The varying estimation of infertility in Ethiopia: the need for a comprehensive definition.

BACKGROUND: Infertility is a marginalized sexual and reproductive health issue in low-resource settings. Globally, millions are affected by infertility, but the lack of a universal definition makes it difficult to estimate the prevalence of infertility at the population level. Estimating the prevalence of infertility may inform targeted and accessible intervention, especially for a resource-limited country like Ethiopia. This study aims to estimate the prevalence of female infertility in Ethiopia using the Demographic and Health Survey (DHS) through two approaches: (i) the demographic approach and (ii) the current duration approach. METHODS: Data from 15,683 women were obtained through the 2016 Ethiopian DHS. The demographic approach estimates infertility among women who had been married/in a union for at least five years, had never used contraceptives, and had a fertility desire. The current duration approach includes women at risk of pregnancy at the time of the survey and determines their current length of time-at-risk of pregnancy at 12, 24, and 36 months. Logistic regression analysis estimated the prevalence of infertility and factors associated using the demographic approach. Parametric survival analysis estimated the prevalence of infertility using the current duration approach. All estimates used sampling weights to account for the DHS sampling design. STATA 14 and R were used to perform the statistical analysis. RESULTS: Using the demographic definition, the prevalence of infertility was 7.6% (95% CI 6.6-8.8). When stratified as primary and secondary infertility, the prevalence was 1.4% (95% CI 1.0-1.9) and 8.7% (95% CI 7.5-10.1), respectively. Using the current duration approach definition, the prevalence of overall infertility was 24.1% (95% CI 18.8-34.0) at 12-months, 13.4% (95% CI 10.1-18.6) at 24-months, and 8.8% (95% CI 6.5-12.3) at 36-months. CONCLUSION: The demographic definition of infertility resulted in a lower estimate of infertility. The current duration approach definition could be more appropriate for the early detection and management of infertility in Ethiopia. The findings also highlight the need for a comprehensive definition of and emphasis on infertility. Future population-based surveys should incorporate direct questions related to infertility to facilitate epidemiological surveillance.

Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: A scoping review.

Cervical cancer is a prevalent disease among women, especially in low- and middle-income countries (LMICs), where most deaths occur. Integrating cervical cancer screening services into healthcare facilities is essential in combating the disease. Thus, this review aims to map evidence related to integrating cervical cancer screening into existing primary care services and identify associated barriers and facilitators in LMICs. The scoping review employed a five-step framework as proposed by Arksey and O'Malley. Five databases (MEDLINE, Maternity Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) were systematically searched. Data were extracted, charted, synthesized, and summarised. A total of 28 original articles conducted in LMICs from 2000 to 2023 were included. Thirty-nine percent of the reviewed studies showed that cervical cancer screening (CCS) was integrated into HIV clinics. The rest of the papers revealed that CCS was integrated into existing reproductive and sexual health clinics, maternal and child health, family planning, well-baby clinics, maternal health clinics, gynecology outpatient departments, and sexually transmitted infections clinics. The cost-effectiveness of integrated services, promotion, and international initiatives were identified as facilitators while resource scarcity, lack of skilled staff, high client loads, lack of preventive oncology policy, territorial disputes, and lack of national guidelines were identified as barriers to the services. The evidence suggests that CCS can be integrated into healthcare facilities in LMICs, in various primary care services, including HIV clinics, reproductive and sexual health clinics, well-baby clinics, maternal health clinics, and gynecology OPDs. However, barriers include limited health system capacity, workload, waiting times, and lack of coordination. Addressing these gaps could strengthen the successful integration of CCS into primary care services and improve cervical cancer prevention and treatment outcomes.

Effective coverage of antenatal care services in Ethiopia: a population-based cross-sectional study.

BACKGROUND: Antenatal care (ANC) is a principal component of safe motherhood and reproductive health strategies across the continuum of care. Although the coverage of antenatal care visits has increased in Ethiopia, there needs to be more evidence of effective coverage of antenatal care. The 'effective coverage' concept can pinpoint where action is required to improve high-quality coverage in Ethiopia. Effective coverage indicates a health system's performance by incorporating need, utilization, and quality into a single measurement. The concept includes the number of contacts, facility readiness, interventions received, and components of services received. This study aimed to measure effective antenatal care coverage in Ethiopia. METHODS: A two-stage cluster sampling method was used and included 2714 women aged 15-49 years and 462 health facilities from six Ethiopian regions from October 2019 to January 2020. The effective coverage cascade was analyzed among the targeted women by computing the proportion who received four or more antenatal care visits where the necessary inputs were available, received iron-folate supplementation and two doses of tetanus vaccination according to process quality components of antenatal care services. RESULTS: Of all women, 40% (95%CI; 38, 43) had four or more visits, ranging from 3% in Afar to 74% in Addis Ababa. The overall mean health facility readiness score of the facilities serving these women was 70%, the vaccination and iron-folate supplementation coverage was 26%, and the ANC process quality was 64%. As reported by women, the least score was given to the quality component of discussing birth preparedness and complication readiness with providers. In the effective coverage cascade, the input-adjusted, intervention-adjusted, and quality-adjusted antenatal coverage estimates were 28%, 18%, and 12%, respectively. CONCLUSION: The overall effective ANC coverage was low, primarily due to a considerable drop in the proportion of women who completed four or more ANC visits. Improving quality of services is crucial to increase ANC up take and completion of the recommended visits along with interventions increasing women's awareness.

Anxiety disorders among youth with substance use and associated factors in Northwest Ethiopia: A community-based study.

INTRODUCTION: Anxiety disorder is an unpleasant emotional feeling with symptoms related to psychological and autonomic symptoms such as headache, perspiration, palpitations, dizziness, and stomach discomfort. The use of substances become a worldwide problem among youth which brings situation that leads to serious social and health-related problems. Anxiety disorders with substance use have a huge impact on their high prevalence, therapeutic issues, and poor prognosis on clinical effects. Although the prevalence of anxiety disorders is significant among young people who use substances, limited studies were conducted. Therefore, this study revealed the burden of anxiety disorders among youth with substance use and associated factors in Ethiopia. METHOD: A community-based multi-stage with a simple random sampling technique was conducted. A total of 372 substance users study participants were recruited for this study. Alcohol, Smoking, and Substance Involvement Screening Tests, Depression Anxiety Stress Scales, and other tools were used to assess anxiety disorders with substance use and associated factors. Data were entered into Epi-data version 4.6, and exported to SPSS version 20 for further analysis. Bi-variables logistic regression analysis was employed to identify variables with a p-value of < 0.2 and associated factors were determined in multi-variables logistic regression analysis with a p-value < 0.05 with AOR and CI. RESULTS: From a total of 372 respondents the overall prevalence of anxiety disorders with substance use was 48.1%. Male sex [AOR = 1.99; 95% CI: (1.01-3.93)], low educational status of the father [AOR = 6.38 95%CI: (1.50-7.08)], and the presence of stress [AOR = 2.48; 95% CI: 2.48(2.43-4.40)] were significantly associated factors with anxiety disorders with substances use. CONCLUSIONS AND RECOMMENDATIONS: The prevalence of anxiety disorders with substance use was 48.1% therefore; it is recommended that the zonal administration give collaborative work with the health bureau and facilitate awareness creation about the impact of substance abuse. Clinicians are recommended to mitigate anxiety disorders with substance use to get a good prognosis for clients with controlling their stress.

Health system's availability and readiness of health facilities for chronic non-communicable diseases: Evidence from the Ethiopian national surveys.

INTRODUCTION: Non-communicable diseases (NCDs) currently cause more deaths than all other causes of deaths. Cardiovascular disease, diabetes, cancer, and chronic respiratory diseases-threaten the health and economies of individuals and populations worldwide. This study aimed to assess the availability and readiness of health facilities for chronic non-communicable diseases (NCDs) and describe the changes of service availability for common NCDs in Ethiopia. Methods We used data from the 2014 Ethiopia Service Provision Assessment Plus (ESPA +) and 2016 and 2018 Service Availability and Readiness Assessment (SARA) surveys, which were cross-sectional health facility-based studies. A total of 873 health facilities in 2014, 547 in 2016, 632 in 2018 were included in the analysis. (ESPA+) and SARA surveys are conducted as a census or a nationally/sub-nationally representative sample of health facilities. Proportion of facilities that offered the service for diabetes, cardiovascular disease, chronic respiratory disease, cancer diseases, mental illness, and chronic renal diseases was calculated to measure health service availability. The health facility service readiness was measured using the mean availably of tracer items that are required to offer the service. Thus, 13 tracer items for diabetes disease, 12 for cardiovascular disease, 11 for chronic respiratory disease and 11 cervical cancer services were used. RESULTS: The services available for diagnosis and management did not show improvement between 2014, 2016 and 2018 for diabetes (59%, 22% and 36%); for cardiovascular diseases (73%, 41% and 49%); chronic respiratory diseases (76%, 45% and 53%). Similarly, at the national level, the mean availability of tracer items between 2014, 2016 and 2018 for diabetes (37%, 53% and 48%); cardiovascular diseases (36%, 41% and 42%); chronic respiratory diseases (26%, 27% and 27%); and cancer diseases (6%, 72% and 51%). However, in 2014 survey year, the mean availability of tracer items was 7% each for mental illness and chronic renal diseases, respectively. CONCLUSIONS: The majority of the health facilities have low and gradual decrement in the availability to provide NCDs services in Ethiopia. There is a need to increase NCD service availability and readiness at primary hospitals and health centers, and private and rural health facilities where majority of the population need the services.

Integration of cervical cancer screening into healthcare facilities in low- and middle-income countries: a scoping review protocol.

BACKGROUND: Cervical cancer is the fourth most common malignancy in women, with 90% of deaths in low- and middle-income countries. Integrating cervical cancer screening services into healthcare facilities is crucial for overcoming the disease. Thus, this review aims to map existing evidence and identify barriers and facilitators in low- and middle-income countries. METHODS: The scoping review will employ a five-step framework as proposed by Arksey and O'Malley. These are (1) formulating the research questions, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data, and (5) collating, summarising and reporting the results. Five databases (MEDLINE, Maternity and Infant Care, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science) will be systematically searched. Grey literature will also be searched. Data will be extracted, charted, synthesised and summarised. ETHICS AND DISSEMINATION: This review does not require ethics approval. Findings will be disseminated through peer-reviewed publications, policy briefs and conference presentations.

Antenatal care coverage in a low-resource setting: Estimations from the Birhan Cohort.

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. The study population were women enrolled and followed during pregnancy between December 2018 and April 2020. ANC visits were measured by prospective facility chart abstraction and self-report at enrollment. The primary study outcomes were the total number of ANC visits attended during pregnancy and the coverage of at least one, four, or eight ANC visits. Additionally, we estimated ANC retention patterns. We included 2069 women, of which 150 (7.2%) women enrolled <13 weeks of gestation with complete prospective facility reporting. Among these 150 women, ANC coverage of at least one visit was 97.3%, whereas coverage of four visits or more was 34.0%. Among all women, coverage of one ANC visit was 92.3%, while coverage of four or more visits was 28.8%. No women were found to have attended eight or more ANC visits. On retention in care, 70.3% of participants who had an ANC visit between weeks 28 and <36 of gestation did not return for a subsequent visit. Despite the high proportion of pregnant women who accessed ANC at least once in our study area, the coverage of four visits remains low. Further efforts are needed to enhance access to more ANC visits, retain women in care, and adhere to the most recent Ethiopian National ANC guideline of at least eight ANC visits. It is essential to identify the factors that lead a large proportion of women to discontinue ANC follow-up.

Treatment outcomes of cutaneous leishmaniasis due to Leishmania aethiopica: A systematic review and meta-analysis.

BACKGROUND: Leishmania aethiopica is a unique species that causes cutaneous leishmaniasis (CL), and studies evaluating treatment outcomes for this condition reported inconsistent findings. This study aimed to summarize the evidence on treatment outcomes of CL caused by L. aethiopica to support decisions or propose further study. METHODS: We searched PubMed, Scopus, and ScienceDirect. In addition, we searched grey literature on Google Scholar and performed manual searching on the reference list of articles. Two authors did the screening, selection, critical appraisal, and data extraction. With the narrative synthesis of evidence, we performed a random effects model meta-analysis using the metaprop package in Stata 17. We did sensitivity and subgroup analyses after assessing heterogeneity using the I-squared test and forest plots. The funnel plot and Egger's test were used to assess publication bias. RESULTS: The review included 22 studies with 808 participants, and the meta-analysis included seven studies with 677 participants. Most studies documented treatment outcomes with antimonial monotherapy, and only one study reported outcomes with combination therapy. The overall pooled proportion of cure was 63% (95% CI: 38-86%). In the subgroup analysis, systemic antimonial monotherapy showed a cure rate of 61%, and the proportion of cure was 87% with topical therapy. Topical therapy showed a better cure for the localized clinical phenotype. A cohort study documented a cure rate of 94.8% with combination therapy for the localized, mucocutaneous, and diffuse clinical phenotypes. The pooled proportion of unfavourable outcomes was partial response (19%), relapse (17%), discontinuation (19%), and unresponsiveness (6%). CONCLUSIONS: The pooled proportion of cure is low with antimonial monotherapy. Despite limited evidence, combination therapies are a promising treatment option for all clinical phenotypes of CL caused by L. aethiopica. Future high-quality randomized control trials are needed to identify effective monotherapies and evaluate the effectiveness of combination therapies.

Community-based newborn care intervention fidelity and its implementation drivers in South Wollo Zone, North-east Ethiopia.

Community-based newborn care (CBNC) has been implemented in Ethiopia across the maternal, neonatal, and child health continuum of care with the goal of lowering newborn mortality. However, neonatal mortality rate in Ethiopian is among the highest in the world. Why neonatal mortality remains high in the face of such effective interventions is the issue. As a result, the authors claim that it is unknown whether the planned intervention is carried out effectively or not. The purpose of this study was to investigate the fidelity of community-based newborn care intervention and its implementation drivers. Multicenter community-based mixed method study was employed on 898 postpartum women, 16 health extension workers (HEWs) and 10 health posts to evaluate CBNC intervention fidelity. Structured questionnaire and facility audit checklist was used to collect quantitative data. In-depth interview technique was used to explore lived experiences of HEWs on CBNC implementation. CBNC intervention fidelity was computed as a composite index of the product of program coverage, frequency and contents. Multilevel linear regression model with adjusted ß-coefficients at P-value of 0.05 and a 95% confidence interval (CI) were used to declare a significant relation between CBNC intervention fidelity and its implementation drivers. Interpretative phenomenological analysis was employed for qualitative data analysis. CBNC intervention fidelity was found to be 4.5% (95% CI: 3.6-5.4) with only two women received the intervention with full fidelity. The overall CBNC intervention coverage was 38.4% (95% CI: 35.2-41.6). Only 8.1% and 1.5% of women received all CBNC interventions with recommended frequency and content, respectively. HEWs knowledge of danger sign was significant facilitator while lack of: health center's feedback, related short-term training, health development army support, health center staff's technical assistance to HEWs and shortage of medical equipment supply were barriers for CBNC intervention fidelity. In conclusion the CBNC intervention fidelity was too low in this study. This indicates that CBNC intervention package was not implemented as envisioned implying an implementation gap. All implementation drivers were poorly implemented to result in improved fidelity and intervention outcomes.

Psychotic symptoms and its associated factors relating to psychoactive substance use among the youth population in Northwest Ethiopia.

Background: Substance use is associated with high rates of psychiatric symptoms including psychotic symptoms. Despite the severity of the problem, there are intervention gaps in Ethiopia. To combat this, relevant evidence is required to raise the awareness of service providers. This study aimed to assess the prevalence of psychotic symptoms and its associated factors among the youth population who uses psychoactive substances in the Central Gondar Zone, Northwest Ethiopia. Methods: A community-based cross-sectional study was conducted among the youth population in the Central Gondar zone, Northwest Ethiopia, from 01 January to 30 March 2021. A multistage sampling technique was used to recruit the study participants. All data were collected using questionnaires assessing socio-demographic; family-related variables; Depression, Anxiety, and Stress Scale; Multidimensional Scale Perceived Social Support (MSPSS), and Self-Reporting Questionnaire (SRQ-24). The data were analyzed using the STATA 14 statistical program. Results: A total of 372 young people who used psychoactive substances (79.57%, 53.49%, 34.14%, and 16.13% were consuming alcohol, Khat, tobacco/cigarette products, and other substances such as shisha, inhalants, and drugs, respectively) were included in the study. The prevalence of psychotic symptoms was 24.2% with a 95% CI: 20.1, 28.8. Being married [AOR = 1.87 95% CI: 1.06, 3.48], recent loss of loved ones [AOR = 1.97 95% CI: 1.10, 3.18], low perceived social support [AOR = 1.61 95% CI: 1.11, 3.02], and severe psychological distress [AOR = 3.23 95% CI; 1.64, 6.54] were the factors associated with psychotic symptoms among young people with psychoactive substances use at a p-value of < 0.05. Conclusion: Psychotic symptoms related to psychoactive substances among the youth population in Northwest Ethiopia were high. Thus, it is better to give a special attention to the youth population with low social support and existing psychological distress concurrent with psychoactive substance use.

Late antenatal care booking and associated factors among pregnant women in Mizan-Aman town, South West Ethiopia, 2021.

BACKGROUND: Antenatal care (ANC) is one of the most important ways to reduce maternal and neonatal morbidity and mortality. According to data from poor countries, the majority of pregnant women attend ANC when they are in their later stages of pregnancy. In this regard, limited information is currently known about the factors that determine ANC scheduling and the type of care for pregnant women in the town of Mizan-Aman in southwestern Ethiopia. Therefore, the purpose of this study was to determine late antenatal care booking and associated factors among pregnant women in the Town. METHOD: The institutional-based cross-sectional study design was conducted in Mizan-Aman town using a systematic random sampling method through structured questions from February 15 to March 25, 2021. The collected data was entered into EPI info-7 which later on, was exported to SPSS version 20 for statistical analysis. Binary and multiple logistic regressions were used to identify associated factors and p-value <0.05 was considered for statistical significance. RESULTS: A total of 425 female pregnant women participated, making a 100% response rate. The prevalence of delayed first ANC bookings in this study was 70.0% [95.0%, CI = 65.65-74.35]. Multivariate analysis revealed that unplanned pregnancy [AOR = 2.63, 95% CI: 1.18, 5.85], inappropriate perception of ANC starting time [AOR = 4.1, 95% CI: 1.9, 8.83], pregnant women who were unaware of pregnancy-related danger signs [AOR = 6.76, 95% CI: 2.83, 16.1], and pregnant women who were unaware of service delivery during working hours in the institution [AOR = 0.44, 95% CI: 0.19, 0.98]. CONCLUSION: The current study showed a greater prevalence of delayed ANC beginnings, and the factors for this were having an unplanned pregnancy, lack of awareness about pregnancy danger signs, inappropriate perception of ANC starting time, and pregnant women who were unaware of service delivery during working hours at the institution. Responsible bodies working in maternal and child health care better create awareness of the benefits of early ANC booking and appropriate ANC starting times. Further, each health institution's MCH clinic should deliver the service through working hours.

Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey.

INTRODUCTION: Childhood illnesses, such as acute respiratory illness, fever, and diarrhoea, continue to be public health problems in low-income countries. Detecting spatial variations of common childhood illnesses and service utilisation is essential for identifying inequities and call for targeted actions. This study aimed to assess the geographical distribution and associated factors for common childhood illnesses and service utilisation across Ethiopia based on the 2016 Demographic and Health Survey. METHODS: The sample was selected using a two-stage stratified sampling process. A total of 10,417 children under five years were included in this analysis. We linked data on their common illnesses during the last two weeks and healthcare utilisation were linked to Global Positioning System (GPS) information of their local area. The spatial data were created in ArcGIS10.1 for each study cluster. We applied a spatial autocorrelation model with Moran's index to determine the spatial clustering of the prevalence of childhood illnesses and healthcare utilisation. Ordinary Least Square (OLS) analysis was done to assess the association between selected explanatory variables and sick child health services utilisation. Hot and cold spot clusters for high or low utilisation were identified using Getis-Ord Gi*. Kriging interpolation was done to predict sick child healthcare utilisation in areas where study samples were not drawn. All statistical analyses were performed using Excel, STATA, and ArcGIS. RESULTS: Overall, 23% (95CI: 21, 25) of children under five years had some illness during the last two weeks before the survey. Of these, 38% (95%CI: 34, 41) sought care from an appropriate provider. Illnesses and service utilisation were not randomly distributed across the country with a Moran's index 0.111, Z-score 6.22, P<0.001, and Moran's index = 0.0804, Z-score 4.498, P< 0.001, respectively. Wealth and reported distance to health facilities were associated with service utilisation. Prevalence of common childhood illnesses was higher in the North, while service utilisation was more likely to be on a low level in the Eastern, South-western, and the Northern parts of the country. CONCLUSION: Our study provided evidence of geographic clustering of common childhood illnesses and health service utilisation when the child was sick. Areas with low service utilisation for childhood illnesses need priority, including actions to counteract barriers such as poverty and long distances to services.

The effect of preeclampsia on adverse maternal outcomes in Sidama region, Ethiopia: a prospective open cohort study.

Ethiopia has made improvements in the reduction of maternal mortality; the high burden of preeclampsia remains a concern in the Sidama region. This study aimed to measure the effect of preeclampsia on adverse maternal outcomes and identify risk factors among women with preeclampsia in Sidama region. A prospective open cohort study was conducted from August 8, 2019, to October 1, 2020. We enrolled a total of 1015 the pregnant women who had preeclampsia and normotensive women at ≥ 20 weeks of gestation and followed them until 42 days after delivery. A log-binomial logistic regression model was used to estimate the incidence of adverse maternal outcomes and its risk factors. There were 276 adverse maternal outcomes observed in the preeclampsia group compared to 154 adverse maternal outcomes in the normotensive group (P < 0.001). Women with severe features of preeclampsia had a 43% (aRR = 1.43, 95% CI 1.3-1.58) higher risk for adverse maternal outcomes compared to women without severe features of preeclampsia. Women without severe features of preeclampsia had a 39% (aRR = 1.39, 95% CI 1.2-1.76) higher risk for adverse maternal outcomes compared to women in the normotensive group. More adverse maternal outcomes occurred among women with preeclampsia after controlling for confounders.

Health-related quality of life among postpartum women with preeclampsia, southern Ethiopia: a prospective cohort study.

BACKGROUND: Preeclampsia affects the health of the mother and the fetus during pregnancy and childbirth. To date, little is known about the impact of preeclampsia on postpartum health-related to quality of life (HRQoL) in the Sidama region of southern Ethiopia. This study aimed to measure the HRQoL and its contributing factors among postpartum women with preeclampsia in the Sidama region. METHODS: A prospective cohort study was conducted by enrolling pregnant women at ≥20 weeks of gestation up until the 37th week of gestation. We then followed them until 12 weeks after delivery. A locally validated, World Health Organization Quality-of-Life-BREF (WHOQOL-BREF) tool was used to assess participants' HRQoL at two time points; the 6th and 12th weeks postpartum. Assessment of HRQoL of participants was based on total scores on the WHOQoL-BREF. Higher scores on the WHOQoL-BREF reflected a higher HRQoL. Multiple linear regression analyses were performed to evaluate the contributing factors to HRQoL. The level of significance was determined at a p-value of < 0.05. RESULTS: The HRQoL of postpartum women with preeclampsia significantly improved over time from 6 (151 ± 17) to 12 weeks (167 ± 18), p < 0.001). However, the overall HRQoL scores were lower (156 ± 16, p < 0.001) among women with preeclampsia compared to normotensive women (181 ± 21). An experience of early neonatal death was found to have a significant negative effect on the HRQoL of women with preeclampsia [ß = - 2.1, 95% CI: - 3.43- - 0.85] compared to normotensive women who did not have early neonatal death. At 6 weeks of the postpartum period, the physical domain was found to have a significantly higher contribution to the lower HRQoL [ß = 1.04, 95% CI: 0.88-1.12] compared to normotensive women, while other factors were constant. CONCLUSIONS: The HRQoL of women with preeclampsia improved over time from 6 to 12 weeks in the postpartum period. Lower HRQoL was observed among postpartum women with preeclampsia, especially among those who experienced preterm birth or early neonatal death. The effects of preeclampsia on the HRQoL of postpartum women should be considered in redesigning postnatal care intervention services.

Quality of life and associated factors among the youth with substance use in Northwest Ethiopia: Using structural equation modeling.

BACKGROUND: Substance use leads to serious clinical conditions with the potential to cause major health and emotional impairments in individuals. Individuals with substance use typically report significantly poorer QoL than the general population and as low as those with other serious psychiatric disorders. It has a high impact on morbidity, mortality, and productivity, it also compromises the general safety and performance of the users, i.e., affects the quality of life. Therefore, this study aimed to assess quality of life and identify the potential predictors among youths who use substances. METHODS: A multicenter cross-sectional study design was applied to assess quality of life and associated factors among substance use youths in the central Gondar zone from January 1 to March 30/ 2021. A total of 373 substance use youths were included in the study. The data were collected using face-to-face interview by structured questionnaires, and entered to Epi-data version 4.6 and exported to STATA version 16, and AMOS software for further statistical analysis. To identify factors associated with health-related quality of life, structural equation modeling was used, and it also used to estimate the relationships among exogenous, mediating, and endogenous variables. RESULTS: Substance used youths had a moderate overall health-related quality of life (mean score = 50.21 and 14.32 standard deviation, p-value < 0.,0001), and poor health-related quality of life in the environmental health domain (mean score of 45.76 with standard deviation of 17.60). Age (ß = 0.06, p<0.001), sex (ß = 0.30, p<0.001), psychotic symptoms (ß = -0.12, p<0.001), employment status (ß = 0.06, p = 0.008,), loss of family (ß = 0.35, p<0.001), and social support (ß = 0.27, p<0.001) were variables significantly associated with health-related quality of life. CONCLUSION: According to the findings of this study, substance abuse during adolescence is associated with lower health-related quality of life and a higher report of psychopathological symptoms. Given this finding, mental health and health promotion professionals should learn about and emphasize the impact of substance use on youth quality of life.

Suicide ideation and/or attempt with substance use and associated factors among the youth in northwest Ethiopia, community-based.

BACKGROUND: Substance use is referring to the use of psychoactive substances like chat, cigarettes, alcohol, and others. The use of substances particularly (alcohol, chat, and cigarette) is a major mental health burden in developing countries including Ethiopia among youth. Suicide ideation and an attempt are thinking or trying to kill oneself that facilitates the act of a person intentionally causing his or her death. Suicide is one of the most serious mental health problems and has a great social impact in the world as it is currently the third leading cause of death for youth. Youth is defined as the period of life between childhood and maturity with an age interval of (15-25). METHOD: A cross-sectional study design was used to assess the prevalence of suicidal ideation and attempts with substance use among youth in northwest Ethiopia. Multi-stage sampling techniques of stratified with simple random sample ware used. In the first stage, substance users are selected then as the second stage among substance users the burden of suicide behavior is assessed. ASIST, DASS-21, and other tools were used to assess suicidal behavior with substance use and associated factors. Data were edited, purified, and entered into Epi-data version 4.6 before being exported to the statistical package for social sciences version 20 for analysis of bi-variables to see the associations' p-value < 0.2 and multi-variables to identify the associated variables with a p-value of < 0.05 AOR and CI also done. RESULTS: From a total of 372 substance user participants over all prevalence of suicidal ideation and attempt among youth was 54(14.5%) with 95% CI of (11.0,18.0) and 37(9.9%) with 95% CI (7.0, 13.0) respectively. Being female [AOR =2.36;95% CI:(1.19, 4.68)], poor social support [AOR =3.03; 95% CI: (1.11, 8.25)], and anxiety [AOR = 3.82: 95% CI; (1.96, 7.46)]. CONCLUSION AND RECOMMENDATIONS: The prevalence of suicidal ideation and attempt among substance users was 14.5 and 9.9% respectively therefore, immediate interventional actions needed to be administered to decrease the burden of suicide by reducing substance use and other associated factors.

High asymptomatic malaria among seasonal migrant workers departing to home from malaria endemic areas in northwest Ethiopia.

BACKGROUND: In Ethiopia, thousands of seasonal migrant workers travel from non-malaria or mild malaria transmission areas to malaria-endemic areas for seasonal farm activities. Most of these migrants stay in the farm areas for land preparation, plowing, planting, weeding, and harvesting for a specific period and return to their living areas. However, there is limited evidence of how seasonal migrant workers contribute to the transmission of malaria to new or less malaria transmission areas. METHODS: A cross-sectional study was conducted at the departure phase of seasonal migrant workers in the Metema district from September 2018 to October 2019. A total of 1208 seasonal migrant workers were interviewed during their departure from farm sites to their homes. The face-to-face interviews were performed using a pretested structured questionnaire. Moreover, blood samples were collected from each study participant for microscopic malaria parasite examination. The data were fitted with the logistic regression model to estimate the predictors of malaria transmission. RESULTS: At departure to home, the prevalence of malaria among seasonal migrant workers was 17.5% (15.6-19.45%). Approximately 71.80% (177/212) of the cases were Plasmodium falciparum, and 28.20% (35/212) were Plasmodium vivax. Most seasonal migrant workers 934 (77.4%) were from rural residences and highlanders 660 (55%). Most 661 (55.4%) of the migrants visited two and more farm sites during their stay at development corridors for harvesting activities. Approximately 116 (54.7%) asymptomatic malaria cases returned to the Dembia 46 (21.7%), Chilaga 46 (19.8%) and Metema 28 (13.2%) districts. CONCLUSION: In this study, asymptomatic malaria remains high among seasonal migrant workers departing to home from malaria endemic areas. This may fuel a resurgence of malaria transmission in the high lands and cause challenges to the country's malaria prevention and elimination efforts. Hence, tailored interventions for seasonal migrant workers could be in place to enhance malaria control and elimination in Ethiopia, such as asymptomatic malaria test and treat positive cases at departure and transit, and integration between malaria officers at their origin and departure for further follow-up to decrease any risk of spread at the origin.

Residential Food Environment, Household Wealth and Maternal Education Association to Preschoolers' Consumption of Plant-Based Vitamin A-Rich Foods: The EAT Addis Survey in Addis Ababa.

Vitamin A deficiency is common among preschoolers in low-income settings and a serious public health concern due to its association to increased morbidity and mortality. The limited consumption of vitamin A-rich food is contributing to the problem. Many factors may influence children's diet, including residential food environment, household wealth, and maternal education. However, very few studies in low-income settings have examined the relationship of these factors to children's diet together. This study aimed to assess the importance of residential food availability of three plant-based groups of vitamin A-rich foods, household wealth, and maternal education for preschoolers' consumption of plant-based vitamin A-rich foods in Addis Ababa. A multistage sampling procedure was used to enroll 5467 households with under-five children and 233 residential food environments with 2568 vendors. Data were analyzed using a multilevel binary logistic regression model. Overall, 36% (95% CI: 34.26, 36.95) of the study children reportedly consumed at least one plant-based vitamin A-rich food group in the 24-h dietary recall period. The odds of consuming any plant-based vitamin A-rich food were significantly higher among children whose mothers had a higher education level (AOR: 2.55; 95% CI: 2.01, 3.25), those living in the highest wealth quintile households (AOR: 2.37; 95% CI: 1.92, 2.93), and in residentials where vitamin A-rich fruits were available (AOR: 1.20; 95% CI: 1.02, 1.41). Further research in residential food environment is necessary to understand the purchasing habits, affordability, and desirability of plant-based vitamin A-rich foods to widen strategic options to improve its consumption among preschoolers in low-income and low-education communities.

Midwife-led continuity of care increases women's satisfaction with antenatal, intrapartum, and postpartum care: North Shoa, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: The provision of midwife-led continuity of care (MLCC) is effective in high-resource settings in improving maternal satisfaction. This study aimed to evaluate the effect of MLCC on women's satisfaction with care in a low-income/resource setting. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals in the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low-risk women were allocated to one of two groups; the MLCC (intervention group) that received all antenatal, intrapartum, and immediate postnatal care from a primary midwife or backup midwife) (n = 589) and the shared model of care (SMC) group that received care following established practice in Ethiopia, care from different staff members at different times) (n = 589). Data for this paper were collected using face-to-face interviews at the women's home at the end of the postpartum period. The study's outcome was the mean sum-score of satisfaction with care through the antenatal, intrapartum, and postnatal period continuum, where mean sum-scores range from 1 (lowest) to 5 (highest). FINDINGS: Compared with SMC, MLCC was associated with statistically significantly higher satisfaction with all continuity of care (4.07 vs. 2.79 adjusted mean difference 1.27, 95% CI 1.18-1.35; p < 0.001), during antenatal care (4.14 vs. 2.81 adjusted mean difference 1.33 (95% CI 1.22-1.52), intrapartum care (3.83 vs. 2.71 adjusted mean difference 1.06 (95% CI 0.88-1.23) and postnatal care (5.46 vs. 3.71 adjusted mean difference 1.75 (95% CI 1.54-1.94)). CONCLUSION: MLCC increased women's satisfaction with maternity care for women at low risk of medical complications. These findings confirm that the MLCC model will be applicable in the Ethiopian health care system with similar settings.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study.

BACKGROUND: In a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. METHOD: A study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FINDINGS: Women in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101-1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227-0.683)). CONCLUSION: In this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.