Incidence and predictors of tuberculosis among HIV-infected children after initiation of antiretroviral therapy in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Globally, Tuberculosis (TB) is the main cause of morbidity and mortality among infectious disease. TB and Human Immune Virus (HIV) are the two deadly pandemics which interconnected each other tragically, and jeopardize the lives of children; particularly in Sub-Saharan Africa. Therefore, this review was aimed to determine the aggregated national pooled incidence of tuberculosis among HIV- infected children and its predictors in Ethiopia. METHODS: An electronic search engine (HINARI, PubMed, Scopus, web of science), Google scholar and free Google databases were searched to find eligible studies. Quality of the studies was checked using the Joanna Briggs Institute (JBI) quality assessment checklists for cohort studies. Heterogeneity between studies was evaluated using Cochrane Q-test and the I2 statistics. RESULT: This review revealed that the pooled national incidence of tuberculosis among children with HIV after initiation of ART was 3.63% (95% CI: 2.726-4.532) per 100-person-years observations. Being Anemic, poor and fair ART adherence, advanced WHO clinical staging, missing of cotrimoxazole and isoniazid preventing therapy, low CD4 cell count, and undernutrition were significant predictors of tuberculosis incidence. CONCLUSION: The study result indicated that the incidence of TB among HIV- infected children is still high. Therefore, parents/guardians should strictly follow and adjust nutritional status of their children to boost immunity, prevent undernutrition and opportunistic infections. Cotrimoxazole and isoniazid preventive therapy need to continually provide for HIV- infected children for the sake of enhancing CD4/immune cells, reduce viral load, and prevent from advanced disease stages. Furthermore, clinicians and parents strictly follow ART adherence.

Charting a landmark-driven path forward for population genetics and ancient DNA research in Africa.

Population history-focused DNA and ancient DNA (aDNA) research in Africa has dramatically increased in the past decade, enabling increasingly fine-scale investigations into the continent's past. However, while international interest in human genomics research in Africa grows, major structural barriers limit the ability of African scholars to lead and engage in such research and impede local communities from partnering with researchers and benefitting from research outcomes. Because conversations about research on African people and their past are often held outside Africa and exclude African voices, an important step for African DNA and aDNA research is moving these conversations to the continent. In May 2023 we held the DNAirobi workshop in Nairobi, Kenya and here we synthesize what emerged most prominently in our discussions. We propose an ideal vision for population history-focused DNA and aDNA research in Africa in ten years' time and acknowledge that to realize this future, we need to chart a path connecting a series of "landmarks" that represent points of consensus in our discussions. These include effective communication across multiple audiences, reframed relationships and capacity building, and action toward structural changes that support science and beyond. We concluded there is no single path to creating an equitable and self-sustaining research ecosystem, but rather many possible routes linking these landmarks. Here we share our diverse perspectives as geneticists, anthropologists, archaeologists, museum curators, and educators to articulate challenges and opportunities for African DNA and aDNA research and share an initial map toward a more inclusive and equitable future.

Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis.

Background: Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia. Methods: A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization. Results: Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization. Conclusion and recommendation: In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.

Predictors of Poststroke Cognitive Decline among Stroke Survivors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

INTRODUCTION: Stroke is a devastating medical disorder associated with significant morbidity and mortality among adults and the elderly worldwide. Although numerous primary studies have been conducted to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa, these studies presented inconsistent findings. Hence, the review aimed to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa. METHODS: The eligible studies were accessed through Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to determine the pooled predictors of poststroke cognitive decline among stroke survivors in Sub-Saharan Africa. RESULTS: A total of 1,710 stroke survivors from 10 primary studies were included in the final meta-analysis. Increased age (≥45 years) (adjusted odds ratio [AOR] = 1.32, 95% CI: 1.13, 1.54), lower educational level (AOR = 4.58, 95% CI: 2.98, 7.03), poor functional recovery (AOR = 1.75, 95% CI: 1.42, 2.15), and left hemisphere stroke (AOR = 4.88, 95% CI: 2.98, 7.99) were significantly associated with poststroke cognitive decline. CONCLUSIONS: Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive decline in Sub-Saharan Africa Healthcare providers, and other concerned bodies should give attention to these risk factors as the early identification may help to improve the cognitive profile of stroke survivors.

Visual impairment among diabetes patients in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients. METHODS: An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment. RESULTS: A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment. CONCLUSIONS: The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.

Uptake of Cervical Cancer Screening and Its Barriers Using Health Belief Model Among Health Professionals Working in Public Hospitals in South Gondar Zone, Northcentral Ethiopia: Multicenter Cross-Sectional Study.

Background: Cervical cancer is a malignant neoplasm that originates in the cervix, and it is a leading cause of mortality, with 270,000 deaths every year globally. Of these, 85% occur in developing countries, including Ethiopia. Routine cervical cancer screening and early treatment can prevent up to 80% of cervical cancers. Health professionals are expected to screen for and be screened for cervical cancer. However, there is limited information about the uptake of cervical cancer screening among health professionals in the study area. Objective: This study aimed to determine the magnitude of cervical cancer screening uptake and identify its barriers among health professionals. Methods: A multicenter cross-sectional study design was conducted among health professionals from December 01 to 30, 2022. A total of 164 respondents were included in the study, and simple random sampling was used to select the respondents. Variables with a p-value of <0.05 at 95% confidence interval (CI) were considered significantly associated with the outcome variable. Results: Of the total respondents, 112 (68.3%) were younger than the age of 30 years, with a mean age of 29.4 years ranging from 21 to 45 years. Seventy-nine of the respondents (48.2%) have work experience of 6-10 years, and 103 (62.8%) are nurses in profession. In this study, the magnitude of cervical cancer screening uptake was 28.1% (95% CI: 27.7%-35.6%). Moreover, attitude (adjusted odds ratio [AOR] = 3.3, 95% CI: 2.1-5.1), age at first sexual intercourse (AOR = 2.1, 95% CI: 1.3-3.4), having history of sexually transmitted infections (STIs; AOR = 3.6, 95% CI: 1.5-11.6), knowing someone who had been screened (AOR = 2.9, 95% CI: 1.8-4.8), and cervical cancer screening training (AOR = 1.6, 95% CI: 1.1-2.9) were significantly associated with cervical cancer screening. Conclusion: Generally, this study reported that the magnitude of cervical cancer screening uptake was low. The study also indicated that attitude, age at first sexual intercourse, history of STIs, knowing someone who had been screened, and training of cervical cancer screening were independent predictors of uptake of cervical cancer screening.

Magnitude of occupational exposure to sharp injuries among nurses working in South Gondar zone public hospitals, Northcentral Ethiopia: institution-based cross-sectional study.

OBJECTIVE: This study aimed to determine the magnitude of occupational exposure to sharp injuries and identify its associated factors among nurses. DESIGN: Institution-based cross-sectional study design was conducted from 1 to 30 November 2022. ANALYSIS: The collected data were entered into EpiData V.4.2; then, exported to Stata V.14 for analysis. Variables with a p value of <0.05 at 95% CI were considered significantly associated with occupational exposure to sharp injuries. SETTING: The study was conducted in South Gondar zone public hospitals. PARTICIPANTS: Nurses working in South Gondar zone public hospitals. RESULTS: Of the total respondents, 213 (56.65%) were between the ages of 25 and 34 with the mean±SD of age 30.22±6.63 years. Similarly, 202 (53.72%) of the respondents were women. This study finding showed that the magnitude of occupational exposure to sharp injuries among nurses was 52.39% (95% CI: 47.92% to 56.37%). Moreover, this study finding showed that year of service >10 years (adjusted OR (AOR)=2.35, 95% CI: 1.21 to 4.57), lack of infection prevention training (AOR=1.85, 95% CI: 1.09 to 3.45), job-related stress (AOR=2.24, 95% CI: 1.27 to 3.89) and presence of contaminated sharps at the workplace (AOR=2.76, 95% CI: 1.67 to 4.72) were significantly associated with occupational exposure to sharp injuries among nurses. CONCLUSIONS: Generally, this study finding reported that the magnitude of occupational exposure to sharp injuries among nurses was high. This study finding also showed that years of service >10 years, lack of infection prevention training, job-related stress and the presence of contaminated sharps at the workplace were independent predictors of occupational exposure to sharp injuries among nurses. Hence, all the concerned bodies should strengthen regular provision of infection prevention training to nurses at all levels. Nurses should practice proper use of safety box more than ever in order to avoid the presence of contaminated needles and other sharp materials at the workplace.

Optimization of alternative breeding schemes for the genetic improvement of common Tigray highland sheep in northern Ethiopia.

BACKGROUND: Genetic improvement is one of the major means to enhance the productivity of livestock, and well-designed animal genetic improvement schemes are necessary to achieve genetic gains. The objective of the current study was to design an alternative breeding program to improve the productivity of common Tigray highland sheep. Two village- and two central nucleus-based breeding schemes were simulated and evaluated in terms of genetic gain, bio-economic efficiency and operational feasibility. METHODS: Four breeding schemes were simulated: scheme 1, a one-tier cooperative village-based breeding scheme, scheme 2, a two-tier cooperative village breeding scheme (dispersed village-based nuclei scheme), scheme 3, a central open nucleus-based scheme with 5% nucleus size; and scheme 4, a three-tier breeding schemes (central open nucleus-based linked with multiplier units). Simulation analyses were performed using the ZPLAN computer program, which is based on a deterministic approach to estimate genetic and economic gains in the breeding programs. RESULTS: Between the two village-based breeding schemes, scheme 2 showed higher genetic gain and economic efficiency in the breeding traits analysed than scheme 1. The central nuclei schemes were more efficient than the village breeding schemes. Scheme 3 was the most efficient with a genetic gain in the breeding objective of US $ 1.03 and a profit of US $ 2.73/ewe/year, but operationally it is also the most difficult to implement as it requires a big central nucleus. A central nucleus linked with the village-based nuclei would be a feasible option to overcome the operational difficulties of the conventional central nucleus schemes. If a village-based breeding program is considered it should be the first step in most low-input systems. In this case, scheme 2 is the most efficient. CONCLUSIONS: With some support from the public sector at the outset and a strong collaboration among the stakeholders including smallholders, scheme 4 could lead to substantial genetic gains in the common Tigray highland sheep breed within its habitat that covers large areas of the Tigray region. Therefore, we recommend a long-term breeding program which should include cross-breeding, genomic selection, updated estimates of genetic and economic values for the common Tigray highland sheep breed.

Attitude, knowledge, and predictors of COVID-19 vaccine uptake among health care providers in South Gondar public hospitals, North Central Ethiopia: multi-facility based study.

Introduction: with this fast-increasing pandemic in terms of morbidity and mortality, all mankind is at risk of infection unless they get vaccinated and all African countries shall incorporate COVID-19 vaccination in their health care programs as long as the world work cooperatively. The pandemic, as the World Health Organization (WHO) stated, could be mitigated when 70% of the population which is nearly 5.6 billion should be immunized and to achieve this objective, the willingness of the community to be vaccinated before vaccination is essential. Methods: institutional-based cross-sectional study design was conducted from March 1st, 2021, up to 30th May, 2021, in South Gondar Province, North Central Ethiopia. A structured interviewer-administered pre-tested questionnaire was used to collect data. The collected data were entered into EPI data version 4.2 and then exported into SPSS window version 22. Bivariate and multivariate analysis was undertaken and information was presented by using simple frequency tables and pie charts. Results: the majority of the respondents who accepted the COVID-19 vaccine accounted for nearly 260 (65%, 95% CI: 60-69). Positive attitude (AOR 2.5, 95% CI: 1.30-11.20), good knowledge (AOR 13, 95% CI: 6-27), bachelor of sciences (B.Sc) and above educational level (AOR 2.70, 95% CI: 1.30-6), TV or radio as source of information (AOR 0.10, 95% CI: 0.04-0.30), social media as source of information (AOR 0.04, 95% CI: 0.01-0.2), political leaders (AOR 0.08, 95% CI: 0.01- 0.90) were predictors of COVID-19 vaccine uptake. Conclusion: healthcare professionals (HCPs) with the decision (yes, sure) for COVID-19 vaccine uptake during data collection were found to be low as compared to other studies. Positive attitude, good knowledge, B.Sc, and above educational level were predictors enhancing COVID-19 vaccination uptake and TV or radio as a source of information, social media as a source of information and political leaders were factors decreasing COVID-19 vaccine uptake. Hence, it might be important to prioritize knowledge and attitude creation programs for HCPs and an alternative way of source of information and agents for the COVID-19 vaccine other than social media and religious leaders.

Thrombocytopenia Among Pregnant Women in Southwest Ethiopia: Burden, Severity, and Predictors.

Background: Thrombocytopenia is a worldwide public health problem in pregnant women and is associated with significant maternal-fetal complications and mortality. Determination of burden, severity, and predictors of thrombocytopenia in pregnant women is imperative to develop intervention measures to mitigate their risk and public health impact, which is not well known in Ethiopia, particularly in the selected study area. Thus, this study aimed to determine the burden, severity, and predictors of thrombocytopenia among pregnant women in Wolkite University Specialized Hospital, southwest Ethiopia. Materials and Methods: A cross-sectional study was employed among 422 pregnant women from May to August 2021. A structured questionnaire was used to collect data on socio-demographic, reproductive, and related characteristics. Venous blood samples were collected and platelet counts were determined by Sysmex XP-300 hematology analyzer. A binary logistic regression analysis was performed using SPSS version 22 software to identify independent predictors of thrombocytopenia. The p-value <0.05 was considered statistically significant. Results: The overall burden of thrombocytopenia among pregnant women was 14.5% (95% CI: 11.4-17.8). Among them, 77%, 16.4%, and 6.6% had mild, moderate, and severe thrombocytopenia, respectively. Rural residence (AOR: 2.9, 95% CI: 1.5-5.8), increasing age (AOR: 1.9, 95% CI: 1.04-3.44), alcohol consumption (AOR: 2.48, 95% CI: 1.3-4.5), and HIV infection (AOR: 8.5, 95% CI: 1.9-18.4) were independent predictors of thrombocytopenia among the pregnant women. Conclusion: A high burden of thrombocytopenia (14.5%) was observed among the pregnant women in this study area. Rural residence, increasing age, consumption of alcohol, and HIV infection were identified as independent predictors of thrombocytopenia. The findings of this study should be taken into consideration to conduct appropriate intervention measures on identified predictors and implement routine screening of platelet count, thrombocytopenia diagnosis, and treatments to reduce the burden of morbidity and mortality among pregnant women.

The state of birth asphyxia in Ethiopia: An umbrella review of systematic review and meta-analysis reports, 2020.

BACKGROUND: To this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these studies are inconsistent which is difficult to make use of the findings for preventing birth asphyxia in the country. Therefore, umbrella review of these studies is required to pool the inconsistent findings into a single summary estimate that can be easily referred by the information users in Ethiopia. METHODS: PubMed, Science direct, web of science, data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for systematic reviews and meta-analyses (SRM) studies on the magnitude and risk factors of perinatal asphyxia in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and predictors of perinatal asphyxia were pooled and summarized with random-effects meta-analysis models. From checking PROSPERO, this umbrella review wasn't registered. RESULTS: We included four SRM studies with a total of 49,417 neonates. The summary estimate for prevalence of birth asphyxia was 22.52% (95% CI = 17.01%-28.02%; I2 = 0.00). From the umbrella review, the reported factors of statistical significance include: maternal illiteracy [AOR = 1.96; 95% CI: 1.44-2.67], primiparity [AOR = 1.29; 95% CI: 1.03-1.62], antepartum hemorrhage [AOR = 3.43; 95% CI: 1.74-6.77], pregnancy induced hypertension [AOR = 4.35; 95% CI: 2.98-6.36], premature rupture of membrane [AOR = 12.27; 95% CI: 2.41, 62.38], prolonged labor [AOR = 3.18; 95% CI: 2.75, 3.60], meconium-stained amniotic fluid [AOR = 5.94; 95% CI: 4.86, 7.03], instrumental delivery [AOR = 3.39; 95% CI: 2.46, 4.32], non-cephalic presentation [AOR = 3.39; 95% CI: 1.53, 5.26], cord prolapse [AOR = 2.95; 95% CI: 1.64, 5.30], labor induction [AOR = 3.69; 95% CI: 2.26-6.01], cesarean section delivery [AOR = 3.62; 95% CI: 3.36, 3.88], low birth weight [AOR = 6.06; 95% CI: 5.13, 6.98] and prematurity [AOR = 3.94; 95% CI: 3.67, 4.21] at 95% CI. CONCLUSION: This umbrella review revealed high burden of birth asphyxia in Ethiopia. The study also indicated significant risk of birth asphyxia among mothers who were unable to read and write, primiparous mothers, those mothers having antepartum hemorrhage, pregnancy induced hypertension, premature rupture of membrane, prolonged labor, meconium-stained amniotic fluid, instrumental delivery, cesarean section delivery, non-cephalic presentation, cord prolapse and labor induction. Moreover, low birth weight and premature neonates were more vulnerable to birth asphyxia compared to their normal birth weight and term counterparts. Therefore, burden of birth asphyxia should be mitigated through special consideration of these risk mothers and neonates during antenatal care, labor and delivery. Mitigation of the problem demands the collaborative efforts of national, regional and local stakeholders of maternal and neonatal health.

The implementation of nursing process during patient care in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Nursing process (NP) is a standard method of ensuring individualized holistic care through systematic assessment, diagnosis, planning, intervention and evaluation of patients. Its standard implementation is mandatory to meet the health target of "ensuring universal quality health-care services" in the sustainable development goals (SDG) launched by World Health Organization (WHO) in 2015. Being a member state of WHO, Ethiopia endorsed the SDG agenda. Therefore, determining the recent pooled estimate and associated factors of NP implementation during patient care would be of greatest importance to improve the quality of nursing care in the country. METHODS: Primary studies were systematically searched from PubMed, Scopus, Cochrane Library, Google Scholar, PsycINFO and CINAHL data bases using different search operators. Each selected primary study was critically appraised using the Joanna Briggs Institute (JBI) appraisal tool for prevalence studies. I2 and Q statistics were used to investigate heterogeneity. Given the substantial heterogeneity between the studies, random effects meta-analysis model was used to estimate the pooled magnitude of NP implementation. Subgroup analyses were performed for evidence of heterogeneity. Egger's test was considered to declare publication bias objectively. The PRISMA guideline was followed to report the results. RESULTS: A total of 17 primary studies with a sample of 2,819 nurses were included in this meta-analysis. The pooled estimate of NP implementation in Ethiopia was 50.22% (95% CI: 43.39%, 57.06%) with severe statistical heterogeneity (I2 = 93.0%, P < 0.001) between the studies. From regional subgroup analysis, NP was least implemented in Tigray region 35.92% (95% CI: 30.86%-40.99%, I2 < 0.001%). Egger's test showed no statistical significance for the presence of publication bias (P = 0.23). Nurses' good knowledge of NP [(Adjusted Odds Ratio (AOR) = 13.16: 9.17-17.15], nurses' Bachelor of Science (BSC) and above level of education (AOR = 4.16; 2.32-5.99), working in a stressful environment (AOR = 0.10; -0.02-0.22), training access (AOR = 3.30; 1.79-4.82) and accessibility of facility required for NP (AOR = 6.05; 3.56-8.53) were significantly associated with NP implementation at 95 % CI. CONCLUSIONS: It was found that only half of the nurses in Ethiopia implemented NP during patient care. Fortunately, its associated factors were modifiable. Therefore, the existing national efforts of increasing nurses' knowledge of NP and their level of education, availing facilities required for NP implementation, training access and ensuring non stressful working environment should be reinforced to meet the quality nursing care demand in Ethiopia. PROSPERO ID: CRD42019138159.

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Substance use during pregnancy mainly khat chewing (20%) and alcohol drinking (18.1%) are commonly practiced in Ethiopia. However, the effect of using these substances has not been studied nationally yet. Thus, this study was aimed to examine national evidence about the effect of substance use during pregnancy on birth outcome in the country, 2020. METHODS: Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size and reported effect of antenatal substance use on birth outcome on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the fixed-effects model due to homogenous primary studies (I2 = 0.0%). Presence of publication bias was detected from asymmetry of funnel plot and statistically significant Egger's test (p = 0.000). RESULTS: In this systematic review and meta-analysis, a total of 5,343 mother-neonate pairs were included from 15 studies. Alcohol, khat, cigarette and narghile were used during pregnancy, and significant adverse birth outcomes attributable to these substances were reported. From the pooled effect of alcohol use, drinking mothers were twice (95%CI: AOR = 2.16; 1.16, 3.17) likely to have newborns with birth defect; 9 times (95% CI: AOR = 9.39; 2.84, 15.94) more prone to own low birth weight neonates; and 1.9 times more prone to deliver preterm neonates (95% CI: AOR = 1.93; 0.52, 3.33) than the nondrinkers. Khat users were 2.4 times (95%CI: AOR = 2.4; 1.11, 5.19) more likely to have congenitally defected neonates; and 3.1 times (95%CI: AOR = 3.19; 1.01, 5.37) more risked to possess low birth weight neonates. Furthermore, antenatal cigarette smokers (95% CI: AOR = 4.36 (1.75, 6.98)) and narghile users (95% CI: AOR = 20.1; 3.94, 103) were at 4 and 20 times more likelihood of having low birth weight neonates as compared to their counterparts. CONCLUSION: Prematurity, low birth weight and congenital malformation were the investigated adverse effects of antenatal substance use in Ethiopia. Therefore, the existing public health efforts should be encouraged to help women stop using these substances completely before pregnancy. Moreover, increasing public awareness about the potential negative impacts of substance use during pregnancy on birth outcome would be of greatest importance for comprehensive prevention of the problem.

The burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever among admitted neonates in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: More than one-third of the neonatal death in Ethiopia has been attributed to neonatal sepsis. However, there is no recent national evidence about the burden of neonatal sepsis and its association with antenatal urinary tract infection and intra-partum fever, which are commonly reported maternal morbidities in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to assess the pooled burden of neonatal sepsis and its association with antenatal urinary tract infection as well as intra-partum fever in the country. METHODS: Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size, reported prevalence of neonatal sepsis, antenatal urinary tract infection and intrapartum fever on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the random inverse varience-effects model due to significant heterogeneity between studies (I2= 99.2%). Subgroup analysis was performed for evidence of heterogeneity. Sensitivity analyses were performed. Absence of publication bias was declared from symmetry of funnel plot and Egger's test (p = 0.244). RESULTS: In this systematic review and meta-analysis, a total of 36,016 admitted neonates were included from 27 studies. Of these 27 studies, 23 employed cross-sectional design whereas 3 studies had case control type and only one study had cohort design. The prevalence of neonatal sepsis among admitted Ethiopian neonates at different regions of the country ranged from 11.7%-77.9%. However, the pooled prevalence of neonatal sepsis was 40.25% [95% CI: 34.00%, 46.50%; I2 = 99.2%]. From regional subgroup analysis, the highest prevalence was observed in the Oromiya region. Neonates born to mothers who had antenatal urinary tract infection were at 3.55 times (95% CI: 2.04, 5.06) higher risk of developing neonatal sepsis as compared to those neonates born to mothers who didn't have antenatal urinary tract infection. Moreover, neonates born to mothers having intra-partum fever were 3.63 times (95% CI: 1.64, 5.62) more likely to develop neonatal sepsis as compared to those born to mothers who were nonfebrile during intrapartum. CONCLUSION: Neonatal sepsis has remained a problem of public health importance in Ethiopia. Both antenatal urinary tract infection and intra-partum fever were positively associated with neonatal sepsis. Therefore, preventing maternal urinary tract infection during pregnancy and optimizing the intra-partum care are recommended to mitigate the burden of neonatal sepsis in Ethiopia.

Prevalence and associated factors of prelacteal feeding among neonates admitted to neonatal intensive care units, North central Ethiopia, 2019.

BACKGROUND: Prelacteal feeding compromises the benefits of exclusive breastfeeding, thereby increasing neonatal malnutrition, infection and mortality. About 26% of the Ethiopian neonates are given prelacteal feeds and nearly 48% of whom are attributed to Amhara region. Besides, prior Ethiopian studies have shown significance of the problem at different community settings in the country. However, the prevalence and associated factors of prelacteal feeding among neonatal admissions has been overlooked in the country in general and in the study area in particular. Therefore, this study was aimed to assess the prevalence and associated factors of prelacteal feeding among neonatal admissions in the study setting. METHODS: A cross-sectional study was conducted among 321 mother-neonate pairs admitted to Neonatal Intensive Care Unit (NICU) of Debre Tabor General Hospital between September 2018 and February 2019. Every fourth mother neonate pair was included to the study. Multivariable logistic regressions were fitted to find out adjusted odds ratios (AORs) of factors associated with pre-lacteal feeding. RESULTS: The prevalence of prelacteal feeding was 20.2% [95% CI: 15.31-26.75%]. Plain water was the most common prelacteal food (32.3%). Factors associated with prelacteal feeding include rural residence (AOR = 4.07, 95% CI: 1.30, 12.81), primiparity (AOR = 4.50, 95% CI: 1.30-12.81), less than four ANC visits (AOR = 4.71, 95% CI: 1.23-17.84), spousal accompany to ANC (AOR = 0.20, 95% CI: 0.05-0.75), home delivery (AOR = 5.94, 95% CI: 1.80-19.67), having twin newborns (AOR = 6.69, 95% CI: 1.25, 35.91) and maternal belief on the purported advantages of prelacteal feeding (AOR = 2.74, 95% CI: 2.09-25.39). CONCLUSION AND RECOMMENDATION: One out of five sick neonates was given prelacteal feeds. Twin neonates, home delivered neonates, rural neonates, neonates born to primiparous mothers, neonates delivered from mothers who had less than four ANC visits, neonates born to mothers who weren't accompanied by their spouse during ANC and those born to mothers who believe on the purported advantages of prelacteal feeding had higher odds of receiving prelacteal feeds. Therefore, mothers of these vulnerable neonates should be provided with more emphasis about counseling of infant and young child feeding practice during their stay at NICU.