Prevalence of active trachoma among 1-9 years of age children in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: The objective of this study is to determine the pooled prevalence of active trachoma among 1-9 years old children in Ethiopia. DESIGN: A systematic review and meta-analysis were employed in accordance with the Preferred Reporting Items for Systematic Reviews. DATA SOURCES: Medline/PubMed, Scopus, Web of Science, African Journal of Online and Google scholar databases were systematically explored to find studies published in English until July 2023. ELIGIBILITY CRITERIA: The following criteria apply: (1) condition (Co): studies examined the prevalence of trachoma among children (1-9) years old; (2) context (Co): studies conducted in Ethiopia; (3) population (Pop): studies that were done among children (1-9) years old; (4) study type: observational studies and (5) language: studies published in English. DATA EXTRACTION AND SYNTHESIS: The data were extracted using a Microsoft Excel spreadsheet. DerSimonian-Laird random effect model was used to estimate the pooled prevalence of active trachoma among 1-9 years old children. Cochrane Q-tests and I2 statistics were used across studies to assess heterogeneity. To identify possible publication bias, Egger's test was performed. PRIMARY OUTCOME: Prevalence of active trachoma among children aged (1-9 years old)". RESULTS: Overall, a total of 42 articles with 235 005 study participants were included in the final analysis. The estimated pooled prevalence of active trachoma using random effect model was 24% (95% CI 20% to 27%). The subgroup analysis by region revealed that the highest prevalence of trachoma was 36% (95% CI 13% to 58%) in the Tigray region, and publication year revealed the prevalence of trachoma was decreasing from 32% to 19% after 2015. CONCLUSION: In this review, the pooled prevalence of active trachoma was found to be high in Ethiopia compared with WHO threshold level. This underscores the need for increased focus on high-risk age groups to decrease trachoma and to achieve the elimination of trachoma from the country by 2030.

Cross-cultural adaptation of the Amharic version of the Compassionate Care Assessment Tool for application in obstetric services of the Ethiopian context.

Background: There are few studies that have evaluated the provision of compassionate care in Ethiopian contexts. One probable factor could be a lack of validated tools for assessing compassionate care in Ethiopia. Objective: To adapt the Compassionate Care Assessment Tool into the Amharic version and to assess its reliability and validity for application in obstetric services of the Ethiopian context. Method: Four hundred ten mothers who gave birth at the four referral hospitals in North West Amhara participated in this study. Using SPSS version 23.0 and SPSS Amos 26 and by applying principal axial factoring, the Compassionate Care Assessment Tool was assessed for structural reliability and validity. Cronbach's alpha was used to evaluate internal consistency and reliability. Factor loadings, composite reliability, average variance extracted and square root of the average variance extracted were used to test convergent and discriminant validity. Results: Three factors with thirteen items were identified that explained 69.87% of the variation in the Compassionate Care Assessment Tool. Cronbach's alpha was 0.917. In the confirmatory factor analysis, all items had factor loadings more than 0.6, and the average variance extracted was greater than 0.5. Composite reliability values were above 0.7, and the square root of the average variance extracted for each element was greater than the correlation of each factor with other factors in the model. Conclusion: The three factors and the thirteen items of the tool have shown internal consistency in the exploratory factor analysis. The factor loadings and the average variance extracted confirmed the convergent validity of the tool, while composite reliability and the square root of the average variance extracted values confirmed discriminant validity. Thus, the Amharic version of the Compassionate Care Assessment Tool was found to have excellent internal consistency as well as adequate structural, convergent, and discriminant validity among obstetric service users in Ethiopia.

Mortality and its predictors among human immunodeficiency virus-infected children younger than 15 years receiving antiretroviral therapy in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Despite antiretroviral treatment (ART), the human immunodeficiency virus (HIV) continues to pose a considerable health burden in resource-poor countries. This systematic review and meta-analysis aimed to determine the pooled incidence density of mortality and identify potential predictors among HIV-infected children receiving ART, from studies conducted in various parts of Ethiopia. METHODS: A comprehensive database search was made in Excerpta Medica, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We reported results following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. Excel Spreadsheet and STATA Version 14 software were used for data abstraction and meta-analysis, respectively. Statistical heterogeneity among studies was assessed using I2 statistics. Meta-regression and subgroup analysis were performed to further explore the sources of statistical heterogeneity. Moreover, publication bias and a leave-out-one sensitivity analysis were performed. RESULTS: Twenty-two articles involving 8,731 participants met inclusion criteria and were included. The pooled incidence density of mortality was 3.08 (95% confidence interval (CI), 2.52 to 3.64) per 100 child years. Predictors of mortality were living in rural areas (hazard ratio (HR), 2.18 [95% CI, 1.20 to 3.98]), poor adherence to ART (HR, 2.85 [ 95% CI, 1.39 to 5.88]), failure to initiate co-trimoxazole preventive therapy (HR, 2.16 [95% CI, 1.52 to 3.07]), anemia (HR, 2.28 [95% CI, 1.51 to 3.45]), opportunistic infections (HR, 1.52 [ 95% CI, 1.15 to 2.00]), underweight (HR, 1.74 [95% CI, 1.26 to 2.41]), wasting (HR, 2.54 [95% CI, 1.56 to 4.16]), stunting (HR, 2.02 [95% CI, 1.63 to 2.51]), World Health Organization classified HIV clinical stages III and IV (HR, 1.71 [95% CI, 1.42 to 2.05]), and Nevirapine-based regimens (HR, 3.91 [95% CI, 3.09 to 4.95]). CONCLUSIONS: This study found that the overall mortality rate among HIV-infected children after ART initiation was high. Therefore, high-level commitment and involvement of responsible caregivers, healthcare providers, social workers, and program managers are of paramount importance to identify these risk factors and thus enhance the survival of HIV-infected children receiving ART.

Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis.

Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger's and Begg's rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs.PROSPERO: CRD42023445294.

Second-line anti-retroviral treatment failure and its predictors among patients with HIV in Ethiopia: A systematic review and meta-analysis.

Antiretroviral therapy (ART) treatment failure remains a major public health concern, with multidimensional consequences, including an increased risk of drug resistance, compromised quality of life, and high healthcare costs. However, little is known about the outcomes of second-line ART in Ethiopia. Therefore, this systematic review and meta-analysis aimed to determine the incidence and determinants of second-line ART treatment failure. Articles published in PubMed, Google Scholar, Science Direct, and Scopus databases were systematically searched. All observational studies on the incidence and predictors of treatment failure among patients with HIV on second-line ART were included. A random-effects model was used to estimate the pooled incidence, and subgroup analysis was performed to identify the possible sources of heterogeneity. Publication bias was checked using forest plot, Begg's test, and Egger's test. The pooled odds ratio was also computed for associated factors. Seven studies with 3,962 study participants were included in this study. The pooled incidence of second-line antiretroviral treatment failure was 5.98 (95% CI: 4.32, 7.63) per 100 person-years of observation. Being in the advanced WHO clinical stage at switch (AHR = 2.98, 95% CI: 2.11, 4.25), having a CD4 count <100 cells/mm3 (AHR = 2.14, 95% CI: 1.57, 2.91), poor drug adherence (AHR = 1.78, 95% CI: 1.4, 2.25), and tuberculosis co-infection (AHR = 2.93, 95% CI: 1.93, 4.34) were risk factors for treatment failure. In conclusion, this study revealed that that out of 100 person-years of follow-up, an estimated six patients with HIV who were on second-line antiretroviral therapy experienced treatment failure. The risk of treatment failure was higher in patients who were in an advanced WHO clinical stage, CD4 count <100 cells/mm3, and presence tuberculosis co-infection. Therefore, addressing predictors reduces the risk of treatment failure and maximizes the duration of stay in second-line regimens.

Neonatal birth trauma and associated factors in low and middle-income countries: A systematic review and meta-analysis.

Neonatal birth trauma, although it has steadily decreased in industrialized nations, constitutes a significant health burden in low-resource settings. Keeping with this, we sought to determine the pooled cumulative incidence (incidence proportion) of birth trauma and identify potential contributing factors in low and middle-income countries. Besides, we aimed to describe the temporal trend, clinical pattern, and immediate adverse neonatal outcomes of birth trauma. We searched articles published in the English language in the Excerpta Medica database, PubMed, Web of Science, Google, African Journals Online, Google Scholar, Scopus, and in the reference list of retrieved articles. Literature search strategies were developed using medical subject headings and text words related to the outcomes of the study. The Joana Briggs Institute quality assessment tool was employed and articles with appraisal scores of seven or more were deemed suitable to be included in the meta-analysis. Data were analyzed using the random-effect Dersimonian-Laird model. The full search identified a total of 827 articles about neonatal birth trauma. Of these, 37 articles involving 365,547 participants met the inclusion criteria. The weighted pooled cumulative incidence of birth trauma was estimated at 34 per 1,000 live births (95% confidence interval (CI) 30.5 to 38.5) with the highest incidence observed in Africa at 52.9 per 1,000 live births (95% CI 46.5 to 59.4). Being born to a mother from rural areas (odds ratio (OR), 1.61; 95% CI1.18 to 2.21); prolonged labor (OR, 5.45; 95% CI 2.30, 9.91); fetal malpresentation at delivery (OR, 4.70; 95% CI1.75 to 12.26); shoulder dystocia (OR, 6.11; 95% CI3.84 to 9.74); operative vaginal delivery (assisted vacuum or forceps extraction) (OR, 3.19; 95% CI 1.92 to 5.31); and macrosomia (OR, 5.06; 95% CI 2.76 to 9.29) were factors associated with neonatal birth trauma. In conclusion, we found a considerably high incidence proportion of neonatal birth trauma in low and middle-income countries. Therefore, early identification of risk factors and prompt decisions on the mode of delivery can potentially contribute to the decreased magnitude and impacts of neonatal birth trauma and promote the newborn's health.

Asymptomatic malaria infection and its associated factors among pregnant women in Ethiopia; a systematic review and meta-analysis.

Background: Asymptomatic malaria during pregnancy is a significant public health concern in malaria-endemic regions, which worsens the various effects of malaria on the mother and fetus and increases maternal and neonatal mortality. To date, no meta-analysis has been conducted on asymptomatic malaria in pregnant women in Ethiopia. Thus, we aimed to estimate the pooled prevalence of asymptomatic malaria and its associated factors in pregnant women in Ethiopia. Methods: PubMed/Medline, Google Scholar, Web of Science, Cochrane, AJOL, and Ethiopian University repositories were systematically searched to identify studies reporting the prevalence of asymptomatic malaria infection among pregnant women in Ethiopia. A random effects model was used to perform the analysis. The heterogeneity of the studies was assessed with the I-squared tests, and subgroup analyses were performed to identify the sources of heterogeneity. Results: Ten articles with 3277 study participants were included in this review. The pooled prevalence of asymptomatic malaria infection among pregnant women in Ethiopia was 7.03% (95% CI: 6.23-9.12); I2 = 81.2%). In the species-specific pooled prevalence estimate, Plasmodium falciparum prevalence was 5.34% (95%CI: 3.38-7.3; I2 = 87.8%), and Plasmodium vivax prevalence was 1.69% (95%CI: 1.2-5; I2 = 91.5%).Not using insecticide-treated bed nets [OR = 7.36, 95% CI (2.75, 19.73)], being primi-gravida [OR = 1.86, 95% CI (1.23, 2.82)]; lack of health education about malaria prevention [OR = 6.86, 95% CI (2.90, 11.44)] were predictors of asymptomatic malaria infection during pregnancy. Conclusion: This study revealed that asymptomatic malaria was prevalent among pregnant women in Ethiopia. This suggests that relying merely on reported symptoms may result in missed malaria cases. Therefore, regular screening and treatment protocols for malaria are recommended in antenatal care. It is also crucial to ensure that pregnant women have access to insecticide-treated bed nets and other effective malaria prevention measures.

Gap analysis of service quality and associated factors at the oncology center of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2022: a cross-sectional study.

OBJECTIVE: To measure the gap between expectations of patients with cancer for oncology services and their perceptions of the actual service and to identify associated factors at the oncology centre of Tikur Anbessa Specialized Hospital, Ethiopia. DESIGN: An institutional-based cross-sectional study design was conducted using the service quality (SERVQUAL) tool from March to April 2022 on a sample of 256 hospitalised patients with cancer at the oncology centre of Tikur Anbessa Specialized Hospital. A paired Wilcoxon test and Kruskal-Wallis tests were used to determine the statistically significant difference between expectation and perception and to quantify the strength of association between the level of gap in the quality of oncology service and dependent variables, respectively. RESULTS: Out of 256 patients with cancer included in the study, all of them agreed and participated, making the response rate 100%. The overall gap in service quality explained by the mean and SD is -1.42 (±0.41). The overall score for expectation and perception is 4.24 (±0.31) and 2.82 (±0.37), respectively. Being female, age greater than 65, having a college degree and above, being a patient with cervical cancer, patients with stage 4 cancer and patients who waited for more than 12 months for radiotherapy were found to have a statistically significant higher expectation compared with their perceived care in one or more dimensions of the SERVQUAL tool. CONCLUSION: Patient perceptions of the quality of service they received were lower than their expectations of the quality of service in all service quality aspects at Tikur Anbessa Specialized Hospital's oncology centre, implying unmet quality expectations from the oncology service users, with tangibility, assurance and empathy being the dimensions with the highest gap recorded, respectively. Therefore, the hospital and other stakeholders should strive to exceed patient expectations and the overall quality of care.

Labor pain management practices and associated factors in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: The pain that women experience during labor and childbirth is the central feature of parturition in humans. Despite improvement in the development of standards for pain assessment and treatment, labor pain is mostly ignored especially in low- and middle-income countries resulting in unmeasured suffering from childbirth for mothers. OBJECTIVES: We aimed to provide a comprehensive estimation of the pooled magnitude and associated factors of labor pain management practices in Ethiopian public health facilities. SEARCH STRATEGY: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Electronic databases including Google Scholar, Web of Science, Excerpta Medica Database (EMBASE), PubMed/MEDLINE, and Scopus were searched from database inception to June 30, 2023. SELECTION CRITERIA: The inclusion criteria were established prior to article review and follows the population, intervention, comparison and outcome criterions. DATA COLLECTION AND ANALYSIS: We evaluated publication bias by means of funnel plots and Egger's test. Heterogeneity between studies was assessed using I2 statistics. For each associated factors in meta-regressions, the pooled odds ratio (OR) and its 95% confidence interval (CI) were extracted. A P value of 0.05 was used to determine the significance of the small study effect. MAIN RESULTS: Our search terms yielded 17 studies with 5735 participants. The pooled prevalence of labor pain management practices in Ethiopia was 45.73% (95% CI: 39.13, 52.32; I2 = 96.4). Having adequate knowledge regarding labor pain management (OR: 3.74; 95% CI: 2.74, 5.11; I2 = 53.8%), a favorable attitude toward labor pain management (OR: 2.90; 95% CI: 2.03, 4.14; I2 = 63.8%), availability of labor analgesics (OR: 3.23; 95% CI: 2.18, 4.79; I2 = 46.2%), and clinical experience of 10 or more years (OR: 3.45; 95% CI: 2.06, 5.78; I2 = 19.0%) were factors that were statistically associated with the use of labor pain management practices. CONCLUSION: We concluded that the routine practices of labor pain management by obstetric health providers in Ethiopia are still low. Therefore, it remains important to call for holistic and inclusive interventions targeting maternity health providers and hospital officials to update their long-standing practices. REGISTRATION: Registered in PROSPERO under protocol number CRD42023429140.

Insecticide-treated bed net utilization and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Malaria infection during pregnancy endangers the pregnant woman, fetus, and newborn child. Thus, the use of an insecticide-treated net (ITN) is one of the most frequently advised methods for preventing malaria during pregnancy. Contrary findings have been reported in various studies on ITN utilization among pregnant women in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of ITN utilization and its associated factors among pregnant women in Ethiopia. METHODS: Published articles from PubMed, Google Scholar, Science Direct, AJOL and Cochrane library were systematically searched. All cross-sectional studies on ITN utilization among pregnant women were included in this meta-analysis. To estimate the pooled prevalence and odds ratio, a random-effect model was used; and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. RESULTS: Ten cross-sectional studies with 7,161 participants were included. The pooled prevalence of ITN utilization among all pregnant women who had access to ITN in Ethiopia was 59.42% (95% CI 51.14, 67.69). Statistically significant heterogeneity was observed (I2 = 97.7%; p < 0.0001). Higher educational status (OR = 3.47, 95% CI 2.32, 5.2), pregnant women who had antenatal care visits (OR = 2.37, 95% CI 1.97, 2.65) and having good knowledge of malaria prevention practices (OR = 10.63, 95% CI 5.31, 21.29) were associated with ITN utilization among pregnant women. CONCLUSION: The utilization of ITNs among pregnant women was much lower than the national target. Higher education status, attending ANC and a good level of knowledge were found to be independent predictors of ITN utilization. Improving women's understanding of ITNs will enhance their use, and the government and health sectors should encourage pregnant mothers to enroll in antenatal care.

Minimum acceptable dietary intake among children aged 6-23 months in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: In the absence of minimum acceptable diet, children aged 6-23 months are vulnerable to malnutrition. Not feeding at least the minimum acceptable diet is a major global problem, particularly in developing countries. Even though many studies have been conducted in Ethiopia there are inconsistencies. Therefore, this review aimed to estimate the pooled prevalence of a minimum acceptable diet in Ethiopia. METHODS: Published articles from various electronic databases, such as PubMed/MEDLINE, EMBASE, Google Scholar, and Science Direct were systematically searched. All cross-sectional studies conducted on the minimum acceptable diet of children aged 6-24 months and published up to October 30/2021 were included in this review. Data were extracted using an Excel spreadsheet and analyzed using STATA version 14.1. The random-effects model was used to estimate the pooled prevalence, and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. RESULTS: Nine cross-sectional studies involving 4,223 participants were included. Significant heterogeneity was observed across the studies (I2 = 99.4%). The pooled prevalence of minimum acceptable diet in Ethiopia was found to be 25.69% (95% CI: 11.96, 39.41). CONCLUSION: This review revealed that the minimum acceptable dietary intake among children aged 6-23 months in Ethiopia was relatively low; only 1 in 4 of children met the minimum acceptable diet. This indicates that the government should promote child feeding practices according to guidelines to increase the proportion of children with a minimum acceptable diet.

Turnover intention among healthcare workers in Ethiopia: a systematic review and meta-analysis.

OBJECTIVE: To determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia. DESIGN: A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. DATA SOURCES: Electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar were searched to identify studies published in the English language before 31 December, 2021. ELIGIBILITY CRITERIA: Studies were included with following criteria: (1) studies conducted or published until 31 December 2021; (2) observational studies; (3) Studies conducted on healthcare workers; (4) reporting turnover intention; (v) studies conducted in Ethiopia and (vi) tudies published in the English language were included. DATA EXTRACTION AND SYNTHESIS: Three independent reviewers screened all the papers for eligibility criteria. Data were extracted by two independent investigators using a standardised data extraction format. Random effects model meta-analysis using STATA V.14.0 statistical software was conducted to estimate the pooled prevalence of turnover intention with 95% CI. Funnel plot and Forest plot were used to check publication bias and heterogeneity between studies, respectively. Leave-one-out sensitivity analysis was done. PRIMARY OUTCOME: Prevalence of turnover intention. RESULT: A total of 29 cross-sectional studies with 9422 participants met the inclusion criteria. The estimated pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93; p value <0.001, I2=93.5%). CONCLUSION: The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia. The Government and policy makers should come up with different mechanisms including a wide variety of healthcare workers retention strategies in order to reduce turnover intention of healthcare workers and retain them.

Dyslipidemia and serum cystatin C levels as biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus.

Background: Diabetic nephropathy is a leading cause of end-stage renal disease. The diagnostic markers of nephropathy, including the presence of albuminuria and/or a reduced estimated glomerular filtration rate, are not clinically ideal, and most of them are raised after a significant reduction in renal function. Therefore, it is crucial to seek more sensitive and non-invasive biomarkers for the diagnosis of diabetic nephropathy. Objective of the study: This study aimed to investigate the serum cystatin C levels and dyslipidemia for the detection of diabetic nephropathy in patients with type 2 diabetes mellitus. Methodology: A hospital-based comparative cross-sectional study was conducted from December 2021 to August 2022 in Tikur, Anbessa specialized teaching hospital with a sample size of 140 patients with type2 diabetes mellitus. Socio-demographic data was collected using a structured questionnaire, and 5 mL of blood was collected from each participant following overnight fasting for biochemical analyses. Results: In type 2 diabetes patients with nephropathy, we found significant lipoprotein abnormalities and an increase in serum cystatin C (P < 0.001) compared to those without nephropathy. Serum cystatin C, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, very low-density lipoprotein, high density lipoprotein, and duration of diabetes were identified as being significantly associated with diabetic nephropathy (P < 0.05) in multivariable logistic regression analysis. The mean values of total cholesterol levels, triglyceride levels, and high-density lipoprotein cholesterol levels were also found to be significantly higher (P < 0.05) in females as compared to male type-2 diabetic patients. The fasting blood glucose levels and lipid profiles of the participants were found to be significantly associated with serum cystatin C levels. Conclusion: The present study found significant serum cystatin C and lipoprotein abnormalities in T2DM patients with diabetic nephropathy when compared with those without diabetic nephropathy, and these lipoprotein abnormalities were significantly associated with serum cystatin C levels.

Knowledge, attitudes and prevention practices related to dog-mediated rabies in Ethiopia: a systematic review and meta-analysis of observational epidemiological studies from inception to 2023.

Background: Rabies is a horrific and neglected zoonotic disease that kills thousands of people worldwide each year and continues to pose threats to public health. Prevention and control of dog-transmitted rabies require mapping the level of understanding, perception, and existing practices to minimize its impacts on health. Therefore, we undertook this systematic review and meta-analysis to pool evidence from available data on knowledge, attitudes, and prevention practices regarding the disease from studies conducted in various areas of Ethiopia. Methods: Articles were searched in electronic bibliographic medical databases such as the Excerpta Medica database, PubMed, Web of Science, African Journals Online, Google Scholar, and Scopus. We used Microsoft Excel spreadsheets and STATA software version 16 for the data excerption and analysis, respectively. The variability among studies was evaluated via Higgins and Thompson's I2 statistics and the x2 test (significant at p ≤ 0.1). The Dersimonian and Laird random-effect meta-analysis model was used to estimate the pooled effect at a 95% uncertainty interval (UI). Visual inspection and Egger's test (significant at p ≤ 0.05) were used to identify the presence of small-study effects. Results: The search identified 1,249 electronic records. Of them, 27 studies involving 11,150 participants met the inclusion criteria. The pooled prevalence of a good level of knowledge was 62.24% (95% UI: 48.56, 75.92). Furthermore, the pooled prevalence of a favorable level of attitudes towards rabies and a good level of rabies prevention practices was only 56.73% (95% UI: 47.16, 66.29) and 52.73% (95% UI: 43.32, 62.15), respectively. Conclusion: The study revealed credible gaps in attitudes and prevention practices, though some level of knowledge about dog-mediated rabies was demonstrated. Therefore, we call for country-wide cross-sectoral collaboration to allow for the realization of a global elimination strategy for dog-mediated human rabies.

Prevalence of contraceptive implant discontinuation among women who used implant in Ethiopia: Systemic review and meta-analysis.

The likelihood of contraceptive implant discontinuation is very common and varies worldwide. This high prevalence of discontinuation may also indicate problems with implementation of family planning programmes. Consequently, a significant number of women are exposed to conception after discontinuation. Although studies have been conducted in Ethiopia, there are inconsistencies across studies. Therefore, this meta-analysis aimed to estimate the pooled prevalence of contraceptive implant discontinuation among women in Ethiopia. Published articles from various electronic databases such as PubMed/MEDLINE, Google Scholar, Science Direct, AJOL and Cochrane library were systematically searched. All cross-sectional studies conducted on prevalence of contraceptive implant discontinuation and published up to 30 January 2022 were included in this review. To estimate the pooled prevalence, random effect model was used and a subgroup analysis was performed to identify the possible source of heterogeneity. Begg's and Egger's tests were used to identify possible publication bias. A total of 13 cross-sectional studies with 5012 participants were included. Significant heterogeneity was observed across studies (I2 = 98.2%). However, there was no evidence of publication bias (p = 0.066). The estimated pooled prevalence of contraceptive implant discontinuation in Ethiopia was found to be 36.95% (95% confidence interval = 27.6-46.3). A subgroup analysis by time of discontinuation indicated that 21.5%, 42.2% and 33.5% of contraceptive implant user discontinue within 12 months, 2.5 years and 3 years, respectively. This meta-analysis indicated that the prevalence of discontinuation of contraceptive implant was found to be high in Ethiopia. Therefore, strengthening the appropriate counselling prior to insertion and proper follow-up, independent choice will improve the proportion of implants retention.