Search

Abstract Background The duration between a patient’s arrival at the Emergency Department (ED) and their actual departure, known as the Emergency Department Length of Stay (EDLOS), can have significant implications for a patient’s health. In Ethiopia, various studies have investigated EDLOS, but a comprehensive nationwide pooled prevalence of prolonged EDLOS, which varies across different locations, is currently lacking. Therefore, the objective of this systematic review and meta-analysis is to provide nationally representative pooled prevalence of prolonged EDLOS and identify associated factors. Methods In this study, we conducted a comprehensive systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. We conducted a thorough search of numerous international databases, including PubMed/Medline, SCOPUS, Web of Science, and Google Scholar. The primary outcome was the prevalence of prolonged EDLOS. The secondary outcome was factors affecting the EDLOS. Random-effects model was used to since there was high heterogeneity. We also conducted subgroup analysis and meta-regression to investigate heterogeneity within the included studies. To assess publication bias, we used Egger’s regression test and funnel plots. All statistical analyses were performed using STATA version 17.0 software to ensure accurate and reliable findings. Result We have identified eight articles that met our inclusion criteria with a total sample size of 8,612 participants. The findings of this systematic review and meta-analysis indicate that the pooled estimate for the prevalence of prolonged EDLOS is 63.67% (95% CI = 45.18, 82.16, I2 = 99.56%, P = 0.0001). The study identified several significant factors associated with prolonged EDLOS, including patients admitted to overcrowded emergency departments (OR = 5.25, 95% CI = 1.77, 15.58), delays in receiving laboratory findings (OR = 3.12, 95% CI = 2.16, 4.49), and delays in receiving radiological results (OR = 3.00, 95% CI = 2.16, 4.16). Conclusion In this review, the EDLOS was found to be very high. Overcrowding, delays in laboratory test findings, and delays in radiology test results make up the factors that have a statistically significant association with prolonged EDLOS. Given the high prevalence of prolonged EDLOS in this review, stakeholders should work to increase the timeliness of ED services in Ethiopia by proper disposition of non-emergency palliative patients to the appropriate destination, and implementing point-of-care testing and imaging.

Abstract Background The viability of community-based health insurance programs depends on beneficiary satisfaction, and healthcare systems evaluate performance through patient reports and ratings to ensure effectiveness and service quality. To our knowledge, Ethiopia lacks national pooled data on the satisfaction of community-based health insurance beneficiaries and related factors. As a result, this review aimed to evaluate the level of beneficiaries’ satisfaction with the scheme’s services and associated factors in Ethiopia. Methods Database searches on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar were conducted on September 1st, 2022. Thirteen studies were chosen for review from the search results. Checklists from the Joan Briggs Institute were used to evaluate the risk of bias for the included studies. The data were extracted using a 2019 Microsoft Excel spreadsheet and analyzed using Stata 17. The odds ratios at p-values less than 0.05 with a 95% confidence interval were used to evaluate the effect estimates. Results The pooled satisfaction of beneficiaries with community-based health insurance was found to be 66.0% (95% CI = 57-76%) and was found to be influenced by socio-demographic, health service-related, the scheme’s related factors, and the beneficiaries’ knowledge of it. The beneficiary satisfaction levels were highest in the Amhara region, at 69.0% (95% CI = 59-79%), followed by Southern Nations Nationalities and Peoples' Region (SNNPR) at 67.0% (95% CI = 40-94%), Oromia at 63.0% (95% CI = 58-68%), and Addis Ababa at 53.0% (95% CI = 45-62%). Conclusion Even though there was a moderate level of satisfaction, there are indications that the quality of health services and the coverage of the entire population lag behind, necessitating greater efforts to achieve universal health coverage.

Abstract Background Assessing the clinical level of competency in nursing students is crucial as it represents the ultimate goal of nursing education. Poor competency result in low performance and can be affected by various factors. Thus, the aim of this study was to identify level of clinical competency and associated factors of nursing students in Ethiopia. Methods systematic review and meta-analysis was employed. Searching strategy was conducted from January up to march 2024 from Web of Science, PubMed and Google Scholar. The quality of studies was assessed using PRISMA checklist. A meta-analysis was performed using R Studio with the meta package Version 1.4.1106. Results in total, 145 studies were identified through database search, and only 7 studies were included in the meta-analysis representing 1937 nursing students. The pooled effect size of clinical competency of nursing students was 28%. Three factors were found to be associated with clinical competency: a positive clinical learning environment, student confidence in performing procedures, and effective staff-student interaction. The effect sizes of these factors were 6.30, 2.23, and 7.76, respectively. Conclusion and recommendation The clinical competency of nursing students was 28%, and it was associated with clinical learning environment, student confidence in performing procedures, and staff-student interaction. Nursing education programs should focus on enhancing students’ competency levels by addressing specific factors. (PROSPERO) International prospective register of systematic reviews CRD42022367057.

Purpose: To improve the academic integrity of online examinations, digital proctoring systems have recently been implemented in higher education institutions (HEIs). The paper aims to understand how digital proctoring has been practised in higher education (HE) and proposes future research directions for studying digital proctoring in HE. Design/methodology/approach: A systematic literature review was conducted. The PRISMA procedure was adapted for the literature search. The topics were identified by topic modelling techniques from 154 relevant publications in seven databases. Findings: Seven widely discussed topics in literature were identified, including solutions for detecting cheating and student authentication, challenges/issues of uptakes and students' performance in different proctoring environments. Research limitations/implications: This paper provides insights for academics, policymakers, practitioners and students to understand the implementation of digital proctoring in academia, its adoption by HEIs, impacts on students' and educators' performance and the rapid increase in its use for digital exams in HEIs, with particular emphasis on the impacts of the systems on digitalising examinations in HE. Originality/value: This review paper has systematically and critically described the state-of-the-art literature on digital proctoring in HE and provides useful insights and implications for future research on digital proctoring, and how academic integrity in online examinations can be enhanced, along with digitalising HE.

Abstract Introduction Pneumococcal disease is a serious global public health concern. The primary causative agent of severe illnesses such as pneumonia, meningitis, acute otitis media, and bacteremia is the pneumococcus bacterium. The pneumococcal conjugate vaccine is a key strategy to reduce the burden of pneumococcal disease. Understanding the spatial distribution of complete childhood pneumococcal conjugate vaccine utilization and its associated factors is crucial for designing strategies to improve vaccination implementation. Therefore, this study aimed to determine the spatial distribution of complete childhood pneumococcal conjugate vaccination coverage and identify its determinants in Ethiopia. Method A spatial and multilevel analysis was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey. The analysis included a total of 2,055 weighted children. The association between the outcome variable and the explanatory variables was determined by calculating adjusted odds ratios at a 95% confidence interval. Explanatory variables were considered significantly associated with the outcome if the p-value was less than 0.05. Result The prevalence of complete childhood pneumococcal conjugate vaccination in Ethiopia was 53.94% (95% CI: 51.77, 56.08). Higher complete childhood pneumococcal vaccination coverage was observed in the Addis Ababa, Tigray, Amhara, Benishangul-Gumuz, and Oromia regions, while lower coverage was seen in the Afar, Somali, and SNNPR regions of Ethiopia. Factors significantly associated with complete childhood pneumococcal conjugate vaccination included maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community antenatal care utilization. Conclusion The distribution of complete childhood pneumococcal conjugate vaccination exhibited spatial variability across Ethiopia. Approximately half of children aged twelve to thirty-five months received the full dose of the childhood pneumococcal conjugate vaccine in the country. Several factors were identified as statistically significant determinants of complete childhood pneumococcal conjugate vaccination, including maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community ANC utilization. Therefore, policies and strategies aimed at combating pneumococcal disease should consider these determinants and address areas with low vaccination coverage.

Introduction: Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia. Methods: A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI). Result: The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, p = 0.047) demonstrated significantly higher accuracy. Conclusion: The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.

Abstract Introduction Despite remarkable achievements in improving maternal and child health, early neonatal deaths still persist, with a sluggish decline in Ethiopia. As a pressing public health issue, it requires frequent and current studies to make appropriate interventions. Therefore, by using the most recent Ethiopian Mini Demographic Health Survey Data of 2019, we aimed to assess the magnitude and factors associated with early neonatal mortality in Ethiopia. Methods Secondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2019. A total weighted sample of 5,753 live births was included for this study. A multilevel logistic regression model was used to identify the determinants of early neonatal mortality. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of

Abstract Background The injectable shorter multi-drug resistant tuberculosis (MDR-TB) regimen, has been reported to be less costly and more effective in the treatment of MDR-TB compared to the longer regimen. Ethiopia introduced the injectable shorter regimen (SR) in April 2018 following official recommendation by the World Health Organization (WHO) in 2016. While the WHO recommendation was based on evidence coming from extensive programmatic studies in some Asian and African countries, there is paucity of information on patient outcomes in the Ethiopian context. Thus, we aimed to assess the treatment outcomes and identify factors associated with the outcomes of MDR-TB patients on injectable SR. Methods A multi-center facility-based retrospective cohort study was conducted in Ethiopia on 245 MDR-TB patients who were treated between April 2018 and March 2020. Data were collected from patients’ medical records and analyzed using SPSS version 25. Descriptive statistics was used to summarize the results while inferential analysis was employed to investigate predictors of treatment outcomes and survival status. Results A total of 245 patients were included in the study, with 129 (52.7%) of them being female. Median age of the patients was 27 (IQR: 21–33). The overall treatment success rate was 87.8%, with 156 (63.7%) cured and 59 (24.1%) patients who completed treatment. The unfavorable outcomes accounted for 12.2%, with 16 (6.5%) treatment failure, 8 (3.3%) death and 6 (2.4%) lost to follow up. Majority of the unfavorable outcomes occurred during the early phase of therapy, with median time to event of 1.8 months (95% CI: 0.99—2.69). The use of khat (a green leafy shrub abused for its stimulant like effect) and being diagnosed with MDR-TB than rifampicin resistant only, were identified as independent factors associated with unfavorable outcomes. Conclusion The injectable SR for MDR-TB was found to have positive treatment outcomes in the context of programmatic management in Ethiopia.

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

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

The field of rechargeable energy storage devices is actively exploring nanostructured materials with intricate morphologies due to several advantages. The integration of nanostructured materials into various electrodes, and rechargeable systems holds the potential to revolutionize energy storage, contributing to a cleaner and more sustainable energy landscape. Among these materials, 2D transition metal dichalcogenides (TMDs) have garnered attention, particularly molybdenum disulfide (MoS2), due to its outstanding properties such as optical characteristics, and unique layer structure. The semiconducting features, tunable bandgap, and high surface area of 2D MoS2 contribute to its suitability for energy storage applications. However, challenges related to conductivity and stability exists. To address challenges related to structure and interface, researchers investigate heterostructure ternary nanocomposites, combining MoS2 with materials such as metal oxides, carbonaceous compounds and conductive polymers. These composites enhance intercalation sites and charge storage capacity, improving ionic diffusion. This review focused on the latest advancements in leveraging electroactive materials like metal oxides, conductive polymers, and carbonaceous compounds to improve MoS2 performance in energy storage applications. We explored the synergistic effects achieved through the incorporation of these materials and their impact on the capacitive behavior, energy density, and cycle life. It thoroughly investigated the application of MoS2-based ternary nanocomposites in energy storage, with a specific focus on supercapacitors and Li-ion batteries.

Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.

Improper mechanical threshing can lead to fissuring and breakage of rice grains, resulting in lower milling quality and increased quantity losses, especially in locally produced rice in Africa due to poor post-harvest practices. This study examined the effects of moisture content (MC), drum peripheral speed (DS) and spike spacing (SS) on grain damage during threshing of three locally grown rice varieties: Shaga, Ediget and Nerica-4. Hand threshing served as the control group. Fissured and broken grain varied significantly by variety, MC, DS, SS and interaction effects. Ediget variety had the highest percentage of fissured grain, while Nerica-4 had the highest percentage of broken grain. As MC increased from 11.44% to 24.01%, fissured and broken grains decreased significantly for all varieties. As DS increased from 17.3 to 24.6 m/s, fissured and broken grain also increased. As SS decreased from 80 to 60 mm, fissured and broken grain increased. Furthermore, the interaction effects also affect grain fissuring and breakage significantly. In general, lower grain fissuring and breakage was observed at highest MC (23.43–24%), lower tip DS (17.3 m/s) and wider SS (80 mm) for all studied varieties. Pre-threshing grain fissuring and breakage had a greater contribution to overall grain damage at lower MC levels. Harvest MC was found to be the most influential factor affecting fissured and broken grain, followed by DS and SS. Overall, these results highlight the importance of proper threshing techniques and highlight areas where improvements can be made to reduce post-harvest losses and improve rice quality.

ABSTRACTBackground: In low- and middle-income countries where vaccination rates are low, tetanus is still an important threat to public health. Although maternal and neonatal tetanus remains a major global health concern, its magnitude and determinates are not well studied. Therefore, this study aimed to assess the number of tetanus toxoid injections and associated factors among pregnant women in low- and middle-income countries.Methods: Data from the most recent Demographic and Health Surveys, which covered 60 low- and middle-income countries from 2010 to 2022, was used for secondary data analysis. The study included a total of 118,704 pregnant women. A statistical software package, STATA 14, was used to analyze the data. A negative binomial regression of a cross-sectional study was carried out. Factors associated with the number of tetanus vaccinations were declared significant at a p-value of < 0.05. The incidence rate ratio and confidence interval were used to interpret the results. A model with the smallest Akaike Information Criterion and Bayesian Information Criterion values and the highest log likelihood was considered the best-fit model for this study.Results: In low- and middle-income countries, 26.0% of pregnant women took at least two doses of the tetanus toxoid vaccine. Factors such as maternal education, primary (IRR = 1.22, 95% CI: 1.17, 1.26), secondary (IRR = 1.19, 95% CI: 1.15, 1.23), higher (IRR = 1.16, 95% CI: 1.12, 1.20), employment (IRR = 1.11, 95% CI: 1.09, 1.13), 1-3 ANC visits (IRR = 2.49, 95% CI: 2.41, 2.57), ≥4 visits (IRR = 2.94, 95% CI: 2.84, 3.03), wealth index (IRR = 1.06; 95% CI: 11.04, 1.08), ≥birth order (IRR = 1.04, 95% CI: 1.02, 1.27), distance to health facility (IRR = 1.02, 95% CI: 1.00, 1.03), and health insurance coverage (IRR = 1.08; 95% CI: 1.06, 1.10) had a significant association with the number of tetanus vaccinations among pregnant women.Conclusions and recommendations: This study concludes that the number of tetanus toxoid vaccinations among pregnant women in low- and middle-income countries is low. In the negative binomial model, the frequency of tetanus vaccinations has a significant association with maternal employment, educational status, wealth index, antenatal care visits, birth order, distance from a health facility, and health insurance. Therefore, the ministries of health in low and middle-income countries should give attention to those women who had no antenatal care visits and women from poor wealth quantiles while designing policies and strategies.