Outcomes and Associated Factors of Induction of Labor in East Gojjam Zone, Northwest Ethiopia: A Multicenter Cross-Sectional Study.

Background: Induction of labor is the initiation of uterine contractions by artificial methods once the fetus has reached viability and prior to spontaneous onset of labor with the aim of achieving vaginal delivery. Although induction of labor is a critical life-saving intervention that potentially reduces adverse pregnancy outcomes, sometimes it has undesirable consequences for the health of the mother and/or the fetus. Hence, this study aimed to evaluate the outcomes and associated factors of labor induction. Methods: An institution-based cross-sectional study was conducted from February 25 to May 25, 2020, among women undergoing induction at East Gojjam zone public hospitals in northwest Ethiopia. A structured interviewer-administered questionnaire was used to collect data from a sample of 411 mothers who were selected using a systematic random sampling technique. Stata/se™ Version 14 statistical software was used to analyze the data. Multivariable binary logistic regression was used to determine the potential factors affecting successful labor induction. Adjusted odds ratios with their 95% CI intervals were used to declare the strength of the association, and a variable with p value <0.05 was considered to have statistical significance. Results: The prevalence of successful induction of labor was 70.3% (65.6, 74.7). The favorable Bishop score ((CI 3.90, 1.63-9.29); p value = 0.002), the intermediate Bishop score ((CI 3.53, 2.15-5.82); p value = 0.001), labor induction using oxytocin with cervical ripening ((CI 2.60, 1.21-5.63); p value = 0.015), and urban residence ((CI 0.48, 0.30-0.78); p value = 0.003) were associated with successful induction of labor. Conclusion: These findings strongly suggest that cervical conditions are important determinants for the success of labor induction. Therefore, healthcare providers should confirm the favorability of the cervical status (using Bishop score) as a strict prerequisite before actual labor induction, and special consideration should be given to those pregnant women who reside in urban areas.

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

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

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

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

Cigarette smoking prevalence and associated factors among college students, Amhara, Ethiopia.

INTRODUCTION: tobacco is the only legal drug that kills many of its users when used exactly as intended by the manufacturers. It is estimated that of the 1.1 billion smokers worldwide, nearly 80% of them live in low and middle-income countries. This trend increases in college and university students with most smokers starting to smoke during adolescent. The aim of this study is to assess cigarette smoking prevalence and associated factors among a select group of college of teachers´ education students. METHODS: a cross-sectional study was conducted. Multistage sampling was used to select 605 study participants from across the eight departments of the Injibara College of Teachers´ Education. Each subject was selected by simple random sampling technique after proportional allocation to each class. EpiData version 4.2 was used for data entry and Stata version 14 was used for data cleaning and analysis. Variables with p-value < 0.2 in bi-variable analysis were selected for multi-variable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported to show the strength of association. RESULTS: the current prevalence of cigarette smoking is 6.8% amongst the Injibara College of Teachers´ Education students. Males [AOR: 2.84 (95% CI: 1.13, 7.14)], divorced marital status [AOR: 7.27 (95% CI: 1.23, 42.85)], food source in hostel [AOR: 11.62 (95% CI 3.23, 41.71)] and exposure to family/other smokers [AOR: 6.17 (95% CI: 2.17, 16.06)] were statistically significant factors for cigarette smoking. CONCLUSION: the prevalence of cigarette smoking was relatively low. Male, marital status, source of food, and exposure to family/other smokers were identified associated factors. Policy makers and health regulatory body are strongly encouraged to consider this evidence and the associated factors for smoking in their efforts to develop and implement tobacco control laws.

Occupational Stress and Burnout Among Health Care Workers in Ethiopia: A Systematic Review and Meta-analysis.

OBJECTIVE: To estimate the pooled national burden of occupational stress, burnout, and contributing factors among health care workers in Ethiopia. DATA SOURCES: Both published and unpublished observational studies conducted on the burden of occupational stress and burnout among health workers in Ethiopia were included. STUDY SELECTION: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered on PROSPERO (CRD42020166585). The eligibility of the studies was evaluated based on predetermined inclusion and exclusion criteria. DATA EXTRACTION: Data extraction was conducted using major databases; PubMed, Google Scholar, Cumulative Index to Nursing and Allied Health, Scopes, Cochrane Library, the Web of Science, and African Journals Online were involved in the review. Two reviewers extracted data independently using a standardized data extraction checklist on Microsoft Excel. Any discrepancy was resolved by including the third reviewer for a possible consensus. DATA SYNTHESIS: Fourteen studies, with a total of 4066 health care workers, were included in the meta-analysis. The pooled burdens of occupational stress and burnout were 52.9% (95% confidence interval [CI], 46.2-59.7) and 39.1% (95% CI, 23.9-52.3), respectively. Major determinants of occupational stress were being female (odds ratio [OR], 1.9; 95% CI, 1.1-3.3), being younger (OR, 1.4; 95% CI, 1.03-1.9), having a lower educational level (OR, 2.7; 95% CI, 1.05-7.2), and being satisfied with a job (OR, 0.3; 95% CI, 0.2-0.5). Being married (OR, 0.7; 95% CI, 0.5-0.9), having a lower educational level (OR, 0.5; 95% CI, 0.4-0.8), and working in shifts (OR, 0.7; 95% CI, 0.5-0.9) were significant predictors of burnout. CONCLUSIONS: More than half and more than one-third of health care workers were affected by occupational stress and burnout, respectively, in Ethiopia, and sociodemographic and occupation-related factors were significant factors. Measures that improve job satisfaction, career development, and educational opportunities should be strengthened.

Prevalence of intestinal parasitic infection and its associated factors among primary school students in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Intestinal parasitic infection are a major public health concern affecting both children and adolescents in Ethiopia. The aim of this systematic review and meta-analysis was to determine pooled prevalence and associated factors of intestinal parasitic infection in this target group. METHOD: We systematically retrieved available articles on the prevalence of intestinal parasitic infection following database searches using PubMed, Scopus, Cochrane Library, and Science Direct between March 1 and May 27, 2020. Two authors independently extracted all relevant data using a standardized Microsoft Excel data extraction form. Heterogeneity among included studies was assessed with the Higgins I2 tests. The pooled estimates and associated factors were assessed with a random-effects model using Stata/se Version 14. RESULT: We retrieved 30 eligible articles with a pooled sample size of 14,445 primary school children with response rate of 97.8%. Entamoeba spp (16.11%), Ascaris lumbricoides (13.98%), hookworm (12.51%) and Giardia lamblia (9.98%) are the top causes of intestinal parasitic infection among primary school children in Ethiopia. The pooled prevalence for at least one intestinal parasitic infection was 46.09 (95% CI: 38.50, 53.68). Heterogeneity was assessed by doing subgroup analysis by study province/region. Thus, the highest prevalence of 66.6% (95% CI: 55.5, 77.7) occurred in Tigray region, which was followed by Southern Nations, Nationalities, and Peoples' Region at 50.8% (95% CI: 33.1, 68.5). No latrine availability (OR = 4.39: 2.50,7.73), no fingernail hygiene (OR = 2.37: 1.67, 3.35), open defecation (OR = 1.67:1.64,4.36), no formal maternal education (OR = 2.02: 1.18,3.47), rural residence (OR = 1.88: 1.46, 2.41), no habit of wearing shoes (OR = 2.66: 1.79, 3.96), non-pipe source of drinking water (OR = 1.99: 1.42,2.76), no regular hand washing practices (OR = 3.45:1.85,6.47), and no habit of washing fruits and vegetables (OR = 1.59:1.01,2.49) were associated with parasitic infection. CONCLUSIONS: The prevalence of intestinal parasitic infection was high (46%). Attention should be given to promoting personal hygiene, latrine utilization, wearing shoes, avoiding eating raw food, creating awareness for those mothers who lack formal education. Moreover, future research ideally will expand on the topic by conducting research in regions which have no prior research.

Magnitude of asymptomatic COVID-19 cases throughout the course of infection: A systematic review and meta-analysis.

BACKGROUND: Asymptomatic SARS-CoV-2 infections are responsible for potentially significant transmission of COVID-19. Worldwide, a number of studies were conducted to estimate the magnitude of asymptomatic COVID-19 cases. However, there is a need for more robust and well-designed studies to have a relevant public health intervention. Synthesis of the available studies significantly strengthens the quality of evidences for public health practice. Thus, this systematic review and meta-analysis aimed to determine the overall magnitude of asymptomatic COVID-19 cases throughout the course of infection using available evidences. METHODS: We followed the PRISMA checklist to present this study. Two experienced review authors (MA and DBK) were systematically searched international electronic databases for studies. We performed meta-analysis using R statistical software. The overall weighted proportion of asymptomatic COVID-19 cases throughout the course infection was computed. The pooled estimates with 95% confidence intervals were presented using forest plot. Egger's tests were used to assess publication bias, and primary estimates were pooled using a random effects model. Furthermore, a sensitivity analysis was conducted to assure the robustness of the result. RESULTS: A total of 28 studies that satisfied the eligibility criteria were included in this systematic review and meta-analysis. Consequently, in the meta-analysis, a total of 6,071 COVID-19 cases were included. The proportion of asymptomatic infections among the included studies ranged from 1.4% to 78.3%. The findings of this meta-analysis showed that the weighted pooled proportion of asymptomatic COVID-19 cases throughout the course of infection was 25% (95%CI: 16-38). The leave-one out result also revealed that the weighted pooled average of asymptomatic SARS-CoV-2 infection was between 28% and 31.4%. CONCLUSIONS: In conclusion, one-fourth of SARS-CoV-2 infections are remained asymptomatic throughout the course infection. Scale-up of testing, which targeting high risk populations is recommended to tackle the pandemic.

Serial interval and incubation period of COVID-19: a systematic review and meta-analysis.

BACKGROUND: Understanding the epidemiological parameters that determine the transmission dynamics of COVID-19 is essential for public health intervention. Globally, a number of studies were conducted to estimate the average serial interval and incubation period of COVID-19. Combining findings of existing studies that estimate the average serial interval and incubation period of COVID-19 significantly improves the quality of evidence. Hence, this study aimed to determine the overall average serial interval and incubation period of COVID-19. METHODS: We followed the PRISMA checklist to present this study. A comprehensive search strategy was carried out from international electronic databases (Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library) by two experienced reviewers (MAA and DBK) authors between the 1st of June and the 31st of July 2020. All observational studies either reporting the serial interval or incubation period in persons diagnosed with COVID-19 were included in this study. Heterogeneity across studies was assessed using the I2 and Higgins test. The NOS adapted for cross-sectional studies was used to evaluate the quality of studies. A random effect Meta-analysis was employed to determine the pooled estimate with 95% (CI). Microsoft Excel was used for data extraction and R software was used for analysis. RESULTS: We combined a total of 23 studies to estimate the overall mean serial interval of COVID-19. The mean serial interval of COVID-19 ranged from 4. 2 to 7.5 days. Our meta-analysis showed that the weighted pooled mean serial interval of COVID-19 was 5.2 (95%CI: 4.9-5.5) days. Additionally, to pool the mean incubation period of COVID-19, we included 14 articles. The mean incubation period of COVID-19 also ranged from 4.8 to 9 days. Accordingly, the weighted pooled mean incubation period of COVID-19 was 6.5 (95%CI: 5.9-7.1) days. CONCLUSIONS: This systematic review and meta-analysis showed that the weighted pooled mean serial interval and incubation period of COVID-19 were 5.2, and 6.5 days, respectively. In this study, the average serial interval of COVID-19 is shorter than the average incubation period, which suggests that substantial numbers of COVID-19 cases will be attributed to presymptomatic transmission.

Availability of adequately iodized salt at the household level in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Iodine deficiency disorder (IDD) is a global, regional, and national public health problem that is preventable. Universal salt iodization is a worldwide accepted strategy to prevent IDD. The level of iodine in the salt should be adequate at the household level (≥15ppm). Though there was fragmented evidence on the proportion of adequately iodized salt at the household level in Ethiopia, the national level proportion of adequately iodized salt at the household level was remaining unknown. Therefore, this systematic review and meta-analysis estimated the pooled proportion of adequately iodized salt at the household level in Ethiopia from 2013-2020. METHOD: We systematically searched the databases: PubMed/MEDLINE, Google Scholar, and Science Direct for studies conducted in Ethiopia on the availability of adequately iodized salt at the household level since 2013. We have included observational studies, which were published between January first, 2013, and 10 August 2020. The report was compiled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of included studies was scored based on the Newcastle Ottawa quality assessment scale adapted for cross-sectional studies. The data were extracted in Microsoft excel and analyzed using Stata version 14.1 software. We employed a random-effects model to estimate the pooled proportion of adequately iodized salt at the household level in Ethiopia. The presence of statistical heterogeneity within the included studies was evaluated using the I-squared statistic. We used Egger's regression test to identify evidence of publication bias. The pooled proportion with a 95% confidence interval (CI) was presented using tables and forest plots. RESULTS: We screened a total of 195 articles. Of these, 28 studies (with 15561 households) were included in the final systematic review and meta-analysis. In Ethiopia, the pooled proportion of adequately iodized salt at the household level was 37% (95% CI: 28, 46%). The subgroup analyses of 28 studies by residence revealed that the pooled proportion of adequately iodized salt at the household level was 32% (95% CI: 29, 35%) and 48% (95% CI: 31, 66%) in rural and urban areas, respectively. Based on geographic location, the highest proportion was found in Addis Ababa (81%; 95%CI: 78, 83), and the lowest proportion found in Dire Dawa (20%; 95%CI: 17, 22). Besides, the proportion of adequately iodized salt at the household level was significantly increased during 2017-2020 (42%; 95% CI: 30, 53%) as compared with 2013-2016 (27%; 95% CI: 17, 39%). CONCLUSIONS: In Ethiopia, the pooled proportion of adequately iodized salt at the household level was very low as compared to the world health organization's recommendation. Thus, the Federal Ministry of Health of Ethiopia and different stakeholders should give more attention to improve the proportion of adequately iodized salt at the household level.

Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: a prospective cohort study.

BACKGROUND: Following delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia. METHODS: A prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association. RESULT: The mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study. CONCLUSION: This study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.

Incidence and Predictors of Pre-Eclampsia Among Pregnant Women Attending Antenatal Care at Debre Markos Referral Hospital, North West Ethiopia: Prospective Cohort Study.

BACKGROUND: Pre-eclampsia is a pregnancy-induced hypertension that occurs after 20 weeks of gestation. It is the leading cause of maternal and perinatal morbidity and mortality globally, but it is higher in developing countries. In Ethiopia, conducting research on the incidence and predictors of pre-eclampsia is crucial due to the paucity of information. METHODS: A prospective cohort study was undertaken using 242 pregnant women between November 1, 2018 and March 30, 2019 at Debre Markos Referral Hospital. All eligible women who fulfilled the inclusion criteria were included in this study. Data were entered into the epic-data Version 4.2 and analyzed using the STATA Version 14.0 software. The Cox-proportional hazard regression model was fitted and Cox-Snell residual test was used to assess the goodness of fit. Pre-eclampsia free survival time was estimated using the Kaplan-Meier survival curve. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of pre-eclampsia. RESULTS: The overall incidence rate of pre-eclampsia was 3.35 per 100 person-years. Having a pre-existing history of diabetes mellitus [AHR=2.7 (95% CI=1.43-8.81)], having a history of multiple pregnancy [AHR=3.4 (95% CI=2.8-6.9)] and being ≥35 years old age [AHR=2.5 (95% CI=1.42-3.54)] were the significant predictors of pre-eclampsia. CONCLUSION: The incidence of pre-eclampsia was high in this study. Having (pre-existing diabetes and multiple pregnancy) and being ≥35 years old age were the significant predictors of pre-eclampsia. Inspiring pregnant women's health-seeking behavior should provide a chance to diagnose pre-eclampsia early to prevent the medical complication of pre-eclampsia.

Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis.

BACKGROUND: Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia. METHODS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I2 statistic and Egger's tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval. RESULTS: Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture. CONCLUSION: Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.

Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia. METHODS: We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies. RESULTS: Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8-28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51-3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49-5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56-16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB. CONCLUSIONS: In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB.

Correction to: High burden of undernutrition among primary school-aged children and its determinant factors in Ethiopia; a systematic review and meta-analysis.

An amendment to this paper has been published and can be accessed via the original article.

High burden of undernutrition among primary school-aged children and its determinant factors in Ethiopia; a systematic review and meta-analysis.

BACKGROUND: Undernutrition remains a major public health concern affecting both children and adolescents in Ethiopia. However, little attention has been given to the undernutrition of primary school-aged children, with their exclusion within national surveys. Therefore, this systematic review and meta-analysis was conducted to determine pooled estimate and determinant factors of undernutrition among primary school-aged children (6 to 15 years of age) in Ethiopia. METHOD: We systematically retrieved available articles on the prevalence of undernutrition in primary school-aged children in Ethiopia by using a number of computerized databases, including PubMed, Scopus, Cochrane Library, Google Scholar, and Science Direct between September 1 and November 25, 2019. Two authors independently extracted relevant data using a standardized data extraction form. Heterogeneity among included studies was assessed with the Cochrane Q test statistics and Higgins I2 tests. The pooled estimates and determinant factors of school-aged undernutrition were assessed with random-effects model using Stata/se Version 14. RESULT: We have retrieved 30 eligible articles with pooled sample size of 16,642 primary school- aged children to determine the prevalence of undernutrition in Ethiopia. Hence, the pooled prevalence of stunting, underweight, and wasting were found to be 21.3% (95% CI: 17.0, 25.5), 18.2% (95% CI: 14.4, 22.0) and 17.7% (95% CI, 13.5, 21.8) respectively. Heterogeneity was assessed by doing subgroup analysis for study province/region. Thus, the highest prevalence of stunting was 27.6% (95% CI, 20.7, 34.5) and underweight 22.7% (95% CI, 19.2, 26.3) in Amhara Region while, in the instance of wasting, it was 19.3%(95% CI: 5.1, 33.4) in Southern Nations, Nationalities and People's Region. Maternal educational status (OR = 1.91, 95% CI: 1.33, 2.73), age of school-aged child (OR = 0.56, 95% CI: 0.44, 0.72) and sex of school-aged child (OR = 0.73, 95% CI: 0.62, 0.85) were found to be significantly associated with stunting. Maternal educational status (OR = 0.6, 95% CI: 0.36, 0.9) and age of school-aged child (OR = 2.74, 95% CI: 1.81, 4.14) were associated with thinness/wasting. Parasitic infection (OR = 2.02, 95% CI: 1.10, 3.73) were associated with underweight of school age children. CONCLUSION: The prevalence of stunting and underweight among primary school-aged children are moderately high while acute undernutrition (wasting) is more critical than under-five national average as reported in the 2016 Ethiopian Demography and Health Survey. Therefore, this finding warrants the need to design a school-aged children nutrition survey and expand school feeding programs to improve the nutritional status of primary school-aged children in the country. In addition, emphasis should be given to female school-aged children in the early school years, creating awareness for those mothers who lack formal education, and preventing and treating/deworming parasitic infection. Moreover, researchers must conduct research in province/regions which have not yet studied school aged children's nutritional status to date.

Risk factors for mortality among drug-resistant tuberculosis patients registered for drug-resistant treatment in Amhara region, Ethiopia: a historical cohort study.

BACKGROUND: The emergency of drug resistant tuberculosis is a major public health concern worldwide including Ethiopia. However, little is known about risk factors of mortality among drug resistant tuberculosis patients in the study site. Thus, this study was aimed to estimate the risks factors for mortality among drug resistant tuberculosis patients registered for drug-resistant treatment in Amhara region, Ethiopia. METHODS: An institutional-based retrospective cohort study was carried out among laboratory-confirmed drug-resistant tuberculosis patients (n = 498) who were initiated treatment for drug-resistant tuberculosis between September 1, 2010, and December 31, 2017. The demographic and clinical characteristics of the patients were obtained from the register of patients treated for drug-resistant tuberculosis. The data were entered using EpiData version 4.2 and exported to Stata Version 14.1 for further analysis. Descriptive measures were used to characterize the study participants. Kaplan-Meier was used to estimate the survival time of the patients. Cox proportional hazard model was used to identify risk factors for mortality. Hazard Ratio (HR) with 95% confidence interval was used to report the strength of association between risk factors and mortality. RESULTS: Death was observed among 14.2% (n = 70) of the 498 patients who met the inclusion criteria. The incidence rate of death was 8.20 (95% CI: 7.62, 20.50) per 1000 Person-months in the course of follow-up. The median age was 29.30 years (IQR:23-41). Age 45 years and above (adjusted hazard ratio (AHR) = 1.28: 95% CI: 1.10, 1.68), smoking cigarette (AHR = 1.39: 95% CI:1.27,3.18), tuberculosis related complication (AHR = 9.31:95% CI:5.11,16.97), anemia (AHR = 3.04:95% CI:1.14, 9.20), HIV/AIDS (AHR = 1.34:95% CI:1.25, 3.35), previous tuberculosis treatment history (AHR = 1.37:95% CI:1.16, 1.86), and diabetes mellitus (AHR = 1.85:95% CI:1.24,5.71) were identified risk factors for mortality. CONCLUSIONS: This study concluded that drug-resistant tuberculosis mortality remains high in the study site. Age 45 years and above, smoking cigarette, tuberculosis related clinical complication, being anemic at baseline, HIV/AID, previous tuberculosis treatment history, and diabetes mellitus were identified risk factors for mortality. Continual support of the integration of TB/HIV service with emphasis and working on identified risk factors may help in reducing drug-resistant tuberculosis mortality.

Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: The morbidity and mortality of stroke is disproportionately high in developing countries owing to the poor health care system and poor neurologic interventions. Though a number of studies were conducted to estimate the in-hospital mortality rate of stroke in Ethiopia, the lack of a nationwide study that determines the overall magnitude of risk factors and in-hospital mortality rate of stroke is an important research gap. Meta-analysis is key to improve the accuracy of estimates through the use of more data sets. Thus, this study was aimed to determine the overall magnitude of risk factors and in-hospital mortality rate of stroke in Ethiopia. METHODS: This study was conducted following the PRISMA checklist. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias adapted for cross-sectional studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall magnitude of risk factors and in-hospital mortality rate of stroke. Also, the subgroup analyses were performed to examine how the in-hospital mortality rate varies across different groups of studies. RESULTS: In this study, the overall magnitude of hypertension, diabetes mellitus, and atrial fibrillation among stroke patients were 47% (95%CI: 40-54), 8% (95CI%:6-12), and 10% (95%CI: 5-19), respectively. The overall in-hospital mortality of stroke in Ethiopia was 18% (95%:14-22). The highest magnitude of in-hospital mortality of stroke was observed in SNNPR and the lowest was noted in Tigray region. In addition, the magnitude of the in-hospital mortality rate of stroke was 15.1% (95%CI: 11.3-19.4), and 19.6%(95%CI: 14.1-25.7), among studies published before and after 2016, respectively. CONCLUSIONS: Our pooled result showed that nearly one-fifth of stroke patients have died during hospitalization. The most common risk factor of stroke among the included studies was hypertension followed by atrial fibrillation and diabetes mellitus. There is a need for a better understanding of the factors associated with high blood pressure, especially in countries with a high risk of stroke.

Time to sputum culture conversion and its associated factors among multidrug-resistant tuberculosis patients in Eastern Africa: A systematic review and meta-analysis.

OBJECTIVE: This study aimed to consider the estimated time to multi-resistant tuberculosis culture conversion, and associated factors, in order to enhance evidence utilization in eastern Africa. METHODS: We systematically identified available articles on multidrug-resistant tuberculosis culture conversion using PubMed, Scopus, Cochrane Library, Web of Science core collection, and Science Direct databases. A random-effects model was employed using the R 3.6.1 version and Stata/se 14 software. RESULTS: Nine articles with a sample size of 2458 multidrug-resistant tuberculosis patients were included. The two-month culture conversion rate was 75.4%, with a median time of 61.2 days (interquartile range: 48.6-73.8). In the included studies, favorable treatment outcomes of MDR-TB patients were seen in 75% of the cases, while unfavorable treatment outcomes were seen in 18% (10% deaths, 7% defaulted, and 1% treatment failure) of the cases. The independent factor for delayed sputum culture conversion was body mass index below 18.5kg/m2 (HR=3.1, 95% CI: 2.0, 6.7). CONCLUSION: The median time to sputum culture conversion was 61.2 days, which is a reasonably short time. Body mass index was the identified associated factor leading to delayed culture conversion. Therefore, there is a need for awareness of how to improve the nutritional status of multidrug-resistant tuberculosis patients through appropriate nutritional supports.

Full vaccination coverage among children aged 12-23 months in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Vaccination is one of the most cost-effective means of public health interventions to prevent childhood deaths from infectious diseases. Although several fragmented studies have been conducted concerning full vaccination coverage among children aged 12-23 months in Ethiopia, the pooled estimate has not been determined so far. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of full vaccination coverage among children aged 12-23 months in Ethiopian. METHODS: To find potentially relevant studies, we systematically searched five major databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct). This review included community based cross-sectional studies reported in English language; had good quality, and published from the 1st of January 2000 to the 20th of November 2019. Data were analyzed using Stata™ Version 14.1 software. The pooled estimates with 95% confidence intervals (CIs) were presented using forest plots. Higgins and Egger's tests were used to assess heterogeneity and publication bias, respectively. Primary estimates were pooled using a random effects meta-analysis model. RESULTS: Of the total of 851 identified articles 21 studies involving 12,094 children met the inclusion criteria and were included in this meta-analysis. The included studies sample size ranged from 173 to 923. The lowest proportion of full vaccination coverage was reported from Afar Region [21% (95% CI: 18, 24%)], whereas the highest proportion of full vaccination coverage was reported from Amhara Region [73% (95% CI: 67, 79%)]. The overall prevalence of full vaccination coverage among children in Ethiopia was 60% (95% CI: 51, 69%). CONCLUSIONS: Our finding suggested that six in every 10 children in Ethiopia were fully vaccinated. However, this finding is much lower than the World Health Organization recommended rate. Moreover, high regional variations in terms of full vaccination coverage across the country was observed. Therefore, a special attention should be given to improve the overall childhood vaccination coverage.

Prevalence of Neonatal Sepsis in Ethiopia: A Systematic Review and Meta-Analysis.

INTRODUCTION: Neonatal sepsis is a systemic infection occurring in infants during the first 4 weeks of life and is a major cause of mortality and morbidities of newborns due to their age-related weak and immature immune systems. In Ethiopia, despite many studies being conducted on neonatal sepsis, the reported findings are inconsistent. The aim of this study is to determine the prevalence of neonatal sepsis to enhance the utility and interpretation of the evidence. METHODS: An extensive systematic review and meta-analysis were performed to extract studies on the prevalence of neonatal sepsis in Ethiopia. The PubMed, Cochrane Library, ScienceDirect, Web of Science, and Google Scholar were systematically searched. Two independent authors selected and extracted the data from each included article. The heterogeneity of included studies was assessed using the Higgins I 2 test, and a random-effects model was performed in Stata/se Version 14. RESULTS: Eighteen studies with a sample size of 10,495 study subjects were included with a reported range of neonatal sepsis from 17% to 78%. The pooled prevalence of neonatal sepsis was 45% (95% CI: 35, 55; I 2 = 99.3%, p < 0.01). Early onset neonatal sepsis was found to have a prevalence of 75.4% (95% CI: 68.3, 82.6). Subgroup analysis in the study area (i.e., by region) was calculated revealing the highest neonatal sepsis in Amhara region at 64.4% (95% CI: 44.9, 84.0) and the lowest in Southern Nations, Nationality, and People at 28% (95% CI: 16, 40). CONCLUSION: In this review, the prevalence of neonatal sepsis in Ethiopia was found to be high, especially in terms of early onset neonatal sepsis. As a result of the findings, it is important to consider the early and optimal points for interventions to better manage the prevalence and outcomes of neonatal sepsis. Further research is needed to investigate the neonatal sepsis status at different regions and associated factors for neonatal sepsis not yet studied.