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Spatial distribution and determinants of solitary childbirth in Ethiopia: Evidence from the 2019 interim demographic and health survey

by Tadesse Tarik Tamir, Berhan Tekeba, Alebachew Ferede Zegeye, Deresse Abebe Gebrehana, Mulugeta Wassie, Gebreeyesus Abera Zeleke, Enyew Getaneh Mekonen

Introduction

Solitary childbirth—giving birth without any form of assistance—remains a serious global public health issue, especially in low-resource settings. It is associated with preventable maternal complications such as hemorrhage and sepsis, and poses significant risks to newborns, including birth asphyxia, infection, and early neonatal death. In Ethiopia, where many births occur outside health facilities, understanding the spatial and socio-demographic patterns of solitary childbirth is vital for informing targeted interventions to improve maternal and child health outcomes. This study aims to identify and map the spatial distribution of solitary childbirth across Ethiopia and to analyze its determinants using data from the 2019 national Interim Demographic and Health Survey.

Method

We analyzed data from the 2019 Interim Ethiopian Demographic and Health Survey to determine the spatial distribution and factors of solitary birth in Ethiopia. A total weighted sample of 3,884 women was included in the analysis. Spatial analysis was used to determine the regional distribution of solitary birth, and multilevel logistic regression was employed to identify its determinants. ArcGIS 10.8 was used for spatial analysis, and Stata 17 was used for multilevel analysis. The fixed effect was analyzed by determining the adjusted odds ratio with a 95% confidence interval.

Result

The prevalence of solitary childbirths in Ethiopia was 12.73%, with a 95% confidence interval spanning from 11.71% to 13.81%. The western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and the west of Amhara regions were hotspot areas for solitary birth. Having no formal education, not attending ANC visits, and residing in pastoral regions were significantly associated with higher odds of solitary birth in Ethiopia.

Cocnlusion

A notable proportion of women are experiencing childbirth alone, which highlights a significant aspect of maternal health in the country, reflecting both the challenges and improvements in childbirth practices. The distribution of solitary births exhibited spatial clustering with its hotspot areas located in western and southern parts of Oromia, all of Benishangul-Gumuz, most parts of the SNNPR, and west of Amhara regions. Lack of education, not having an ANC visit, and being a resident of pastoral regions were significant determinants of solitary birth. The implementation of maternal and child health strategies in Ethiopia could benefit from considering the hotspot areas and determinants of solitary birth.

Cardiovascular disease risk and its determinants among hypertensive patients in Eastern Ethiopia: an institution-based cross-sectional study

Por: Ali · S. Y. · Shegere · M. M. · Abdulahi · A. · Hussein · A. A. · Abdinur · A. H. · Muhumed · A. A. · Ayele · Z. A. · Abebe · D. · Abdu · S. M. · Gemechu · W. D.
Objectives

This study aims to assess the level of cardiovascular disease (CVD) risk and its associated determinants among hypertensive patients in Jigjiga, Somali Region, Ethiopia using the WHO 10-year CVD risk score.

Design

An institution-based cross-sectional study design was employed.

Setting

Hypertensive patients aged 40–74 years in two public hospitals in Jigjiga, Somali Region, Ethiopia, from 20 December 2023 to 20 February 2024.

Participants

Randomly selected 344 hypertensive patients aged 40–74 years with a duration of 1 year or more from the time of diagnosis and at least having 6-month follow-up.

Primary outcome measures

10-year CVD risk level was assessed by using WHO 10-year CVD risk score. Risk levels were categorised as low (

Secondary outcome measures

Associated factors influencing CVD risk.

Results

The study included 341 hypertensive individuals, with a 99.1% response rate. Of the respondents, 58.9% were men. The overall prevalence of CVD risk within the coming 10 years was 134 (39.3%; 95% CI: 34.1% to 44.5%). Multivariable logistic regression analysis identified age, khat chewing, smoking and comorbid conditions as significant independent predictors of CVD risk. Specifically, individuals aged 60–69 years had an adjusted OR (AOR) of 3.97 (95% CI: 1.94 to 8.16) and those aged 70–74 years had an AOR of 2.99 (95% CI: 1.57 to 5.71). Khat chewers had an AOR of 2.58 (95% CI: 1.22 to 5.46), smokers an AOR of 3.44 (95% CI: 1.59 to 7.48) and individuals with comorbidities an AOR of 2.42 (95% CI: 1.47 to 3.99).

Conclusion

There is a significant increase in 10-year CVD risk among hypertensive patients in the study area. Age, khat chewing, smoking and comorbidities were independent predictors. Regular CVD risk screening for older patients, focused health education to reduce khat and tobacco use and integrated management of comorbidities are essential to lower future cardiovascular risk.

Prevalence, pathogenic bacteria, and risk factors associated with pediatric sepsis among under five children in a rural district hospital in Rwanda

by Patrick Orikiriza, Deogratius Ruhangaza, David S. Ayebare, Ezechiel Bizimana, Jean Baptiste Niyibizi, Irene Nshimiyimana, Louis Mujyuwisha, Abebe Bekele

Background

Pediatric sepsis poses a significant health challenge in Sub-Saharan Africa, with limited data on prevalence and pathogen profiles. This study determined the prevalence of pediatric sepsis, identified bacterial pathogens, and evaluated associated risk factors among children aged 1–59 months at Butaro Hospital, Rwanda.

Methods

A cross-sectional study was conducted from March 2022 to December 2022. The study included 114 children aged 1–59 months with suspected sepsis admitted to the pediatric ward at Butaro Hospital. Blood cultures were analyzed, and risk factors assessed using multiple logistic regression. Data were analyzed using Stata 17.

Results

Of 114 enrolled children, 60.5% (n = 69) had positive blood cultures (95% CI: 51.2–69.1). Among these 69 children, the majority were females, 70.0% (n = 35) (95% CI: 53.7–81.3) and below 6 months 68.1% (n = 15) (95% CI: 45.3–84.7). Pathogenic bacteria identified were Coagulase-Negative Staphylococci (CNS), 59.4% (n = 41) and Staphylococcus aureus, 40.6% (n = 28). Female gender (AOR = 2.4, 95% CI: 1.0–5.4, p = 0.045) and leukocytosis (AOR = 6.0, 95% CI: 2.0–20.2, p = 0.003) were the risk factors for sepsis.

Conclusions

The study reveals a high prevalence of sepsis among children under-five, especially females and less than 6 months with female gender and diagnosis with leukocytosis being a significant risk factor. Diagnostic strategies should focus on WBC counts to better manage at-risk children. These single-center study results however may not be broadly representative due to regional and resource differences, but they offer valuable insights for improving pediatric care in similar low-resource settings.

Incidence and predictors of mortality among children with severe acute malnutrition admitted to therapeutic feeding units in Ethiopia: a systematic review and meta-analysis

Por: Adugna · A. · Abebe · G. F. · Alie · M. S. · Girma · D.
Objective

To estimate the mortality rate and identify predictors of mortality among under-five children with severe acute malnutrition (SAM) admitted to therapeutic feeding units (TFUs) in Ethiopia.

Methods

We searched PubMed, HINARI, Science Direct, Google Scholar and African Journals Online from 1 March to 30 May 2024. The Joanna Briggs Institute checklist was used to appraise the included studies. Heterogeneity was identified using I2 statistics. Funnel plots and Egger’s tests were used to determine publication bias.

Results

Out of 1085 studies, 15 were included in this analysis. The pooled mortality rate among under-five children with SAM admitted to TFUs in Ethiopia was 8.32 per 1000 person-days of observation (95% CI: 6.25 to 11.06). The mortality rate has not changed over time. HIV infection (HR: 2.84; 95% CI: 1.25 to 6.42), tuberculosis (HR: 1.86; 95% CI: 1.35 to 2.56), intravenous fluid use (HR: 3.37; 95% CI: 2.39 to 4.75), altered body temperature (HR: 4.47; 95% CI: 1.90 to 10.51), impaired consciousness (HR: 2.91; 95% CI: 1.94 to 4.37), not receiving F-100 supplementation (HR: 4.51; 95% CI: 3.25 to 6.26), shock (HR: 4.20; 95% CI: 2.92 to 6.04), and nasogastric tube feeding (HR: 2.02; 95% CI: 1.67 to 2.44) were predictors of mortality.

Conclusion

The pooled mortality rate in Ethiopia was 8.32 per 1000 person-days, and it has not decreased over time. Most of the identified factors are related to comorbidities and complications of SAM, as well as nutritional therapy. Thus, it is essential to strengthen nutrition policies, programme implementation and healthcare services, which focus on the timely management of SAM complications, integrated care for comorbidities and improved F-100 supplementation.

PROSPERO registration number

CRD42024555014.

Causal analysis of undernutrition among adolescents in the context of the agrarian community of North-West Ethiopia: a general structural equation modelling approach

Por: Agedew · E. · Abebe · Z. · Ayelign · A.
Objective

This study was conducted to evaluate the causal analysis of undernutrition among adolescents in the context of the agrarian community of North-West Ethiopia.

Design

A community-based case-control study was conducted among 149 cases and 297 control adolescents.

Setting

Agrarian communities of North-West Ethiopia.

Participants

Adolescents aged 10–19 years, who reside in a randomly selected study setting.

Outcome measures

The stunting and thinness nutritional status of adolescents was determined using the WHO AnthroPlus 2010 software. A general structural equation modelling approach was used to determine a multicausal analysis of undernutrition. The Food Frequency Questionnaire was tested for internal reliability among 30 adolescents. The reliability test for the actual dietary tool was done using Cronbach’s alpha coefficient (α), which was 0.79. The model adequacy was tested using the Akaike information criterion and Bayesian information criterion. The significant direct and indirect determinants were identified with a value of p

Result

Adolescents with lower traditional and mixed dietary pattern consumption habits were determinant factors for stunting with adjusted β=0.65, 95% CL (0.143 to 1.159) with a value of p=0.012, adjusted β=2.697, 95% CL (0.563 to 4.831) with a value of p=0.013, respectively. Breakfast eating frequency had a negative indirect determinant factor on the reduction of stunting via lower traditional habits, with adjusted β=–0.207 (–0.299 to–0.116) with a value of p=0.001, and higher consumption habits of animal sources with traditional alcoholic drinking habits with adjusted β=–0.163, 95% CL (–0.260 to –0.065) with a value of p=0.001. Whereas breakfast eating frequency had a direct influence on thinness with adjusted β=–0.332, 95% CL (–0.588 to –0.076) with a value of p=0.011, and an indirect influence via dietary patterns for both stunting and thinness (p

Conclusion

Dietary patterns and breakfast-eating frequency were direct and indirect determinant factors for adolescents’ stunting and thinness. Public health interventions should be implemented to reduce stunting and thinness by improving the dietary feeding and breakfast consumption habits of adolescents and strengthening the national deworming programmes in study areas and similar settings.

Spatial distribution of mixed milk feeding and its determinants among mothers of infants aged under 6 months in Ethiopia: Spatial and geographical weighted regression analysis

by Mekuriaw Nibret Aweke, Muluken Chanie Agimas, Moges Tadesse Abebe, Tigabu Kidie Tesfie, Meron Asmamaw Alemayehu, Werkneh Melkie Tilahun, Gebrie Getu Alemu, Worku Necho Asferie

Background

Mixed milk feeding is defined as providing formula and/or animal milk along with breast milk to infants under six months old which is prevalent in many countries. However, this practice is generally not recommended as it can reduce the intake of breast milk, depriving the infant of its optimal nutritional and immunological benefits. Unlike formula, breast milk contains complex bioactive constituents that promote intestinal and pancreatic growth and develop mucosal defenses. The aim of this study was to analyze the spatial distribution and predictors of MMF practices in Ethiopia.

Methods

This study utilized data from the 2019 Mini-Ethiopian Demographic and Health Survey (MiniEDHS), a nationally representative cross-sectional survey conducted from March to June 2019. The total weighted sample size derived from the data examined in this study amounted to 524 infants. The data analysis used Global Moran’s I for spatial autocorrelation and the Getis-Ord Gi * statistic for local cluster analysis to assess the spatial distribution of mixed milk feeding prevalence across Ethiopia’s administrative regions and cities. Empirical Bayesian Kriging was used for spatial interpolation to estimate mixed milk feeding prevalence in unsampled areas. The analysis utilized a maximum spatial cluster size threshold of 50% of the population to detect clusters of varying sizes. Ordinary least squares regression analysis identified significant spatial predictors. In geographically weighted regression analysis, the effect of predictor variables on the spatial variation of mixed milk feeding was detected using local coefficients.

Results

The overall weighted prevalence of Mixed Milk Feeding (MMF) in Ethiopia was 10.12% (95% CI: 7.8, 13.01). This prevalence shows significant regional variations across the country emphasizing regional disparities in prevalence and distribution. The Global Moran’s I statistic was 0.14, with a Z-score of 3.18 and a p-value of Conclusion

The study found significant regional variations in mixed milk feeding practices in Ethiopia. Households with middle wealth index and baby without postnatal check were significant spatial predictors of mixed milk feeding. To reduce mixed milk feeding prevalence, targeted interventions should engage community leaders, enhance breastfeeding education in maternal health services, and integrate counseling into routine healthcare to support informed maternal choices and improve child health outcomes nationwide.

Susceptibility status of <i>Aedes aegypti</i> (Diptera: Culicidae) to public health insecticides in Southern Afar Region, Ethiopia

by Mohammed Seid, Esayas Aklilu, Abebe Animut

Mosquito-borne viral diseases such as dengue fever, chikungunya, and yellow fever have been documented in Ethiopia since the 1960s. However, the efficacy of public health insecticides against Aedes aegypti that transmits these viruses remains poorly understood in the country, particularly in the Afar Region. Thus, the aim of the study was to assess the susceptibility status of Ae. aegypti to deltamethrin, permethrin, alpha-cypermethrin, pirimiphos-methyl, bendiocarb, and propoxur insecticides. Larvae and pupae of Aedes species were collected from Awash Arba, Awash Sebat, and Werer towns of the Afar Region of Ethiopia during July-October 2022, brought to the Aklilu Lemma Institute of Pathobiology, insectary and reared to adults. Non-blood-fed, 3–5 days-old females Ae. aegypti were exposed to pyrethroid, carbamate, and organophosphate insecticide impregnated papers in tube test following the standard guidelines. Knockdown rates were noted at 10 minutes interval until one hour. The mortality in mosquitoes was recorded 24 hours after 60 minutes of exposure. The mortality rates of Ae. aegypti exposed to propoxur were 87% in all the study towns. Similarly, 88% mortality in Ae. aegypti was recorded when tested with bendiocarb in Awash Sebat and Awash Arba towns. Suspected resistance of Ae. aegypti (95% mortality) to alpha-cypermethrin was observed in Awash Arba town. However, Ae. aegypti collected from all the three sites was observed to be susceptible to deltamethrin, permethrin, and pirimiphos-methyl. Ae. aegypti was resistant to 0.1% bendiocarb and 0.1% propoxur and possibly resistant to 0.05% alpha-cypermethrin. On the other hand, it was susceptible to 0.05% deltamethrin, 0.75% permethrin, and 0.25% pirimiphos-methyl. Thus, vector control products with deltamethrin, permethrin, and pirimiphos-methyl can be used in the control of adult Ae. aegypti in the Afar Region of Ethiopia. However, further studies should be carried out to evaluate the susceptibility status of Ae. aegypti to alpha-cypermethrin in the Awash Arba area.
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