Incomplete immunization uptake and associated factors among children aged 12-23 months in sub-Saharan African countries; multilevel analysis evidenced from latest demography and health survey data, 2023

BACKGROUND

In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to control vaccine-preventable diseases, saving millions of lives annually. However, the coverage of basic vaccines recommended by the WHO in Africa was only 75%, which fell short of the goal of 90% by 2015. To formulate effective policies and implementation programs to reduce incomplete vaccination rates, it is important to conduct a study to determine the factors contributing to incomplete immunization among children aged 12-23 months.

METHODS

The study was conducted in 16 sub-Saharan African countries, using data extracted from the latest DHS data. It was a community-based cross-sectional survey that used two-stage stratified probability sampling sample designs. The vaccination coverage was assessed using vaccination cards and mother recalls. Multilevel multivariable logistic regression was used to determine the extent of incomplete immunization and the individual and community-level factors associated with partial immunization among children aged 12-23 months. Variables with a p-value less than 0.05 were considered statistically significant predictors of incomplete immunization.

RESULT

A total of 35, 193 weighted samples were used to determine the pooled prevalence of partial immunization. The pooled prevalence of incomplete immunization was 36.06%. In the final model factors significantly associated were: being uneducated mother(AOR:1.75;95%CI:1.48,2.05), being an unemployed mother (AOR:1.16;95%CI:1.09,1.23), no history of family planning utilization (AOR: 1.71; 95% CI: 1.61, 1.84), non-antenatal care (AOR: 1.79; 95% CI: 1.58, 2.04), non-postnatal care (AOR: 1.25; 95%CI: 1.17, 1.35), rural residence(AOR:1.50;95%CI:1.37,1.63), home delivery (AOR: 2.04; 95%CI:1.89, 2.21), having children more than five (AOR: 1.56; 95%CI: 1.13, 2.17), and non-utilization of health insurance (AOR: 1.74; 95%CI: 1.48, 2.05).

CONCLUSION

The pooled prevalence of incomplete immunization was found to be high in this investigation. Based on the findings of the study we recommended that policymakers and stakeholders prioritize enhancing prenatal and postnatal care, contraception, and reducing home birth rates to minimize the rate of incomplete immunization.

Incidence rate of mortality and its predictors among tuberculosis and human immunodeficiency virus coinfected patients on antiretroviral therapy in Ethiopia: systematic review and meta-analysis

Background

Tuberculosis (TB) is the leading cause of death among HIV-infected adults and children globally. Therefore, this study was aimed at determining the pooled mortality rate and its predictors among TB/HIV-coinfected patients in Ethiopia.

Methods

Extensive database searching was done via PubMed, EMBASE, SCOPUS, ScienceDirect, Google Scholar, and Google from the time of idea conception on March 1, 2023, to the last search via Google on March 31, 2023. A meta-analysis was performed using the random-effects model to determine the pooled mortality rate and its predictors among TB/HIV-coinfected patients. Heterogeneity was handled using subgroup analysis, meta-regression, and sensitivity analysis.

Results

Out of 2,100 records, 18 articles were included, with 26,291 total patients. The pooled incidence rate of mortality among TB/HIV patients was 12.49 (95% CI: 9.24-15.74) per 100 person-years observation (PYO); I2 = 96.9%. The mortality rate among children and adults was 5.10 per 100 PYO (95% CI: 2.15-8.01; I2 = 84.6%) and 15.78 per 100 PYO (95% CI: 10.84-20.73; I2 = 97.7%), respectively. Age ≥ 45 (pooled hazard ratios (PHR) 2.58, 95% CI: 2.00- 3.31), unemployed (PHR 2.17, 95% CI: 1.37-3.46), not HIV-disclosed (PHR = 2.79, 95% CI: 1.65-4.70), bedridden (PHR 5.89, 95% CI: 3.43-10.12), OI (PHR 3.5, 95% CI: 2.16-5.66), WHO stage IV (PHR 3.16, 95% CI: 2.18-4.58), BMI < 18.5 (PHR 4.11, 95% CI: 2.28-7.40), anemia (PHR 4.43, 95% CI: 2.73-7.18), EPTB 5.78, 95% CI: 2.61-12.78 significantly affected the mortality. The effect of TB on mortality was 1.95 times higher (PHR 1.95, 95% CI: 1.19-3.20; I2 = 0) than in TB-free individuals.

Conclusions

The mortality rate among TB/HIV-coinfected patients in Ethiopia was higher compared with many African countries. Many clinical factors were identified as significant risk factors for mortality. Therefore, TB/HIV program managers and clinicians need to design an intervention early.

Delay in seeking treatment and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel zone, Benishangul Gumuz region, Western Ethiopia

Background

Tuberculosis is a major global public health problem and a leading cause of morbidity and mortality in Ethiopia. TB prevention and control in low-income countries, such as Ethiopia, face significant challenges, including late detection and treatment initiation. A delay in the initiation of tuberculosis treatment increases the morbidity and mortality of patients and community transmission. Therefore, this study aimed to assess patient delay and associated factors among pulmonary tuberculosis patients attending public health facilities in the Metekel Zone, Benishangul Gumuz Region, Western Ethiopia.

Methods

An institution-based cross-sectional study was conducted from March to August 2020 among newly diagnosed pulmonary tuberculosis patients. All pulmonary tuberculosis patients (416) who came to all public health facilities of the Metekel zone for treatment during the period were included. Data were collected through face-to-face interviews using a structured and pretested questionnaire. A multivariable logistic regression was fitted to identify independent factors for delay in seeking treatment among PTB patients. Adjusted odds ratios with 95% CIs were determined, and variables with p values <0.05 were considered statistically significant.

Results

Nearly three-fourths 302 (72.6, 95% CI: 68.5, 76.7) of the patients were delayed in seeking medical advice, with a median patient delay of 27 days (IQR: 21-31). Age of the patients [above 54 years (AOR = 2.65, 95% CI: 1.30, 5.40), 36-54 years (AOR = 1.86, 95% CI: 1.14,3.02)], family size of 5 members and above (AOR = 1.62, 95% CI: 1.10-3.14), travel time above 60 min (AOR = 3.65, 95% CI: 1.55, 8.60), history of visits to informal care providers (AOR = 1.74, 95% CI: 1.11, 3.14), and poor knowledge about PTB (AOR = 1.64, 95% CI: 1.04-2.44) were statistically significant factors associated with delays in seeking treatment among PTB patients.

Conclusion

Most pulmonary tuberculosis patients delay seeking medical advice for their illnesses. Delays in seeking treatment were associated with older age, large household size, longer travel time to reach the nearby health facility, visiting informal care providers, and poor knowledge about pulmonary tuberculosis. Hence, it is crucial to consider community screening programs, enhance public awareness, and ensure the accessibility of TB diagnostic and treatment services.

Trend and determinants of home delivery in Gambia, evidence from 2013 and 2020 Gambia Demographic and Health Survey: A multivariate decomposition analysis

BACKGROUND

Home delivery is defined as is an even of pregnant women getting giving birth in a woman her home or other homes without an unskilled health professional assistance. It is continuing as public health problem since its responsible for death of women and newborn. In Gambia there is a high maternal mortality rate, which may be related to home delivery. Therefore, this study aimed to assess the trend of home delivery and identify predictors using Gambia Demographic and Health Survey (GDHS) 2013 and 2019-2020 data sets.

METHODS

A Cross-Section survey was conducted based on GDHS 2013 and 2019-2020 among reproductive age group women. A total of 8607 women participated in this study. A bivariate decomposition model was fitted, and variables that had a p-value > 0.25 were dropped. Finally, variables that got a p-value of < 0.05 with 95% confidence interval (CI) in the multivariate decomposition analysis were considered as statistical significance variables in the overall decomposition.

RESULTS

There has been a dramatic decrement in maternal home delivery in Gambia. It was 36.18% (95% CI:34.78, 37.58) in 2013 GDHS and 14.39% (95% CI:13.31,15.47) in 2019-2020 GDHS. This reduction is real because there was a change in the characteristics effect of the population and the coefficient effect some variables in the home delivery. Changes in characteristics effect of husband education, women education, rural residents, more than three antenatal cares follow up, and no problem reaching health facilities played a significant role in the reduction of home delivery. Being urban resident and women who had occupation were variables that had a positive effect on coefficient effect change.

CONCLUSION

In this study, the home delivery rate had steeply declined in the Gambia during the study period of the two surveys. Just above nine-tenths decrement in home delivery rate resulted because there was a change in the characteristics effect of the study participants. Enhancing more citizens to attend high school and above, narrowing the gap between rural and urban in terms of accessing health facilities, and improving the availability of infrastructure should be done.

Health-related quality of life and associated factors among prisoners in Gondar city prison, Northwest Ethiopia: Using structural equation modeling

BACKGROUND

Prisoners usually need more comprehensive health and social support than the general population. Due to the growing number of prisoners in Ethiopia and limited access to health service, quality of life is a key concern. Compromised health-related quality of life imposes short and long-term consequences on the prisoners, their families, and the healthcare system. In Ethiopia, there are limited studies that investigate health outcomes and health-related quality of life in this particular population. Therefore, this study aimed to assess the magnitude of health-related quality of life and associated factors among prisoners considering the multidimensional nature of health related quality of life.

METHODS

An institution-based cross-sectional study was conducted on 1,246 prisoners who were enrolled using simple random sampling. The World Health Organization Quality of Life (WHOQoL-BREF-26) and Patient Health Questionnaire (PHQ-9) tools were used to assess the HRQoL and depression among prisoners, respectively. The relationships between exogenous, mediating, and endogenous variables were identified using structural equation modeling. As the mediation of effects were present, then the direct, indirect, and total effects were determined. General fit indices of the final model were acceptable (x2/df = 1.76, p < 0.001, RMSEA = 0.06, TLI = 0.90, CFI = 0.91, and SRMR = 0.06).

RESULT

The mean (standard deviation) score of the overall health related quality of life was 53.25 (15.12). Having an underlying medical condition had negative total effect on health related quality of life while visits in prison had positive total effect. Having income-generating work in prison had only a direct positive effect. Whereas, older age, being married, longer duration of imprisonment, and depression all had only a negative direct effect on one or more domains of quality of life (p<0.05).

CONCLUSION

Inmates in Gondar Prison have very poor and compromised levels of physical and psychological health despite having a modest degree of overall HRQoL. The result of this study is significant for people who work in and research the prison environment because it can assist in recognizing prisoners' health needs and devising treatment procedures that take into consideration physical, psychological, environmental, and social relationship aspects.

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

BACKGROUND

Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH).

METHODS

An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant.

RESULTS

The majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19-16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84-12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08-9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52-37.19) were found to prefer the trial of labor compared with their counterparts.

CONCLUSION

This study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.

Trachoma prevention practice and associated factors among mothers having children aged under nine years in Andabet district, northwest Ethiopia, 2022: A multi-level analysis

BACKGROUND

The world health organization (WHO) adopted the Surgery, Antibiotic, facial cleanliness, and environmental improvement (SAFE) strategy for the prevention of trachoma, and different prevention strategies have been employed in Andabet district. Trachoma still has a high prevalence despite these efforts. So, it is imperative to assess ground trachoma prevention practice (TPP) since there are insufficient studies in the study area.

OBJECTIVE

To determine the magnitude and factors associated with TPP among mothers having children aged under nine years in Andabet district, Northwest Ethiopia.

METHOD

A community-based cross-sectional study involving 624 participants was conducted June 1-30, 2022. Systematic random sampling was carried out to select study participants. Multi-level binary logistic regression analysis was used to identify factors associated with poor TPP. Descriptive and summary statistics were performed and variables with p-value < 0.05 in the best-fitted model were declared to be significantly associated with poor TPP.

RESULTS

In this study, the proportion of poor TPP was found to be 50.16% (95%CI = 46.23, 54.08). In the multi-variable multi-level logistic regression; having no formal education (AOR = 2.95; 95%CI: 1.41,6.15) and primary education (AOR = 2.33; 95%CI:1.04, 5.24), being a farmer (AOR = 3.02; 95%CI:1.73,5.28), and merchant (AOR = 2.63; 95%CI:1.20, 5.75), time taken to water point >30 minutes (AOR = 4.60,95CI:1.30,16.26) and didn't receive health education about trachoma (AOR = 2.36;95CI:1.16,4.79) were significantly associated with poor TPP.

CONCLUSION

The proportion of poor TPP was high relative to other studies. Level of education, occupation, time taken to the water point, and health education were significantly associated with poor TPP. Therefore, taking special attention to these high-risk groups could decrease the poor TPP.

The magnitude and determinants of delayed initiation of antenatal care among pregnant women in Gambia; evidence from Gambia demographic and health survey data

BACKGROUND

Despite gains throughout the 20th century, maternal health remains a major public health concern. Despite global efforts to enhance access to maternal and child healthcare services, women in low- and middle-income countries still have a high risk of dying during pregnancy and after birth. This study aimed to determine the magnitude and determinants of late antenatal care initiation among reproductive age women in Gambia.

METHOD

Secondary data analysis was conducted using the 2019-20 Gambian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had an antenatal care visit for the last child were included in this study. The total weighted sample size analyzed was 5310. Due to the hierarchical nature of demographic and health survey data, a multi-level logistic regression model was performed to identify the individual and community level factors associated with delayed first antenatal care initiation.

RESULT

In this study, the prevalence of delayed initiation of initial antenatal care was 56% ranged from 56 to 59%. Women with age 25-34 [Adjusted Odds Ratio = 0.77; 95% CI 0.67-0.89], 35-49 [Adjusted Odds Ratio = 0.77; 95% CI 0.65-0.90] and women reside in urban area [Adjusted Odds Ratio = 0.59; 95% CI 0.47-0.75] respectively had lower odds of delayed first antenatal care initiation. While women with unplanned pregnancy [Adjusted Odds Ratio = 1.60; 95% CI 1.37-1.84], no health insurance [Adjusted Odds Ratio = 1.78; 95% CI 1.14-2.76] and previous history of cesarean delivery [Adjusted Odds Ratio = 1.50; 95% CI 1.10-2.07] had higher odds of delayed initiation of antenatal care.

CONCLUSION

Despite the established advantages of early antenatal care initiation, this study revealed that late antenatal care initiation is still common in Gambia. Unplanned pregnancy, residence, health insurance, history of caesarian delivery, and age were significantly associated with delayed first antenatal care presentation. Therefore, focusing extra attention on these high-risk individuals could reduce delayed first antenatal care visit and this further minimizes maternal and fetal health concerns by recognizing and acting early.

Spatial and Multilevel Analysis of Unscheduled Contraceptive Discontinuation in Ethiopia: Further analysis of 2005 and 2016 Ethiopia Demography and Health Surveys

Background

Unscheduled discontinuation of contraceptives is a public health problem among women of reproductive age. Particularly, it is associated with unwanted pregnancies that lead to maternal and child mortality, but little is known about the spatial distribution of the problem. Therefore, this study aims to assess the spatial distribution and associated factors of unscheduled contraceptive discontinuation in Ethiopia.

Method

This study used secondary data from the Ethiopia Demography and Health Survey (EDHS) data of 2005 and 2016. The study population was women who used contraceptives in the preceding 5 years before the survey. A total of 2,327 and 3,858 eligible women were included in the final analysis of the 2005 and 2016 EDHS, respectively. For the spatial analysis, both the 2005 and the 2016 EDHS data were analyzed using ArcGIS version 10.7, while for multilevel regression analysis, the 2016 EDHS data were used. The final model reported an adjusted odds ratio (AOR) with a 95% confidence interval (CI), and a p-value of 0.05 was used to declare statistical significance.

Result

This study revealed that unscheduled discontinuation of contraceptives varied geographically, and hotspots were detected in the central, north, and eastern parts of Ethiopia. Moreover, diploma and higher education (AOR = 1.40; 95% CI: 1.01-1.95), urban residence (AOR = 1.37; 95% CI: 1.08-1.72), history of termination of pregnancy (AOR = 1.47; 95% CI: 1.14-1.94), married women (AOR = 10.79; 95% CI: 6.98-16.69), separated/divorced women (AOR = 1.54: 95% CI: 1.07-2.30), -two to four number of children (AOR = 1.46; 95% CI: 1.15-1.84), and involvement in the decision-making process of contraceptive use (AOR = 39.26; 95% CI: 28.84-53.45) were all factors associated with unscheduled discontinuation of contraceptives.

Conclusion

This study revealed that unscheduled discontinuation of contraceptive distribution was significantly clustered in the central, north, and eastern parts of Ethiopia, as found in two surveys. The magnitude of this discontinuation increased from 2005 to 2016. The finding underscores that further interventions such as the availability of multiple mixed methods and improvement in women's decision-making ability in the choice of contraceptive methods and utilization are needed in hotspot areas of Ethiopia.

Translation, reliability, and validity of Amharic versions of the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7)

Purpose

Pelvic Floor Disorders (PFDs) affects many women and have a significant impact on their quality of life. Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) help to assess PFDs; however, both are not culturally translated into the Amharic-language. Hence, we aimed to translate the English versions of short forms of the PFDI-20 and PFIQ-7 into Amharic-language and evaluate their psychometric properties in Amharic-speaking Ethiopian women with symptomatic PFDs.

Methods

The PFDI-20 and PFIQ-7 were translated into Amharic language using standard procedures. The Amharic versions were completed by 197 patients (response rate 92%) with PFDs from University of Gondar specialized and comprehensive Hospital. Internal consistency and test-retest reliability were examined through Cronbach’s alpha and Intraclass correlation coefficients (ICC). A relative criterion standard, POP-SS-7 score, was correlated with total PFDI-20 and subscale POPDI-6 scores using spearman’s rank order correlation (SCC). Construct validity was evaluated by known group validity using the Mann–Whitney U test.

Results

Both instruments were successfully translated and adapted with an excellent content validity (> 0.90). The Amharic versions of the PFDI-20 and PFIQ-7 showed excellent internal consistency and test-retest reliability in both summary and subscales (Cronbach’s alpha: 0.92 for PFDI-20 and 0.91 for PFIQ-7; and ICC: 0.97 for PFDI-20 and 0.86 for PFIQ-7). Criterion validity was good for POPDI-6 (SCC = 0.71; p < 0.001). Moreover, construct validity was acceptable, showing significant differences among groups of PFDs in the PFDI-20 and PFIQ-7 scores (Mann–Whitney U Test; p < 0.001).

Conclusions

The Amharic versions of the PFDI-20 and PFIQ-7 are comprehensible, reliable, valid, and feasible in Ethiopian Amharic-speaking women with PFDs to evaluate symptoms and its impact during research and clinical practice. However, further studies are needed to evaluate the responsiveness.

Trends and factors associated with thinness among late adolescent girls in Ethiopia: Multivariate decomposition and multilevel analysis

Background

Undernutrition among adolescent girls is still a major public health problem in low- and middle-income countries (LMICs). Even though the global prevalence of thinness among adolescent girls declined over time, it remains steady in LMICs including Ethiopia. Therefore, this study aimed to assess the trends and factors associated with thinness.

Methods

A logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify factors that contributed to the change in thinness over time. For the associated factors, a multilevel binary logistic regression model was employed. The intra-class correlation coefficient (ICC) and likelihood ratio (LR) test were used to assess the presence of the clustering effect, and deviance was used for model comparison. Statistical significance was declared at p < 0.05.

Results

Thinness among late adolescent girls declined significantly from 34.4% (95% CI: 32.8%, 36.0%) in 2000 to 24.9% (95% CI: 23.4%, 26.5%) in 2016 with an annual average reduction rate of 1.73%. About 84% of the decrement in thinness was attributed to the change in the effect of the characteristics. The place of residence and marital status were significantly associated with a change in thinness due to the change in coefficients. The compositional changes in the age of the adolescents, religion, and types of toilet facilities were also significantly associated with the change in thinness. From the multilevel binary logistic regression, higher age of adolescents (AOR = 0.83; 95% CI: 0.77, 0.90), improved toilet facility (AOR = 0.45; 95% CI: 0.31, 0.65), middle wealth index (AOR = 1.45; 95% CI: 1.10, 1.90), and female head of the household (AOR = 0.77; 95% CI: 0.61, 0.98) were significantly associated at an individual level, whereas being from Somali (AOR = 2.14; 95% CI:1.76, 3.10) and SNNP region (AOR = 0.35; 95% CI: 0.18, 0.68), they had a statistically significant association with thinness at community level.

Conclusion

Thinness among late adolescent girls declined substantially, but it remains a major public health concern. Nutritional interventions targeting thinness reduction among late adolescent girls should base on the identified factors. Age, residence, marital status, type of toilet facility, religion, wealth index, sex of head of the household, and region were all associated with thinness in this study.

Prevalence and determinants of scabies among school-age children in Central Armachiho district, Northwest, Ethiopia

Background

Scabies is a major global public health issue that might affect people from all socioeconomic levels. Globally, scabies affects more than 200 million people at any time. It remains one of the commonest skin diseases seen in developing countries including Ethiopia. Therefore, this study aimed to assess the prevalence and determinants of scabies among school-age children in Central Armachiho district, Northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from August to September 2020. A multi-stage sampling technique was used to select 850 study populations. Data was checked for its completeness, coded, and entered by using EPI-INFO version 7 and exported to the SPSS version 20 for analysis. A Binary logistic regression model was fitted to identify the determinants of scabies. Crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% CI were used as measurements for the associations. P-values <0.005 were considered significant.

Result

Prevalence of scabies among the 850 participants studied was 10.82% (95% CI: 8.7–12.9). Contact history with confirmed scabies patient (AOR = 5.28,95% CI: 2.96–9.44), child not attending school (AOR = 3.08, 95% CI;1.45–6.54), rarely changing clothes (AOR = 2.43,95% CI: 1.27–4.62), sleeping on the floor (AOR = 4.11, 95% CI:1.95–8.67), bed sharing; (AOR = 3.38, 95% CI:2.86–6.15), rarely washing cloth: (AOR = 5.08,95% CI:2.75–9.36), living with internally displaced people; (AOR,95% CI: 3.47 (1.30–9.24) and using only water to wash hands; (AOR = 3.18,95% CI:1.74–5.80) had a statistically significant association with scabies infestation among school-age children.

Conclusion

The current study found nearly one out of ten school-age children had scabies. Not attended school, contact history with confirmed scabies patient, not washing cloth, infrequent changing clothes, bedding sharing, sleeping on the floor, living with internally displaced people, and only using water for handwashing practice were the independent predictors for the occurrence of scabies. Health education better to given to the parents or caregivers about the washing of clothing, changing clothes at least once per week, and avoid physical contact with known scabies cases.

Level of activity limitations and predictors in women with pregnancy-related pelvic girdle pain: Prospective cross-sectional study

Background

For many pregnant women, pelvic girdle pain caused by pregnancy has an impact on their daily living. Women with lumbo-pelvic pain have moderate to severe discomfort that makes daily activities like getting out of a chair, bending, and walking difficult. The aim of this study was to determine the extent of daily activity restrictions and to discover predictors of pregnancy-related pelvic girdle pain.

Study design

Prospective cross-sectional study.

Methods

This prospective cross-sectional study was undertaken from January October 2018 to October 29/2019 among 337 gravid mothers with pregnancy-related limbo-pelvic pain. A structured questionnaire adapted from the activity limitation-related pelvic girdle pain questionnaire was used for data collection. Epi-info version 7.1 for data entry and STATA version 14 for statistical analysis were used. Ordinal regression with an odds ratio of 95% confidence interval and p-value < 0.05 were cast-off to assess the association between the outcome and dependent variables.

Results

Among 324 pregnant women with pelvic girdle pain 96 (29.6%) had small extent level of activity limitation, 185 (57.1%) had moderate activity limitation, and 43 (13.3%) large extent level of activity limitation. Having previous children (AOR = 0.37, 95% CI:0.14, 0.98), occupation (AOR = 1.77, 95% CI: 1.06, 2.95) and taking alcohol (AOR = 0.43, 95% CI: 0.19, 0.99) were the independent predictors for activity limitation.

Conclusion

Nearly one-third of the participants had a modest degree of activity restriction, while more than half of the pregnant women with PPGP had a moderate to high level of restriction. Previous children, occupation, and alcohol consumption were all independent predictors of activity limitation among pregnant women.

•

PGP and LBP are commonly reported by pregnant women all over the world.

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Women's during pregnancy reported limitations in activities of daily life.

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One-third of the pregnant women with PPGP had a modest degree of activity restriction.

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More than half of the pregnant women with PPGP had a moderate to high level of restriction.

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Having children, occupation, and alcohol consumption were independent predictors of activity limitation.

Community Attitude Towards Epilepsy Patients and Associated Factors in South Achefer District, Northwest Ethiopia: A Mixed-Methods Study

BACKGROUND

Epilepsy, defined as seizure activity that is recurrent, unpredictable, and typically unprovoked. It is one of the most common disorders of the nervous system. Sociocultural attitudes in many African nations continue to have a negative impact on epilepsy management. It has been found that stigma and discrimination against people with epilepsy are more devastating and harmful than the illness itself. This is mainly attributed to misconceptions about the disease with fear and fright of the public on confronting an epileptic seizure. So, the current study assesses the community's attitude toward epilepsy patients and associated factors towards epilepsy in South Achefer District, Northwest Ethiopia.

METHODS

Community-based cross-sectional study triangulated with the qualitative method was conducted from March 1 to May 30, 2020 in South Achefer District. A systematic sampling technique was used to select a total of 762 individuals. Data were collected by face-to-face interview using a structured questionnaire and analyzed using SPSS version 23. Logistic regression analysis was performed and P < 0.05 with a 95% confidence interval was considered to measure statistically significant variables. For the qualitative study participants were selected purposively. Focus Group Discussion, key Informant Interview, and Individual Depth Interview were conducted until it reaches the point of saturation. Thematic analysis was done by using an open code software version 4.2.

RESULTS

A total of 753 respondents participated which gave a 98.8% response rate. Among those 60.8% (95% CI: 57.2-64.3) were found to have a favorable attitude towards epilepsy patients. Being informed about epilepsy (AOR=1.47; 95% CI, 1.02-2.11), witnessing seizure in the past (AOR=1.6; 95% CI, 1.14-2.27), and having good knowledge about epilepsy (AOR=2.08; CI, 1.49-2.89) were the variables that showed statistically significant association with a favorable attitude.

CONCLUSION

The favorable attitude of the community towards epilepsy patients was found high in the study area. Information about epilepsy, witnessing seizure, and knowledge about epilepsy showed a significant association with attitude. Therefore, health professional and health extension workers should provide a larger and comprehensive community-based education to enhance people's knowledge about epilepsy to bring attitude change against a negative attitude towards epilepsy.

Spatial distribution of stillbirth and associated factors in Ethiopia: a spatial and multilevel analysis

OBJECTIVE

Although the rate of stillbirth has decreased globally, it remains unacceptably high in developing countries. Today, only 10 countries share the burden of more than 65% of the global rate of stillbirth and these include Ethiopia. Ethiopia ranks seventh in terms of high rate of stillbirths. Exploring the spatial distribution of stillbirth is critical to developing successful interventions and monitoring public health programmes. However, there is no study on the spatial distribution and the associated factors of stillbirth in Ethiopia. Therefore, this study aimed to explore the spatial distribution and the associated factors of stillbirth.

METHODS

Secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 11 375 women were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and ArcGIS V.10.6 to explore the spatial distribution of stillbirth. For associated factors, a multilevel binary logistic regression model was fitted using STATA V.14 software. Variables with a p value of less than 0.2 were considered for the multivariable multilevel analysis. In the multivariable multilevel analysis, adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors of stillbirth.

RESULTS

The spatial analysis showed that stillbirth has significant spatial variation across the country. The SaTScan analysis identified significant primary clusters of stillbirth in the Northeast Somali region (log likelihood ratio (LLR)=13.4, p<0.001) and secondary clusters in the border area of Oromia and Amhara regions (LLR=8.8, p<0.05). In the multilevel analysis, rural residence (AOR=4.83, 95% CI 1.44 to 16.19), primary education (AOR=0.39, 95% CI 0.20 to 0.74), no antenatal care (ANC) visit (AOR=2.77, 95% CI 1.70 to 4.51), caesarean delivery (AOR=5.07, 95% CI 1.65 to 15.58), birth interval <24 months (AOR=1.95, 95% CI 1.20 to 3.10) and height <150 cm (AOR=2.73, 95% CI 1.45 to 4.97) were significantly associated with stillbirth.

CONCLUSION AND RECOMMENDATION

In Ethiopia, stillbirth had significant spatial variations across the country. Residence, maternal stature, preceding birth interval, caesarean delivery, education and ANC visit were significantly associated with stillbirth. Therefore, public health interventions that enhance maternal healthcare service utilisation and maternal education in hotspot areas of stillbirth are crucial to reducing stillbirth in Ethiopia.

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

BACKGROUND

Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities.

METHODS

We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs.

FINDINGS

Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4-40·7) to 50·3% (50·0-50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1-46·5) in 2017, compared with 28·7% (28·5-29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2-89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6-80·7) of countries from 2000 to 2017, and in 53·9% (50·6-59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017.

INTERPRETATION

Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.

FUNDING

Bill & Melinda Gates Foundation.

Trends of stillbirth among reproductive-age women in Ethiopia based on Ethiopian demographic and health surveys: a multivariate decomposition analysis

Background

Despite the effort to reduce stillbirth, Ethiopia remains one of the countries with the highest rate in the world. Therefore, this study aimed to analyze the trends of stillbirth among births from reproductive age women over time based on Ethiopian Demographic and Health Surveys (EDHSs).

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 12,037, 10,588, and 11,375 in 2005, 2011 and 2016 respectively were included for analysis. Trend and Logistic based decomposition analysis technique was used for analyzing the trends of stillbirth over time and factors contributing to the change in stillbirth rate. STATA 14 was employed for data management and analyses. All analyses presented in this paper were weighted for the sampling probabilities and non-response. Complex sampling procedures were also considered during testing of statistical significance.

Results

Among women of reproductive age, the stillbirth rate declined from 13.3/1000 births in 2005 to 9.2 per 1000 births in 2016 with the annual rate of reduction of 3.1%. The study found that the stillbirth rate has been declined over time concerning the place of residence, region, antenatal care, education and place of delivery. The decomposition analysis indicated that about 82.3% of the overall change stillbirth rate was due to the difference in women’s composition. Particularly, an increase in women’s urban place of residence, health facility delivery, and cesarean delivery were significant predictors for the decline in stillbirth rate over the surveys.

Conclusions

The stillbirth rate has been declined over time. More than 3/4th of the decrease in stillbirth rate was due to the difference in characteristics of women over the surveys. The increase in women’s urban place of residence, an increase in cesarean delivery and health facility delivery significantly contributed to the decrease in stillbirth rate over time. Public health interventions targeting rural resident women, strengthening emergency obstetric services and health facility delivery would help to maintain the decreasing trend of stillbirth rate in Ethiopia.

Incidence of Mortality and Its Predictors Among Adult Visceral Leishmaniasis Patients at the University of Gondar Hospital: A Retrospective Cohort Study

Background

Visceral leishmaniasis (VL) is a neglected tropical disease, affecting the poor and productive age group of a country, resulting in a huge impact on its economic development. Even though anti-leishmanial drugs reduce the incidence of mortality among VL patients, there is still death of these patients while on treatment. In this aspect, there are limited studies in Ethiopia; therefore, this study aimed to determine the incidence of mortality and its predictors among adult VL patients at the University of Gondar Hospital.

Methods

Institution-based retrospective cohort study was conducted among 586 adult visceral leishmaniasis patients who were admitted to the University of Gondar Hospital from 2013 to 2018. Data were collected from the patients’ charts and registration books, and analyzed using Stata 14 software. Kaplan–Meier failure curve and Log rank test was used to compare the survival probability of patients with independent variables. A multivariable stratified Cox regression model was used to identify predictors of mortality among VL patients. P≤ 0.05 was employed to declare statistically significant factors. Adjusted hazard ratio (AHR) and 95% confidence interval (95% CI) were estimated for potential risk factors included in the multivariable model.

Results

A total of 586 VL patients were included in the study. The age of patients ranged from 18 to 55 years with a median age of 27 years. The incidence of mortality was 6.6 (95% CI: 5.2–8.4) per 1000 person-days of observation. Independent predictors of mortality were presence of comorbidity (AHR=2.29 (95% CI: 1.27–4.11)), relapse VL (AHR=3.03 (95% CI: 1.25–7.35)), treatment toxicity (AHR=5.87 (95% CI: 3.30–10.44)), nasal bleeding (AHR=2.58 (95% CI: 1.48–4.51)), jaundice (AHR=2.84 (95% CI: 1.57–5.16)) and being bedridden at admission (AHR=3.26 (95% CI: 1.86–5.73)).

Conclusion

The incidence of mortality among VL patients was high. Mortality was higher among VL patients with concomitant disease, relapse VL, treatment toxicity, nasal bleeding, jaundice, and those who were bedridden at admission, which implies that great care should be taken for these risky groups through strict follow-up and treatments.

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.

METHODS

We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.

FINDINGS

The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

INTERPRETATION

The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.

FUNDING

Bill & Melinda Gates Foundation.

Level of mother's knowledge about neonatal danger signs and associated factors in North West of Ethiopia: a community based study

BACKGROUND

Neonatal danger has become a substantial problem in many developing countries like Ethiopia. More specifically, neonatal rates in Ethiopia are among the highest in the world. In this regard, health-seeking behavior of mothers for neonatal care highly relies on their knowledge about neonatal danger sign, and it has been hardly investigated. Therefore, this study was intended to determine the level of mother's knowledge about neonatal danger signs and to identify factors associated with good mother's knowledge.

METHODS

Community-based cross-sectional study was conducted from February to May 2014. A multi-stage sampling technique was used to select 603 mothers. A structured, pre-tested, and interview-administered questionnaire comprehending 13 neonatal danger signs was employed to collect the data. Data were entered into EPI-Info 3.5.2 and analyzed by SPSS version 16. Binary logistic regression model was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength and significant level of the association.

RESULTS

All mothers expected to participate in the study were interviewed. The results of the study showed that mothers who had knowledge of three or more neonatal danger signs (good knowledge) were found to be 18.2% (95% CI 15.1, 21.3%). The odds of having good knowledge was positively associated with mother's (AOR = 3.41, 95% CI 1.37, 8.52) and father's (AOR = 3.91, 95% CI 1.23, 12.36) higher educational achievement. Similarly, the odds of having good knowledge about neonatal danger signs was higher among Antenatal care (AOR = 2.28, 95% CI 1.05, 4.95) and Postnatal care attendant mothers (AOR = 2.08, 95% CI 1.22, 3.54). Furthermore, access to television was also associated with mothers' good knowledge about neonatal danger signs (AOR = 3.49, 95% CI 1.30, 9.39).

CONCLUSION

Maternal knowledge about neonatal danger signs was low. Therefore, intervention modalities that focus on increasing level of parental education, access to antenatal and postnatal care and PNC service, and advocating the use of television was pinpointed.