Introduction: Promoting healthy lifestyle behaviors during pregnancy is a crucial health promotion strategy that could reduce pregnancy-related complications that may harm women and their fetuses. However, very few studies have assessed the prevalence of health-promoting lifestyle behaviors among pregnant women in Ethiopia. This study aimed to evaluate the extent and associated factors of health-promoting lifestyle behaviors among pregnant women in public health institutions in Debre Markos, northwest Ethiopia.
Methods: An institutional-based cross-sectional study was conducted among 275 pregnant women who were recruited using a systematic random sampling technique from 19 April to 19 May 2021. A face-to-face interview-administered questionnaire was used to collect the data. The data were analyzed using SPSS version 25. Multivariable binary logistic regression was used to identify the factors associated with the outcome variable. adjusted odds ratio (AOR), with a 95% confidence interval (CI) were used to measure the strength of the associations at a p-value

Background: An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods: This study was based on secondary data sources from 33 Sub-Saharan countries’ recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable. Results: The prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality. Conclusion: Under-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality. Keywords: Under-five mortality, Associated factors, Bayesian, Sub-saharan Africa, DHS

Background: Despite progress in reducing neonatal mortality rates in Ethiopia, the country still has a high neonatal mortality rate compared with the global average. Primary hospitals are critical in delivering basic neonatal care, particularly in rural areas. However, data on neonatal mortality and contributing factors in these settings are scarce. This study aimed to determine the survival status and predictors of neonatal mortality among neonates admitted to Bichena Primary Hospital, Northwest Ethiopia.
Methods: A retrospective cohort study was conducted among 638 neonates admitted to the Bichena Primary Hospital neonatal intensive care unit from January 1, 2021, to April 30, 2023. Neonates were selected via a consecutive sampling method. Data were collected from medical records using a pretested checklist. A Kaplan-Meier survival curve was used to estimate the neonatal survival time, and a Cox proportional hazard regression model was used to identify independent predictors of neonatal mortality.
Results: Of the 638 neonates followed, 21.5% died during the study period. The overall incidence rate of death was 66.69 per 1,000 neonate days. Hypothermia, birth injury, perinatal asphyxia, preterm birth, maternal history of abortion, low birth weight, and neonatal hypoglycemia were independent predictors of neonatal mortality.
Conclusion and recommendation: The study found a high rate of neonatal mortality, exceeding rates reported in other regions of Ethiopia. Most predictors were preventable and treatable. Therefore, early identification of obstetric complications, immediate interventions and postnatal care are crucial to reduce neonatal mortality and enhance overall neonatal outcomes.
Keywords: Ethiopia; neonate; predictors; primary hospitals; survival status.

Background: Diagnosing pulmonary tuberculosis (pTB) in children is challenging due to the difficulties in acquiring respiratory specimens, which unspecific and paucibacillary disease presentation, and the lack of sensitive diagnostic assays with non-invasive sample collection methods. As a result, millions of children around the world get tuberculosis (TB) each year, which is a leading cause of morbidity and mortality.  
Objective: The aim of this study was to assess the diagnostic accuracy of Stool and Respiratory Sample-based Genexpert MTB/RIF assay from presumptive TB among children in Northwest, Ethiopia.
 Methods and Materials: Hospital based cross-sectional with diagnostic accuracy study was conducted on consecutively recruited presumptive TB children. Data were collected by sem-structured questionnaires. Single respiratory (5ml) and 3g stool specimen were collected Lowenstein Jensen (LJ) and Xpert assay. Laboratory SOPs were strictly followed to assure the quality of whole procedures. The diagnostic accuracy of stool Xpert was evaluated against respiratory specimen Xpert, culture and composite reference standards (CRS). Sensitivity, specificity, and predictive values for the stool Xpert assay were calculated with a 95% confidence interval (95% CI) with MedCal statistical software. Data were entered in EPIData V4.2 and exported to SPSS 25 for further analysis.
Results: A total of 557 children were recruited; 510 of whom had complete microbiological results. Overall, pTB was diagnosed in 52/510 (10.2%) of the children with presumptive TB. Of these, only four had microbiologically unconfirmed pTB, were clinically diagnosed with positive response to anti-TB and the remaining 48 were microbiologically confirmed (Positive Xeprt and LJ culture). Stool specimen Xpert had sensitivity of 93.8 %( 95%CI: 82.8-98.6) and specificity of 99.8% (95%CI: 98.7–100) compared to culture; however, the sensitivity of stool was 88.5% (72-95.6) and specificity 100% (99.2-100) when compared to CRS. The Xpert on respiratory specimen had sensitivity and specificity of 95.8 % (85.8– 99.5) and 99.8% (98.7–100) to culture and 92.3 %( 81.4-97.9) and 100% (99.2-100) compared to CRS.
Conclusion: The sensitivity and specificity of Xpert assay for stool specimen is almost similar to that of respiratory specimen. Stool specimen is a highly promising alternative specimen in the diagnosis of pTB in children when respiratory specimen is impossible. 


Key words: Diagnostic accuracy, pulmonary tuberculosis, Xpert MTB/RIF, Stool, Children

 

Background: Hepatitis B virus (HBV) is highly infectious and poses significant global health challenges. Healthcare workers (HCWs) are particularly at risk of HBV infection due to occupational exposure through contact with infected blood or body fluids. To mitigate this risk, hepatitis B vaccination is recommended for all healthcare workers and is administered in three doses at 0, 1, and 6 months, aiming to reduce exposure and provide immunity against the virus. However, the effectiveness of the HBV vaccine remains uncertain in the study area.
Objective: This study aimed to evaluate hepatitis B vaccine efficacy and factors affecting vaccine effectiveness among healthcare workers in all Hospitals of East Gojjam Zone Amhara Region, North West Ethiopia
Materials and Methods: A hospital-based cross-sectional study was conducted among 422 healthcare workers from March 25, 2024, to November 30, 2024. Simple random sampling technique was used to recruit the study participants. Total sample size was allocated proportionally to each hospital. Socio-demographic and clinical data were collected using a pretested structured questionnaire. Moreover, venous blood samples (4–5 ml) were collected from the study participants, and serum samples were analyzed to measure and detect the concentrations of anti-hepatitis B surface antigen (anti-HBs), hepatitis B surface antigen (HBsAg), and anti-hepatitis B core antibody (anti-HBc) using a sandwich enzyme-linked immunosorbent assay (ELISA). Additionally, hepatitis B virus DNA (HBV DNA) was assessed using real-time polymerase chain reaction (qPCR). Data were analyzed using SPSS software version 25. Logistic regression model with 95% CI was used to show the statistical association. P value < 0.05 was considered as statistically significant.
Results: The overall sero-prevalence of HBsAg among all study participants was 23/422 (5.5%) (95% CI: 3.0-8.0). In multivariable logistic regression, blood transfusion (AOR: 16.5, 95% CI: 1.53, 29.24) (P<0.011) and dental extraction (AOR: 13.5, 95% CI: 3.99, 45.57) (P<0.000) were significantly associated with HBsAg positivity. In addition, the overall sero-reactivity of anti-HBc was 30/422 (7.1%) (95% CI: 5.0-10.0). Injectable medication (AOR: 4.3, 95% CI: 1.73, 10.72) (P<0.002) was significant determinant for anti-HBc sero-positivity. Furthermore, of fully vaccinated healthcare workers, 346/422 (82.0%) (95% CI: 78.0- 86.0 %) of them were sero-protected (had anti-HBs titer ≥ 10 mIU/ml). The paradoxical sero-positivity of HBsAg and anti-HBs among fully vaccinated healthcare workers was 16(4.6%). Moreover, among HBsAg-positive individuals, HBV DNA was detected in 17 (73.9%) of them.
Conclusions and recommendations: The study identified intermediate HBV seroprevalence among vaccinated healthcare workers, indicating suboptimal vaccine efficacy. These findings emphasize the necessity of monitoring post-vaccination anti-HBs antibody levels to address gaps in protection.
Keywords: Hepatitis B vaccine effectiveness, Healthcare workers, Hospitals   

Introduction: Growth monitoring and promotion services are strategies to promote child health and reduce child mortality. Even though Ethiopia is attempting different strategies to cope with the low rate of GMP utilization, the problem is still unresolved.
Objective: Determine the pooled proportion of GMP utilization and its contributing factors among children less than two years in Ethiopia.
Method: The review protocol was registered with PROSPERO, number CRD42023472746. The PRISMA-2020 statement guided the conduct of this review. Electronic databases and grey literature were used. Heterogeneity was evaluated using I2. Subgroup analysis was conducted. The random effect model was used to summarize the pooled effect sizes with their respective 95% CI with STATA version 17. To test the small study effect, the funnel plot and Egger’s test were applied.
Result: A total of seven (7) studies with 4027 participants were considered in this meta-analysis. The pooled proportion of GMP utilization reported by seven studies was 25.71% (95%CI: 24.39, 27.04). ANC follow-up (AOR = 2.11; 95% CI: 1.47, 2.76), PNC follow-up (AOR = 1.96; 95% CI: 1.44, 2.49), counseling (AOR = 2.88; 95% CI: 2.09, 3.68), maternal education (AOR = 2.89; 95% CI: 1.66, 4.13), paternal education (AOR = 3.78; 95% CI: 2.25, 5.32), family health card (AOR = 2.31; 95% CI: 1.67, 2.96), and mothers good knowledge towards GMP (AOR = 2.90; 95% CI: 1.72, 4.07) variables were positively associated with GMP service utilization.
Conclusion and recommendation: The pooled proportion of GMP remains low in Ethiopia. ANC and PNC follow-up, counseling, maternal and paternal education, family health cards, maternal knowledge towards GMP were significantly associated. Findings are essential for evidence-based policy making, intervention, and input for ongoing research.

Abstract Background: Hospitals usually encounter human, capital, and financial resource constraints which alerts the efficient use of allocated resources more than ever. Health system managers are required to identify inefficient hospitals and the drivers of the inefficiencies. Although there are multiple studies examining the efficiency of public hospitals in East Africa, their findings are often variable and inconsistent. Therefore, this study aimed to review published articles on technical efficiency of public hospitals in East African countries. Methods: A systematic search of published articles on the technical efficiency of public hospitals was employed using Pubmed, Cochrane library, and google scholar and thirteen studies were included to this review. The studies were described in terms of their publication year, sample size, inputs and outputs used in the efficiency analysis, and the technical efficiency levels. Finally, we assessed their quality and estimate the mean technical efficiency using meta-analysis. Results: The technical efficiency score of public hospitals varied across countries in east Africa which ranged from 0.64 ± 0.34 in Tanzania to 0.99 ± 0.03 in Ethiopia. The mean technical efficiency was 0.82 (95% CI = 0.56, 1.07) for primary hospitals and 0.88 (95% CI = 0.82, 0.95) for secondary level hospitals. Technical efficiency of public hospitals was negatively correlated with the number of hospitals (the sample size) and positively correlated with the number of inputs and outputs included in the efficiency analysis. Conclusions: This review revealed that the technical efficiency of public hospitals in east Africa requires an improvement. To enable effective and efficient hospital management and improvement in hospital efficiency, health man-agers and policymakers must identify the drivers of hospital inefficiency. Systematic reviews on public hospital efficiency, which are currently rare in Africa, should be conducted on a much larger scale in order to create more, and validated information for use in policy-making. Trial registration: This review protocol was registered and approved by the international prospective register of systematic reviews with a Protocol ID: CRD42023444729. Keywords: Technical efficiency, Hospitals, Data envelopment analysis, East Africa, Systematic review

Abnormal lipid profiles are a major risk factor for atherosclerosis and cardiovascular diseases andrepresent a growing public health concern influenced by socioeconomic, cultural, and ethnic factors. inethiopia, where chronic illnesses are increasingly prevalent, dyslipidemia poses a significant healthburden. this systematic review and meta-analysis aimed to estimate the pooled prevalence of abnormallipid profiles and identify associated risk factors among chronically ill patients in ethiopia. Relevantstudies were systematically retrieved from multiple databases, and data were extracted and analyzedusing StAtA/MP 17.0. A weighted inverse variance random-effects model was employed to compute thepooled estimates. the analysis revealed a pooled prevalence of abnormal lipid profiles of 54.14%, withthe highest burden found among diabetic patients (75.75%) and in the Southern Nations, Nationalities,and Peoples Region (69.28%). the likelihood of abnormal lipid profiles was significantly higher amongfemales, individuals older than 40 years, and those with hypertension. these findings highlight theurgent need for routine lipid screening and targeted interventions for high-risk populations to addressthe rising burden of dyslipidemia among chronically ill patients in ethiopia.
Keywords: Lipid profile, dyslipidemia, chronic disease, hypertension, systematic review, meta-analysis, Ethiopia

 

Background: Staphylococcus aureus is a major pathogenic bacterium associated with high morbidity and mortality worldwide. It exhibits resistance to multiple antibiotics, complicating treatment options. Despite its clinical significance, there is limited data on the prevalence of S. aureus infections and the patterns of methicillin and inducible clindamycin resistance, particularly in Ethiopia. Understanding these resistance trends is essential for guiding appropriate therapy and improving patient outcomes.
Objective: To assess the prevalence of S. aureus, methicillin and inducible clindamycin resistance patterns, and associated factors among patients with suspected bacterial infection at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
Method: A hospital-based cross-sectional study was conducted among patients suspected of bacterial infections from 10 June 2023 to 28 February 2024. Blood, wound swab, cerebrospinal fluid, urine, eye swab, synovial fluid, ear swab, and pleural fluid were collected aseptically and inoculated onto appropriate media. S. aureus was identified based on colony morphology, Gram staining, DNase test and biochemical tests. Antimicrobial susceptibility testing was performed on the isolates using the disk diffusion and the D-test techniques based on CLSI guideline. Data were entered into SPSS version 26 for analysis. Logistic regression was applied to assess the relationship between predictors and the outcome variable. A P-value of ≤ 0.05 with a 95% CI was considered statistically significant.
Results: Among the 339 study participants, 38 (11.2%) (95% CI: 8-15) tested positive for S. aureus. Of these isolates, 14/38 (36.9%) were resistant to methicillin, 5/38 (13.1%) isolates were resistance to clindamycin by routine disk diffusion test whereas 10/38 (26.3%) isolates exhibited inducible clindamycin resistance using the D-test. The level of multidrug resistance was noted in 10/38 (26.3%) of the isolates. Significant factors associated with S. aureus infection included illiteracy (AOR = 13.51; 95% CI: 3.56-21.90; P = 0.018), having larger family size (AOR = 12.14; 95% CI: 2.38-20.43; P = 0.024), and income level of less than 3,000 ETB (AOR = 6.20; 95% CI: 1.03-30.09; P = 0.046).
Conclusion: The study revealed an 11.2% occurrence of S. aureus among the study participants, with a substantial proportion exhibiting methicillin resistance (36.9%) and inducible clindamycin resistance (26.3%). These findings highlight a higher burden of clindamycin resistance in MRSA, underscoring the need for routine D-test screening to guide appropriate antibiotic therapy. Additionally, factors such illiteracy, low income and residing in rural areas were associated with S. aureus infection. Targeted health education initiatives should be implemented, especially in rural areas and among populations with low literacy levels, to improve hygiene practices and reduce transmission.

Keywords:  Ethiopia; S. aureus; antimicrobial resistance; inducible clindamycin resistance; methicillin resistance; prevalence.

Background: Managing chronic illness requires navigating a complex trajectory from diagnosis to end-of-life, with each phase necessitating specific nursing approaches. Effective management throughout these phases is vital for improving patient outcomes and quality of life.
Objective: This study aims to explore nursing approaches in managing chronic illness across its trajectory, from diagnosis to end-of-life care, focusing on phase-specific care, emotional support, education, interdisciplinary collaboration, and the challenges faced by nurses.
Methods: A qualitative research design using a grounded theory approach was employed to construct a theoretical framework grounded with the insights and experience of nurses' approaches across the chronic illness trajectory within Western Amhara, Ethiopia. The study comprised 24 nurses who were selected through the process of purposeful and theoretical sampling methods. Data was collected via in-depth interviews. Data analysis followed a constant comparative method, involving open, axial, and selective coding to identify key strategies and challenges across the illness trajectory.
Results: The primary finding of this study emphasizes the evolving and adaptive role of nurses in chronic illness management, highlighting their ability to provide personalized care, emotional support, and education throughout the illness trajectory. Central to the investigation is the theory of nurses' evolving and adaptive role in chronic illness management, where they adjust their strategies to address the physical, emotional, and psychological needs of patients and families, from pre-diagnosis to end-of-life care. The study identifies key adaptive strategies, including fostering resilience, facilitating interdisciplinary collaboration, and managing fluctuating symptoms. Despite challenges such as heavy workloads and emotional strain, nurses require training for continuous professional development, technological integration, and collaborative platforms to reinforce their critical role in optimizing patient outcomes in chronic illness management.
Conclusion: This study highlights nurses' adaptive role in chronic illness care, focusing on phase-specific interventions, emotional support, interdisciplinary collaboration, and education across entire illness trajectory to meet diverse needs of patients and their families. Despite challenges such as heavy workloads and emotional strain, the study recommends ongoing professional development and technological integration to optimize patient outcomes.

Keywords:  chronic illness trajectory; diagnosis; end-of-life; grounded theory; nursing approaches.