Household- and community-level factors of zero vegetable or fruit consumption among children aged 6-23 months in East Africa.

Introduction: The World Health Organization recommends that children aged 6-23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Method: The study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6-23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant. Results: The overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries. Conclusion: Considering the high overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

Uptake of cervical cancer screening and associated factors among HIV positive women attending adult art clinic at public hospitals in Addis Ababa, Ethiopia, 2022.

BACKGROUND: Cervical cancer is the second most common malignancy in Ethiopia and first in some African countries. It is six times more likely to occur in positive cases of the human immunodeficiency virus than in the general population. If diagnosed and treated early enough, cervical cancer is both treatable and preventable. However, among Ethiopian women who test positive for HIV, the uptake of cervical cancer screening is low. Its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. OBJECTIVE: To assess uptake of cervical cancer screening services and associated factors among HIV-positive women attending an adult antiretroviral treatment clinic at public hospitals in Addis Ababa, Ethiopia, June 1-30, 2022. METHODS: A cross-sectional investigation was carried out in a hospital. 407 participants in all were chosen using the systematic sampling technique. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association. RESULT: Among a total of 407 respondents, 238 (58.5%), 95% CI (53.5-63.3), HIV-positive women were screened at least once in the last five years. In multivariable analysis, age > 45 years old (AOR = 0.18, 95% CI: 0.053-0.644), number of children (3 children) (AOR = 0.19, 95% CI:0.036-0.979), perception of being susceptible to cervical cancer (AOR = 6.39, 95% CI: 1.79-22.74), knowledge of cervical cancer and its screening (AOR = 19.34, 95% CI: 7.87-47.75), and positive attitude towards cervical cancer screening (AOR = 8.06, 95% CI:3.62-17.91) were significantly associated factors with the uptake of cervical cancer screening. CONCLUSION AND RECOMMENDATION: in this study, Age > 45 years, having less than three children, feeling susceptible, knowing about cervical cancer and screening, and having a positive attitude toward cervical cancer screening were significant factor of uptake of cervical cancer screening service. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.

The association between children's exposure to pesticides and asthma, wheezing, and lower respiratory tract infections. A systematic review and meta-analysis.

Background: Exposure to pesticides is a global public health problem, especially for children. Its association with chronic respiratory disease among children has attracted considerable attention, but the existing evidence remains inconclusive and cannot be certain. Therefore, this systematic review and meta-analysis aim to determine the global pooled effect size of association with pesticide exposure and asthma, wheezing, and respiratory tract infections among children. Methods: A comprehensive search was conducted for relevant literature from electronic databases, including PubMed, Google Scholar, Hinari, Semantic Scholar, and Science Direct. Studies that provided effect size on the association between pesticide exposure and childhood asthma, wheezing, and respiratory tract infections in children were included. The articles were screened, data was extracted, and the quality of each study was assessed with four independent reviewers. Random effects models for significant heterogeneity and fixed effect models for homogeneous studies were conducted to estimate pooled effect sizes with 95% confidence intervals using Comprehensive Meta-Analysis version 3.3.070 and MetaXL version 2. Funnel plot and Higgins I 2 statistics were used to determine the heterogeneity of the included studies. Subgroup analyses were computed based on the types of pesticide exposure, study design, sample size category, and outcome assessment technique. Result: A total of 38 articles with 118,303 children less than 18 years of age were included in this meta-analysis. Pesticide exposure among children increased the risk of asthma by 24%; (OR = 1.24, 95% CI: 1.14-1.35) with extreme heterogeneity (I 2 = 81%, p < 0.001). Exposure to pesticides increased the odds of developing wheezing among children by 34% (OR = 1.34, 95% CI: 1.14-1.57), with high heterogeneity (I 2 = 79%, p < 0.001) and also increased the risk of developing lower respiratory tract infection by 79% (OR = 1.79, 95% CI: 1.45-2.21) with nonsignificant low heterogeneity (I 2 = 30%, p-value = 0.18). Conclusion: This meta-analysis provided valuable evidence supporting the association between childhood asthma, wheezing, and lower respiratory tract infection with pesticide exposure. The findings would contribute to a better understanding of the estimate of the effect of pesticide exposure on respiratory health in children and inform evidence-based preventive strategies and public health interventions.

Spatial distribution and determinants of Early sexual initiation in Ethiopia.

INTRODUCTION: Early sexual initiation has negative health, social, and economic consequences for both women and future generations. The trend of early sexual initiation is increasing globally, leading to higher rates of sexually transmitted diseases and unplanned pregnancies. Ethiopia has been challenged various disasters that makes women vulnerable and position them at heightened risk of early sexual initiation in the last four years. The spatial patterns and factors of early sexual initiation in the post-conflict-post pandemic settings is not well understood. Hence this research aimed at mapping Spatial Patterns and identifying determinant factors in the Post-COVID-Post-Conflict Settings. METHODS: The study was conducted on secondary data from the PMA 2021 cross-sectional survey which conducted nationally from November 2021 to January 2022 which is in the post pandemic and post-war period. Total weighted sample of 6,036 reproductive age women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Multilevel logistic regression model was used to estimate the effects of independent variables on early sexual initiation at individual and community level factors. Adjusted odds ratio with the 95% confidence interval was reported to declare the strength and statistical significance of the association. RESULT: The spatial distribution of early sexual initiation was clustered in Ethiopia with a global Moran's I index value of 0.09 and Z-score 6.01 (p-value < 0.001).Significant hotspots were detected in East Gojjam zone of Amhara region, Bale, Arsi, West Hararge, East Wellega and Horo Gudru Wellega zones of Oromia region. The odds of having early sexual initiation was higher in women with primary education (AOR = 1.23, 95%CI: 1.03, 1.47), secondary or above education (AOR = 4.36, 95%CI: 3.49, 5.44), Women aged 26 to 25 (AOR = 1.91, 95%CI: 1.61, 2.26), women aged 36 to 49(AOR = 1.51, 95%CI: 1.24, 1.84). However, there was a significant lower likelihood of early sexual initiation in rural resident women (AOR = 0.53, 95%CI: 0.35, 0.81) and women living in 5 to 7 family size (AOR = 0.79, 95%CI: 0.68, 0.92), and more than 7 members (AOR = 0.63, 95%CI: 0.49, 0.81). CONCLUSIONS: The spatial distribution of early sexual initiation was clustered in Ethiopia. Interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas. Policies and interventions targeted to this problem may also take the identified associated factors into account for better results.

The burden of health expenditure on household impoverishment in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ethiopia, like many low-income countries, faces significant challenges in providing accessible and affordable healthcare to its population. Health expenditure is a critical factor in determining the quality and accessibility of healthcare. However, high health expenditure can also have detrimental effects on households, potentially leading to impoverishment. To the best knowledge of investigators, no similar study has been conducted in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the pooled burden of health expenditure on household impoverishment in Ethiopia. METHODS: This systematic review and meta-analysis used the updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Cochrane Library, HINARI, Google Scholar and Epistemonikos electronic databases were searched systematically. Moreover, direct manual searching through google was conducted. The analysis was performed using STATA version 17 software. Heterogeneity and publication bias were assessed using I2 statistics and Egger's test, respectively. The trim and fill method was also performed to adjust the pooled estimate. Forest plots were used to present the pooled incidence with a 95% confidence interval of meta-analysis using the random effect model. RESULTS: This systematic review and meta-analysis included a total of 12 studies with a sample size of 66344 participants. The pooled incidence of impoverishment, among households, attributed to health expenditure in Ethiopia was 5.20% (95% CI: 4.30%, 6.20%). Moreover, there was significant heterogeneity between the studies (I2 = 98.25%, P = 0.000). As a result, a random effect model was employed. CONCLUSION: The pooled incidence of impoverishment of households attributed to their health expenditure in Ethiopia was higher than the incidence of impoverishment reported by the world health organization in 2023.

Virological Suppression and its Predictors Among HIV/AIDS Patients on Antiretroviral Therapy in Ethiopia: Systematic Review and Meta-analysis.

Background: Achieving viral load suppression is crucial for the prevention of complications and deaths related to HIV infection. Ethiopia has embraced the worldwide 95-95-95 target, but there is no national representative information regarding virological suppression. Therefore, this review aims to determine the pooled virological suppression rate and identify the pooled effect of contributing factors of viral suppression for HIV-positive patients on antiretroviral therapy in Ethiopia. Methods: We systematically searched websites and databases, including online repositories, to obtain primary studies. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale appraisal checklist. Publication bias was checked using Egger's regression test, the heterogeneity of the studies was assessed using I2 statistics and Q statistics, and a sensitivity analysis was performed to identify any outlier results in the included studies. The Der Simonian Laird random-effects model was used to estimate the overall proportion of viral suppression, and STATA 17 statistical software was used for all types of analysis. Results: A total of 21 eligible articles primarily conducted in Ethiopia using HIV program data were used for this quantitative synthesis. The overall pooled virological suppression rate was 71% (95% CI, 64%-77%). The pooled effects of poor adherence to ART (adjusted odds ratio [AOR], 0.33; 95% CI, 0.28-0.40), body mass index (18.5-24.9 kg/m2; AOR, 1.8; 95% CI, 1.37-2.36), disclosure (AOR, 1.41; 95% CI, 1.05-1.89), absence of opportunistic infection (AOR, 1.68; 95% CI, 1.43-1.97), and high baseline viral load count (AOR, 0.65; 95% CI, 0.52-0.81) were identified as significant predictors of viral suppression. Conclusions: The overall pooled percentage of virological suppression was low compared with the global target of viral suppression and the Ethiopian Public Health Institute report. Poor adherence, normal body mass index, disclosure, absence of opportunistic infection, and high baseline viral load count were factors contributing to viral suppression in Ethiopia. Responsible stakeholders should maximize their efforts to achieve the global target of virological suppression by addressing significant predictors.

Under utilization of long-lasting insecticidal nets (LLINs) is challenging malaria elimination program in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Malaria is one of the most common causes of morbidity and mortality in developing countries including Ethiopia. Mass distribution of insecticide-treated nets and indoor residual spray for high malaria risk groups are the major prevention measures in different countries. Achievement of the malaria elimination plan is highly determined by the level of effective utilization of intervention measures. However, there is scarce information showing the national level of insecticide-treated nets utilization. OBJECTIVE: To estimate the pooled prevalence of insecticide-treated nets utilization in Ethiopia, 2023. METHOD: A Systematic Review and Meta-analysis employed to assess the utilization of long-lasting insecticidal nets in Ethiopia. Published articles were searched from Google Scholar, PubMed, Web Sciences, CINAHIL, EMBASE, and Scopus. The collected articles were screened for data extraction and further analysis using preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart. The quality of each study was assessed using the Jonna Briggs Institute (JBI) checklist. The data were extracted using Microsoft Excel and exported to STATA version 17.0 for analysis. The overall pooled prevalence of long-lasting insecticidal nets utilization was determined using a random effects model. RESULT: Out of 1657 articles reviewed, only 21 of them were eligible for final analysis. All of the included studies were used to estimate the pooled prevalence of long-lasting insecticidal net utilization. The point prevalence of LLIN utilization ranged from 14.23 to 91.9%. The Meta-analysis estimated that the overall pooled prevalence of insecticidal nets utilization among all study participants in Ethiopia was 56.26% (95%CI: 44.04-68.48%). Subgroup analysis revealed that insecticidal nets utilization was relatively highest in the Amhara region [63.0, 95%CI (37.0-89.0%)] and during 2020-2023 [61, 95% CI (53.0-69.0%)]. CONCLUSION: Long-lasting insecticidal nets utilization in Ethiopia is lower than the national target plan. Hence, it needs extra follow-up and intervention to enhance its utilization.

Patient knowledge of surgical informed consent and shared decision-making process among surgical patients in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Informed consent is one of the safeguarding of the patient in medical practice at different standards such as ethical, legal, and administrative purposes. Patient knowledge and perception of informed consent are one of the priority concerns in surgical procedures. Patient knowledge and perception towards informed consent increased patient satisfaction, feeling high power on their determination, and accountability for the management, and facilitated positive treatment outcomes. Despite this, in Ethiopia, there are small-scale primary studies with inconsistent and inconclusive findings. Therefore, this systematic review and meta-analysis study estimated the pooled prevalence of patient knowledge and perception of informed consent and its determinants in Ethiopia. METHODS: We searched major databases such as PubMed, Hinary, MEDLINE, Cochrane Library, EMBASE, Scopus, African Journal Online (AJO), Semantic Scholar, Google Scholar, google, and reference lists. Besides this, University databases in the country were also searched from August 20, 2023, until September 30, 2023,. All published and unpublished studies that report the prevalence of patient knowledge and perception toward informed consent and its associated factors were included. All studies reported in English were included. Studies conducted between January 01, 2015 to September 30, 2023 were included. There are three outcome measurements pooled level of patient knowledge towards informed consent, pooled level of patient perception towards informed consent, and pooled effect that affects patient knowledge of informed consent. Three reviewers (MMM, NK, and YT) independently screened the articles that fulfilled the inclusion criteria to avoid the risk of bias. The studies' quality was appraised using a modified Newcastle-Ottawa Scale (NOS) version. RESULTS: The pooled prevalence of appropriate patient knowledge and perception towards informed consent was 32% (95% CI: 21, 43) and 40% (95% CI: 16, 65) respectively. Having formal education 2.69 (95% CI: 1.18, 6.15) and having a history of signed informed consent before 3.65 (95% CI:1.02,13.11) had a statistically significant association with good patient knowledge towards informed consent. CONCLUSION: The appropriate patient knowledge and perception of informed consent in Ethiopia is low. Formal education and history of signed informed consent were positive factors for appropriate patient knowledge of informed consent in Ethiopia. Physicians, policymakers, and health facility managers should focus on patients without prior experience with signed informed consent and not have formal education to improve patient knowledge towards informed consent. The protocol was registered at Prospero with number CRD42023445409 and is available from: https://www.crd.york.ac.uk/PROSPERO/#myprospero .

Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis.

BACKGROUND: Early sexual initiation refers to engaging in sexual activity at a young age, typically before the age of 18. Even though many studies have been conducted in Ethiopia, the result is inconsistent between studies. In the study area, the pooled prevalence and associated factors of early initiation of sexual intercourse among youth were not done before. Therefore, this study aimed to determine the pooled prevalence and associated factors of early initiation of sexual intercourse among Youth in Ethiopia. METHODS: This study used a systematic review and meta-analysis of studies conducted from 2008 to 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran's Q statistics and Funnel plots, Egger test, and Begg rank tests respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Pooled analysis was conducted using the inverse-variance fixed-effects model. RESULTS: A total of 10 articles were included in this systematic review and meta-analysis. The pooled prevalence of early initiation of sexual intercourse among youth in Ethiopia was 24.7% (95%CI: 10.4, 38.9). Being female (AOR = 3.57; 95% CI: 1.387, 5.743), having poor knowledge of HIV/AIDS prevention (AOR = 3.65; 95% CI: 1.981,5.309), alcohol use (AOR = 2.05; 95% CI: 1.415, 2.679), khat chewing (AOR = 3.03; 95% CI: 1.800, 4.254), Viewed pornographic film(AOR = 4.21, 95% CI: 2.135, 6.283), Cigarette smoking (AOR = 2.74; 95% CI: 2.102, 3.370) and Poor family controls (AOR = 4.39; 95% CI: 2.572, 6.199)were associated factors of early initiation of sexual intercourse. CONCLUSIONS: The pooled prevalence of early initiation of sexual intercourse among Youth in Ethiopia was high. Being female, poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, Viewing pornographic films, Cigarette smoking, and poor family controls were associated factors of early initiation of sexual intercourse. It is recommended that targeted interventions be put in place to address the high prevalence of early initiation of sexual intercourse among youth in Ethiopia. These interventions should focus on addressing the associated factors such as poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, viewing pornographic films, cigarette smoking, and poor family controls. It is important that these interventions are gender-sensitive and take into consideration the unique challenges faced by females in accessing sexual and reproductive health services.

The efficacy of theory of planned behavior to predict breast self-examination among women: systematic review and meta-Analysis.

Background: Even though a few studies have been conducted, the result is inconsistent between studies. The Theory of Planned Behavior (TPB) is a widely used framework for predicting and understanding health behaviors. In the study area, the theory of planned behavior ability to predict breast self-examination among women was not done before. Therefore, this study aimed to determine the efficacy of the Theory of Planned Behavior to predict breast self-examination among women. Methods: This study used a systematic review and meta-analysis of studies conducted from 2008 to 2018 globally. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Semantic Scholar, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran's Q statistics, Funnel plots, and the Egger test respectively. Pooled analysis was conducted using the random-effects model of the DerSimonian-Laird method. Results: A total of 5 articles were included in this systematic review and meta-analysis. The overall Pooled Proportion of variance of the Theory of Planned Behavior ability to predict breast self-examination among women was explained at 38% (95%CI: 26.9, 49.1). Conclusions: The overall Pooled Proportion of variance explained by the Theory of Planned Behavior ability to predict breast self-examination among women was low as compared to the original assumption of variance explained. While the Theory of Planned Behavior provides a useful framework for understanding health behaviors, it may not fully capture all the complex factors contributing to breast self-examination. Additionally, future studies should consider using alternative measures of variance explained to provide a more comprehensive understanding of the predictive power of the theory of planned behavior.

Determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals: a case-control study.

BACKGROUND: Cervical cancer is the second leading cause of cancer-related death and one of the top 20 causes of death among women in Ethiopia. Cervical cancer screening service has a vital value to reduce morbidity and mortality. Even though cervical cancer screening service utilization in Ethiopia is unacceptably low, its determinant factors were not well studied in the study area. Hence, this study was aimed at filling this information gap. This study aimed to identify determinants of cervical cancer screening service utilization among women attending healthcare services in Amhara region referral hospitals, Ethiopia. METHODS: Hospital-based case-control study was conducted among 441 women (147 cases and 294 controls) from May to July 2021. Cases were included consecutively and controls were selected using a systematic random sampling technique from the randomly selected hospitals. A pretested interviewer-administered questionnaire was used to collect the data from respondents. The data were entered into Epi data version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression analysis was employed. Adjusted odds ratio with its 95% confidence interval and p value < 0.05 were used to estimate the strength and significance of the association. RESULT: A total of 147 cases and 294 controls were enrolled in this study. Women with 30-39 years-old [AOR = 2.3; 95% CI 1.21, 4.68] and 40-49 years-old [AOR = 4.4 95% CI 1.97, 10.12], urban residence [AOR = 2.6; 95% CI 1.36, 5.21], secondary education [AOR = 4.4; 95% CI 2.18, 8.87] and diploma and above [AOR = 2.0; 95% CI: 1.05, 4.59], ever gave birth [AOR = 9.4; 95% CI 4.92, 18.26], having multiple sexual partners [AOR = 2.8; 95% CI 1.60, 5.03], good knowledge towards cervical cancer screening [AOR = 3.6; 95% CI 2.07, 6.43] and positive attitude on cervical cancer screening [AOR = 2.0, 95% CI 1.20, 3.70] were significant determinants of cervical cancer screening service utilization. CONCLUSION: In this study, age (30-39 and 40-49), urban residence, secondary education, ever gave birth, good knowledge of cervical cancer screening, positive attitude towards cervical cancer screening, and having multiple sexual partners were significant determinants of cervical cancer screening service utilization. There is a need to strengthen the policy and health education on safe sexual practices and healthy lifestyles through information dissemination and communication to scale up screening service utilization.

Acceptance of COVID-19 Vaccine and Its Associated Factors Among Ethiopian Population: A Systematic Review.

Introduction: Coronavirus disease 2019 (COVID-19) is a global health threat. Millions of lives were lost to COVID-19 and it has caused a substantial economic crisis throughout the world. The development of coronavirus vaccines has pinned a new hope in combating the pandemic. The success of vaccination and development of herd immunity highly depend on the willingness to be vaccinated, not merely on the availability of a vaccine. This review aims to provide comprehensive evidence on acceptance of COVID-19 vaccine and its associated factors in Ethiopia. Methods: Literature searching was done using PubMed, Google scholar and Science direct databases. Studies conducted in Ethiopia, published in English language from inception until January 9, 2022 were included. Retrieved articles were screened based on titles, abstracts and full text reading to identify studies that met the inclusion criteria. About 21 eligible studies were included in this systematic review. The data were extracted using a data extraction checklist. Results: A total of 2058 records were retrieved, of which 21 were eligible for this systematic review. All of the articles were cross-sectional studies published in 2021. In Ethiopia, the level of COVID-19 vaccine acceptance ranged from 31.4% to 92.33%. The vaccine acceptance level was significantly associated with age groups, sex, educational status, perceived susceptibility, perceived benefit, knowledge about COVID-19 vaccine, and other socio-demographic factors. Conclusion: A significant portion of the studies revealed vaccine acceptance level was low. Variation of vaccine acceptance was associated with socio-demographic factors (age, sex, educational status, etc.), information-related factors, and other health-related behaviors. Dissemination of clear and adequate information concerning the vaccine might be the required prior activity to increase acceptance of the vaccine. Hence, there should be a coordinated effort to halt the pandemic through increasing the acceptance of COVID-19 vaccine.