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Postnatal care immediately after birth is a crucial component to save lives of mothers and the newborns. A paucity of evidence indicated that women's unwillingness to receive care after birth is a remained challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the utilization of postnatal care within 48 h after birth and its determinants in northwest Ethiopia. A community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had birth within the last one year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and p value of 0.05. The study revealed that 13.3% (95% CI 10.9-15.7%) of women attended postnatal care visits within 48 h after birth. Attending secondary and above education (AOR = 2.39; 95% CI 1.18, 4.84); health extension workers home visiting during pregnancy (AOR = 1.74; 95% CI 1.08, 2.82); birth order (AOR = 2.07; 95% CI 1.03, 4.14); place of delivery (AOR = 7.49; 95% CI 3.73, 15.06); and short distance to health facility (AOR = 4.19; 95% CI 1.64, 10.70) were significantly associated with postnatal care utilization within 48 h after birth. Postnatal care utilization within 48 h is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider multilevel intervention strategies focusing on maternal health education, engaging community health workers in health promotion, and ensuring physical accessibility of healthcare facilities to be more effective in improving postnatal care utilization within 48 h., (© 2024. The Author(s).)

Background: Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding., Methods: A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results., Results: The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=-0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=-0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data., Conclusion: Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors., (© 2024. The Author(s).)

Introduction: postnatal care after birth is a crucial component in saving the lives of mothers and new-borns. A paucity of evidence indicated that women's unwillingness to receive care after birth remains a challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the level of postnatal care utilization and factors affecting it in northwest Ethiopia., Methods: a community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had given birth within the last year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and a p-value of <0.05., Results: the study revealed that postnatal care utilization was 19.85% (95% CI: 20.8-29.4) in northwest Ethiopia. Maternal education of secondary and above (AOR =2.65; 95% CI: 1.43, 4.94); facility delivery (AOR = 3.99; 95% CI: 2.44, 6.55); membership in women associations in the community (AOR = 1.6; 95% CI: 1.07, 2.4); four or more ANC contacts (AOR = 1.51; 95% CI: 1.03, 2.22); having health education at health post level (AOR = 1.77; 95% CI: 1.21, 2.58), and birth order (AOR = 2.64; 95% CI: 1.21, 5.78) were significantly associated with postnatal care utilization., Conclusion: postnatal care utilization is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider community-based intervention strategies focusing on maternal health education, healthcare accessibility, and promoting women's participation in the community to be more effective in improving postnatal care utilization., Competing Interests: The authors declare no competing interests., (Copyright: Tesfahun Hailemariam et al.)

Introduction: Teleradiology allows distant facilities to electronically transmit images for interpretation, thereby bridging the radiology service gap between urban and rural areas. The technology improves healthcare quality, treatment options, and diagnostic accuracy. However, in low resource settings like Ethiopia, teleradiology services are limited, posing challenges for implementation. Therefore, this study is aimed at exploring the factors that facilitated or hindered the implementation of web-based teleradiology in the public hospitals of the South Gondar Zone, Northwest Ethiopia. Methods: In this study, a purposive sampling method was employed to select seventeen participants, including hospital managers, physicians, emergency surgeons, and radiologists, for an in-depth interview (IDI). The interviews were conducted from March to May 2023. A reflexive thematic analysis was conducted using an abductive coding technique at the semantic/explicit level. Data were collected through semistructured interviews conducted face-to-face and virtually, with audio recordings transcribed, translated, and analyzed using Open Code version 4.02 software. Trustworthiness was ensured through prolonged engagement, reflective journaling, and review by coauthors. Results: The study examined eight main themes, with barriers to sustainable teleradiology implementation falling into five categories: technological, organizational, environmental, individual, and workflow and communication. Conversely, identified facilitators included improved radiology service efficiency, system accessibility, collaboration opportunities, and user trust in the radiology ecosystem. Within each theme, factors with potential impacts on teleradiology system sustainability were identified, such as the lack of system handover mechanisms, absence of a central image consultation center, and inadequate staffing of full-time radiologists and technical personnel. Conclusions: The study highlights the positive user perception of a web-based teleradiology system's user-friendliness and efficiency. Overcoming challenges and leveraging facilitators are crucial for optimizing teleradiology and improving service delivery and patient outcomes. A centralized consultation center with dedicated radiologists and technical personnel is recommended for maximizing efficiency., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Araya Mesfin Nigatu et al.)

Background: Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia., Objective: This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia., Methods: We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the "Wegera" and "Tach-armacheho" districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95% CIs, was computed using a difference-in-differences model., Results: In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95% CI 4.18-19; P=.03) than in the comparator district., Conclusions: This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up., (©Biniam Kefiyalew Taye, Lemma Derseh Gezie, Asmamaw Atnafu, Shegaw Anagaw Mengiste, Jens Kaasbøll, Monika Knudsen Gullslett, Binyam Tilahun. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 05.04.2024.)

Background: Considering individual differences caused by personality differences is crucial for end users' technology acceptance. However, previous studies overlooked the influence of users' technology readiness on technology acceptance. This study, therefore, aimed to evaluate the influence of technology readiness on teleradiology acceptance in the Amhara Regional State Public Hospitals using a technology readiness acceptance model., Methods: An institutional-based cross-sectional mixed study design was conducted in September 2021 among 547 health professionals working at sixteen public hospitals in the Amhara region of northwest Ethiopia. Eight key informants were interviewed to explore organizational-related factors. Face-to-face and Google Meet approaches were used to collect the data. We applied structural equation modeling to investigate the influence of technology readiness on health professionals' teleradiology acceptance using Analysis of Moment Structures Version 23 software., Results: Of the total participants, 70.2% and 85.7% were ready and intended to use teleradiology, respectively. According to technology readiness measuring constructs, optimism and innovativeness positively influenced health professionals' technology acceptance. Perceived ease of use and perceived usefulness showed a statistically positive significant effect on health professionals' intention to use teleradiology. In addition, a statistically significant mediation effect was observed between technology readiness measuring constructs and behavioral intention to use. Furthermore, a shortage of budget, inadequate infrastructure, and users' lack of adequate skills were reported as critical organizational challenges., Conclusions: We found a higher proportion of readiness and intention to use teleradiology among health professionals. Personality difference measuring constructs and organizational factors played considerable influence on teleradiology acceptance. Therefore, before the actual implementation of teleradiology, ensuring the system's user-friendliness, improving infrastructure, allocating an adequate budget, and availing of capacity-building opportunities are recommended., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright: © 2024 Nigatu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Caring is a universal phenomenon that influences nurse-patient interactions and feelings, forming the foundation of the nursing profession. How nurses perceive and experience caring in low-income settings is not well understood. Therefore, the purpose of this study was to explore Ethiopian nurses' perceptions and experiences of caring using a qualitative descriptive design. Individual semi-structured interviews were conducted with 13 nurses aged 28-57. Interviews were analyzed inductively using reflexive thematic analysis guided by the recommendations of Braun and Clarke. The analysis resulted in three themes: caring is the heartbeat of patient care, constraints to the provision of care, and ways to overcome constraints. The results revealed that nurses were committed to fulfilling their professional obligations and meeting patients' needs despite experiencing multiple constraints. The findings provide a comprehensive perspective in understanding nurses' experiences of caring. Their narratives demonstrate that they face constraints in their clinical practice, which limit the quality of care, including rotation and lack of resources. Cooperation between health policymakers and nurse authorities is essential for shifting the clinical environment from the prevailing traditional task-oriented approach to patient-centered care., (© 2024 John Wiley & Sons Australia, Ltd.)

Background: To ensure a child's full growth, health, and development during infancy and the early years, adequate nutrition is crucial. A crucial window of opportunity for ensuring children's proper growth and development through adequate eating exists during the first two years of life. According to the evidence of the efficacy of interventions, achieving universal coverage of optimal breastfeeding could prevent 13% of deaths in children under the age of 5 worldwide, and using complementary feeding methods appropriately would lead to an additional 6% decrease in under-five mortality., Methods: From several electronic databases, all published, unpublished, and gray literature was extracted and exported into EndNote version X20. For further analysis of the review, the retrieved data from the excel sheet were imported into the statistical software program Stata version. Metanalysis was used to determine the prevalence of MAD, and a random effects model was used to estimate the pooled prevalence of MAD. The DerSimonian-Laird Random effects model (REM) was used to combine the determinant factors from all qualifying papers for the meta-analysis, and the heterogeneity was independently assessed using a χ2 test, Q statistics, and matching I2 statistics. To retrieve the extent of publication bias, funnel plots were scattered and tested for asymmetry and, additionally, Egger's test was computed with the user-written "meta bias" command in Stata (version 11) software. To end, sensitivity analyses with trim and fill were performed., Results: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia was 22% with (95% CI: 16, 28%) with a random effect model. However, eight papers were filled during trim and fill in order to counteract the small study effect. The overall filled pooled estimate was 7.9% with (95%CI: 11, 14.8%). Maternal education (primary and secondary) is 1.714 (95% CI 1.244,2.363) and 2.150(95% CI: 1.449,3.190), respectively, Ages of children with range of 12-17 months (2.158 (95% CI 1. 9,3.006) and 18-23 months 2.948(95% CI: 1.675,5.190)), Nutrition information ((1.883 (95% CI 1.169,3.032)) media exposure (1.778(95% CI: 1.396,2.265), and maternal knowledge (2.449 (95% CI 1.232, 5.027) were significantly associated with MAD., Conclusion: The pooled estimate of the overall prevalence of minimum acceptable diet in 16 studies in Ethiopia were low. Maternal education (primary and secondary), ages of child with range of 12-17 month and 18-23 months, mothers having nutrition information, mothers who have media exposure,and mothers having good knowledge were significantly associated with Minimum acceptable diet. The government, NGO, and other stakeholders should focus on improving Minimum acceptable diet among 6 to 23 months of children through promoting with mass media, focuses on nutrition council during critical contact point in health facility, and doing capacity building for the mothers/caregivers., (© 2024. The Author(s).)

Background: Ensuring the data quality of Individual Medical Records becomes a crucial strategy in mitigating maternal and newborn morbidity and mortality during and around childbirth. However, previous research in Ethiopia primarily focused on studying data quality of institutional birth at the facility level, overlooking the data quality within Individual Medical Records. This study examined the data completeness and consistency within Individual Medical Records of the institutional birth service and associated factors., Methods: An institution-based retrospective cross-sectional study was conducted in two districts of Northwest Ethiopia. Data were obtained by reviewing three sets of Individual Medical Records of 651 women: the delivery register, Integrated Individual Folder, and integrated card. The proportions of completeness and consistency were computed. A multilevel binary logistic regression was used to identify factors of completeness and consistency. An odds ratio with a 95% confidence interval was used to assess the level of significance., Results: Overall, 74.0% of women's Individual Medical Records demonstrated good data completeness ( > = 70%), 95%CI (70.5, 77.3), while 26% exhibited good consistency, 95%CI (22.9, 29.7). The presence of trained providers in data quality (AOR = 2.9, 95%CI: (1.5, 5.7)) and supportive supervision (AOR = 11.5, 95%CI: (4.8, 27.2)) were found to be associated with completeness. Health facilities' practice of root cause analysis on data quality gaps (AOR = 8.7, 9%CI: (1.5, 50.9)) was statistically significantly associated with the consistency., Conclusions: Most medical records were found to have good completeness, but nearly only a quarter of them found to contain consistent data. Completeness and consistency varied on the type of medical record. Health facility's root cause analysis of data quality gaps, the presence of trained providers in data quality, and supportive supervision from higher officials were identified as factors affecting data quality in institutional birth service. These results emphasize the importance of focused efforts to enhance data completeness and consistency within Individual Medical Records, particularly through consideration of Individual Medical Records in future provider training, supervision, and the implementation of root cause analysis practices., (© 2023. The Author(s).)

Background: Prisoners usually need more comprehensive health and social support than the general population. Due to the growing number of prisoners in Ethiopia and limited access to health service, quality of life is a key concern. Compromised health-related quality of life imposes short and long-term consequences on the prisoners, their families, and the healthcare system. In Ethiopia, there are limited studies that investigate health outcomes and health-related quality of life in this particular population. Therefore, this study aimed to assess the magnitude of health-related quality of life and associated factors among prisoners considering the multidimensional nature of health related quality of life., Methods: An institution-based cross-sectional study was conducted on 1,246 prisoners who were enrolled using simple random sampling. The World Health Organization Quality of Life (WHOQoL-BREF-26) and Patient Health Questionnaire (PHQ-9) tools were used to assess the HRQoL and depression among prisoners, respectively. The relationships between exogenous, mediating, and endogenous variables were identified using structural equation modeling. As the mediation of effects were present, then the direct, indirect, and total effects were determined. General fit indices of the final model were acceptable (x2/df = 1.76, p < 0.001, RMSEA = 0.06, TLI = 0.90, CFI = 0.91, and SRMR = 0.06)., Result: The mean (standard deviation) score of the overall health related quality of life was 53.25 (15.12). Having an underlying medical condition had negative total effect on health related quality of life while visits in prison had positive total effect. Having income-generating work in prison had only a direct positive effect. Whereas, older age, being married, longer duration of imprisonment, and depression all had only a negative direct effect on one or more domains of quality of life (p<0.05)., Conclusion: Inmates in Gondar Prison have very poor and compromised levels of physical and psychological health despite having a modest degree of overall HRQoL. The result of this study is significant for people who work in and research the prison environment because it can assist in recognizing prisoners' health needs and devising treatment procedures that take into consideration physical, psychological, environmental, and social relationship aspects., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Seifu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists' services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system., Methods: Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software., Results: Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service., Conclusions: This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians' ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians' competence through long-term and short-term trainings are recommended to improve the referral consultation practice., (© 2023. The Author(s).)

Objective: The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions., Methods: A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients ( n  = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis., Results: Patients' perceptions of nurse caring behaviors were high (total Mean  = 4.86, SD  = 0.72). Behaviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years ( B  = -0.19, P  = 0.012) and single ( B  = -0.13, P  = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level ( B  = 0.35, P  = 0.001), cared for at surgery units ( B  = 0.11, P  = 0.027), and reported having spent more time with a nurse in the past 8-h shift ( B  = 0.16, P  < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satisfaction with received care, as measured with the Patient Satisfaction Instrument ( r  = 0.62, P  < 0.001)., Conclusion: Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors., Competing Interests: The authors have declared no conflict of interest., (© 2023 The Authors.)

Background: The government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation., Method: We conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings., Results: First, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders' engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis., Conclusion: The findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation., (© 2023. The Author(s).)

Community health workers, also known as health extension workers (HEWs), play an important role in health promotion. This study evaluates HEWs' knowledge, attitude, and self-efficacy for non-communicable diseases (NCD) health promotion. HEWs (n = 203) completed a structured questionnaire on knowledge, attitude, behaviour, self-efficacy and NCD risk perception. Regression analysis was used to determine the association between self-efficacy and NCD risk perception with knowledge (high, medium, low), attitude (favourable/unfavourable) and physical activity (sufficient/insufficient). HEWs with higher self-efficacy were more likely to have high NCD knowledge (AOR: 2.21; 95% CI: 1.21. 4.07), favourable attitude towards NCD health promotion (AOR: 6.27; 95% CI: 3.11. 12.61) and were more physically active (AOR: 2.27; 95% CI: 1.08. 4.74) than those with lower self-efficacy. HEWs with higher NCD susceptibility (AOR: 1.89; 95% CI: 1.04. 3.47) and perceived severity (AOR: 2.69; 95% CI: 1.46, 4.93) had higher odds of NCD knowledge than their counterparts. Moreover, sufficient physical activity was influenced by HEWs' perceived NCD susceptibility and perceived benefits of lifestyle change. Therefore, HEWs need to adopt healthy lifestyle choices to become effective role models for the community. Our findings highlight the need to include a healthy lifestyle when training HEWs, which might increase self-efficacy for NCD health promotion., Competing Interests: The authors declare no conflict of interest.

Optimal antenatal care visits (ANC4+) and institutional delivery are essentials to save lives of the women and the baby during pregnancy and delivery. Though focused antenatal care visits and institutional delivery is recommended by World Health Organization, Ethiopia has sub-optimal antenatal care and lagged facility delivery. A community-based cross-sectional study was conducted among 811 lactating women in Northwest Ethiopia. Multivariable logistic regression analysis was performed using 95% confidence level and p < 0.05. The prevalence of optimal antenatal care visits and institutional delivery were 39.6% (95%CI: 36.2-43) and 62.6% (95%CI: 59.2-66), respectively. Maternal education (AOR = 2.05; 95%CI: 1.14, 3.69), home visiting by health extension workers (AOR = 1.57; 95%CI: 1.01, 2.29), and early antenatal care booking (AOR = 11.92; 95%CI: 8.22, 17.31) were significant predictors of optimal antenatal care. Exposure to mass media (AOR = 1.65; 95% CI: 1.02, 2.65); intended pregnancy(AOR = 1.68; 95%CI:1.12, 3.63); parity of one (AO = 3.46; 95% CI: 1.73, 6.89); 1-3 antenatal care visits (AOR = 2.17; 95% CI: 1.29, 3.63); and ANC4 + (AOR = 3.57; 95% CI: 2.07, 6.14); history of pregnancy-related complications(AOR = 1.63; 95%CI: 1.04, 2.57), and access to transportation to reach a health facility(AOR = 1.58; 95%CI: 1.00, 2.45) were significant predictors of institutional delivery. Addressing the modifiable factors identified in this study could improve optimal antenatal care visit and institutional delivery., (© 2023. The Author(s).)

Background: Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation., Methods: This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy., Results: Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers., Conclusion: The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Delie, Gezie, Gebeyehu, Tarekegn and Muche.)

Background: Over 155 million children under five suffer from stunting, and it is responsible for over one million deaths and 54.9 million Disability Adjusted Life Years (DALYS) of under-five children worldwide. These predominantly occurred in low-and middle-income countries like sub-Saharan Africa. Stunted children begin their lives at a marked disadvantage. Some of these are; poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life and the devastating effects of stunting can last a lifetime and even affect the next generation. Despite this, its magnitude rises in the past 25 years in sub-Saharan Africa. Studies that capture the pooled prevalence and associated factors of stunting among children aged 6-59 months in sub-Saharan Africa are limited. Therefore, this study was carried out on the basis of the Bayesian approach to determine the pooled prevalence and predictors of stunting among children aged 6-59 months in Sub-Saharan Africa., Objective: To assess the pooled prevalence of stunting and associated factors among children aged 6-59 months in Sub-Saharan Africa., Methods: For this study a total of 173,483 weighted samples from the demography and health survey data set of 35 sub-Saharan African countries from 2008 to 2020 were used. After checking Variation between cluster by computing Intraclass Correlation Coefficient, binary logistic regression model was conducted based on hierarchical Bayesian statistical approach to account the hierarchical nature of demography and health survey data and to get reliable estimates by using additional information from the prior distribution. Adjusted odds ratio with 95% credible interval of the best fitted model was used to ascertain the predictors., Results: The pooled prevalence of stunting in Sub-Saharan Africa was about 35% (95%CI: 34.87, 35.31). Of the sub-regions, the highest prevalence of stunting was in East Africa, 37% (95%, CI: 36.96, 37.63) followed by Central Africa, 35% (95%CI: (34.93, 35.94). Being male (AOR = 1.27, 95% CrI 1.25, 1.30), small birth size (AOR = 1.29, CrI 1.25, 1.32), home delivery (AOR = 1.17, CrI 1.14, 1.20), and no education of mothers (AOR = 3.07, CrI 2.79, 3.39) were some of the significant predictors of stunting of children., Conclusion and Recommendation: The prevalence of stunting of children in sub-Saharan Africa is among the highest in the world. Predictors such as being male, being small at birth, a child delivered at home, and, low level of maternal education were some of the predictors of childhood stunting. Stakeholders and non-governmental organizations should consider those contributing factors of stunting when they plan and design nutritional improvement programs., Competing Interests: The authors have declared that no competing interests exist.

Background: Non-adherence to the maternal continuum of care remains a significant challenge. Though early initiation and continuum of care are recommended for mothers' and newborns' well-being, there is a paucity of evidence that clarify this condition in resource-limited settings. This study aimed to assess the level of women's completion of the maternal continuum of care and factors affecting it in Northwest Ethiopia., Methods: A community-based cross-sectional study was conducted from October to November, 2020. Data were collected from 811 women who had a recent history of birth within the past one year. The random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval. The p-value of 0.05 was used to declare significantly associated factors with women's completion of the maternal continuum of care., Results: The study revealed that 6.9% (95%CI: 5.3-8.9%) of women were retained fully on the continuum of maternal care, while 7.89% of women did not receive any care from the existing healthcare system. Attending secondary and above education (AOR = 3.15; 95%CI: 1.25,7.89), membership in the women's development army (AOR = 2.91; 95%CI: 1.56,5.44); being insured (AOR = 2.59; 95%CI: 1.33,5.01); getting health education (AOR = 2.44; 95%CI: 1.33,4.45); short distance to health facility (AOR = 4.81; 95%CI: 1.55,14.95); and mass-media exposure (AOR = 2.39; 95%CI: 1.11,5.15) were significantly associated with maternal continuum of care., Conclusions: The maternal continuum of care is low in rural northwest Ethiopia compared to findings from most resource-limited settings. Therefore, the existing health system should consider multilevel intervention strategies that focus on providing maternal health education, facilitating insurance mechanisms, encouraging women's participation in health clubs, and ensuring physical accessibility to healthcare facilities to be more effective in improving maternal health services., Competing Interests: The authors declare that they have no competing interests.

Background: The Caring Behaviors Inventory-16 (CBI-16) is a comprehensive instrument measuring caring behaviors as experienced by patients. The study aimed to translate, culturally adapt and evaluate the psychometric properties of the CBI-16 among adult patients who speak the Amharic language. Methods: The measure was completed by 304 hospitalized patients. Construct validity was evaluated via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and contrasted groups’ validity. Total CBI-16 scores were compared between groups that differed in self-rated satisfaction with care (Patient Satisfaction Instrument) to examine the contrasted groups’ validity. Reliability was assessed using internal consistency (Cronbach’s alpha). Results: The EFA suggested a four-factor model accounting for 66.1% of the total variance. The items loaded onto the subscales were similar to the CBI-24. The CFA supported the four-factor model with acceptable fit indices: normed Chi-square value 2.65 (X2 = 259.60, df = 98), SRMR = 0.06, and RMSEA = 0.07, CFI = 0.88 and TLI = 0.86. The contrasted groups’ validity was supported by significantly higher CBI-16 scores reported by patients more satisfied with their care (t = 3.66, p < 0.001). The reliability of the instrument was satisfactory (Cronbach’s alpha = 0.83). Conclusions: The Amharic version of the CBI-16 displayed a four-factor solution and was shown to be a valid and reliable instrument for the assessment of the perceptions of caring behaviors in Ethiopia.

Background: The magnitude of childhood anemia was increased from time to time. Thus, Even if the Ethiopian government applied tremendous efforts, anemia in children continues as a major public health problem. There is limited evidence on the spatial variation of and determinant factors of childhood anemia at the national level. Therefore, this study aimed to explore spatial distribution and determinants of anemia among children aged 6 to 59 months in Ethiopia., Method: A stratified two-stage cluster sampling technique was used in Ethiopian Demographic Health Survey 2016 data. In this study 8602 children aged 6-59 months were included. Bernoulli model was used to explore the presence of purely spatial clusters of Anemia in children in age 6-59 months using Sat scan. ArcGIS version 10.3 was used to know the distribution of anemia cases across the country. A mixed-effects Logistic regression model was used to identify determinant factors of anemia., Results: The finding indicates that the spatial distribution of childhood anemia was non-random in the country with Moran's I: 0.65, p < 0.001. The SaT scan analysis identified a total of 180 significant primary clusters located in the Somali and Afar regions (LLR = 14.47, P-value< 0.001, RR = 1.47). Age of child 12-23 months (AOR = 0, 68, 95%CI: 0.55, 0.85), 24-35 months (AOR = 0.38, 95%CI: 0.31, 0.47), and36-47 months (AOR = 0.25, 95%CI, 0.20, 0.31), working mother (AOR = 0.87, 95%CI: 0.76, 0.99), anemic mother (AOR = 1.53, 95%CI, 1.35, 1.73), had fever in the last 2 weeks (AOR = 1.36,95%CI:1.13, 1.65), moderate stunting (AOR = 1.31,95%CI: 1.13, 1.50),Severely stunting (AOR = 1.82,95%CI: 1.54, 2.16), religion, wealth index, and number of under-five children in the household were statistically significant associated with childhood anemia., Conclusion: Spatial variation of childhood anemia across the country was non-random. Age of the child, wealth index, stunting, religion, number of under-five children in the household, fever in the last 2 weeks, anemic mother, and working status of the mother were determinants of childhood anemia. Therefore, interventions should be a priority concern for high-risk (hot spot) areas regarding allocation of resources and improved access to health facilities, and to reduce the consequence of anemia among the generation policymakers and concerned bodies should be implemented these specific determinant factors., (© 2021. The Author(s).)

Background: A number of individuals in Ethiopia are involved in illegal types of transnational migration, namely human trafficking and smuggling. The magnitude is not declining despite efforts to curb it. An in-depth understanding of the reasons for trafficking is needed to control human trafficking and its consequences., Methods: The study included four focus group discussions and 44 in-depth interviews conducted in three border towns, five trafficking-stricken areas, and the IOM transit center for returnees in Addis Ababa. Participants were victims of trafficking, emigrants, community members, police, immigration personnel, and staff of labor and social affairs offices and non-government organizations. Based on the social-ecological model framework, content analysis was implemented using opencode-4.03 software., Results: Factors identified as possibly encouraging acts of illegal migration included community attitudes such as having a child abroad being considered a measure of status, and the reluctance to do certain types of works associated with low social status when at home. There was, however, willingness to do similar work abroad, which was coupled with the belief that wages for such jobs were better abroad than at home and a lack of knowledge regarding differences in working conditions in the two settings. Further reasons given were poor government service provisions, ineffective immigration policies, political instability, government focus on reactive and poorly coordinated control rather than on sustainable prevention of human trafficking and corruption. Corruption was said to be the underlying factor for the poor coordination among government agencies, communities, and individuals. These factors, among others, led to the loss of trust and belief in local governance, resources, and opportunities to build one's future at home, thereby creating fertile ground for illegal migration, including smuggling and possibly trafficking., Conclusions: Individual lack of trust and belief in local governance, resources, and opportunities to build one's future was the main reason why people resorted to migrate in a manner subjecting them to human trafficking. Thus, comprehensive and coordinated efforts involving government agencies, communities, and other stakeholders are needed to help curb human trafficking and its consequences.

In developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6-59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6-59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child's age (AOR = 1.022; 95% CrI 1.018-1.026), being a male child (AOR = 1.16; 95%CrI 1.05-1.29), a twin (AOR = 2.55; 95% CrI 1.78-3.56), having fever (AOR = 1.23; 95%CrI 1.02-1.46), having no formal education (AOR = 1.99; 95%CrI 1.28-2.96) and primary education (AOR = 83; 95%CrI 1.19-2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20-1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93-0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35-2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

Objective: Although the rate of stillbirth has decreased globally, it remains unacceptably high in developing countries. Today, only 10 countries share the burden of more than 65% of the global rate of stillbirth and these include Ethiopia. Ethiopia ranks seventh in terms of high rate of stillbirths. Exploring the spatial distribution of stillbirth is critical to developing successful interventions and monitoring public health programmes. However, there is no study on the spatial distribution and the associated factors of stillbirth in Ethiopia. Therefore, this study aimed to explore the spatial distribution and the associated factors of stillbirth., Methods: Secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11 375 women were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and ArcGIS V.10.6 to explore the spatial distribution of stillbirth. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Variables with a p value of less than 0.2 were considered for the multivariable multilevel analysis. In the multivariable multilevel analysis, adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors of stillbirth., Results: The spatial analysis showed that stillbirth has significant spatial variation across the country. The SaTScan analysis identified significant primary clusters of stillbirth in the Northeast Somali region (log likelihood ratio (LLR)=13.4, p<0.001) and secondary clusters in the border area of Oromia and Amhara regions (LLR=8.8, p<0.05). In the multilevel analysis, rural residence (AOR=4.83, 95% CI 1.44 to 16.19), primary education (AOR=0.39, 95% CI 0.20 to 0.74), no antenatal care (ANC) visit (AOR=2.77, 95% CI 1.70 to 4.51), caesarean delivery (AOR=5.07, 95% CI 1.65 to 15.58), birth interval <24 months (AOR=1.95, 95% CI 1.20 to 3.10) and height <150 cm (AOR=2.73, 95% CI 1.45 to 4.97) were significantly associated with stillbirth., Conclusion and Recommendation: In Ethiopia, stillbirth had significant spatial variations across the country. Residence, maternal stature, preceding birth interval, caesarean delivery, education and ANC visit were significantly associated with stillbirth. Therefore, public health interventions that enhance maternal healthcare service utilisation and maternal education in hotspot areas of stillbirth are crucial to reducing stillbirth in Ethiopia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Human immunodeficiency virus (HIV) infection results in a gradual depletion of immune function, particularly CD4 cells. The CD4 assessment plays a significant role in assessing treatment responses and clinical decision-making for patients on combination antiretroviral therapy (ART) in resource-limited settings. However, new data on CD4 count changes are scarce; the volatility of CD4 counts after initiation of ART over time remains largely uncharacterized. This study aimed to identify the predictors of CD4 changes over time among HIV-infected children who began ART in Amhara, Ethiopia., Methods: A retrospective follow-up study was performed. A total of 983 HIV-infected children who initiated ART in government hospitals in the Amhara region between 2010 and 2016 were included using a simple random sampling technique. Data were extracted using a structured checklist. An exploratory data analysis was carried out to explain individual and average profile plots. The linear mixed model was used to identify the CD4 change count predictors over time. Variables with p value < 0.05 were considered statistically significant in a multivariable linear mixed regression analysis., Results: The mean CD4 count of the participants was 465.1 cells/mm 3 with an average CD4 count increase of 30.06 cells/mm 3 over 6 months from baseline CD4 count and ART initiation. Childhood age ( β = - 0.015; 95% Cl - 0.021, - 0.009), opportunistic infection at ART initiation ( β = - 0.044, 95% CI - 0.085, - 0.004), hemoglobin level ( β = 0.013; 95% CI 0.004, 0.022), and baseline WHO clinical stage II ( β = - 0.046, 95% CI - 0.091, - 0.0003) were significant predictors of CD4 changes over time., Conclusions: The average CD4 count increase was sufficient in HIV patients who began combined antiretroviral therapy over time. The younger age of the infant, the higher baseline level of hemoglobin, the baseline WHO clinical stage II, and opportunistic infections led to changes in CD4 counts. As a result, timely diagnosis and treatment of opportunistic infections will reduce the risk of opportunistic infections., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Despite the effort to reduce stillbirth, Ethiopia remains one of the countries with the highest rate in the world. Therefore, this study aimed to analyze the trends of stillbirth among births from reproductive age women over time based on Ethiopian Demographic and Health Surveys (EDHSs)., Methods: Secondary data analysis was conducted based on the Ethiopian Demographic Health Surveys (EDHSs) conducted in 2005, 2011 and 2016. A total weighted sample of 12,037, 10,588, and 11,375 in 2005, 2011 and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of stillbirth over time and factors contributing to the change in stillbirth rate. STATA 14 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance., Results: Among women of reproductive age, the stillbirth rate declined from 13.3/1000 births in 2005 to 9.2 per 1000 births in 2016 with the annual rate of reduction of 3.1%. The study found that the stillbirth rate has been declined over time concerning the place of residence, region, antenatal care, education and place of delivery. The decomposition analysis indicated that about 82.3% of the overall change stillbirth rate was due to the difference in women's composition. Particularly, an increase in women's urban place of residence, health facility delivery, and cesarean delivery were significant predictors for the decline in stillbirth rate over the surveys., Conclusions: The stillbirth rate has been declined over time. More than 3/4th of the decrease in stillbirth rate was due to the difference in characteristics of women over the surveys. The increase in women's urban place of residence, an increase in cesarean delivery and health facility delivery significantly contributed to the decrease in stillbirth rate over time. Public health interventions targeting rural resident women, strengthening emergency obstetric services and health facility delivery would help to maintain the decreasing trend of stillbirth rate in Ethiopia.

Background: Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments of domestic violence related adverse effect. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of domestic violence related disclosure and synthesize its associated factors., Methods: We followed the PRISMA Guidelines to report the results of the finding. Databases including PubMed, Cochrane Library and Web of Sciences were searched. The heterogeneity between studies was measured by the index of heterogeneity (I 2 statistics) test. Funnel plots and Egger's test were used to determine publication bias. Moreover, sensitivity analysis was carried out. To calculate the pooled prevalence, a random effects model was utilized., Results: Twenty one eligible studies were included in this systematic review and meta-analysis. The pooled prevalence of domestic violence related non-disclosure was found to be 36.2% (95% CI, 31.8-40.5%). Considering violence as normal or not serious, shame, embarrassment and fear of disclosure related consequences were the common barriers for non-disclosure., Conclusion: More than one third of women and girls were not disclosed their experience of domestic violence. The finding of this study suggests the need of evaluation and strengthening of the collaborative work among different sectors such as: policy-makers, service providers, administrative personnel and community leaders including the engagement of men partner. This study also suggests the needs of women empowerments against the traditional belief, attitude, and practice.

Objectives: Occupational exposure to blood and body fluids is a major risk factor for the transmission of infections to health professionals in developing countries like Ethiopia. The aim of this study was to assess standard precaution practices (SPPs) and its associated factors among health professionals working at Addis Ababa government hospitals., Methods: A cross-sectional study was conducted on 772 health professionals working at eight government hospitals in Addis Ababa, 2015. The multistage sampling technique was used to select study participants. Health professionals who were directly participating in screening, diagnosis, treatment and follow-ups of patients were studied. SPPs by health professionals were determined by a self-rated response to a 30-item Likert scale. A respondent would be graded as 'good' compliant for the assessment if they scored at least the mean of the total score, or would be considered as poor compliant if they scored less. To take the hierarchical structure of the data into account during analysis, multilevel binary logistic regressions were used. The intraclass correlation coefficient was calculated to evaluate whether variations in score were primarily within or between hospitals., Result: Out of the participants, 50.65% had good SPPs. At the individual level, attitude, age and educational status were found to be important factors of SPPs. Controlling individual-level factors, applying regular observations (adjusted OR (AOR) 1.82; 95% CI 1.2 to 2.76), providing sufficient materials (AOR 1.53; 95% CI 1.03 to 2.28) and weak measures on reported incidences (AOR 0.49; 95% CI 0.30 to 0.8) were also hospital-level factors associated with SPPs., Conclusion: SPPs in the healthcare facilities were found to be so low that both patients and health professionals were at a significant risk for infections. The finding suggests the need for optimising individual-level and hospital-level precautionary practices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aimed to assess the evolution of body mass index (BMI) of HIV-positive adults on second-line antiretroviral therapy (ART) over time and factors affecting it in north-west Ethiopia., Design: An institution-based retrospective follow-up study was conducted using data extracted from 1016 patient cards from February 2008 to February 2016., Setting: Eight referral hospitals from Amhara region, Ethiopia were included., Participants: HIV patients who started second-line ART., Outcome Measures: Change in BMI since starting second-line ART., Results: Five hundred and thirty-eight (52.95%) participants were males and the median age of the participants was 33 years (IQR: 28; 39). The median follow-up time was 18 months (IQR: 5.2; 32.2). The average change of BMI showed linear increase over time. The amount of BMI increment or decrement according to each variable was shown as β coefficients. Treatment duration (β=0.013, 95% CI 0.004 to 0.022), isoniazid prophylaxis (β=0.87, 95% CI 0.32 to 1.42), cotrimoxazole prophylaxis (β=0.63, 95% CI 0.08 to 1.19), ambulatory functional status (β=-1.16, 95% CI -1.95 to 1.31), bedridden functional status (β=-1.83, 95% CI -2.47 to 1.21), WHO stage III (β=-0.42, 95% CI -0.65 to 0.20), WHO stage IV (β=-0.62, 95% CI -1.02 to 0.22), CD4 count (β=0.001, 95% CI 0.0008 to 0.0015), and time interaction of variables like tertiary educational status (β=0.02, 95% CI 0.01 to 0.04), ambulatory functional status (β=0.03, 95% CI 0.01 to 0.05) and WHO stages III (β=0.01, 95% CI 0.007 to 0.02) were found to be significant predictors., Conclusion: The BMI of patients has shown linear increment over the treatment time. Factors affecting it have been identified but its effect on cardiovascular disease needs further study., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial for evidence-based decision-making. However, the spatial pattern of measles-containing vaccine (MCV1) and its predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of childhood MCV1 coverage., Methods: An in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a total of 3722 children nested in 611 enumeration areas were included in the analysis. Global Moran's I statistic and Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with childhood MCV1., Results: Spatial hetrogeniety of childhood MCV1 was observed (Global Moran's I = 0.13, p-value < 0.0001), and seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region. In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25-1.88), pentavalent vaccination first dose (AOR = 9.09; 95%CI: 6.86-12.03) and third dose (AOR = 7.12; 95%CI: 5.51-9.18, secondary and above maternal education (AOR = 1.62; 95%CI: 1.03-2.55) and media exposure were the factors that increased the odds of MCV1 vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI = 1.12-1.61)., Conclusion: A clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination interventions.

Objectives: Evidence showed that the prevalence of sexual violence during the whole human trafficking period was high. However, the distribution of sexual violence along the stages of the trafficking cycle is unclear. This study aimed to determine the prevalence of sexual violence at each stage of trafficking and factors associated with it among Ethiopian trafficked females., Design: A retrospective cohort study was conducted to study trafficking returnees regarding their previous experiences at each stage of trafficking., Settings: Data were collected at immigration offices in three border towns of Ethiopia located bordering Sudan, Kenya and Djibouti., Participants: Six hundred and seventy-one women who were trafficked from Ethiopia were recruited into the study consecutively. They were recruited when they came back home via the three border towns either by deportation or voluntary return., Outcome Measure: The outcome variable was sexual violence., Results: The prevalence of sexual violence was estimated at 10% (95% CI 7.9 to 12.5) during predeparture, 35.0% (95% CI 31.5 to 38.7) travelling period, 58.1% (95% CI 54.2 to 61.8) at destination and 19.5% (95% CI 15.2 to 24.6) detention stages. The odds of sexual violence among returnees aged 14-17 years was about twofold when compared with that of women aged 26-49 years (adjusted OR (AOR)=1.97; 95% CI 1.11 to 3.52). Similarly, being smuggled initially (AOR=1.54; 95% CI 1.09 to 1.93), restricted freedom (AOR=1.45; 95% CI 1.13 to 1.86) and time spent at each stage of trafficking (AOR=1.028; 95% CI 1.024 to 1.033) were positively associated with sexual violence., Conclusions: The prevalence of sexual violence at each stage of trafficking after departure was high. This could imply that victims might be affected by subsequent negative sexual health outcomes. Young age, initially being smuggled and time spent at each stage of the trafficking process were positively associated with the events of sexual violence. Efforts must be made on modifiable factors such as 'smuggling' to minimise subsequent sexual violence during trafficking., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Second line anti-tuberculosis drugs are substantially complex, long term, more costly, and more toxic than first line anti-tuberculosis drugs. In Ethiopia, evidence on the incidence and predictors of adverse drug events has been limited. Thus, this study aimed at assessing incidence and predictors of major adverse drug events among drug resistant tuberculosis patients on second line tuberculosis treatment in Amhara Regional State public hospitals, Ethiopia., Methods: A multi-center retrospective cohort study was conducted on 570 drug resistant tuberculosis Patients. Data were entered in to EPI-Data version 4.2.0.0 and exported to Stata version 14 for analysis. Proportional hazard assumption was checked. The univariate Weibull regression gamma frailty model was fitted. Cox-Snell residual was used to test goodness of fit and Akaike Information Criteria (AIC) for model selection. Hazard ratio with 95% CI was computed and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors for adverse drug event., Results: A total of 570 patients were followed for 5045.09 person-month (PM) observation with a median follow-uptime of 8.23 months (Inter Quartile Range (IQR) =2.66-23.33). The overall incidence rate of major adverse drug events was 5.79 per 100 PM (95% CI: 5.16, 6.49). Incidence rate at the end of 2nd, 4th, and 6th months was 13.73, 9.25, 5.97 events per 100 PM observations, respectively. Age at 25-49 (Adjusted Hazard Ratio (AHR) = 3.36, 95% CI: 1.36, 8.28), and above 50 years (AHR = 5.60, 95% CI: 1.65, 19.05), co-morbid conditions (AHR = 2.74 CI: 1.12, 6.68), and anemia (AHR = 3.25 CI: 1.40, 7.53) were significant predictors of major adverse drug events., Conclusion: The incidence rate of major adverse drug events in the early 6 months of treatment was higher than that of the subsequent months. Age above 25 years, base line anemia, and co-morbid conditions were independent predictors of adverse drug events. Thus, addressing significant predictors and strengthening continuous follow-ups are highly recommended in the study setting.

Background: Human trafficking was affecting a number of individuals in Ethiopia that resulted in various health problems and human right violations. Though the pushing and pulling factors of human trafficking were identified qualitatively, their effect on trafficking status were not measured quantitatively; the magnitude of human trafficking among returnees was not also quantified., Methods: Primary data were collected from 1342 Ethiopian returning migrants from abroad via Metemma-Yohannes, Moyale, and Galafi border towns from May to October 2016 consecutively. The status of each returnee as trafficked or non-trafficked was determined based on the UN 2000 definition of human trafficking. Factor analyses were conducted on the push and pull factors of migration to identify the underlying constructs. Considering the common underlying concept of items that load on the push and pull factors, the newly emerged construct variables were named in consultation with sociologists before used as independent variables. Finally, the effect of these and other variables on trafficking status were measured using generalized estimation equation., Result: The magnitude of human trafficking among returning migrants was estimated at 50.89% (95%CI: 0.4822-0.5357). The odds of being trafficked was positively associated with female sex (AOR = 1.55, 95%CI: 1.10-2.17), low household wealth quintile (AOR = 2.55, 95%CI: 1.46-4.44), being smuggled at departure (AOR = 4.48, 95%CI: 3.19-6.29), strong desire for successful oversea life (AOR = 3.98, 95%CI: 2.63-6.02), high level of risk-opportunity imbalance before departure (AOR = 6.10, 95%CI: 4.01-9.30), and strong feeling of hopelessness at success in home-country (AOR = 8.64, 95%CI: 5.62-13.30)., Conclusion: Half of the returned Ethiopian migrants were trafficked. Sex, household wealth quintile, smuggling status, exposure to seductive information about oversea life, risk-opportunity imbalance before departure, and feeling hopelessness for success at home were among the factors associated with human trafficking.

Background: Mental health problems among trafficked persons could be the result of concomitantly interwoven effects of various factors. Analyzing the networked relationships concurrently could be a more substantive approach to better understand the role of risk factors in this population. This study aimed to assess the magnitude of mental health symptoms as well as the association among socio-demographic, trafficking related exposure variables, and mental health problems of Ethiopian returnees from trafficking., Methods: A sample of 1387 returnees who were trafficked via three major human trafficking corridors of Ethiopia were selected consecutively. Data related to socio-economic, trafficking exposure variables, and symptoms of mental illness were collected in personal interviews. Anxiety was measured with a brief measure for generalized anxiety disorder (GAD-7), depression with a patient health questionnaire (PHQ-9), and PTSD with post-traumatic checklist (PCL-C). Generalized structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously., Results: The prevalence of symptoms of anxiety was estimated at 51.9% (95% CI 49.3-54.6%); PTSD was estimated at 34.5% (95% CI 32.1-37.1%) and depression at 58.3% (95% CI 55.6-60.9%). Restricted freedom of movement had a direct positive effect on anxiety (β = 1.24, 95% CI 0.97-1.51), depression (β = 0.94, 95% CI 0.71-1.17) and PTSD (13.00, 95% CI 11.23-14.77). Violence experienced during the trafficking period was a mediator variable and significantly associated with anxiety (β = 0.46; 95% CI 0.26-0.66) and PTSD (β = 4.00; 95% CI 2.06-5.94). History of detention had a positive total effect on GAD (total β = 1.380, 95% CI 1.074-1.687) and PTSD (total β = 15.63, 95% CI 13.708-17.545), and direct positive effect on depression (β = 0.89, 95% CI 0.65-1.13)., Conclusion: Ethiopian trafficked persons were highly likely to return with increased levels of mental health symptoms, namely anxiety, depression, and PTSD. Socio-economic and trafficking related exposures mediated by violence were factors affecting mental health symptoms. Thus, in addition to economic re-integrations of victims, strategies should be designed and implemented to address the prevalent mental health problems.

Background: Motherhood is a time of anticipation of joy for a woman, her family, and her community. In spite of this fact, it is not as enjoyable as it should be because of numerous reasons. Insufficiency or lack of birth preparedness and complication readiness is the most common reason. The aim of this study was to assess the practice of birth preparedness and complication readiness and associated factors among pregnant women in Tehuledere district, northeast Ethiopia., Methods: A community-based cross-sectional study was conducted in Tehuledere district, northeast Ethiopia. Participants were selected using the multistage sampling technique, and data were analyzed both descriptively and analytically using the binary logistic regression., Result: Out of the total 507 samples, 500 (response rate 98.6%) pregnant women participated in the study. Less than half (44.6%) and (43.4%) of the respondents had knowledge and practice on birth preparedness and complication readiness, respectively. In the multivariate analysis, knowledge of birth preparedness and complication readiness (AOR = 1.648, 95%CI: 1.073, 2.531), knowledge of danger signs during pregnancy (AOR = 2.802, 95% CI: 1.637, 4.793), gestational age (AOR = 3.379, 95% CI: 2.114, 5.401), and antenatal care follow up starting time (AOR = 2.841, 95% CI: 1.330, 6.068) were significantly associated with the practice of birth preparedness and complication readiness, but pregnant women in rural areas (AOR = 0.442, 95% CI:0.244, 0.803) were less associated with birth preparedness and complication readiness compared to women in urban settlements., Conclusion: This study identified that poor knowledge, inadequate birth preparedness, and complication readiness were prevalent among mothers in the study area. Government officials, partners, and health care providers working in the areas of maternal and child health should operate together to maximize birth preparedness and complication readiness practices., Competing Interests: Principal Investigator: Demlie Belete Endeshaw.Ethical approval was obtained from University of Gondar, College of Medicine and Health Science, Institute of Public Health Institutional Review Board (IRB). Letter of permission to conduct the study at the area was collected from Tehulederie Woreda Health Office. Since the authors thought that there was no any potential risk associated on the provision of the data and it is a cross-sectional study, informed verbal consent was considered and obtained from each respondent. The ethics committee also approved the appropriateness of the informed verbal consent for this study. Participants were informed about their rights to decline if they didn’t want to continue. The questions were coded instead of using names; so confidentiality was assured throughout the study. Involving the use of any animal or human data or tissue: “Not applicable” in this research section. Data from any individual person in any form (including individual details, images or videos): “Not applicable” in this research.“is not applicable” in the cross-sectional study.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Background: CD4 cells are the major targets for human immunodeficiency virus (HIV) and treatment with Antiretroviral Therapy (ART) influences the CD4 cell count of HIV patients. In addition to ART, the time required to reach normal range of CD4 counts (500 cells/mm 3 ) can be affected by clinical, socio-demographic, and behavioral factors. This retrospective cohort study was conducted to determine the incidence of having the normal range of CD4 cell counts and factors that affect the time required to reach this normal range among adult HIV patients who initiated into ART., Methods: Data of 4 years were retrospectively retrieved from routinely registered characteristics of 937 ART users enrolled in 2010. Survival time until immunologic recovery and its determinant factors were examined using the frailty model with different parametric distributions alternatively., Results: Most (80.8%) of the ART attendants had CD4 cell count of 200 cells/mm 3 or less at initiation. The overall incidence rate of immunologic recovery was 12.67 persons per 1000 person-months (95% CI 11.30, 14.20). The dependency of frailties of immunologic recovery by residence was statistically significant (Theta = 0.05, p value = 0.006). Baseline age (Adjusted Hazard Ratio (AHR) = 0.98, 95% CI 0.97, 0.99), baseline CD4 count (AHR = 1.006, 95% CI 1.005, 1.008), and female sex (AHR = 1.34, 95% CI 1.03, 1.73) were significantly associated with shorter survival time for immunologic recovery., Conclusion: Higher baseline CD4 count, lower baseline age, and female sex were positively associated with the time to immunologic recovery, which also dependent on proximity/residence of ART users. Therefore, further scale up of ART services with due emphasis to patients with low CD4 count at baseline particularly for male and older ART users are recommended to reach the normal range of CD4 count in a shorter time of treatment.

Background: Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed, except drops or syrups consisting of vitamins, mineral supplements or medicine. Exclusive breastfeeding is one of the essential actions for infant development and survival. However, the prevalence of exclusive breastfeeding in Ethiopia has been estimated at 52% which is far less than the World Health Organization (WHO) recommendations. Moreover, there are inconsistencies among estimates in different districts of the country. Therefore, this study aimed to assess the prevalence and associated factors of exclusive breastfeeding among mothers in Gozamin district, northwest Ethiopia., Methods: Using the simple random sampling technique, seven kebeles (lowest administrative units) were selected as the primary sampling unit of the district. Sample mother-infant pairs were then selected using the systematic random sampling technique that involved our moving from house to house in each village. Data were collected from 506 mother-infant pairs using interviews. Factors associated with exclusive breastfeeding were determined using logistic regression. The measure of association used was the odds ratio, and statistical tests with p -values of less than 0.05 were considered as statistically significant., Results: In this study, the prevalence of exclusive breastfeeding among mothers was 74.1% (95% CI 70.80, 79.10). For government employee mothers, the odds of exclusive breastfeeding were reduced by half compared to housewives (AOR 0.49, 95% CI 0.26, 0.94). Mothers who did not receive breastfeeding counseling after delivery were 0.43 times less likely to practice exclusive breastfeeding compared with mothers who received the services (AOR 0.43, 95% CI 0.25, 0.72). Mothers who gave birth at health institutions were more likely to practice exclusive breastfeeding., Conclusion: Even though the estimated prevalence is relatively high, more effort to meet WHO recommendations is still necessary. Therefore, we suggest health institutions encourage hospital birthing and increase breastfeeding counseling after delivery, and employers needs to give longer maternity leave to improve exclusive breastfeeding practice.

Background: The response of HIV patients to antiretroviral therapy could be measured by its strong predictor, the CD4+ T cell (CD4) count for the initiation of antiretroviral therapy and proper management of disease progress. However, in addition to HIV, there are other factors which can influence the CD4 cell count. Patient's socio-economic, demographic, and behavioral variables, accessibility, duration of treatment etc., can be used to predict CD4 count., Methods: A retrospective cohort study was conducted to examine the predictors of CD4 count among ART users enrolled in the first 6 months of 2010 and followed upto mid 2014. The covariance components model was employed to determine the predictors of CD4 count over time., Results: A total of 1196 ART attendants were used to analyze their data descriptively. Eight hundred sixty-one of the attendants had two or more CD4 count measurements and were used in modeling their data using the linear mixed method. Thus, the mean rates of incensement of CD4 counts for patients with ambulatory/bedridden and working baseline functional status were 17.4 and 30.6 cells/mm(3) per year, respectively. After adjusting for other variables, for each additional baseline CD4 count, the gain in CD4 count during treatment was 0.818 cells/mm(3) (p value <0.001). Patient's age and baseline functional status were also statistically significantly associated with CD4 count., Conclusion: In this study, higher baseline CD4 count, younger age, working functional status, and time in treatment contributed positively to the increment of the CD4 count. However, the observed increment at 4 year was unsatisfactory as the proportion of ART users who reached the normal range of CD4 count was very low. To see their long term treatment outcome, it requires further research with a sufficiently longer follow up data. In line with this, the local CD4 count for HIV negative persons should also be investigated for better comparison and proper disease management.

Background: Because of the nature of their work, female sex workers are at risk of sexually transmitted diseases. Cross-border areas are places where this situation becomes worse. In Ethiopia, there has been a serious scarcity of studies on the time at which unsafe sexual practice starts and on factors which determine the practice among female sex workers there. Therefore, this study aimed to fill this identified gap., Method: A total of 467 women who had been sex workers at least for three months prior to the resumption of the study were included. A structured and pre-tested questionnaire was used to collect data from July-August, 2010. Descriptive statistics was used to explore the data, and the Extended Cox-Regression model was employed to identify the predictors of time-to-unsafe sexual practice., Result: The study participants were followed for 6, 643 person-months. The overall incidence density of unsafe sexual practice was 44.71 persons per 1000 persons-months. The hazard of unsafe sexual practice increased by 3.0 % every month (p-value =0.040) due to problem-drinking. Those female sex workers with familiarized clients had a two-fold hazard of practicing unsafe sex compared to their counterparts (AHR = 1.94 95 % CI 1.49, 2.53). The predominant sexual client type and the work place of sex workers were the other significant predictors of unsafe sexual practice., Conclusions: The incidence of unsafe sexual practice was found to be high among sex workers in the cross-border area. Time-to-unsafe sexual practice was significantly associated with female sex workers' status of familiarity with their clients, predominant sexual client type, their work place, and the interaction term of time and problem-drinking. Interventions need to be made on these controllable social and behavioral characteristics to help sex workers extend the duration of their safe sexual practice beyond the time they will quit sex work.