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1.
BMC Pediatr ; 21(1): 176, 2021 04 16.
Article in English | MEDLINE | ID: covidwho-1793973

ABSTRACT

BACKGROUND: Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. METHODS: A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. RESULTS: Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. CONCLUSION: The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.


Subject(s)
HIV Infections , Severe Acute Malnutrition , Child , Ethiopia/epidemiology , Hospitals , Humans , Retrospective Studies
2.
BMC Pediatr ; 21(1): 413, 2021 09 20.
Article in English | MEDLINE | ID: covidwho-1793969

ABSTRACT

BACKGROUND: Lower respiratory infections are a leading cause of morbidity and mortality worldwide, particularly in children younger than 5 years. Even if the burden of lower respiratory infections in children under 5 years old had decreased dramatically in the last 10 years, it is still the main cause of morbidity and mortality in children under-5 years old in developing countries, so the aim of this study was to assess the magnitude of lower respiratory tract infections and associated factors among under-five children visiting Wolaita Sodo University Teaching and Referral Hospital. METHOD: A cross-sectional study was conducted from 1st to 30th April 2019, among under-five child/mother or caretaker pairs visiting Wolaita Sodo University Teaching and Referral Hospital. Child/mother or caretaker pairs who visits outpatient department for curative care service or follow up were recruited for the study. Data were collected using a semi-structured pre-tested interviewer-guided questionnaire. Epi-info (version 7.1.2.0) was used for data entry, and Statistical Package for Social Sciences version 20 was used for analysis. Bivariate and multivariate logistic regression, crude and adjusted odds ratios with their 95 % confidence intervals was computed. Finally, a p-value ≤ 0.05 was used to identify variables that had a significant association with acute lower respiratory infection. RESULT: A total of 414 child/mother or caretaker pairs were recruited for the study. The magnitude of acute lower respiratory infections among under-five children was 40.3 % (95 % CI: 35.7- 44.9 %). Unvaccinated children (AOR: 2, 95 % CI, (1.27-3.16)), non-exclusive/replacement feeding (AOR: 1.85, 95 % CI, (1.18-2.91)), households mainly used unclean fuel for cooking (AOR: 2.12, 95 % CI, (1.07-4.19)), absence of separate kitchen (AOR: 1.7, 95 % CI, (1.09-2.65)), and absence of window in the kitchen room (AOR: 1.69, 95 % CI, (1.07-2.68)) showed significant association with acute lower respiratory infection. CONCLUSIONS: The magnitude of acute lower respiratory tract infections among under-five children visiting outpatient department was 40.3 %. Unvaccinated children, non-exclusive/replacement feeding, using unclean fuel for cooking, absence of a separate kitchen, and absence of window in the kitchen showed significant association with acute lower respiratory infection. Therefore, special attention should be given to the environmental sanitation and family health components of health extension packages.


Subject(s)
Respiratory Tract Infections , Universities , Child , Child, Preschool , Cross-Sectional Studies , Ethiopia/epidemiology , Hospitals , Humans , Referral and Consultation , Respiratory Tract Infections/epidemiology
3.
PLoS One ; 17(3): e0264633, 2022.
Article in English | MEDLINE | ID: covidwho-1793512

ABSTRACT

BACKGROUND: In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country. METHODS: The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. RESULTS: Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. CONCLUSION: The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Vaccination Refusal/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Attitude to Health , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Humans , Immunization Programs , Income/statistics & numerical data , Male , Middle Aged , Patient Participation/psychology , Patient Participation/statistics & numerical data , Poverty , SARS-CoV-2/immunology , Vaccination , /statistics & numerical data , Vaccination Refusal/psychology , Young Adult
4.
BMJ Open ; 12(4): e055790, 2022 Apr 12.
Article in English | MEDLINE | ID: covidwho-1788963

ABSTRACT

OBJECTIVES: This multimethods study aimed to: (1) compare the prevalence of intimate partner violence (IPV) during pregnancy pre-COVID-19 and during the COVID-19 pandemic using quantitative data and (2) contextualise pregnant women's IPV experiences during the COVID-19 pandemic through supplemental interviews. DESIGN: Quantitative analyses use data from Performance Monitoring for Action-Ethiopia, a cohort of 2868 pregnant women that collects data at pregnancy, 6 weeks, 6 months and 1-year postpartum. Following 6-week postpartum survey, in-depth semistructured interviews contextualised experiences of IPV during pregnancy with a subset of participants (n=24). PARTICIPANTS: All pregnant women residing within six regions of Ethiopia, covering 91% of the population, were eligible for the cohort study (n=2868 completed baseline survey). Quantitative analyses were restricted to the 2388 women with complete 6-week survey data (retention=82.7%). A purposive sampling frame was used to select qualitative participants on baseline survey data, with inclusion criteria specifying completion of quantitative 6-week interview after the onset of the COVID-19 pandemic, and indication of IPV experience. INTERVENTIONS: A State of Emergency in Ethiopia was declared in response to the COVID-19 pandemic approximately halfway through 6-week postpartum interview, enabling a natural experiment (n=1405 pre-COVID-19; n=983 during-COVID-19). PRIMARY OUTCOME MEASURES: IPV during pregnancy was assessed via the 10-item Revised Conflict and Tactics Scale. RESULTS: 1-in-10 women experienced any IPV during pregnancy prior to COVID-19 (10.5%), and prevalence of IPV during pregnancy increased to 15.1% during the COVID-19 pandemic (aOR=1.51; p=0.02). Stratified by residence, odds of IPV during the pandemic increased for urban women only (aOR=2.09; p=0.03), however, IPV prevalence was higher in rural regions at both time points. Qualitative data reveal COVID-19-related stressors, namely loss of household income and increased time spent within the household, exacerbated IPV. CONCLUSIONS: These multimethods results highlight the prevalent, severe violence that pregnant Ethiopian women experience, with pandemic-related increases concentrated in urban areas. Integration of IPV response and safety planning across the continuum of care can mitigate impact.


Subject(s)
COVID-19 , Intimate Partner Violence , COVID-19/epidemiology , Cohort Studies , Ethiopia/epidemiology , Female , Humans , Pandemics , Pregnancy , Pregnant Women , Risk Factors
5.
BMJ Open ; 12(4): e057404, 2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1784825

ABSTRACT

OBJECTIVE: This study aimed to assess COVID-19 preventive behaviours and their associated factors among university students. METHODS: An institution-based cross-sectional study was employed among 405 university students and the study participants were chosen using a stratified simple random selection procedure. A pretested self-administered questionnaire was used to assess participants' perception of and preventive behaviour towards COVID-19. A multivariable logistic regression analysis was employed to identify factors associated with COVID-19 preventive behaviour. RESULT: A total of 405 students participated in this study with a response rate of 97.4%. The mean age of the participants was 23.6 (SD ±2.4, range 19-30) years. Two hundred and twenty of the participants (45.7% with 95% CI 41.0% to 51.0%) had good preventive behaviour towards COVID-19. COVID-19 preventive behaviour was significantly associated with age (adjusted OR (AOR)=1.1, 95% CI 1.00 to 1.2), female sex (AOR=1.6, 95% CI 1.02 to 2.60), knowing anyone infected with COVID-19 (AOR=4.05, 95% CI 1.9 to 8.8), participants who had high perceived susceptibility (AOR=2.14, 95% CI 1.44 to 3.35) and participants who were enrolled in health programmes (AOR=4.23, 95% CI 2.6 to 7.0). CONCLUSION AND RECOMMENDATION: The overall COVID-19 preventive behaviour among university students is unsatisfactory. Students' COVID-19 preventive behaviour was influenced by age, sex, knowing a COVID-19 infected person, perceived susceptibility and the sort of programme in which they had enrolled. The findings revealed that health communication interventions aimed at changing people's perceptions of COVID-19 and related prevention strategies are urgently needed to improve this population's COVID-19 preventive behaviour.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Perception , Students , Surveys and Questionnaires , Universities , Young Adult
6.
PLoS One ; 17(4): e0266037, 2022.
Article in English | MEDLINE | ID: covidwho-1779759

ABSTRACT

BACKGROUND: Biomedical waste management is an important precondition to safeguard the healthcare workers and community members, as well as the environment, from being contaminated with infectious substances. However, biomedical waste management practices during the pandemic era of COVID-19 were unknown. OBJECTIVE: This study was aimed to assess biomedical waste management practices and associated factors among health care workers during the COVID-19 pandemic era at metropolitan city private hospitals, Amhara Region, Ethiopia. METHODS: An institutional-based cross-sectional study was conducted at metropolitan city private hospitals in Amhara Region. Simple random sampling was used to select 431 study participants. Data were collected through a self-administered questionnaire and observational checklists. The data were cleaned, coded, and entered into the Epi-data version 4.6, and then exported to SPSS version 20. for analysis. Variables with a p-value less than 0.05 were considered as significant factors in multivariable logistic regression analysis and AOR with a 95% confidence level was used to measure the strength of association. RESULTS: The proportion of health care workers who had good practices in biomedical waste management was 49.4%. Participants who had MSc education level, [AOR = 4.20, 95% CI (1.01, 17.40)], Bachelor degree [AOR = 3.52, 95% CI (2.13, 5.82)], got training on biomedical waste management [AOR = 4.33, 95% CI (2.71, 6.93)], access to color-coded three bins in their working department [AOR = 6.24.95% CI (3.84, 10.13)] and those who had good attitude (AOR = 2.64, 95% CI (1.65, 4.22), were significantly associated with biomedical waste management practices in private hospitals. CONCLUSION: The practice of biomedical waste management in the study area was low. Level of education, taking training on biomedical waste management, availability of color-coded three bins, and attitude of health care workers were significantly associated with biomedical waste management practices. Hence, in-service training is recommended to improve biomedical waste management practices.


Subject(s)
COVID-19 , Waste Management , COVID-19/epidemiology , Cross-Sectional Studies , Ethiopia/epidemiology , Health Knowledge, Attitudes, Practice , Health Personnel , Hospitals, Private , Humans , Pandemics , Surveys and Questionnaires
7.
Front Public Health ; 10: 808626, 2022.
Article in English | MEDLINE | ID: covidwho-1776005

ABSTRACT

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality in Ethiopia. Investigation of the Mycobacterium tuberculosis complex (MTBC) species circulating in the Ethiopian population would contribute to the efforts made to control TB in the country. Therefore, this study was conducted to investigate the MTBC species and spoligo patterns in the Oromia region (central) of Ethiopia. Methods: A cross-sectional study design was used to recruit 450 smear positive pulmonary TB (PTB) cases from the Oromia region between September 2017 and August 2018. Mycobacteria were isolated from sputum samples on the Lowenstein Jensen (LJ) medium. Molecular identification of the isolates was performed by spoligotyping. The results of spoligotyping were transferred into a query box in the SITVIT2 database and Run TB-Lineage in the TB Insight website for the identification of spoligo international type (SIT) number and linages of the isolates, respectively. Statistical Product and Service Solutions (SPSS) 20 was applied for statistical analysis. Results: Three hundred and fifteen isolates were grouped under 181 different spoligotype patterns. The most dominantly isolated spoligotype pattern was SIT149 and it consisted of 23 isolates. The majority of the isolates were grouped under Euro-American (EA), East-African-Indian (EAI), and Indo-Oceanic (IO) lineages. These lineages consisted of 79.4, 9.8, and 9.8% of the isolates, respectively. One hundred and sixty-five of the isolates were classified under 31 clustered spoligotypes whereas the remaining 150 were singleton types. Furthermore, 91.1% of the total isolates were classified as orphan types. Clustering of spoligotypes was associated (p < 0.001) with EAI lineage. Conclusion: SIT149 and EA lineage were predominantly isolated from the Oromia region substantiating the findings of the similar studies conducted in other regions of Ethiopia. The observation of significant number of singleton and orphan spoligotypes warrants for additional genetic typing of the isolates using method(s) with a better discriminatory power than spoligotyping.


Subject(s)
Mycobacterium tuberculosis , Tuberculosis, Pulmonary , Bacterial Typing Techniques , Cross-Sectional Studies , Ethiopia/epidemiology , Humans , Mycobacterium tuberculosis/classification , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/microbiology
8.
Front Public Health ; 10: 796687, 2022.
Article in English | MEDLINE | ID: covidwho-1775997

ABSTRACT

Background: Substance use indicated the use of psychoactive substances such as alcohol, cigarettes, khat, and illegal drugs. Substance use has varying impacts on the health and socio-economics of countries, and is a major public health concern globally. Currently, substance use is a common public health problem among Ethiopian youth mainly in the city of Jimma. Therefore, this study aimed to assess the magnitude of Cigarette smoking, alcohol drinking, khat chewing, and associated factors among the youth of Jimma town in 2019. Methods: A community-based cross-sectional study was conducted among youth of Jimma town from March 2019 to April 2019. A simple random sampling technique was used to select 423 study participants. Data were collected using a structured interviewer-administered questionnaire. The collected data were entered into EPI data manager version 4.4.1 and transported to SPSS version 23 for data cleaning and analyses. The disruptive study was carried out to determine the prevalence of cigarette smoking, alcohol consumption, and khat chewing. Binary and multivariable analyses were carried out to identify factories associated with cigarette smoking, alcohol consumption, and khat chewing. Finally, adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the presence and strength of association. Results: The current prevalence of cigarette use, alcohol use, and khat use was 16.0, 30.6, and 45.7%, respectively. Factors associated with current smoking use were substance use by siblings, subjective norm factors, and perceived benefits of substance use. Factors associated with current alcohol consumption were youth who highly perceived substance use as important. Factors associated with current khat use were male, substance use by siblings, out-of-school youth, and subjective norms. Concussion: The study findings indicated that the prevalence of khat, alcohol, and cigarettes was high among the youth of the city of Jimma. To reduce the prevalence of khat, alcohol, and cigarettes among youth, coordinated efforts from the youth, the government, health professionals, and the community at large are needed.


Subject(s)
Substance-Related Disorders , Adolescent , Cross-Sectional Studies , Ethiopia/epidemiology , Humans , Male , Risk Factors , Substance-Related Disorders/epidemiology , Universities
9.
Front Public Health ; 10: 731326, 2022.
Article in English | MEDLINE | ID: covidwho-1775965

ABSTRACT

Background: Studies indicate that children and adolescent populations in most countries show a low level of physical activity (PA) and an increasing prevalence of obesity. Addressing gender disparity in PA is the main element of public health programs. There is currently a paucity of studies, particularly, in developing countries that investigate gender differences and correlates of PA among children and adolescents. Objective: The study is aimed to assess the gender difference and correlates of PA among children and adolescents in Ethiopia. Methods: An observational population-based cross-sectional study was conducted in representative samples of children and adolescents in the capital city of Ethiopia, Addis Ababa. Multivariable logistic regression models with robust estimation of SEs were fitted to predict the odds ratios (ORs) and 95% CIs. Results: A total of 632 children and adolescents-parent dyads were included in the study. More boys than girls (17.0 and 11.7%) were engaged in moderate intensity PA 3 days a week or more (p = 0.057). Age, mothers working in a private business, attending public schools, longer sleep duration, and being taught the benefits of PA were positively associated with meeting moderate-to-vigorous PA (MVPA) in both sexes combined and in a sub-sample of boys. Furthermore, an inverse association was found between overweight/obesity and MVPA in the overall children and girls as well. For moderate PA (MPA); the age of the children, maternal education and occupation, school type, overweight/obesity, and sleep duration on school nights were significant correlates among the studied children. Conclusions: The present study provided evidence of several correlates identified associated with meeting MVPA and MPA in both sexes combined. Girls are less likely than boys to engage in PA. Therefore, there is a need to take into perspectives the provision of a comprehensive multifaceted health behavior modification and interventions, such as focused and regular physical education in schools.


Subject(s)
Exercise , Sex Factors , Adolescent , Child , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Humans , Male , Urban Population
10.
Front Public Health ; 9: 750551, 2021.
Article in English | MEDLINE | ID: covidwho-1775934

ABSTRACT

Campylobacter is the most common cause of bacterial infectious diarrhea and acute gastroenteritis globally, and is recognized as a significant zoonotic pathogen. Antimicrobial resistance amongst Campylobacter isolates is a significant global concern. A cross-sectional study was conducted to identify and characterize Campylobacter species in humans, animals and water sources in livestock owning households of peri-urban Addis Ababa, Ethiopia; and to characterize antimicrobial resistance. A total of 519 fecal samples from humans (n = 99), livestock (n = 179), poultry (n = 69), and water (n = 172) were collected. Samples were cultured for viable Campylobacter spp. and multiplex PCR utilized for the identification and confirmation. Antimicrobial susceptibility of the isolates was assessed using the Kirby-Bauer disc diffusion method. Campylobacter spp. was detected in 67/519 (13.0%) of the total tested samples, and the household level prevalence of Campylobacter was 42.4%. The prevalence of Campylobacter spp. was: humans (10.1%), cattle (18.5%), poultry (13.0%), sheep (13.3%), goats (7.1%), and water (10.5%). Campylobacter jejuni and C. fetus were the most frequently isolated species, followed by C. coli. The majority of isolates obtained from human samples had co-occurrence with isolates from cattle, poultry or water samples from the same household. The use of stored water, the practice of indoor and outdoor manure collecting, and animal species Campylobacter positivity were significantly associated with greater odds of human Campylobacter spp. positivity. All Campylobacter isolates from humans, poultry, sheep, goats and water, and 96.0% of isolates from cattle were resistant to at least one or more of the tested antimicrobials, with 95.5% of isolates resistant to three or more classes of antimicrobials. A One Health approach is recommended to further investigate Campylobacter species infections, and other zoonotic infectious diseases, in the livestock owning populations in Ethiopia, where there is close interaction between humans, animals and the environment.


Subject(s)
Campylobacter , One Health , Animals , Anti-Bacterial Agents/pharmacology , Cattle , Cross-Sectional Studies , Ethiopia/epidemiology , Humans , Livestock , Microbial Sensitivity Tests , Sheep , Water
11.
Front Public Health ; 9: 686682, 2021.
Article in English | MEDLINE | ID: covidwho-1771111

ABSTRACT

Background: Despite the induction of labor (IOL) having had some undesired consequences, it also has several benefits for maternal and perinatal outcomes. This study aimed to assess the proportion and outcome of IOL among mothers who delivered in Teaching Hospital, southwest Ethiopia. Methods: A retrospective cross-sectional study was conducted from June 10 to June 20, 2019, among 294 mothers who gave birth between November 30, 2018, and May 30, 2019, by reviewing their cards using a structured checklist to assess the prevalence, outcome, and consequences of induction of labor. A binary logistic regression analysis was computed to look for the association between outcome variables and independent variables. Results: The prevalence of labor induction was 20.4%. The most commonly reported cause of induction was preeclampsia (41.6%). The factors associated with IOL were mothers aged 25-34 years [AOR = 2.55, 95% CI (1.18-5.50)] and ≥35 years [AOR = 10.6, 95% CI (4.20-26.9)], having no history of antenatal care [AOR = 2.12, 95% CI (1.10-4.07)], and being Primipara AOR = 2.33, 95% CI (1.18-3.24)]. Of the 60 induced mothers, 23.3% had failed induction. The proportion of mothers with dead fetal outcomes and maternal complications was 5 and 41.7%, respectively. The unfavorable Bishop Score before induction [AOR = 1.85, 95% CI (1.32-4.87)] and induction using misoprostol [AOR = 1.48, 95% CI (1.24-5.23)] were the factors associated with failed induction of labor. Conclusion: The prevalence of induced labor was considerably higher than rates in other Ethiopian studies; however, the prevalence of induction failure was comparable to other studies done in Ethiopia. The study found that Bishop's unfavorable score before induction and induction using misoprostol was the factor associated with unsuccessful induction. Therefore, the health professionals should confirm the favorability of the cervical status before the IOL to increase the success rate of induction of labor.


Subject(s)
Mothers , Adult , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Hospitals, Teaching , Humans , Labor, Induced , Pregnancy , Retrospective Studies
12.
BMC Infect Dis ; 22(1): 325, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1770496

ABSTRACT

BACKGROUND: The health impacts of COVID-19 are not evenly distributed in societies. Chronic patients are highly affected and develop dangerous symptoms of COVID-19. Understanding their information seeking about COVID-19 may help to improve the effectiveness of public health strategies in the future, the adoption of safety measures, and minimize the spread of the pandemic. However, there is little evidence on information seeking specifically on COVID-19 in this study setting. Therefore, this study aimed to assess information seeking about COVID-19 and associated factors among chronic patients. METHOD: An institutional-based cross-sectional study supplemented with qualitative data was conducted at Bahir Dar city public hospitals in Northwest Ethiopia from April 8 to June 15, 2021. A total of 423 chronic patients were selected using systematic random sampling techniques with an interval of 5. Bi-variable and multivariable logistic regression analysis was fitted to identify factors associated with information seeking about COVID-19. A p-value < 0.05 was used to declare statistical significance. Qualitative data were analyzed using a thematic approach. Finally, it was triangulated with quantitative findings. RESULT: The proportion of information seeking about COVID-19 among chronic patients was 44.0% (95% CI = 39.0, 49.0). Being living in urban [AOR = 4.4, 95% CI (2.01, 9.58)], having high perceived susceptibility to COVID-19 [AOR = 3.4, 95%CI (1.98, 5.70)], having high perceived severity to COVID-19 [AOR = 1.7, 95%CI (1.04, 2.91)], having high self-efficacy to COVID-19 [AOR = 4.3, 95%CI (2.52, 7.34)], and having adequate health literacy [AOR = 1.8, 95%CI (1.10, 3.03)] were significant factors associated with information-seeking about COVID-19. CONCLUSION: The overall proportion of information seeking about COVID-19 among chronic patients was low. Thus, health promotion programs should emphasize the chronic patients living in a rural area; enhance perceived risk and severity of COVID-19, enhancing self-efficacy and health literacy interventions to improve information seeking.


Subject(s)
COVID-19 , Information Seeking Behavior , COVID-19/epidemiology , Cross-Sectional Studies , Ethiopia/epidemiology , Hospitals, Public , Humans
13.
Misganaw, Awoke, Naghavi, Mohsen, Walker, Ally, Mirkuzie, Alemnesh H.; Giref, Ababi Zergaw, Berheto, Tezera Moshago, Waktola, Ebba Abate, Kempen, John H.; Eticha, Getachew Tollera, Wolde, Tsigereda Kifle, Deguma, Dereje, Abate, Kalkidan Hassen, Abegaz, Kedir Hussein, Ahmed, Muktar Beshir, Akalu, Yonas, Aklilu, Addis, Alemu, Biresaw Wassihun, Asemahagn, Mulusew A.; Awedew, Atalel Fentahun, Balakrishnan, Senthilkumar, Bekuma, Tariku Tesfaye, Beyene, Addisu Shunu, Beyene, Misrak Getnet, Bezabih, Yihienew Mequanint, Birhanu, Biruk Tesfaye, Chichiabellu, Tesfaye Yitna, Dachew, Berihun Assefa, Dagnew, Amare Belachew, Demeke, Feleke Mekonnen, Demissie, Getu Debalkie, Derbew Molla, Meseret, Dereje, Nebiyu, Deribe, Kebede, Desta, Abebaw Alemayehu, Eshetu, Munir Kassa, Ferede, Tomas Y.; Gebreyohannes, Eyob Alemayehu, Geremew, Abraham, Gesesew, Hailay Abrha, Getacher, Lemma, Glenn, Scott D.; Hafebo, Aregash Samuel, Hashi, Abdiwahab, Hassen, Hamid Yimam, Hay, Simon I.; Hordofa, Diriba Fufa, Huluko, Dawit Hoyiso, Kasa, Ayele Semachew, Kassahun Azene, Getinet, Kebede, Ermiyas Mulu, Kebede, Hafte Kahsay, Kelkay, Bayew, Kidane, Samuel Z.; Legesse, Samson Mideksa, Manamo, Wondimu Ayele, Melaku, Yohannes Adama A.; Mengesha, Endalkachew Worku, Mengesha, Sisay Derso, Merie, Hayimro Edemealem, Mersha, Abera M.; Mersha, Amanual Getnet, Mirutse, Mizan Kiros, Mohammed, Ammas Siraj, Mohammed, Hussen, Mohammed, Salahuddin, Netsere, Henok Biresaw, Nigatu, Dabere, Obsa, Mohammed Suleiman, Odo, Daniel Bogale, Omer, Muktar, Regassa, Lemma Demissie, Sahiledengle, Biniyam, Shaka, Mohammed Feyisso, Shiferaw, Wondimeneh Shibabaw, Sidemo, Negussie Boti, Sinke, Abiy H.; Sintayehu, Yitagesu, Sorrie, Muluken Bekele, Tadesse, Birkneh Tilahun, Tadesse, Eyayou Girma, Tamir, Zemenu, Tamiru, Animut Tagele, Tareke, Amare Abera, Tefera, Yonas Getaye, Tekalegn, Yohannes, Tesema, Ayenew Kassie, Tesema, Tefera Tadele, Tesfay, Fisaha Haile, Tessema, Zemenu Tadesse, Tilahun, Tadesse, Tsegaye, Gebiyaw Wudie, Tusa, Biruk Shalmeno, Weledesemayat, Geremew Tassew, Yazie, Taklo Simeneh, Yeshitila, Yordanos Gizachew, Yirdaw, Birhanu Wubale, Zegeye, Desalegn Tegabu, Murray, Christopher J. L.; Gebremedhin, Lia Tadesse.
Lancet ; 399(10332): 1322-1335, 2022 Apr 02.
Article in English | MEDLINE | ID: covidwho-1768603

ABSTRACT

BACKGROUND: Previous Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities. METHODS: We gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment. FINDINGS: The SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59-7·20) in 1990 to 4·43 (4·01-4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96-6·86) in Somali to 1·50 (1·26-1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79-22·07), from 46·91 years (45·71-48·11) in 1990 to 68·84 years (67·51-70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91-72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53-66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69-1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities. INTERPRETATION: There were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets. FUNDING: Bill & Melinda Gates Foundation.


Subject(s)
Global Burden of Disease , Global Health , Life Expectancy , Adult , Aged , Bayes Theorem , Cause of Death , Child , Ethiopia/epidemiology , Humans , Infant, Newborn , Quality-Adjusted Life Years , Risk Factors
14.
PLoS One ; 17(3): e0263627, 2022.
Article in English | MEDLINE | ID: covidwho-1759943

ABSTRACT

BACKGROUND: Serological testing for SARS-CoV-2 plays an important role for epidemiological studies, in aiding the diagnosis of COVID-19, and assess vaccine responses. Little is known on dynamics of SARS-CoV-2 serology in African settings. Here, we aimed to characterize the longitudinal antibody response profile to SARS-CoV-2 in Ethiopia. METHODS: In this prospective study, a total of 102 PCR-confirmed COVID-19 patients were enrolled. We obtained 802 plasma samples collected serially. SARS-CoV-2 antibodies were determined using four lateral flow immune-assays (LFIAs), and an electrochemiluminescent immunoassay. We determined longitudinal antibody response to SARS-CoV-2 as well as seroconversion dynamics. RESULTS: Serological positivity rate ranged between 12%-91%, depending on timing after symptom onset. There was no difference in positivity rate between severe and non-severe COVID-19 cases. The specificity ranged between 90%-97%. Agreement between different assays ranged between 84%-92%. The estimated positive predictive value (PPV) for IgM or IgG in a scenario with seroprevalence at 5% varies from 33% to 58%. Nonetheless, when the population seroprevalence increases to 25% and 50%, there is a corresponding increases in the estimated PPVs. The estimated negative-predictive value (NPV) in a low seroprevalence scenario (5%) is high (>99%). However, the estimated NPV in a high seroprevalence scenario (50%) for IgM or IgG is reduced significantly to 80% to 85%. Overall, 28/102 (27.5%) seroconverted by one or more assays tested, within a median time of 11 (IQR: 9-15) days post symptom onset. The median seroconversion time among symptomatic cases tended to be shorter when compared to asymptomatic patients [9 (IQR: 6-11) vs. 15 (IQR: 13-21) days; p = 0.002]. Overall, seroconversion reached 100% 5.5 weeks after the onset of symptoms. Notably, of the remaining 74 COVID-19 patients included in the cohort, 64 (62.8%) were positive for antibody at the time of enrollment, and 10 (9.8%) patients failed to mount a detectable antibody response by any of the assays tested during follow-up. CONCLUSIONS: Longitudinal assessment of antibody response in African COVID-19 patients revealed heterogeneous responses. This underscores the need for a comprehensive evaluation of seroassays before implementation. Factors associated with failure to seroconvert needs further research.


Subject(s)
Antibody Formation , COVID-19/immunology , SARS-CoV-2/immunology , Adult , Antibodies, Viral/immunology , COVID-19/epidemiology , COVID-19 Serological Testing/methods , Ethiopia/epidemiology , Female , Humans , Immunoassay , Longitudinal Studies , Male , Middle Aged , Patient Acuity , Prospective Studies , Seroepidemiologic Studies
15.
PLoS One ; 17(3): e0264617, 2022.
Article in English | MEDLINE | ID: covidwho-1753190

ABSTRACT

BACKGROUND: Coronavirus disease 2019 has had a global effect on people's lifestyles. Many people have developed irregular eating patterns and become physically inactive, which leads to an aggravation of lifestyle-related diseases and unhealthier lifestyles; these, subsequently raise the severity of coronavirus disease 2019. This study aimed to assess lifestyle changes during coronavirus disease 2019 pandemic in Gondar town, North West, Ethiopia. METHOD: Community-based cross-sectional study design was conducted among households at Gondar town from June to August 2021. The study participants were selected by a systematic random sampling technique from proportionally allocated kebeles. Data were collected using face-to-face interview techniques and were entered and analyzed by using a statistical package for the social sciences version 24; P-values < 0.05 were considered as statistically significant. RESULT: Overall, 348 study participants were included in the study. Among those respondents, 52.3% (182) were female study participants and the mean age of the respondents was 30.95±14.4. In this study, there was a significant decrement in non-homemade food from 20.4% to 13.4% at (P = <0.001). Concerning water intake, 11.5% (40) of respondents consumed ≥8 cups/day before the coronavirus disease 2019 pandemic, and the percentage increased to 14.7% (51) during the coronavirus disease 2019 pandemic (p = 0.01). Of the participants, 46% participants were reported never engaging in any physical activity before the coronavirus pandemic, and the percentage decreased to 29.9% during the pandemic (P = 0.002). The respondents also exhibited increment tension in large from 4.9% to 22.7% before and during the coronavirus disease 2019 pandemic, respectively. Furthermore, about 6.3% of the study participants slept badly before the coronavirus disease 2019 pandemics and the effects of sleeping badly and restlessly increased to 25.9% during the coronavirus disease 2019 pandemic (P = <0.001). CONCLUSION: The current study demonstrates that there is a noticeable alteration in food consumption, food choices, regular mealtime, sleeping habits, mental exhaustion, and practice of physical activity.


Subject(s)
COVID-19/epidemiology , Exercise/statistics & numerical data , Adolescent , Adult , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Interviews as Topic , Life Style , Male , Middle Aged , Young Adult
16.
PLoS One ; 17(3): e0263568, 2022.
Article in English | MEDLINE | ID: covidwho-1753186

ABSTRACT

BACKGROUND: COVID-19 is a new pandemic that poses a threat to people globally. In Ethiopia, where classrooms are limited, students are at higher risk for COVID-19 unless they take consistent preventative actions. However, there is a lack of evidence in the study area regarding student compliance with COVID-19 preventive behavior (CPB) and its predictors. OBJECTIVE: This study aimed to assess CPB and its predictors among students based on the perspective of the Health Belief Model (HBM). METHOD AND MATERIALS: A school-based cross-sectional survey was conducted from November to December 2020 to evaluate the determinants of CPB among high school students using a self-administered structured questionnaire. 370 participants were selected using stratified simple random sampling. Descriptive statistics were used to summarize data, and partial least squares structural equation modeling (PLS-SEM) analyses to evaluate the measurement and structural models proposed by the HBM and to identify associations between HBM variables. A T-value of > 1.96 with 95% CI and a P-value of < 0.05 were used to declare the statistical significance of path coefficients. RESULT: A total of 370 students participated with a response rate of 92%. The median (interquartile range) age of the participants (51.9% females) was 18 (2) years. Only 97 (26.2%), 121 (32.7%), and 108 (29.2%) of the students had good practice in keeping physical distance, frequent hand washing, and facemask use respectively. The HBM explained 43% of the variance in CPB. Perceived barrier (ß = - 0.15, p < 0.001) and self-efficacy (ß = 0.51, p <0.001) were significant predictors of student compliance to CPB. Moreover, the measurement model demonstrated that the instrument had acceptable reliability and validity. CONCLUSION AND RECOMMENDATIONS: COVID-19 prevention practice is quite low among students. HBM demonstrated adequate predictive utility in predicting CPBs among students, where perceived barriers and self-efficacy emerged as significant predictors of CPBs. According to the findings of this study, theory-based behavioral change interventions are urgently required for students to improve their prevention practice. Furthermore, these interventions will be effective if they are designed to remove barriers to CPBs and improve students' self-efficacy in taking preventive measures.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Students/psychology , Adolescent , COVID-19/psychology , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Health Behavior , Health Belief Model , Health Knowledge, Attitudes, Practice , Humans , Latent Class Analysis , Male , Reproducibility of Results , Self Efficacy , Surveys and Questionnaires , Young Adult
17.
BMC Infect Dis ; 22(1): 261, 2022 Mar 16.
Article in English | MEDLINE | ID: covidwho-1745480

ABSTRACT

BACKGROUND: COVID-19 pandemic has a devastating impact on the economies and health care system of sub-Saharan Africa. Healthcare workers (HWs), the main actors of the health system, are at higher risk because of their occupation. Serology-based estimates of SARS-CoV-2 infection among HWs represent a measure of HWs' exposure to the virus and could be used as a guide to the prevalence of SARS-CoV-2 in the community and valuable in combating COVID-19. This information is currently lacking in Ethiopia and other African countries. This study aimed to develop an in-house antibody testing assay, assess the prevalence of SARS-CoV-2 antibodies among Ethiopian high-risk frontline HWs. METHODS: We developed and validated an in-house Enzyme-Linked Immunosorbent Assay (ELISA) for specific detection of anti-SARS-CoV-2 receptor binding domain immunoglobin G (IgG) antibodies. We then used this assay to assess the seroprevalence among HWs in five public hospitals located in different geographic regions of Ethiopia. From consenting HWs, blood samples were collected between December 2020 and February 2021, the period between the two peaks of COVID-19 in Ethiopia. Socio-demographic and clinical data were collected using questionnaire-based interviews. Descriptive statistics and bivariate and multivariate logistic regression were used to determine the overall and post-stratified seroprevalence and the association between seropositivity and potential risk factors. RESULTS: Our successfully developed in-house assay sensitivity was 100% in serum samples collected 2- weeks after the first onset of symptoms whereas its specificity in pre-COVID-19 pandemic sera was 97.7%. Using this assay, we analyzed a total of 1997 sera collected from HWs. Of 1997 HWs who provided a blood sample, and demographic and clinical data, 51.7% were females, 74.0% had no symptoms compatible with COVID-19, and 29.0% had a history of contact with suspected or confirmed patients with SARS-CoV-2 infection. The overall seroprevalence was 39.6%. The lowest (24.5%) and the highest (48.0%) seroprevalence rates were found in Hiwot Fana Specialized Hospital in Harar and ALERT Hospital in Addis Ababa, respectively. Of the 821 seropositive HWs, 224(27.3%) of them had a history of symptoms consistent with COVID-19 while 436 (> 53%) of them had no contact with COVID-19 cases as well as no history of COVID-19 like symptoms. A history of close contact with suspected/confirmed COVID-19 cases is associated with seropositivity (Adjusted Odds Ratio (AOR) = 1.4, 95% CI 1.1-1.8; p = 0.015). CONCLUSION: High SARS-CoV-2 seroprevalence levels were observed in the five Ethiopian hospitals. These findings highlight the significant burden of asymptomatic infection in Ethiopia and may reflect the scale of transmission in the general population.


Subject(s)
COVID-19 , Pandemics , COVID-19/diagnosis , COVID-19/epidemiology , Ethiopia/epidemiology , Female , Health Personnel , Humans , SARS-CoV-2 , Seroepidemiologic Studies
18.
Ethiop J Health Sci ; 32(1): 37-44, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1744765

ABSTRACT

Background: The COVID-19 pandemic has caused substantial disruptions to surgical-care delivery mainly due to diversion of available resources from surgical to COVID-19 care, reduced flow of patients, supply-chain interruptions and social distancing and restriction measures. The purpose of this study was to understand the impact of the pandemic on surgical volume in our hospital. Methods: A descriptive cross-sectional study was done at Tikur Anbessa Specialized Hospital. A 2- year data was collected from March 2019 up to March 2021 from the operation theatre registration books. The data registry at the admission records office was also reviewed to extract the number pf patients on the elective surgery waiting list. Data were recorded, analyzed and reported using SPSS software package 26. Results: The findings showed that there was a significant drop in surgical volume during the COVID-19 era. Surgical volume has dropped by 19% for emergency and by 32% for elective surgeries. COVID-19 test positivity of patients was identified as the single most important reason for elective operation cancellation during the first wave of the pandemic, contributing to as high as 85% of the reasons. Conclusion: The outcome of our study showed that COVID-19 has adversely affected elective and emergency surgical volume in our institution. This has also led to a dramatic increase in the surgical waiting list load. We recommend immediate surgical systems strengthening measures to re-build the surgical care ecosystem significantly affected by COVID-19. Surgical and anesthesia systems strengthening should be an integral part of pandemic preparedness and management.


Subject(s)
COVID-19 , COVID-19/epidemiology , Cross-Sectional Studies , Ecosystem , Ethiopia/epidemiology , Humans , Pandemics , SARS-CoV-2
19.
Ethiop J Health Sci ; 32(1): 3-14, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1726502

ABSTRACT

Background: According to the world health organization, the COVID-19 outbreak has currently affected millions of people worldwide. Since the start of the pandemic in China, everything countries have thrown at the virus turned unsuccessful. As there is no established vaccine to halt the virus transmission, it might be very difficult for developing countries like Ethiopia even after vaccine development. Thus, focusing on improving knowledge, perception, and preparedness related to the virus might be very vital. Methods: A community-based cross-sectional survey was conducted using the questionnaire applied in most countries which is suitable to apply in the Konso zone in South Nations Nationalities Region (SNNPR) from April.2020 to July 2020. Data were collected, cleaned, coded, checked, and entered into Epi Info and then exported and analyzed in STATA 15. We fitted a binary logistic regression model. Categorical variables were presented using figure tables, and proportion and for continuous variables, mean and standard deviation were used. The results were also presented using Adjusted Odds Ratio (AOR) with 95% CI. Results: From 636 respondents expected, 615(97%) were participated and possessed the knowledge of 39%, and 64% perception and preparedness each. Measurements related to the policy and interventions like restrictions to movement, self-isolation, wearing a face mask, & the need for more tests was not supported by most participants. Conclusion: The poor knowledge, perception, and preparedness were correlated with the unavailability of water and electricity, less education, and informal source of information which could be improved through area appropriate health education interventions.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Ethiopia/epidemiology , Health Knowledge, Attitudes, Practice , Humans , Perception , Rural Population , SARS-CoV-2 , Surveys and Questionnaires
20.
PLoS One ; 17(3): e0264237, 2022.
Article in English | MEDLINE | ID: covidwho-1724847

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes more than five million deaths worldwide. Pregnant women are at high risk for infection due to the physiologic change in the immune and cardiopulmonary system and also it increases the risk of severe disease, intensive care unit admission, and receive mechanical ventilation when compared with non-pregnant women. It is associated with adverse maternal and neonatal outcomes. So pregnant women need to have adhered to preventive measures to prevent COVID-19 related consequences. Therefore, this study aimed to assess adherence toCOVID-19 preventive practice and associated factors among pregnant women in Gondar city, northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted from July 1st to 30th, 2021, in Gondar city. A cluster sampling technique was employed to select 678 pregnant women. Data were collected using a pre-tested, face-to-face interviewer-administered questionnaire. Data were entered into EPI DATA version 4.6 and exported to SPSS version 25 for analysis. Both bivariable and multivariable logistic regression analysis was fitted to identify associated factors. Adjusted odds ratio with a 95% confidence interval was used to report the association between covariates and the outcome variable. RESULTS: The prevalence of good adherence to COVID-19 preventive practice was 44.8% (95% CI: 41.3, 48.7). Maternal age (≤24 years) [AOR = 2.89, 95% CI: 1.37, 6.10], maternal education (secondary school) [AOR = 2.95, 95% CI: 1.58, 5.53] and (college and above) [AOR = 4.57,95% CI: 2.42, 8.62], having ANC follow up [AOR = 2.95, 95% CI: 1.35, 6.46] and adequate knowledge towards COVID-19 [AOR = 1.70, 95% CI: 1.20, 2.41] were significantly associated with good adherence to COVID-19 preventive practice. CONCLUSION: In this study, adherence towards COVID-19 preventive practice in pregnant women is low. Hence, it is important to strengthen women's awareness about COVID-19 through different media and health education. In addition, empowering women to attain ANC and special consideration should be given to women who had no formal education.


Subject(s)
COVID-19/prevention & control , Patient Compliance/statistics & numerical data , Primary Prevention/statistics & numerical data , Adult , Cities , Community-Based Participatory Research , Cross-Sectional Studies , Educational Status , Ethiopia/epidemiology , Female , Health Knowledge, Attitudes, Practice , Humans , Maternal Age , Pregnancy , Primary Prevention/education , Socioeconomic Factors , Surveys and Questionnaires , Young Adult
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