Search

Background Cancer, a major global health challenge, not only threatens lives but also imposes severe financial burdens, known as ‘financial toxicity’. This strain extends beyond treatment costs to include indirect expenses like lost income and out-of-pocket payments. Despite its urgency, global insights remain fragmented, often limited to specific regions with inconsistent findings. This systematic review and meta-analysis aims to provide a comprehensive overview of cancer-related financial toxicity and identify key risk factors contributing to this burden.Methods We conducted a systematic review and meta-analysis, searching databases like Medline, Web of Science, PubMed, Scopus, International Scientific Indexing and Google Scholar for peer-reviewed observational studies. Data were extracted into Microsoft Excel 2021, and study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Statistical analysis was performed using STATA V.17, with catastrophic health expenditures (CHEs) pooled via a random-effects model. Heterogeneity was explored to understand variations in study outcomes. Subgroup and sensitivity analyses were conducted to assess individual study impacts, while publication bias was evaluated using Begger and Egger’s tests. Univariate meta-regression analysis determined the impact of study-level covariates on CHE estimates.Results This analysis included 35 observational studies, covering 428 373 patients with cancer. The pooled prevalence of CHE was 56.1% (95% CI 48.3% to 63.8%). Key risk factors included large family size, low income, lack of health insurance, longer disease duration, older age and multiple treatments. Higher education levels were associated with reduced CHE risk.Conclusion Over half of patients with cancer (56.1%) face catastrophic health expenditures, highlighting a severe financial burden. Addressing this issue requires expanding health insurance, providing financial support and ensuring affordable cancer care. Improving education access can also reduce CHE risk among patients with cancer.

Objectives To identify the determinants of traditional birth attendants’ utilisation among reproductive-age women in Ethiopia.Design Cross-sectional study design.Setting Ethiopia.Participants A total of 3979 weighted samples of reproductive-age women were included.Outcome measure Traditional birth attendant utilisation.Results This study found a high prevalence (29.76%) of Ethiopian mothers using traditional birth attendants for delivery, based on data from the 2019 Ethiopian Demographic and Health Survey. Mothers with higher education (adjusted OR (AOR)=0.11, 95% CI: 0.01 to 0.62), who had four or more antenatal care visits (AOR=0.34, 95% CI: 0.21 to 0.54), communities with lower levels of education (AOR=2.21, 95% CI: 1.30 to 3.73), communities with higher poverty levels (AOR=1.71, 95% CI: 1.99 to 2.96) and those from peripheral regions (AOR=3.41, 95% CI: 1.77 to 6.56) were found to be predictors of traditional birth attendants.Conclusion This study indicates a high prevalence (29.76%) of Ethiopian mothers using traditional birth attendants, highlighting the need for targeted interventions to promote skilled birth attendance. Policymakers should focus on implementing educational programmes targeting reproductive-age women and improving access to quality antenatal care. Specific initiatives could include community-based educational workshops and subsidies for transportation to healthcare facilities. Furthermore, mothers in remote and border districts should receive specialised attention in terms of resource allocation, including skilled personnel and enhanced healthcare access.

BackgroundAlthough micronutrients (MNs) are important for children’s growth and development, their intake has not received enough attention. MN deficiency is a significant public health problem, especially in developing countries like Ethiopia. However, there is a lack of empirical evidence using advanced statistical methods, such as machine learning. Therefore, this study aimed to use advanced supervised algorithms to predict the micronutrient intake status in Ethiopian children aged 6–23 months.MethodsA total weighted of 2,499 children aged 6–23 months from the Ethiopia Demographic and Health Survey 2016 data set were utilized. The data underwent preprocessing, with 80% of the observations used for training and 20% for testing the model. Twelve machine learning algorithms were employed. To select best predictive model, their performance was assessed using different evaluation metrics in Python software. The Boruta algorithm was used to select the most relevant features. Besides, seven data balancing techniques and three hyper parameter tuning methods were employed. To determine the association between independent and targeted feature, association rule mining was conducted using the a priori algorithm in R software.ResultsAccording to the 2016 Ethiopia Demographic and Health Survey, out of 2,499 weighted children aged 12–23 months, 1,728 (69.15%) had MN intake. The random forest, catboost, and light gradient boosting algorithm outperformed in predicting MN intake status among all selected classifiers. Region, wealth index, place of delivery, mothers’ occupation, child age, fathers’ educational status, desire for more children, access to media exposure, religion, residence, and antenatal care (ANC) follow-up were the top attributes to predict MN intake. Association rule mining was identified the top seven best rules that most frequently associated with MN intake among children aged 6–23 months in Ethiopia.ConclusionThe random forest, catboost, and light gradient boosting algorithm achieved a highest performance and identifying the relevant predictors of MN intake. Therefore, policymakers and healthcare providers can develop targeted interventions to enhance the uptake of micronutrient supplementation among children. Customizing strategies based on identified association rules has the potential to improve child health outcomes and decrease the impact of micronutrient deficiencies in Ethiopia.

[This corrects the article DOI: 10.1371/journal.pone.0271127.].

Cerebral palsy (CP) is the most common motor disability in childhood which causes a child's behavioral, feeding, and sleep difficulties. It remains a poorly studied health problem in Africa. The main aim of this study was assessing the pooled prevalence of Cerebral Palsy (CP) and its clinical characteristics in Africa context. Systematic review and meta-analysis were conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search articles from electronic databases (Cochrane library, Ovid platform) (Medline, Embase, and Emcare), Google Scholar, CINAHL, PubMed, Maternity and Infant Care Database (MIDIRS). The last search date was on 12/05/ 2023 G. C. A weighted inverse variance random-effects model was used to estimate the pooled estimates of cerebral palsy and its types. The subgroup analysis, publication bias and sensitivity analysis were done. Studies on prevalence and clinical characteristics of cerebral palsy were included. The primary and secondary outcomes were prevalence and clinical characteristics of cerebral palsy respectively. A total of 15 articles with (n = 498406 patients) were included for the final analysis. The pooled prevalence of cerebral palsy in Africa was found to be 3·34 (2·70, 3·98). The most common type is spastic cerebral palsy accounting 69·30% (66·76, 71·83) of all cases. The second one is quadriplegic cerebral palsy which was found to be 41·49% (33·16, 49·81). Ataxic cerebral palsy accounted 5·36% (3·22, 7·50). On the other hand, dyskinetic cerebral palsy was found to be 10.88% (6·26, 15·49). About 32·10% (19·25, 44.95) of cases were bilateral while 25·17% (16·84, 33·50) were unilateral. The incidence of cerebral palsy in Africa surpasses the reported rates in developed nations. Spastic and quadriplegic subtypes emerge as the most frequently observed. It is recommended to channel initiatives toward the strategic focus on preventive measures, early detection strategies, and comprehensive management protocols.

BackgroundAntiretroviral therapy (ART) has shown promising effects on the reduction of new HIV infection as well as HIV-related morbidity and mortality. In order to boost the effect of ART on ending HIV epidemics by 2030, the World Health Organization (WHO) indeed introduced a universal test and treat strategy in 2015 that recommends rapid (within seven days) initiation of ART for all HIV-positive patients. However, in low-income countries, a substantial number of HIV-positive patients were not enrolled in time, and information on delayed ART initiation status in Ethiopia is limited.MethodA multicenter cross-sectional study was conducted on 400 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northwest Ethiopia. A structured checklist was used to extract data from the patient's medical record. Data was entered into Epi-data version 4.6 and exported to SPSS version 26 for further analysis. Both simple and multivariable binary logistic regressions were executed, and variables with a p-value < 0.05 in the final model were considered significant predictors of delayed ART initiation.ResultsThe magnitude of delayed ART initiation was 39% (95% CI: 34%-44%). Being male [Adjusted odds ratio(AOR) = 1.99, 95%CI:1.3-3.2], having opportunistic infections (OIs) [AOR = 2.50, 95%CI:1.4-4.6], having other chronic diseases [AOR = 3.70,95%CI:1.7-8.3], substance abuse [AOR = 3.79, 95%CI: 1.9-7.4], having ambulatory functional status [AOR = 5.38, 95%CI: 1.4-9.6] and didn't have other HIV-positive family member [AOR = 1.85, 95%CI: 1.2-2.9] increases the odds of delayed ART initiation.Conclusion and recommendationThe burden of delayed ART initiation is found to be high. The presence of OIs and other chronic problems, substance abuse, ambulatory functional status, being male, and not having other HIV-positive family members were identified as significant predictors of delayed ART initiation. Special emphasis needs to be considered for those individuals with the identified risk factors.