Prevalence and associated factors of anemia among postpartum mothers in public health facilities in Ethiopia, 2024: a systematic review and meta-analysis.

BACKGROUND: Postpartum anemia, characterized by hematocrit or hemoglobin levels below the defined cutoff point (< 11gm/dl or hematocrit < 33%), is a prevalent global issue. It serves as an indirect contributor to maternal mortality and morbidity. Mothers in the postpartum period experience diminished quality of life, impaired cognitive function, emotional instability, and an increased risk of postpartum depression due to anemia. Additionally, infants of affected mothers may face challenges such as insufficient breast milk supply and a lack of proper care. Examining the combined prevalence and factors associated with postpartum anemia is crucial for addressing maternal health risks and complications during the postnatal phase attributed to anemia. OBJECTIVE: The study aimed to synthesize the existing literature on the prevalence and associated factors of postpartum anemia in public health facilities of Ethiopia, in 2024. METHODS: The study was conducted by searching through the Google Scholar, PubMed, and Cochrane Library search engines. The search utilized keywords and MeSH terms such as anemia, low hemoglobin, postpartum, postnatal women, and Ethiopia. The collected data underwent analysis and comparison with the WHO criteria to determine if it met the threshold for declaring a public health concern. Heterogeneity was evaluated through the Cochran Q test and I2 statistics. Prevalence and odds ratio estimations were performed using a random-effects model with a 95% confidence interval. RESULT: Four studies were included in this systematic review and meta-analysis. The overall pooled prevalence of anemia among postpartum women in Ethiopia was 69% (95% CI: 60- 77%).Lack of formal education(OR = 3.5;CI:2.639,4.408),Low Pre-delivery hemoglobin (OR = 4.2;CI: 1.768-6.668), Postpartum women < 4 ANC visit (OR = 2.72; 95% CI:2.14,3.3 ),history of post partum hemorrhage (OR = 2.49; CI: 1.075-3.978),history of Forceps/vacuum delivery(OR = 3.96; CI:2.986-4.947), Poor iron and folic acid adherence (OR = 2.8;95% CI:2.311,3.297), C/S (OR = 4.04; 95% CI: 3.426,4.671),lower dietary diversity (OR = 4.295% CI:1.768,6.668) were significantly associated postpartum anemia. CONCLUSION: Postpartum women in Ethiopia continue to face a considerable public health challenge in the form of anemia. Consequently, there is a pressing need for the government to formulate comprehensive, multi-sectorial policies and strategies. These initiatives should be designed to address the substantial regional disparities influenced by interconnected factors, with the aim of reducing the prevalence of anemia among postpartum women in Ethiopia.

Lived Experience of People with Type 1 Diabetes in North East Ethiopia; Psycho-Social and Economical Perspective, a Phenomenological Study.

Objective: To explore lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective. Methods: A descriptive phenomenological study was conducted to explore the lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective from March 02 to March 25, 2020. A heterogeneous purposive sample method was used to choose the participants. The lead investigator used an in-depth interview to collect data, using an audio recorder and an interview guide. The data were analysed using the thematic analysis method. Atlas. ti software version 7 was used to facilitate the data analysis process. Results: A total of 13 participants were enrolled in this study. The participants age range were 14 to 70 years and their duration of diabetes since diagnosis were from 8 months to 16 years. The three interconnected themes that emerged from the analysis are: (1) psychological experience with two sub-themes (psychological problems due to diabetes including fear and coping strategies for psychological problems), (2) social experience, which has five categories (influence on intimate relationships, influence on social participation, disclosure status, social isolation and stigma, social support, and influence on education); and (3) economic experience. Conclusion: Fear was one of the psychological experiences felt by people with type 1 diabetes. Although type 1 diabetes is a biomedical problem, it is also accompanied by other psychological and socio-economic issues, that require a holistic approach to address it. So, health professionals should strengthen health information dissemination programs.

Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: Cross-sectional study.

BACKGROUND: Father Involvement is exercising positive influences on child feeding. Mothers are usually the primary caregivers for young children. The role of fathers in the proper child feeding of young children has not been a frequent topic of study. Past research has found low rates and little is known about fathers' involvement in child feeding for children 6-23 months in Ethiopia. The aim of this study is to assess fathers' involvement in child feeding children aged 6-24 Months. OBJECTIVES: To assess fathers' involvement in child feeding and associated factors among fathers having children aged 6 to 24 months. METHODOLOGY: A community-based cross-sectional study design was conducted from Jan 23/2022 to April 07/2022. A systematic random sampling technique was applied to select study participants. A total of 408 respondents participated in the study. Data was entered into EPI data version 3.1 and then exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression was used for analysis. RESULT: Father's involvement in child feeding was 43.1%. Factors that were significantly associated with good fathers involvement in child feeding include urban residence(AOR = 3.878, 95% CI = (1.408-10.678), male sex of the youngest child(AOR = 3.681, 95% CI = (1.678-8.075)), first birth order of the youngest child(AOR = 3.970, 95% CI = (1.212-13.005)), Better(secondary and higher) educational status (AOR = 4.945,95% CI = (1.043-23.454)) and AOR = 5.151, 95% CI = (1.122-23.651)), having ever heard information(AOR = 8.593, 95% CI = (3.044-24.261)), good knowledge (AOR = 3.843,95% CI = (1.318-11.210)), positive attitude (AOR = 8.565, 95% CI = (3.521-20.837)) and good culture (AOR = 10.582,95% CI = (2.818-39.734)). CONCLUSIONS: Father involvement in child feeding was poor in Antsokia Gemza Woreda. Urban residences, male sex of the youngest child, first birth order of the youngest child, better (secondary and higher) educational status, having ever heard information, good knowledge, positive attitude, and good culture were significantly associated with fathers' involvement in child feeding. Health information dissemination on father involvement in child feeding should be strengthened.

First data from a population based cancer registry in Ethiopia.

BACKGROUND: The Addis Ababa City Cancer Registry, established in September 2011, is the only population-based cancer registry in Ethiopia, covering a catchment population of just over three million habitants. Herein, we report incidence data based on the first two years of registration, 2012-2013. METHODS: Newly-diagnosed cancer cases in the capital city were actively collected from 22 hospitals, clinics, and diagnostic facilities. RESULTS: During 2012-2013, a total of 4139 newly diagnosed cases were recorded, with the majority (67%) occurring in females. Cancers of the breast (31.5%) and cervix (14.1%) were the two most common cancers among females, while colorectal cancers (10.6%) and non-Hodgkin lymphomas (10.2%) were the most common cancers among males. The average annual age-standardized rate for all sites 2012-13 were 136.2 (per 100,000) and 70.7 in females and males, respectively. Female age-standardized rates were 40.6 for breast cancer and 21.5 for cervix, while equivalent rates in males were 7.6 per 100,000 for colorectal cancer and 6.8 per 100,000 for non-Hodgkin lymphoma. CONCLUSION: In general, these incidence patterns were similar to those reported in neighboring countries, which suggests that the majority of cancer cases occurring in Addis Ababa are captured within this starting phase of the registry. However, our finding of colorectal cancer as the most commonly-diagnosed cancer in males is novel and requires further investigation.

Results of a phase II study of Short-course Accelerated Radiation Therapy (SHARON) for multiple brain metastases.

OBJECTIVES: To assess the effectiveness of a SHort-course Accelerated RadiatiON therapy (SHARON) in the treatment of patients with multiple brain metastases. MATERIALS AND METHODS: A phase II clinical trial was designed. Eligibility criteria included patients with at least 3 brain metastases or metastatic disease in >3 organ systems, and Eastern Cooperative Oncology Group performance status of ≤3. Fifty patients were treated with whole brain radiotherapy at 18 Gy (4.5 Gy per fraction) in 2 days with a twice daily fractionation. The primary endpoint was the assessment of efficacy in terms of overall survival. RESULTS: Characteristics of the 50 enrolled patients were: male/female: 24/26; median age: 65 years (range, 45 to 80 y). Eastern Cooperative Oncology Group performance status was <3 in 42 patients (84%). Nineteen patients (38%) were considered to have recursive partitioning analysis class 3 disease. Grade 1-2 acute neurological (46%) and skin (24%) toxicities were recorded. Three patients (6%) experienced neurological grade 3 acute toxicity. With a median follow-up time of 6 months (range, 1 to 18 mo) 2 skin grade 1 late toxicities has been observed. Seventeen of 27 symptomatic patients showed an improvement or resolution of baseline symptoms (overall palliative response rate: 63.0%; 95% confidence interval, 36.6%-82.4%).Two-month overall survival was 86% (median survival time=7 mo). CONCLUSIONS: Short-course accelerated whole brain radiotherapy of 18 Gy in twice daily fractions for 2 consecutive days is tolerated and effective in terms of symptom relief and median survival time. These results justify a phase III comparison against the standard-of-care in this patient population (30 Gy in 10 fractions).

The prevalence of estrogen receptor-negative breast cancer in Ethiopia.

BACKGROUND: In contrast with breast cancers (BCs) in other parts of the world, most previous studies reported that the majority of BCs in sub-Saharan Africa are estrogen-receptor (ER) negative. However, a recent study using the US SEER database showed that the proportion of ER-negative BC is comparable between US-born blacks and West-African born blacks but substantially lower in East African-born blacks, with over 74% of patients Ethiopians or Eritreans. In this paper, we provide the first report on the proportion of ER-negative BC in Ethiopia, and the relation to progesterone-receptor (PgR) status. METHODS: We analysed 352 female patients with ER results available out of 1208 consecutive female BC patients treated at Addis Ababa-University Hospital, Ethiopia, from June 2005 through December 2010. The influences of age, stage, and histology on the probability of ER-negative tumours were assessed by a log-linear regression model. RESULTS: Of the 352 patients, only 35% were ER-negative. The proportion of ER-negative tumours decreased with advancing age at diagnosis and was not affected by histology or stage. For age, the proportion decreased by 6% for each additional 5 years (stage-adjusted prevalence ratio PR=0.94, 95% CI: 0.89-1.00). About 31% were ER- and PgR-negative, and 69% were ER- and/or PgR-positive. CONCLUSIONS: Contrary to most previous reports in other parts of sub-Saharan Africa, the majority of patients in Ethiopia are ER-positive rather than ER-negative. These findings are in line with low proportions of ER-negative BCs from East African immigrants within the SEER database, and they have clinical implications for management of BC patients in Ethiopia and other parts of sub-Saharan Africa where ER-status is not ascertained as part of routine management of the disease. Since the majority of patients showed ER-positive BC, Tamoxifen-therapy should be given to all patients even with unknown ER status.

Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer.

This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT) treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned "field-in-field" IMRT technique (Co-FinF) where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. Dmean, D98%, D2%, V95%, V107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D2%) and high-dose volume (V110%). Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.

Experience of initial symptoms of breast cancer and triggers for action in ethiopia.

Objective. This study assessed the initial experiences, symptoms, and actions of patients in Ethiopia ultimately determined to have breast cancer. Methods. 69 participants in a comprehensive breast cancer treatment program at the main national cancer hospital in Ethiopia were interviewed using mixed qualitative and quantitative approaches. Participants' narratives of their initial cancer experience were coded and analyzed for themes around their symptoms, time to seeking advice, triggers for action, and contextual factors. The assessment was approved by the Addis Ababa University Faculty of Medicine Institutional Review Board. Results. Nearly all women first noticed lumps, though few sought medical advice within the first year (average time to action: 1.5 years). Eventually, changes in their symptoms motivated most participants to seek advice. Most participants did not think the initial lump would be cancer, nor was a lump of any particular concern until symptoms changed. Conclusion. Given the frequency with which lumps are the first symptom noticed, raising awareness among participants that lumps should trigger medical consultation could contribute significantly to more rapid medical advice-seeking among women in Ethiopia. Primary care sites should be trained and equipped to offer evaluation of lumps so that women can be referred appropriately for assessment if needed.

A mixed-method assessment of beliefs and practice around breast cancer in Ethiopia: implications for public health programming and cancer control.

A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients.

Complex care systems in developing countries: breast cancer patient navigation in Ethiopia.

BACKGROUND: As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently. METHODS: This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed. RESULTS: Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital. Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from 1 health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers. CONCLUSIONS: The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral.

Management of traumatic arterio-venous fistulas, experience in Armed Forces General Hospital, Addis Ababa.

In Armed Forces General Hospital from March to December 1999, 53 patients were operated for Arterio-venous fistula. All were males, their age ranging from 19 to 46 years, average 27 years. The diagnosis of arterio-venous fistulas was established clinically. The pathological distribution of the lesions were: 23(43.4%) Arterio-Venous aneurysm; 11(20.75%) Arterio-Venous fistula, 19(35.85%) Arterial false aneurysms. The anatomical location was: 15 femoral, 10 Tibial, 6 poplitial, 6 brachial, 4 Axilláry, 1 ulnar, 7 external carotid and 1 occipital. The types of surgical procedures performed were: 29 (54.72%) excision of the arterio-venous fistula and aneurismal sac with arterial restoration by end to end anastomosis and/or saphenous vein graft, 16(30.19%) by excision of arteriovenous fistula and quadriple ligation of small vessels, 8(15.09%) excision of the false aneurismal sac and lateral repair of the artery (lateral arterioraphy). During the post operative period the patients were followed for three months, and we had the following results based on the clinical outcome criteria; 37(69.81%) excellent, 15(28.3%) good and 1(1.89%) fair.