Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis.

Background: Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia. Methods: Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis. Results: Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals. Conclusions: The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.

Risk score prediction for bacteriologically confirmed tuberculosis among HIV-infected adults on antiretroviral therapy in Ethiopia: prognostic model development.

OBJECTIVE: This study was aimed at developing a risk score prediction model for bacteriologically confirmed TB among HIV-infected adults receiving antiretroviral therapy in Ethiopia. METHODS: An institutional-based retrospective follow-up study was conducted among 569 HIV-infected adults on ART. We used demographic and clinical prognostic factors to develop a risk prediction model. Model performance was evaluated by discrimination and calibration using the area under the receiver operating characteristic (AUROC) curve and calibration plot. Bootstrapping was used for internal validation. A decision curve analysis was used to evaluate the clinical utility. RESULTS: Opportunistic infection, functional status, anemia, isoniazid preventive therapy, and WHO clinical stages were used to develop risk prediction. The AUROC curve of the original model was 87.53% (95% CI: 83.88-91.25) and the calibration plot (p-value = 0.51). After internal validation, the AUROC curve of 86.61% (95% CI: 82.92-90.29%) was comparable with the original model, with an optimism coefficient of 0.0096 and good calibration (p-value = 0.10). Our model revealed excellent sensitivity (92.65%) and negative predictive value (NPV) (98.60%) with very good specificity (70.06%) and accuracy (72.76%). After validation, accuracy (74.85%) and specificity (76.27%) were improved, but sensitivity (86.76%) and NPV (97.66%) were relatively reduced. The risk prediction model had a net benefit up to 7.5 threshold probabilities. CONCLUSION: This prognostic model had very good performance. Moreover, it had very good sensitivity and excellent NPV. The model could help clinicians use risk estimation and stratification for early diagnosis and treatment to improve patient outcomes and quality of life.

Spatial variation and associated factors of inadequate counselling regarding pregnancy danger signs during antenatal care visits among pregnant women in Ethiopia: a Geographically Weighted Regression Model.

INTRODUCTION: Inadequate counselling of pregnant women regarding pregnancy danger signs contributes to a delay in deciding to seek care, which causes up to 77% of all maternal deaths in developing countries. However, its spatial variation and region-specific predictors have not been studied in Ethiopia. Hence, the current study aimed to model its predictors using geographically weighted regression analysis. METHODS: The 2019 Ethiopian Mini Demographic and Health Survey data were used. A total weighted sample of 2922 women from 283 clusters was included in the final analysis. The analysis was performed using ArcGIS Pro, STATA V.14.2 and SaTScan V.10.1 software. The spatial variation of inadequate counselling was examined using hotspot analysis. Ordinary least squares regression was used to identify factors for geographical variations. Geographically weighted regression was used to explore the spatial heterogeneity of selected variables to predict inadequate counselling. RESULTS: Significant hotspots of inadequate counselling regarding pregnancy danger signs were found in Gambella region, the border between Amhara and Afar regions, Somali region and parts of Oromia region. Antenatal care provided by health extension workers, late first antenatal care initiation and antenatal care follow-up at health centres were spatially varying predictors. The geographically weighted regression model explained about 66% of the variation in the model. CONCLUSION: Inadequate counselling service regarding pregnancy danger signs in Ethiopia varies across regions and there exists within country inequality in the service provision and utilisation. Prioritisation and extra efforts should be made by concerned actors for those underprivileged areas and communities (as shown in the maps), and health extension workers, as they are found in the study.

Geospatial variation of exclusive breastfeeding and its determinants among mothers of infants under 6 months in Ethiopia: spatial and geographical weighted regression analysis.

BACKGROUND: Exclusive breastfeeding (EBF) is a major public health problem in Ethiopia. However, the spatial variation of EBF and the associated factors have not been studied as much as we have searched. This study aimed at assessing geospatial variation and the predictors of EBF using geographically weighted regression. METHODS: A cross-sectional study was conducted using the 2019 Mini-Ethiopian Demographic and Health Survey data set. The study used a total weighted sample of 548 infants. Hotspot spatial analysis showed the hotspot and cold spot areas of EBF. The spatial distribution of EBF was interpolated for the target population using spatial interpolation analysis. SaTScan V.9.6 software was used to detect significant clusters. Ordinary least squares regression analysis identified significant spatial predictors. In geographically weighted regression analysis, the effect of predictor variables on the spatial variation of EBF was detected using local coefficients. RESULTS: The weighted prevalence of EBF in Ethiopia was 58.97% (95% CI 52.67% to 64.99%), and its spatial distribution was found to be clustered (global Moran's I=0.56, p<0.001). Significant hotspot areas were located in Amhara, Tigray, Southern Nations, Nationalities, and Peoples' Region, and Somali regions, while significant cold spots were located in Dire Dawa, Addis Ababa and Oromia regions. Kulldorff's SaTScan V.9.6 was used to detect significant clusters of EBF using a 50% maximum cluster size per population. The geographically weighted regression model explained 35.75% of the spatial variation in EBF. The proportions of households with middle wealth index and married women were significant spatial predictors of EBF. CONCLUSION: Middle wealth index and married women were significant spatial predictors of EBF. Our detailed map of EBF hotspot areas will help policymakers and health programmers encourage the practice of EBF in hotspot areas and set national and regional programmes focused on improving EBF in cold spots by considering significant predictor variables.

Correction: Spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis.

[This corrects the article DOI: 10.1371/journal.pone.0296123.].

Prevalence of delayed treatment for sexually transmitted infections and its determinants in sub-Saharan Africa. A systematic review and meta-analysis.

BACKGROUND: Sexually transmitted infection is a common public health issue, and it is characteristically transmitted through sexual intercourse. Around the globe, particularly in less developed countries, delayed treatment of this infection could lead to a health and economic burden. Even though the health and economic burden of sexually transmitted infections is high, studies to identify the pooled proportion and the possible factor of delayed treatment seeking are rare in sub-Saharan African countries. OBJECTIVE: To assess the prevalence of delayed treatment for STIs and its determinants in sub-Saharan African countries. METHOD: Articles searched on search engines like Medline via PubMed, HINARI, Embase, Scopus, Cochrane Library, Science Direct, and websites like Google Scholar. The searching mechanism was using keywords and medical subject heading terms by combining the key terms of the title. To assure the quality of the included articles, Joana Brigg's Institute critical appraisal checklist was used. To assess the heterogeneity of the studies, a sensitivity analysis was conducted. The PRISMA checklist was used, and to estimate the pooled odds ratio, a random effect model was considered. The pooled odds ratio of 95% CL was used to identify the factors. RESULTS: About 13 studies with 46,722 participants were incorporated. Despite considerable heterogeneity, the pooled prevalence of delayed treatment for STI in Sub-Saharan Africa was 47% (95% CI: 42%-51%, I2 = 98.42, p<0.001). Geographically, the higher pooled prevalence of delayed treatment for STI was in the eastern part of Africa (50%) (95% CI: 41%-59%, I2 = 98.42, p<0.001). Rural residence (OR = 1.44, 95% CI: 1.03-2.01, I2 = 39.3%, p-value = 0.19), poor knowledge about STI (OR = 1.49, 95% CI: 1.04-2.13, I2 = 93.1%, p-value = <0.001), perceived as STIs not serious (OR = 2.1, 95% CI: 1.86-2.36, I2 = 73.7%, p-value = 0.022), misconception for STD cause (OR = 1.39, 95% CI: 1.12-1.72), no education (OR = 4.1, 95% CI: 3.4-5.1), primary education (OR = 3.17, 95% CI: 2.23-4.2), and secondary education (OR = 1.57, 95% CI: 1.1-2.76) as compared to secondary and above education were factors associated with delayed treatment for STIs. CONCLUSION: The pooled prevalence of delayed treatment for STIs in Sub-Saharan African countries was high. Poor knowledge, attitude, and educational status affect the treatment delay for STIs. Thus, improving knowledge, educational status, and attitude are highly recommended to reduce the delayed treatment of STIs.

Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis.

INTRODUCTION: Cervical cancer is the most common malignant tumor among women. It is the main cause of death among women in sub-Saharan African countries. Particularly, the incidence and mortality rates are highest in East Africa. Even though the burden of human papilloma virus-related cervical cancer is high in East Africa, there is no conclusive evidence about the prevalence of human papilloma virus vaccine uptake and its predictors. OBJECTIVE: To assess the pooled prevalence of human papilloma virus vaccine uptake and its determinants in East Africa. METHOD: Eligible articles were searched on PubMed, Embase, Scopus, Cochrane Library, Google Scholar, and Google. Those articles incorporating the outcome of interest, both analytical and descriptive study designs, and published or unpublished articles at any time were included. Keywords and Medical Subjects Heading terms or synonyms of human papilloma virus vaccine and Boolean operators were used to retrieve the articles. To assure the quality of articles, Joana Brigg's Institute critical appraisal checklist for cross-sectional studies was used. Sensitivity analysis was conducted to assess the heterogeneity among the studies, and a random effect model was used to analyze the pooled effect size. RESULT: A total of 29 articles were included, and the pooled prevalence of HPV vaccine uptake in East Africa was 35% (95% CI: 26-45%). Good knowledge (OR = 1.6, 95%CI; 1.43-1.8), positive attitude (OR = 2.54, 95% CI; 2.13-3.03), ever heard about HPV vaccine (OR = 1.41, 95% CI; 1.03-1.94), mother educational status above college (OR = 1.84, 95%CI; 1.03-3.31), middle wealth index (OR = 1.33, 95%CI; 1.04-1.7), ≥ 9 family size (OR = 0.76, 95%CI; 0.68-0.98), availability of promotion (OR = 2.53, 95%CI: 1.51-4.26), availability of adequate vaccine (OR = 4.84, 95%CI; 2.9-8.08), outreach vaccination practice (OR = 1.47, 95%CI; 1.02-2.12) and family support (OR = 4.3, 95% CI; 2.98-6.21) were the significant factors for the uptake of human papilloma virus vaccine. CONCLUSION: As compared to the global strategic plan, the pooled prevalence of HPV vaccine uptake in east Africa was low. The uptake of the HPV vaccine was higher among adolescents than youths. Knowledge about the HPV vaccine, attitude towards the HPV vaccine, ever hearing about the HPV vaccine, residence, mother's educational status, mother's occupational status, wealth index, and family size were the significant determinants of HPV vaccine uptake. Therefore, we recommend focusing on awareness creation and behavioral change to expand the uptake of vaccines in East Africa.

Magnitude and determinant of healthcare-seeking behavior for childhood acute respiratory tract infections in Ethiopia: a cross-sectional study.

BACKGROUND: Acute respiratory infections (ARIs) remain a major public health concern which become the leading cause of mortality and morbidity in children under the age of five. A large percentage of childhood deaths and complications can be avoided by seeking proper medical care. Therefore, this study aimed to assess the magnitude, and individual and community-level determinants of mothers' healthcare-seeking behavior for their children under the age of five who had ARI symptoms in Ethiopia. METHOD: A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Surveys(EDHS) with a total weighted sample of 643 under-five children who had ARI symptoms within two weeks of the survey. Due to the hierarchical nature of the EDHS data, a multi-level logistic regression model was used to identify the individual and community-level factors influencing mothers' health care-seeking behavior for their children with ARI symptoms. In the multivariable multilevel analysis, those variables with a p-value < 0.05 were considered to be significant predictors of the outcome variable. RESULTS: Healthcare-seeking behavior among mothers or caregivers for children with symptoms of ARIs was 32.61% (95% CI: 29.08-36.33%) in Ethiopia. The ICC in the null model indicated that about 55% of the total variability of treatment-seeking behavior was due to differences between clusters. Child aged > 24 months [AOR = 0.35; 0.19-0.63], having primary education [AOR = 3.25; 1.27-8.32], being media exposed [AOR = 2.49; 1.15, 5.38], female household head[AOR = 3.90; 1.35, 11.24], and delivery at health institution[AOR = 2.24; 1.00, 5.01] were significant predictors of health care seeking behavior of mother for their children with ARI symptoms. CONCLUSION: There is poor treatment-seeking behavior for children with symptoms of ARI in Ethiopia with significant community level variations. The multilevel logistic regression analysis showed that improving mothers' education, women's empowerment, facilitating institutional delivery and media accessibility are critical to promoting health-seeking behaviors among mothers or caregivers of under-five children with ARI symptoms. Hence, concerned bodies should design targeted interventions that increase mothers' or caregivers' treatment-seeking behavior for childhood ARI to reduce child morbidity and mortality.

Spatial variation and determinants of inappropriate complementary feeding practice and its effect on the undernutrition of infants and young children aged 6 to 23 months in Ethiopia by using the Ethiopian Mini-demographic and health survey, 2019: spatial and multilevel analysis.

Background: Inappropriate complementary feeding practices (IACFPs) are major public health issues in Ethiopia, which usually result in stunting and becoming an intergenerational cycle. However, the spatial patterns and determinants of IACFP and its effect on undernutrition are not well understood in Ethiopia. Therefore, the aim of this study was to explore the spatial patterns and determinants of IACFPs and their effects on the undernutrition of infants and young children (IYC) in Ethiopia. Methods: This was a nationwide community-based survey study among 1,463 mothers of IYC aged 6-23 months in Ethiopia. The global spatial autocorrelation was assessed using the global Moran's-I to evaluate the spatial clustering of IACFPs. Significant clusters with high and low rates of IACFPs were explored. A multilevel mixed-effect logistic regression with cluster-level random effects was fitted to identify determinants of IACFPs with an AOR and 95% CI. Results: The prevalence of IACFPs was 90.22%. The spatial pattern of IACFP in Ethiopia was clustered across regions (Global Moran's I = 0.63, Z-score = 12.77, value of p ≤0.001). Clusters with a high rate of IACFP were detected in southern, northwest, and eastern Ethiopia. Individual and community-level variables accounted for 63% of IACFP variation. Mothers with no education were 3.97 times (AOR = 3.97; 95% CI: 1.64-9.60) more likely to have IACFPs than those with higher education. The poorest HHs had 4.80 times the odds of having IACFPs as the richest HHs (AOR = 4.80, 95% CI: 1.23-18.71). The odds of having IACFPs were 2.18 times (AOR = 2.18; 95% CI: 1.28-3.72) higher among babies with no postnatal checkup. Non-breastfed IYC were 2.8 times (AOR = 2.80; 95% CI: 1.29-6.10) more likely to have IACFP when compared with breastfed ones. IYC with the inadequate introduction of solid, semi-solid, and soft foods, inadequate minimum dietary diversity, and inadequate minimum acceptable diet were more likely to have wasting, underweight, and stunting. Conclusion: This study showed the prevalence of IACFPs was very high, which had an effect on undernutrition and showed spatial variation in Ethiopia. Therefore, the government of Ethiopia and stakeholders should focus on women with no education and the poorest HHs, encourage PNC checkups, and encourage breastfeeding in the hotspot areas to minimize IACFPs in Ethiopia.

Spatial variations and determinants of knowledge of ovulatory period among young women in Ethiopia: a spatial and multilevel analysis using 2016 EDHS.

BACKGROUND: Knowledge of the ovulatory period enables women in avoiding and engaging in sexual intercourse either to avoid and to have pregnancy as desired. It has been reported that young people have less knowledge of the ovulatory period. There is limited evidence about the spatial variability of knowledge of the ovulatory period among young women in Ethiopia. Hence, this study aimed to assess the spatial variation and factors sociated with knowledge of the ovulatory period among youths in Ethiopia for providing geographically targeted interventions. METHOD: A secondary data analysis was carried out using the 2016 Ethiopian Demographic and Health Surveys with a total weighted sample of 6143 youths. Multilevel logistic regression analysis was utilized to identify factors influencing knowledge of the ovulatory period. ArcGIS version 10.7 software and Kuldorff's SaTScan version 9.6 was used for the spatial analysis. RESULTS: Being older youth [AOR = 1.98; 1.46, 2.70], youths having primary education [AOR = 1.70; 1.23, 2.35], youths having secondary & higher education [AOR = 2.30; 1.41, 3.74], youths whose husbands have primary education [AOR = 1.39; 1.02, 1.91], and youths who use contraception [AOR = 1.66; 1.24, 2.22] were significant predictors of knowledge of ovulatory period. Knowledge of the ovulatory period among youth had non random spatial distribution across Ethiopia, and the primary clusters of incorrect knowledge of the ovulatory period were observed in Somalia, SNNPR, Benishangul gumuz, and Gambella regions of Ethiopia. CONCLUSION: There was a non-random spatial pattern in the distribution of knowledge of the ovulation period among young women in Ethiopia. Age of youth, educational status, education of husband, and contraceptive use were significant predictors of knowledge of the ovulatory period among young women in Ethiopia. Hence, interventions should prioritize at-risk youths residing in regions with limited knowledge of the ovulatory period to enhance their awareness of the fertility window.

Spatial patterns and determinants of undernutrition among late-adolescent girls in Ethiopia by using Ethiopian demographic and health surveys, 2000, 2005, 2011 and 2016: a spatial and multilevel analysis.

BACKGROUND: Undernutrition among late-adolescent girls (15-19 years) in Ethiopia is the highest among Southern and Eastern African countries. However, the spatial variation of undernutrition as a national context is not well understood in Ethiopia. This study aimed at the spatial patterns and determinants of undernutrition among late-adolescent girls in Ethiopia. METHODS: Secondary data analysis was conducted from women's data of four consecutive Ethiopian Demographic and Health Surveys (EDHS) from 2000 to 2016. A total of 12,056 late-adolescent girls were included in this study. The global spatial autocorrelation was assessed using the Global Moran's I autocorrelation to evaluate the presence of geographical clustering and variability of undernutrition. SaTScan cluster analysis by using the Bernoulli model to detect most likely SaTScan cluster areas of significant high-rate and low-rate of undernutrition was explored. A Multilevel binary logistic regression model with cluster-level random effects was fitted to determine factors associated with undernutrition among late-adolescent girls in Ethiopia. RESULTS: Undernutrition was clustered nationally during each survey (Global Moran's I = 0.009-0.045, Z-score = 5.55-27.24, p-value < 0.001). In the final model, individual and community level factors accounted for about 31.02% of the regional variations for undernutrition. The odds of undernutrition among 18-19 years of adolescent girls, was 57% (AOR = 0.43; 95% CI: (0.35-0.53) lower than those 15-17 years old. Late-adolescent girls with higher educational status were 4.40 times (AOR = 4.40; 95% CI: (1.64-11.76) more likely to be undernourished than those with no educational status. The odds of undernutrition among late-adolescent girls, with the occupation of sales, was 40% (AOR = 0.60; 95% CI: 0.43-0.84) lower than those with not working adolescents. The odds of undernutrition, among late-adolescent girls, having an unimproved latrine type, was 1.79 times (AOR = 1.79; 95% CI: 1.15-2.79) higher than those participants with improved latrine type. The odds of undernutrition among late-adolescent girls with rural residents was 2.33 times higher (AOR = 2.33; 95% CI: 1.29-4.22) than those with urban residents. CONCLUSION: Undernutrition among late-adolescent girls was spatially clustered in Ethiopia. The local significant clusters with high prevalence of undernutrition was observed in Northern and Eastern Ethiopia. Those regions with a high prevalence of undernutrition should design interventions to combat undernutrition.

Incidence and predictors of tuberculosis among HIV patients after initiation of antiretroviral treatment in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Tuberculosis is the oldest infectious disease and it is still the leading cause of morbidity and mortality worldwide. Even though several primary studies have been conducted on the incidence of tuberculosis among HIV-infected individuals in Ethiopia, national-level tuberculosis incidence is unknown. Therefore, this study is aimed to assess the TB incidence rate and its predictors among HIV-infected individuals after the initiation of ART in Ethiopia. METHODS: We conducted an extensive search of literature as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). The databases used were PubMed, Google Scholar, and HINARI literature. We used the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument for critical appraisal of studies. The meta-analysis and Meta regressions were conducted using STATA 14 software. Met-analysis and meta-regression were computed to present the pooled incidence rate and predictors of tuberculosis among HIV-infected patients after initiation of ART with a 95% confidence interval. RESULTS: Among a total of 189 studies, 11 studies were included in this analysis. The estimated pooled incidence rate of TB per 100-person year observation (PYO) among HIV-infected patients after initiation of ART therapy was 4.8(95% CI 3.69-5.83). In subgroup analysis, the estimated pooled incidence of tuberculosis showed a slight difference between adults and children after initiation of ART treatment, which was 4.3 (95% CI 2.96, 5.71) and 5.0 (95% CI 3.51, 6.50), respectively. Significantly pooled estimates of predictors of TB incidence by a meta-analysis were being anemic (2.30, 95% CI 1.75, 3.02); on clinical stages III and IV (2.26, 95% CI 1.70, 3.02); and not on cotrimoxazole preventive therapy (CPT) (2.16, 95% CI 1.23, 3.72). Besides, a meta-regression revealed that CD4 <200 cells/mm3 (2.12, 95% CI 1.17, 3.86) was a positive significant predictor of TB among HIV patients after the initiation of ART. CONCLUSIONS: The current study showed that the pooled incidence of TB among HIV patients was found to be lower than the WHO 2018 national estimate. Being anemic, WHO stages III and IV, not on CPT, CD4<200cells/µl, and being male were significant predictors of tuberculosis. Therefore, the existing strategies to decrease TB should be strengthening. STUDY PROTOCOL REGISTRATION: CRD42020155573.