Using geographically weighted regression analysis to assess predictors of home birth hot spots in Ethiopia.

BACKGROUND: Annually, 30 million women in Africa become pregnant, with the majority of deliveries taking place at home without the assistance of skilled healthcare personnel. In Ethiopia the proportion of home birth is high with regional disparity. Also limited evidence on spatial regression and deriving predictors. Therefore, this study aimed to assess the predictors of home birth hot spots using geographically weighted regression in Ethiopia. METHODS: This study used secondary data from the 2019 Ethiopian Mini Demographic and Health Survey. First, Moran's I and Getis-OrdGi* statistics were used to examine the geographic variation in home births. Further, spatial regression was analyzed using ordinary least squares regression and geographically weighted regression to predict hotspot area of home delivery. RESULT: According to this result, Somalia, Afar, and the SNNPR region were shown to be high risk locations for home births. Women from rural residence, women having no-education, poorest wealth index, Muslim religion follower, and women with no-ANC visit were predictors of home delivery hotspot locations. CONCLUSION: The spatial regression revealed women from rural resident, women having no-education, women being in the household with a poorest wealth index, women with Muslim religion follower, and women having no-ANC visit were predictors of home delivery hotspot regions. Therefore, governmental and other stakeholders should remain the effort to decrease home childbirth through access to healthcare services especially for rural resident, strengthen the women for antenatal care visits.

Satisfaction of health informatics professionals with Ethiopian health system: the case of three zones in Ethiopia.

BACKGROUND: The importance of the health information system faces multiple challenges such as supply, acceptance, and pressure from other professions in Ethiopia. Work-related challenges might cause low professional satisfaction and hinder service provision. There is a paucity of evidence for policy decisions to improve these challenges. Therefore, this study aims to assess Health Informatics professional satisfaction in the Ethiopian health system and associated factors to provide evidence for future improvements. METHODS: We conducted an institutions-based cross-sectional study on health informatics professionals in three zones in Southern Ethiopia in 2020. We used a simple random sampling technique to select 215 participants. The local health officials were contacted regarding the research questions, and letters of permission were collected for data collection. RESULTS: Out of 211(98%) Health Informatics professionals who accepted the interview, 50.8% (95%CI: 47.74%-53.86%) were satisfied. Age (AOR = 0.57; 95% CI: 0.53, 0.95), experience (AOR = 5; 95% CI: 1.50, 19.30), working time (AOR = 1.35; 95% CI: 1.10, 1.70), working as HMIS officers (AOR 2.30; 95% CI: 3.80, 13), single marital status (AOR = 9.60; 95% CI: 2.88, 32), and urban residence (AOR = 8.10; 95% CI: 2.95, 22) were some of the associated factors. CONCLUSIONS: We found low satisfaction among health informatics professionals compared to other studies. It was suggested that the responsible bodies must keep experienced professionals and reduce pressure from other professions through panel discussions. Work departments and working hours need consideration, as they are the determinants of satisfaction. Improving educational opportunities and career structure is the potential implication area.

Understanding Child Wasting in Ethiopia: Cross-sectional Analysis of 2019 Ethiopian Demographic and Health Survey Data Using Generalized Linear Latent and Mixed Models.

BACKGROUND: Wasting is an immediate, visible, and life-threatening form of undernutrition in children aged <5 years. Within a short time, wasting causes recurrent sickness, delayed physical and mental growth, impatience, poor feeding, and low body weight. The long-term consequences of wasting and undernutrition are stunting, inability to learn, poor health status, and poor work performance. Wasting remains a public health problem in Ethiopia. According to the World Health Organization, countries have to reduce undernutrition including child wasting to below 5% by 2025. Ethiopia is attempting to attain national and international targets of undernutrition while struggling with many problems. OBJECTIVE: This study aimed to identify the prevalence and associated factors of wasting to provide information for further renewing policy commitments. METHODS: We used community-based, cross-sectional data from the Ethiopian Mini Demographic and Health Survey. The survey was conducted in 9 regions and 2 city administrations. Two-stage cluster sampling was used to recruit study participants. In the first stage, enumerations areas were selected, and 28-35 households per enumeration area were selected in the second stage. Our analysis included 2016 women with children aged <5 years from the 2019 EMDHS data set. We dropped incomplete records and included all women who fulfilled the eligibility criteria. We used multilevel ordinal regression using Generalized Linear Latent and Mixed Models (GLLAMM) and predicted probability with log-likelihood ratio tests. Fulfilling the proportional odds model's assumption during the application of multilevel ordinary logistic regression was a cumbersome task. GLLAMM enabled us to perform the multilevel proportional odds model using an alternative method. RESULTS: In our analysis, wasting was 7.68% (95% CI 6.56%-8.93%). Around 26.82% of mothers never used antenatal care for their current child. Most mothers (52.2%) did not have formal education, and 86.8% did not have postnatal care for their children. Additionally, half (50.93%) of the mothers have ≥6 household members. Wasting was associated with feeding diverse foods (coefficient 4.90, 95% CI 4.90-4.98), female sex of the household head (-40.40, 95% CI -40.41 to -40.32), home delivery (-35.51, 95% CI -35.55 to -35.47), first (16.66, 95% CI, 16.60-16.72) and second (16.65, 95% CI 16.60-16.70) birth order, female child (-12.65, 95% CI -12.69 to -12.62), and household size of 1 to 3 (10.86, 95% CI 10.80-10.92). CONCLUSIONS: According to the target set by World Health Organization for reducing undernutrition in children aged <5 years to below 5% by 2025, child wasting of 7.68% in Ethiopia should spark an immediate reaction from the government and stakeholders. Informed policy decisions, technology-based child-feeding education, and food self-sufficiency support could improve the current challenges. Additional effort is important to improve low maternal education, family planning, awareness of sex preferences, women empowerment, and maternal health services.

Pooled prevalence and associated factors of pregnancy termination among youth aged 15-24 year women in East Africa: Multilevel level analysis.

BACKGROUND: Most of unwanted pregnancies among adolescent girls and young women (AGYW) in Africa result in pregnancy termination. Despite attempts to enhance maternal health care service utilization, unsafe abortion remains the leading cause of maternal death in Sub-Saharan Africa (SSA), there is still a study gap, notably in East Africa, where community-level issues are not studied. Therefore, this study aimed to assess pooled prevalence pregnancy termination and associated factors among youth (15-24 year-old) women in the East Africa. METHODS: The study was conducted based on the most recent Demographic and Health Surveys (DHS) in the 12 East African countries. A total weighted sample of 44,846 youth (15-24) age group women was included in this study. To detect the existence of a substantial clustering effect, the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were used. Furthermore, because the models were nested, deviance (-2LLR) was used for model comparison. In the multilevel logistic model, significant factors related to pregnancy termination were declared using Adjusted Odds Ratios (AOR) with a 95%Confidence Interval (CI) and p-value of 0.05. RESULT: The pooled prevalence of pregnancy termination in East African countries was 7.79% (95% CI: 7.54, 8.04) with the highest prevalence in Uganda 12.51% (95% CI: 11.56, 13.41) and lowest was observed in Zambia 5.64% ((95% CI: 4.86, 6.41). In multilevel multivariable logistic regression result, age 20-24 [AOR = 1.93; 95% CI: 1.71, 2.16], media exposure [AOR = 1.22; 95% CI: 1.12, 1.34], married [AOR = 1.32, 95% CI: 1.21, 1.43], had working [AOR = 1.13; 95% CI: 1.04, 1.23],no education[AOR = 3.98, 95% CI: 2.32, 6.81], primary education [AOR = 4.05, 95% CI: 2.38, 6.88], secondary education [AOR = 2.96, 95% CI: 1.74, 5.03], multiparous [AOR = 0.85; 95%CI: 0.79, 0.93], sexual initiation greater or equal to 15 [AOR = 0.82; 95%CI: 0.74, 0.99] were significantly associated with pregnancy termination. CONCLUSION: The pooled prevalence of pregnancy termination in East Africa was high in this study. Maternal age, marital status, education status, parity, age at first sex, media exposure, working status and living countries were significantly associated with pregnancy termination. The finding provides critical information for developing health interventions to decrease unplanned pregnancies and illegal pregnancy termination.

Prevalence and associated factors of early sexual initiation among female youth in East Africa: further analysis of recent demographic and health survey.

BACKGROUND: Early sexual initiation is one of the risky sexual practices. Early sexual beginning is associated with an increased risk of HIV/AIDS, sexually transmitted infections (STIs), unexpected pregnancies, unsafe abortion, premature deliveries, and psychosocial issues. However, there is still a lack of evidence, particularly in East Africa, where community-level factors are not investigated. Therefore, this study aimed to estimate the pooled prevalence and to identify associated factors of early sexual initiation among female youth in Eastern Africa. METHODS: A total weighted sample of 49,716 female youth was included in this analysis. STATA version 14 software was used for data extraction, recoding, and analysis. A multilevel binary logistic regression model was fitted to identify determinants of early sexual initiation in the region. Finally, Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to declare the factors that are significantly associated with early sexual initiation. RESULT: The prevalence of early sexual initiation in East Africa was 21.14% [95% CI: 20.00%, 21.50%]. In the multivariable multilevel analysis; being age 20-24 years [AOR = 0.65: 95% CI; 0.61, 0.69], primary [AOR = 0.73: 95% CI; 0.67, 0.78], secondary &above education [AOR = 0.30: 95% CI; 0.27,0.33], married [AOR = 1.85: 95% CI; 1.73,1.97], middle wealth [AOR = 0.78: 95% CI; 0.72,0.84], richest [AOR = 0.74: 95% CI; 0.68,0.80], and reading newspaper [AOR 0.77: 95% CI;0.71,0.83] were significantly associated with early sexual initiation. CONCLUSION: The study revealed that early sexual initiation among female youth was high in East Africa. Educational status, respondent age, marital status, wealth index, age at first cohabitation, contraceptive use, reading newspaper, and place of residence were associated with early sexual initiation. Therefore, the survey findings will help policymakers, as well as governmental and non-governmental organizations, design the most effective interventions. Moreover, strengthening information, education, and wealth status are important intervention areas to delay the age of early sexual debut.

Determinants of peripheral neuropathy among diabetic patients under follow-up in chronic care clinics of public hospitals at Gamo and Gofa zones, southern Ethiopia.

BACKGROUND: Peripheral neuropathy is a leading cause of morbidity and increased mortality among diabetic patients. It is characterized by significant deficits in vibration and tactile sensation. With an annual incidence of 2%, it affects as many as 110 million people worldwide. The aim of this study was to assess factors associated with peripheral neuropathy among diabetic patients in chronic care clinic in Gamo and Gofa zone, South Ethiopia. METHODS: An institution- based unmatched case control study was employed among 528 randomly selected participants using a pre-tested, interviewer-administered, and structured questionnaire. Bivariate and multivariable logistic regression analysis was conducted to identifiy determinants of peripheral neuropathy using IBM SPSS version 25. RESULT: The odds of being an urban dweller was 2.67 times higher among cases than controls [AOR = 2.67 (1.27, 5.63)]. The likelihood of fasting blood glucose level between 203 and 282 and 282 and above was 2.55 and 3.88 times higher among cases than controls [AOR = 2.55 (1.91, 7.16)] and [AOR = 3.88 (1.42, 10.60)] respectively. The probability of living with diabetes mellitus for 10 and more years was 3.88 times higher among cases than controls [AOR = 3.88 (1.42, 10.60)]. The odds of controlling glucose level after developing symptom was 5.33 times higher among cases than controls [AOR = 5.33 (1.28, 12.24)]. The probability of having high blood pressure was 2.36 times higher among cases than controls [AOR = 2.36 (1.26, 4.43)]. The likelihood of having a family history of complication from diabetes mellitus was 5.60 times higher among cases than controls [AOR = 5.60 (2.03, 15.43)]. The odds of exercising 3 times per week for 15 to 30 minutes and for less than 15 minutes were 2.96 and 4.92 times higher among cases than controls respectively [AOR = 2.96 (1.32, 6.61)] and AOR = 4.92, 95% CI (1.85, 13.04) respectively. The likelihood of having a waist circumference greater than or equal to 40 inch was 2.72 times higher among cases than controls [AOR = 2.72 (1.07, 6.94)]. CONCLUSION: This study showed that residence, duration of diabetic mellitus, family history of complication from diabetic mellitus, level of fasting blood glucose, method of glycemic control, having a high blood pressure/hypertension/, frequency and duration of physical activity and waist circumference were found to be determinants of peripheral neuropathy. Thus, the concerned health authorities and health professionals should target on these factors in their efforts to prevent peripheral neuropathy among diabetics in the study area.

Intention and Practice on Personal Preventive Measures Against the COVID-19 Pandemic Among Adults with Chronic Conditions in Southern Ethiopia: A Survey Using the Theory of Planned Behavior.

PURPOSE: With prevention being the only and best available intervention, COVID-19 has recently become a global threat, having had and continuing to have enormous health, economic, and societal impacts. Evidence so far has documented a heightened risk of mortality to people with chronic conditions. There is a dearth of evidence regarding chronic disease patients' intention and practice on the preventive measures. This study tried to fill this gap by assessing the intention to practice and practice on personal preventive measures (PPMs) among adults with chronic conditions. MATERIALS AND METHODS: A facility-based cross-sectional study was conducted in Southern Ethiopia among 806 adults with chronic conditions by employing a multistage sampling technique. Data were collected using a pre-tested and structured questionnaire. Statistical analysis was done using IBM SPSS software version 25. Binary logistic regression analysis was done to identify factors associated with intention and practice. Level of statistical significance was declared at a P-value of less than 0.05. RESULTS: The study showed that 52% (95% CI=47.61-54.80) and 76.3% (95% CI=73.36-79.24) of adults with chronic conditions were intending to practice and had ever practiced the personal preventive measures. Participants' subjective norm (SN) (AOR=4.94; 95% CI=3.49-6.96) and perceived behavioral control (PBC) (AOR=4.13; 95% CI=2.69-6.34) were the factors associated with their intention. Good knowledge and a positive attitude were found to be significant factors associated with the participants' actual practice of the PPMs among other independent factors. CONCLUSION: Around half of the participants were intending to practice PPMs, and three-quarters had good practice on the PPMs against COVID-19. Interventions targeted to improve intention and practice on the PPMs need to take into account improving knowledge and attitude, and build positive subjective norms and heighten the confidence to control the preventive behaviors.