Search

Abebaw Bires Adal,1 Getahun Fetensa,2 Tekalign Markos Chamiso,3 Chalachew Teshome Tiruneh,4 Melkamu Getaneh Jebesa,5 Zebenay Workneh Bitew6 1College of medicine and health science, department of nursing, Injibara University, Injebara, Ethiopia; 2Department of surgical nursing, St. Paul’s millennium medical college, Addis Ababa, Ethiopia; 3Department of cardiovascular nursing, St. Paul’s millennium medical college, Addis Ababa, Ethiopia; 4Department of care and treatment, AIDS Healthcare Foundation, Addis Ababa, Ethiopia; 5Department of cardiovascular nursing, St Paul’s millennium medical college, Addis Ababa, Ethiopia; 6Department of Pediatrics and child health nursing, St. Paul’s millennium medical college, Addis Ababa, EthiopiaCorrespondence: Abebaw Bires Adal, Injibara University, Injebara, Ethiopia, Email abebawbires27@gmail.com Chalachew Teshome Tiruneh, AIDS Healthcare Foundation, Addis Ababa, Ethiopia, Email linkchale01@gmail.comBackground: Rheumatic heart disease is a preventable cardiovascular disease that affects over forty million people worldwide. Poor adherence to secondary prophylaxis increases the risk of recurrent acute rheumatic fever. Studies on adherence to secondary prophylaxis in Ethiopia are scarce. Thus, this study aimed to determine adherence to secondary prophylaxis and risk factors among patients with rheumatic heart disease.Methods: Facility-based cross-sectional study design was employed to conduct this study from December 25/2021 to January 22/2022. The study was performed among rheumatic heart disease patients in randomly selected four public hospitals in Addis Ababa. Data were collected through face-to-face interviews using a structured questionnaire from follow-up patients after using a pre-tested questionnaire. Data were entered into EPI info version 7.2 and exported to SPSS version 26 for analysis. Multivariable logistic regression analysis was performed using variables with a p-value of less than 0.25 in bi-variable logistic regression analysis. Adjusted Odds Ratio (AOR) with a 95% confidence interval was estimated to determine the strength of association with poor adherence. Statistical significance multivariable logistic regression analysis was declared when the p-value is < 0.05.Results: Three hundred and eighty-one study participants completed the study with a response rate of 95%. The mean age of the respondents was 26.45 ± 10.5 years. The overall poor level of adherence was 29.1% (95% CI: 24.7– 33.8%). Rural residency (AOR = 2.637, 95% CI: 1.068– 6.513), living with > family members (AOR = 2.879, 1.282– 6.465), living more than 30 km from health clinic (AOR = 3.247, 95% CI: 1.051– 10.033), lack of penicillin V (AOR = 6.772, 95% CI: 3.234– 14.177) and fear of catching Covid-19 (AOR = 0.04, 95% CI: 0.014– 0.114) were independently associated with risk factors for poor adherence.Conclusion: Considerable proportion of patients with rheumatic heart disease in Addis Ababa had a poor level of adherence to secondary prophylaxis. Stakeholder’s better supply penicillin regularly and administers them at primary health-care facilities.Keywords: rheumatic heart disease, secondary prophylaxis, adherence

Ayinalem Alemu,1,2 Zebenay Workneh Bitew,3 Aman Yesuf,3 Betselot Zerihun,1 Melak Getu1 1Ethiopian Public Health Institute, Addis Ababa, Ethiopia; 2Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia; 3St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Ayinalem Alemu Tel +251912366676Email ayinalemal@gmail.comBackground: The introduction of antiretroviral therapy (ART) significantly decreases the incidence of tuberculosis (TB) in people living with human immunodeficiency virus (PLWHIV). However, a considerable proportion is still co-infected with TB after ART initiation. Thus, this study aimed to assess the effect of long-term HAART on the incidence of TB among PLWHIV in Addis Ababa, Ethiopia.Methods: A matched nested case–control study was conducted among PLWHIV who were enrolled in ART clinics in Addis Ababa, Ethiopia from 2013 up to 2018. Cases were HIV-TB co-infected individuals who were taking antiretroviral treatment, while controls were PLWHIV without TB who were taking antiretroviral treatment. The cases and controls are matched exactly in age and sex. Data were entered in Epi Info version 7.1 and analyzed using SPSS version 20. Bi-variable and multivariable conditional logistic regression were employed along with 95% CI. A P-value < 0.05 in the multivariable analysis was considered statistically significant.Results: Fifty-seven cases were compared with 114 controls. Accordingly, previous TB history (X2; 13.790, P < 0.001), baseline functional status (X2; 9.120, P = 0.010), baseline WHO clinical stage (X2; 10.083, P = 0.001), baseline hemoglobin value (X2; 6.985, P = 0.008), baseline body mass index (X2; 3.873, P = 0.049), isoniazid preventive treatment (X2; 8.047, P = 0.005), baseline CD4 value (X2; 12.741, P < 0.001) and length of stay on ART (X2; 53.359, P < 0.001) were associated with developing TB. Length of stay on ART was found to be the statistically significant determinant of TB infection after ART initiation (aOR = 5.925, 95% CI = 2.649– 13.250).Conclusion: Advanced clinical stages at the baseline, previous TB history, and not taking IPT were associated with TB infection. The long-term ART exposure significantly decreases tuberculosis incidence in PLWHIV. Thus, retaining PLWHIV on ART would be important to decrease the incidence of TB in this group of individuals.Keywords: HAART, tuberculosis, long-term ART, matched nested case–control study

Tigist Tsegaye, Teshome Gishu, Mekdes Hailegebreal Habte, Zebenay Workneh Bitew St. Paul’s Hospital Millennium Medical College, Addis Ababa, EthiopiaCorrespondence: Tigist TsegayeSt. Paul’s Hospital Millennium Medical College, Addis Ababa EthiopiaEmail tigisttsegayebe@gmail.comBackground: Coronary artery disease (CAD) is the leading cause of mortality and morbidity in the world, including Ethiopia. Over seven million people die annually due to acute coronary syndrome (ACS) secondary to CAD. Despite this fact, studies are scant in Ethiopia.Objective: To determine recovery rate and predictors of time to recovery among ACS patients in St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia from October 2017 to October 2019.Methodology: A retrospective cohort study was conducted among ACS patients. Patient charts were reviewed using a structured checklist. The Kaplan–Meier survival curve was used to estimate the survival time. Log–log plots were used to check proportional hazard assumption among categorical predictors. Bivariable and multivariable Cox regression analyses were performed to identify predictors of time to recovery. In bivariable analysis, variables with P ≤ 0.25 were fitted for multivariable Cox regression. Factors with P < 0.05 in the multivariable Cox regression were independent predictors of time to recovery.Results: A total of 471 patient charts with a diagnosis of ACS were reviewed. The mean length of hospital stay was 2.98 ± 1.30 days with a total follow-up time of 1397 person-days. The recovery rate was 61.8%. The incidence density rate of recovery was found to be 20.5 per 100 person-days. Percutaneous coronary intervention (PCI) (AHR = 2.08, 95% CI: 1.57, 2.74) and absence of major bleeding (AHR = 1.44, 95% CI: 1.11, 1.87) were predictors of time to recovery.Conclusion: In the current study, a considerable number of patients recovered within the first few days of admission. Absence of major bleeding and PCI were found to enhance early recovery of patients. Hence, early implementation of PCI and treatment of major bleeding may be vital to augment early recovery of patients with ACS. This can be achieved through involving case managers who can enhance the quality of treatment.Keywords: acute coronary syndrome, coronary artery disease, recovery, survival rate

Introduction: Ethiopia implemented measures to reduce preterm mortality, and much is currently being done to avoid preterm death, yet preterm death remains the top cause of infant death. As a result, evaluating median time of recovery and determinants will provide information to planners and policymakers to design strategies to improve preterm survival., Methods: Hospital-based retrospective follow-up study was conducted in four selected public hospitals of Addis Ababa from September 2018 to August 2021. Data were collected using a pretested structured questionnaire. Epi-data 4.6 and STATA Version 16 were used for data entry and analysis. Kaplan-Meier survival curve, log-rank test, and median time were computed. To find predictors of time to recovery, a multivariable Cox proportional hazards regression model was fitted, and variables with a p-value less than 0.05 were considered statistically significant., Results: A total of 466 preterm babies were included in the study of which 261 (56.1%) preterm neonates survived and were discharged from NICUs. The median time to recovery was 10 days (95% CI: 9-12). Low birth weight (Adjusted hazard-ratio [AHR]: 1.91, 95% CI: 1.2-3.06), normal birth weight (AHR: 2.09, 95% CI: 1.16-3.76), late preterm (AHR: 1.91, 95% CI: 1.02-3.55), no hospital-acquired infection (AHR: 2.19, 95% CI: 1.36-3.5), no thrombocytopenia (AHR: 1.96, 95% CI: 1.27-3.02), continuous positive airway pressure (AHR: 0.66, 95% CI: 0.48-0.91), and kangaroo mother care (AHR: 2.04, 95% CI: 1.48-2.81) were found to be independent predictors of time to recovery of preterm babies., Discussion/conclusion: The recovery rate was found relatively low. Several predictors of preterm recovery time were discovered in the study. The majority of predictors were preventable or treatable. Therefore, emphasis should be given towards prevention and early anticipation, and management of these predictors. Studies to assess the quality of care and cause of low survival rate of preterm infants are recommended., (© 2024. The Author(s).)

Background: Preterm infants are highly susceptible to infections, which significantly contribute to morbidity and mortality. This systematic review and meta-analysis investigated the effectiveness of topical emollient oil application in preventing infections among preterm infants., Methods: A comprehensive search was conducted across multiple electronic databases (PubMed, Cochrane, Scopus, Clinical trials, Epistemonikos, HINARI and Global Index Medicus) and other sources. A total of 2185 articles were identified and screened for eligibility. The quality of included studies was assessed using the Cochrane Risk of Bias Tool for randomised controlled trials. Data analysis was performed using StataCrop MP V.17 software. Heterogeneity among the studies was evaluated using the I 2 and Cochrane Q test statistics. Sensitivity and subgroup analyses were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist guided the presentation of the results., Results: Of 2185 retrieved articles from initial searches, 11 met eligibility criteria and were included in the final analysis. A random effects meta-analysis revealed that infants who received massages with emollient oils had a 21% reduced risk of infection (risk ratio=0.79, 95% CI 0.64 to 0.97, I 2 =0.00%). Subgroup analyses indicated that preterm babies who received topical emollient oil massages with coconut oil, administered twice a day for more than 2 weeks, had a lower likelihood of acquiring an infection compared with their non-massaged counterparts., Conclusion: It is quite evident from this analysis that topical emollient oil application in preterm neonates is most likely effective in preventing infection. However, further studies, particularly from the African continent, are warranted to support universal recommendations., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Synthesizing current evidence on interventions to improve survival outcomes in preterm infants is crucial for informing programs and policies. The objective of this study is to investigate the impact of topical emollient oil application on the weight of preterm infants., Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. To identify relevant studies, comprehensive searches were conducted across multiple databases, including PubMed, Cochrane, Scopus, Clinical trials, ProQuest Central, Epistemonikos, and gray literature sources. The inclusion criteria were based on the PICO (Population, Intervention, Comparison, and Outcomes) format. Study quality was assessed using the Cochrane risk of bias tool for randomized trials (RoB 2.0). Data analysis was performed using StataCrop MP V.17 software, which included evaluating heterogeneity, conducting subgroup analysis, sensitivity analysis, and meta-regression. The findings were reported in accordance with the PRISMA checklist, and the review was registered with PROSPERO (CRD42023413770)., Results: Out of the initial pool of 2734 articles, a total of 18 studies involving 1454 preterm neonates were included in the final analysis. Fourteen of these studies provided data that contributed to the calculation of the pooled difference in mean weight gain in preterm neonates. The random effects meta-analysis revealed a significant pooled difference in mean weight gain of 52.15 grams (95% CI: 45.96, 58.35), albeit with high heterogeneity (I2 > 93.24%, p 0.000). Subgroup analyses were conducted, revealing that preterm infants who received massages three times daily with either sunflower oil or coconut oil exhibited greater mean differences in weight gain. Meta-regression analysis indicated that the type of emollient oil, duration of therapy, and frequency of application significantly contributed to the observed heterogeneity. A sensitivity analysis was performed, excluding two outlier studies, resulting in a pooled mean weight difference of 78.57grams (95% CI: 52.46, 104.68). Among the nine studies that reported adverse events, only two mentioned occurrences of rash and accidental slippage in the intervention groups., Conclusion: The available evidence suggests that the application of topical emollient oil in preterm neonates is likely to be effective in promoting weight gain, with a moderate-to-high level of certainty. Based on these findings, it is recommended that local policymakers and health planners prioritize the routine use of emollient oils in newborn care for preterm infants. By incorporating emollient oils into standard care protocols, healthcare providers can provide additional support to promote optimal growth and development in preterm infants., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Getaneh 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.)

Introduction: Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide., Methods: A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315., Results: This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers., Conclusion: Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors., 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., (© 2024 Seid, Fufa and Bitew.)

In sub-Saharan Africa, there are different studies on contraceptive use and associated factors among people with disabilities. However, the findings are inconsistent and inconclusive. This study aimed to estimate the pooled prevalence of contraceptive use and associated factors among women with disabilities in sub-Saharan Africa. Comprehensive search was performed from different databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed to report the results. The data were analyzed by using STATA software. Heterogeneity and publication bias was checked. The pooled odds ratio (POR) with a 95% confidence interval (CI) was used to report the measures of associations. The pooled prevalence of contraceptive use was 25.61% (95% CI: 20.68, 30.54). Being married (POR = 2.96; 95% CI: 1.31, 4.62), high income (POR = 2.20; 95% CI: 1.42, 2.97), having media access (POR = 1.74; 95% CI: 1.24, 2.23), being in the age group of 25-34 (POR = 2.52; 95% CI: 1.01, 3.94), vision impairment (POR = 3.82; 95% CI: 2.05, 5.59), good contraceptive knowledge (POR = 2.09; 95% CI: 1.27, 2.91), primary education (POR = 1.82; 95% CI: 1.25, 2.39), secondary education (POR = 2.31; 95% CI: 1.03, 3.59) and tertiary educational status (POR = 3.37; 95% CI: 1.28, 5.46) were factors associated with contraceptive use. Contraceptive use among women with disabilities is considerably low in sub-Saharan Africa. The use of contraceptives is primarily dependent on socio-demographic and economic status., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: To date, isoniazid mono-resistant tuberculosis (TB) is becoming an emerging global public health problem. It is associated with poor treatment outcome. Different studies have assessed the treatment outcome of isoniazid mono-resistant TB cases, however, the findings are inconsistent and there is limited global comprehensive report. Thus, this study aimed to assess the poor treatment outcome and its associated risk factors among patients with isoniazid mono-resistant TB., Methods: Studies that reported the treatment outcomes and associated factors among isoniazid mono-resistant TB were searched from electronic databases and other sources. We used Joana Briggs Institute critical appraisal tool to assess the study's quality. We assessed publication bias through visual inspection of the funnel plot and confirmed by Egger's regression test. We used STATA version 17 for statistical analysis., Results: Among 347 studies identified from the whole search, data were extracted from 25 studies reported from 47 countries. The pooled successful and poor treatment outcomes were 78% (95%CI; 74%-83%) and 22% (95%CI; 17%-26%), respectively. Specifically, complete, cure, treatment failure, mortality, loss to follow-up and relapse rates were 34%(95%CI; 17%-52%), 62% (95%CI; 50%-73%), 5% (95%CI; 3%-7%), 6% (95%CI; 4%-8%), 12% (95%CI; 8%-17%), and 1.7% (95%CI; 0.4%-3.1%), respectively. Higher prevalence of pooled poor treatment outcome was found in the South East Asian Region (estimate; 40%, 95%C; 34%-45%), and African Region (estimate; 33%, 95%CI; 24%-42%). Previous TB treatment (OR; 1.74, 95%CI; 1.15-2.33), having cancer (OR; 3.53, 95%CI; 1.43-5.62), and being initially smear positive (OR; 1.26, 95%CI; 1.08-1.43) were associated with poor treatment outcome. While those patients who took rifampicin in the continuation phase (OR; 0.22, 95%CI; 0.04-0.41), had extrapulmonary TB (OR; 0.70, 95%CI; 0.55-0.85), and took second-line injectable drugs (OR; 0.54, 95%CI; 0.33-0.75) had reduced risk of poor treatment outcome., Conclusion: Isoniazid mono-resistant TB patients had high poor treatment outcome. Thus, determination of isoniazid resistance pattern for all bacteriologically confirmed TB cases is critical for successful treatment outcome. PROSPERO registration number: CRD42022372367., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Alemu 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.)

Objective: To estimate the prevalence of latent tuberculosis infection (LTBI) in chronic kidney disease (CKD) patients ., Methods: This study was conducted following the PRISMA guidelines. We identified, 3694 studies from the whole search, and 59 studies were included. Each study's quality was assessed using JBI checklist. We employed STATA version 17 for statistical analysis. We assessed heterogeneity using I 2 heterogeneity test. Publication bias was assessed using funnel plot and Egger's test. We estimated the pooled LTBI prevalence in CKD patients along with 95%CI., Results: The pooled prevalence of LTBI among CKD patients using data collected from 53 studies having 12,772 patients was 30.2% (95%CI; 25.5, 34.8). The pooled prevalence among pre-dialysis, hemodialysis, peritoneal dialysis, and renal transplanted patients was 17.8% (95%CI; 3.3, 32.4), 34.8% (95%CI; 29.1, 40.5), 25% (95%CI; 11, 38), and 16% (95%CI; 7, 25), respectively. The pooled prevalence of LTBI stratified by the laboratory screening methods was 25.3% (95%CI: 20.3-30.3) using TST, 28.0% (95%CI; 23.9-32.0) using QFT, and 32.6%, (95%CI: 23.7-41.5) using T-SPOT., Conclusion: There is high prevalence of LTBI among CKD patients mainly in patients on dialysis. Thus, early diagnosis and treatment of LTBI in CKD patients should be performed to prevent active TB in CKD patients. PROSPERO registration number: CRD42022372441., 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.)

Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa. A systematic review of observational studies published between January 2000 and April 2022 was undertaken using the Google Scholar, PubMed, and CINAHL databases. The PRISMA checklist was followed to present the results. Microsoft Excel was used to abstract the data. STATA version 17 was used to analyze the data, and a random-effects meta-analysis model was applied to compute the pooled estimates. The study was registered in PROSPERO with protocol number CRD42022320873. A total of 22 publications with 9,696 participants were included in the final meta-analysis. The pooled adjusted odds ratio (AOR) for inadequate dietary diversity and maternal anemia was 2.15 (95% CI, 1.66-2.65), while that for low birth weight was 2.04 (95% CI, 1.46-2.63). The highest pooled estimate of maternal anemia was reported in Cameroon (AOR = 9.8, 95% CI: 1.68-17.92), followed by Ethiopia (AOR = 2.6, 95% CI: 1.95-3.25). Similarly, the pooled estimates of low birth weight were highest in Cameroon (AOR = 3.04, 95% CI: 1.19-4.88) and Ethiopia (AOR = 1.8, 95% CI: 1.29-2.39). In Africa, pregnant mothers with inadequate dietary diversity are two times more likely to develop anemia and low birth weight. Social protection policies that prioritize pregnant women, maternal nutrition promotion in the community, and dietary counseling during antenatal care visits, using national food-based dietary guidelines, should be strengthened., Competing Interests: The authors declare that they have no competing interests., (© 2023 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Introduction: To date, acquired resistance to second-line antituberculosis drugs (SLDs) during multi-drug resistant tuberculosis (MDR-TB) treatment is becoming a public health concern. Different studies have assessed the incidence of acquired resistance to SLDs. However, the findings are inconsistent and there is limited global evidence. Thus, we are going to assess the incidence and predictors of acquired resistance to SLDs during MDR-TB treatment., Methods and Analysis: We designed this protocol following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Electronic databases and grey literature sources will be searched systematically for articles published up to 25 March 2023. Studies reporting the incidence and predictors of acquired resistance to SLDs in MDR-TB patients will be explored. The studies will be managed using Endnote X8 citation manager and a stepwise approach will be followed to select studies. Data will be summarised using Microsoft Excel 2016 spreadsheet. A Newcastle-Ottawa Scale quality assessment and cochrane risk-of-bias tools will be used to assess the study's quality. The authors will independently search databases, select studies, assess the study's quality and extract data. Data will be analysed using STATA V.17 software. We will estimate the pooled incidence of acquired resistance with 95% CI. In addition, the pooled effect measures (OR, HR, risk ratio) with their 95% CI will be estimated. Heterogeneity will be assessed using the I 2 statistics. Publication bias will be assessed using funnel plot and Egger's test. A subgroup analysis will be conducted for the primary outcome (acquired resistance) per each study characteristics such as WHO regional category, country's TB/MDR-TB burden, data collection period and per the specific second-line anti-TB drug., Ethics and Dissemination: Since this study will be based on data extraction from published studies, ethical approval is not mandatory. The study will be published in peer-reviewed scientific journals and the findings will be presented at different scientific conferences., Prospero Registration Number: CRD42022371014., 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: Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the most commonly affected region with HIV and malnutrition, a meta-analysis study that estimates the prevalence and correlates of undernutrition among adults living with HIV has not yet been conducted. The objective of this study was to determine the pooled prevalence of undernutrition and associated factors among adults living with HIV/AIDS in sub-Saharan Africa., Methods: Studies published in English were searched systematically from databases such as PubMed, Google Scholar, and gray literature, as well as manually from references in published articles. Observational studies published from 2009 to November 2021 were included. The data extraction checklist was prepared using Microsoft Excel and includes author names, study area, publication year, sample size, prevalence/odds ratio, and confidence intervals. The results were presented and summarized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard. Heterogeneity was investigated using the Q test, I2, τ2, τ and predictive interval. STATA version 17 was used to analyze the data. A meta-analysis using a random-effects model was used to determine the overall prevalence and adjusted odds ratio. The study has been registered in PROSPERO with a protocol number of CRD42021268603., Results: In this study, a total of 44 studies and 22,316 participants were included. The pooled prevalence of undernutrition among adult people living with HIV (PLWHIV) was 23.72% (95% CI: 20.69-26.85). The factors associated with undernutrition were participants' age (AOR = 0.5, 95% CI: 0.29-0.88), gender (AOR = 2.08, 95% CI: 0.22-20.00), World Health Organization (WHO) clinical stage (AOR = 3.25, 95% CI: 2.57-3.93), Cluster of Differentiation 4 (CD4 count) (AOR = 1.94, 95% CI: 1.53-2.28), and duration of ART (AOR = 2.32, 95% CI: 1.6-3.02)., Conclusion: The pooled prevalence of undernutrition among adult PLWHIV in sub-Saharan Africa remained high. WHO clinical stage, CD4 count, duration of ART treatment, age, and sex were found to be the factors associated with undernutrition. Reinforcing nutrition counseling, care, and support for adults living with HIV is recommended. Priority nutritional screening and interventions should be provided for patients with advanced WHO clinical stages, low CD4 counts, the male gender, younger age groups, and ART beginners., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Seid 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.)

The primary method for preventing health and health-related problems in diabetic people is glycemic control. Numerous studies have documented the importance of glycemic control and the factors that influence it. However, the results are dispersed. This study sought to identify the prevalence of poor glycemic control and associated factors in Ethiopia. Findings will be crucial to reduce the burden of poor glycemic control. Comprehensive search was performed from databases: PubMed, Global Health, CINAHL, IRIS, and FSTA. Gray literature sources were also explored. This document was prepared based on the PRISMA flowchart. The protocol is registered in PROSPERO (ID: CRD42022296583). STATA software was used for data analyses and I 2 test with Cochrane Q statistics, and forest plot were used to verify heterogeneity. When the I 2 value was higher than 50% and the p-value was 0.05, heterogeneity was deemed significant. To confirm publication bias, a funnel plot with an Egger's regression test was performed. The factors related to poor glycemic control were reported using pooled odds ratios (POR) and a 95% confidence interval. In this study, 46 papers totaling 15 457 people were used to calculate the pooled estimates. It was determined that 32.6% (95% CI: 28.3, 36.9) and 61.92% (95% CI: 57.92, 65.92) of the subjects, respectively, had good and poor glycemic control. Being male protected against poor glycemic control, while poor diet adherence, lack of exercise, poor adherence to anti-diabetic medications, and smoking increased the likelihood of poor glycemic control. Lack of formal education, no family history of diabetes, lack of glucometer for blood glucose monitoring, comorbidity, being overweight and prolonged length of stay with diabetes all contributed to poor glycemic control. Ethiopia had a fairly high rate of poor glycemic control. The main determinants are lifestyle factors. Therefore, it is important to focus on behavioral interventions.

Background: The emergence of COVID-19 overwhelmed tuberculosis (TB) prevention and control, resulting in a decrease in TB detection rate and an increase in TB deaths. Furthermore, the temporary immunosuppressive effects, lung inflammation, and the corticosteroids used to treat COVID-19, may play a direct role in immunosuppression, leading to reactivation of either previous infection or latent TB or the development of new TB. Thus, the aim of this study was to review TB incidence in individuals who recovered from COVID-19., Methods: We conducted a systematic search of available databases for previously published studies that reported TB in COVID-19 survivors. The PRISMA checklist was used to guide the review, and the JBI checklist was used to evaluate the study's quality. The descriptive data were summarized., Results: Data were extracted from 21 studies conducted in 13 countries having 33 cases. The median age was 44 years (range; 13.5-80), and more than half (18, 54.5%) were males. Twelve patients immigrated from TB endemic settings. All 17 patients assessed for HIV were seronegative, and all 11 patients assessed for BCG vaccination status were vaccinated. The majority (20, 69%) of patients had some type of comorbidity with diabetes (12/29) and hypertension (9/29) being the most common. Four patients (30.77%) had a history of TB. Corticosteroids were used to treat COVID-19 in 62.5% (10) of individuals. Dexamethasone, remdesivir, azithromycin, hydroxychloroquine, and enoxaparin were the most commonly used drugs to treat COVID-19. The most common TB symptoms were fever, cough, weight loss, dyspnea, and fatigue. Twenty, eleven, and two patients developed pulmonary, extrapulmonary, and disseminated/miliary TB respectively. It may take up to seven months after COVID-19 recovery to develop tuberculosis. Data on the final treatment outcome was found for 24 patients, and five patients died during the anti-TB treatment period., Conclusion: Tuberculosis after recovering from COVID-19 is becoming more common, potentially leading to a TB outbreak in the post-COVID-19 era. The immunosuppressive nature of the disease and its treatment modalities may contribute to post COVID-19 TB. Thus, we recommend a further study with a large sample size. Furthermore, we recommend feasibility studies to assess and treat latent TB in COVID-19 patients residing in TB endemic counties since treatment of latent TB is done only in TB non-endemic countries., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Alemu 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: Limited knowledge on the proportion of admission hypothermia and factors of death in hypothermic preterm neonates is hindering early and appropriate interventions in Ethiopia. Thus, studies on the proportion of admission hypothermia and factors of death in hypothermic preterm neonates are critical to enhancing preterm infants' survival., Methods: Hospital-based cross-sectional study was conducted on 398 participants using the systematic sampling method from October 10, 2021, to December 15, 2022. A pretested data extraction tool was used to collect data. EpiData version 4.6 and STATA version 16 were used for data entry and analysis. Multivariable logistic regression analysis evaluated the association between independent and outcome variables with a 95% confidence interval (CI). Hosmer and Lemeshow test and variance inflation factor were assessed to check model fitness and collinearity, respectively. P value < 0.05 was considered statistically significant., Result: Of the 398 admitted preterm neonates, 331(83.2%) had hypothermia at admission. Factors that were significantly associated with mortality included outborn babies [Adjusted hazard ratio (AOR) = 2.18 : 95% CI (1.03-4.62)], GA less than 32 weeks [AOR = 6.64 : 95% CI (1.87-13.58)], weight less than 1500 gram [AOR = 7.91 : 95% CI (1.21-15.38)], thrombocytopenia [AOR = 3.36 : 95% CI (1.49-7.58)], and kangaroo mother care [AOR = 0.38 : 95% CI (0.16-0.88)]., Conclusion: The proportion of admission hypothermia was high. Outborn babies, birth weight less than 1500 gram, gestational age < 32 weeks, being thrombocytopenic, and lack of kangaroo mother care were identified as risk factors for hypothermic preterm neonatal mortality. Preterm labor prevention, improved inborn delivery, and kangaroo mother care may alleviate the high proportion of admission hypothermia and related mortalities in preterm neonates., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2022 Fekadeselassie Belege Getaneh et al.)

Objective: The aim of this study was to estimate global TB incidence in patients with CKD., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was followed to perform the study. Electronic and gray literature sources were investigated for studies published between 2000 and 2021. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the studies, and STATA version 16 was used for analysis. The I 2 heterogeneity test was employed to assess heterogeneity. To examine publication bias, funnel plots and Egger's regression tests were performed., Results: A total of 104 studies with a sample size of 1,548,774 were included. TB incidence in patients with CKD ranges from 60 per 100,000 in the UK to 19,270 per 100,000 in China. The pooled TB incidence was estimated as 3718 per 100,000 (95%CI; 3024, 4411). Higher pooled TB incidence was found in the African region (9952/100,000, 95%CI; 6854, 13,051), followed by the South-East Asian (7200/100,000, 95%CI; 4537, 9863) and Eastern Mediterranean (5508/100,000, 95%CI; 3470, 7547) regions. In particular, patients on hemodialysis (5611/100,000) and on peritoneal dialysis (3533/100,000) had higher incidence of TB than did renal transplantation patients (2700/100,000) and patients with predialysis CKD (913/100,000). Furthermore, extrapulmonary TB (2227/100,000) was more common than pulmonary TB (1786/100,000)., Conclusion: This study identifies high TB incidence in patients with CKD with regional disparities. Thus, the authors recommend active TB screening in this group of individuals., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programmes including Ethiopia. Different risk factors are associated with DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with DR-TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed to conduct this study. We systematically searched the articles from electronic databases and grey literature sources. We used the JBI tools to assess the quality of studies. Data were analysed using STATA version 15. We estimated the pooled odds ratio (OR) along with 95% Confidence Interval (CI). The forest plot and I 2 heterogeneity test were used to assess heterogeneity among studies. We explored the presence of publication bias through visual inspection of the funnel plot and Egger's regression test. After screening 2238 articles, 27 studies were included in the final analysis. Based on the pooled analysis of the OR, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), previous TB history (OR; 4.83, 95% CI; 3.02, 6.64), contact with known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), contact with the known multi-drug resistant (MDR) TB patient (OR; 2.54, 95% CI; 1.46, 3.63) and having pulmonary TB (PTB; OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of DR-TB, while elders (OR; 0.77, 95%CI; 0.60, 0.95) including above 45 years (OR; 0.76, 95%CI; 0.55, 0.97) and males (OR; 0.86, 95%CI; 0.76, 0.97) had lower DR-TB risk, compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti-TB treatment. Besides, having contact with a TB patient, contact with an MDR-TB patient, having PTB and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community., (© 2021 Wiley-VCH GmbH.)

Background: Globally, perinatal asphyxia (PNA) is a significant cause of most neonatal deaths. Similarly, the burden of birth asphyxia in Ethiopia remains high (22.52%) and has been noted the second leading cause of neonatal mortality. Thus, researches on survival status and predictors of perinatal asphyxia are critical to tackle it. Therefore, the current study intended to determine the survival status and predictors of asphyxia among neonates admitted in Neonatal Intensive Care Units of public hospitals, Addis Ababa, Ethiopia., Methods: Hospital-based retrospective follow-up study was conducted in four selected public hospitals of Addis Ababa from January 2016 to December 2020. Data were collected using a pretested structured questionnaire. Epi-data 4.6 and STATA Version 16 was used for data entry and analysis, respectively. Kaplan-Meier survival curve, log-rank test and Median time were computed. To find the predictors of time to recovery, a multivariable Cox proportional hazards regression model was fitted, and variables with a P-value less than 0.05 were considered statistically significant. Finally, the Schoenfeld residual test was used to check overall model fitness., Result: Four hundred eleven admitted asphyxiated babies were followed a total of 3062 neonate-days with a minimum of 1 h to a maximum of 28 days. The Overall incidence density rate of survival was 10 (95% CI: 0.08-0.11) per 100 neonate-days of observation with a median recovery time of 8 days (95% CI: 7.527-8.473). Low birth weight (Adjusted hazard ratio [AHR]: 0.67, 95% CI: 0.47-0.96), stage II hypoxic ischemic encephalopathy (HIE) (AHR: 0.70, 95% CI: 0.51-0.97), stage III HIE (AHR: 0.44, 95% CI: 0.27-0.71), seizure (AHR: 0.61, 95% CI: 0.38-0.97), thrombocytopenia (AHR: 0.44, 95% CI: 0.24-0.80) and calcium gluconate (AHR: 0.75, 95% CI: 0.58-0.99) were found to be independent predictors of time to recovery of asphyxiated neonates., Conclusion: In the current findings, the recovery time was prolonged compared to others finding. This implies early prevention, strict monitoring and taking appropriate measures timely is mandatory before babies transferred into highest stage of HIE and managing complications are recommended to hasten recovery time and increase survival of neonates., (© 2022. The Author(s).)

Background: Promoting exclusive breastfeeding (EBF) is a major child survival strategy in developing countries like Ethiopia. Studies in EBF are found in a fragmented and inconclusive way in Ethiopia. Therefore, the aim of this study was to examine evidences on the effect of post natal care counseling and maternal employment status on exclusive breastfeeding practice of women in Ethiopia., Methods: A systematic literature search was conducted from PubMed (contains MEDLINE), CINAHL (EBSCO), Global Health, Food Science and Technology Abstracts (FSTA) (EBSCO) and Grey literature sources such as Google and Google scholar. All primary studies on the effects of employment status and/or post-natal care utilization on EBF practices of women in Ethiopia were included. Data analyses were performed using STATA software. Forest plot, I 2 test and the Cochrane Q statistics were used to detect heterogeneity among studies. Heterogeneity was considered significant when the I 2 value was ≥ 50%, with p-value < 0.05. Publication bias was checked by looking the asymmetry of funnel and confirmed by Egger's regression test at a 5% significant level. The pooled odds ratio (POR) with 95% confidence interval (CI) was used to report the measures of associations., Result: A total of 622 studies were identified in the initial search of which 42 articles were included this systematic review and meta-analysis. A meta-analysis of 24 studies indicated that maternal employment status was significantly associated (POR = 0.51, 95% CI 0.16, 0.86) EBF practice in that employed mother were less likely to practice to practice EBF. Post-natal care service utilization significantly increases (POR = 1.76, 95% CI 1.32, 2.34) the EBF practice in Ethiopia and it was computed using 25 eligible articles. Besides, the pooled estimates of EBF practice was found to be 62.58% (95% CI 56.98, 68.19, I 2  = 96.4%, p < 0.001)., Conclusion: This review found that post-natal care service utilization and maternal employment status has a significant effect on EBF practice. The findings from this review may be used to inform for better supportive and promotive strategies for EBF practice in Ethiopia., (© 2022. The Author(s).)

Background: Management of severe acute malnutrition (SAM) has been a program priority in Ethiopia, but it remains the leading cause of mortality in under-five children. Hence, this study aimed to identify the incidence density rate of mortality and determinants among under-five children with severe acute malnutrition in St. Paul's Hospital Millennium Medical College, 2012 to 2019., Methods: A retrospective cohort study was conducted and data were collected using a structured checklist from 673 charts, of which 610 charts were included in the final analysis. The Kaplan-Meier survival curve with Log-rank test was used to estimate the survival time. Bi-variable and multi-variable Cox proportional hazard regression models were fitted to identify determinants of death. Schoenfeld residuals test was used to check a proportional hazard assumption. Goodness of fit of the final model was checked using Nelson Aalen cumulative hazard function against Cox-Snell residual., Results: In this study, 61 (10%) children died making the incidence density rate of death 5.6 (95% CI: 4.4, 7.2) per 1000 child-days. Shock (Adjusted Hazard Ratio) [AHR] =3.2; 95% CI: 1.6, 6.3)), IV fluid infusion (AHR = 5.2; 95% CI: 2.4, 10.4), supplementing F100 (AHR = 0.12; 95%CI: 0.06, 0.23) and zinc (AHR = 0.45; 95% CI: 0.22, 0.93) were determinants of death., Conclusion: The overall proportion of deaths was within the range put forth by the Sphere standard and the national SAM management protocol. Shock and IV fluid infusion increased the hazard of death, whereas F100 & zinc were found to decrease the likelihood death. Children with SAM presented with shock should be handled carefully and IV fluids should be given with precautions., (© 2021. The Author(s).)

Background: Health professionals' job satisfaction is crucial for health professionals' life which determines health care service quality. This study aimed to estimate pooled prevalence of job satisfaction of health professionals and associated factors in Ethiopia., Methods: Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was followed to prepare this study. Studies were searched from PubMed (EBSCOhost), Directory of open access journals (DOAJ), Global health, African Index Medicus, IRIS (WHO digital publication), African Journals Online (AJOL), Google Scholar, and Google. Random-effect model was used to estimate the pooled prevalence of job satisfaction and associated factors. Heterogeneity was assessed using I 2 test statistics. Publication bias was checked using funnel plot, Egger's regression test, and sensitivity analysis., Result: The pooled prevalence of health professionals' job satisfaction was computed from 35 studies, and it was 46.68% (95%, confidence interval (CI): 41.82, 51.54, I 2  = 95.8%). Specifically, job satisfaction was 57.56%, 48.80%, 48.57%, 48.48%, 44.56%, 39.20%, and 16.5% among pharmacy professionals, health officers, midwives, nurses, anesthetists, physicians, and health extension workers, respectively. Secured working environment (pooled odds ratio [POR] = 6.50, 95% CI: 3.41-9.58) , coworkers relationship (POR = 5.14, 95% CI: 1.27, 9.02), good relationship with supervisors (POR = 5.86, 95% CI: 2.56-9.16) and having bachelor's degree (POR = 2.52, 95% CI: 1.31, 3.72) were significantly associated with job satisfaction., Conclusion: Job satisfaction among Ethiopian health professionals is considerably low. Secured working environment, positive relationships among staff, and having a bachelor's enhanced the job satisfaction. Designing strategies to improve safety in the work environment and improved communication among workers could improve job satisfaction., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Objective: The aim of our study was to estimate the pooled prevalence of tuberculosis (TB) and diabetes mellitus (DM) co-occurrences, and associated risk factors, in Ethiopia., Methods: In total, 392 articles were identified, and 14 were included in the analysis. The study's quality was assessed using the JBI tool. Data were analyzed using STATA version 16. The pooled prevalences of TB among DM patients and of DM among TB patients, with 95% CI, were estimated. In addition, the pooled OR values for each risk factor were estimated. The study's heterogeneity was assessed using forest plots and the I 2 heterogeneity test. Publication bias was assessed using funnel plots and Egger's regression test., Results: The pooled prevalence of TB among DM patients was 4.14% (95% CI 2.45-5.83%). The pooled prevalence of DM among TB patients was 12.77% (95% CI 6.91-18.62%). Type 1 DM patients had a higher TB risk (OR 2.70, 95% CI 1.41-3.99). Older age (OR 2.25, 95% CI 1.38-3.13) and family DM history (OR 3.65, 95% CI 1.89-5.41) were associated with DM co-occurrence among TB patients., Conclusions: Higher prevalences of TB among DM patients and of DM among TB patients were noted in Ethiopia, when compared with the general population. Thus, active screening of DM patients for TB and vice versa is recommended., (© 2021 The Author(s).)

Objectives: The purpose of this study is to examine the effects of coronavirus disease 2019 pandemic on the prevalence of anxiety, depression, stress, insomnia, and social dysfunction among pregnant and/or lactating women and to measure the global pooled prevalence of mental health effects among these populations in the era of coronavirus disease 2019 pandemic., Methods: Comprehensive literature searching was conducted and studies published from 1 January 2020 to 30 September 2020 reporting the prevalence of anxiety, depression; stress, insomnia, and social dysfunctions were included. The pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunctions was estimated using a random-effect model. In this study, all statistical analyses were performed using STATA (version 15) software., Results: There were a total of 19 studies included in the meta-analysis, of which 16, 14, 4, 2, and 2 studies were included in computing the pooled prevalence of anxiety, depression, stress, insomnia, and social dysfunction, respectively. The pooled prevalence of anxiety was 33% (95% confidence interval: 50%-61%), with significant heterogeneity between studies (I 2  = 99.68%, p = 0.001). The pooled prevalence of depression was 27% (95% confidence interval: 9%-45%), with remarkable heterogeneity between studies (I 2  = 99.29%, p = 0.001). Likewise, the pooled prevalence of stress was 56% (95% confidence interval: 30.07%-82.22%), with significant heterogeneity between studies (I 2  = 98.8%, p = 0.0001). The pooled prevalence of social dysfunction was 24.3% (95% confidence interval: 13.41%-62.03%), with significant heterogeneity between studies (I 2  = 97.5%, p = 0.0001) and finally, the pooled prevalence of insomnia was 33.53% (95% confidence interval: 3.05%-64.0%), with significant heterogeneity between studies (I 2  = 99.6%, p = 0.0001)., Conclusions: In this study, the mental health effects of the COVID-19 pandemic among pregnant and lactating women were found to be significant. Stress was the most common mental health problem in these population groups. Therefore, policymakers and health planners should give great emphasis to addressing maternal mental well-being during and after this global health crisis. Maternal mental health must be one of the international and national public health priority agendas to enhance the well-being of pregnant and lactating women. Besides, giving psychological support to pregnant and lactating women may reduce the long-term negative effects of this pandemic., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Even though the lives of millions have been saved in the past decades, the mortality rate in patients with drug-resistant tuberculosis is still high. Different factors are associated with this mortality. However, there is no comprehensive global report addressing these risk factors. This study aimed to determine the predictors of mortality using data generated at the global level., Methods: We systematically searched five electronic major databases (PubMed/Medline, CINAHL, EMBASE, Scopus, Web of Science), and other sources (Google Scholar, Google). We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of included articles. Heterogeneity assessment was conducted using the forest plot and I2 heterogeneity test. Data were analyzed using STATA Version 15. The pooled hazard ratio, risk ratio, and odd's ratio were estimated along with their 95% CIs., Result: After reviewing 640 articles, 49 studies met the inclusion criteria and were included in the final analysis. The predictors of mortality were; being male (HR = 1.25,95%CI;1.08,1.41,I2;30.5%), older age (HR = 2.13, 95%CI;1.64,2.62,I2;59.0%,RR = 1.40,95%CI; 1.26, 1.53, I2; 48.4%) including a 1 year increase in age (HR = 1.01, 95%CI;1.00,1.03,I2;73.0%), undernutrition (HR = 1.62,95%CI;1.28,1.97,I2;87.2%, RR = 3.13, 95% CI; 2.17,4.09, I2;0.0%), presence of any type of co-morbidity (HR = 1.92,95%CI;1.50-2.33,I2;61.4%, RR = 1.61, 95%CI;1.29, 1.93,I2;0.0%), having diabetes (HR = 1.74, 95%CI; 1.24,2.24, I2;37.3%, RR = 1.60, 95%CI;1.13,2.07, I2;0.0%), HIV co-infection (HR = 2.15, 95%CI;1.69,2.61, I2; 48.2%, RR = 1.49, 95%CI;1.27,1.72, I2;19.5%), TB history (HR = 1.30,95%CI;1.06,1.54, I2;64.6%), previous second-line anti-TB treatment (HR = 2.52, 95% CI;2.15,2.88, I2;0.0%), being smear positive at the baseline (HR = 1.45, 95%CI;1.14,1.76, I2;49.2%, RR = 1.58,95%CI;1.46,1.69, I2;48.7%), having XDR-TB (HR = 2.01, 95%CI;1.50,2.52, I2;60.8%, RR = 2.44, 95%CI;2.16,2.73,I2;46.1%), and any type of clinical complication (HR = 2.98, 95%CI; 2.32, 3.64, I2; 69.9%). There are differences and overlaps of predictors of mortality across different drug-resistance categories. The common predictors of mortality among different drug-resistance categories include; older age, presence of any type of co-morbidity, and undernutrition., Conclusion: Different patient-related demographic (male sex, older age), and clinical factors (undernutrition, HIV co-infection, co-morbidity, diabetes, clinical complications, TB history, previous second-line anti-TB treatment, smear-positive TB, and XDR-TB) were the predictors of mortality in patients with drug-resistant tuberculosis. The findings would be an important input to the global community to take important measures., Competing Interests: The authors have declared that no competing interests exist.

Background: the rapid spread of COVID-19, its lethality in severe cases and the absence of specific medicine poses a huge threat to human life and health, as well as huge impact on the mental health. Facing this critical situation, health care workers on the front line who are directly involved in the diagnosis, treatment, and care of patients with COVID-19 are at risk of developing psychological distress and other mental health symptoms including emotional disturbance., Objective: the aim of this study will be to assess the current state of emotional responses and perceived stressors of frontline medical staffs in case of Addis Ababa COVID-19 Treatment Centers and obstetrics emergency and abortion care, Ethiopia 2020., Methods: Hospital based comparative cross-section study design was conducted by using self-administered questionnaire survey from June 1st to 30th of 2020 among 133 and 266 frontline medical staffs from obstetric emergency and abortion care clinic and COVID-19 treatment centers respectively. The data were collected after getting written consent from each participant and it entered into the computer using Epi-data version 7, then exported to SPSS version 20 for further analysis. Descriptive analysis was done using frequencies & percent. All independent determinants with P-value < 0.05 were used to identify important predictors of emotional responses and perceived stressors., Result: A total of 399 frontline medical staffs were included in the study. The mean age of the respondents of those who were working in obstetrics emergency and abortion care clinic was 27.47 (SD, 3.46) years and it was 28.12 (SD, 4.09) years for the other groups. This study revealed that, 72.9 and 5.6% of the study participant from obstetrics emergency and abortion clinic and COVID-19 treatment centers had a positive emotional response, respectively. Factors such as having a low level of motivational factors (AOR 2.78, 95% CI (1.13, 6.84)), being a nurse (AOR 10.53, 95% CI (1.31, 85.26)) and working at triage (AOR 8.61, 95% CI (1.15, 64.81))) had statistically significant association with negative emotional response., Conclusion: The current study revealed that a high proportion of front line a negative emotional responses had negative emotional response. Further, almost all of the medical staffs working in COVID-19 treatment centers and at obstetrics emergency and abortion care unit had perceived the outbreak related stressors. So, providing comprehensive psychological support is warranted for health care providers working in such kinds of department or units.

The dietary diversity of pregnant and lactating women remains unacceptably poor in resource-limited countries such as Ethiopia. Despite the presence of inconsistent and inconclusive small-scale studies, it is difficult to portray an actual picture of dietary diversity and dietary practices of women in Ethiopia. This study aimed to identify the prevalence of dietary diversity, dietary practice, and dietary patterns of pregnant and lactating women in Ethiopia. Electronic and gray literature sources were explored. A total of 3,256 articles were found, of which 38 were included in the final analysis. The data were analyzed by using STATA version 15. The pooled estimates were presented using random-effects models due to considerable heterogeneities among studies. In this study, 16,412 pregnant and lactating women were included. The pooled prevalence of low, medium, and high dietary diversity scores of pregnant women was 37.1%, 41.55%, and 39.3%, respectively. Likewise, low, medium, and high dietary diversity scores of lactating women were 50.31%, 41.22%, and 9.1%, respectively. The mean dietary diversity of pregnant and lactating women was 3.99 ± 0.20. Regarding the minimum dietary diversity, 56.6% of pregnant women and 50.21% of lactating women were found to have inadequate dietary diversities. Two-third (65.7%) of pregnant women were found to have poor dietary practice. Starchy foods were the main staple foods of study subjects, whereas organ meats were least consumed food types. The dietary diversity score, minimum dietary diversity, and dietary practices of women are suboptimal and below WHO and FAO recommendations. This could lead to both macro- and micronutrient deficiencies. Policymakers, program managers, healthcare workers, and stakeholders need to redesign nutrition promotion and intervention programs to alleviate this issue., Competing Interests: The authors declare that they do not have any conflict of interest., (© 2021 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Background: Metabolic syndrome (MetS) is a clustering of cardiovascular risk factors, which is rising in the low and middle income countries (LMICs). There are various studies with inconsistent findings that are inconclusive for policy makers and program planners. Thus, this systematic review and meta-analysis aimed at estimating the pooled prevalence of MetS and its components in LMICs., Methods: Electronic searches were conducted in international databases including PubMed, Web of Science, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), Science direct (Elsevier), Food Science and Technology Abstracts (FSTA), Global Health and Medline, and other sources (World Cat, Google Scholar, and Google). The pooled estimates were computed in the random effect model. The pooled prevalence was computed using the three diagnostic methods (IDF, ATP III and de Ferranti). Publication bias was verified using funnel plot and Egger's regression test. Subgroup and sensitivity analysis were performed to identify the possible sources of heterogeneity among the included studies., Result: In this study, 142,142 children and adolescents from 76 eligible articles were included to compute the pooled prevalence of MetS and its components in LMCIs. MeTs among overweight and obese population was computed from 20 articles with the pooled prevalence of 24.09%, 36.5%, and 56.32% in IDF, ATP III and de Ferranti criteria, respectively. Similarly, a total of 56 articles were eligible to compute the pooled prevalence of MetS in the general population of children and adolescents. Hence, Mets was found in 3.98% (IDF), 6.71% (ATP III) and 8.91% (de Ferranti) of study subjects. Regarding the components of MetS, abdominal obesity was the major component in overweight and obese population and low HDL-C was the most common component in the general population. This study also revealed that males were highly affected by MetS than females., Conclusion: This study illustrates that MetS among children and adolescents is an emerging public health challenge in LMICs, where the prevalence of obesity is on the move. Preventive strategies such as community and school based intervention need to be designed. Promoting physical activities and healthy eating behaviors could avert this problem., Competing Interests: Competing interestsThere are no competing interests., (© The Author(s) 2020.)

Background: Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined., Methods: Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed., Results: Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community., Conclusion: The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Zebenay Workneh Bitew et al.)

Objective: To assess poor treatment outcomes and their predictors among drug-resistant tuberculosis patients treated in Ethiopia., Methods: Data were searched from both electronic databases and other sources. From the whole search, 404 articles were reviewed and 17 articles that fulfilled the inclusion criteria were included in the analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed and Joanna Briggs Institute Critical Appraisal checklist was used for assessing the quality. Risk of bias was assessed using forest plot and Egger's regression test. Data were analyzed using STATA version 15 and Review Manager Software version 5.3., Results: The overall pooled proportion of poor treatment outcome and mortality was 17.86% and 15.13% respectively. The incidence density rate of poor treatment outcome and mortality was 10.41/1000 person-months and 9.28/1000 person-months respectively. Survival status and successful treatment outcomes were 76.97% and 63.82% respectively. HIV positivity, non-HIV comorbidities, clinical complications, extrapulmonary involvement, undernutrition, anemia, treatment delay, lower body weight, and older age were the predictors of poor treatment outcome., Conclusion: Better survival and treatment success rates were noted in Ethiopia as compared to the global average. The majority of the poor treatment outcomes occurred within the intensive phase. Early initiation of anti-tuberculosis treatment would be important for successful treatment outcomes., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region., Methods: A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables., Results: The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5, 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality., Conclusion: A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

Introduction: Malnutrition is a public health problem in under-five children in several parts of the world even after decades of the implementation of management protocols. An estimated 17 million children under the age of five years are living with severe acute malnutrition and the majorities are found in Asia and Africa, including Ethiopia., Objective: The main objective of this study was to determine the recovery rate and its predictors among under-five children who were admitted to St. Paul's Hospital Millennium Medical College from 2012 to 2019., Methods: An institution based retrospective cohort study was employed at St. Paul's Hospital Millennium Medical College from May 20, 2019 to June 28, 2019. Data were collected by reviewing children's' medical records using a structured checklist. A total of 534 charts were selected using a simple random sampling method and 515 of them were used for the final analysis. Ep-info version 7 software was used for data entry and STATA Version 15 for analysis. The Kaplan Meier failure estimate with Log-rank test was used to determine the survival estimates. Bi-variable and multivariable Cox proportional hazards regression model were fitted to identify predictors of mortality. Finally, variables with p-values less than 0.05 in the multivariable Cox regression were considered as independent predictors. The proportional hazards assumption was checked using the Schoenfeld residuals test and the final model fitness was checked using the Cox-Snail residual test., Result: In this study, a total of 515 subjects were followed for 8672 child-days and 79% of the subjects recovered from SAM with the median time of 17 days. The incidence density rate of recovery was 46 per 1000 child-days. Tuberculosis (AHR(Adjusted Hazard Ratio) 0.44 & 95% CI: 0.32, 0.62), pale conjunctiva (AHR,0.67 & 95% CI: 0.52, 0.88), IV fluid infusion (AHR, 0.71 & 95 CI: 0.51, 0.98), feeding F100 (AHR, 1.63 & 95% CI:1.04,2.54), Vitamin A supplementation (AHR, 1.3 & 95% CI:1.07, 1.59) and bottle feeding (AHR, 0.79 & 95CI%: 0.64-0.98) were the independent predictors of time to recovery from SAM., Conclusion: In conclusion, the recovery rate was relatively higher than the Sphere standard and the national SAM management protocol. Co-morbidities and the treatments given were the main determinants of recovery of children. Co-morbidities must be managed as early as possible and the treatments given during the SAM management process need to be given with precaution., Competing Interests: The authors have declared that no competing interests exist.

Neural tube defects remain a major problem in developing countries, but there are limited comprehensive national reports to date in Ethiopia. Therefore, this study aimed to assess the prevalence of neural tube defects and associated factors in Ethiopia. Electronic databases and other sources were used to retrieve studies. Fifteen out of 862 studies were included in the final analysis. The estimated pooled prevalence of neural tube defects among children in Ethiopia was 63.3 cases per 10 000 children. The pooled prevalence of spinal bifida, anencephaly, and encephalocele was 41.09, 18.90, and 1.07 per 10 000 children, respectively. Previous family history and unplanned pregnancy were risk factors for neural tube defects. Folic acid supplementation during the first trimester of pregnancy was found to be protective. Neural tube defects are widespread in Ethiopia. Hence, fortification of food with folic acid or folic acid supplementation during childbearing age is recommended., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Background: Tuberculosis and intestinal parasites are mostly affecting poor people. They are in a vicious since one is the risk factor for the other. However, the comprehensive report on the burden and co-incidence of intestinal parasites and tuberculosis in Ethiopia is scant. This systematic review and meta-analysis aimed to provide abridge conclusive evidence on the intestinal parasite-tuberculosis co-infection in Ethiopia., Methods: A total of 414 articles published in English were searched from both electronic databases (CINAHL, DOAJ, Embase, Emcare, Medline, ProQuest, and PubMed, Science Direct, and Web of Science) and other sources. The qualities of the included studies were assessed using the Joanna Briggs Institute Critical Appraisal tools and the publication bias was measured using the funnel plot and Eggers regression test. Comprehensive meta-analysis (CMA) Version 3.3.07 and Review Manager software were used to estimate pooled prevalence and associations of intestinal parasites and tuberculosis infection., Results: Eleven articles with a total of 3158 tuberculosis patients included in the analysis based on the eligibility criteria. The estimated pooled prevalence of intestinal parasites co-infection was 33% (95% CI: 23.3, 44.3) using the random-effects model. The most common intestinal parasites were Ascaris lumbricoides 10.5% (95% CI: 6.0, 17.5), Hookworm 9.5% (95% CI: 6.10, 14.4), Giardia lamblia 5.7% (95% CI: 2.90, 10.9) and Strongyloides sterocoralis 5.6% (95% CI: 3.3, 9.5). The odds of intestinal parasites infection was higher among tuberculosis patients compared to tuberculosis free individuals (OR = 1.76; 95% CI: 1.17, 2.63). A significant difference was observed among TB patients for infection with intestinal helminths (OR = 2.01; 95% CI: 1.07, 3.80) but not for intestinal protozoans when compared with their counterparts. The odds of multiple parasitic infections was higher among tuberculosis patients (OR = 2.59, 95% CI: 1.90, 3.55) compared to tuberculosis free individuals. However, intestinal parasites co-infection was not associated with HIV status among tuberculosis patients (OR = 0.97; 95% CI: 0.71, 1.32)., Conclusion: One-third of tuberculosis patients are co-infected with one or more intestinal parasites, and they are more likely to be infected with intestinal helminths and multiple intestinal parasitic infections compared to TB free individuals. We recommend routine screening of tuberculosis patients for intestinal parasites. The effect of mass deworming on tuberculosis incidence would be important to be considered in future researches., Trial Registration: Registered on PROSPERO with reference number ID: CRD42019135350 .

Background: Severe acute malnutrition affects around 17 million under-five children in the world, of which the highest burden is accounted by Sub-Saharan Africa where Ethiopia is found. Though there are few individual, inconsistent and inconclusive studies, there is no nationally representative study on treatment outcomes of SAM in outpatient therapeutic feeding programs of Ethiopia. This study aimed at estimating the pooled treatment outcomes and predictors of recovery rate among under- five children with SAM in Ethiopia., Methods: Electronic databases (PubMed, Medline (EBSCOhost), EMBASE (Elsevier), CINAHL (EBSCOhost), web of science, Scopus, Science Direct and Food Science and Technology Abstracts (FSTA)), and grey literature sources (Google scholar, Mednar, World Cat and google) were used to retrieve articles. The random effect model was used to estimate the pooled treatment outcomes. Hazard ratios were used to determine the predictors of recovery rate. Cochran's Q, I 2 , and univariate Meta regression were done for heterogeneity. Begg's & Egger's tests were used for publication bias., Results: Nineteen articles with a total number of 23,395 under-five children with SAM were used for this meta-analysis. The pooled recovery, death, defaulter and non-recovery rates were 70% (95% CI: 64, 76), 2% (95% CI: 1, 2), 10% (95%CI: 7, 12), 15% (95% CI: 10, 20), respectively. Diarrhea (HR = 0.8, 95% CI: 0.75, 0.94), no edema (HR = 0.41, 95% CI: 0.33, 0.50) and amoxicillin (HR = 1.81, 95% CI: 1.18, 2.44) were independent predictors of recovery rate of children with SAM in Ethiopia. Publication year was found to be the potential source of heterogeneity between included studies., Conclusion: The treatment outcomes of children with SAM from outpatient therapeutic feeding programs of Ethiopia are lower than the sphere guidelines, WHO and national recommendations. Diarrhea and no edema antagonized the recovery rate of children, while amoxicillin enhanced the recovery rate of children from SAM. Community health workers need to be trained. Especial attention should be given while treating children with diarrhea and severe wasting. Community mobilization is also recommended to improve community awareness about the therapeutic foods.

Objective: To assess the incidence and determinants of tuberculosis (TB) among HIV-positive individuals in selected health facilities of Addis Ababa, Ethiopia, during the period January 2013 to December 2018., Methods: Data were collected from the records of 566 HIV-positive individuals. A retrospective cohort study design was employed. Data were entered into Epi Info 7 and analyzed using IBM SPSS Statistics version 20. TB incidence density was determined per 100 person-years. Time-to-event distributions were estimated using Kaplan-Meier estimates. Survival curves and hazards across different categories were compared using log-rank tests. Determinants were identified using the Cox proportional hazards model. The hazard ratio (HR) and 95% confidence interval (CI) were computed. A p-value <0.05 in the multivariate analysis was considered statistically significant., Results: A total of 566 HIV-positive individuals were followed for 2140.08 person-years, giving a TB incidence density rate of 6.82/100 person-years (146, 25.8%). The highest incidence was observed within the first year of follow-up. Independent determinants were large family size (adjusted HR (AHR) 1.783, 95% CI 1.113-2.855), lower baseline CD4 (AHR 2.568, 95% CI 1.602-4.116), and baseline body mass index <18.5 kg/m 2 (AHR 1.907, 95% CI 1.530-2.690). Being enrolled in antiretroviral treatment (AHR 0.066, 95% CI 0.045-0.98) and taking isoniazid prophylaxis treatment (AHR 0.202, 95% CI 0.108-0.380) had a protective effect., Conclusions: TB is still a major cause of morbidity among HIV-positive individuals. Early HIV diagnosis, enrollment on antiretroviral treatment, and isoniazid prophylaxis treatment should be considered to decrease the TB risk., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Extrapulmonary tuberculosis is an emerging public health problem among HIV positives compared to the general population. This study aimed to assess the incidence and predictors of extrapulmonary tuberculosis among people living with HIV in selected health facilities in Addis Ababa, Ethiopia, from 01 January 2013 up to 31 December 2018., Methods: A retrospective cohort study design was employed based on data collected from 566 HIV positive individuals. Data were entered using EpiInfo version 7.1 and analyzed by SPSS version 20. The incidence rate was determined per 100 person-years. Kaplan-Meier estimates used to estimate survivor and the hazard function, whereas log-rank tests used to compare survival curves and hazard across different categories. Cox proportional hazard model was used to identify the predictors and 95%CI of the hazard ratio were computed. P-value<0.05 in the multivariable analysis was considered statistically significant., Results: Five hundred sixty-six HIV positive individuals were followed for 2140.08 person-years. Among them, 72 developed extrapulmonary tuberculosis that gives an incidence rate of 3.36/100 person-years (95%CI = 2.68-4.22). The most frequent forms of extrapulmonary tuberculosis were; lymph node tuberculosis (56%, 41) followed equally by pleural tuberculosis (15%, 11) and disseminated tuberculosis (15%, 11). The majority (70.83%) of the cases occurred within the first year of follow-up. In multivariable Cox regression analysis, baseline WHO stage III/IV (AHR = 2.720, 95%CI = 1.575-4.697), baseline CD4 count<50cells/μl (AHR = 4.073, 95%CI = 2.064-8.040), baseline CD4 count 50-200 cells/μl (AHR = 2.360, 95%CI = 1.314-4.239) and baseline Hgb<10 mg/dl (AHR = 1.979, 95%CI = 1.091-3.591) were the independent risk factors. While isoniazid prophylaxis (AHR = 0.232, 95%CI = 0.095-0.565) and taking antiretroviral drugs (AHR = 0.134, 95%CI = 0.075-0.238) had a protective benefit., Conclusion: Extrapulmonary tuberculosis co-infection was common among HIV positive individuals, and mostly occurred in those with advanced immune suppression. The risk decreases in those taking antiretroviral therapy and took isoniazid preventive treatment. Screening of HIV positives for extrapulmonary tuberculosis throughout their follow-up would be important., Competing Interests: The authors have declared that no competing interests exist.