Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019

Background

Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level.

Methods

Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors.

Results

The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086).

Conclusion

The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.

Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis

BACKGROUND

Previous reviews explored the association between maternal use of folic acid and multivitamin supplements and risk of neural tube defect (NTD) in children, with no definitive conclusion. These reviews had produced contradictory results, and there had been no umbrella review. Therefore, the objective of this umbrella review is to combine the inconsistent data on the effect of prenatal folic acid and/or multivitamin supplementation for the prevention of NTD in offspring.

METHODS

Using the PRISMA guideline, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar reported that the effects of folic acid and/or multivitamin supplementation for the prevention of NTD in offspring were searched. The quality of the included studies was assessed using Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULT

Ten SRM with 296,816 study participants were included. The random-effects model analysis from 10 included systematic review and meta-analysis revealed that the pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD globally is found to be 0.43 (95% CI: 0.29, 0.58) (I2 = 93.50%; p ≤0.001). In the subgroup analysis, the pooled effect was found to be 0.23 (0.09, 0.37) in folic acid group, while this estimate is 0.63 (0.53, 0.72) and 0.61 (0.46, 0.75) in groups who took multivitamin. The pooled effect of prevention of NTD was found to be 0.50 (0.34, 0.66) in SRMs aimed at occurrence prevention (primary prevention) group, while this estimate is 0.20 (-0.01, 0.41) among SRMs, which aimed at reoccurrence (secondary) prevention, and 0.61 (0.46, 0.75) among those SRMs aimed to assess the effect folic acid or multivitamin for the prevention of both occurrence and reoccurrence. The pooled effect of either folic acid or multivitamin supplementation for the prevention of NTD was found to be 0.45 (0.03, 0.87) in SRMs of observational studies, while this estimate is 0.43 (0.32, 0.54) among SRMs of randomized controlled trials.

CONCLUSION

This umbrella review of systematic review and meta-analysis found that prenatal folic acid and/or multivitamin supplementation was associated with a 57% reduction in NTD. Participants who took folic acid supplementation were associated with a slightly higher (77%) percentage of reduction in NTD compared with those who took multivitamin (37%). Reductions of 80% and 50% were observed for reoccurrence and occurrence prevention of NTD. Reductions of 57% and 55% of NTD have been found in SRM of RCTs and observational studies. This umbrella review revealed that both folic acid and multivitamin were associated with significantly lower levels of NTD in children. Considering the incorporation of those supplements in NTD prevention strategies during the preconception period is recommended. More large-scale prospective cohort and RCTs are needed to understand the protective effect of multivitamins and/or folic acid on NTD risk addressing the molecular mechanisms and to determine the optimal dose, duration, and timing of maternal multivitamin and folic acid intake for best child NTD risk reduction.

Virological outcomes of antiretroviral therapy and its determinants among HIV patients in Ethiopia: Implications for achieving the 95-95-95 target

BACKGROUND

Despite significant advancements in HIV treatment, virological outcomes remain a critical issue. Ethiopia did not meet the 90:90:90 targets set for 2020, which aimed for 90% of people on antiretroviral therapy to achieve viral suppression. As the country shifts its focus toward the 95:95:95 targets for 2030-seeking to achieve 95% viral suppression among those on ART-it is crucial to deepen our understanding of viral suppression and the factors that influence it.

METHODS

Virological suppression was examined among 410 HIV-positive individuals on ART using the EPHIA survey. The survey employed a two-stage, stratified sampling design across urban areas in nine regions and two city administrations. Data analysis was conducted with STATA version 18, and multicollinearity was assessed using variance inflation factors. A logistic regression model identified significant determinants of viral suppression, with variables having a p-value of ≤0.05 considered statistically significant in the multivariable analysis.

RESULTS

The findings revealed that 364 participants (88.78%) achieved viral suppression. Key determinants of virological outcomes included a higher wealth level (AOR = 2.67, 95% CI: 1.15-6.22), the presence of active TB (AOR = 0.27, 95% CI: 0.14-0.57), hepatitis B virus (AOR = 0.20, 95% CI: 0.10-0.31), and the utilization of HIV support group care (AOR = 3.14, 95% CI: 1.35-6.30).

CONCLUSION

Viral suppression among HIV patients is 88.78%, which even falls short of the WHO's 90% target for 2020, indicating the substantial work required to achieve 95% by 2030. To improve virological outcomes, it is crucial to increase support for low-income patients, enhance management of co-infections like TB and hepatitis B, and expand access to HIV support groups for better adherence and care.

Surgical site infection following appendectomy in children

Surgical site infection (SSI) is one of the most common postoperative complications after appendectomy leading to recurrent surgery, prolonged hospital stay, and the use of antibiotics. The burden of surgical site infection varies from 1.2 to 20% across the previously conducted studies. However, there are limited studies available on this problem in Ethiopia. Therefore, this study aimed to assess prevalence of post-appendectomy surgical site infection among children in Amhara region, Ethiopia. A cross-sectional study was employed. The data extraction tool was used to collect data from 423 sampled participants. Simple random sampling technique was used. Data cleaned, coded and entered into Epi Data version 4.6 and exported to STATA version 14.0. The data was presented using table and text forms. The logistic regression model was fitted after checking the required assumptions through Hosmer and lemeshow test to identify predictors of post-operative complications. The bivariable analysis was done to identify associations between dependent and each independent variable. Moreover, variables with P ≤ 0.25 levels in the bivariable analysis were entered into the multivariable analysis. Adjusted odd ratio with 95% CI was used to assess the direction, strength of association and statistical significance. Any statistical test was considered significant at P-value < 0.05. A total of 406 study participants were considered for analysis. The prevalence of surgical site infection was 9.11% (95%CI; 6.67%, 12.34%). Having fever (AOR = 2.788, 95%CI (1.10, 7.05)), being taking preoperative antibiotics (AOR = 7.3, 95%CI (2.5, 21)) and having drainage following appendectomy (AOR = 6.3, 95%CI (2.7, 14.7)) were statistically significant predictors of surgical site infection following appendectomy in children. The prevalence of surgical site infection was high as compared the national target. Taking preoperative antibiotics, having fever, and having drainage after operation were significantly associated with surgical site infection. Therefore, a prospective follow up study is important. Those children with appendicitis who presented with a clinical symptom of fever, leaving drainage after procedure and timing of preoperative antibiotics requires special attention of the surgical safety team.

Non-exclusive breastfeeding is associated with pneumonia and asthma in under-five children: an umbrella review of systematic review and meta-analysis

BACKGROUND

Despite numerous reviews examining the impact of exclusive breastfeeding on preventing childhood pneumonia and asthma, a comprehensive and up-to-date synthesis is lacking. This umbrella review aims to consolidate the current evidence on the link between non-exclusive breastfeeding and the risk of pneumonia and asthma in under-five children.

METHODS

A comprehensive search was conducted in PubMed, Embase, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar to identify systematic review and meta-analysis (SRM) studies evaluating the effect of exclusive breastfeeding on preventing childhood pneumonia and asthma globally. The latest search was conducted on January 25/2025. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews Two (AMSTAR-2) tool. A weighted inverse variance random-effects model was employed to generate pooled estimates. Summary effect estimates were expressed using odds ratios (OR) with 95% confidence intervals (CI). We evaluated the quality of evidence for each association using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework, categorising it as convincing (class I), highly suggestive (class II), suggestive (class III), and weak (class IV).

RESULTS

Twelve SRMs, including 270 primary studies with over ten million participants, were analysed. The random-effects model revealed a highly suggestive association between non-exclusive breastfeeding and an increase in the risk of pneumonia (OR 2.34; 95% CI 1.89, 2.78, GRADE: highly suggestive). Similarly, there was highly suggestive evidence that non-exclusive breastfeeding was associated with a 29% higher risk of childhood asthma (OR 1.21; 95% CI 1.07, 1.34, GRADE: highly suggestive).

CONCLUSION

Our results highlighted that non-exclusive breastfeeding is associated with an increased risk of pneumonia and asthma in under-five children. These findings emphasise the critical role of exclusive breastfeeding in reducing the risk of respiratory health issues, highlighting the need for policies and initiatives that promote breastfeeding as a key strategy for improving children's health outcomes.

Time to First Sexual Experience and Its Determinants among Female Youths in Ethiopia: Survival Analysis Based on EDHS 2016

Background

The first sexual experience is the most significant event in a woman's life. Early sexual experience has short- and long-term health and behavioral risks. Studying the estimated time for a female to have her first sexual debut is important to reduce its health, demographic, and socioeconomic consequences. Thus, this study is aimed at assessing the time to first sexual experience and its determinants in Ethiopia.

Methods

A survival analysis of time to first sexual experience was conducted among 6143 weighted study subjects. The data were extracted from EDHS 2016 using STATA version 16 software. A Kaplan-Meier survival curve was computed to estimate the time of first sexual experience. A log-rank test was used to compare the difference in survival curves. The Cox proportional hazard regression model was used to identify significant predictors. On multivariable analysis, variables having a p value of ≤ 0.05 are considered statically significant.

Results

The overall median survival time was 16 years. The significant determinants of time to first sexual experience are educational level (no education (AHR = 2.72, 95% CI: 2.16, 3.39), primary education (AHR = 2.17, 95% CI: 1.79, 2.63), and secondary education (AHR = 1.47, 95% CI: 1.21, 1.77)) and wealth index (poor (AHR = 1.15, 95% CI: 1.00, 1.32)).

Conclusion

About 50% of female youths have a sexual experience for the first time before their 16th birthday. The timing of the first sexual experience in Ethiopia was mainly influenced by educational level and wealth index. Universal access to education and poverty reduction should be the area of concern.

Determinants of traditional birth attendant utilisation among reproductive age women in Ethiopia: a multilevel analysis of the 2019 Ethiopian Demographic and Health Survey

OBJECTIVES

To identify the determinants of traditional birth attendants' utilisation among reproductive-age women in Ethiopia.

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

A total of 3979 weighted samples of reproductive-age women were included.

OUTCOME MEASURE

Traditional birth attendant utilisation.

RESULTS

This study found a high prevalence (29.76%) of Ethiopian mothers using traditional birth attendants for delivery, based on data from the 2019 Ethiopian Demographic and Health Survey. Mothers with higher education (adjusted OR (AOR)=0.11, 95% CI: 0.01 to 0.62), who had four or more antenatal care visits (AOR=0.34, 95% CI: 0.21 to 0.54), communities with lower levels of education (AOR=2.21, 95% CI: 1.30 to 3.73), communities with higher poverty levels (AOR=1.71, 95% CI: 1.99 to 2.96) and those from peripheral regions (AOR=3.41, 95% CI: 1.77 to 6.56) were found to be predictors of traditional birth attendants.

CONCLUSION

This study indicates a high prevalence (29.76%) of Ethiopian mothers using traditional birth attendants, highlighting the need for targeted interventions to promote skilled birth attendance. Policymakers should focus on implementing educational programmes targeting reproductive-age women and improving access to quality antenatal care. Specific initiatives could include community-based educational workshops and subsidies for transportation to healthcare facilities. Furthermore, mothers in remote and border districts should receive specialised attention in terms of resource allocation, including skilled personnel and enhanced healthcare access.

Determinants of knowledge of preconception care among healthcare providers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To assess the determinants of knowledge of preconception care (PCC) among healthcare providers in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

Comprehensive literature searches were conducted in PubMed, Scopus and Health Internetwork Access to Research Initiative (HINARI) published until 20 March 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary studies that reported the prevalence, determinants or associated factors were included.

DATA EXTRACTION AND ANALYSIS

Three authors extracted all the relevant data using a standardised Joanna Briggs Institute data extraction format. Meta-analysis was done using a random-effects model. A funnel plot and Egger's test were done to assess publication bias, which was corrected by trim and fill analysis.

RESULT

Out of 102 studies, the final analysis included six studies involving 2758 healthcare providers. The pooled knowledge of PCC among healthcare providers in Ethiopia was determined to be 51.43% (Adjusted OR), with a 95% CI ranging from 41.21% to 61.65%. Several factors were identified as determinants of healthcare providers' knowledge based on the pooled estimate. These factors include having an educational qualification above a BSc degree (OR=2.36, 95% CI 1.46, 3.08), the presence of guidelines in their institution (OR=2.07, 95% CI 1.37, 2.77), working in hospitals (OR=2.68, 95% CI 1.83, 3.53) and receiving training on PCC and related topics (OR=4.05, 95% CI 2.52, 5.59).

CONCLUSION

Healthcare professionals exhibited limited knowledge of PCC in Ethiopia. Key elements influencing their comprehension encompass advanced educational credentials beyond a BSc degree, adherence to institutional guidelines, employment in hospital settings and exposure to specialised training. The ORs linked to these factors highlight the substantial influence of education, institutional procedures, hospital roles and specific training in enhancing healthcare providers' expertise. Enhancing awareness and understanding among healthcare practitioners through customised educational programmes, institutional structures and organised training efforts stands out as a crucial approach to improve healthcare services and results throughout Ethiopia.

PROSPERO REGISTRATION NUMBER

CRD42024516077.

Magnitude and clinical characteristics of cerebral palsy among children in Africa: A systematic review and meta-analysis

Cerebral palsy (CP) is the most common motor disability in childhood which causes a child's behavioral, feeding, and sleep difficulties. It remains a poorly studied health problem in Africa. The main aim of this study was assessing the pooled prevalence of Cerebral Palsy (CP) and its clinical characteristics in Africa context. Systematic review and meta-analysis were conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search articles from electronic databases (Cochrane library, Ovid platform) (Medline, Embase, and Emcare), Google Scholar, CINAHL, PubMed, Maternity and Infant Care Database (MIDIRS). The last search date was on 12/05/ 2023 G. C. A weighted inverse variance random-effects model was used to estimate the pooled estimates of cerebral palsy and its types. The subgroup analysis, publication bias and sensitivity analysis were done. Studies on prevalence and clinical characteristics of cerebral palsy were included. The primary and secondary outcomes were prevalence and clinical characteristics of cerebral palsy respectively. A total of 15 articles with (n = 498406 patients) were included for the final analysis. The pooled prevalence of cerebral palsy in Africa was found to be 3·34 (2·70, 3·98). The most common type is spastic cerebral palsy accounting 69·30% (66·76, 71·83) of all cases. The second one is quadriplegic cerebral palsy which was found to be 41·49% (33·16, 49·81). Ataxic cerebral palsy accounted 5·36% (3·22, 7·50). On the other hand, dyskinetic cerebral palsy was found to be 10.88% (6·26, 15·49). About 32·10% (19·25, 44.95) of cases were bilateral while 25·17% (16·84, 33·50) were unilateral. The incidence of cerebral palsy in Africa surpasses the reported rates in developed nations. Spastic and quadriplegic subtypes emerge as the most frequently observed. It is recommended to channel initiatives toward the strategic focus on preventive measures, early detection strategies, and comprehensive management protocols.

The financial toxicity of cancer: unveiling global burden and risk factors - a systematic review and meta-analysis

BACKGROUND

Cancer, a major global health challenge, not only threatens lives but also imposes severe financial burdens, known as 'financial toxicity'. This strain extends beyond treatment costs to include indirect expenses like lost income and out-of-pocket payments. Despite its urgency, global insights remain fragmented, often limited to specific regions with inconsistent findings. This systematic review and meta-analysis aims to provide a comprehensive overview of cancer-related financial toxicity and identify key risk factors contributing to this burden.

METHODS

We conducted a systematic review and meta-analysis, searching databases like Medline, Web of Science, PubMed, Scopus, International Scientific Indexing and Google Scholar for peer-reviewed observational studies. Data were extracted into Microsoft Excel 2021, and study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Statistical analysis was performed using STATA V.17, with catastrophic health expenditures (CHEs) pooled via a random-effects model. Heterogeneity was explored to understand variations in study outcomes. Subgroup and sensitivity analyses were conducted to assess individual study impacts, while publication bias was evaluated using Begger and Egger's tests. Univariate meta-regression analysis determined the impact of study-level covariates on CHE estimates.

RESULTS

This analysis included 35 observational studies, covering 428 373 patients with cancer. The pooled prevalence of CHE was 56.1% (95% CI 48.3% to 63.8%). Key risk factors included large family size, low income, lack of health insurance, longer disease duration, older age and multiple treatments. Higher education levels were associated with reduced CHE risk.

CONCLUSION

Over half of patients with cancer (56.1%) face catastrophic health expenditures, highlighting a severe financial burden. Addressing this issue requires expanding health insurance, providing financial support and ensuring affordable cancer care. Improving education access can also reduce CHE risk among patients with cancer.

Lower limb lymphoedema-related mental depression: A systematic review and meta-analysis of non-cancer-related studies

Background

Lower limb lymphoedema, characterized by persistent swelling in the legs due to lymphatic dysfunction, not only imposes a physical burden but is also associated with significant mental depression. While emerging research suggests a strong link between lower limb lymphoedema and depression, the extent of the problem remains underexplored. This study aims to investigate the relationship between lower limb lymphoedema and mental depression through a meta-analysis of existing studies.

Methods

A comprehensive search was conducted across databases including PubMed, MEDLINE, EMBASE, International Scientific Indexing, Web of Science, and Google Scholar. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A weighted inverse variance random-effects model was used for pooled estimates, along with subgroup analysis, heterogeneity assessment, publication bias testing, and sensitivity analysis. The prediction interval was computed to estimate where future observations may fall. The review protocol was registered in PROSPERO (CRD42024541596).

Results

Thirteen studies involving 3503 patients with lower limb lymphoedema due to lymphatic filariasis, podoconiosis, or leprosy were included. The pooled estimate of depression related to lower limb lymphoedema was 38.4 % (95 % CI: 26.3 %, 50.5 %). High heterogeneity (I2 = 81.48 %) highlighted significant variability among the studies. Depression was more prevalent among leprosy patients (38.1 %) and podoconiosis patients (36.4 %), showing little difference between the two. However, the prevalence was notably lower among those with lymphatic filariasis (22.4 %). A higher prevalence of depression was found in Africa (39.4 %) compared to other regions (36.1 %).

Conclusion

Patients with lower limb lymphoedema experience disproportionately high rates of mental depression compared to the general population. Integrating mental health assessment and treatment into care packages for lymphoedema management is essential, with special attention needed for leprosy patients.

Prevalence, determinants, and complications of adolescent pregnancy: an umbrella review of systematic reviews and meta-analyses

OBJECTIVE

This study aimed to assess the magnitude, determinants, and outcomes of adolescent pregnancy by combining data from previous systematic reviews and meta-analyses.

DATA SOURCES

Online databases.

STUDY ELIGIBILITY CRITERIA

Systematic Review and Meta-analysis.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar, which reported the magnitude, predictors, and/or outcomes of adolescent pregnancy, were searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse variance random-effects model was used to determine the pooled estimates. In addition, subgroup heterogeneity, publication bias, and sensitivity were assessed.

RESULTS

A total of 14 systematic reviews and meta-analyses involving 677,431 participants were included in the final analysis of this umbrella review. The pooled prevalence of adolescent pregnancy from global systematic reviews and meta-analyses was found to be 17.90 (95% confidence interval, 12.25-23.54). Level of education (adjusted odds ratio ranging from 1.40 to 9.07), socioeconomic status (lower: adjusted odds ratio ranging from 1.13 to 3.81), residency (rural: adjusted odds ratio ranging from 1.80 to 3.60), abuse (adjusted odds ratio ranging from 2.21 to 3.83), marital status (married: adjusted odds ratio ranging from 1.27 to 6.02), and contraceptive use (no: adjusted odds ratio ranging from 0.19 to 3.53) were identified as predictors of adolescent pregnancy. Anemia (adjusted odds ratio, 1.49; 95% confidence interval, 0.29-1.69; I2 = 91.7%), stillbirth (adjusted odds ratio, 1.71; 95% confidence interval, 0.24-3.17; I2 = 61.3%), preeclampsia/eclampsia, (adjusted odds ratio, 1.63; 95% confidence interval, 0.72-2.55), preterm birth (adjusted odds ratio, 1.90; 95% confidence interval, 1.36-2.40), and low birthweight (adjusted odds ratio, 1.46; 95% confidence interval, 1.25-1.66) were found to be significant complications of adolescent pregnancy in a global context.

CONCLUSION

The prevalence of adolescent pregnancy varied significantly across previous systematic reviews and meta-analyses. The key determinants identified included low socioeconomic status, rural residency, a history of abuse, early marriage, and no contraceptive use. The complications associated with adolescent pregnancy included anemia, stillbirth, preeclampsia/eclampsia, preterm birth, and low birthweight. To reduce the burden of adolescent pregnancy, collaborative efforts are required from global, regional, and local stakeholders, such as policymakers and reproductive health program planners, through health education and training that focus on the most vulnerable populations.

Geospatial pattern of HIV seropositivity and its predictors among women in Ethiopia. A spatial and multiscale geographically weighted regression analysis

BACKGROUND

Although promising efforts have been made so far, HIV remains a public health concern. Women in Ethiopia are disproportionately affected by HIV, accounting for a majority of new infections and AIDS-related deaths. However, the geospatial distribution of HIV among women in Ethiopia is not well understood, making it challenging to develop geographically targeted measures. Besides, to accelerate the pathway of decreasing HIV prevalence and plan geographically specific interventions, understanding the geospatial distribution of HIV seropositivity and its predictors among women plays a significant role.

METHODS

A spatial and multiscale geographically weighted regression analysis was conducted using the 2016 EDHS dataset, comprising 14,778 weighted samples of women in the reproductive age group. The EDHS sample underwent two-stage stratification and selection. The data were extracted between October 18 and 30, 2023. Non-spatial analysis was carried out using STATA version 17. Additionally, ArcGIS Pro and Sat Scan version 9.6 were used to visually map HIV seropositivity. Global Moran's I was computed to evaluate the distribution of HIV seropositivity. The Getis-Ord Gi* spatial statistic was utilized to identify significant spatial clusters of cold and hot spot areas. Geographically weighted regression analysis was subsequently performed to identify significant predictors of HIV seropositivity. Significance was established at a P-value <0.05 throughout all statistical analyses.

RESULTS

HIV seropositivity among women in Ethiopia is distributed non-randomly (Global Moran's I = 0.16, p-value <0.001 and Z-score = 7.12). Significant hotspot clustering of HIV seropositivity was found in the Addis Ababa, Harari, Dire Dawa, and Gambela region. Poor wealth index, being divorced and widowed, having more than one sexual partner, and early first sexual experience (<15 years) were found to be predictors of geographical variation of HIV seropositivity among women.

CONCLUSION

HIV seropositivity among women in Ethiopia varies geographically. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on improving the economic empowerment of women to prevent the from engaging in risky sexual behaviors. Furthermore, comprehensive sex education programs in schools and community settings regarding the consequences of early first sexual debut might play a role in reducing HIV seropositivity among women in Ethiopia.

Umbrella review protocol: Global burden and risk factors of erectile dysfunction in diabetic population

Background

Erectile dysfunction (ED) is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of ED and associated risk factors among diabetic patients in the global context.

Methods

Following PRISMA guidelines will be searched for relevant Systematic Review and Meta-analysis studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. The quality of the included studies will be assessed using the new regress tool, the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of ED, we will employ a weighted inverse variance random-effects model. We will further conduct subgroup analyses, assess heterogeneity and publication bias, and perform sensitivity analyses to strengthen the robustness of our findings. Prediction intervals will also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance will be declared at p value < 0.05.

Discussion

This umbrella review of systemic review and meta-analysis will be the first to systematically explore and integrate evidence regarding the burden of ED and associated risk factors in the diabetic population in a global context. By estimating the worldwide burden and identifying risk factors of ED in this population, the study will contribute to uncovering the hidden burden. Thereby, the issue will get international attention to reduce its consequences on the sexual health of the diabetic population. Besides, it will also provide input and direction for future research outlook.

Incidence and determinants of mortality among patients with colorectal cancer in oncology centers of Amhara region, Ethiopia, 2024: multicenter retrospective follow up study

INTRODUCTION

Colorectal cancer is a significant cause of mortality globally, with several factors impacting patient outcomes, including access to healthcare, early detection, and treatment. Despite this, the specific factors affecting incidence of death among colorectal cancer patients in the Amhara region have not been thoroughly investigated. Thus, this study seeks to assess incidence and determinants of mortality among colorectal cancer patients in Amhara Region oncology centers.

RESULTS

The mean age of the participants was 48.6 years (SD ± 15). Median survival time was 23.8 months. The overall incidence rate or incidence density of a colorectal cancer mortality rate was 2.9 per 100 person-months (95% CI: 2.5-3.4). Survival rates of colorectal cancer patients 1and 5 year was 69.78% and 16.1%, respectively. The result of the multivariable analysis showed that colorectal cancer patients who had presenting symptoms [AHR = 2.67 (95% CI: 1.95, 3.67)], Base line HGB level < 12.5 mg/dl [AHR = 1.63 (95% CI: 1.12, 2.37)], WHO or ECOG poor performance status [AHR = 2.99 (95% CI: 2.17, 4.12), late stage of cancer [AHR = 2.32 (95% CI: 1.42, 3.79)] and location of tumor on colorectal [AHR = 1.76 (95% CI: 1.20, 2.55)] were significantly associated with mortality of colorectal cancer.

CONCLUSION AND RECOMMENDATION

The study highlights significant findings on the survival and mortality of colorectal cancer patients. The overall mortality rate was 2.9 per 100 person-months. Multivariable analysis identified presenting symptoms, low baseline hemoglobin levels, poor performance status, late-stage cancer, and tumor location as significant predictors of mortality. Highlighting the need for early detection and targeted care strategies.

HIV Support Group Care Utilization and its Effect on Treatment Outcome Among HIV Patients on Antiretroviral Therapy: Evidence from Ethiopia Population-Based HIV Impact Assessment

In the realm of HIV care, support groups play a pivotal role by bringing together individuals living with HIV to share experiences and receive guidance from healthcare professionals. These groups are renowned for their substantial benefits, including improving emotional well-being, enhancing treatment adherence, and fostering a strong sense of community. However, despite these advantages, there is a notable gap in Ethiopia regarding concrete evidence of their impact on key treatment outcomes. This study aims to bridge this gap by exploring how support group care influences viral suppression rates among HIV patients. The study was conducted among 259 HIV-positive individuals on ART using the EPHIA survey, employing a two-stage, stratified sampling design across urban areas in nine regions and two city administrations. Data analysis was performed using STATA version 17, and multicollinearity was assessed (VIF = 1.07). A multivariate logistic regression model was fitted, with a p-value of ≤ 0.05 considered statistically significant. Results showed that 25.12% of participants utilized HIV support groups. Those who participated in support groups were 3.14 times more likely to achieve viral load suppression compared to non-participants (AOR = 3.14, 95% CI: 1.35-6.30). This study highlights that HIV support groups significantly boost viral suppression rates, underscoring the importance of integrating these groups into standard treatment protocols. These findings underline the need for continued research to assess long-term outcomes and further optimize the effectiveness of support group care in enhancing HIV treatment outcomes.

Adverse Childhood Experiences Are Associated with Mental Health Problems Later in Life: An Umbrella Review of Systematic Review and Meta-Analysis

INTRODUCTION

Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.

METHODS

PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.

CONCLUSION

This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.

Virological outcomes of third-line antiretroviral therapy in a global context: a systematic reviews and meta-analysis

BACKGROUND

Despite remarkable progress, HIV's influence on global health remains firm, demanding continued attention. Understanding the effectiveness of third-line antiretroviral therapy in individuals who do not respond to second-line drugs is crucial for improving treatment strategies. The virological outcomes of third-line antiretroviral therapy vary from study to study, highlighting the need for robust global estimates.

METHODS

A comprehensive search of databases including PubMed, MEDLINE, International Scientific Indexing, Web of Science, and Google Scholar, was conducted. STATA version 17 statistical software was used for analysis. A random-effects model was applied to compute the pooled estimates. Subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also performed. The prediction interval is computed to estimate the interval in which a future study will fall. The GRADE tool was also used to determine the quality of the evidence.

RESULTS

In this systematic review and meta-analysis, 15 studies involving 1768 HIV patients receiving third-line antiretroviral therapy were included. The pooled viral suppression of third-line antiretroviral therapy was 76.6% (95% CI: 71.5- 81.7%). The viral suppression rates at 6 and 12 months were 75.5% and 78.6%, respectively. Furthermore, third-line therapy effectively suppressed viral RNA copy numbers to ≤ 50 copies/mL, ≤ 200 copies/mL, and ≤ 400 copies/mL with rates of 70.7%, 85.4%, and 85.7%, respectively.

CONCLUSION

More than three-fourths of patients on third-line antiretroviral therapy achieve viral suppression. Consequently, improving access to and timely initiation of third-line therapy may positively impact the quality of life for those with second-line treatment failure.

Predictors of late initiation of breastfeeding practice in Ethiopia: a multilevel mixed-effects analysis of recent evidence from EDHS 2019

OBJECTIVES

To identify the predictors of late initiation of breastfeeding practice in Ethiopia.

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

A total of 1982 weighted samples of mothers with children aged under 24 months were included.

OUTCOME MEASURE

Late initiation of breastfeeding practice.

RESULTS

The prevalence of late breastfeeding initiation practice is 26.4% (95 CI 24.4 to 28.3). Being a young mother (15-24 years) (adjusted odds ratio (AOR) =1.66; 95 CI 1.06 to 2.62), no antenatal care (ANC) visit (AOR=1.45; 95 CI 1.04 to 2.02), caesarean section (AOR=4.79; 95 CI 3.19 to 7.21) and home delivery (AOR=1.53; 95 CI 1.14 to 2.06) were found to be the determinants of late initiation of breast feeding.

CONCLUSION

More than one-fourth of newborn children do not start breast feeding within the WHO-recommended time (first hour). Programmes should focus on promoting the health facility birth and increasing the ANC visits. Further emphasis should be placed on young mothers and those who deliver via caesarean section to improve the timely initiation of breast feeding.

The global burden of erectile dysfunction and its associated risk factors in diabetic patients: an umbrella reviews

BACKGROUND

Erectile dysfunction is no longer a whisper in the shadows; it's a rising tide threatening the sexual health of millions of men in different regions. In the cases of diabetes, the condition worsens and has a potent cocktail of physical and psychological distress, chipping away at men's confidence, self-esteem, and mental health. This worrying trend shows no signs of slowing down, with projections claiming a staggering 322 million men globally could be affected in the near future. This urgent issue demands immediate attention and action. Thus, this umbrella review intended to estimate the current burden of erectile dysfunction and associated risk factors among diabetic patients in the global context.

METHODS

Following PRISMA guidelines, we searched for relevant studies in PubMed, Embase, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. These studies reported the prevalence of erectile dysfunction and associated risk factors in diabetic patients. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews 2 tool. To estimate the pooled prevalence of erectile dysfunction, we employed a weighted inverse variance random-effects model. We further conducted subgroup analyses, assessed heterogeneity and publication bias, and performed sensitivity analyses to strengthen the robustness of our findings. Prediction intervals were also calculated to estimate the range within which future observations will likely fall. In all statistical analyses, the statistical significance was declared at P- value < 0.05.

RESULTS

In this umbrella review, a total of 108 030 male diabetic patients were included to estimate the global prevalence of erectile dysfunction. The pooled global prevalence of erectile dysfunction in diabetic patients was 65.8% (95CI: 58.3 - 73.3%), while In Africa it was 62.9% (95CI: 46.1-79.7). Age (> 40 years) (AOR = 1.95, 95CI: 1.03-3.24), DM duration (> 10years) (AOR = 1.90,95CI: 1.16-2.65), peripheral vascular disease (AOR = 2.74, 95CI: 1.42-4.06) and BMI (> 30 kg/m2) (AOR = 1.07,95CI: 1.01-1.20) were identified as associated risk factors of erectile dysfunction in diabetic patient.

CONCLUSION

The high global prevalence of erectile dysfunction (ED) in diabetic patients is alarming, with an estimated two-thirds experiencing the condition. These findings underscore the significant burden of ED faced by diabetic men and emphasize the urgent need for global attention to the issue. This includes promoting early screening for erectile dysfunction in this population and ensuring access to appropriate treatment and support.

Magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in low- and middle-income countries: An umbrella review of systematic review and meta-analysis

Background

To date, findings from systematic reviews and meta-analyses on unintended pregnancies in low-income and middle-income countries (LMICs) are inconsistent, posing challenges for preventive efforts. Therefore, the aim of this study is to determine the magnitude, determinants, and adverse outcomes of unintended pregnancy among pregnant mothers in LMICs: an umbrella review of systematic review and meta-analysis.

Methods

PubMed, Scopus, Science Direct, Web of Science, as well as databases specific to systematic reviews, such as the Cochrane Database, have investigated the magnitude, risk factors, and adverse outcomes of unintended pregnancy in LMICs. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates from the included studies regarding the magnitude and predictors of unintended pregnancy were then pooled and summarised using random-effects meta-analysis models.

Results

We included 13 systematic review and meta-analysis (SRM) studies involving 1 446 122 women. The summary estimate for the magnitude of unintended pregnancy was 28.38% (95% CI = 23.06-33.7%, I2 = 100%). From the umbrella review, the reported factors and complications of statistical significance were as follows: maternal illiteracy (AOR = 3.79; 95% CI = 1.36-8.94), being unmarried (AOR = 12.98; 95% CI = 1.88-27.85), lack of communication with the husband about family planning (AOR = 3.43; 95% CI = 1.68-5.19), inability to attend antenatal care (AOR = 1.4; 95% CI = 0.62-2.17), never using family planning (AOR = 1.4; 95% CI = 0.62-2.17), maternal depression (AOR = 1.72; 95% CI = 0.81-2.64), stunting (AOR = 1.76; 95% CI = 1.25-2.48), and parity 3.83 (AOR = 1.3; 95% CI = 1.3-11.3).

Conclusions

The pooled magnitude of unintended pregnancies in LMICs was high. Therefore, it is crucial to integrate family planning and maternal health care services to prevent unintended pregnancy. Additionally, interventions targeting rural, unmarried, less-educated, and adolescent women are important for preventing unintended pregnancies in LMICs.

Time to recovery from severe community-acquired pneumonia and its determinants among older adults admitted to North Wollo hospitals: A multi-centred cohort study

Background

Severe community-acquired pneumonia presents a looming threat to older adults globally, often resulting in alarming mortality rates. Despite advancements in treatment, challenges persist, exacerbated by factors like increasing comorbidity. As age rises, so does the risk of mortality and prolonged recovery periods. Particularly in low-income countries such as Ethiopia, the burden of severe community-acquired pneumonia is staggering. Yet, research on the estimated time to recovery and its determinants among older adults in this region remains insufficient, demanding urgent attention. Hence, in this study we endeavour to uncover insights into the recovery time and contributing factors among older adults.

Methods

We conducted a multi-centred retrospective cohort study among 422 older adults aged >65 years. We collected data using a structured checklist, and the final sample was meticulously selected using a systematic sampling technique. We computed Kaplan-Meier survival curves and log-rank tests to compare survival curves. We assessed multicollinearity using variance inflation factors. Further, we employed a Cox regression model to identify significant determinants, with model fitness evaluated using a Cox-Snell residual plot. Statistical significance was declared at a P ≤ 0.05.

Results

In this study, 79.3% (95% confidence interval (CI) = 75.58-83.29) of patients achieved recovery, with a median time to recovery from severe community-acquired pneumonia of 19 days. Age >75 years, diabetes mellitus, chronic obstructive pulmonary disease, elevated creatinine level and baseline white blood cells greater than 11.0 × 109/L were found to be significant determinants.

Conclusions

On average, older adults take 19 days to recover from severe community-acquired pneumonia. Recovery times are notably longer for individuals aged >75 years, those with comorbidities, and those with elevated white blood cell and creatinine levels. Therefore, tailored interventions addressing these specific factors could potentially improve patient outcomes.

Spatial variation, 20-year trends, and determinants of the double burden of wasting and stunting among under-five children in Ethiopia: a geo-spatial and multivariate decomposition analysis (2000-2019)

Despite extensive efforts, malnutrition persists as a critical public health concern, particularly in developing nations like Ethiopia. Concurrent occurrence of wasting and stunting poses severe consequences. Analyzing trends and factors contributing to this double burden is vital for evaluating and enhancing existing nutritional programs. Additionally, understanding the spatial distribution of malnutrition is crucial for targeted resource allocation, expediting progress towards optimal child growth. A 20-year trend and spatial analysis was conducted among 27,138 weighted samples of under-five children using EDHS (2000-2019). The data extraction was conducted between October 1 and November 1, 2023. STATA 18, ArcGIS Pro, and Sat Scan 9.6 were used for analysis. A logit-based multivariate decomposition analysis was used to identify contributing factors for the change in the double burden of wasting and stunting in the past 20 years. The statistical significance was declared at a P-value < 0.05. The double burden of wasting and stunting had shown a decline from 8.42% in 2000 to 3.31% in 2019. There is a clustered distribution of wasting and stunting (Moran's I = 0.0712, p-value = 0.0290). Significant clustering is detected in the Somali, Afar, and Tigray regions. Among the changes in the effect of the characteristics (coefficient), maternal education level [β = -0.0012, 95% CI -0.0021, -0.0006], wealth level [β = -0.0049, 95% CI -0.0223, -0.0014], family size [β = -0.0014, 95% CI -0.0132, -0.0009] and media access [β = -0.0027, 95% CI -0.0039, -0.0014] were found to be significant contributors to the reduction of the double burden of wasting and stunting over the past 20 years. Despite the significant progress observed in the past 20 years, the problem still requires urgent attention. Thus, improving maternal education and household wealth levels is crucial. Furthermore, enhancing access to and utilization of family planning services and media coverage will help alleviate the burden and end malnutrition. Additionally, deploying additional resources in hotspot areas is also recommended.

Prevalence of polypharmacy among older adults in Ethiopia: a systematic review and meta-analysis

Polypharmacy is a significant concern for older adults. Taking multiple medicines to prevent and treat comorbidities is very common in older adults, potentially leading to polypharmacy. Polypharmacy is associated with the development of geriatric syndromes, including cognitive impairment, delirium, falls, frailty, urinary incontinence, and weight loss. The prevalence of polypharmacy varies according to the literature. There is a paucity of data regarding the prevalence of polypharmacy among older adults. Therefore, this study aimed to estimate the pooled prevalence of polypharmacy among older adults in Ethiopia. A comprehensive search of databases, including PubMed, MEDLINE, EMBASE, Hinari, Cumulative Index to Nursing and Allied Health Literature, International Scientific Indexing, Cochrane library and Web of Science, and Google Scholar, was conducted. STATA statistical software (version 17) was used to analyze the data. Forest plot and I2 heterogeneity test were computed to examine the existence of heterogeneity. Subgroup analysis and sensitivity analysis were done to explore the source of heterogeneity. Publication bias was evaluated by using funnel plots and Egger's test. A random effect model was used to determine the pooled prevalence of polypharmacy. After reviewing 123 studies, 13 studies with a total of 3547 older adults fulfilled the inclusion criteria and were included in this meta-analysis. The result from 13 studies revealed that the pooled prevalence of polypharmacy among older adults in Ethiopia was 37.10% (95CI: 28.28-45.91). A Subgroup Meta-analysis showed that the heterogeneity level was slightly lower among studies done in Oromia region (I2 = 46.62, P-value = 0.154). Higher pooled polypharmacy prevalence was found among older adults with cardiovascular disorders (42.7%) and admitted patients (51.4%). In general, it was found that the pooled prevalence of polypharmacy among older adults in Ethiopia was high. More than one in three older adults take five or more medications at a time. Thus, intervention focusing on rational geriatric pharmacotherapy is significant to prevent unnecessary pill burden, adverse drug events, medical costs, geriatric morbidity, and mortality. Furthermore, enhancing pharmacist roles towards medication therapy management and safety monitoring in older adults is also indicated.

Spatial variation and determinants of delayed breastfeeding initiation in Ethiopia: spatial and multilevel analysis of recent evidence from EDHS 2019

BACKGROUND

Despite the World Health Organization's firm recommendation to start breastfeeding during the first hour after delivery, nearly 54% of children in low- and middle-income countries are unable to initiate breastfeeding within the recommended time frame. Understanding the initiation of breastfeeding is essential for optimal child health and maternal well-being.

METHODS

This study was conducted using the recent Ethiopian Demographic and Health Survey (EDHS) data (2019) on a weighted sample of 1982 Ethiopian mothers of children aged under 24 months. The data extraction was conducted between August 1 and 30, 2023. Delayed' initiation of breastfeeding is defined as failure to initiate breastfeeding within one hour after birth. STATA version 17 was used for non-spatial analysis. ArcGIS Pro and Sat Scan version 9.6 were used to map the visual presentation of delayed breastfeeding initiation. Global Moran's I was computed to determine whether delayed breastfeeding initiation is randomly distributed, clustered, or dispersed. Getis-Ord Gi* Spatial Statistics was done to identify significant spatial clusters of cold and hot spot areas. Multilevel mixed-effect logistic regression analysis was computed to identify determinants of delayed breastfeeding initiation.

RESULTS

The prevalence of delayed breastfeeding initiation is 26.4% (95% CI 24.4, 28.3). Significant clustering of delayed initiation of breastfeeding practice was found in the Somali region. Less clustering was identified in Northern Amhara, Addis Ababa and Dire Dawa. Being a young mother (15-24 years) (AOR 1.66; 95% CI 1.06, 2.62), no antenatal care (AOR 1.45; 95% CI 1.04, 2.02), cesarean section (AOR 4.79; 95% CI 3.19, 7.21) and home birth (AOR 1.53; 95% CI 1.14, 2.06) were found to be determinants of delayed initiation of breastfeeding.

CONCLUSIONS

In Ethiopia, delayed breastfeeding initiation is distributed non-randomly. Significant hotspot areas were identified in the eastern part of Ethiopia. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on promoting health facility birth and increasing antenatal care visits. Further emphasis should be considered on supporting young mothers and those giving birth via cesarean section to improve timely breastfeeding initiation.