Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis.

CONTEXT: Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive. OBJECTIVE: The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs). DATA SOURCES: Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded. DATA EXTRACTION: Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation. DATA ANALYSIS: The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55). CONCLUSION: A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42023409483.

Consistent condom utilization among sexually active HIV positive individuals in Sub-Saharan Africa: systematic review and meta-analysis.

This study aimed to ascertain the pooled prevalence and trend of consistent condom use in Sub-Saharan Africa, addressing the fragmented and inconsistent research on its role in preventing HIV transmission. In this meta-analysis, we systematically searched electronic databases such as PubMed, Embase, Scopus, Web of Science, Global Index Medicus, ScienceDirect, Africa-Wide Information (via EBSCOhost), as well as clinical trial registries, and the search engine Google Scholar. All necessary data were extracted using a standardized data extraction format. The data were analyzed using STATA 17 statistical software. Heterogeneity among the studies was assessed using the I2 test. A random-effect model was computed to estimate the pooled rate of consistent condom utilization. This meta-analysis, which included thirty-three full-text studies, found a pooled prevalence of 44.66% (95% CI 18.49-70.83; I2 = 0.00%) for consistent condom use in Sub-Saharan Africa. While the prevalence fluctuated between 2007 and 2022, the year-to-year variations were not statistically significant. The current study identified low rates of consistent condom use, with utilization fluctuating annually in the study area. Therefore, uncovering the underlying reasons and addressing barriers to consistent condom use is crucial in the region.

Socioeconomic status and health behavior in children and adolescents: a systematic literature review.

Socioeconomic status affects individuals' health behaviors and contributes to a complex relationship between health and development. Due to this complexity, the relationship between SES and health behaviors is not yet fully understood. This literature review, therefore, aims to assess the association between socioeconomic status and health behaviors in childhood and adolescence. Preferred Reporting for Systematic Review and Meta-Analysis protocol guidelines were used to conduct a systematic literature review. The electronic online databases EBSCO Host, PubMed, Web of Science, and Science Direct were utilized to systematically search published articles. The Joanna Briggs Institute's critical appeal tool was used to assess the quality of included studies. Eligibility criteria such as study context, study participants, study setting, outcome measures, and key findings were used to identify relevant literature that measured the association between socioeconomic status and health behaviors. Out of 2,391 studies, only 46 met the final eligibility criteria and were assessed in this study. Our review found that children and adolescents with low socioeconomic status face an elevated risk of unhealthy behaviors (e.g., early initiation of smoking, high-energy-dense food, low physical activity, and involvement in drug abuse), in contrast to their counterparts. Conversely, children and adolescents from higher socioeconomic backgrounds exhibit a higher prevalence of health-promoting behaviors, such as increased consumption of fruit and vegetables, dairy products, regular breakfast, adherence to a nutritious diet, and engagement in an active lifestyle. The findings of this study underscore the necessity of implementing specific intervention measures aimed at providing assistance to families from disadvantaged socioeconomic backgrounds to mitigate the substantial disparities in health behavior outcomes in children and adolescents.

Delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia: a multicentre cross-sectional study.

OBJECTIVES: Delays in obtaining proper cancer treatment can lead to advanced stages at diagnosis. Despite the problems, there is not enough evidence regarding delay in presentation. This study aims to assess delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia. DESIGN: Multicentre cross-sectional study design. SETTING: Data were collected from selected oncology centres in Ethiopia. PARTICIPANTS: A multistage sampling technique was used to select 635 study participants from May 9 to June 9 2022. OUTCOME MEASURES: Patients who have a duration of ≥3 months from symptom recognition to the first healthcare visit were considered as delay in health-seeking behaviour. Data were entered using Epi data and exported to SPSS for further analysis. Before analysis, model fitness was carried out using Hosmer and Lemeshow test. Variables with a p value<0.25 in the bivariable analysis were included in multivariable logistic regression. In multivariable logistic regression, a p value<0.05 significant level was considered as the factor for delay in health-seeking behaviour. RESULTS: In this study, a total of 628 adult patients with cancer participated. A total of 72.6% of patients had a delay in health-seeking behaviour. Variables such as being female (AOR=2.81; 95% CI=1.29 to 6.14), rural residence (AOR=2.82; 95% CI=1.43 to 5.58), low social support (AOR=4.16; 95% CI=2.04 to 8.49), not having comorbidity (AOR=4.44; 95% CI=2.28 to 8.66), stage III cancer (AOR=3.73; 95% CI=1.37 to 9.98), stage IV cancer (AOR=3.07; 95% CI=1.28 to 6.41), additional symptoms (AOR=3.03; 95% CI=1.55 to 5.94), never heard about cancers (AOR=4.09; 95% CI=2.06 to 8.11) and never heard about cancer screening (AOR=2.16; 95% CI=1.06 to 4.40) were identified as factors for delay in health-seeking behaviour. CONCLUSION: This study showed that relatively higher magnitude in which approximately three-fourth of adult patients with cancer were delayed in seeking medical attention. As a result, more effort must be made to tackle delay in health-seeking behaviour and associated factors.

Inadequate dietary diversity during pregnancy increases the risk of maternal anemia and low birth weight in Africa: A systematic review and meta-analysis.

Inadequately diversified food consumption during pregnancy can lead to micronutrient deficiencies, which can affect maternal and newborn health outcomes. Previous studies on maternal dietary diversity have either been limited to a specific geographical region or consist entirely of systematic reviews, without meta-analyses. Thus, this study aimed to determine the pooled estimate of the association between inadequate dietary diversity during pregnancy, maternal anemia, and low birth weight in Africa. A systematic review of observational studies published between January 2000 and April 2022 was undertaken using the Google Scholar, PubMed, and CINAHL databases. The PRISMA checklist was followed to present the results. Microsoft Excel was used to abstract the data. STATA version 17 was used to analyze the data, and a random-effects meta-analysis model was applied to compute the pooled estimates. The study was registered in PROSPERO with protocol number CRD42022320873. A total of 22 publications with 9,696 participants were included in the final meta-analysis. The pooled adjusted odds ratio (AOR) for inadequate dietary diversity and maternal anemia was 2.15 (95% CI, 1.66-2.65), while that for low birth weight was 2.04 (95% CI, 1.46-2.63). The highest pooled estimate of maternal anemia was reported in Cameroon (AOR = 9.8, 95% CI: 1.68-17.92), followed by Ethiopia (AOR = 2.6, 95% CI: 1.95-3.25). Similarly, the pooled estimates of low birth weight were highest in Cameroon (AOR = 3.04, 95% CI: 1.19-4.88) and Ethiopia (AOR = 1.8, 95% CI: 1.29-2.39). In Africa, pregnant mothers with inadequate dietary diversity are two times more likely to develop anemia and low birth weight. Social protection policies that prioritize pregnant women, maternal nutrition promotion in the community, and dietary counseling during antenatal care visits, using national food-based dietary guidelines, should be strengthened.

Prevalence of undernutrition and associated factors among adults taking antiretroviral therapy in sub-Saharan Africa: A systematic review and meta-analysis.

BACKGROUND: Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the most commonly affected region with HIV and malnutrition, a meta-analysis study that estimates the prevalence and correlates of undernutrition among adults living with HIV has not yet been conducted. The objective of this study was to determine the pooled prevalence of undernutrition and associated factors among adults living with HIV/AIDS in sub-Saharan Africa. METHODS: Studies published in English were searched systematically from databases such as PubMed, Google Scholar, and gray literature, as well as manually from references in published articles. Observational studies published from 2009 to November 2021 were included. The data extraction checklist was prepared using Microsoft Excel and includes author names, study area, publication year, sample size, prevalence/odds ratio, and confidence intervals. The results were presented and summarized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard. Heterogeneity was investigated using the Q test, I2, τ2, τ and predictive interval. STATA version 17 was used to analyze the data. A meta-analysis using a random-effects model was used to determine the overall prevalence and adjusted odds ratio. The study has been registered in PROSPERO with a protocol number of CRD42021268603. RESULTS: In this study, a total of 44 studies and 22,316 participants were included. The pooled prevalence of undernutrition among adult people living with HIV (PLWHIV) was 23.72% (95% CI: 20.69-26.85). The factors associated with undernutrition were participants' age (AOR = 0.5, 95% CI: 0.29-0.88), gender (AOR = 2.08, 95% CI: 0.22-20.00), World Health Organization (WHO) clinical stage (AOR = 3.25, 95% CI: 2.57-3.93), Cluster of Differentiation 4 (CD4 count) (AOR = 1.94, 95% CI: 1.53-2.28), and duration of ART (AOR = 2.32, 95% CI: 1.6-3.02). CONCLUSION: The pooled prevalence of undernutrition among adult PLWHIV in sub-Saharan Africa remained high. WHO clinical stage, CD4 count, duration of ART treatment, age, and sex were found to be the factors associated with undernutrition. Reinforcing nutrition counseling, care, and support for adults living with HIV is recommended. Priority nutritional screening and interventions should be provided for patients with advanced WHO clinical stages, low CD4 counts, the male gender, younger age groups, and ART beginners.

Effectiveness of healthcare workers and volunteers training on improving tuberculosis case detection: A systematic review and meta-analysis.

INTRODUCTION: Tuberculosis is the second most common infectious cause of death globally. Low TB case detection remains a major challenge to achieve the global End TB targets. This systematic review and meta-analysis aimed to determine whether training of health professionals and volunteers increase TB case detection. METHODS: We performed a systematic review and meta-analysis of randomized control trials and non-randomized control trials reporting on the effectiveness of health professionals and volunteers training on TB case detection. We searched PubMed, SCOPUS, Cochrane Library, and reference sections of included articles from inception through to 15 February 2021, for studies published in English. Study screening, data extraction, and bias assessments were performed independently by two reviewers with third and fourth reviewers participating to resolve conflicts. The risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. Meta-analyses were performed with a random effect model to estimate the effectiveness of training intervention on TB case detection. RESULTS: Of the 2015 unique records identified through our search strategies, 2007 records were excluded following the screening, leaving eight studies to be included in the final systematic review and meta-analysis. The results showed that providing training to health professionals and volunteers significantly increased TB case detection (RR: 1.60, 95% CI: 1.53, 1.66). There was not a significant degree of heterogeneity across the included study on the outcome of interest (I2 = 0.00%, p = 0.667). CONCLUSIONS: Providing training to healthcare workers and volunteers can increase TB case detection.

Effectiveness of home visiting on tuberculosis case detection: Systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) is a public health agenda globally. Most TB cases are detected using the usual passive method. Starting a decade, cases are detected using an active detection strategy. The home-visiting strategy is one of the active case findings approaches. However, no study shows the pooled effect of home visiting on tuberculosis case detection rate. Thus, we conducted this study to evaluate the effectiveness of home visiting on tuberculosis case detection. METHODS: In this systematic review and meta-analysis, the PRISMA checklist was used to report findings. A systematic comprehensive search was done to address all possible search databases. We used to search databases such as PubMed/MEDLINE, Scopus, and Science Direct to identify relevant articles. Data were extracted by two authors and consistency was checked by two co-authors. Cochrane risk of bias tool was used to assess the quality of studies. Data were extracted using a Microsoft Excel spreadsheet then; data were transferred to Stata version 16 for further analysis. Heterogeneity across studies was checked using the Q statistics (I2). RESULTS: Overall, 4174 articles were found. Two thousand one hundred seventy-five (2175) articles were excluded due to duplications. One thousand nine hundred twenty-four articles were excluded after reviewing titles and abstracts. Seventy-five articles were assessed using their full texts articles and 70 articles were excluded with unclear outcomes and poor methodological quality. Finally, 5 articles were selected for the final analysis. In all studies, the case-notification rate was significantly increased in the intervention arm than the control arm. The pooled effect size was RR: 1.65 (95% CI: 0.92, 2.39). This study showed that there was a significant heterogeneity (I2 = 98.9%, P < 0.001). Visual examination of the funnel plot showed asymmetric distribution. However, the egger's and bigger tests showed there was no significant publication bias ((P = 0.313). CONCLUSION: Home to home visiting is an effective TB case finding method as compared to the usual passive detection methods. The health system should be strengthened home to home visiting to enhance TB case detection. The protocol PROSPERO registration was CRD42021227860.

Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the "Universal Test and Treat strategy" at public health institutions in Northern Ethiopia. A retrospective follow-up study.

Introduction: Since 2016, the Ethiopian Federal Ministry of Health has adopted a "Universal Test and Treat" strategy to treat human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). In this test and treat era, access to anti-retroviral therapy (ART) has been rapidly expanded. On the other hand, poor retention of patients on ART remains a serious concern for reaching ART program goals. Thus, this study is targeted at investigating the attrition rate and its predictors among HIV-positive adults following the implementation of the "test and treat" strategy in Ethiopia. Methods: An institution-based retrospective follow-up study was conducted among 1048 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northern Ethiopia. Data were extracted from randomly selected patient charts, entered into Epidata 4.6 and exported to Stata 14.2 for analysis. Kaplan-Meier curve was used to estimate individuals' attrition-free probability at each specific point in time. Both bivariable and multivariable cox regression models were fitted, and variables with a P-value of <0.05 in the multivariable model were considered as significant predictors of attrition. Results: A total of 1020 (97.3%) study participants were included in the final analysis. The attrition rate of individuals was 15 per 100 person-years of observation (95% CI: 13.5-16.9 per 100 PYO). World Health organization (WHO) stage III/IV clinical diseases (Adjusted hazard ratio/AHR/1.75 (95% CI:1.24-2.48)), Not disclosing HIV-status (AHR 1.6 (95% CI: 1.24-2.05)), rapid initiation of ART (AHR 2.05 (95%CI:1.56-7.69)), No history of ART regime change (AHR2.03 (95% CI: 1.49-2.76)), "1J (TDF_3TC-DTG)" ART regimen (AHR 0.46 (95%CI: 2.18-3.65)), and Poor ART adherence (AHR2.82 (95%CI: 2.18-3.65)) were identified as significant predictors of attrition rate of HIV positive adults. Conclusion: Following the implementation of the universal test and treat area, the attrition rate of adults living with (HIV) found to be high. Due attention shall be provided to those individuals who didn't disclose their status, were initiated into ART within seven days, had WHO stage III/IV clinical disease, had poor adherence history, had no regimen change, and are not on 1J (TDF_3TC-DTG) ART regimen type.

Change in stunting and its associated factors among children aged less than 5 years in Ethiopia using Ethiopia Demographic and Health Survey data from 2005 to 2019: a multivariate decomposition analysis.

OBJECTIVE: The aim of this study is to assess change in stunting and its associated factors among children aged less than 5 years in Ethiopia using Ethiopia Demographic and Health Survey data from 2005 to 2019. DESIGN: A community-based cross-sectional study was conducted. SETTING: The study was conducted in Ethiopia. PARTICIPANTS: In 2005, 4586 individuals were examined, followed by 10 282 in 2011, 9462 in 2016 and 4937 in 2019. PRIMARY AND SECONDARY OUTCOMES: The primary outcome of the study was stunting, and the secondary outcome was factors associated with stunting and its change. A multilevel logistic regression model was fitted to identify individual and community-level factors associated with stunting among children aged less than 5 years. Multivariate decomposition analysis was also carried out to assess the role of compositional characteristics and behavioural change for decline in stunting among children aged less than 5 years in Ethiopia. RESULTS: Over the study period, the prevalence rate of stunting in children aged less than 5 years decreased from 47% to 37% in 2019. Differences in behavioural change among children under the age of 5 years account for 76.69% of the overall decline in stunting prevalence rate in the years 2005-2011, 86.53% in the years 2005-2016, 98.9% in the years 2005-2019, 70.34% in the years 2011-2016 and 73.77% in the years 2011-2019. Behavioural adjustments among breastfed children, diet diversity, place of delivery, ANC follow-up and region have all had a major effect on stunting prevalence rate. The wealth index, parenteral education, child's age in months, length of breast feeding and area were among the compositional change factors. CONCLUSION: A large percentage of children aged less than 5 years remains stunted in Ethiopia. Stunting was associated with alterations in the compositional and behavioural characteristics of children. Stimulating existing nutritional measures and improving the wealth index will make a significant difference in reducing stunting among Ethiopian children aged less than 5 years.

Loss to follow-up in "test and treat era" and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study.

Background: People living with HIV/AIDS are enrolled in lifelong Anti-Retroviral Treatment (ART) irrespective of their clinical staging as well as CD4 cell count. Although this "Universal Test and Treat" strategy of ART was found to have numerous benefits, loss from follow-up and poor retention remained a long-term challenge for the achievement of ART program targets. Hence, this study is aimed at addressing the much-needed effect of the test and treat strategy on the incidence of loss to follow-up (LTFU) in Ethiopia. Method and materials: An institution-based follow-up study was conducted on 513 adults (age ≥15) who enrolled in ART at a public health institution in Bahir Dar City, Northwest Ethiopia. Data were extracted from the charts of selected patients and exported to Stata 14.2 software for analysis. Basic socio-demographic, epidemiological, and clinical characteristics were described. The Kaplan-Meier curve was used to estimate the loss to follow-up free (survival) probability of HIV-positive adults at 6, 12, 24, and 48 months of ART therapy. We fitted a multivariable Cox model to determine the statistically significant predictors of LTFU. Result: The incidence density of LTFU was 9.7 per 100 person-years of observation (95% CI: 7.9-11.9 per 100 PYO). Overall, LTFU is higher in the rapid ART initiation (24% in rapid initiated vs. 11.3% in lately initiated, AHR 2.08, P = 0.004), in males (23% males vs. 14.7% females, AHR1.96, P = 0.004), in singles (34% single vs. 11% married, with AHR1.83, P = 0.044), in non-disclosed HIV-status (33% non-disclosed 11% disclosed, AHR 2.00 p = 0.001). Patients with poor/fair ART adherence were also identified as another risk group of LTFU (37% in poor vs. 10.5% in good adherence group, AHR 4.35, P = 0.001). Conclusion: The incidence of LTFU in this universal test and treat era was high, and the highest figure was observed in the first 6 months. Immediate initiation of ART in a universal test and treat strategy shall be implemented cautiously to improve patient retention and due attention shall be given to those high-risk patients.

Early diagnosis, vertical transmission of HIV and its associated factors among exposed infants after implementation of the Option B+ regime in Ethiopia: a systematic review and meta-analysis.

Introduction: : Despite scaling up programmes to prevent vertical transmission of human immunodeficiency virus (HIV), over 400 children are infected every day globally. Guidelines recommend that all HIV-exposed infants should be tested within 4-6 weeks of birth. This meta-analysis aimed to explore concrete evidence on early diagnosis, pooled prevalence of HIV among HIV-exposed infants and its associated factors in Ethiopia following implementation of the Option B+ regime in 2013. Methods: : Electronic databases such as PubMed/MEDLINE, EMBASE and Cochrane Library were used to retrieve eligible articles. This meta-analysis was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Heterogeneity and publication bias were evaluated using Cochran's Q statistic quantified with inverse variance and Egger's statistical test. Random effect model meta-analysis was used to report the pooled estimate. Results: : The pooled estimate of early diagnosis and prevalence of mother-to-child transmission (MTCT) of HIV since implementation of the Option B+ regime in Ethiopia were 64.84% and 5.64%, respectively. No antenatal care [odds ratio (OR) 4.4], home delivery (OR 6.8), infant enrolment >6 weeks after birth (OR 2.2), mixed feeding (OR 4.1) and no antiretroviral prophylaxis after birth (OR 13.2) were associated with increased risk of MTCT. Conclusion: : This review of 19 studies from six regions of Ethiopia found that only two-thirds of HIV-exposed infants were tested at ≤6 weeks of age. Although there has been a major reduction in the prevalence of MTCT of HIV since implementation of the Option B+ region, the pooled prevalence of MTCT of HIV remains higher than the WHO target of 5% among breastfeeding participants. From the evidence obtained in the 19 studies included in this review and international MTCT practice, recommendations to minimize the high prevalence of MTCT of HIV include encouraging antenatal care follow-up and institutional delivery; enrolling HIV-exposed infants immediately after delivery or at least before 6 weeks of age; promotion of exclusive breastfeeding; improving adherence to antiretroviral therapy during antenatal care, labour/delivery and breastfeeding; and increasing the provision of antiretroviral prophylaxis at birth for exposed neonates. A national representative study of MTCT of HIV for all regions of Ethiopia is needed to obtain an updated view of this programme.

Incidence and predictors of initial antiretroviral therapy regimen change among children in public health facilities of Bahir Dar City, Northwest Ethiopia, 2021: multicenter retrospective follow-up study.

BACKGROUND: The inconsistent use of antiretroviral therapy can lead to the risk of cross-resistance between drugs. This reduces subsequent antiretroviral drug options. The burden of initial antiretroviral therapy ranges from 11.3% in South Africa to 71.8% in Malaysia. There is evidence that it is important to maintain children's initial antiretroviral therapy regimens. However, the incidence and predictive factors of initial antiretroviral therapy regimen changes in the research context are still unknown in the study setting. So, the study was aimed to assess incidence and predictors of initial antiretroviral therapy regimen changes among children in public health facilities of Bahir Dar city. METHODS: A retrospective follow-up study was conducted in 485 children who received antiretroviral therapy between January 1, 2011 and December 30, 2020. These children were selected using simple random sampling techniques. The data were entered by Epi data 3.1 and the analysis was completed by STATA 14.0. The missing data was treated with multiple imputation method. The data were also summarized by median or mean, interquartile range or standard deviation, proportion and frequency. The survival time was determined using the Kaplan Meier curve. The Cox Proportional Hazard model was fitted to identify predictors of initial antiretroviral therapy regimen change. The global and Shoenfeld graphical proportional hazard tests were checked. Any statistical test was considered significant at P-value < 0.05. Finally, the data were presented in the form of tables, graphics and text. RESULT: Among the 459 study participants, 315 of them underwent initial regimen changes during the study accumulation period. The shortest and longest follow up time of the study were 1 month and 118 months, respectively. The overall incidence rate of initial regimen change was 1.85, 95% CI (1.66-2.07) per 100 person-month observation and the median follow up time of 49 (IQR 45, 53) months. The independent predictors of initial regimen changes were poor adherence (AHR = 1.49, 95%CI [1.16, 1.92]), NVP based regimen (AHR = 1.45, 95%CI [1.15, 1.84]) comparing to EFV based regimen, LPVr based regimen (AHR = 0.22, 95%CI: (0.07, 0.70)) comparing to EFV based regimen, history of tuberculosis (AHR = 1.59, 95%CI [1.14, 2.23]) and being male (AHR = 1.28, 95%CI [1.02, 1.60]). CONCLUSIONS AND RECOMMENDATIONS: In this study, the incidence of initial regimen change was high. The risk of initial regimen change would be increased by being male, poor adherence, having history of tuberculosis and NVP based initial regimen. Therefore, strengthening the health care providers' adherence counseling capability, strengthening tuberculosis screening and prevention strategies and care of initial regimen type choice needs attention in the HIV/AIDS care and treatment programs.

Treatment failure and its associated factors among children receiving highly active antiretroviral therapy in Ethiopia: A systematic review and meta-analysis.

OBJECTIVES: Over the last decades, large number of children living with human immunodeficiency virus (HIV) have been successfully enrolled in care and initiated treatment. However, treatment failure is still a major challenge in the track, missing far too many children. National-level evidence on antiretroviral therapy failure and its associated factors among children receiving highly active antiretroviral therapy is required to alleviate this challenge. METHODS: PubMed/Medline, EMBASE, CINAHL, Cochrane library, Google, and Google Scholar databases were used to access eligible studies. This meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In addition, Newcastle-Ottawa Scale quality assessment was applied for critical appraisal. Cochran's Q statistic, funnel asymmetry plot, and Egger's test were used to assess heterogeneity and publication bias. Random effect model was computed to explore the pooled burden of treatment failure and its associated factors among children living with HIV. Odds ratio with 95% confidence interval was considered to identify associated factors. RESULT: The overall pooled prevalence of treatment failure among children living with HIV was 16.6%. Whereas virological, immunological, and clinical failure were 4.49%, 5.41%, and 5.71% respectively, where either of parent is deceased (odds ratio = 2.13, 95% confidence interval: 1.4-3.3), opportunistic infection (odds ratio = 1.67, 95% confidence interval: 1.1-2.5), absence of disclosure of status (odds ratio = 1.6, 95% confidence interval: 1.0-2.5), advanced World Health Organization stage (odds ratio = 4.2, 95% confidence interval: 1.6-10.5), and drug substitution (odds ratio = 2.0, 95% CI: 1.5-2.7) were significantly associated factors. CONCLUSION: The pooled prevalence of treatment failure among children living with HIV in Ethiopia was lower when compared to most African countries. Accordingly, either prevention or early treatment of opportunistic infection and advanced World Health Organization clinical stages, special care for children whose either parents are deceased, advocating disclosure of status, and avoiding drug substitution as much as possible were still needed to prevent treatment failure.

The impact of tuberculosis co-infection on virological failure among adults living with HIV in Ethiopia: A systematic review and meta-analysis.

Introduction: Tuberculosis (TB) is the most common serious opportunistic infection among people with Human Immunodeficiency Virus (HIV) infection and are considered as the double burden diseases of the world. TB is the leading cause of death among people living with HIV, accounting one in three HIV related deaths. Although TB is responsible for high burden of virological unsuppressed in Ethiopia, there is no national level evidence. Therefore, this systematic review and meta-analysis was aimed at estimating the pooled burden of virological unsuppressed among adults with both HIV-TB and impact of TB on virological failure in Ethiopia. Methods: The finding of this meta-analysis was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists. Major data bases PubMed, Scopus, Cochrane Library, Science Direct and Google scholar were searched to access articles. Cochran's Q statistic quantified with inverse variance was computed to check heterogeneity. Funnel plot visualization and Egger's test were fitted to assess publication bias across included studies. Random effects model meta-analysis using STATA version-15 statistical software was used to estimate the pooled effect with respective 95% confidence intervals. Results: A total of 15 primary studies reporting on impact of tuberculosis on virological unsuppressed among adults living with HIV in Ethiopia were eligible for this meta-analysis. Accordingly, the pooled prevalence of virological unsuppressed among adults with both HIV-TB in Ethiopia was 39.09% (95% CI: 29.04, 49.15). In addition, the odds of virological unsuppressed among adults with both HIV-TB was 2.46 times higher when compared with adults living with HIV infection alone (OR = 2.46, 95% CI: 1.74, 3.46). Conclusion: The present systematic review and meta-analysis evidenced that the pooled prevalence of virological unsuppressed among adults with both HIV-TB was much higher than virological unsuppressed among adults living with HIV alone. Moreover, the odds of virological failure among adults with both HIV-TB was significantly higher when compared with among only HIV infection in Ethiopia. Therefore, strengthening TB prevention interventions, early identification and managing the case and prioritizing viral load monitoring and adherence support among adults living with HIV are recommended.

Neonatal mortality and its association with antenatal care visits among live births in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Even though neonatal mortality is reduced from time to time, the problem is still prevalent in Ethiopia. Despite a few studies tried to show the extent of neonatal mortality in Ethiopia, the pooled estimation of neonatal mortality remains inconclusive and inconsistent. Thus, this systematic review and meta-analysis were intended to determine the pooled prevalence of neonatal mortality rate and its association with antenatal care visits in Ethiopia. METHODS: Studies were retrieved through reputable search engines in; CINAHL, Embase, Medline, PubMed, Google Scholar, ISI Web of Science, ScienceDirect, and SCOPUS in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Newcastle-Ottawa Quality assessment tool for cross-sectional studies was used for critical appraisal of studies which were included. Risk of Bias in nonrandomized studies of Interventions (ROBINS-I) tool was also used to assess the risk of bias. Random-effects meta-analysis was used to estimate the level of pooled prevalence of neonatal mortality and its association with antenatal care visits at 95% confidence interval and with its respective odds ratio (OR). Meta-regression was also carried out to identify the potential source of heterogeneity. Begs and egger test followed by trim and fill analysis were used to determine publication bias. Subgroup analyses, based on study setting, were also carried out. RESULT: A total of 5839 articles were identified through searching, of which 11 articles representing participants were included in the final analysis. The average pooled prevalence of neonatal mortality in Ethiopia was 6.78% (CI: 4.45, 9.12). Subgroup analysis was undertaken and the pooled estimate of neonatal mortality among these communities based studies was 2.56% and in hospital-based study it was 11.8%. Neonatal mortality was more significant among mothers who had antenatal visits of less than three times during their pregnancy period with OR of 1.76 (95% CI: 1.42, 3.16). CONCLUSION: The pooled prevalence of neonatal mortality in Ethiopia was slightly low compared to the national 2016 demographic Health Survey of the country. Therefore, the government of Ethiopia should influence the health sector to give attention for increasing antenatal care visits and further research is needed to investigate further factors of neonatal mortality.

Prevalence of Urinary Tract Infection and Its Associated Factors among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

OBJECTIVE: Urinary tract infection (UTI) is the most common bacterial infections during pregnancy. It is associated with different maternal and neonatal adverse outcomes such as low birth weight, preterm birth, still birth, preeclampsia, maternal anemia, sepsis, and amnionitis, even when the infection is asymptomatic. However, in Ethiopia, it is represented with fragmented and inconclusive pocket studies. Therefore, this systematic review and meta-analysis is aimed at estimating the pooled prevalence of UTI and its associated factors among pregnant women in Ethiopia. METHODS: PubMed/Medline, Embase, Cochrane Library, Google Scholar, and local sources were used to access eligible studies. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was applied for critical appraisal. Heterogeneity and publication bias were evaluated using I 2 statistic, funnel plot asymmetry, and Egger's tests. Random effect model was employed to estimate the pooled burden of UTI and its associated factors among pregnant women with its corresponding odds ratio (OR) and 95% confidence interval (CI). RESULT: From all systematically searched articles, 14 studies were eligible for this analysis. The overall pooled prevalence of UTI among pregnant women in Ethiopia was 15.37% (95% CI: 12.54, 18.19). Family monthly income (OR = 3.8 and 95% CI: 1.29, 11.23), parity (OR = 1.59 and 95% CI: 1.01, 2.50), history of catheterization (OR = 2.76 and 95% CI: 1.31, 5.84), and history of UTI (OR = 3.12 and 95% CI: 1.74, 5.60) were factors significantly associated with UTI among pregnant women in Ethiopia. CONCLUSION: The overall pooled estimate of UTI among pregnant women in Ethiopia was higher compared with CDC estimation which was 8%. Family monthly income < 1000ETB, multipara, previous history of catheterization, and history of UTI were factors increased burden of UTI during pregnancy. So, strategies targeting in economic reforms, universal access of family planning, and standardized prenatal care service should be addressed to alleviate this high prevalence of UTI during pregnancy.

Experiences and Reasons of Attrition from Option B+ Among Mothers Under Prevention of Mother to Child Transmission Program in Northwest Ethiopia: Qualitative Study.

BACKGROUND: Human immunodeficiency virus-infected children share the highest risk of death compared with all other age groups, and more than 90% of this viral infection of children was accounted for by transmission from mother to infant. This rate can be prevented and reduced with implementation of option B+ effectively. However, unacceptably high lost follow-up of mothers highly affected the effectiveness of this program. In Ethiopia, only 71% of mothers were adherent on their follow-up. So, this study was aimed to understand the reasons and experiences of lost follow-up of mothers under the prevention of mother to child transmission (option B+) program in North West Ethiopia. METHODS: A qualitative study using a case study design was carried out using in-depth interviews among 20 mothers who had started the option B+ treatment protocol but discontinued their follow-up for more than two months, and 6 key informants and individuals who were engaged in management and control of human immunodeficiency virus at Woreda and Zonal level. An unstructured interview guide was used and translated into the local language. Study participants were selected using purposive sampling technique. After written consent was obtained, all study participants' interviews were audio-recorded and analyzed using deductive content analysis. RESULTS: A total of 26 mothers participated in this study. Accordingly, the most frequently raised reasons were lack of formal education which affects income level, lack of disclosure, lack of partner and family support, absence of male involvement and stigma-discrimination. But, unavailability of option B+ regimens in the nearest health facility or long distance from health facility, discordance and lack of experienced professionals in terms of counseling during initiation were also essential reasons. CONCLUSION: Educational and economic empowerment intervention (particularly for vulnerable households), promoting family support and male involvement, active counseling at initiation and during follow up and community level awareness improvement should be addressed to increase option B+ regimen adherence and retention.

Effect of a self-care educational intervention to improve self-care adherence among patients with chronic heart failure: a clustered randomized controlled trial in Northwest Ethiopia.

BACKGROUND: As the burden of cardiovascular disease increases in sub-Saharan Africa, there is a growing need for low-cost interventions to mitigate its impact. Providing self-care health education to patients with chronic heart failure (CHF) is recommended as an intervention to prevent complications, improve quality of life, and reduce financial burdens on fragile health systems. However, little is known about health education's effectiveness at improving CHF self-management adherence in sub-Saharan Africa. Therefore the present study aimed to assess the effectiveness of an educational intervention to improve self-care adherence among patients with CHF at Debre Markos and Felege Hiwot Referral Hospitals in Northwest Ethiopia. METHODS: To address this gap, we adapted a health education intervention based on social cognitive theory comprising of intensive four-day training and, one-day follow-up sessions offered every four months. Patients also received illustrated educational leaflets. We then conducted a clustered randomized control trial of the intervention with 186 randomly-selected patients at Debre Markos and Felege Hiwot referral hospitals. We collected self-reported data on self-care behavior before each educational session. We analyzed these data using a generalized estimating equations model to identify health education's effect on a validated 8-item self-care adherence scale. RESULTS: Self-care adherence scores were balanced at baseline. After the intervention, patients in the intervention group (n = 88) had higher adherence scores than those in the control group (n = 98). This difference was statistically significant (ß = 4.15, p < 0.05) and increased with each round of education. Other factors significantly associated with adherence scores were being single (ß = - 0.25, p < 0.05), taking aspirin (ß = 0.76, p < 0.05), and having a history of hospitalization (ß = 0.91, p < 0.05). CONCLUSIONS: We find that self-care education significantly improved self-care adherence scores among CHF patients. This suggests that policymakers should consider incorporating self-care education into CHF management. TRIAL REGISTRATION NUMBER: PACTR201908812642231.

A Systemic Review and Meta-analysis of the Leading Pathogens Causing Neonatal Sepsis in Developing Countries.

BACKGROUND: Neonatal sepsis is one of the major public health problems globally, particularly, in developing countries. Klebsiella, Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli are the common pathogens for neonatal sepsis in developing countries. However, the pooled estimate of common pathogens causing neonatal sepsis in developing countries is still unknown. Therefore, this study is aimed at computing the pooled proportion of the leading cause of pathogens for neonatal sepsis in developing countries. METHODS: We strictly followed the Preferred Reporting Items for Systemic Reviews and Meta-analysis guidelines to report this systematic review and meta-analysis. PubMed, Cochrane Library, Web of Science, CINAHL, Science Direct, and other search engines such as Google Scholar, Africa Journals Online, and Hinari were used to obtain studies related to the leading cause of pathogens for neonatal sepsis in developing countries. The search was done from October 1 to December 30, 2018, by considering both published and gray literature. Studies were evaluated based on the PRISMA guideline checklist by using their titles, abstracts, and full texts. Studies were extracted using Microsoft Excel spreadsheets, and STATA software version 14 was used to analyze data. Heterogeneity between studies was checked based on Cochran's Q-test and the corresponding I 2 statistic test. RESULTS: The pooled prevalence of the leading cause of pathogens of neonatal sepsis in developing countries were Klebsiella (26.36%), Staphylococcus aureus (23.22%), Coagulase-negative Staphylococcus (23.22%), and Escherichia coli (15.30%). Common pathogens were varied across regions; for instance, pooled isolated Coagulase-negative Staphylococcus was 25.98% in Africa, 16.62% in Asia, and 36.71% in Latin America, and Klebsiella was 29.80% in Africa, 23.21% in Asia, and 22.00% in Latin America. Also, Staphylococcus aureus was 27.87% in Africa and 18.28% in Asia, and Escherichia coli was 22.97% in Asia and 9.43% in Africa. CONCLUSIONS: This study highlights that the more prevalent common isolated pathogens in developing countries were Klebsiella, Staphylococcus aureus, Coagulase-negative Staphylococcus, and Escherichia coli, Klebsiella, and Staphylococcus aureus pathogens were predominantly high in Africa as compared to other Asian and Latin American countries. At the same time, Coagulase-negative Staphylococcus was more prevalent in Latin America compared to other regions. Escherichia coli is more dominant in Asia as compared to Africa and Latin America.