Risk factors for precancerous cervical lesion among women screened for cervical cancer in south Ethiopia: Unmatched case-control study.

BACKGROUND: Nearly 90% of deaths from cervical cancer occur in a low resource setting. In Ethiopia, the magnitude of precancerous cervical lesions ranges from 7% to 28%. Precancerous cervical lesions may progress to cervical cancer. Early screening and treatment of precancerous cervical lesions is a cost-effective way to avert the growth of cervical cancer. However, there has been limited research on risk factors for precancerous cervical lesions in Ethiopia. Therefore, this study aimed to identify risk factors for precancerous cervical lesions among women screened for cervical cancer in south Ethiopia. METHOD: A facility-based unmatched case-control study was carried out in five health facilities in south Ethiopia between 8 May to 28 September 2018. Interviewer administered questionnaires were used to collect data from 98 cases and 197 controls. Multivariate logistic regression was employed to identify determinants of precancerous cervical lesions. RESULTS: Women aged 30-39 years (AOR = 2.51, 95% CI: 1.03-6.08), monthly income ≤66 (AOR = 3.51, 95% CI: 1.77-6.97), initiation of first sexual intercourse at age less than or equal to 20 (AOR = 2.39, 95% CI: 1.14-5.47), having more than one lifetime sexual partner (AOR = 4.70, 95% CI: 2.02-10.95), having a partner/ husband with more than one lifetime sexual partner (AOR = 2.98, 95% CI: 1.35-6.65) had higher odds of precancerous cervical lesions. CONCLUSION AND RECOMMENDATION: Strategies to prevent precancerous cervical lesions should focus on modification of lifestyle and sexual behaviour. The findings of this study highlight several implications for policymakers: targeting older women for cervical cancer screening, addressing inequalities and education relating to risky sexual behaviour may reduce precancerous cervical lesions. Furthermore, future longitudinal studies are needed to assess the awareness of women about cervical cancer screening.

Dietary Diversity and Associated Factors among Pregnant Women Attending Antenatal Clinic in Shashemane, Oromia, Central Ethiopia: A Cross-Sectional Study.

BACKGROUND: Maternal dietary diversity is a proxy indicator of maternal nutrient adequacy and improves health outcomes for both mothers and babies. However, little is documented on dietary diversity among pregnant mothers. Therefore, this study assessed diet diversity and associated factors among pregnant mothers attending the antenatal clinic in Shashemane, Oromia, Central Ethiopia. METHODS: An institution-based cross-sectional study was conducted on 315 systematically selected pregnant women attending antenatal clinic of Shashemane town in April 2017. Dietary diversity was assessed using a 24 h dietary recall method, and the dietary diversity score was computed for ten food groups. Bivariate and multivariate logistic regressions were computed to identify associated factors of dietary diversity. RESULT: In this study, only a quarter (25.4%) of pregnant mothers consumed adequate dietary diversity. Mother's tertiary (AOR 3.18; 95% CI: 1.8, 6.35) and secondary (AOR 2.13; 95% CI: 2.32, 8.72) education, household monthly income above 3500 ETB (AOR = 2.24; 95% CI: 1.47, 7.78), livestock ownership (AOR = 4.15; 95% CI: 2.07, 9.86), women who got emotional support from the husband (AOR = 3.49; 95% CI: 1.12, 8.23), and women who participated in the shooping (AOR = 2.54; 95% CI: 3.27, 9.83) were more likely to attain the adequate dietary diversity. CONCLUSION: The study revealed that the overall consumption of adequate dietary diversity was found to be low. Developing the educational level of women, increasing household income and owning of livestock, increasing husbands' support, and improving women's participation in the shopping are recommended to improve women's adequate dietary diversity.

Neonatal mortality in Ethiopia: a protocol for systematic review and meta-analysis.

BACKGROUND: A child's risk of dying is highest in the neonatal period, i.e. the first 28 days of life. Newborn death accounts for nearly half of under-five death. More than 80% of newborn deaths are the result of preventable and treatable conditions. Ethiopia has made significant progress towards reducing under-five mortality; however, the rate of neonatal mortality (NMR) still accounts for 41% of under-five deaths. With this systematic review and meta-analysis, we aim to determine the magnitude, causes, and determinants of neonatal mortality in Ethiopia. METHODS: We will conduct a comprehensive search of the following electronic databases: PubMed, MEDLINE, EMBASE, CINAHL, Google Scholar, and maternity and infant care databases as well as grey literature. We will assess the quality of studies by using Newcastle-Ottawa Scale (NOS) checklist. Two reviewers will screen all retrieved articles, conduct data extraction, and then critically appraise all identified studies. We will analyse data by using STATA 11 statistical software. We will demonstrate pooled estimates and determinants of neonatal mortality with effect size and 95% confidence interval. DISCUSSION: The result from this systematic review will inform and guide health policy planners and researchers on the burden, causes, and determinants of neonatal mortality in Ethiopia. To our knowledge, this is the first systematic review in Ethiopia. We will synthesise the findings to generate up-to-date knowledge on neonatal mortality in Ethiopia. SYSTEMATIC REVIEW REGISTRATION: PROSPERO-CRD42018099663.

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study.

Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

Breast and complementary feeding in Ethiopia: new national evidence from systematic review and meta-analyses of studies in the past 10 years.

PURPOSE: The aim of this systematic review and meta-analysis was to provide a national estimate of breast and complementary feeding practices and its predictors in Ethiopia. METHODS: PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases were searched for all available literature published until April 2018. Observational studies including cross-sectional, case-control and cohort studies were included. Newcastle-Ottawa Scale was used to assess the quality of studies. Heterogeneity of studies was quantified using Cochran's Q χ2 statistic and Higgins's method (I2). A meta-analysis using a weighted inverse variance method was performed. Subgroup analysis was carried out based on region and study area. RESULTS: In total, 70 studies that involved > 55,000 women from nine regions and two chartered cities in Ethiopia were included. The pooled national prevalence for timely initiation of breastfeeding (TIBF), exclusive breastfeeding (EBF) and timely initiation of complementary feeding was 66.5%, 60.1% and 62.5%, respectively. Guidance and counselling on breastfeeding, vaginal delivery and health institution delivery significantly increased the odds of TIBF and EBF. In addition, TIBF significantly associated with high EBF practice. Maternal occupational status significantly associated with low EBF practice, but not TIBF. CONCLUSIONS: Based on the WHO standard, the current breast and complementary feeding practice in Ethiopia is good and improving. Integrated intervention is still required for further improvement and minimizing the effect of occupational status.

Prevalence and Determinants of Complete Postnatal Care Service Utilization in Northern Shoa, Ethiopia.

BACKGROUND: Postnatal period presents the highest risk of death for mothers and newborns. Although progress has been made in expanding the coverage for most of maternal health services, national prevalence of postnatal care service utilization in Ethiopia is still extremely limited. Hence, this study aims to determine the prevalence and factors associated with complete postnatal care service utilization in Northern Shoa, Ethiopia. METHODS: Community based cross-sectional survey was conducted between November 2016 and February 2017. A total of 510 mothers were included in the study using multistage sampling technique. The data were collected through face-to-face interview. Bivariate and multivariate logistic regression models were fitted to identify factors associated with complete postnatal care utilization at p value of < 0.05. SPSS version 20 was used to analyze the data. RESULTS: The prevalence of complete postnatal care utilization was found to be 28.4% in the study area. Mode of delivery (AOR=5.7, 95% CI = 3.9, 19), number of children (AOR= 2.5 95% CI, 1.4, 14.2), and level of education (AOR=3.2 95% CI, 1.1, 9.2) were the factors statistically associated with complete postnatal service uptake. Being healthy was the major (48.8%) reason mentioned for not complying with the recommended three postnatal visits. CONCLUSION: The prevalence of complete postnatal care service in the study area was found to be low, and it is far less than the targeted zonal and regional plan. Reinforcing the existing policies and strategies to increase women level of awareness about postnatal care and intensive counseling during antenatal care and delivery are the recommendations based upon the current finding.

Adherence to prenatal iron-folic acid supplementation in low- and middle-income countries (LMIC): a protocol for systematic review and meta-analysis.

BACKGROUND: Daily iron-folic acid supplementation reduces anemia and various adverse obstetric outcomes such as preterm delivery, low birthweight, hemorrhage, and perinatal and maternal morbidity and mortality. However, its supplementation has not been successful that attributed to several determinants including poor adherence. Therefore, we aimed to conduct a systematic review and meta-analysis on the prevalence and determinants of adherence to prenatal iron-folic acid supplementation in low- and middle-income countries. In addition, we will develop a conceptual framework in the context of low- and middle-income countries (LMIC). METHODS/DESIGN: We will search PubMed, MEDLINE, EMBASE, EBSCO, Web of Science, SCOPUS, WHO Global Index Medicus, and African Journals Online (AJOL) databases to retrieve relevant literatures. Observational (i.e., case-control, cohort, cross-sectional, survey, and surveillance reports) and quasi-randomized and randomized controlled trial studies conducted in LMIC will be included. The Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) critical appraisal checklist will be used to assess the quality of observational and randomized controlled trial studies respectively. The pooled prevalence and odds ratio of determinants of adherence will be generated using a weighted inverse-variance meta-analysis model. Statistical heterogeneity among studies will be assessed by Cochran's Q χ2 statistics and Higgins (I2 statistics) method. The result will be presented using forest plots and Harvest plots when necessary. Furthermore, we will perform Jackknife sensitivity and subgroup analysis. Data will be analyzed using comprehensive meta-analysis software (version 2). DISCUSSION: Contemporary evidence about the prevalence and determinants of adherence in LMIC will be synthesized to generate up-to-date knowledge. To our knowledge, this is the first systematic review. It would have substantial implications for researchers, clinicians, and policymakers for optimizing maternal and child health outcomes in LMIC. SYSTEMATIC REVIEW REGISTRATION: The protocol has been registered on International Prospective Register of Systematic Review (PROSPERO), University of York Center for Reviews and Dissemination ( https://www.crd.york.ac.uk/ ), registration number CRD42017080245 .

Attitude and Vaccination Status of Healthcare Workers against Hepatitis B Infection in a Teaching Hospital, Ethiopia.

BACKGROUND: World Health Organization and Centers for Disease Control and Prevention recommend all health professionals to get vaccinated against hepatitis B virus before they start the clinical attachments during their stay in the medical school. However, only 18-39% of healthcare workers in low- and middle-income countries received the vaccine. Therefore, this study aims to determine the attitude and vaccination status of health professionals working at Adama General Hospital and Medical College. METHODS: An institution-based cross-sectional study was conducted from December 2016 to February 2017 with 403 health professionals working at Adama General Hospital and Medical College. Data were collected using self-administered questionnaire distributed at the participant's work unit and analyzed using SPSS version 20. Multiple logistic regression analysis was conducted to identify factors that affect the complete vaccination status and p value < 0.05 was considered statistically significant. RESULT: The prevalence of complete vaccination against hepatitis B virus was 25.6%. The most frequently mentioned reasons for not being vaccinated were high cost of the vaccine (41%) and unavailability of the vaccine (36%). More than three-fourths (77.8%) of study participants strongly agreed that hepatitis B is a major public health threat and there was tendency among participants to believe that their profession will put them at increased risk of acquiring the disease (strongly agreed: 75.9%). Attending infection-prevention training [AOR = 2.3; 95% CI, 1.24-6.31], history of exposure to risky behavior [AOR = 5.5; 95% CI, 2.86-9.29], and long years of work experience [AOR = 3.1; 95% CI, 1.98-5.24] were statistically significant with complete vaccination status. CONCLUSION: Only one-quarter of health professionals received the recommended full dose of the vaccine. Sustained hepatitis B vaccination programs for healthcare workers need to be established by collaboration of different stakeholders to optimize health professionals' safety against this contagious infection.

Premarital sexual practice and its predictors among university students: institution based cross sectional study.

INTRODUCTION: Adolescents are susceptible to different social, peer and cultural pressures that Drives them into earlier sexual experimentation. Despite the fact that delaying sexual activity until marriage reduces the spread of HIV/AIDS and various sexually transmitted infections (STI), sexual activities among youths have been reported to be increasing worldwide. METHODS: Institution Based cross-sectional survey was conducted between January 2016 to March 2016. A total of 604 students were included in the study using multi-stage sampling technique. Mixed Quantitative and Qualitative approach was applied. Bivariate and multivariate logistic regression model was fitted to identify factors associated with premarital sexual practice. RESULTS: The proportion of premarital sexual practice in the study area was found to be 54.3%. The mean age of first sexual debut was 18.7±1.96. Half (50.6%) of these sexual activities were performed because of student's interest to meet their sexual desire. Being Male, watching pornography and High academic performance were the factors significantly associated with premarital sexual practice. CONCLUSION: The study had revealed that more than half of the participants were sexually active. Being male, watching pornography and high academic performance were predictors of premarital sexual practice. Therefore, Institute of Medicine and health science, gender office and HIV resource center have to organize different programs targeting at bringing behavioral change to minimize the prevailing prevalence of premarital sexual practice as well as its common consequences.