Prevalence of stunting and associated factors among under-five children in sub-Saharan Africa: Multilevel ordinal logistic regression analysis modeling.

INTRODUCTION: Stunting is still a major public health problem all over the world, it affecting more than one-third of under-five children in the world that leads to growth retardation, life-threatening complication and accelerate mortality and morbidity. The evidence is scarce on prevalence and associated factors of stunting among under-five children in Sub-Saharan Africa for incorporated intervention. Therefore this study aimed to investigate the prevalence and determinants of stunting among under-five children in Sub-Saharan Africa using recent demographic and health surveys of each country. METHODS: This study was based on the most recent Demographic and Health Survey data of 36 sub-Saharan African countries. A total of 203,852(weighted sample) under-five children were included in the analysis. The multi-level ordinal logistic regression was fitted to identify determinants of stunting. Parallel line (proportional odds) assumption was cheeked by Brant test and it is satisfied (p-value = 0.68) which is greater than 0.05. Due to the nested nature of the dataset deviance was used model comparison rather than AIC and BIC. Finally the adjusted odds ratio (AOR) with 95% CI was reported identify statistical significant determinants of stunting among under-five children. RESULTS: In this study, the prevalence of stunting among under-five children in Sub-Saharan Africa 34.04% (95% CI: 33.83%, 34.24%) with a large difference between specific countries which ranges from 16.14% in Gabon to 56.17% in Burundi. In the multi-level ordinal logistic regression good maternal education, born from mothers aged above 35 years, high household wealth status, small family size, being female child, being female household head, having media exposure and having consecutive ANC visit were significantly associated with lower odds of stunting. Whereas, living from rural residence, being 24-59 month children age, single or divorced marital status, higher birth order and having diarrhea in the last two weeks were significantly associated with higher odds of stunting. CONCLUSION: Stunting among under-five children is still public health problem in Sub-Saharan Africa. Therefore designing interventions to address diarrhea and other infectious disease, improving the literacy level of the area and increase the economic level of the family to reduce the prevalence of stunting in the study area.

Development and Validation of a Risk Prediction Model to Estimate the Risk of Stroke Among Hypertensive Patients in University of Gondar Comprehensive Specialized Hospital, Gondar, 2012 to 2022.

Background: A risk prediction model to predict the risk of stroke has been developed for hypertensive patients. However, the discriminating power is poor, and the predictors are not easily accessible in low-income countries. Therefore, developing a validated risk prediction model to estimate the risk of stroke could help physicians to choose optimal treatment and precisely estimate the risk of stroke. Objective: This study aims to develop and validate a risk prediction model to estimate the risk of stroke among hypertensive patients at the University of Gondar Comprehensive Specialized Hospital. Methods: A retrospective follow-up study was conducted among 743 hypertensive patients between September 01/2012 and January 31/2022. The participants were selected using a simple random sampling technique. Model performance was evaluated using discrimination, calibration, and Brier scores. Internal validity and clinical utility were evaluated using bootstrapping and a decision curve analysis. Results: Incidence of stroke was 31.4 per 1000 person-years (95% CI: 26.0, 37.7). Combinations of six predictors were selected for model development (sex, residence, baseline diastolic blood pressure, comorbidity, diabetes, and uncontrolled hypertension). In multivariable logistic regression, the discriminatory power of the model was 0.973 (95% CI: 0.959, 0.987). Calibration plot illustrated an overlap between the probabilities of the predicted and actual observed risks after 10,000 times bootstrap re-sampling, with a sensitivity of 92.79%, specificity 93.51%, and accuracy of 93.41%. The decision curve analysis demonstrated that the net benefit of the model was better than other intervention strategies, starting from the initial point. Conclusion: An internally validated, accurate prediction model was developed and visualized in a nomogram. The model is then changed to an offline mobile web-based application to facilitate clinical applicability. The authors recommend that other researchers eternally validate the model.

Magnitude and determinants of breastfeeding initiation within one hour among reproductive women in Sub-Saharan Africa; evidence from demographic and health survey data: a multilevel study.

BACKGROUND: Early initiation of breastfeeding is one of the most simple and essential intervention for child development and survival in the world. World Health Organization recommended to begin breast milk with one hour after delivery. The objective of this study was to determine the magnitude of early initiation of breastfeeding in Sub-Saharan Africa using DHS data set. METHODS: This study was carried out within 32 Sub-Saharan African countries from 2010-2020, a pooled study of early initiation of breastfeeding was performed. For assessing model fitness and contrast, intra-class correlation coefficient, median odds ratio, proportional change in variance, and deviance were used. In order to identify possible covariates associated with early initiation of breastfeeding in the study area, the multilevel multivariable logistic regression model was adapted. Adjusted Odds Ratio was used with 95% confidence interval to declare major breastfeeding factors. RESULT: The pooled prevalence of early initiation of breastfeeding in Sub-Saharan Africa countries was 57% (95% CI; 56%-61%), the highest prevalence rate of early initiation of breastfeeding was found in Malawi while the lowest prevalence was found in Congo Brazzaville (24%). In multilevel multivariable logistic regression model; wealth index (AOR = 1.20; 95% CI 1.16 - 1.26), place of delivery (AOR = 1.97; 95% CI 1.89 - 2.05), skin-to-skin contact (AOR = 1.51; 95% CI 1.47 - 1.57), mode of delivery (AOR = 0.27; 95% CI 0.25 - 0.29), media exposure (AOR = 1.36; 95% CI 1.31 - 1.41) were significantly correlated with early initiation of breastfeeding in Sub-Saharan Africa. CONCLUSION: The magnitude of early initiation of breastfeeding rate was low in Sub-Saharan Africa. Covariates significantly associated with early initiation of breastfeeding was wealth index, place of delivery, mode of delivery, women educational status, and media exposure. Structural improvements are required for women with caesarean births to achieve optimal breastfeeding practice in Sub-Saharan Africa.

Trends of infant mortality and its determinants in Ethiopia: mixed-effect binary logistic regression and multivariate decomposition analysis.

BACKGROUND: Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs). METHODS: This analysis was based on the data from four EDHSs (EDHS 2000, 2005, 2011, and 2016). A total weighted sample of 46,317 live births was included for the final analysis. The logit-based multivariate decomposition analysis was used to identify significantly contributing factors for the decrease in infant mortality in Ethiopia over the last 16 years. To identify determinants, a mixed-effect logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of a significant clustering effect. Deviance, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to identify the statistically significant determinants of infant mortality. RESULTS: Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval <  24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI <  18.5 kg/m2 (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality. CONCLUSION: This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia's declining infant mortality rate. Furthermore, improving the use of ANC services and maternal nutrition is crucial to reducing infant mortality and achieving the SDG targets in Ethiopia.

Trends and determinants of breastfeeding within one hour in Ethiopia, further analysis of Ethiopian Demographic and Health Survey: multivariate decomposition analysis.

BACKGROUND: Despite the substantial efforts to improve timely/early initiation of breastfeeding, avoidance of colostrum, and delayed initiation of breastfeeding remains a big challenge in developing countries. Therefore, this study aimed to analyze the trends of early breastfeeding rate over time based on the Ethiopian Demographic and Health Survey (EDHS). METHODS: Secondary data analysis was conducted based on the Ethiopian Demographic Health Surveys (EDHSs) conducted in 2005, 2011, and 2016. A total weighted sample of 9, 111, 10,106, and 8564 in 2005, 2011, and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of early breastfeeding initiation over time and factors contributing to the change in early breastfeeding initiation rate. STATA 15 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response. RESULT: Among children age less than 5 years the rate of early breastfeeding initiation rate overtime was increased from 70.5% in 2005 to 72.7% in 2016. The highest rate of improvement was seen in the second phase of the study (2011-2016) while it shows a decline in the first phase (2005-2011) from 70.5 to 55.1%. The decomposition analysis indicated that about half of the overall change in early breastfeeding initiation rate was due to the difference in women's composition. Particularly, an increase in health facility delivery and vaginal delivery was a significant predictor of the increasing rate of early breastfeeding initiation over the surveys. CONCLUSION: Early initiation of breastfeeding slightly increasing over the last 10 years in Ethiopia. Half of the overall increase in the early initiation of breastfeeding was due to the change in compositional characteristics of women over 10 years in Ethiopia. Change in the composition of women according to health facility delivery and vaginal delivery were the major source of the increase in early breastfeeding initiation over time. Public interventions including promoting health facility delivery of women for further improvements of early breastfeeding initiation should be needed.

Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model.

BACKGROUND: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival. METHODS: A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05. RESULTS: The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR = 2.33, 95% CI 2.08-2.63), secondary education level (AHR = 0.84, 95% CI 0.78-0.96), higher education level (AHR = 0.75, 95% CI 0.65-0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22-25.64), intercourse 15-17 years in married stratum (AHR = 5.56, 95% CI 5.26-5.88), spousal age difference (AHR = 1.11, 95% CI 1.05-1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13-1.20) than low risk clusters adjusting for other factors. CONCLUSION: In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

Trends and determinants of an acceptable antenatal care coverage in Ethiopia, evidence from 2005-2016 Ethiopian demographic and health survey; Multivariate decomposition analysis.

BACKGROUND: an acceptable antenatal care (ANC4+) is defined as attending at least four antenatal care visit, received at least one dose of tetanus toxoid (TT) injections and consumed 100 iron-folic acids (IFA) tablets/syrup during the last pregnancy. Since maternal health care service utilization continues to be an essential indicator for monitoring the improvements of maternal and child health outcomes. This study aimed to analyze the trends and determinants that contributed to the change in an acceptable antenatal care visit over the last 10 years in Ethiopia. METHODS: Nationally representative repeated cross-sectional survey was conducted using 2005, 2011, and 2016 Ethiopian Demographic and Health Survey datasets. The data were weighted and analyzed by STATA 14.1 software. Multivariate decomposition regression analysis was used to identify factors that contribute for the change in an acceptable antenatal care visit. A p-value < 0.05 was taken to declare statistically significant predictors to acceptable antenatal care visit. RESULTS: among the reproductive age women the rate of an acceptable antenatal care visits was increased from 16% in 2005 to 35% in 2016 in Ethiopia. In the multivariate decomposition analysis, about 29% of the increase in acceptable antenatal care visit was due to a difference in composition of women (endowments) across the surveys. Residence, religion, husband educational attainment, and wealth status was the main source of compositional change factors for the improvements of an acceptable antenatal care visit. Almost two-thirds of an overall change in acceptable antenatal care visit was due to the difference in coefficients/ change in behavior of the population. Religion, educational attainment (both women and husband), and residence are significantly contributed to the change in full antenatal care visit in Ethiopia over the last decades. CONCLUSION: Besides the relevance of receiving an acceptable antenatal care visit for pregnant women and their babies, an acceptable antenatal care visit was slightly increased over time in Ethiopia. Women's characteristics and behavior change were significantly associated with the change in acceptable antenatal care visits. Public interventions needed to improve acceptable antenatal care coverage, women's education, and further advancing of health care facilities in rural communities should be done to maintain the further improvements acceptable antenatal care visits.

Prevalence and Associated Factor of Brown Adipose Tissue: Systematic Review and Meta-Analysis.

BACKGROUND: Brown adipose tissue generates heat instead of storing energy. It is important in the regulation of body weight, and individual variation in adaptive thermogenesis can be attributed to variations in the amount or activity of BAT. OBJECTIVE: The objective of this study was to systematically review different articles to assess the prevalence of BAT and its associated factors and relation with obesity and diabetes mellitus. METHODS: A systematic review and meta-analysis were employed on published research works from different electronic databases using keywords. Cross-sectional studies and a few experimental studies were included for systematic review, and only studies done on human population were used for quantitative analysis. Twenty-two peer-reviewed papers were included in the systematic review, and eight papers were used for the meta-analysis for estimation of pooled prevalence of brown adipose tissue using selection criteria. RESULTS: The pooled prevalence of brown adipose tissue among adults was 6.97% (95% CI: 6.51-7.43), and it was 7.4% (95% CI 6.51-7.43) after sequential omission of a single study. The heterogeneity in estimating the pooled prevalence among the studies was statistically significant (Cochran Q test, P < 0.001, I 2 = 71.2%), and after sequential omission of a single study, it becomes Cochran Q test, P = 0.065, I 2 = 49.4%. The brown adipose tissue activity was significantly lower in overweight or obese subjects than in lean subjects. CONCLUSION: The percentage of adult individuals with brown adipose tissue was high, and its activity was reduced in obese individuals. Although it is reduced in amount, still it presents in obese individuals. So, activation of the brown adipose tissue in adult and older individuals should be a target for the treatment of obesity.