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Introduction: In 2021, a staggering five million children globally succumbed to mortality before celebrating their fifth birthdays. Alarmingly, children residing in Sub-Saharan African nations faced mortality risks 15 and 19 times higher than their counterparts in Europe and Northern America, as well as the region encompassing Australia and New Zealand, respectively. Ethiopia, situated in Sub-Saharan Africa, shoulders a significant burden of under-five mortality, securing the third position in Africa and the tenth globally. The primary objective of this study was to scrutinize the trends in under-five mortality inequalities based on maternal education in Ethiopia from 2000 to 2016. Method: The analysis utilized data from repeated cross-sectional surveys, drawing upon a pooled total sample of 35,404 children aged 0–59 months. This sample was derived from the Ethiopian Demography and Health Surveys conducted in 2000, 2005, 2011, and 2016. To explore the determinants of under-five mortality among this age group, we employed multilevel binary logistic regression analysis. This approach allowed us to assess the impact of various factors at the individual, household, and community levels. Additionally, we conducted multivariate decomposition, concentration index, and decomposition rate analyses to scrutinize the evolving trends in maternal education-based disparities in under-five mortality. Result: Maternal education emerged as a significant factor influencing under-five mortality in Ethiopia. Notably, approximately one-third (31%) of the observed inequalities in under-five mortality based on maternal education could be accounted for by the effects of observed characteristics. Over the years, there has been a noteworthy reduction in absolute inequalities in under-five mortality. Specifically, a decline of 0.14 was observed between 2000 and 2005, and a more substantial decrease of 0.32 occurred in the period spanning 2000 to 2016, resulting in an overall change of 56.25%. Furthermore, this study revealed that about 43.12% of the reduction in under-five mortality could be attributed to the narrowed gap in maternal education during the survey period. Conclusion: The implications drawn from these findings underscore the importance of directing interventions aimed at reducing early mortality toward the promotion of maternal education. It is evident that addressing maternal education plays a pivotal role in mitigating inequalities in under-five mortality. Additionally, there is a pressing need to revisit and enhance existing population and health policies. Establishing stronger linkages between child survival issues and the education sector is crucial for achieving the targets outlined in the Sustainable Development Goals related to under-five mortality. By aligning policies with these insights, there is a greater likelihood of fostering sustainable improvements in child survival and advancing towards the overarching goal of reducing under-five mortality. [ABSTRACT FROM AUTHOR]

Children who do not consume enough iron have decreased growth, reduced immunity, and poor cognitive development. This study aimed to assess the pooled iron-rich food consumption, trends, and predictors among children aged 6–59 months old in Ethiopia. This study used Ethiopian demographic and health survey (EDHS-2005–2016) data with a total weighted sample size of 26,773 among children aged 6–59 months old. A multilevel mixed-effects logistic regression analysis was used to identify predictors of good iron-rich food consumption. The pooled proportion of iron-rich food consumed among children aged 6–59 months in Ethiopia was 11.77% (10.71, 12.92%). In Ethiopia, the proportion of iron-rich food intake by children aged 6–59 months was slightly increased from 9.25% (8.04, 10.62%) in EDHS 2005 to 10.86% (9.06, 12.95%) in EDHS 2011, and sharply increased to 17.49% (15.04, 20.24%) in EDHS 2016. The findings indicated that being children born to mothers aged 20 to 34 years old [AOR = 0.56, 95% CI: 0.35, 0.89], mothers aged ≥ 35 years old [AOR = 0.47, 95% CI: 0.28, 0.82], married parents [AOR = 1.68, 95% CI: 1.14, 2.48], completed primary education [AOR = 1.32, 95% CI: 1.02, 1.73], secondary education [AOR = 2.66, 95% CI: 1.53, 4.59], a higher education status of mother [AOR = 3.98, 95% CI: 1.92, 8.23], medium family [AOR = 1.39, 95% CI: 1.03, 1.89], rich family [AOR = 1.45, 95% CI: 1.09, 1.95], media exposure [AOR = 1.35, 95% CI: 1.06, 1.72], residents of the Tigray [AOR = 2.69, 95% CI: 1.51, 4.79], Oromia [AOR = 3.30, 95% CI: 1.30, 4.02], Benishangul [AOR = 2.12, 95% CI: 1.15, 3.88], Gambela [AOR = 5.85, 95% CI: 2.97, 11.50], and Dire Dawa region [AOR = 3.38, 95% CI: 1.76, 6.47], were significantly associated with good iron-rich food consumption among children aged 6–59 months old. The findings revealed that iron-rich food intake was considerably low among Ethiopian children aged 6–59 months. Increasing women's literacy and economic empowerment improves iron-rich food consumption among children aged 6–59 months old. [ABSTRACT FROM AUTHOR]

Introduction: Cervical cancer is a leading cause of cancer-related mortality in Ethiopia, despite being preventable. Screening programs remain underutilized despite multiple initiatives. This systematic review and meta-analysis aimed to assess the pooled prevalence of intention to undergo cervical cancer screening and its associated factors among Ethiopian women, addressing a significant gap in national data. Methods and materials: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases such as PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, HINARI, Google Scholar, and African Journals online were searched using specific keywords and Medical Subject Headings (MeSH). Studies were assessed using a standardized appraisal format adapted from the Newcastle-Ottawa Scale (NOS). Data extraction and analysis were performed using Microsoft Excel-10 and STATA 17 software, respectively. Heterogeneity was evaluated with the I2 statistic and publication bias was examined using Egger's test. Meta-analysis employed a random-effects model. Result: Out of the 750 articles retrieved, nine were included in this systematic review and meta-analysis. The pooled prevalence of intention to screen for cervical cancer in Ethiopia was 33% (95% CI: 9%-56%). Factors significantly associated with intention to undergo cervical cancer screening included favorable attitude (POR = 2.15, 95% CI: 1.29, 4.26), good knowledge about cervical cancer screening (POR: 3.49; 95% CI: 2.04, 6.93), and direct subjective norm (POR: 1.54; 95% CI: 1.32, 3.54). Conclusion: Based on the findings of this meta-analysis, it was observed that women's intention toward cervical cancer screening was low. Determinants identified included favorable attitude, direct subjective norm, and good knowledge of cervical cancer screening. To enhance women's intention for cervical cancer screening, strategies, and activities should be developed to positively influence perceptions among women and those who influence their decisions. Additionally, efforts to enhance public awareness about cervical cancer and its prevention are crucial. [ABSTRACT FROM AUTHOR]

Introduction: Datura stramonium poisoning, resulting from the ingestion of seeds, leaves, or flowers of Datura stramonium, is a severe condition with significant risks, particularly for young children. Most documented cases of Datura stramonium poisoning in the literature involve teenagers who intentionally ingest the plant to induce hallucinogenic and euphoric experiences. This report presents a rare instance of unintentional Datura stramonium poisoning in a 3year-old Ethiopian toddler. Case presentation: He presented with symptoms consistent with anticholinergic toxidrome, including altered mental status, agitation, seizures, dilated pupils, and tachycardia. Laboratory tests, including complete blood count, liver function test, renal function test, electrolyte levels and cerebrospinal fluid analysis were normal. Results of blood toxicology screen were negative. Timely recognition and supportive care lead to a positive outcome. Conclusion: Through this report, we aim to add to the limited body of literature on Datura stramonium poisoning in toddlers and offer insights into its clinical course and management in paediatric patients. [ABSTRACT FROM AUTHOR]

Background: Nasopharyngeal carriage of S. pneumoniae is a global health problem that has been associated with the emergence of severe disease and pathogen dissemination in the community. However, summary data on the carriage rate, antimicrobial susceptibility profile, and determinant factors is lacking. Method: Articles were extensively searched in bibliographic databases and gray literature using entry terms or phrases. Studies meeting eligibility criteria were extracted in MS Excel and exported to STATA version 17 software for statistical analysis. A random-effects model was used to compute the pooled magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The heterogeneity was quantified by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis was done to assess the impact of a single study on the pooled effect size. Result: Of the 146 studies identified, 8 studies containing a total of 3223 children were selected for meta-analysis of the magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The overall pooled prevalence of nasal carriage of S. pneumoniae and its MDR status in Ethiopian children was 32.77% (95%CI: 25.1, 40.44). and 31.22% (95%CI: 15.06, 46.84), respectively. The highest resistant pattern of S. pneumoniae was against tetracycline, which was 46.27% (95%CI: 37.75, 54.79), followed by 45.68% (95%CI: 34.43, 57.28) trimethoprim-sulfamethoxazole, while the least pooled prevalence was against chloramphenicol, which was 16.2% (95%CI: 9.44, 22.95). The pooled effect of age less than 5 years old (pooled OR = 1.97; 95% CI: 1.35, 2.88, P < 0.001), co-sleeping habit with others (pooled OR = 2.36; 95% CI: 1.77, 3.66; P < 0.001), sibling (pooled OR = 1.82; 95% CI: 1.14, 2.91, P = 0.01), history of hospitalization (pooled OR = 4.39; 95% CI: 1.86, 10.34, P = 0.001), and malnutrition (pooled OR = 2.18; 95% CI: 1.49, 3.19; P < 0.001) showed a statistical association with S. pneumoniae nasal carriage rate by using the random effect Sidik-Jonkman model. Conclusion: The magnitude of the nasopharyngeal carriage rate and multi-drug resistance status of S. pneumoniae alarms the need for immediate interventions such as strengthening antimicrobial stewardship programs, undertaking national antimicrobial surveillance, one-health initiatives, and national immunization programs. [ABSTRACT FROM AUTHOR]

This essay centers on one African woman, Ṭaytu Bǝṭul (1851–1918), and argues that her path to empowerment has a significant African and Ethiopian precedent. African scholars write about how African women have obtained authority through shifting aspects of their identities through the religious, economic and political spheres. The Ethiopian precedent is seen in the lives of historical Ethiopian women like Mǝntǝwwab, Mänän, and Wällätä Petros. Using the relevant primary and secondary sources, I continue to argue that Ṭaytu used the strategies that served these women in the past, such as the prominent position of women in African religions, imperial marriages of her relatives throughout her and her husband’s growing Empire, and her central place in her husband’s inner circle to create, maintain and expand her influence culminating in her governing the nation for years after a series of strokes incapacitated her husband Mǝnilǝk II. [ABSTRACT FROM AUTHOR]

This paper discusses cluster statehood and its implications on minority ethnic groups. Using the three statehood exercises (South-Western Ethiopian Peoples, Southern Ethiopia and Central Ethiopian regional state) as a case study, this paper highlights the main issues and challenges minority ethnic groups face in the process of statehood exercise. These include the application of the simple majority vote rule in a statehood referendum, the implication of cluster statehood on minority ethnic groups’ rights, the challenge of clustering ethnic minorities without their wishes and restructuring minorities’ ethnic administrative boundaries without a referendum. It concludes that the simple majority followed in statehood referendum makes the role of minority ethnic groups rubber-stamp rather than reflect their real interests. Creating the Central Ethiopian State without a referendum is a flagrant disregard of the constitutional procedure and hinders the full political authority of minority nnp s to decide on their affairs. [ABSTRACT FROM AUTHOR]

Introduction: Fertility refers to the biological capacity to reproduce and have children. It is a key aspect of reproductive health influenced by various factors. Therefore, this study aims to explore the determinants of fertility rates based on urban and rural settings in Ethiopia. Method: A stratified two-stage cluster sampling approach was used, employing data from the 2019 Ethiopian Mini Demographic and Health Survey (https://dhsprogram.com). The study comprised 8,885 women aged 15 to 49 years. The study employed Stata 17, and the data was described using descriptive statistics. Associations were examined using decomposition analysis and negative binomial regression. The Incidence Rate Ratio and p-value were used to determine the statistical significance of the variables examined. Results: The negative binomial regression found that factors such as maternal age (IRR, 1.08, P-value,0.00), living in rural (IRR,1.09, P-value,0.00), being Muslim (IRR,1.13, P-value,0.00), being from other religious groups (IRR,1.16, P-value,0.00), having six up to nine household members (IRR,1.24, P-value,0.00), having greater than nine household member(IRR,1.14, P-value,0.04), having one child under five year (IRR,1.35, P-value,0.00), having two children under five year (IRR,1.77, P-value,0.00), and having more than two under five years (IRR,1.99, P-value,0.00), being currently pregnant (IRR,1.08, P-value,0.00), use of contraceptive(IRR,1.13, P-value,0.00) are positively associated with bearing more children. On the other hand, completing primary education (IRR,0.84, P-value,0.00), secondary education (IRR,0.61, P-value,0.00), being from the richest household (IRR = 0.94, P-value,0.00), and being single/divorced and widowed (IRR,0.49, P-value,0.00) are negatively associated with having more children because their IRR is less than one. The decomposition analysis also demonstrated that marital status has a stronger negative correlation with fertility in rural compared to urban settings. Additionally, the number of children under five exerts a greater influence on fertility in urban areas. Conclusion: the study found significant rural-urban differences in the factors shaping fertility in Ethiopia. While demographics like maternal age, education, and wealth influenced fertility in both settings, the relationships varied in nature and magnitude. To address this, Policymakers should develop targeted fertility programs that address the unique needs and challenges faced by rural and urban populations. [ABSTRACT FROM AUTHOR]

Background: The Health Services Provision Assessment in Ethiopia (SPA-ET) is a survey that generates data on the availability and quality of health services in Ethiopia. Despite the presence of integrated management of childhood illness guidelines in healthcare settings, there has been inadequate exploration or assessment of how effectively and consistently health professionals follow the guidelines. Objective: This study aims to identify factors influencing healthcare worker adherence to the integrated management of childhood illness guidelines to identify spatial clusters. Methods: The data for this study were gathered from the Service Provision Assessment (SPA) survey in Ethiopia, which was conducted nationwide from August 11, 2021, to February 4, 2022. It included a total of 788 health professionals who assessed sick children experiencing at least one of the three main childhood illness symptoms: fever, cough, or diarrhea. We employed STATA version 16 for data analysis, utilizing cross-tabulations to explore relationships between variables and logistic regression modeling to identify factors influencing adherence. To account for the hierarchical structure of the health survey data, we employed multilevel logistic regression. Model selection was based on comparison parameters including the Bayesian Information Criterion (BIC) and Akaike Information Criterion (AIC). We computed adjusted odds ratios with 95% confidence intervals, and statistical significance was determined at a significance level of p < 0.05. Results: The rate of adherence to the integrated management of childhood illness guideline was 33% (95% CI: 29.70%, 36.26%). The analysis revealed several factors influencing adherence to IMCI protocols. child's age (being ≥24 months) [aOR = 0.66, 95% CI: (0.45, 0.87)], facility type (health center) [aOR = 2.61, 95% CI: (1.84, 3.37)], place of residency (being rural) [aOR = 0.54, 95% CI: (0.38, 0.77)], and care provider's qualification (health officer) [aOR = 1.71, 95% CI: (1.18, 2.48)] were all statistically significant. Moreover, the primary cluster is situated in the west Oromia region, with a central focus at coordinates (7.982108 N, 36.203355 E) and extends to a radius of 78.28 km. Conclusion: This study confirms a low adherence rate (33%) among health professionals in Ethiopia to the IMCI guideline for assessing the three main symptoms of sick children. The study identified child's age, facility type, academic qualification, and place of residence as crucial factors correlated with adherence rate. Furthermore, 5 secondary clusters (hotspot areas) were identified using SaTScan software. To address the higher protocol refusal, interventional plan needs to be based on academic qualification of care provider, facility type, age of child and place of residency. Moreover, interventions to reduce non-adherence to IMCI guidelines should be location-tailored based on identified hotspot areas to restore guidelines adherence equality. [ABSTRACT FROM AUTHOR]

Background: Soil-transmitted helminths (STHs) and mutualistic gut microbes coexist in the gastrointestinal tract. However, limited data exist regarding how STH infections are associated with gut microbiome profiles. Method: We conducted a cross-sectional analysis of baseline data collected in a longitudinal study to identify and explain differences in microbial communities between STH-infected and non-infected Ethiopian school children. We collected 138 stool samples and analyzed them for STH infection using standard direct wet mount and Kato Katz methods. The gut microbiome profiles were characterized using targeted amplicon sequencing of the 16S rRNA gene from the total DNA extracted from the stools. Results: Children infected with Trichuris trichiura showed significantly lower microbial diversity than those who were non-infected (p<0.05). We also observed significant difference in microbiome composition based on Trichuris trichiura infection status (PERMANOVA p< 0.01). A comparison of microbial taxa at the genus level among participants infected with different helminth species showed a significant increase in Agathobacter relative abundance among children infected with Trichuris trichiura compared to non-infected subjects (adjusted p = 0.001). Conclusions: Our results indicate that changes in the gut microbiome composition may vary depending on the species of helminth present. Further studies should investigate how Trichuris trichiura selectively alters microbiome composition compared to other STH species. Author summary: The coexistence of soil-transmitted helminths (STHs) and mutualistic gut microbes in the gastrointestinal tract is poorly understood. We studied the gut microbiome in Ethiopian school children infected and non-infected with soil-transmitted helminths (STHs). We found that children infected with Trichuris trichiura showed significantly lower microbial diversity. Comparing microbial taxa at the genus level, we observed a significant increase in Agathobacter relative abundance among children infected with Trichuris trichiura compared to non-infected subjects. These findings indicate that the gut microbiome composition may vary depending on the species of helminth present. Further research is needed to understand how Trichuris trichiura selectively alters the gut microbiome compared to other STH species. Data on soil-transmitted helminths (STHs) and their relationship to the microbiome would be valuable for planning future public health interventions. This is particularly important for controlling helminth infections while considering the microbial community. [ABSTRACT FROM AUTHOR]

Background: Community perception of mental illness is a collective belief system and attitude about mental disorders; it affects the availability of services, the level of stigma, and the help-seeking intention. This study assessed community perceptions towards mental illness and help-seeking intentions in Southwest Ethiopia. Methods and material: A community-based analytical cross-sectional study was done in Southwest Ethiopian People's Regional State (SWEPRS), from March 1st to June 30th, 2021. All adult individuals >18 years old living in the region were the source population, while all adult >18 years old living in the selected household were the study population. The calculated sample size was 1028. Participants were selected using a multistage sampling technique. A structured, interview-based questionnaire was used to collect the data. The data were entered into Epidata Manager and exported to SPSS for analysis. Result: The response rate for this study was 95.4%. The prevalence of poor perception and unfavorable help-seeking intention of mental illness were 45.8%, 95% CI (42.6, 48.9), and 49.5%, 95% CI (46.4, 52.7) respectively. Being rural [AOR = 1.94 (95% CI:(1.41, 2.66)]c, lack of information [AOR = 4.82(95% CI: (3.39,6.83)], exposure to mental illness [AOR = 4.11(95% CI:(2.64,6.38)] were significantly associated with poor perception of mental illness. Also, gating mental illness information [AOR = 0.40 (95% CI: (0.19, 0.83)], and being exposed to mental illness [AOR = 0.56 (95% CI: (0.41, 0.79)] were significantly associated with unfavorable help-seeking intentions for mental illness. Conclusion: The high prevalence of poor perceptions and unfavorable help-seeking intentions for mental illness can be minimized through providing tailored information regarding the cause, type, and severity of the problem, particularly in the rural areas. [ABSTRACT FROM AUTHOR]

Background: Childbearing under the age of 20 is referred to as teenage childbearing. Compared to high-income countries, it is significantly higher in low-income countries. Adolescent childbearing is influenced by a number of variables, including economic, demographic, and social factors, and these vary geographically. Thus, this study aimed to determine the predictors of adolescent childbearing among Ethiopian women with spatial effect adjustment. Methods: A total weighted sample of 4712 women aged 15 to 49 were included. The data were obtained from the 2019 Ethiopia Demographic and Health Survey. A generalized Geoadditive model which accounts for spatial effect and the non-linear effect of continuous variables was adopted to determine the associated factors of adolescent childbearing among Ethiopian women. Results: The spatial pattern of adolescent childbearing was non-random in Ethiopia with Moran's index statistics 1.731999 (P-value < 0.001). Based on the evidence of spatial variation in a model, the highest risk of adolescent childbearing was observed in Jijiga, Shinilie, Welwel and Walder, Afar (Zone1 and Zone 5), Assosa, Metekel, and Gambela (Zone1). We also noted that women not intending to use a contraceptive method, Muslim religion, living in a rural area, and large household family size were significantly associated with a high risk of adolescent childbearing. Furthermore, our model results also confirmed that higher educational levels, older household age, and good economic status significantly reduced the risk of adolescent childbearing. Conclusions: This study revealed that adolescent childbearing distribution was significantly clustered in the Eastern and Southwestern parts of Ethiopia. Intervention programs aimed at the prevention of early marriage and raising awareness of sexual activity are essential to reducing adolescent childbearing. [ABSTRACT FROM AUTHOR]

Introduction: According to the World Health Organization and Ethiopian Demographic and Health Survey on birth spacing, there should be at least a two-year gap between conception and the first of two children born in quick succession. In poor nations like Ethiopia, resource issues were complex, making it difficult to get statistics for the entire country. However, by examining Ethiopian mini demographic and health survey data, we were able to provide data at the national level. Method: The cross-sectional survey-based study was conducted in several of Ethiopia's administrative cities and nine regions. In the analysis, sampling weight was used to correct the survey's non-proportional sample distribution to strata and areas throughout the survey process and restore representative data. The study's household population was presented and described using descriptive statistics such as weighted frequencies and percentages. The statistically significant factors linked to frequent short birth intervals were found using a multivariable, multilevel logistic regression analysis. Result: Overall, 4306 weighted multigravida mothers nested within 305 enumeration areas were included in the analysis. The respondents' mean (standard deviation) of the birth interval was 42.027(26.69). Higher-educated women had 12% lower odds of having a shorter pregnancy (AOR = 0.88; 95% CI: 0.35, 0.98) than women without higher education. The odds of a short birth interval were 3.04 times greater among women in the age category of 40–49 years at first marriage (AOR = 3.04; 95% CI: 1.08, 8.46) than among women in the age category of 15–19 years. This indicates that older women were most likely to have short birth intervals. Conclusion: In the multilevel logistic regression model, maternal age, maternal educational status, the wealth quintile index, use of contraceptives, duration of breastfeeding, and contextual regions were significantly associated with short birth intervals in Ethiopia. [ABSTRACT FROM AUTHOR]

Introduction: Vitamin A (VA) cannot be made in the human body and thus foods rich in VA are the only sources of vitamin A for the body. However, ensuring availability in adequate amount of foods rich in VA remains a challenge, mainly in low-income counties including Ethiopia. In addition, children from the poorest and less educated families of same country have disproportionately limited consumptions of foods rich in VA. Therefore, the present study aimed assessing the wealth related inequality in vitamin A consumption (VAC) and decompose it to the various contributing factors. Methods: This study was conducted using the 2019 Ethiopian demographic and health survey data on a weighted sample of 1,497 children of age 6–23 months in Ethiopia. The wealth related inequality in VAC was quantified using concentration index and plotted using concentration curve. The Wagstaff decomposition analysis was performed to assess the relative contributions of each explanatory variable to the inequalities in the overall concentration index of VAC. Result: The overall Wagstaff normalized concentration index (C) analyses of the wealth-related inequality in consumption of foods rich in VA among children aged 6–23 months was [C = 0.25; 95% C: 0.15, 0.35]. Further decomposition of the C by the explanatory variables reported the following contributions; primary level of women's education (7.2%), secondary and above (17.8%), having ANC visit during pregnancy (62.1%), delivery at a health institution (26.53%), living in the metropolis (13.7%), central region (34.2%), child age 18–23 months (4.7%) contributed to the observed wealth related inequality in the consumption of foods rich in vitamin A in Ethiopia. Conclusion: We found pro-rich wealth-related inequality in VAC among children of age 6–23 months in Ethiopia. Additionally, maternal education, region, ANC visit, and place of delivery were the significant contributors of wealth-related inequality of VAC. Nutritional related interventions should prioritise children from poorer households and less educated mothers. Moreover, enhancing access to ANC and health facilities delivery services through education, advocacy, and campaign programs is highly recommended in the study setting. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pelvic organ prolapse (POP) has a profound influence on a woman's quality of life (QoL). Assessment of QoL using patient-reported outcome (PRO) measures in pelvic organ prolapse surgery is common practice in developed countries, but despite the burden of POP in developing countries, such as Ethiopia, the use of PROs to record preoperative and postoperative QoL scores is limited. This study is aimed at assessing the QoL among Ethiopian women with POP before and after surgery using the validated Pelvic Organ Quality of Life (P-QoL) questionnaire. Additionally, we will compare postoperative QoL measurements of reconstructive procedures with those of obliterative procedures. Methods: This is a prospective observational study conducted at a single hospital in Ethiopia on women who were scheduled for surgery for symptomatic POP. Patients' QoL was assessed preoperatively using the P-QoL questionnaire and at each subsequent follow-up visit for 1 year (3, 6, 9, and 12 months). Patients undergoing an obliterative procedure were evaluated and compared with those having reconstructive procedures. Results: The mean score for general health perceptions, prolapse impact, role limitations, physical limitations, social limitations, and emotions was 0 at 12 months postoperatively. Despite significant improvements from baseline, personal relationships, sleep or energy disturbance, and symptom severity measures continued to negatively impact QoL at 12 months postoperatively. Conclusions: Quality of life among Ethiopian women with POP is poor across all domains. Native tissue repair employing either reconstructive or obliterative methods significantly improves QoL across all domains up to 12 months postoperatively. The use of validated tools to assess PROs is essential to provide evidence-based care that improves QoL in ways that are meaningful to patients. [ABSTRACT FROM AUTHOR]

This research intends to shed light on the household migration decision‐making process of Ethiopian irregular migrants heading to the Republic of South Africa. Data were drawn from a cross‐sectional household survey (n = 659) and in‐depth interviews (n = 24) conducted in 2022. Descriptive statistics, binary logistic regressions and thematic analysis were employed to analyse the data. Our findings reveal that being a young male, having a large household size, the presence of family members and smugglers positively influence households' decisions for irregular migration. Possession of farmland, being employed and married have a negative influence on household decisions for migration. The study findings further show that prior information about the migration destination is important in the household's migration decision‐making process. We suggest that government actions and policy interventions should be based on such empirical evidence to promote safe and regular migrations while addressing potential migrants' aspirations and needs in their pursuit of a better life. [ABSTRACT FROM AUTHOR]

Cervical cancer is the second most commonly diagnosed cancer in women in Ethiopia. However, data are limited on the prevalence of human papillomavirus (HPV) genotypes. Self-sampled vaginal lavages were obtained consecutively from 783 women attending 7 health facilities across Ethiopia. Genotype prevalence was assessed by Multiplex- Papillomavirus-Genotyping which detects and individually identifies 51 genotypes and 3 subtypes. Genotype-specific prevalence was described and associations with known risk factors were analysed. The overall HPV prevalence (age range 18-45) was 33.1% (95% confidence interval (CI) 29.8-36.4). The prevalence of HPV was different in the rural and urban population with 17.6% (95%CI 11.6-23.7) and 36.8% (95%CI 33.1-40.6) (p < 0.001 chi-square test), respectively. The most common high-risk types were HPV 16 (6.6%), followed by HPV 52 (4.3%), 51 and 39 (both 2.9%). Urban women compared to rural women had a higher risk of being HPV positive (odds ratio 2.36 (95% CI 1.47-3.79; p < 0.001). Age at sexual debut ≤15 years and polygamous husband (in urban women) also increased the risk of being HPV positive nearly two-fold. The high prevalence of hr-HPV in Ethiopian women in the reproductive age group shows the need for screening programs. The nonavalent HPV vaccine covers the most prevalent hr-HPV genotypes as found in this study and can therefore be used effectively. Since antenatal care is the bestutilised health service, implementing self-sampled vaginal lavage could be an opportunity for screening in this age group. Screening algorithms and triage still need to be defined to avoid over-treatment in these women. [ABSTRACT FROM AUTHOR]

Human immunodeficiency virus (HIV) co-infection is a major challenge for visceral leishmaniasis (VL) control, particularly in Ethiopia where the incidence of both pathogens is high. VL-HIV often leads to high rates of antileishmanial treatment failure and recurrent VL disease relapses. Considering the high prevalence of HIV and Leishmania in the Ethiopian population, preventing the progression of asymptomatic Leishmania infection to disease would be a valuable asset to VL disease control and to the clinical management of people living with HIV (PLWH). However, such a strategy requires good understanding of risk factors for VL development. In immunocompetent individuals living in Brazil, India, or Iran, the Human Leukocyte Antigen (HLA) gene region has been associated with VL development. We used NanoTYPE, an Oxford Nanopore Technologies sequencing-based HLA genotyping method, to detect associations between HLA genotype and VL development by comparing 78 PLWH with VL history and 46 PLWH that controlled a Leishmania infection, all living in a VL endemic region of North-West Ethiopia. We identified an association between HLA-A*03:01 and increased risk of VL development (OR = 3.89). These data provide candidate HLA alleles that can be further explored for inclusion in a potential Leishmania screen-and-treat strategy in VL endemic regions. Author summary: Human immunodeficiency virus (HIV) co-infection is a major challenge for the control of visceral leishmaniasis (VL), particularly in Ethiopia where both frequently occur. VL-HIV disease is often hard to treat, and some treated patients will relapse after initially thought to be cured. However, there is a long period of asymptomatic Leishmania infection prior to the development of VL-HIV symptoms, and tackling the infection at this stage will be valuable in the effort to combat VL-HIV disease. However, this requires good understanding of human risk factors for VL development. In this work, we tested the Human Leukocyte Antigen gene region and the association with VL disease development, as genetic risk factors. We identified a preliminary association between the HLA-A*03:01 gene variant and an increased risk for VL development. This would need to be tested again in a larger study, to assess whether it can be used to see if asymptomatic Leishmania-infected individuals will develop VL disease. [ABSTRACT FROM AUTHOR]

Previous research in Ethiopia mainly contemplated studying children's mental distress and the negative effects of orphanages. However, there is a dearth of documented evidence on how positive psychological resources, social support, basic needs services, and mental health impact the well-being of children in childcare institutions and how care centers can benefit vulnerable children. This study aimed to investigate the direct impact of perceived social support (PSS), basic need services (BNS), and Psychological Capital (PsyCap) on the mental health of children in childcare settings. Additionally, the study sought to explore the mediating role of PsyCap between PSS, BNS, and children's positive mental health (PMH). A total of 420 institutionalized Ethiopian children, comprising 187 females and 233 males, were selected by using a stratified multistage random sampling approach. Validated and standardized measures of psychological well-being (PWB), PsyCap, BNS, and PSS were employed to collect data from the study participants. The findings from the structural equation modeling (SEM) analysis revealed that BNS and PsyCap directly and significantly predicted the PMH of children. Moreover, both BNS and PSS exhibited a positive and significant effect on the higher-order PsyCap construct. Although PSS did not directly influence positive mental health, it indirectly predicted mental health outcomes through the presence of PsyCap. Furthermore, PsyCap played a mediating role between BNS and positive mental health outcomes. It is recommended that future research replicate and expand upon the current study's findings to gain insights into the positive mental health of institutionalized children. [ABSTRACT FROM AUTHOR]

Background: Ethiopia has had a long-standing national commitment to improving child health for the last five decades. However, evidence on trends of ever-breastfeeding and early initiation remained fragmented, and there existed a paucity of holistic evidence on the extent of the impacts of the policy and the associated factors. This study examined trends, disparities, and factors influencing ever-breastfed and early initiation in the last twenty years. Methods: The Ethiopian Demographic and Health Surveys (EDHS 2000–2019) datasets were used and extracted for children aged 0–23 months and their mothers. Data analyses were performed using SPSS version 25. Trend and time-series analysis was used to visualize changes over time. Multivariable logistic regression was used to identify associated factors. Results: Prevalence of ever-breastfeeding declined from 99.4% in 2000, to 84.01% in 2019; and early initiation showed inconsistency, increasing from 48.55% in 2000 to 69.57% in 2016 and remained unchanged (69.78%) in 2019. Maternal age, religion, and maternal healthcare utilization significantly influenced early initiation (p < 0.001). Both ever-breastfeeding and early initiation varied across regional states (< 0.001). Disparities in breastfeeding and early initiation were observed across socio-cultural settings and regional states (p < 0.05). Conclusion: The prevalence of ever-breastfeeding declined nationwide between 2000 and 2019, which was not uniform and early initiation showed inconsistency across socio-cultural settings and regional states. These findings highlight the need to revisit current policies and interventions. Further research is crucial to inform the development of regionally tailored and culturally sensitive strategies that promote equitable and sustained breastfeeding improvement across Ethiopia. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionWe compared the distribution of the HLA-B27 allele among Ethiopian patients with acute anterior uveitis (AAU) and controls without that disease.The clinical features of patients were collected from their medical records. HLA-B27 genotyping was performed for 64 patients, with AAU using the real-time polymerase chain reaction (RT-PCR), and the results were compared to those from a panel of 192 healthy, unrelated volunteer control participants (refraction patients and volunteers) free of signs of anterior uveitis. Other outcomes were assessed comparing HLA-B27 positive vs. negative patients.The histocompatibility antigen HLA-B27 was identified in 6 out of 64 (9.4%) AAU patients, compared with 1.0% in controls (Odds Ratio = 9.8, 95% CI (1.93, 50.01)). Sub-group analysis of the cases revealed that patients with HLA-B27 positivity had a higher incidence of ocular hypertension (Odds Ratio = 5.93, 95% CI (1.29, 27.2)).The antigen HLA-B27 was represented ~10-fold more frequently in the patient group than in the control group. HLA-B27 allele distribution in both cases and controls is lower than in reports from Caucasian and Asian populations, but similar to South Africa. [ABSTRACT FROM AUTHOR]

Background: Unmet need for family planning is a major cause of unwanted pregnancies, which may contribute to the death of mothers and children. The aim of this study is to examine inequalities in the demand and unmet need for contraception among women in four regions (i.e., Afar, Benishangul-Gumzu, Gambela and Somali regions) of Ethiopia. Methods: The study utilized data from the 2016 Ethiopian Demographic Health Survey (EDHS), collected from 3,343 women of reproductive age 15–49 years situated in these study regions. Multilevel binary and multivariable logistic regression analysis, concentration index, and multivariate decomposition analysis were employed. Results: The study revealed that women's employment status, education level, household wealth index, total number of children ever born, and husband's working status had a statistically significant association with the demand for contraception. Furthermore, women's educational level, household size, wealth index and husband's working status had statistically significant association with unmet need for contraception. The results of the concentration index indicated that illiteracy among respondents (56%), being in the richest economic status/ wealth index (41%) and non-working status of respondents (21%) contributed substantially to the inequality in the demand for contraception use. Illiteracy of the husband (197%) and the household size less than or equal to five (184%) contributed positively, but illiteracy of respondent (-249%) and unemployment status of respondents (-119%) contributed negatively to the existing inequality in unmet need for contraception. Conclusion: The findings of this study highlight the presence of unacceptably high inequality in the demand and unmet need for contraception among women in the four study regions. Policymakers should give due attention to reducing existing socio-economic inequality to address the high unmet need for family planning and increase demand for contraception in these regions. The study strongly recommends implementing multidimensional and multisectoral approaches, which will significantly reduce inequalities in the outcome variables. [ABSTRACT FROM AUTHOR]

Animal‐source foods (ASFs), contain high amounts of essential nutrients that are readily absorbed by the body. However, children in resource‐constrained settings often have limited access to these nutritious foods. This study aimed to investigate the reasons for the low consumption of ASFs among children in the Amhara region of Ethiopia. A community‐based mixed‐methods study was conducted, using exploratory qualitative methods supplemented by the analysis of secondary data from the Ethiopian Demographic and Health Survey (EDHS). The qualitative study employed a multiphase stepwise design and the maximum variation purposive sampling technique, enroling a diverse range of participants such as mothers and/or caregivers, household heads, religious and community leaders, health and nutrition experts, and others. The qualitative data were analysed using a thematic framework analysis method, while the quantitative data were analysed using SPSS v22 statistical software. Multivariable logistic regression analysis was performed to identify the predictors of ASFs among children under 5 years of age in the region. Despite the large and diverse livestock populations available, only 13.2% of children consumed at least one animal‐source food (ASF) in the prior day. The most consumed ASFs were dairy and eggs, whereas beef, organ meat, and seafood were the least consumed. Household demographics such as residence, literacy level, paternal age, and household wealth quintiles influenced the overall consumption of ASFs. The main reasons for the low consumption of ASFs among children were unaffordability and poor awareness among caregivers. In addition, religious misconceptions, price hikes, limited availability during certain seasons, low productivity, insufficient support from health professionals, and time constraints for caregivers were also mentioned as significant barriers to ASF consumption in the area. The consumption of ASFs among children in Ethiopia, particularly in the Amhara region, remains very low. This is mainly due to the caregivers' levels of awareness and unaffordability of ASFs. It is recommended that behavioural and sociocultural interventions be implemented that target caregivers to improve the consumption of ASFs among children. [ABSTRACT FROM AUTHOR]

By anchoring on the self-determination theory in an Ethiopian context, this study tried to establish the basic need satisfaction sport scales (BNSSS) reliability and validity. Despite the scale's usefulness in measuring athletes' psychological need fulfillment during a sporting event, no study has proven the scale's validity in a setting of Ethiopian sports. To validate the BNSSS scale, confirmatory factor analysis was used in the study. The 20 items of the BNSSS questionnaire's English translation are divided into five categories: relatedness, competence, autonomy-perceived locus of internal causality, autonomy-choice, and volition. Senior language experts translated the BNSSS questionnaire into Amharic. The Amharic version of the instrument was used to gather data from 321 athletes, 174 men, and 147 women, with a mean age of 23.34 22.59 and a standard deviation of 5.08 and mean age 5.32; a standard deviation of 2.33 year of experience in their sports from four baseball games. With a Cronbach's alpha value ranging from 0.848 to 0.882 (IPLOC to Volition respectively) across the five subscales and, the results confirm the reliability of the BNSSS for evaluating satisfaction with basic needs and motivation among Ethiopian athletes." The result demonstrated an acceptable fit with the data (CFI, = 0.958, GFI, = 0.933, RMR, = 0.76, RMSEA, = 0.39) as well as internal consistency. All of the components' Cronbach's alpha values met expectations. The instrument's Amharic translation was thus valid and reliable for determining the extent to which Ethiopian athletes' basic needs were met. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Method Result and Discussion Conclusion Few psychosis screening instruments have been tested for use in Africa, yet appropriate tools can increase the detection of self‐reported psychotic symptoms, improve the detection of psychosis and impact its prognosis.The construct validity and factor structure of Psychosis Screening Questionnaire (PSQ) were tested with confirmatory factor analysis (CFA) and item response theory (IRT) in a sample of 1928 Ethiopian adults without any history of psychosis. We tested a unidimensional model with and without an item on mania. For IRT, unidimensional latent structure one‐parameter logistic (1PL) and two‐parameter (2PL) logistic models were tested and compared for relative fit using a likelihood‐ratio test.The prevalence of lifetime positive screens was 2.8% in an Ethiopian sample of adults from a general medical setting. A unidimensional model demonstrated good fit for the PSQ, (CFI = 0.993, TLI = 0.986 and RMSEA = 0.025). For IRT, a 2PL model was the best fitting one. IRT tests of item difficulty and discrimination parameters showed that paranoia had the highest discrimination α=4.59$$ \left(\alpha =4.59\right) $$ and lowest difficulty (β=2.53$$ \beta =2.53 $$), likely to be endorsed at low levels of psychotic features. Thought insertion had the highest item difficulty (β=2.98$$ \beta =2.98 $$). Overall, the measure captures the psychosis construct at higher levels of the latent trait and may be suited for detecting moderate to severe levels of psychosis.The PSQ is found to have good construct validity in screening for psychosis among Ethiopian adults. Future studies may focus on the diagnostic validity of the PSQ comparing it with a structured clinical interview. [ABSTRACT FROM AUTHOR]

Diarrhea claims >500,000 lives annually among children under five years of age in low- and middle-income countries. Mortality due to acute diarrhea (<7 days' duration) is decreasing, but prolonged (7-13 days) and persistent (≥14 days of duration) diarrhea remains a massive challenge. Here, we use a case-control study to decipher if fecal gut microbiota compositional differences between Ethiopian children with acute (n=554) or prolonged/persistent (n=95) diarrhea and frequency-matched non-diarrheal controls (n=663) are linked to diarrheal etiology. We show that diarrhea cases are associated with lower bacterial diversity and enriched in Escherichia spp., Campylobacter spp., and Streptococcus spp. Further, diarrhea cases are depleted in gut commensals such as Prevotella copri, Faecalibacterium prausnitzii, and Dialister succinatiphilus, with depletion being most pronounced in prolonged/persistent cases, suggesting that prolonged duration of diarrhea is accompanied by depletion of gut commensals and that re-establishing these via e.g., microbiota-directed food supplements offer a potential treatment strategy. Here, the authors profile the gut microbiome of Ethiopian children suffering from acute and prolonged diarrhea, showing the latter group to exhibit a higher degree of microbial imbalance, characterized by a reduction of gut commensals and an enrichment of potential pathogens. [ABSTRACT FROM AUTHOR]

Reggae music, a genre that was created in Jamaica in the late 1960s, has become popular across the globe for promoting positive representations of Ethiopia and Africa due to reggae's connections with the Rastafari movement. Ethiopian reggae musicians, through their interactions with Rastafari, have served as cultural ambassadors for a type of pan-Africanism that incorporates elements of Rastafari beliefs and promotes transatlantic solidarity. Some Ethiopians who emigrated have encountered Rastafari and reggae music while living outside of Ethiopia. Some Rastafari have left the Western world behind to repatriate to Ethiopia, believing it to be their homeland and Promised Land, leading to opportunities for cultural exchanges within Ethiopia. Ethiopian musicians work across cultural and linguistic barriers to engage with Rastafari and pan-Africanism through their social interactions and approaches to reggae performance conventions while navigating differences in worldviews. Based on ethnographic research with reggae musicians in Ethiopia, I argue that Ethiopian musicians use different composition and performance techniques to narrate and build on the historical connections between Ethiopia, Jamaica, and Rastafari in ways that articulate and promote a type of transatlantic solidarity informed by pan-African discourse. [ABSTRACT FROM AUTHOR]

Background: Giving birth in a healthcare facility with the guidance of skilled healthcare providers allows access to necessary medical interventions. Ethiopia has implemented several strategies to enhance institutional delivery and decrease maternal mortality; however, the rate of institutional delivery remains low. This study examines the role of distance to healthcare institutions on institutional delivery in Ethiopia, and how this has changed over time. Method: This study used data from two rounds of the Ethiopian Demographic and Health Survey (2011 and 2016), a spatial database detailing the locations of healthcare facilities, and Ethiopian road network data. The sample included 22,881 women who delivered within the 5 years preceding each survey and lived in 1,295 villages. Bivariate and multivariable logistic regression analyses were used to investigate how the distance to health facilities and other potential determinants influenced institutional delivery trends. Results: The rate of institutional deliveries in Ethiopia has increased from 10% in 2011 to 26% in 2016. Likewise, the average transportation distance to health facilities has decreased from 22.4 km in 2011 to 20.2 km in 2016 at the national level. Furthermore, a one-kilometer increase in the distance to the nearest health facility was associated with a 1% decrease in the likelihood of delivering at a health facility in 2016 (odds ratio (OR) = 0.99, 95% CI [0.98–0.99], p < 0.05). Additionally, mothers who are more educated, have completed more antenatal care visits, live in wealthier households in more urban areas, and cohabit with more educated husbands are more likely to deliver at healthcare facilities. These variables showed consistent relevance in both survey rounds, suggesting that key determinants remained largely unchanged throughout the study period. Conclusion: The impact of distance from health facilities on institutional delivery in Ethiopia remains evident, although its influence is relatively modest. The other factors, including education, antenatal care, socioeconomic status, urban residence, and partner education, remained consistent between the two surveys. These determinants have consistently influenced institutional delivery, highlighting the importance of a comprehensive approach that addresses both access to and socioeconomic factors to improve maternal and infant health across the country. [ABSTRACT FROM AUTHOR]

The global centenarian population is expected to reach 4 million by 2050, yet little is known about the health status of centenarians in Sub-Saharan Africa. A case study examined the health conditions and functionality of nine Ethiopian centenarians. In-depth interviews revealed that all nine were Orthodox Christians and lived with extended family; eight were male. Aside from minor health complaints, centenarians in rural Ethiopia perceived that their sensory/cognitive functionality was normal until their late 90s. Despite a lack of medical care, the centenarians included two survivors, four delayers, and three escapers. Centenarians in rural Ethiopia were embedded in closely knit, religious, multigenerational households and communities and aspired to live resiliently. These findings call for the consideration of the unique health status of centenarians in Global South nations in their own cultural context. [ABSTRACT FROM AUTHOR]

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Poor land management coupled with increasing climate extremes is affecting the livelihoods of Ethiopian communities. So, evaluating the possible impact of climate change on water resource is essential for planning a sustainable water use system. As a result, this study aimed to investigate the impact of climatic variable changes on streamflow in the Borkena River Catchment, Awash Basin, Ethiopia, using projected climate data of canESM2 (Canadian Earth System Model of second generation) global climate model. Future scenario, analysis was performed for the 2020s, 2050s and 2080s for the Representative Concentration Pathway of RCP4.5 and RCP8.5. Impact assessment of climatic variable changes on streamflow was done by HBV Light hydrological models. The model was calibrated using a semi-automated method and the performance was measured by the coefficient of determination (R2), Nash–Sutcliffe efficiency (NSE) and mean difference. The performance of HBV Light hydrological model during the calibration and validation period showed a satisfactory agreement between observed and simulated flow with R2, NSE and mean difference. The value of R2, NSE and mean differences was 0.84, 0.82 and 0 for calibration and 0.83, 0.78 and 8.23 for validation periods, respectively. The downscaled precipitation and temperature result reveals decrease and increase value in all future three-time horizon for both RCP8.5 and RCP4.5 scenarios in an annual basis respectively. This condition was expected to result decreased in mean annual streamflow of Borkena River in the future three-time horizon with the value of –16.81%,–17.25% and –18.28% for RCP8.5 scenario and –6.88%, –9.89% and –10.66% for RCP4.5 scenario in the 2020s, 2050s and 2080s, respectively. Inoculation future climate variation has a significant impact on the surface water potential of the catchment. So, for sustainable development of the River catchment in water use the streamflow of the catchment should be harvested. [ABSTRACT FROM AUTHOR]

Background: Early neonatal deaths, occurring within the first six days of life, remain a critical public health challenge. Understanding the trends and factors associated with this issue is crucial for designing effective interventions and achieving global health goals. This study aims to examine the trends in early neonatal mortality in Ethiopia and identify the key factors associated with changes in early neonatal mortality over time. Methods: This study utilized five consecutive Ethiopian Demographic and Health Survey datasets from 2000 to 2019. To investigate the trends and identify factors influencing changes in early neonatal mortality over time, conducted a trend analysis and a logit-based multivariate decomposition analysis. Data management and analyses were performed using STATA version 17/MP software. All analyses were weighted to account for sampling probabilities and non-response. Statistical significance was determined at a two-sided p-value threshold of less than 0.05. Result: The analysis included a total of 12,260 weighted women from the 2000 survey and 5,527 weighted women from the 2019 survey. Over the study period, there was an overall downward trend in early neonatal mortality, decreasing from 34 deaths per 1000 live births in 2000 to 27 deaths per 1000 live births in 2019. The annual rate of reduction was estimated to be 1.03%. Approximately 45% of the observed decline in early neonatal mortality rate can be attributed to changes in population characteristics or endowments (E) during the study period. Factors such as the mother's age, maternal education, marital status, preceding birth interval, types of pregnancy, and the sex of the child significantly contributed to the compositional change in the early neonatal mortality rate. Conclusion: Over the past two decades, Ethiopia has seen a modest decline in early neonatal mortality, but this progress falls short of the Sustainable Development Goal (SDGs) targets. To achieve the SDGs, the Ministry of Health and its partners should intensify efforts to reduce early neonatal mortality. Strategies like preventing early/late pregnancies, promoting appropriate marriage timing, and prioritizing education could help further reduce early neonatal deaths. Further research is also needed to explore the factors driving this issue. [ABSTRACT FROM AUTHOR]

Background: Breast milk is the first, highly valuable, and solely natural food recommended for infants in their first six months of life, which is critical for children's overall growth and development. Evidence suggests that exclusive breastfeeding differs by geographic area in Ethiopia. However, little is known regarding the geographic distribution of exclusive breastfeeding practice. Hence, this study aimed to assess exclusive breastfeeding practice, its geographic variation and associated factors among Ethiopian mothers. Method: The study used the 2019 Ethiopian mini demographic and health survey data. All living children born 0–23 months before the survey were included. Global Moran's I statistics on Arc-GIS and Getis Ord Gi* statistics was used to visualize the spatial pattern and hotspot and cold spot areas, respectively. Kulldorff SaTScan was used to show purely significant spatial clusters. The associated factors were identified using a multilevel mixed-effects logistic regression model. Statistically significant factors were reported using the AOR with a 95% CI and a p-value of < 5%. Result: The coverage of exclusive breastfeeding practice in Ethiopia was 56.05% (95% CI: 53.95%, 58.10%). The spatial pattern was non-random across the country's regions. Somalia, Gambela, Benshangul Gumuz, Dire Dawa, and Harari regions had low clustering of exclusive breastfeeding practices, whereas Amhara, Eastern SNNPR, and Central and Northern Oromia regions had high clustering. Children born through caesarean delivery [AOR = 0.36; 95% CI: 0.21, 0.63], initiated breastfeeding within the first 1 h [AOR = 0.55; 95% CI: 0.34, 0.90], after 1–24 h of delivery [AOR = 0.36; 95% CI: 0.24, 0.54], after a day [AOR = 0.04; 95% CI: 0.02, 0.08], and women residing in the pastoralist region [AOR = 0.22; 95% CI: 0.12, 0.39] or city administrations [AOR = 0.49; 95% CI: 0.27, 0.89] had lower odds of exclusive breastfeeding practice. Conclusion: Exclusive breastfeeding practice in Ethiopia remained low. The practice had a spatial variation across the country. Caesarean section delivery, late breastfeeding initiation, and region were statistically significant variables. Therefore, promoting timely initiation of breastfeeding and improving the utilization of maternal health services and designing special intervention strategy for women residing in city administrations and pastoralist regions of the country may increase the coverage of exclusive breastfeeding practice. [ABSTRACT FROM AUTHOR]

Background: Contraceptive usage in Ethiopia is significantly influenced by the decision-maker at the household level. Joint decision-making involving both women and their husbands/partners is considered ideal for improving contraceptive uptake among women and for managing health outcomes related to contraceptive side effects. However, there is a lack of substantial evidence regarding the prevalence and impact of joint decision-making on contraceptive use in Ethiopia. Therefore, the current study aimed to assess the magnitude of joint decision-making on contraceptive use and its determinant factors among married, contraceptive-using, reproductive-age women in Ethiopia. Methods: This study was conducted based on the Ethiopian Demographic and Health Survey (EDHS) 2016 data. A total weighted sample of 3,669 married, contraceptive-using, reproductive-age women were included in the study. Multilevel logistic regression was employed due to the hierarchical nature of the data. Variables with a p-value of ≤ 0.2 in the bivariate multilevel analysis were included in the multivariable multilevel analysis. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to determine the direction and strength of associations. Variables with a p-value of < 0.05 in the multivariable multilevel analysis were considered statistically significant for joint decision-making on contraceptive use. Results: The prevalence of joint decision-making on contraceptive use in Ethiopia was 78.81% [95% CI: 71.35-74.23%]. Several factors were found to be statistically significant in relation to joint decision-making on contraceptive use: Women educational level primary, secondary, and higher (Adjusted odds' ratio (AOR = 1.5; CI 1.2–1.9), (AOR = 1.9; CI 1.3–2.9), and (AOR = 2.1; CI 1.2–3.5) respectively, protestant in religion (AOR = 1.7; CI 1.7–2.5), wealth status rich (AOR = 1.4; CI 1.1–1.9), media exposure (AOR = 1.4; CI 1.1–1.9), and community poverty high (AOR = 0.6; CI 0.6–0.9). Conclusions: In Ethiopia, the majority of contraceptive users are married, reproductive-age women, and their decision to use contraceptives is typically made jointly with their husbands or partners. Factors positively associated with joint decision-making on contraceptive use include women's educational level (primary, secondary, and higher), being Protestant, having a higher wealth status, and media exposure. Conversely, women living in communities with high poverty levels are less likely to make joint decisions about contraceptive use. Health care providers, health care programmers and policy makers should be focused on these determinant factors to enhance joint decision-making in women's contraceptive use in Ethiopia. [ABSTRACT FROM AUTHOR]

The unique health-related traditions, perceptions, and communication patterns of Ethiopian immigrants are challenging to Israeli healthcare providers who are trained in western medicine. The aim of this review was to conduct a survey of traditions, beliefs, and symptom reporting by Ethiopian immigrants and culturally oriented interventions to improve the care of Ethiopian immigrants. We used the keywords "Ethiopian immigrants Israel" and "Ethiopian Jews." Of 418 articles initially retrieved, 35 satisfied the inclusion and exclusion criteria. We described health-related traditions and their possible complications. Possession syndrome was frequently misdiagnosed as a neurological or psychiatric disorder. The medical staff was unfamiliar with these health and illness beliefs, somatization patterns, and the communication style of Ethiopian immigrants. There were successful interventions that involved liaisons from the Ethiopian community and community-based educational activities. Medical professionals working with African immigrants worldwide can use the Israeli experience to develop effective, culturally oriented interventions to optimize the health care for these immigrants. [ABSTRACT FROM AUTHOR]

Background: While evidence-based practice has demonstrated its capacity to enhance healthcare quality and bolster clinical outcomes, the translation of research into clinical practice encounters persistent challenges. In Ethiopia, there remains a dearth of comprehensive and nationally representative data concerning the extent of Evidence-based practice adoption among nurses. Thus, this systematic review and meta-analysis endeavors to assess the overall prevalence of Evidence-based practice implementation and delve into its determinants among Ethiopian nurses. Methods: A systematic review and meta-analysis were conducted following the PRISMA guidelines. In order to identify pertinent studies, a search was conducted across PubMed, Scopus, Google Scholar, and EMBASE databases. A weighted inverse variance random-effects model was employed to estimate the pooled prevalence. Cochrane's Q-test and I2 statistics were calculated to assess heterogeneity among studies. Funnel plots and Egger's test were utilized to evaluate publication bias. Pooled implementation rates and meta-regression analysis were carried out using STATA 17. Results: Of the total 1,590 retrieved articles, twelve studies including 4,933 nurses were included in the final analysis. The pooled prevalence of Evidence-based practice uptake among nurses in Ethiopia is 53% (95% CI: 46%-60%). Having knowledge about Evidence-based practice (AOR = 2.29; 95% CI: 1.90, 2.69; I2 = 70.95%), holding a favorable attitude towards Evidence-based practice (AOR = 2.56; 95% CI: 1.63, 3.49; I2 = 88.39%), occupying a head nurse position (AOR = 3.15; 95% CI: 1.85, 4.46; I2 = 87.42%), possessing effective communication skills (AOR = 4.99; 95% CI: 1.47, 8.51; I2 = 99.86%), and having access to Evidencebased practice guidelines (AOR = 1.90; 95% CI: 1.55, 2.24; I2 = 57.24%) were identified as predictors of the uptake of Evidence-based practice. Conclusion: Only half of Ethiopia's nurses exhibit a strong embrace of Evidence-Based Practice within clinical settings, underscoring the urgent necessity for coordinated endeavors to cultivate this essential practice. Possessing knowledge, effective communication skills, access to updated guidelines, maintaining a positive attitude towards Evidence-Based Practice, and holding a position as head nurse emerged as predictors of successful implementation of Evidence-Based Practice. Hence, policymakers must prioritize capacity-building initiatives, disseminate the latest EBP guidelines widely, and strengthen mentorship roles for head nurses. [ABSTRACT FROM AUTHOR]

This study explores the transition and adjustment of African immigrant women, particularly Ethiopian immigrant women (EIW), as they navigate the U.S. healthcare system and their ability to access and utilize healthcare services. A qualitative cross-sectional design with a mix of purposive and snowball sampling techniques was utilized to recruit EIW (N = 21, ≥18 years) who arrived in the U.S. within the last five years. One-on-one in-depth interviews were conducted to collect data. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically using Nvivo12 software. The thematic analysis revealed three major themes: (1) settling into new life in the U.S. delays EIWs' ability to access primary healthcare; (2) adjusting to the U.S. healthcare system: confusions and mixed perceptions; and (3) avoidance of care: EIW's reasons for PHC visits changed in the U.S. Participants avoided healthcare, except for life-threatening conditions, general check-ups, and maternal healthcare services. Transitional support for legal, residential, employment, and health information could help tackle the challenges of accessing primary healthcare for EIW. Future research should analyze access to healthcare in relation to the everyday struggles of immigrant women, as well as legal and complex structural issues beyond acculturative issues. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is the second-most prevalent cause of mortality resulting from infectious diseases worldwide. It is caused by bacteria belonging to the Mycobacterium tuberculosis complex (MTBC). In Israel, TB incidence is low, acknowledged by the WHO as being in a pre-elimination phase. Most cases occur among immigrants from high TB incidence regions like the Horn of Africa and the former Soviet Union (FSU), with occasional outbreaks. The outbreak described in this report occurred between 2018 and 2024, increasing the incidence rate of TB in the region. Control of this outbreak posed challenges due to factors including a diverse population (including Ethiopian immigrants, Israeli-born citizens, and immigrants from other countries), economic and social barriers, and hesitancy to disclose information. The unique multidisciplinary team formed to address these challenges, involving the local TB clinic, district health ministry, health maintenance organization (HMO) infectious disease consultant, neighborhood clinic, and National Mycobacterium Reference Laboratory (NMRL), achieved effective treatment and containment. Whole genome sequencing (WGS) proved pivotal in unraveling patient connections during the outbreak. It pinpointed those patients overlooked in initial field investigations, established connections between patients across different health departments, and uncovered the existence of two distinct clusters with separate transmission chains within the same neighborhood. This study underscores collaborative efforts across sectors that successfully contained a challenging outbreak. [ABSTRACT FROM AUTHOR]

Background: Undiagnosed diabetes mellitus poses a significant global public health concern, exerting a substantial impact on the well-being of individuals, their families, and societies at large. Those individuals with undiagnosed diabetes miss opportunities to maintain quality of life and prevent diabetes-related complications. Even if there are ample primary studies on undiagnosed diabetes in Ethiopia, the results reveal conflicting results. Therefore, a comprehensive national picture of undiagnosed diabetes is essential for designing effective strategies at the national level. Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for prevalence studies (PROSPERO ID: CRD42021266676). PubMed, Web of Science and the World Health Organization's Hinari portal were searched using a strategy developed in collaboration with Liberians. The inclusion criteria comprised studies reporting undiagnosed diabetes in Ethiopia. Two independent reviewers conducted a quality assessment using a 10-item appraisal tool. Meta-analysis and metaregression were performed using a random-effects model. Result: Twenty-five studies with 22,193 participants met the inclusion criteria. The pooled prevalence of undiagnosed diabetes among the Ethiopian adult population was 5.68% (95% CI: 4.53 - 6.83, I² = 75.4). Factors significantly associated with undiagnosed diabetes include age, waist circumference, overweight, family history of diabetes, and a history of hypertension. Conclusion: Our systematic review found a noteworthy prevalence of undiagnosed diabetes in Ethiopia. The majority of factors linked with undiagnosed diabetes in this review were modifiable. This underscores the importance of targeted factors and public health interventions to improve early detection and reduce the burden of undiagnosed diabetes and its complications in Ethiopia. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common surgical emergency in Ethiopian clinical practice. Although a multitude of scoring systems have been used in clinical practice, none have been universally validated. The purpose of this study was to validate the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system in the Ethiopian context. Methods: A total of 315 consecutive patients who presented with a presumptive diagnosis of acute appendicitis and were planned to undergo appendectomy were studied. All the studied patients had diagnostic sonography and underwent the RIPASA scoring system. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA and ultrasound results with intraoperative gross examinations. Results: The mean age of the participants was 27.4 ± 11.5 years, with a male-to-female ratio of 1.6:1. The concordance between ultrasound and RIPASA for the diagnosis of acute appendicitis was 93.6%. The sensitivity, specificity, positive predictive value, and negative predictive value of RIPASA were 96.2%, 30.8%, 93.9%, and 42.1%, respectively. Similarly, the sensitivity, specificity, positive predictive value, and negative predictive value of ultrasound were 95.3%, 27.8%, 95.6%, and 26.3%, respectively. White cell count and RIPASA scores were weakly correlated with intraoperative stages of acute appendicitis, r(313) = 0.18, p = 0.001, and r(313) = 0.129, p = 0.022, respectively. The rate of a negative appendectomy was 6%. Conclusion: RIPASA and ultrasound had equivalent performance in the diagnosis of acute appendicitis. In both cases, the rate of negative appendectomy was low enough to validate RIPASA for clinical practice in low-income institutions where sonographic diagnosis by a conventionally trained radiologist is not available. [ABSTRACT FROM AUTHOR]

A growing body of evidence indicates the emergence of overweight/obesity in developing countries before the battle against undernutrition has been won. We conducted this study to quantify the reduction of underweight and the emergence of overweight among Ethiopian women from 2000 to 2016 and evaluate factors explaining the progress. We used the four Ethiopian Demographic and Health Surveys (2000–2016) to analyze body mass index (BMI) trends among women. Data from 43,815 non-pregnant, non-puerperal reproductive-age women was used to evaluate the linear change in BMI and changes in the percentage of overweight and underweight over time. Using multivariate decomposition analysis of change in underweight and overweight percentages, we identified sources of change in BMI in the past 16 years of the survey periods. The BMI of Ethiopian reproductive-age women increased by 0.88 kg/m2 from 2000 to 2016. The increment was pronounced in urban areas with 1.46 kg/m2. There has been a significant reduction in underweight women since 2000 (p-value < 0.001), and 87.62% of the changes were attributed to behavioral changes toward weight management. And there was a significant upswing in overweight women from 2000 to 2016 (p-value < 0.001) as well. A compositional change of factors including region, women's age, women's educational status, religion, type of place of residence, and use of contraceptives contributed to 57.51% of the observed increment in the percentage of overweight women. A relatively slow decrease in underweight and an increment in overweight have been observed. This progress can be disaggregated into persistent underweight in the rural and poorest, and swift development of overweight in the urban and richest communities. Targeted nutrition interventions for both underweight and overweight women are mandatory. Nutritional interventions in Ethiopia should focus on behavioral change to reduce hunger and malnutrition as well as to avert the emergence of overweight or obesity in the affected communities. [ABSTRACT FROM AUTHOR]

In this paper, I analyse forms of belonging and un-belonging created in a situation of permanent liminal legality in one’s place of residence. The concept of liminal legality zooms in on spaces of social existence in everyday lives in a context of legal ambiguity. The focus of the paper is Eritrean and Ethiopian migrant communities who resided in the Sudanese capital Khartoum in 2021. The majority had lived in Khartoum for decades, or were even born there, but remain without any hope for full legal status or citizenship in Khartoum. Based on 30 in-depth interviews with Eritrean and Ethiopian migrants, I analyse the complex and ambiguous forms of belonging and un-belonging this liminal legality produces, and how aspirations are created and shaped by it. I argue that in certain aspects of everyday life, liminal legality does not hinder a social existence as quasi-citizens of Khartoum. At the same time, important aspirations are being curtailed by liminal legality. This creates forms of un-belonging that undermine social existence. I conclude that migrants are subject to the enduring power of the nation-state in defining who belongs and who is excluded. [ABSTRACT FROM AUTHOR]

Background: Childbirth-related mortality and morbidity affect many women globally, especially in low-income countries like Ethiopia. Obstetric fistula–a preventable condition mainly caused by prolonged and obstructed labor–can lead to physical, psychological, and social challenges, affecting women's social participation and inclusion. Objective: This study aims to understand women's social participation and inclusion experiences post-obstetric fistula surgery. Methods: This study is part of a larger research project investigating the social inclusion process of women who have had obstetric fistula surgery in Ethiopia. For this study, we conducted a qualitative exploration of women's experiences, guided by a constructivist grounded theory approach. Twenty-one women discharged from fistula treatment facilities following obstetric fistula surgery were interviewed using a semi-structured interview guide. Data was analyzed using Charmaz's inductive analysis approach, which involves an initial line-by-line coding followed by focused coding to identify the most significant codes. Subsequently, sub-themes and themes were developed from the focused codes. Result: The data analysis revealed four themes reflecting the women's experiences of social participation and inclusion. These are the experience of recovery and the journey toward social participation, participating in expected and meaningful activities, the continued challenge with a romantic relationship, and formal and informal support. Overall, the women who received fistula surgery reported positive life changes, especially regarding their physical well-being. However, they continued to face social challenges such as financial hardship, reproductive health problems, and issues with marriage and family life, which negatively impacted their social participation and inclusion experiences. Conclusion: While more research is needed, the findings of this study suggest that the social aspects of obstetric fistula are crucial for healthcare professionals to consider. Providing appropriate care and support to address unmet social relationship, employment, and childcare needs could enable women to lead fulfilling lives. [ABSTRACT FROM AUTHOR]

Background: Vaccine card is a crucial tool for gauging vaccine coverage. It is imperative to hold these health cards to have well-fitted data which are crucial in reaching data-driven decisions in the era of immunization surveillance and monitoring processes. However, there is limited knowledge about the retention rate of vaccination card and its associated factors in Ethiopia. Objective: This research aimed to assess the retention rate and associated factors of vaccination card in Ethiopia, using data from the 2016 Ethiopian demographic health survey. Methods: This study included a total of 1304 (weighted) children aged 12─23 months who were vaccinated and provided with a vaccination card. We used a multilevel logistic regression model to analyze factors associated with vaccination card retention. We considered factors to be statistically significant if they had a p-value of less than 0.05 with a respective 95% confidence interval. Result: Among the cohort of 1,304 immunized children, it was observed that 684, representing 52.5% (95% CI: 49.7%─55.2%), were able to present their respective vaccination card during the interview time. According to the results of the multilevel logistic analysis, there is a considerable reduction in the rate of vaccination card retention by 65% (adjusted OR 0.35, 95% CI: 0.19─0.65) and 37% (adjusted OR 0.63, 95% CI: 0.4─0.91) for individuals who are rural residents and those who are fully vaccinated, respectively. Furthermore, it is noteworthy to mention that individuals originating from socio-economic backgrounds with low poverty levels exhibit a 59% increase in vaccination card possession (adjusted OR 1.59, 95% CI: 1.11─2.50). Conclusion: This study revealed a low rate of holding vaccination cards. Place of residency, wealth status, and vaccination status were factors that contributed to the change in the vaccination card retention rate. It is advisable to customize the interventional strategy by taking into account the individual's residency, immunization status, and degree of poverty within the community, to achieve a favorable rate of holding vaccination cards. [ABSTRACT FROM AUTHOR]

Introduction: More than two-third of global child death is occurred due to inappropriate feeding practice that happened during early childhood period. Evidence on meal frequency status among infant and young children at national level can be used to design appropriate interventions to improve the recommended feeding frequency. Therefore, this study was aimed to explore the spatial distribution and identify associated factors of inadequate meal frequency among children aged 6–23 months in Ethiopia. Methods: Secondary data analysis was conducted using the 2019 mini Ethiopian Demographic and Health Survey data. A total weighted sample of 1,532 children aged 6–23 months were included. To identify significant factors associated with of inadequate meal frequency, multilevel binary logistic regression model was fitted. Variables with p-value < 0.25 from the bi-variable model were exported to multivariable analysis. In the multivariable model, variables with p-value < 0.05 were declared as significantly associated factors and adjusted odds ratio (AOR) with its 95% confidence interval were reported. Multilevel models were compared using deviance and log-likelihood. Spatial analysis tools were utilized to visualize the distribution of inadequate meal frequency. Bernoulli model was fitted using SaTScan V.9.6 to identify most likely clusters and ArcGIS V.10.8 was used to map the hotspot areas. Ordinary least square and geographic weighted regression models were used and compared using information criteria and adjusted-R2. Local coefficients of factors associated with hotspots of inadequate meal frequency were mapped. Results: The prevalence of inadequate meal frequency was 47.03% (95% CI: 44.54%, 49.53%) in Ethiopia. Age of the child, sex of the household head, timely initiation of breastfeeding, current breastfeeding status, number of antenatal care visit, maternal education, and region were significantly associated with inadequate meal frequency. The spatial distribution of inadequate meal frequency was showed significant variation across Ethiopia (Global Moran's I = 0.164, p-value <0.001). A total of 38 significant clusters were detected through SaTScan analysis, from these the 22 primary clusters were located in Somali and Harari. Conclusion and recommendation: The prevalence of inadequate meal frequency was high in Ethiopia and had significant clustering patter. Significant hotspot clusters were located in Somali, northern Afar, Harari, Amhara, Gambela, and eastern South nation nationalities and peoples' region. Therefore, public health interventions which enhance breastfeeding practice, optimal number of antenatal care visits, educational empowerments should target hotspot areas to decrease inadequate meal frequency practice. [ABSTRACT FROM AUTHOR]

Background: Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1–2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia. Methods: Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. Results: In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout. Conclusions: Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia. [ABSTRACT FROM AUTHOR]

Although, written corrective feedback (hereafter referred to as CF) is applauded in many writing courses for fostering students' quality writing, its impact on grammatical accuracy in L2 students' writing remains a debated topic. Thus, this study looked into the effect of CF types on L2 students' grammatical accuracy in writing. To achieve this objective, the design of this study was quasi-experiment. During the intervention of the study three groups: two experimental groups and one control group were participated with a total of 150 students. Over the intervention of 8 weeks, the students received pretest, immediate post-test and a delayed post-test was given. The data collected through the writing tests was analyzed using one-way ANOVA and Scheffe post hoc tests. The findings indicated that although CF types have positive effects during the immediate posttest scores, they did not have any positive effect on L2 students' grammatical accuracy in writing context in the delayed posttest scores. This implies that CF alone is not sufficient for improving the grammatical accuracy of high school students in Ethiopia. Although the CF literature discussed its importance in the language acquisition, teachers are advised to focus on students' additional exposures in writing accuracy rather than grammatical correction in their writing classes and use longer treatment to allow language learners' engagement with the CF types provided. [ABSTRACT FROM AUTHOR]

While national registry systems are evolving worldwide and, in some cases, replacing reliance on censuses, in countries where well-established population registers are lacking, the population and housing census remains the primary source of detailed data on the number of people, their spatial distribution, age and gender structure, living conditions, and other key socio-economic characteristics. The quality of the census findings is crucial for several reasons, including building public trust in the national statistical system. In many developing countries, conducting a Post-Enumeration Survey appears to be the only feasible way to evaluate the census results. Indeed, the lack or incompleteness of reliable demographic data from alternative sources precludes the use of other methods. This paper discusses some aspects of the feasibility of a Post-Enumeration Survey in Ethiopia. In particular, the paper reports on the main critical issues that emerged from the pilot surveys carried out in the framework of a cooperation project – funded by the Italian Agency for Development Cooperation – aimed at providing methodological support and technical assistance for the preparation of the 4th Ethiopian Population and Housing Census. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. Methods: Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. Results: 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. Conclusion: Healthcare provider–performed antenatal ultrasound – supported by obstetricians via tele-ultrasound – showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging. [ABSTRACT FROM AUTHOR]