Prevalence of episiotomy and associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia: A cross-sectional study.

INTRODUCTION: Maternal morbidity and mortality has remained a major public health concern worldwide. Basic emergency obstetric care is the primary intervention to prevent obstetric complications and maternal death. Episiotomy is one of the basic obstetrical procedures used to facilitate vaginal delivery, shorten the second stage of labor and prevent complications. However, there is a paucity of evidence on the prevalence and factors associated with episiotomy among women who gave birth in eastern Ethiopia. OBJECTIVE: This study aimed to determine the prevalence of episiotomy and its associated factors among women who gave birth at public health facilities in Jigjiga town, eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among women who gave birth vaginally from May 1 to June 30, 2022. A total of 422 study participants were recruited using systematic random sampling. Data were collected using structured questionnaires through a face-to-face interview supported with standard observational checklist and reviewing medical records. A logistic regression analysis was carried out to examine the association between explanatory variables and episiotomy. An adjusted odds ratio (AOR) at a 95% confidence interval (CI) at a P-value <0.05 was used to declare significant association. RESULTS: The prevalence of episiotomy among women was 52.6% (95% CI: 47.8%, 57.0%). Obstetric complications during current pregnancy (AOR:3.92, 95% CI: 1.59, 9.68), birth weight ≥4000 gm (AOR: 4.30, 95% CI: 1.53, 12.04), induction of labor (AOR: 3.10, 95% CI: 1.62, 5.93), meconium-stained amniotic fluid (AOR:2.10, 95% CI: 1.14, 3.88), duration of the second stage of labor ≥90 minutes (AOR:3.09, 95% CI: 1.53, 6.23), instrumental delivery (AOR: 2.69, 95%, CI: 1.39, 5.19), and female genital mutilation (AOR: 2.91, 95% CI: 1.83, 4.64) were factors significantly associated with episiotomy. CONCLUSION: Slightly more than half of the women who gave birth at public health facilities in the study area underwent episiotomies. In addition to the common obstetric factors, having a female genital mutilation scar increased the risk of women's experiencing episiotomies. Therefore, intervention should be tailored to address the identified obstetric risk factors and avoid female genital mutilation in the community to reduce women's experiences of episiotomies in the future.

Barriers to proper maternal referral system in selected health facilities in Eastern Ethiopia: a qualitative study.

BACKGROUND: Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia. METHODS: Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding and merging. The data were thematically synthesized. RESULTS: The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre-referral communication and feedback, using informal communication, incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number of health professions. CONCLUSIONS: The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral are essential to improve maternal referral system.

HIV Pre-Exposure Prophylaxis Uptake Among High-Risk Population in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Globally, 38.4 million people are affected by the human immunodeficiency virus (HIV) pandemic, and more than 2.5 million new HIV infections occur yearly. HIV pre-exposure prophylaxis (PrEP) has been widely recognized as a potential way to prevent new infections among risk population. There is a paucity of abridged evidence on the level and barriers to PrEP service uptake in sub-Saharan Africa (SSA). Therefore, we conducted a systematic review to synthesize existing evidence on PrEP uptake in SSA. Relevant studies were searched from major databases (PubMed and PsychInfo) and direct Google Scholar. Data were extracted and recorded using a pilot-tested template. Methodological rigor, heterogeneity and publication bias of studies were assessed to minimize the inclusion of erroneous findings. A random effect model was used for the meta-analysis followed by narrative metasynthesis. The protocol of this systematic review has been by registered PROSPERO (ID: CRD42022308855). A total of 1830 studies were retrieved, and 30 studies met inclusion criteria of the systematic review. People who heard about PrEP ranged from 23% to 98%. The pooled prevalence of willingness to use PrEP was 64.2% (95% confidence interval: 55.5-72.0). Fear of side effect, stigma, nonreceptive attitude, cost of pills, low awareness about PrEP, perceived reason about the effectiveness of PrEP, and lack of friendly services were the common barriers to PrEP uptake in Africa. In conclusion, comprehensive knowledge and willingness to use PrEP were low in SSA. The barriers to low PrEP service uptake are avoidable through comprehensive awareness creation and availing essential services to key population in Africa. Expanding educational messages to key population using friendly approaches and more accessible platforms, engaging stakeholders, and integrating PrEP service with routine health care are important to foster HIV prevention and control in the future.

Challenges for research uptake for health policymaking and practice in low- and middle-income countries: a scoping review.

BACKGROUND: An estimated 85% of research resources are wasted worldwide, while there is growing demand for context-based evidence-informed health policymaking. In low- and middle-income countries (LMICs), research uptake for health policymaking and practice is even lower, while little is known about the barriers to the translation of health evidence to policy and local implementation. We aimed to compile the current evidence on barriers to uptake of research in health policy and practice in LMICs using scoping review. METHODS: The scoping review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses-extension for Scoping Reviews (PRISMA-ScR) and the Arksey and O'Malley framework. Both published evidence and grey literature on research uptake were systematically searched from major databases (PubMed, Cochrane Library, CINAHL (EBSCO), Global Health (Ovid)) and direct Google Scholar. Literature exploring barriers to uptake of research evidence in health policy and practice in LMICs were included and their key findings were synthesized using thematic areas to address the review question. RESULTS: A total of 4291 publications were retrieved in the initial search, of which 142 were included meeting the eligibility criteria. Overall, research uptake for policymaking and practice in LMICs was very low. The challenges to research uptake were related to lack of understanding of the local contexts, low political priority, poor stakeholder engagement and partnership, resource and capacity constraints, low system response for accountability and lack of communication and dissemination platforms. CONCLUSION: Important barriers to research uptake, mainly limited contextual understanding and low participation of key stakeholders and ownership, have been identified. Understanding the local research and policy context and participatory evidence production and dissemination may promote research uptake for policy and practice. Institutions that bridge the chasm between knowledge formation, evidence synthesis and translation may play critical role in the translation process.

Pneumatosis cystoids intestinalis in a patient with small bowel obstruction: a case report.

Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. A 35-year-old male patient presented with signs and symptoms of intestinal obstruction. Then the patient was diagnosed with pneumatosis cystoides intestinalis. The patient underwent surgery, and antibiotic treatment, and was discharged improved with no incident. Pneumatosis cystoides intestinalis is a surgical condition that resembles other life-threatening top surgical emergencies and affects clinicians' decisions on diagnosis and treatment plans substantially, mainly in low-income countries. So, surgeons have to consider such kind of conditions and avoid the costs and morbidities associated with unnecessary bowel resection or surgery.

Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review.

BACKGROUND: More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. METHODS: A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. RESULTS: The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. CONCLUSIONS: The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.

Workplace violence and its associated factors among nurses working in public hospitals of eastern Ethiopia: a cross-sectional study.

BACKGROUND: Workplace violence is one of the global health concerns. Although nurses are the backbone of the health care provision, they are highly subjected to workplace violence in healthcare. Nevertheless, there is a paucity of evidence on the extent of workplace violence against nurses in Ethiopia in general and Eastern Ethiopia in particular. Hence, this study aimed to assess the extent of workplace violence against nurses and its associated factors among nurse professionals working at public hospitals in eastern Ethiopia. METHODS: Hospital-based cross-sectional study was conducted among 603 nurses working in public hospitals in eastern Ethiopia. Nurses were recruited using a simple random sampling method at their workplace (health facilities). A pretested self-administered questionnaire was used to collect data. Descriptive, binary and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare significant association. RESULTS: Among the 620 estimated sample, 603(97.3%) of the nurses gave consent and completed the self-administered questionnaire. The prevalence of workplace violence against nurse professionals in the last 12 months was 64.0% (95%CI: 60.2-67.7%). Nurses who were working in surgical (AOR: 2.30, 95%CI: 1.01-5.26), psychiatric (AOR: 3.06, 95%CI: 1.11-8.46), emergency (AOR: 3.62, 95%CI: 1.46-8.98), and medical wards (AOR: 5.20, 95%CI: 2.40-11.27); being worried of workplace violence (AOR: 1.71, 95%CI: 1.09-2.69); witnessed of physical workplace violence (AOR: 5.31, 95%CI: 3.28-8.59); claimed "absence/not-aware" of reporting procedure on workplace violence (AOR: 2.24, 95%CI: 1.45-3.46); and claimed "absence/not-aware" of institutional policies against workplace violence (AOR: 2.68, 95%CI: 1.73-4.13) were factors associated with nurses' experience of workplace violence in eastern Ethiopia. CONCLUSIONS: Workplace violence against nurses was found to be unacceptably high in the study area (eastern Ethiopia). We suggest that stakeholders could work on early risk identification and management of violent incidents, establish violence reporting and sanction mechanisms using contextual strategies to prevent workplace violence against nurse professionals.

Knowledge of obstetric fistula and its associated factors among women of reproductive age in Northwestern Ethiopia: a community-based cross-sectional study.

BACKGROUND: Obstetric fistula has been a major maternal health challenges in low and middle-income countries, especially in Ethiopia, due to high child marriage and poor access to healthcare. Obstetric fistula is common among teenage mothers that results in a vast social, economic and cultural sequel. In Ethiopia, there is a paucity of research evidence on women's knowledge about obstetric fistula. Therefore, this study aimed to assess women's knowledge about obstetric fistula and its associated factors at Banja District, Northwestern Ethiopia. METHODS: A community-based cross-sectional study design was conducted from 1st -21th July 2021. Systematic sampling method was used to recruit 784 women in the reproductive age from six rural and one urban sub-districts. Two days of training was given to research assistants regarding the objective of the study, inclusion and exclusion criteria, checking completeness and ways of protecting confidentiality. Data were collected using face-to-face interview method. Collected data were entered into EpiData and exported into SPSS version 24 for cleaning and analysis. Descriptive statistics, binary and multivariable logistic regression analysis were performed to identify associated factors. Adjusted odds ratio (AOR) at 95% CI with p < 0.05 was used to declare significant association with women's knowledge of obstetric fistula. RESULTS: A total of 773 women gave a complete response with response rate of 98.6% (773/784). One-third (36.4%; 95%CI: 32.9-39.7%) had good knowledge about obstetric fistula. Women who had completed primary education (AOR:3.47, 95%CI:2.01-5.98), secondary and above (AOR:3.30, 95%CI:1.88-5.80), being a student (AOR: 6.78, 95%CI:3.88-11.86), get counseling about obstetric fistula (AOR:6.22, 95%CI: 3.78-10.24), participated in pregnant women's discussion forum (AOR:3.36, 95%CI: 1.99-5.66), had antenatal care follow-up (AOR: 2.40, 95% CI: 1.39-4.13), being an urban resident (AOR: 3.19, 95% CI: 1.33-7.66), and having access to Television/Radio (AOR:1.68, 95%CI:1.10-2.60) were significantly associated with women's good knowledge about obstetric fistula. CONCLUSION: Women's knowledge about obstetric fistula is unacceptably low. Therefore, concerned stakeholders should enhance awareness creation programs, strengthen antenatal care, counselling and women's discussion forum that could substantially optimize women's knowledge about obstetric fistula and its risk factors of obstetric fistula.

Food taboos among pregnant women and associated factors in eastern Ethiopia: A community-based cross-sectional study.

Objective: The main aim of this study was to assess food taboos and associated factors among pregnant women in eastern Ethiopia. Methods: A community-based cross-sectional study was conducted among randomly selected 422 pregnant women at Haramaya Demographic Surveillance System from Haramaya District, eastern Ethiopia. Data on sociodemographic conditions, the presence of food taboos, and perceived reasons were collected using the face-to-face interview method by trained data collectors through arranged home visits. Collected data were entered into EpiData 3.1 and exported to statistical package for social sciences version 23 for cleaning and analysis. Descriptive, binary, and multiple logistic regression analyses were carried out to determine the relationship between explanatory and outcome variables. Adjusted odds ratio (AOR) with 95% confidence interval (CI) at p value less than 0.05 was used to declare significant association. Results: Approximately half (48%, 95% CI: 43%, 52%) of the pregnant women reported the presence of pregnancy-related food taboos. Pregnant women who have heard about food taboos (AOR: 3.58; 95% CI: 1.89, 6.83), pregnant women had friends who avoided food (AOR: 1.91; 95% CI: 1.22, 2.99), women's monthly income ⩽840 ETB (AOR: 1.73; 95% CI: 1.10, 2.73), and pregnant women who had not attended formal education (AOR: 1.95; 95% CI: 1.18, 3.23) were more likely to report food taboos. The odds of pregnant women who had attended uptake of immunization services were less likely to have food taboos (AOR: 0.35; 95% CI: 0.21, 0.58). Conclusion: Pregnancy-related food taboos among pregnant women are unacceptably high. Therefore, awareness creation and nutritional counseling at health service delivery points are imperative actions for pregnant women to avoid food taboos norms. Further research should be done to understand the social and cultural ground of food taboos during pregnancy.

Attitudes toward safe abortion care and its associated factors among health care providers working in public health facilities in eastern Ethiopia.

Objectives: The main aim of this study was to assess health care providers' attitudes toward safe abortion services and its associated factors in public health facilities of Harar city, Eastern Ethiopia. Methods: Facility-based cross-sectional study was conducted among 411 health care providers who were working at public health facilities in Harari regional state, in eastern Ethiopia. A simple random sampling technique was used to select study participants. Data were collected using self-administered questionnaires, and collected data were entered into EpiData version 4.6 and then exported to SPSS version 26 for cleaning and analysis. Descriptive statistics, bivariable, and multivariable logistic regression analysis were carried out to compute the prevalence of the outcome variables and to identify factors associated with the outcome variable, respectively. Adjusted odds ratio at 95% confidence interval and p-value < 0.05 was used to declare a significant association. Results: More than half (58.4%, 95% confidence interval: 53.8-63.2) of the health care providers had a favorable attitude toward safe abortion care. Being male (adjusted odds ratio = 2.90; 95% confidence interval: 1.80-4.65), ever trained on safe abortion (adjusted odds ratio = 2.55; 95% confidence interval: 1.39-4.66), familiarity with the current abortion law of Ethiopia (adjusted odds ratio = 2.38; 95% confidence interval: 1.40-4.05), preference of unrestricted abortion law (adjusted odds ratio = 1.86; 95% confidence interval: 1.15-3.02), and being medical doctors or health officers (adjusted odds ratio = 1.90; 95% confidence interval: 1.06-3.41) were the factors significantly associated with health care providers' favorable attitude toward safe abortion care. Conclusion: Approximately three in five of the health care providers working at public health facilities had a favorable attitude toward safe abortion care in eastern Ethiopia. We suggest giving pre-service or in-service training on safe abortion care and supporting health care providers to be familiar with the country's abortion laws are crucial to improve health care providers' attitudes toward safe abortion service in Ethiopia.

Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study.

Objectives: Although neonatal near miss is an emerging concept and a tool for improving neonatal care, its magnitude and associated factors are less researched in Ethiopia. Thus, this study was aimed to uncover the magnitude of neonatal near miss and its associated factors in public hospitals in Eastern Ethiopia. Methods: A facility-based cross-sectional study was employed on a randomly selected 405 mother-neonate pairs. An interview using a structured questionnaire accompanied by review of medical records was used to collect data from the mothers and records of the neonates. Neonatal near miss was defined as having any of the pragmatic (gestational age < 33 weeks, birth weight < 1750 g, and fifth minutes Apgar score < 7) or management criteria. Crude and adjusted logistic regression analysis was done to identify associated factors and presented with adjusted odds ratio with 95% confidence interval. Results: Of 401 mother-neonate pairs included in the study, 126 (31.4%, 95% confidence interval = [26.9, 36.2]) neonates had at least one neonatal near miss event at discharge. Neonatal near miss was more likely among neonates from referred women (adjusted odds ratio = 2.24, 95% confidence interval = [1.25, 4.03]), no antenatal care (adjusted odds ratio = 2.08, 95% confidence interval = [1.10, 3.93]), antepartum hemorrhage (adjusted odds ratio = 4.29, 95% confidence interval = [2.16, 8.53]), premature rupture of membrane (adjusted odds ratio = 4.07, 95% confidence interval = [2.05, 8.07]), obstructed labor (adjusted odds ratio = 2.61, 95% confidence interval = [1.23, 5.52]), non-vertex presentation (adjusted odds ratio = 3.03, 95% confidence interval = [1.54, 5.95]), and primiparous (adjusted odd ratio = 2.67, 95% confidence interval = [1.49, 4.77]). Conclusions: In this study, we found that neonatal near miss is higher than previous findings in Ethiopia. Improving neonatal near miss requires promoting antenatal care, maternal referral system, and early identification and management of obstetric complications.

Physical fighting among adolescents in eastern Ethiopia: a cross-sectional study.

BACKGROUND: Physical fights have been a common health problem among adolescents, and approximately a million adolescents' lives are lost due to violence-related incidents worldwide. There is a lack of information on the burden of adolescents' physical fights in eastern Ethiopia. Hence, the study aims to estimate the magnitude and assess factors associated with physical attacks and fighting among adolescents in eastern Ethiopia. METHODS: A community-based cross-sectional study was conducted among 2424 adolescents in eastern Ethiopia in 2016. Simple random sampling was used to recruit study participants. Data were collected by trained interviewers using a structured questionnaire developed by the Africa Research, Implementation Science and Education (ARISE) network and adapted from the World Health Organization Global school-based student health survey. Descriptive statistics, binary and multivariable logistic regression were performed. Statistical associations were determined using adjusted odds ratio (AOR) at 95% Confidence Intervals (95% CIs) and P-value < 0.05. RESULTS: Prevalence of physical attacks and physical fights was 5.8%, and 26.4%, respectively. Adolescents who attended school (AOR 0.4, 95% CI: 0.2-0.9) and who chewed Khat (AOR 0.4, 95% CI: 0.2-0.8) were less likely to experience physical attacks. Male adolescents were two times more likely to engage in physical fights than female adolescents (AOR 2.4, 95% CI: 1.8-3.2). In-school adolescents who attended secondary (AOR 0.4, 95% CI: 0.2-0.7) or tertiary level of education (AOR 0.2, 95% CI: 0.1-0.7) were less likely to participate in physical fighting than those with primary level education. Adolescents who had ever engaged in physical work to earn money for food or drink were 1.9 times more likely to be physically attacked compared to those who had not (AOR 1.9, 95% CI: 1.0-3.5). CONCLUSION: Physical attacks and fights were found to be common experiences of adolescents in eastern Ethiopia. Future research and programs should emphasize preventive health programs for reducing violence and promoting school enrolment and retention.

Incomplete Vaccination and Its Predictors among Children in Ethiopia: A Systematic Review and Meta-Analysis.

Background. Vaccination is an effective public health intervention that has contributed to a substantial reduction in the burden of vaccine-preventable diseases. Abridged evidence on incomplete vaccination is not well established in Ethiopia. Therefore, this meta-analysis aimed to estimate the pooled prevalence of incomplete vaccination and its predictors among children aged 12 to 23 months. Methods. Primary studies conducted in Ethiopia were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The analysis was conducted using STATA 14 and RevMan. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using I2 statistics. Pooled prevalence and odds ratio (OR) were computed at a 95% confidence interval (CI). Results. The pooled prevalence of incomplete vaccination was 30% (95% CI: 25-35). Maternal illiteracy (OR = 1.96; 95% CI: 1.40, 2.74) and home delivery (OR = 2.78; 95% CI: 2.28, 3.38) were associated factors that increased incomplete vaccination. However, maternal autonomy (OR = 0.54; 95% CI: 0.33, 0.89), maternal knowledge (OR = 0.31; 95% CI: 0.20, 0.47), husband employment (OR = 0.49; 95% CI: 0.35, 0.67), urban residence (OR = 0.61; 95% CI: 0.43, 0.86), ANC visits (OR = 0.30; 95% CI: 0.23, 0.39), postnatal care (OR = 0.39; 95% CI: 0.30, 0.52), and tetanus toxoid vaccine (3+) (OR = 0.42; 95% CI: 0.26, 0.69) were factors that reduced incomplete vaccination. Conclusion. In Ethiopia, 3 out of 10 children have incomplete vaccination. Policies should focus on strengthening and improving women's education, maternal health knowledge, empowering women, and the utilization of prenatal care can overcome some of the barriers.

Nurses' work-related stress and associated factors in governmental hospitals in Harar, Eastern Ethiopia: A cross-sectional study.

INTRODUCTION: Work-related stress causes poor quality of nursing care and increases the risk of medical errors. Research evidence is so limited to nurses' work-related stress in eastern Ethiopia. Therefore, this study aimed to assess work-related stress and associated factors among nurses working in governmental hospitals in Harar, Eastern Ethiopia. METHODS: Institution-based quantitative cross-sectional study was conducted among 367 nurses from 15th to 30th March, 2015. Simple random sampling technique was applied to recruit study participants. Data were collected using structured self-administered questionnaire. Descriptive statistics, bivariate and multivariate logistic regressions were carried out. The statistical association was declared using adjusted odds ratio at 95% confidence interval (CI) and P-value of less than 0.05. RESULTS: A total of 398 study participants were involved in the study, and the response rate was 92.2% (367/398). More than half of 202(55%) of the participants were males. One third (33.8%, n = 124) of study participants' age ranged between 26 to 34 years. The prevalence of work-related stress in the current study was 66.2%. Nurses, who reared child (AOR = 2.1, 95% CI: 1.2, 3.7), working in intensive care units (AOR = 4.5, 95% CI: 1.4, 17.7), work on rotation (AOR = 2.5, 95% CI: 1.4, 4.4), and nurses who had a chronic medical illness (AOR = 2.6, 95% CI: 1.2, 5.7) were significantly associated with nurses' work-related stress. CONCLUSION: Two-thirds of nurses who were working at government hospitals had work-related stress. Work-related stress was associated with child-rearing, working units, work on rotation, and chronic medical illness. We suggested the hospital's administration, and other concerned stakeholders should design a strategy to undertake necessary measures such as hiring more nurses to minimize workload and rescheduling work shift to alleviate work-related stress among nurses.

Childhood hearing impairment and its associated factors in sub-Saharan Africa in the 21st century: A systematic review and meta-analysis.

BACKGROUND: Childhood hearing impairment is still a significant cause of disability in the 21st century in developing countries. Particularly, the burden is more severe in sub-Saharan Africa, where the majority of children with hearing problems is living. Thre are great variations and inconsistencies of available findings conducted in sub-Saharan Africa. Hence, the aim of this review was to determine the pooled prevalence of childhood hearing impairment and its associated factors in sub-Saharan Africa. METHODS: Studies were searched from main databases (PubMed, CINAHL, and African Journals Online), Google Scholar, and other relevant sources using electronic and manual techniques. All observational studies, written in English and conducted among participants (aged less than 18 years) from 2000 to 2018, were eligible. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of the funnel plot. Statistical analysis was carried out to determine pooled prevalence using Stata version 14. In addition, subgroup analysis was carried out for the normality criteria of hearing thresholds and characteristics of the study populations. RESULTS: The pooled prevalence of hearing impairment was 10% (95% confidence interval (CI): 9%-11%). The magnitude of hearing impairment varies with the normality criterion used. The most commonly used threshold was 25 and 30 dB hearing level. The prevalence of hearing impairment based on normality criterion (>20 dB, >25 dB, >30 dB, and >35 dB) were 17%, 19%, 2%, and 1%, respectively. While in the questionnaire-based evaluation, the prevalence was 6% (95% CI: 3%-9%). In addition, based on population characteristics, the prevalence of hearing impairment for school or community-based children was 6% (95% CI: 5%-7%) while the prevalence for children with comorbidities was 23% (95% CI: 15%-31%). Chronic suppurative otitis media, impacted cerumen, advanced stage of human immunodeficiency virus, tuberculosis infection, and age of the children were associated with hearing impairment in sub-Saharan Africa. CONCLUSION: Hearing impairment in children and adolescents in sub-Saharan Africa was high, and associated with preventable and treatable risk factors.

Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis.

BACKGROUND: Major psychiatric disorders are growing public health concern that attributed 14% of the global burden of diseases. The management of major psychiatric disorders is challenging mainly due to medication non-adherence. However, there is a paucity of summarized evidence on the prevalence of psychotropic medication non-adherence and associated factors. Therefore, we aimed to summarize existing primary studies' finding to determine the pooled prevalence and factors associated with psychotropic medication non-adherence. METHODS: A total of 4504 studies written in English until December 31, 2017, were searched from the main databases (n = 3125) (PubMed (MEDLINE), Embase, CINAHL, PsycINFO, and Web of Science) and other relevant sources (mainly from Google Scholar, n = 1379). Study selection, screening, and data extraction were carried out independently by two authors. Observational studies that had been conducted among adult patients (18 years and older) with major psychiatric disorders were eligible for the selection process. Critical appraisal of the included studies was carried out using the Newcastle Ottawa Scale. Systematic synthesis of the studies was carried out to summarize factors associated with psychotropic medication non-adherence. Meta-analysis was carried using Stata 14. Random effects model was used to compute the pooled prevalence, and sub-group analysis at 95% confidence interval. RESULTS: Forty-six studies were included in the systematic review. Of these, 35 studies (schizophrenia (n = 9), depressive (n = 16), and bipolar (n = 10) disorders) were included in the meta-analysis. Overall, 49% of major psychiatric disorder patients were non-adherent to their psychotropic medication. Of these, psychotropic medication non-adherence for schizophrenia, major depressive disorders, and bipolar disorders were 56%, 50%, and 44%, respectively. Individual patient's behaviors, lack of social support, clinical or treatment and illness-related, and health system factors influenced psychotropic medication non-adherence. CONCLUSION: Psychotropic medication non-adherence was high. It was influenced by various factors operating at different levels. Therefore, comprehensive intervention strategies should be designed to address factors associated with psychotropic medication non-adherence. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017067436.

HIV/AIDS awareness and testing practices among adolescents in eastern Ethiopia.

OBJECTIVE: To examine HIV/AIDS awareness, HIV testing practices and associated factors among adolescents in two eastern Ethiopian communities. METHODS: Community-based, cross-sectional study among 2010 adolescents aged 10-19 years. Participants were asked about their awareness of HIV/AIDS and HIV testing practices, and whether they had ever been tested for HIV. Regression models were applied to identify the factors of statistical significance at P-value < 0.05. RESULTS: Of 90% were aware of HIV/AIDS, but only a quarter had ever been tested for HIV. Rural adolescents were less aware of HIV than urban adolescents (AOR = 0.16; 95% CI: 0.05, 0.58), and in-school adolescents had more knowledge about HIV/AIDS than that out-of-school adolescents (AOR = 2.79; 95% CI: 1.88, 4.15). Factors associated with lower uptake of HIV testing were male sex (AOR = 0.74; 95% CI; 0.58, 0.91) and being from a rural area (AOR = 0.16; 95% CI: 0.07, 0.36). Factors associated with higher uptake of HIV testing were being in school (AOR = 1.66; 95% CI: 1.16, 2.38), using the Internet (AOR = 1.52; 95% CI: 1.01, 2.28), and ever visiting a health facility (AOR = 1.54; 95% CI: 1.21, 1.96). CONCLUSIONS: Awareness of HIV/AIDS was high, whereas HIV testing was rare. HIV awareness programs for adolescents should target rural and out-of-school adolescents. Programmes to increase HIV testing implemented in these and similar communities should focus on male and rural adolescents.

OBJECTIF: Examiner la sensibilisation au VIH/SIDA, les pratiques de dépistage du VIH et les facteurs associés chez les adolescents de deux communautés dans l'est de l'Ethiopie. MÉTHODES: Etude transversale, à base communautaire auprès de 2.010 adolescents âgés de 10 à 19 ans. Les participants ont été interrogés sur leurs connaissances sur le VIH/SIDA et sur les pratiques de dépistage du VIH, et s'ils avaient déjà subi un test de dépistage du VIH. Des modèles de régression ont été appliqués pour identifier les facteurs ayant une signification statistique à une valeur P < 0,05. RÉSULTATS: 90% des participants étaient au courant du VIH/SIDA, mais seulement un quart avait déjà subi un test de dépistage du VIH. Les adolescents ruraux étaient moins au courant du VIH que les adolescents urbains (AOR = 0,16; IC95%: 0,05-0,58), et les adolescents scolarisés avaient plus de connaissances sur le VIH/SIDA que les adolescents non scolarisés (AOR = 2,79; IC95%: 1,88-4,15). Les facteurs associés à une moindre adoption du test de dépistage du VIH étaient le sexe masculin (AOR = 0,74; IC95%: 0,58-0,91) et provenir d'une zone rurale (AOR = 0,16; IC95%: 0,07-0,36). Les facteurs associés à une plus grande adoption du test de dépistage du VIH étaient le fait d'être scolarisé (AOR = 1,66; IC95%: 1,16-2,38), l'utilisation d'Internet (AOR = 1,52; IC95%: 1,01, 2,28) et avoir déjà visité un établissement de santé (AOR = 1,54; IC95%: 1,21-1,96). CONCLUSIONS: La sensibilisation au VIH/SIDA était élevée alors que le dépistage du VIH était rare. Les programmes de sensibilisation au VIH devraient cibler les adolescents des zones rurales et ceux non scolarisés. Les programmes pour augmenter le dépistage du VIH, mis en œuvre dans ces communautés et dans des communautés similaires, devraient se concentrer sur les adolescents masculins et ceux vivant en milieu rural.

Prevalence, associated factors and consequences of substance use among health and medical science students of Haramaya University, eastern Ethiopia, 2018: a cross-sectional study.

BACKGROUND: Substance use has a terrible impact on health, behavior and country's economy because the number of people particularly the youngsters being involved in this practice is increasing rapidly. However, the prevalence, determinants and consequence of substance use in the study area has been overlooked. METHODS: A descriptive quantitative cross-sectional study was conducted among 254 health science students of Haramaya University. The respondents were selected randomly after double stratification based on their department and batch respectively. A pre-tested self-administrable anonymous questionnaire was used. The collected data were entered into epidata version 3.1 and exported to SPSS version 23. Descriptive statistical analysis was done to examine findings. Besides, chi-square (X2) test was considered to examine the nonparametric association of factors with ever substance use. RESULTS: Prevalence of ever substance use for at least one substance was found to be 114(45.4%). Ever khat chewers take the highest percentage [107(93.9%)] followed by ever smokers 45(39.5%) and ever drinkers 44(38.6%). Among these ever substance users, 80(70.2%) were found to be current substance users. Being a preparatory student (26.3%) and freshman at university (57.9%) were critical times to initiate substance use. Sex, monthly income, sexual risk behavior and family history of substance use were found to be significantly associated with being ever substance user as witnessed by their respective X2 values of 19.67, 72.28, 28.99 and 139.72 at P-value = 0.05 and degree of freedom (df = 1). From the overall ever substance users, 31.6% had undesirable health consequences. Among these consequences, anorexia [40 (35.1%)] accounted for the highest percentage followed by insomnia [29 (25.4%)], depression [25 (22%)], gastritis [25 (22%)], dental caries [23 (20.2%)] and increased sexual activity [12 (10.5%)]. CONCLUSION: Prevalence of ever substance use in the study area was relatively high. Therefore attention should be given to the major reasons for substance use mainly orientation of freshman students about better stress coping mechanisms and expansion of adequate recreational activities.

Are interventions focused on gender-norms effective in preventing domestic violence against women in low and lower-middle income countries? A systematic review and meta-analysis.

BACKGROUND: One in three women experience intimate partner violence worldwide, according to many primary studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic violence against women in low and lower-middle income countries. METHODS: Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of Science), Google scholar and other relevant sources using electronic and manual techniques. Published and unpublished studies written in English and conducted among women aged (15-49 years) from 1994 to 2017 were eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence. RESULTS: Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis. The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20% (95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0% (95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders' engagement, women's empowerment, intervention integration and policy/legal framework were highly recommended interventions to prevent intimate partner violence. CONCLUSION: Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders, empower women and integrate service to prevent violence against women. PROTOCOL REGISTRATION: PROSPERO: 2017: CRD42017079977 .

Survival rate of HIV-infected children after initiation of the antiretroviral therapy and its predictors in Ethiopia: A facility-based retrospective cohort.

OBJECTIVE: To determine the survival rate and predictors of HIV-infected children on antiretroviral therapy at two selected facilities in North Ethiopia. METHODS: A facility-based retrospective cohort study was conducted in Debre Tabor General Hospital and Dessie Referral Hospital from December 2005 to November 2015. A total of 426 records were included in the study. Multivariable Cox proportional hazards regression model was used to identify independent predictors of survival. RESULTS: At the end of follow-up, 97 (22.9%) HIV-infected children died and 325 (77.1%) were alive. The probabilities of survival at 12, 24, 36 and 48 months of on antiretroviral therapy were 0.91, 0.85, 0.84 and 0.80, respectively. The median survival time was 91.6 months (95% confidence interval: 89.0-94.2). Almost half (51%) of the deaths occurred within the first 2 years of treatment. Study participants who had poor adherence to antiretroviral therapy (adjusted hazard ratio = 3.0; 95% confidence interval: 1.2-7.5) and who started antiretroviral therapy with lower baseline weight-for-age Z-score (adjusted hazard ratio = 2.5; 95% confidence interval: 1.1-6.1) were significantly associated with high risk of mortality. On the other hand, study participants with a baseline CD4 count above 200 cells/mm3 (adjusted hazard ratio = 0.7; 95% confidence interval: 0.4-0.9) and those participants who had psychosocial support during follow-up (adjusted hazard ratio = 0.03; 95% confidence interval: 0.1-0.7) were significantly associated with less mortality event. CONCLUSION: Mortality of children on antiretroviral therapy was high. The risk of mortality is increased if the child was underweight at the commencement of antiretroviral therapy, had lower baseline CD4 count, had poor adherence to antiretroviral therapy and had no psychosocial support. Concerned stakeholders should focus on antiretroviral therapy adherence, nutritional interventions, psychological support and early initiation of antiretroviral therapy regardless of their CD4 count to enhance survival of HIV-infected children on antiretroviral therapy.