Introduction Depression and anxiety are prevalent psychological disorders that significantly affect physical,emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especiallychallenging for cancer survivors, complicating treatment management, affecting adherence, and potentiallyimpacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, andanxiety, as well as their determinants among cancer patients.Method An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants ofpain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses.The review involved a thorough search of multiple databases and included studies published in English up to July2024 that reported on these symptoms. The process involved screening and selecting studies based on specificcriteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determineoverall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understandingof these psychological issues in cancer survivors and guide future research and interventions.Result The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59–38.74),while anxiety had a prevalence of 30.55% (95% CI 24.04–37.06). Pain prevalence after treatment was 39.77% (95%CI 31.84–47.70). Before treatment, 65.22% (95% CI 62.86–67.57) of cancer patients reported pain, which persistedin 51.34% (95% CI 40.01–62.67) during treatment. The analysis also found that during the COVID-19 pandemic,depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI41.25–45.26) and 52.93% (95% CI 50.91–54.96), respectively.Conclusion The umbrella review found that depression and anxiety prevalence among cancer survivors was33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factorscontributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxietywas significantly linked to advanced cancer stage and poor sleep quality.
Clinical trial number Not applicable.Keywords Cancer, Oncology, Pain, Depression, Anxiety, Cancer survivors, Systematic review, Meta-analysis, Umbrellareview

Industries are among the largest global consumers of water, with a significant portion beingconverted into industrial wastewater. Paint factories, in particular, are major contributors toenvironmental lead pollution, releasing lead (II) through untreated effluents. Exposure to lead (II)poses serious health risks, including carcinogenic effects, neurological disorders, blood-relatedcomplications, and damage to vital organs such as the liver, kidneys, and lungs. While exten-sive research has focused on lead (II) removal from synthetic wastewater, limited studies haveaddressed the application of these methods to real industrial wastewater. This study aimed toevaluate the efficiency of Noug stalk activated carbon in removing lead (II) from paint factoryeffluent under optimized conditions. Laboratory experiments were conducted to assess the per-formance of Noug stalk activated carbon in treating wastewater from a paint factory. Statisticalanalysis using Statistical Package for Social Sciences version 20 was employed, with a pairedsample t-test determining the significance of differences in lead (II) concentrations before andafter treatment, considering a p-value of

Introduction Protecting digital health data from unauthorized access, alteration, and destruction is a crucial aspectof healthcare digitalization. Currently, digital security breaches are becoming more common. Healthcare databreaches have compromised over 50 million medical records per year. In Ethiopia, health digitization has growngradually. However, there is a limitation of study in digital health security. Studying digital health data security helpsindividuals protect digital data as a baseline and contributes to developing a digital health security policy.Objective To assess the practice of healthcare professionals in digital health data security among specializedteaching referral hospitals in Amhara Region, Ethiopia.Method A cross-sectional study design supplemented by a qualitative purposive sampling method was usedto measure the digital data security practices of health professionals. The sample size was determined via singlepopulation proportion formula. A simple random sampling technique was used for the study participants. Then, self-administered questionnaires were administered. Multivariable logistic analysis was used to identify associated factorsusing STATA software. For the qualitative study, key informant interviews were used and analyzed using thematicanalysis approach via open-code software.Results Out of the 423 health professionals, 95.0% were involved in the survey. The finding indicates digital healthdata security practice of health professionals working at specialized teaching hospitals were 45.0%, CI: (40, 50). Healthprofessionals 41–45-year age group (AOR = 0.107), master’s degree (AOR = 2.45), postmaster’s degree (AOR = 3.87),time to visit the internet for more than two hours (AOR = 2.46), basic computer training (AOR = 2.77), training indigital data security (AOR = 2.14), and knowledge (AOR = 1.76) were associated with the practice of digital health datasecurity. For the qualitative study, three teams were prepared. The findings indicate digital health data security can beimproved through training, advanced knowledge and working with digital security.
Conclusion The practice of digital health data security in specialized teaching hospitals in the Amhara region wasinadequate. Therefore, it can be improved through enhancing education status, increasing the time needed to visitthe internet, providing computer training, and updating health professionals’ knowledge toward digital health datasecurity.Keywords Practice, Digital health, Digital data security, Health profession

Background: Heart failure is a leading cause of hospital readmissions in the Amhara region, Northwest Ethiopia.Aim: This study aimed to determine the number of readmissions and identify the determinants among patients with heartfailure at referral hospitals in the Amhara region, Northwest Ethiopia, in 2023.Methods: A cross‐sectional study was conducted with 663 heart failure patients in Amhara region referral hospitals fromSeptember 2022 to February 2023. Simple random sampling was used for patient selection, and data were collected throughchart reviews and interviewer‐administered questionnaires. Zero‐inflated negative binomial models were applied for dataanalysis. Data collection tools were pre‐tested for reliability and validity.Results: Among 663 patients, 237 (35.7%) were readmitted at least once. An increased respiratory rate (IRR = 1.015; 95%CI: 1.0004, 1.031; p < 0.044) and longer medication duration (IRR = 1.011; 95% CI: 1.016, 1.051; p < 0.0001) were asso-ciated with more readmissions. Patients with poor social support had 59.4% fewer readmissions compared to those withgood social support (IRR = −1.595; 95% CI: −0.02, −0.005; p < 0.041). A higher body mass index (IRR = 0.115; 95% CI:0.035, 0.196; p < 0.004) was linked with a higher likelihood of remaining in the “always‐zero” group, while an increasedpulse rate reduced the odds (IRR = −0.013; 95% CI: −0.025, −0.008; p < 0.036). The mortality rate among readmittedpatients was 11.39%.Conclusion: This study found significant readmission rates among HF patients. Factors such as respiratory rate andmedication duration were linked to increased readmissions, while poor social support was associated with fewerreadmissions, this likely reflects limited healthcare access in low‐ and middle‐income countries among individuals withlower social support. The high mortality rate underscores the need for targeted interventions to improve patientoutcomes.

Background
Anemia is a critical complication among hemodialysis patients, often leading to poor outcomes. This study aimed to assess anemia prevalence and identify predictors among hemodialysis patients at Felege Hiote Referral Hospital, Northwest Ethiopia, in 2022.


Research design and methods
A retrospective cohort study analyzed 410 hemodialysis patients from January 2018 to February 2022. Data was collected from medical records, entered using Epi-data Version 4.1, and analyzed with STATA Version 14. Kaplan-Meier survival curves assessed survival time, while Cox regression identified anemia predictors.


Results
Of 410 patients, 66 (16.1%) developed anemia, with an incidence rate of 7.9 per 100 person-years (95% CI: 3.1–13.5). Significant predictors included female sex (IRR: 1.5, p = 0.04), rural residence (IRR: 2.5, p = 0.01), low body mass index (IRR: 1.6, p = 0.02), and congestive heart failure (IRR: 6.9, p = 0.02).


Conclusions
Anemia prevalence among hemodialysis patients is high, with key predictors including gender, residence, body mass index, and comorbidities. Interventions targeting these factors, especially in rural areas, could reduce anemia incidence. Study limitations include single-center data, incomplete variables, and lack of causality.





KEYWORDS: Anemia, incidence, predictors of anemia, end stage kidney disease, hemodialysis

IntroductionLimited or shared sanitation services are considered improved sanitation facilities, but theyare shared between two or more households. Globally, 600 million people use shared toiletfacilities. Although shared facilities are not classified as improved sanitation due to potentialinfection risks, inaccessibility, and safety concerns, this is a significant issue in developingcountries like Ethiopia. Evidence on the distribution of shared sanitation services and theirdeterminants in Ethiopia is limited. Therefore, this study aimed to assess the extent ofshared toilet facilities and their determinants among households in Ethiopia.MethodsThe 2019 Ethiopian Demographic and Health Survey (EDHS) served as the basis for thecross-sectional secondary data analysis. The analysis included a total of 7,770 householdsfrom the weighted sample. STATA 14 software was used to clean, weigh, and analyze thedata. To explore the distribution and determine the factors associated with shared toilet facil-ities in Ethiopia, both spatial and mixed-effect analyses were utilized. A p-value of less than0.05 was used to display the relationships between the dependent and independent vari-ables, employing adjusted odds ratios and 95% confidence intervals.ResultsThe magnitude of improved shared sanitation facilities among households in Ethiopia,according to the EDHS 2019, was 10.5% (95% CI: 9.88, 11.24). The prevalence was highestin Addis Ababa at 70.2% and lowest in the Southern Nations, Nationalities, and Peoples’Region at 2.4%. Individual-level variables significantly associated with the use of improvedshared toilet facilities included being a household head aged 55 years or older [AOR = 0.48;
95% CI: 0.33, 0.71], having secondary education or higher [AOR = 2.43; 95% CI: 1.80,3.28], and belonging to middle or rich wealth status [middle: AOR = 2.32; 95% CI: 1.35,3.96; rich: AOR = 6.23; 95% CI: 3.84, 10.11]. Community-level characteristics such as resid-ing in urban areas [AOR = 7.60; 95% CI: 3.47, 16.67], the metropolitan region [AOR =25.83; 95% CI: 10.1, 66.3], and periphery regions [AOR = 5.01; 95% CI: 2.40, 10.48] werealso associated with the use of shared toilet facilities.ConclusionThe usage of improved shared toilet facilities among households in Ethiopia is relatively low.Significant factors related to the use of shared toilet facilities were being 55 years of age orolder, possessing secondary or higher education, having a middle or rich wealth status, liv-ing in urban areas, and residing in metropolitan or peripheral regions. To improve access toand utilization of shared sanitation facilities, Ethiopian policy should emphasize user educa-tion and awareness.

AbstractIntroduction The emergence of First-line Antiretroviral Therapy (ART) regimens fails; it necessitates the use of morecostly and less tolerable second-line medications. Therefore, it is crucial to identify and address factors that increasethe likelihood of first-line ART regimen failure in children. Although numerous primary studies have examinedthe incidence of first-line ART failure among HIV-infected children in Ethiopia, national-level data on the onsetand predictors remain inconsistent. Hence, this study was conducted to fill the gaps in determining the onset of first-line ART failure and its predictors among HIV-infected children in Ethiopia.Methods Articles related to our topic of interest were searched using a systematic approach in national and interna-tional electronic databases. The retrospective follow-up cohort studies published in English up to 2022 were included.The data were extracted using a Microsoft Excel spread sheet and exported into Stata™ Version 17.0 for further man-agement and analysis. The level of heterogeneity was quantified using I 2 test together with a 95% confidence interval(CI). The incidence of the primary estimates was estimated using a random effects model in the Dersimonian-Laired-method. Subgroup analysis, Meta regression, and sensitivity analysis were computed to identify the source of het-erogeneity but not explained. The predictors of first-line ART failure were explained using relative risk (RR) with 95%confidence interval (CI).Results Ten studies having a total of 5446 children were included. The pooled onset of first-line ART failure was 3.18(95% CI: 1.91, 4.44) per 100 child-years of observations. Those study participants who began ART at an advanced WHOclinical stage at ART initiation had a 3.05 (95% CI: 1.47, 6.36), having poor ART adherence had a 2.19 (95% CI: 1.29, 3.70),and having TB-HIV coinfection at ART initiation had a 1.43 (95% CI: 1.06, 1.94) times higher chance of experiencingfirst-line ART failure than their corresponding counterparts.Conclusion The onset of first-line ART failure was high to achieve the 2030 UNAIDS target of ending the AIDSepidemic. Advanced WHO clinical stage, poor first-line ART adherence, and having TB-HIV coinfection were identifiedpredictors. Hence, community HIV screening should continue to strengthen early ART initiation, and the attention
of ART adherence should be kept to achieve ending the AIDS epidemic. The baseline tests and diagnosis, like TB diag-nosis should be maintained for HIV-infected children while they begin ART.Keywords First-line ART failure, Onset, Predictors, Children, Ethiopia

Background: Developmental delay is a group of disorders that cause commondeficits of adaptive and intellectual function in children. It happens when achild fails to achieve one aspect of developmental skills. Limited informationis available regarding the prevalence of developmental delay among childrenaged 12–59 months in the study area. Therefore, this study aimed to assessthe prevalence of developmental delay and its associated factors among thispopulation.Methods: A community-based cross-sectional study was conducted inDembecha district among 702 children aged 12–59 months. Data were gatheredthrough face-to-face interviews, and by taking anthropometric measurementsusing a pretested structured questionnaire. Data were entered into Epi Dataversion 4.2 software and exported into Statistical Package for Social Science(SPSS) version 25 software for analysis. The WHO Anthro software was used toanalyze anthropometric-related data. Bivariable and multivariable binary logisticregression analyses were done to identify factors associated with developmentaldelay. The odds ratio with a 95% Confidence Interval (CI) was estimated todetermine the strength of the association.Results: The prevalence of developmental delay among children was 26.7%(95% CI: 23.5, 30.2). Toddler child age (AOR = 2.60; 95% CI: 1.42, 4.87), lowbirth weight (LBW; AOR =4.90; 95% CI: 2.14, 11.48), cesarean section mode ofdelivery (AOR = 8.60; 95% CI: 3.93, 18.65), preterm delivery (AOR = 2.5; 95% CI:1.28, 4.74), early initiation of complementary feeding (AOR = 8.40; 95% CI: 3.61,19.63), stunting (AOR = 2.90; 95% CI: 1.67, 5.22) inadequate meal frequency(AOR = 3.20; 95% CI: 1.74, 5.94), and inadequate dietary diversity (AOR = 3.10;95% CI: 1.68, 5.85) were significantly associated with child developmental delay.Conclusion: The prevalence of developmental delay among children was highin Dembecha district compared to the global prevalence. Child developmentaldelay was associated with toddler child age, LBW, cesarean section mode of

BACKGRouNd: Trachoma is the leading infectious cause of blindness worldwide, particularly impacting the poorest nations, includingEthiopia.oBjECTivE: To assess knowledge, practice, and associated factors of trachoma transmission and prevention among primary school stu-dents in Addis Zemen town, South Gondar, Northwest Ethiopia, 2022.METhodS: An institution-based cross-sectional study was conducted on 407 randomly selected primary school students (grades 5-8),aged 10 to 24 years. Data collection included face-to-face interviews using structured questionnaires and an observation checklist. Epi-dataversion 4.2.0.0 and SPSS version 20 were used to enter and analyze the collected data, respectively. The data were analyzed using thedescriptive statistical method and using bivariable and multivariable logistic regression models. Variables with a P-value

AbstractIntroduction Despite the existence of numerous blood donation centers globally, there remains a significant gapbetween the demand and supply of blood. In Ethiopia, replacement blood donation is more common than voluntarydonation. The National Blood Bank of Ethiopia collects approximately 200,000 units of blood each year, while thedaily requirement is 18,000 units. Donors’ knowledge and attitudes are vital for ensuring a steady blood supply. Thissystematic review and meta-analysis sought to evaluate the knowledge and attitudes of Ethiopian residents regardingblood donation and the factors influencing them.Methods Relevant research articles were identified through searches of various databases. Data extraction andorganization were performed using Microsoft Excel, and the data were then analyzed using STATA/MP 17.0. Aweighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data.Heterogeneity was examined with the Galbraith plot and Cochrane I² statistics. To identify sources of heterogeneity,meta-regression, subgroup analysis, and sensitivity analysis were conducted. Publication bias was assessed usingEgger’s test and managed with trim and fill analysis. The adjusted odds ratio was calculated to explore the relationshipbetween knowledge and attitudes towards blood donation, with a significance threshold of p < 0.05.Results The pooled prevalence of favorable attitudes towards blood donation was 65.95%. Moderators such as studyyear (p = 0.72), publication year (p = 0.877), and sample size (p = 0.291) were not significant, indicating they did notcontribute to heterogeneity. Studies from Northern Ethiopia reported the highest prevalence of favorable attitudes at69.95%, while research on healthcare workers also indicated a high proportion of favorable attitudes at 69.29%. Therewas a significant association between knowledge and attitudes towards blood donation (AOR = 2.03).Conclusion The pooled prevalence of favorable attitudes towards blood donation was 65.95%, with the highestlevels observed in Northern Ethiopia and among healthcare workers. A significant association between knowledgeand positive attitudes towards blood donation was found. To enhance attitudes towards blood donation, increasingpublic awareness and education about the importance and safety of donating blood is crucial.Keywords Blood, Blood donation, Knowledge, Attitude, Systematic review, Meta-analysis, Ethiopia