Mortality In Ethiopia Research Articles

Correlates of undernutrition of children (Aged 5–14 Years) in Haramaya District, Eastern Ethiopia

Undernutrition continues to contribute substantially to childhood morbidity and mortality in Ethiopia, as elsewhere. In Ethiopia, most studies unraveling the correlates of risk are based on school-based anthropometric surveys of wasting and stunting. Therefore, this study aimed to determine prevalence of undernutrition and detail associated factors among children aged 5–14 years from a population-representative sample of households in the Haramaya District Demographic and Health Surveillance site, Eastern Ethiopia. Data were collected June 30th to July 15th, 2020. A detailed community-based cross sectional survey was conducted among 822 randomly selected children aged 5–14 years, including interviews with mothers/guardians and measurements of children. Wasting and stunting status of children was assessed via anthropometric measurements and WHO Anthro Survey Analyzer was used to analyze Z-score. Multivariable binary logistic regression model was fitted including an array of contextual variables, including highly local considerations such as khat (chat) use. Variables with a p-value<0.05 were declared significant factors associated under-nutrition. The prevalence of stunting and thinness was found to be 22.4% [(95% CI: 19.7, 25.5] and 11.9% [(95% CI: 9.8, 14.3], respectively. Parents Kchat chewing is associated with acute malnutrition (wasting) (AOR (1.43(1.19, 2.97). but not chronic malnutrition (stunting). Children being from poor households [AOR = 1.60, 95% CI: 1.05, 2.42], family size greater than three [AOR = 1.71, 95% CI: 1.13, 2.60], and dietary diversity score three or less food groups [AOR = 1.5, 95% CI: 1.07, 2.13] were significantly associated with stunting. While being in age range of 13–14 [AOR = 2.25, 95% CI: 1.13, 4.47], family size of 4 and above [AOR = 2.60, 95% CI: 1.34, 5.03] and dietary diversity score three or less food groups [AOR = 1.89, 95% CI: 1.17, 3.04] were significantly associated with thinness. The finding of this study showed that there was high prevalence of stunting and thinness among children aged from 5 to 14 years old in Haramaya district. Therefore, all stakeholders should need to strengthen nutritional counseling of family and sensitization of family planning program. • Parents Kchat chewing is associated with acute malnutrition (wasting) but not chronic malnutrition (stunting). • The finding of this study showed that there was high prevalence of stunting and thinness. • Increase family size and poor dietary diversity is related with both thinness and stunting.

Knowledge, attitude, and practice towards burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia. A cross-sectional study

BackgroundBurn injuries are thought to be preventable but are still a prevalent global health problem, especially in low- and middle-income countries. It continues to remain a leading cause of morbidity and mortality in Ethiopia. Proper knowledge about burn first aid minimizes the overall impact of the injury. PurposeThis study aimed to assess the knowledge, attitude, and practice toward burn first aid and its associated factors among caregivers attending burn units in Addis Ababa, Ethiopia, 2021/22. MethodsA hospital-based cross-sectional study was conducted among caregivers of burn patients attending Yekatit 12 hospital medical college and Addis Ababa Burn Emergency and Trauma (AaBET) hospital burn units. A total of 305 caregivers were recruited by a simple random sampling method from both hospitals. Data was collected using a standard interviewer-administrated questionnaire, cleaned, coded, and entered into EPI data version 6, and then exported to SPSS version 26 for further analysis. The generated data were compiled by frequency tables, charts, and graphs. A logistic regression model was used to measure the association between independent versus outcome variables, considering the AOR, 95% CI, and p < 0.05 as significant for all the independent variables. ResultA total of 305 participants responded to this study. Among these, the majority, 185(60.7%) of caregivers were females, while 120(39.3%) were Males. The main source of knowledge for those who had previous information on a burn and its first aid treatment were families, friends, colleagues, and guardians. A significant portion of 246(80.7%) respondents did not take any form of burn first aid training. The study indicates that 202(66.2%) and 195(63.9%) of the study participants have poor knowledge and practice, respectively, despite the majority. 225(73.8%) of responders have a favorable attitude regarding burn first aid. Conclusion and recommendationThis study showed an explicit knowledge and practice gap among caregivers towards burn first aid even though the majorities have a favorable attitude. Developing an effective nationwide burn prevention program and early burn first aid treatment in Ethiopia and promoting a consistent guideline for burn first aid.

Reducing Calf Mortality in Ethiopia

Simple SummaryDisease and death of young livestock cause financial and production difficulties to farmers around the world. High rates of disease and death occur in various production systems in Ethiopia, hampering livestock production, reducing incomes, and damaging livelihoods. Over the last 10 years, studies carried out in Ethiopia have reported death and disease incidence rates in young livestock as high as 31% and 67%, respectively. Diarrhea and respiratory infections are the two leading causes of disease and death in calves in all production systems. In this paper, we describe findings from the experience of the Young Stock Mortality Reduction Consortium. This unique group produced important information on the main causes of disease and death in Ethiopia and created activities for small-scale farmers to address these problems. We found that several diseases caused diarrhea and respiratory infections in young calves in Ethiopia. Improving farmer knowledge and behaviors with respect to basic livestock management led to considerable reductions in young livestock disease and death and has the potential to help improve livestock productivity and human livelihoods in Ethiopia.Morbidity and mortality of young stock present economic and production challenges to livestock producers globally. In Ethiopia, calf morbidity and mortality rates, particularly due to diarrhea and respiratory disease, are high, limiting production, incomes, and the ability of farmers to improve their livelihoods. In this paper, we present findings from the combined experience of the Young Stock Mortality Reduction Consortium, which conducted epidemiological and intervention testing in calves across three production systems. This innovative alliance identified Cryptosporidium parvum and E. Coli K99 as the most common causes of diarrhea in pastoral and peri-urban calves; Strongyloides spp. as the most common fecal parasite in mixed crop–livestock and peri-urban calves; and bovine adenovirus, parainfluenza virus-3, and bovine respiratory syncytial virus as the most common respiratory pathogens in peri-urban calves. Furthermore, by improving producer knowledge with respect to fundamental livestock husbandry, feeding, housing, and neonatal care practices, calf mortality risk across production systems was reduced by 31.4 to 71.4% compared to baseline (between 10.5 and 32.1%), whereas risk of diarrhea was reduced by 52.6–75.3% (baseline between 11.4 and 30.4%) and risk of respiratory disease was reduced by 23.6–80.8% (baseline between 3.3 and 16.3%). These findings have informed scaling strategies and can potentially contribute to improved livestock productivity and human livelihoods in Ethiopia.

Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa.

BackgroundBloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria.ObjectiveTo determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia.MethodsA cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software.ResultsThe prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI.ConclusionPediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.

Health sector performance in Ethiopia: a study in regional disparities

The paper is an attempt to review the status of health parameters in the light of demographic attributes of population growth and mortality in Ethiopia. Health infrastructures, health personnel and health services to population ratios have been worked out and compared at regional levels. Twenty-six variables have been used to analyze national and regional situations. Results have been explained in terms of regional development levels, regional disparity, relative disparity and absolute disparity in the case of health services, infrastructures and health personnel to population ratios. In terms of health sector development; Addis Ababa, Amhara and Harari regions have high development (D.I= 0.283-0.74); Dire Dawa, Oromia and Tigray have moderately high development (D.I. = 0.165-0.220); Afar, SNNPR, and Somali regions have a moderately low level of development (D.I. from 0.125 to 0.155); while regions of Gambella and Beneshangul Gumuz reflect a low level of development (D.I. from 0.114 to 0.115) in relation to health facilities and infrastructures. The absolute disparity was extremely high in variables such as Basic Emergency Obstetric Care (BemOC) (1:534) and Comprehensive Emergency Obstetric Care (CemOC) (1:204) and availability of all other health professionals (1: 118.13).Similarly, the relative disparity was very high in cases of the functional health center to population ratio (230.71 %), all other health professionals (133.22%), BEmOC (120.36),CEmOC (116.52% and deaths due to malaria (114.85%). In terms of health sector performance Addis Ababa and Amhara regions present low regional disparities while Gambella and Beneshangul Gumuz regions reflect a very high regional disparity.

Factors associated with post-neonatal mortality in Ethiopia: Using the 2019 Ethiopia mini demographic and health survey.

Post-neonatal mortality is the number of deaths of infants aged 28 days through 11 months and is expressed as post-neonatal deaths per 1000 live births per year. This study aimed to identify the factors that influence post-neonatal death using the 2019 Ethiopia mini demographic and health survey (EMDHS2019). The study included 2126 post neonates born from mothers who had been interviewed about births in the five years before the survey. The survey gathering period was carried out from March 21, 2019, to June 28, 2019. The data were first analyzed with a chi-square test of association, and then relevant factors were evaluated with binary logistic regression models and the results were interpreted using adjusted odds ratio (AOR) and confidence interval(CI) of parameters. The prevalence of post neonatal death was 16% (95% CI: 15.46, 17.78). The study also showed that not vaccinated post-neonates (AOR = 2.325, 95% CI: 1.784, 3.029), mothers who were not receiving any tetanus injection (AOR = 2.891, 95% CI: 2.254, 3.708), mothers age group 15-24(AOR = 1.836, 95% CI: 1.168, 2.886), Afar (AOR = 2.868, 95% CI: 1.264, 6.506), Somali(AOR = 2.273, 95% CI: 1.029, 5.020), Southern Nations, Nationalities, and People's Region(SNNP) (AOR = 2.619, 95% CI: 1.096, 6.257), 2-4 birth orders (AOR = 1.936, 95% CI: 1.225, 3.060), not attend antenatal care(ANC) visit (AOR = 6.491, 95% CI: 3.928, 10.726), and preceding birth interval less than 24 months (AOR = 1.755, 95% CI: 1.363,2.261) statistically associated with a higher risk of post neonatal death. Although not given anything other than breast milk (AOR = 0.604, 95% CI 0.462, 0.789), urban residents (AOR = 0.545, 95% CI: 0.338, 0.877), single births (AOR = 0.150, 95% CI: 0.096, 0.234), less than 3 children in a family (AOR = 0.665, 95% CI 0.470, 0.939) and the head of the male household (AOR = 0.442, 95% CI: 0.270, 0.724) were statistically associated with a lower risk of post-neonatal mortality. It is highly suggested that maternal and child health care services (including antenatal care visits, postnatal care visits, and immunization) be strengthened and monitored during the early stages of infancy. Mothers from Somali, Afar, and SNNP regions, as well as multiple births, rural residents, and those giving birth to a child with a birth gap of fewer than 24 months, demand special care.

Multilevel log linear model to estimate the risk factors associated with infant mortality in Ethiopia: further analysis of 2016 EDHS

BackgroundInfant mortality is defined as the death of a child at any time after birth and before the child’s first birthday. Sub-Saharan Africa has the highest infant and child mortality rate in the world. Infant and child mortality rates are higher in Ethiopia. A study was carried out to estimate the risk factors that affect infant mortality in Ethiopia.MethodThe EDHS− 2016 data set was used for this study. A total of 10,547 mothers from 11 regions were included in the study’s findings. To estimate the risk factors associated with infant mortality in Ethiopia, several count models (Poisson, Negative Binomial, Zero-Infated Poisson, Zero-Infated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial) were considered.ResultThe average number of infant deaths was 0.526, with a variance of 0.994, indicating over-dispersion. The highest mean number of infant death occurred in Somali (0.69) and the lowest in Addis Ababa (0.089). Among the multilevel log linear models, the ZINB regression model with deviance (17,868.74), AIC (17,938.74), and BIC (1892.97) are chosen as the best model for estimating the risk factors affecting infant mortality in Ethiopia. However, the results of a multilevel ZINB model with a random intercept and slope model revealed that residence, mother’s age, household size, mother’s age at first birth, breast feeding, child weight, contraceptive use, birth order, wealth index, father education level, and birth interval are associated with infant mortality in Ethiopia.ConclusionInfant deaths remains high and infant deaths per mother differ across regions. An optimal fit was found to the data based on a multilevel ZINB model. We suggest fitting the ZINB model to count data with excess zeros originating from unknown sources such as infant mortality.

Assessing Individual- and Community-Level Variability in Predictors of Neonatal, Infant, and Under-Five Child Mortality in Ethiopia Using a Multilevel Modeling Approach.

Background: In low-and middle-income countries, child mortality rates are basic indicators of a country’s socio-economic situation and quality of life. The Ethiopian government is currently working to reduce child mortality to accomplish its long-term development goals. Using data from the Ethiopian Mini Demographic and Health Survey, 2019, this study analyzed the determinants of child mortality in Ethiopia. Methods: A total of 4806 children were considered in the final analyses. Multivariate analysis was used to estimate the effects of the predictors simultaneously on each child mortality outcome. Results: The findings revealed that 31.6% of children died during the neonatal stage, 39.1% during the infant stage, and 48.5% during the under-five stage. Variation in child mortality was discovered between Ethiopian community clusters, with the result of heterogeneity between clusters on newborn mortality (χ2 = 202.4, p-value < 0.0001), (χ2 = 777.35, p-value < 0.0001), and (χ2 = 112.92, p-value < 0.0001). Children’s neonatal, infant, and under-five mortality intracluster correlation coefficient (ICC) were 0.35, 0.33, and 0.36, respectively, across communities. Conclusions: In Ethiopia, under-five mortality remains a serious public health issue, with wide variations and high rates among community clusters. Intervention measures focusing on lowering rates of household poverty, increasing education opportunities, and improving access to health care could assist in reducing child mortality in Ethiopia.

Prevalence and associated factors of neonatal mortality in Ethiopia

Neonatal mortality is the death of a live-born baby within the first 28 days of birth. For the selected households, neonatal mortality was collected from children aged 0–28 days and women aged 15–49. The neonatal period is a significant 4-week period in human life because it carries a greater mortality risk. To identify the determinant factors of neonatal mortality in Ethiopia based on EDHS 2016 data with the application of count regression models. In this study, all neonates in Ethiopia were born within the 5 years preceding EDHS 2016 of the source population in the selected EAs from September to December 2015. Count regression models were used to analyze the data. A total of 10,641 live-born neonates within the previous 5 years of EDHS 2016 had neonatal mortality of women aged 15–49, which was considered in the study to be 7193. The data were found to have excess zeros (96.6%), and the variance (0.052) was higher than its mean (0.04). The count regression model (ZINB) was best fitted to the data with maximum likelihood parameter estimation methods. The average neonatal mortality difference in multiple births was increased by IRR = 8.53 times compared with a single birth. The average number of neonatal deaths experienced during breastfeeding was lower (IRR = 0.38) than that experienced by mothers who did not experience breastfeeding their child. The average neonatal mortality difference in rural residences was increased by IRR = 3.99 times compared to urban mothers' residences. In this study, the prevalence of Neonatal mortality in Ethiopia was higher. For selected ZINB count regression models of explanatory variables, such as multiple birth types, having rural residence factors of neonatal mortality increased the risk of death. However, having early breastfeeding, a female household head, and antenatal visits (1–4) and (5–10) during pregnancy decrease the risk of neonatal death.

COVID-19 Case Fatality Rate and Factors Contributing to Mortality in Ethiopia: A Systematic Review of Current Evidence

BackgroundThe ongoing novel coronavirus disease 2019 (COVID-19) is triggering significant morbidity and mortality due to its contagious nature and absence of definitive management. In Ethiopia, despite a number of primary studies have been conducted to estimate the case fatality rate (CFR) of COVID-19, no review study has attempted to summarize the findings to better understand the nature of pandemics and the virulence of the disease.ObjectiveTo summarize the CFR of COVID-19 and factors contributing to mortality in Ethiopia.MethodsPRISMA guideline was followed. PubMed, Science Direct, CINAHL, SCOPUS, Hinari, and Google Scholar were systematically searched using pre-specified keywords. Observational studies ie, cohort, cross-sectional, and case-control studies were included. The Newcastle-Ottawa scale adapted for observational studies was used to assess the quality of included studies. CFR was defined as the proportion of COVID-19 cases with the outcome of death within a given period. Factors contributing to COVID-19 mortality at p-value <0.05 were described narratively from the eligible articles.ResultsA total of 13 observational studies were included in this study. Consequently, this review confirmed the CFR of COVID-19 in Ethiopia ranges between 1–20%. Additionally, comorbid conditions, older age group, male sex, substance use, clinical manifestations (abnormal oxygen saturation level, atypical lymphocyte count, fever, and shortness of breath), disease severity, and history of surgery/trauma increased the likelihood of death from COVID-19 death.ConclusionThis study shows that the range of CFR of COVID-19 in Ethiopia is almost equivalent to other countries, despite the country’s low testing capacity and case detection rate in reference to its total population. Comorbid diseases, older age group, male sex, cigarette smoking, alcohol drinking, clinical manifestations and disease severity, and history of surgery/trauma were factors contributing to COVID-19 mortality in Ethiopia. Therefore, given the alarming global situation and rapidly evolving large-scale pandemics, urgent interdisciplinary interventions should be implemented in those vulnerable groups to lessen the risk of mortality. Furthermore, the CFR of COVID-19 should be estimated from all treatment and rehabilitation centers in the country, as underestimation could be linked to a lack of preparedness and mitigation. A large set of prospective studies are also compulsory to better understand the CFR of COVID-19 in Ethiopia.

Bayesian spatial analysis of factors influencing neonatal mortality and its geographic variation in Ethiopia.

BackgroundEthiopia is a Sub-Saharan country with very high neonatal mortality rates, varying across its regions. The rate of neonatal mortality reduction in Ethiopia is slow, and Ethiopia may not meet the third United Nations sustainable development target by 2030. This study aimed to investigate the spatial variations and contributing factors for neonatal mortality rates in Ethiopia.MethodsWe analysed data from the 2016 Ethiopian Demographic and Health Survey (EDHS), which used a two-stage cluster sampling technique with a census enumeration area as primary and households as secondary sampling units. A Bayesian spatial logistic regression model using the Stochastic Partial Differential Equation (SPDE) method was fitted accounting for socio-economic, health service-related and geographic factors.ResultsHigher neonatal mortality rates were observed in eastern, northeastern and southeastern Ethiopia, and the Somali region had higher risks of neonatal mortality. Neonates from frequently drought-affected areas had a higher mortality risk than less drought-affected areas. Application of traditional substances on the cord increased the risk of neonatal mortality (Adjusted Odds Ratio (AOR) = 2.07, 95% Credible Interval (CrI): 1.12 to 4.30) and getting health facility delivery services had a lower odds of neonatal mortality (AOR = 0.60, 95% CrI: 0.37, 0.98).ConclusionsResiding in drought-affected areas, applying traditional substances on the umbilical cord and not delivering at health facilities were associated with a higher risk of neonatal mortality. Policy-makers and resource administrators at different administrative levels could leverage the findings to prioritise and target areas identified with higher neonatal mortality rates.

The factors associated with under-five mortality in Ethiopia

BackgroundUnder-five mortality refers to the likelihood of dying between the ages of birth and five. The number of children under the age of five who die each year continues to climb worldwide. Over the previous few decades, the industry has made great progress in reducing mortality among children under the age of five. The study aims to identify the factors associated with under-five mortality in Ethiopia. Subject and methodCommunity-based Cross-sectional data came from Ethiopia's Mini Demographic and Health Survey 2019. In two stages, the 2019 EMDHS sample was stratified and selected. 8855 women of reproductive age were interviewed using a nationally representative Woman (ages 15 to 49) and 5753 children were included. Ethiopia's under-five mortality served as the study's dependent (response) or outcome variable. Binary logistic regression was used to see if there is an association between the dependent and independent variables. All variables with a p-value of less than 0.25 in the bivariate analysis were chosen for the multivariable logistic regression to compensate for putative confounders. Significant predictors were defined as factors with a p-value of less than 0.05. ResultsA total of 5753 under-5 mortality were enrolled in this study. 339 (5.9%) of under-five Mortality have been declared lifeless before reaching the age of five. There were 1328(23.1%) and 4425(76.1%) with 72 (5.42%) and 267 (6.02%) of under-five mortality occurring in urban and rural respectively. Under-five mortality in the Afar region was 2.280 times more likely Compared to Children born in Tigray Region (AOR = 2.280 95% CI = 1.137–4.568, P = .020). Under-five Mortality in Rural residences was 1.908 times more likely as Compared to Urban Residence (AOR = 1.908, 95% CI = 1.257–4.539, P = .035). Under-five mortality in Poorer index Households was 0.343 times Less likely as compared to children born in the poorest index Household (AOR = 0.343,95% CI = 0.128–0.910, P = ). Under-five mortality in the public sector was 1.763 times less likely than among children born at Home (AOR = 1.763, 95% CI = 1.252–2.482, P = .033). Under-five Mortality of second multiple births was 2.389 times more likely Compared to Single birth (AOR = 2.389, 95% CI = 1.257–4.539, P = .008). ConclusionThis study found that the prevalence of under-five mortality, is 5.9% (59/1000) or 59 death per one thousand live children in Ethiopia. The under-five mortality rate is rapidly declining, and access to and utilization of health care is improving. Region, residence, level of education, wealth index, Place of Delivery and multiple births have all been statistically significant factors of under-five mortality in Ethiopia. The government and all stockholders should be given attention to maternal and infant health care to reduce under-five mortality.

Level of Postnatal Checkup in Ethiopia - Implications for Child Health Services.

BackgroundHigh neonatal mortality rates continue to be a major public health issue in Ethiopia. Despite different maternal and neonatal care interventions, neonatal mortality in Ethiopia is at a steady state. This could be due to the low utilization of neonatal checkups. Thus, nationally assessing the level and predictors of postnatal checkups could provide important information for further improving neonatal healthcare services.Materials and MethodsA secondary data analysis of the 2016 Ethiopia Demographic and Health Survey (EDHS) was performed on 7,586 women who had live births in the 2 years before the survey. All variables with a p-value of ≤0.25 in the bivariable analysis were entered into the final model for multivariable analysis, and the level of statistical significance was declared at a P-value of <0.05.ResultsAccording to the national survey, only 8.3% [95% CI: 8.19, 8.41] of neonates received postnatal checkups. About two-thirds of women, 62.8% had antenatal care visits, 67.9%, gave birth at home, and 95.7% were unaware of neonatal danger signs. Distance from health care institutions [AOR = 1.42; 95% CI: 1.06, 1.89], giving birth in a healthcare facility [AOR = 1.55; 95% CI: 1.12, 2.15], antenatal care visit [AOR = 3.0; 95% CI: 1.99, 4.53], and neonatal danger signs awareness [AOR = 3.06; 95% CI: 2.09, 4.5] were all associated with postnatal care visits.ConclusionThe number of neonates who had a postnatal checkup was low. Increasing antenatal care visit utilization, improving institutional delivery, raising awareness about neonatal danger signs, increasing access to health care facilities, and implementing home-based neonatal care visits by healthcare providers could all help to improve postnatal checkups.

Health Care Readiness in Management of Preeclampsia/Eclampsia in Ethiopia: Evidence from National Facility-Based Survey.

BackgroundEarly case detection, treatment, and timely referral for better services can significantly reduce the negative outcomes of preeclampsia and eclampsia. However, evidence on health facilities’ readiness to provide such services and the associated challenges is limited in Ethiopia. Therefore, this study aimed to assess the readiness of Ethiopian health care facilities to manage preeclampsia and eclampsia.MethodsThis study used the 2016 Ethiopia national emergency management of obstetrics and newborn care (EmONC) survey. This survey was a national cross-sectional census of health facilities that provided delivery services. Data on facility infrastructure, equipment and supplies were collected through a facility checklist, and interview health provider experiences. Cross tabulation, summarisation and chi square tests by facility type, location, and management authority were conducted.ResultsThere were 3804 health facilities included in the survey across all regions of Ethiopia. The majority of facilities (92%) were public/government managed with only 1% of available hospitals located in rural areas. Poor availability of dipsticks for proteinuria tests (55.3%), caesarean sections (7.9%), and ambulance services (18.4%) were reported across health facilities with high variations in terms of facility type, location, and type of managing authority. Diazepam was a widely available anticonvulsant compared with magnesium sulfate (MgSO4), with more available in private for-profit facilities compared with public facilities. Nearly one third of health care providers were not trained to administer MgSO4 intravenously. The result indicated that the chi-square test was statistically significant at P < 0.001.Conclusions and RecommendationsThere were notable gaps in readiness of facilities in detection and management of preeclampsia/eclampsia that increase maternal and perinatal mortality in Ethiopia. Therefore, availability of essential supplies, medications, and referrals are required. In addition, refresher training to healthcare providers on screening, diagnosis and management of preeclampsia/eclampsia and continuous supervision should be provided.

Magnitude and Predictors of In-Hospital Stroke Mortality in Ethiopia: A Systematic Review and Meta-Analysis.

Introduction Stroke is the second leading cause of mortality worldwide, accounting for approximately 5.5 million deaths each year. Due to demographic and health changes, the epidemiology of stroke is shifting from industrialized to low- and middle-income nations. Ethiopia is a developing country with a population that reflects this shift. Therefore, this systematic review and meta-analysis are aimed at evaluating the extent of in-hospital mortality of both ischemic and hemorrhagic stroke in Ethiopia and determining relevant factors associated with the mortality. Methods Observational studies published as of July 15, 2020, that reported the magnitude, predictors, and causes of in-hospital mortality of stroke were systematically and comprehensively retrieved using the PRISMA 2020 criteria from databases such as PubMed/MEDLINE, Science Direct, and Google Scholar. The review papers were chosen based on the study methodology (facility-based observational), the study area (Ethiopia), the study population (adult patients with stroke), the outcome (in-hospital mortality), and the fact that they were published in English. Result A total of 3709 patients with stroke were included in this systematic review and meta-analysis, which included 19 publications. In-hospital mortality was 14.03 percent on average in the studies, with reports ranging from 6.04 percent to 37.37 percent. Patients with hemorrhagic type stroke, admission Glasgow Coma Scale less than or equal to 12, impaired mental status, National Institutes of Health Stroke Scale stroke level greater than 13, prolonged hospital stay, any incontinence, pneumonia, and/or swallowing trouble had an increased risk of death after stroke. Conclusion The magnitude of in-hospital mortality of patients with stroke in Ethiopia is high. The assessment of the level of consciousness is vital for clinical management and as an indicator of prognosis. Patients with unfavorable prognostic signs, such as entry Glasgow Coma Scale, National Institutes of Health Stroke Scale stroke level > 13, hemorrhagic stroke, pneumonia, incontinence, and dysphagia, should be given priority.

Neonatal Mortality Rate and Its Determinants: A Community-Based Panel Study in Ethiopia.

BackgroundThe Sustainable Development Goals specifically target a reduction in neonatal mortality rates. However, the highest neonatal mortality rates occur in sub-Saharan Africa, including Ethiopia. Although several factors contributing to these high rates have been explored, there continues to be a general dearth of studies and inconsistencies of factors to understand the problem. Therefore, this study aimed to identify the prevalence and factors associated with neonatal mortality in Ethiopia.MethodsA panel study was conducted among 2,855 pregnant or recently postpartum women selected using the multistage cluster sampling technique from October 2019 to September 2020. Data were collected by experienced and trained female resident enumerators and coded, cleaned, and analyzed using STATA version 16.1 software. We used the Kaplan–Meier survival curve to show the pattern of neonatal deaths during the first 28 days of life. Frequencies and rates were reported along with the percentages and using a 95% confidence interval, respectively. The Cox proportional hazard regression model was used to explore the association of explanatory and outcome variables. Finally, an adjusted hazard ratio with a 95% confidence interval was used to report the results, with a p < 0.05 to declare statistical significance.ResultsThe neonatal mortality rate was 26.84 (95% CI: 19.43, 36.96) per 1,000 live births. Neonates born to rural resident mothers (AHR = 2.18, 95% CI: 1.05, 4.54), mothers of advanced age (AHR = 2.49, 95% CI: 1.19, 5.21), and primipara mothers (AHR = 3.16, 95% CI: 1.52, 6.60) had a higher hazard of neonatal mortality. However, neonates born to women who attended technical and vocational level education (AHR = 0.08, 95% CI: 0.01, 0.62) had a lower hazard of neonatal mortality.ConclusionsThe neonatal mortality rate in Ethiopia is high, with increased risk among specific subsets of the population. The findings highlight that neonatal survival can be improved through tailored interventions for rural residents, emerging regions, and primipara women by improving female education and avoiding pregnancy at an advanced maternal age to achieve Sustainable Development Goal target 3.2.

Determinants of under-five mortality in Ethiopia using the recent 2019 Ethiopian demographic and health survey data: nested shared frailty survival analysis

BackgroundWorldwide, there is remarkable progress in child survival in the past three decades. Ethiopia is off-track on sustainable development targets in under-five mortality since 2020. Therefore, this study aimed to investigate time to death and its associated factors among under-five children in Ethiopia.MethodsNationally representative demographic and health survey data were used for this study. A total of 5772 under-five children were included. Data were analyzed using R software. Semi-parametric nested shared frailty survival analysis was employed to identify factors affecting under-five mortality. Adjusted hazard ratio (AHR) with 95% Confidence interval (CI) was reported and log-likelihood was used for model comparison. Statistical significance was declared at P-value < 0.05.ResultsThe weighted incidence of under-five death before celebrating the first fifth year was 5.76% (95% CI: 5.17 – 6.40). Female sex and under-five children living in urban areas were high probability of survival than their counterparts. After controlling cluster and region level frailty, multiple births (AHR = 7.03, 95% CI: 4.40—11.24), breastfed within one hour after birth (AHR = 0.41, 95% CI: 0.28—0.61), preceding birth interval 18–23 months (AHR = 1.62, 95% CI: 1.12 -2.36), and under-five children younger than 18 months (AHR = 2.73, 95% CI: 1.93 -3.86), and teenage pregnancy (AHR = 1.70, 95% CI: 1.01—2.87) were statistically significant factors for time to under-five death.ConclusionEven though Ethiopia has a significant decline under-five death, still a significant number of under-five children were dying. Early initiation of breastfeeding, preceding birth interval and teenage pregnancy were the preventable factors of under-five mortality. To curve and achieve the SDG targets regarding under-five mortality in Ethiopia, policymakers and health planners should give prior attention to preventable factors for under-five mortality.

Association of maternal high-risk fertility behavior and under-five mortality in Ethiopia: Community-based survey.

BackgroundHigh-risk fertility behavior is a major public health concern in low and middle-income countries including Ethiopia. Some studies show that the relationship between high-risk fertility behavior and child mortality has analyzed each fertility behavior individually. Yet, there are limited studies that have analyzed outcomes associated with the joint impact of high-risk fertility behaviors. Therefore, the objective of this study was to examine the individual and combined influence of high-risk fertility behavior on under-five mortalities in Ethiopia.MethodsData from the 2016 Ethiopian Demographic and Health Survey were used analyzed. A total of 10,773 mothers who gave live births were included in the final analysis. Both descriptive and bivariate and multivariate logistic regression analyses were performed using STATA V.14.ResultsOverall, 62.1%, 24.0%, and 2.3% of women experienced at least one, two, and three high-risk fertility behaviors, respectively. In the multivariable analysis, under-five mortality was significantly associated with a combination of two or more maternal high-risk fertility behaviors. The odds of under-five mortality among children of women who were engaged in a combination of two high-risk fertility behaviors (AOR = 2.17, 95%CI: 1.52–3.08) and three high-risk fertility behaviors (AOR = 3.69, 95%CI:1.80, 7.55) was higher compared to children of women who have not engaged any high-risk fertility behaviors.ConclusionThis study revealed that a single high-risk fertility behavior was not associated with under-five mortality, yet the presence of two or more maternal high-risk fertility behaviors was an important factor that increased the likelihood of under-five child death. Thus, special emphasis should be given to children of women who engage in a combination of high-risk fertility behaviors. Furthermore, more emphasis should be placed on increasing access to family planning services and raising awareness about high-risk reproductive behaviors among Ethiopian women.

Risk factors of concurrent malnutrition among children in Ethiopia: a bivariate spatial modeling approach

Malnutrition among children remains a challenge to public health in Africa, and it is responsible for the increased infant mortality rate in Ethiopia. This study aims to identify the joint determinant factors of malnutrition among under-age five children in Ethiopia and quantify the regional prevalence across the country. A Bayesian hierarchical linear mixed model, with a bivariate conditional autoregressive model, was adopted to account for the joint spatial prevalence pattern of malnutrition among under-age five children in Ethiopia. The data were provided by the Demography and Health Surveys program. The study revealed that gender, wealth index, mothers' education, toilet system, fever, birth order, birth interval, contraceptive use, and diarrhea, are significant risk factors of child malnutrition. The three malnutrition indicators are most prevalent in the Afar region, while stunting and underweight are most prevalent in Amhara, Beneshangul Gumuz, and Tigray, and the wasting and underweight are most prevalent in the Gambela and Somali. Findings revealed that a stunted child is more likely to be underweight than being wasted, and a wasted child is more likely to be underweight than being stunted. The findings also revealed significant changes in the prevalence of malnutrition for different mothers and children age groups. For cost-effective malnutrition intervention, programs for parents, such as awareness creation about the modern types of contraceptives, appropriate birth spacing, the benefits of antenatal and postnatal care, for example, are a propitious method to mitigate malnutrition in high prevalent regions than direct intervention to the children. Abbreviations: BICAR, Bivariate Conditional Autoregressive; DHS, Demographic and Health Survey; EDHS, Ethiopia Demographic and Health Survey; EA, Enumeration Area; GMRF, Gaussian Markov Random Field; HAZ, Height for Age Z-sscore; INLA, Integrated Nexted Laplace Approximation; MCAR, Multivariate Conditional Autoregressive; MCMC, Markov Chain Monte Carlo; SNNPR, Southern Nations, Nationalities, and People's Region; WAZ, Weight for Age Z-score; WHZ, Weight for Height Z-score; WHO, World Health Organization

Incidence and Risk Factors of Neonatal Mortality in Eastern Ethiopia, A Prospective Cohort Study in Kersa Health and Demographic Surveillance System (Kersa HDSS)

Background: So far few studies were done to determine predictors of neonatal mortality in Ethiopia. This study was aimed to provide information on the incidence and risk factors of neonatal survival in Eastern Ethiopia from September, 2007 to August, 2012.&#x0D; Methods: The study uses data extracted from Kersa Health and Demographic Surveillance (Kersa HDSS) System database, which is located in the Oromiya Regional State, Eastern Ethiopia. The surveillance system is an open cohort, which was established in 2007. Data extraction includes all live births recorded in the system. The main outcome variable was the occurrence of death within 28 days after birth (neonatal death). The survival time was calculated in days using the time interval between the date of birth and date of event (death). Kaplan-Meier model and Cox-proportional hazard techniques were used to identify predictors of neonatal death.&#x0D; Results: The overall, Early and Late Neonatal Mortality Rate was 28.37, 19.55 and 8.82 per 1000 live births, respectively. A Neonatal Mortality Incidence Rate was 1 per 1000 (95% CI, 0.87-1.15) person days. Risk factors of neonatal survival include birth type (HR=5.40; 95% CI, 3.64-8.02), preterm birth (HR=11.17; 95% CI, 7.17-17.40), and previous infant sibling born (died HR=2.15; 95% CI, 1.39-3.33: no previous birth HR=1.78; 95% CI, 1.17-2.72).&#x0D; Conclusion: A significantly high level of neonatal mortality incidence rate was observed, which majority of the neonatal deaths were found to occur at early neonatal period. Therefore, efforts needs to be exerted in addressing the risk factors identified as predictors of neonatal mortality.