14-31.5%), shock (10.9%, 95%CI 7.4-14.4%), acute kidney injury (7%, 95%CI 3.8-10.4%), and acute cardiac injury (6.4%, 95%CI 2.8-15.6%). Univariate meta-regression revealed that as the mean age increased by 1 year, the incidence of acute respiratory distress syndrome, acute kidney injury, acute cardiac injury, and shock increased by a factor of 2.9 (β = 2.9, 95%CI 2.4-3.4, adjusted R 2 = 88), 0.4 (β = 0.4, 95%CI 0.04-0.72, adjusted R 2 = 54), 1.6 (β = 1.6, 95%CI 1.1-2.1, adjusted R 2 = 85), and 1.1 (β = 1.1, 95%CI 0.8-1.5, adjusted R 2 = 26) times respectively., Conclusion: Significant complications of COVID-19 viral infections were reported. Older populations were a high-risk group of developing adverse complications as compared to their counterparts. Health care professionals should give primary attention to those risk group individuals.

Background: Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though several primary studies have been conducted on the incidence of tuberculosis among HIV-infected individuals in Ethiopia, national-level tuberculosis incidence is unknown. Therefore, this study is aimed to assess the TB incidence rate and its predictors among HIV-infected individuals after the initiation of ART in Ethiopia., Methods: We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. We used the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. Met-analysis and meta-regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV-infected patients after initiation of ART with a 95% confidence interval., Results: Among a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV-infected patients after initiation of ART therapy was 4.8(95% CI 3.69-5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slight difference between adults and children after initiation of ART treatment, which was 4.3 (95% CI 2.96, 5.71) and 5.0 (95% CI 3.51, 6.50), respectively. Significantly pooled estimates of predictors of TB incidence by a meta-analysis were being anemic (2.30, 95% CI 1.75, 3.02); on clinical stages III and IV (2.26, 95% CI 1.70, 3.02); and not on cotrimoxazole preventive therapy (CPT) (2.16, 95% CI 1.23, 3.72). Besides, a meta-regression revealed that CD4 <200 cells/mm 3 (2.12, 95% CI 1.17, 3.86) was a positive significant predictor of TB among HIV patients after the initiation of ART., Conclusions: The current study showed that the pooled incidence of TB among HIV patients was found to be lower than the WHO 2018 national estimate. Being anemic, WHO stages III and IV, not on CPT, CD4<200cells/μl, and being male were significant predictors of tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening., Study Protocol Registration: CRD42020155573.

Background: Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences, needs, and values and ensuring that their values guide all clinical decisions during childbirth. Although person-centered health care is one of the factors that increase client satisfaction and increased health service utilization in Ethiopia, little is known about predictors of person-centered maternity care. Therefore, the aim of this study was to identify the determinant factors of person-centered maternity care among mothers who gave birth in selected health facilities in Dessie town, Northeastern, Ethiopia., Methods: A community-based cross-sectional study was conducted with a total of 317 study participants at Dessie town selected by a simple random sampling technique. The data was coded and entered Epi-data version 4.4 and analyzed using SPSS version 23. Descriptive statistics was presented using tables and figures. Multivariable linear regression analysis was used to identify factors associated with Person-Centered Maternity Care. Two sides P-value < 0.05 was taken to declare statistically significant., Results: Overall, 310 study participants participated with a response rate of 97.8%. In multivariable linear regression, rural residence (β = -4.12; 95% CI: -7.60, -0.67), family average monthly income ≤ 3000 birr (β = -6.20, 95% CI: -9.40, -3.04), night time delivery(β = -2.98, 95%CI: -5.90, -0.06), dead fetus outcome during delivery (β = -12.7; 95% CI: -21.80, -3.50), and 2-7 days health facility length of stay (β = -5.07, 95% CI: -9.20, -0.92) were significantly decreased Person Center Maternity Care score, whereas private health institution delivery (β = 14.13, 95% CI: 7.70, 20.60) is significantly increased Person centered maternity care score., Conclusions: This study revealed that most of the factors that affect person-centered maternity care are modifiable factors. Therefore, Primary attention should be given to improve the quality of care through effective communication between clients and providers at each level of the health care delivery system to increase the uptake of high-quality facility-based births.

Background: Maternal and child mortalities are the main public health problems worldwide and both are the major health concern in developing countries such as Africa and Asia. The fertility behavior of women characterized by maternal age, birth spacing, and order, impacts the health of women and children. The aim of this study was to assess the geographically variation in risk factors of high-risk fertility behavior (HRFB) among reproductive-age women in Ethiopia using the 2016 Demographic and Health Survey., Methods: A total of 11,022 reproductive-age women were included in this study. The data were cleaned and weighted by STATA 14.1 software. Bernoulli based spatial scan statistics was used to identify the presence of pure high-risk fertility behavior spatial clusters using Kulldorff's SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial distribution of high-risk fertility behavior. Geographically weighted regression analysis was employed by multiscale geographical using Multiscale geographical weighted regression version 2.0 software. A p -value of less than 0.05 was used to declare statistically significant predictors (at a local level)., Results: Overall, 76% with 95% confidence interval of 75.60 to 77.20 of reproductive age women were faced with high-risk fertility problems in Ethiopia. High-risk fertility behavior was highly clustered in the Somali and Afar regions of Ethiopia. SaTScan identified 385 primary spatial clusters (RR = 1.13, P  <  0.001) located at Somali, Afar, and some parts of Oromia Regional Stateregional state of Ethiopia. Women who are living in primary clusters were 13% more likely venerable to high-risk fertility behavior than outside the cluster. In geographically weighted regression, not using contraceptives and home delivery were statistically significant vary risk factors affecting high- risk fertility behavior spatially. No contraceptive use and home delivery were statistically significant predictors (at the local level) in different regions of Ethiopia., Conclusion: In Ethiopia, HRFB varies across regions. Statistically, a significant-high hot spot high-risk fertility behavior was identified at Somali and Afar. No contraceptive use and home delivery were statistically significant predictors (at a local level) in different regions of Ethiopia. Therefore, policymakers and health planners better to design an effective intervention program at Somali, and Afar to reduce high-risk fertility behavior and Special attention needs about health education on the advantage of contraceptive utilization and health facility delivery to reduce high-risk fertility behavior., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)