Spatially-informed insights into early marriage and school dropout: An advanced bivariate binary multilevel model for understanding Ethiopia's context.

The phenomenon of school dropout, which entails the failure to meet the minimum educational requirements, and early marriage, which involves the marital union of girls prior to attaining 18 years of age, constitute crucial issues in Ethiopia. This research endeavor sought to identify the determinants of these two outcomes. A weighted sample of 3091 girls who had experienced early marriage and school dropout was drawn from the 2016 Ethiopian Demographic and Health Survey (EDHS) dataset and analyzed utilizing bivariate binary multilevel models featuring spatial effects. The prevalence rates of early marriage and school dropout were 62.9 % and 75.4 %, respectively. We observed non-uniform spatial distributions of early marriage and school dropout across Ethiopia. The odds ratio of the association between early marriage and school dropout was 1.39, indicating a significant interdependence of these two outcomes. The probability of early marriage and school dropout was estimated to be 1.63 and 1.18 times higher, respectively, for girls hailing from rural areas and 1.70 and 1.23 times higher, respectively, for those classified in the poorest wealth index, as compared to their counterparts. Therefore, stakeholders and policymakers must prioritize hotspots, socio-economic, and demographic factors to achieve a meaningful reduction in the incidence of early marriage and school dropout.

Food Safety and hygiene practices and the Determinants among street vendors during the Chain of Food Production in Northwest Ethiopia.

Background: There is mounting evidence that Ethiopia is becoming a more street-food-consuming nation. The hygienic and safety procedures, however, are not adequately evaluated. Objectives: This study aimed to determine the magnitude of food safety and hygiene practices and associated factors among street food vendors of Bahir Dar City. Method: A community-based cross-sectional study design was conducted from March 10 to April 10, 2019. The data were collected using an interviewer-administered questionnaire with an observational checklist. The collected data were entered into EPI Data and analyzed by R software. Descriptive statistics were computed. A Binary logistic regression model was fit to identify the association and strength of exploratory variables and food safety and hygiene practices at a 95 % confidence interval and p-value <0.05. Results: A total of 421 participants participated. The level of good food safety and hygiene practices was 36 % (95%CI: 31, 41). Monthly income of >2500 Birr (AOR = 4.99; 95%CI: 2.42, 10.3), work experience of >2 years (AOR = 2.05; 95%CI: 1.15, 3.65), having supervision by health professionals (AOR = 2.45; 95%CI: 1.25, 4.85), having good knowledge about food safety and hygiene (AOR = 3.84; 95%CI: 1.42, 10.36), and having a favorable attitude towards food safety and hygiene (AOR = 2.71; 95%CI: 1.12, 6.57) were determinants of food safety and hygiene practice. Conclusions: The level of good food safety and hygiene practices was low. Monthly income, work experience, supervision by health professionals, knowledge, and attitude toward food safety and hygiene were identified as the determinants of good food safety and hygiene practice.

Geographical disparities and determinants of infant mortality in Ethiopia: mapping and spatial analysis using EDHS data.

BACKGROUND: Infant mortality remains a public health challenge in Ethiopia. Exploring infant mortality will aid in tracking the progress toward achieving sustainable development goals. OBJECTIVE: The study aimed to explore the geographical variations and associated factors of infant mortality in Ethiopia. METHOD: A total of 11,023 infants from the 2016 Ethiopian Demographic and Health Survey (EDHS) data were extracted and included in the analysis. EDHS used a two-stage cluster sampling design with a census enumeration area as the primary sampling unit and households as the secondary sampling unit. Arc GIS software was used for spatial analysis using clusters for exploring geographical variations in infant mortality. A binary logistic regression was employed using R software to identify the significant determinants of infant mortality. RESULTS: The study revealed that the spatial distribution of infant mortality was non-random in the country. Infants whose mothers not receiving ANC (AOR = 1.45; 95%CI: 1.17, 1.79), not breastfed status (AOR = 3.94; 95%CI: 3.19, 4.81), poor wealth index (AOR = 1.36; 95%CI: 1.04, 1.77), male infants (AOR = 1.59; 95%CI: 1.29, 1.95), birth order of six or above (AOR = 3.11; 95%CI: 2.08, 4.62), small birth size (AOR = 1.27; 95%CI: 1.26, 1.60), birth spacing [(≤ 24 months (AOR = 2.29; 95%CI: 1.79, 2.92), 25-36 months (AOR = 1.16; 95%CI: 1.12, 1.49)], multiple births (AOR = 6.82; 95%CI: 4.76, 10.81), rural residence (AOR = 1.63; 95%CI: 1.05, 2.77) and regions [Afar (AOR = 1.54; 95%CI: 1.01, 2.36), Harari (AOR = 1.56; 95%CI: 1.04, 2.56), and Somali (AOR = 1.52; 95%CI: 1.03, 2.39)] were the determinants of infant death in Ethiopia. CONCLUSIONS: There is a great geographical disparity in infant mortality rates across regions. Afar, Harari, and Somali regions were verified as hot spot areas. ANC usage, breastfed status, wealth index, sex of the infant, birth order, birth size, birth spacing, birth type, residence, and region were the determinants of infant death in Ethiopia. Therefore, appropriate interventions need to be implemented in the hot spots to alleviate the risk factors for infant mortality.

Magnitude of common mental disorders and associated factors among patients with Epilepsy in Amhara regional state, Northwest Ethiopia.

BACKGROUND: Common mental disorders are severe and frequent co-morbid psychiatric illnesses with epilepsy. Different study findings across the world showed that patients with epilepsy have a higher burden of mental disorders than the general population. However, these issues in patients with epilepsy have been consistently undiagnosed. OBJECTIVES: The study aimed to screen common mental disorders and the determinants among patients with epilepsy attending at Fenote Selam hospital. METHODS: An institutional-based cross-sectional study was conducted among patients with Epilepsy from March 10 to May 15, 2019. Patients were assessed for the risk of common mental disorders using a pretested, structured, self-reporting questionnaire (SRQ-20). The collected data were entered into Epi-data version 3.1 software and analyzed using R version 4.0 software. Descriptive statistics were computed using frequency, percent, mean, and standard deviations. A simple logistic regression model was fit to identify the association and strength of exploratory variables and common mental disorders at a 95% confidence interval and p-value < 0.05. RESULTS: The study included 202 patients diagnosed with epilepsy and yielded a response of 91.4%. About 53% of the patients were males. The magnitude of common mental disorders among patients with epilepsy was 57.9% (95% CI: 44.56, 71.24). Being more than one substance user (AOR = 5.7; 95%CI: 1.6, 20.7) and Not having social support (AOR = 4.3; 95%CI: 1.5, 11.9) were the identified determinants of common mental disorders. CONCLUSION: The magnitude of common mental disorders among patients with epilepsy were high. Not having social support and khat chewing were the identified risk factors significantly associated with common mental disorders. Early screening and treatments are the key interventions to prevent complications and deaths from common mental disorders.

Potential mediators of the link between wealth index and anthropometric indices of under-five children in Ethiopia.

Background: Malnutrition of under-five children has adverse effects on child's health and development, such as growth failure and muscle wasting. The household wealth index has a direct contribution to child malnutrition despite little attention being given to its indirect effect through other factors. This study aimed to identify the potential mediators of the link between wealth index and malnutrition. Methods: In this study, a cross-sectional study design was implemented based on the data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), which consists of a total of 3,918 under-five children. Mediation analysis of structural equation (SEM) was implemented to determine and estimate the effects of potential mediators of the link between wealth index and under-five children malnutrition. Results: Among 3,918 under-five children involved in this study, 51.4% were male children and 20.2% were from urban areas. The place of delivery of the majority of mothers (56.1%) was at home, and the majority of children were from the poorest household (36.4%). The estimated effects of height-for-age of female children were higher (1.31:95% CI = 0.45, 0.200), indicating that female children had a lower likelihood of stunting than males. As compared to children in an urban area, children from rural areas were more likely to be stunted (-0.269; 95%CI = -0.388, -0.135). The estimated total indirect effects of wealth index on stunting and underweight was 0.69 (95% = 0.045, 0.094) and 0.036 (95% = 0.013, 0.054), respectively, and significant (p-value of <0.05). Conclusion: Environmental, maternal, biological, and behavioral factors were the potential mediators of the link between the wealth index and the anthropometric indices. Besides, the total effects of the household wealth index had a significant effect on stunting, underweight, and wasting in which children from a household with low economic status were more likely to be malnourished.

Cancers preventive practice and the determinants in Amhara regional state, Northwest Ethiopia.

BACKGROUND: Cancer is the leading cause of morbidity and mortality globally. In Ethiopia, 5.8% of deaths are attributed to cancer. Therefore, this study aimed to examine the cancers preventive practice and associated factors in North West Ethiopia, 2019. METHODS: A community-based cross-sectional study was conducted among Bahir Dar city residents. A multistage sampling technique was used to select 845 study participants. Data were collected through a validated interviewer administered questionnaire. The questionnaire was adapted from the American cancer association cancer prevention toolkit. Descriptive statistics were computed and presented in charts and texts. The model fitness was checked using Hosmer and Lemeshow goodness of fit (P > 0.05). Bivariable and multivariable logistic regressions were used to identify factors associated with cancer preventive practice. A p-value < 0.2 at bivariate analysis was candidate variables for multivariable logistic regression analysis. Finally, p-value of < 0.05 was considered as a statistically significant predictor for cancer preventive practice at the 95% confidence interval. RESULT: A total of 845 study participants took part in the study. Nearly 63% of the respondents were females. About 28% (95%CI: 24, 30) of the study participants had good preventive practice. Age ≥ 45 years (AOR = 0.31; 95%CI: 0.15, 0.62), female (AOR = 0.50, 95%CI: 0.35, 0.71) family member with cancer (AOR = 1.68, 95%CI: 1.07, 2.62) and had good knowledge (AOR = 1.66, 95%CI: 1.14, 2.42) were the identified determinants of cancer preventive practices. CONCLUSION: This study revealed that the level of cancer preventive practices was low. Family member with cancer, knowledge about cancer, older age, and being female were significantly associated with cancer preventive practices. This finding underscores the importance of interventions to enhance cancer preventive practices.

Prevalence of stunting and associated factors among public primary school pupils of Bahir Dar city, Ethiopia: School-based cross-sectional study.

BACKGROUND: Stunting is a well-established child-health indicator of chronic malnutrition, which reliably gives a picture of the past nutritional history and the prevailing environmental and socioeconomic circumstances. OBJECTIVE: To investigate the prevalence of stunting and associated factors among public primary school children of the Bahir Dar city. METHOD: A cross-sectional study was carried out from March to June 2019. Data were coded and entered into the Epi-Data and exported to SPSS version 23 software. The pupil was stunted if the height- for-age was ≤ -2 SDs from the median growth standards according to the WHO. A descriptive summary was computed using frequency, percent, mean, median and standard deviation. A simple logistic regression model was fitted to identify associated factors between the independent variables and the dependent variable at a 95% confidence interval (CI) and p-value <0.05. RESULTS: 370 primary school pupils were included in the study with the mean age of 10.15 (± 2.23 SD) years. 51.6% of the pupils were females. The total prevalence of stunting was 15.13% (95%CI; 11%, 19%). The burden of stunting was higher in the age group of 11 years and older. Pupil's age older than 11 years (AOR = 15. 6; 95%CI; 3.31, 73.45; p-value < 0. 001) and male sex (AOR = 7. 07; 95%CI: 2.51, 19.89; p-value < 0. 0002) were significantly associated with stunting. CONCLUSION: The prevalence of stunting was relatively lower than the regional estimated stunting level. Older age and male sex were significantly associated with stunting.

The Size of Anterior Fontanelle and Its Determinants at Birth Among Neonates in Northern Ethiopia: A Cross-Sectional Study.

BACKGROUND: Fontanels are anatomical features of the infant human skull comprising any of the soft membranous gaps between the cranial bones that make up the calvaria of a neonate. Various factors are taught to be responsible for the differences in the size of the fontanel at birth. Accordingly, this study is performed to examine the size of the anterior fontanel, associated factors, and the clinical significance in Northern Ethiopia at birth. METHODS AND MATERIALS: A Cross-sectional study was conducted in a sample of 425 neonates. The data were analyzed using SPSS version 21. Descriptive and summary statistics were presented in the form of tables and figures. All the data were presented as mean ± S.D. The association between dependent variables and independent variables was explored by using Pearson's chi-square test and logistic regressions. P-values <0.05 were considered to be statistically significant. RESULTS: The mean anterior fontanel size for the study population was 3.07 cm with a 95% confidence interval (3.00, 3.14). For a unit increase of head circumference of a neonate, the odds of having abnormal fontanel increase by 52.6%. Term neonates were 74.4% less likely to have abnormal fontanel size than preterm. Vaginally delivered neonates were 64.2% less likely to have abnormal fontanel size than neonates born by caesarean section. Low birth weight neonates were at risk of abnormal fontanel size. The odds ratio of the normal weight of neonate at birth was 0.327473 [95%, CI, (0.153364, 0.6992422)]. CONCLUSION: Gestational age, mode of delivery, head circumference, and birth weight are the most important determinant factors associated with anterior fontanel size.

Community-Based Health Insurance and Associated Factors in North-Western Ethiopia. The Case of Bahir Dar City.

BACKGROUND: Health insurance provides access to health care with financial risk protection. Knowledge and attitude have been found to influence enrolment in community-based health insurance, which avoids catastrophic health-care expenditure. However, knowledge and attitude levels towards health insurance are not well studied. The objective of this study was to determine the knowledge and attitude level of the informal workers of the Bahir Dar city towards community-based health insurance. METHODS: A community-based cross-sectional study was conducted with systematically selected 335 informal workers. We conducted structured face-to-face interviews using a newly developed and validated questionnaire. The collected data were coded and then entered into Epi data and exported to SPSS software for analysis. Logistic regression analysis was used to identify potential associations between the study variables. RESULTS: Out of 325 informal workers, 51% of them had good knowledge of community-based health insurance, while 56% of participants had a favorable attitude towards community-based health insurance. Being single (AOR=3.4, 95% CI; 1.3, 9.0), daily laborer (AOR=2.73, 95% CI; 1.36, 5.48), attending secondary education (AOR=0.29; 95% CI: 0.12, 0.71), and obtaining information from television (AOR=0.31, 95% CI; 0.14, 0.71) were found to be statistically associated with knowledge. While being single (AOR=0.23, 95% CI: 0.08, 0.67), married (AOR=0.29, 95% CI: 0.11, 0.73), daily laborer (AOR=2.84, 95% CI: 1.37. 5.88), getting information from television (AOR= 3.09, 95% CI: 1.37, 6.93) and family (AOR= 2.63, 95% CI: 1.23, 5.61) were found to be statistically associated with the attitude towards community-based health insurance. CONCLUSION: The knowledge and attitude level of the informal workers towards community-based health insurance were low. Therefore, community-based health insurance should be promoted to ensure the accessibility of health care to all.

Determinants of neonatal mortality in Ethiopia: an analysis of the 2016 Ethiopia Demographic and Health Survey.

BACKGROUND: The first 28 days of life, the neonatal period, are the most vulnerable time for a child's survival. Neonatal mortality accounts for about 38% of under-five deaths in low and middle income countries. This study aimed to identify the determinants of neonatal mortality in Ethiopia. METHODS: The study used data from the nationally representative 2016 Ethiopia Demographic and Health Survey (EDHS). Once the data were extracted; editing, coding and cleaning were done by using SAS 9.4.Sampling weights was applied to ensure the representativeness of the sample in this study. Both bivariate and multivariable logistic regression statistical analysis was used to identify determinants of neonatal mortality in Ethiopia. RESULTS: A total of 11,023 weighted live-born neonates born within five years preceding the 2016 EDHS were included this in this study. Multiple logistic regression analysis showed that multiple birth neonates (Adjusted Odds Ratio (AOR)=6.38;95%-Confidence Interval (CI):4.42-9.21), large birth size (AOR=1.35; 95% CI: 0.28-1.62), neonates born to mothers who did not utilize ANC (AOR=1.41; 95% CI: 1.11-1.81), neonates from rural area (AOR=1.88; 95% CI: 1.15-3.05) and neonates born in Harari region (AOR=1.45; 95% CI: 0.61-3.45)had higher odds of neonatal mortality. On the other hand, female neonates (AOR=0.60; 95% CI: 0.47-0.75), neonates born within the interval of more than 36 months of the preceding birth (AOR=0.56; 95% CI: 0.43-0.75), neonates born to fathers with secondary and higher education level (AOR=0.51; 95%CI: 0.22-0.88) had lower odds of neonatal mortality in Ethiopia. CONCLUSION: To reduce neonatal mortality in Ethiopia, there is a need to implement sex specific public health intervention mainly focusing on male neonate during pregnancy, child birth and postnatal period. A relatively simple and cost-effective public health intervention should be implemented to make sure that all pregnant women are screened for multiple pregnancy and if positive, extra care should be given during pregnancy, child birth and postnatal.

Determinants of early marriage among female children in Amhara Region, Ethiopia.

BACKGROUND: Early Marriage is one of the global problems that undermine the personal development and the rights of women seriously. It is delicate among the developing countries such as Ethiopia. It has major consequences for public health, national security, social development, human rights, economic development, and gender equality. METHODS: The analyzed data were obtained from the 2016 EDHS and 1120 samples were considered in this analysis. Both bivariate and multivariable binary logistic regression model were used to identify the determinants of early marriage practice. RESULTS: The prevalence of early marriage practice was 48.57% in the study area. The odds of early marriage practice were 2.04(AOR=2.04, 95% CI: 1.88, 2.45) times higher among rural residents compared to urban. The odds of early marriage practice was 0.94(AOR=0.94, 95%CI: 0.57, 1.98) times lower among women who had primary education compared to uneducated women. Those who did not know the legal marital age were 1.61(AOR=1.61, 95%CI: 1.26, 2.07) times more likely to practice early marriage compared to parents who knew the legal marital age. CONCLUSION: Education level, family monthly income, residence, literacy level and knowledge of legal marital were significant determinants of early marriage practice.

Prevalence of malnutrition and associated factors among under-five children in Ethiopia: evidence from the 2016 Ethiopia Demographic and Health Survey.

OBJECTIVE: The aim of this study was to assess the risk factors for malnutrition among children aged 0-59 months in Ethiopia. The analyzed data were obtained from the 2016 EDHS and 9495 under-5 years' children were considered in this analysis. The data was extracted, edited and analyzed by using SPSS Version 23.0. Both bivariate and multivariable binary logistic regression model was used to identify the determinants of children malnutrition. RESULTS: The prevalence of stunting, wasting, and underweight were 38.3%, 10.1%, and 23.3%, respectively. About 19.47% of children were both stunted and underweighted, and only 3.87% of children had all the three conditions. Among the factors that considered in this study, age of a child, residence region, mothers' education level, mothers' BMI, household wealth index, sex of a child, family size, water and toilet facility were significantly associated with malnutrition in Ethiopia. The authors concluded that malnutrition among under-five children was one of the public health problems in Ethiopia. Therefore, the influence of these factors should be considered to develop strategies for reducing malnutrition in Ethiopia.

Spatial Frailty Survival Model for Multidrug-Resistant Tuberculosis Mortality in Amhara Region, Ethiopia.

Tuberculosis (TB), a disease caused by Mycobacterium tuberculosis (MTB), is the main cause of death. It disproportionally affects those living in the different regions of countries and within the region. The aim of this study was to examine spatial variation of mortality and the risk factor of death on multidrug-resistant tuberculosis patients treated in different MDR-TB hospitals of Amhara region. The data for this study was used from multidrug-resistant tuberculosis patients' record charts and analyzed using STATA software. The result of this study shows that 61 (29.47%) of the patients died, and the rest, 146 (70.53%), of the patients were censored at the time of the study. Out of 207 MDR-TB, 146 (70.53%) were males and 61 (29.5%) were females. This study revealed that there was no heterogeneity for death in patients treated in different hospitals. Older patients, therapeutic delay, alcohol use, any clinical complication previously not treated, HIV coinfection, and presence of any chronic disease were the risk factors that influenced the death of multidrug-resistant tuberculosis patients.