Abstract

Introduction: The most common and severe cause of morbidity and mortality among HIV- positive children is opportunistic infections (OIs). All HIV-infected children are at risk of developing a variety of OIs. Healthcare workers, programmers, and other stakeholders are in doubt about using the onset and predictors of OIs among schoolchildren on antiretroviral therapy (ART) due to the presence of conflicting results found in the primary studies. Hence, this study was conducted to provide a single figure of onset and specific predictors of OIs by overcoming the existing heterogeneity in Ethiopia.
Methods: The included studies were searched from different national and international databases systematically. The included studies were cohort in design and published in English between 2015 and 2022. The data were extracted using a validated Microsoft Excel tool after the quality of the included studies was assured. The extracted data were exported to Stata Version 17.0 for further management and analysis. The presence of heterogeneity across studies was checked using the Chi-square test and quantified using the I 2 test. Various methods, including forest plots, publication bias assessment, sensitivity tests, subgroup analysis, and meta-regression, were employed to determine the source of heterogeneity, but none were successful. The overall onset of OIs was estimated by pooling the incidence of primary studies using a random-effects meta-analysis model. The predictors were identified using meta-regression and the presence of significant association was declared using a p-value of 0.05 with 95% CI. The strength of association was reported using an adjusted hazard ratio with 95% CI.
Results: Eleven studies were included in this systematic review and meta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was 5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations. Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) times higher chance of getting OIs when compared with those children having one or both parents. Children who had poor ART adherence had a 2.96 (95% CI: 1.66, 5.29) times higher chance of experiencing OIs than children who had good ART adherence. Finally, the chance of experiencing OIs among rural children was 2.15 (95% CI: 1.63, 2.83) times higher than their counterparts in Ethiopia.
Conclusions: Three in every 33 schoolchildren on ART developed OIs in Ethiopia. Predictors of OIs included schoolchildren without parents, those with poor adherence to ART, and rural residents. This suggests that social support, medication adherence, and access to healthcare services may play important roles in preventing and controlling OIs among schoolchildren living with HIV in rural areas.

Keywords:  Ethiopia; children on ART; onset and predictors; opportunistic infections; schoolchildren.

Introduction: The most common and severe cause of morbidity and mortalityamong HIV- positive children is opportunistic infections (OIs). All HIV-infectedchildren are at risk of developing a variety of OIs. Healthcare workers,programmers, and other stakeholders are in doubt about using the onset andpredictors of OIs among schoolchildren on antiretroviral therapy (ART) due tothe presence of conflicting results found in the primary studies. Hence, thisstudy was conducted to provide a single figure of onset and specificpredictors of OIs by overcoming the existing heterogeneity in Ethiopia.Methods: The included studies were searched from different national andinternational databases systematically. The included studies were cohort indesign and published in English between 2015 and 2022. The data wereextracted using a validated Microsoft Excel tool after the quality of theincluded studies was assured. The extracted data were exported to StataVersion 17.0 for further management and analysis. The presence ofheterogeneity across studies was checked using the Chi-square test andquantified using the I2 test. Various methods, including forest plots,publication bias assessment, sensitivity tests, subgroup analysis, andmeta-regression, were employed to determine the source of heterogeneity,but none were successful. The overall onset of OIs was estimated by poolingthe incidence of primary studies using a random-effects meta-analysis model.The predictors were identified using meta-regression and the presence ofsignificant association was declared using a p-value of 0.05 with 95% CI. Thestrength of association was reported using an adjusted hazard ratio with 95% CI.Results: Eleven studies were included in this systematic review andmeta-analysis. The onset of OIs among schoolchildren on ART in Ethiopia was5.58 (95% CI: 4.50, 6.67) per 100 children-years of OI-free observations.Those children who had no parents had a 1.41 (95% CI: 1.10, 1.80) timeshigher chance of getting OIs when compared with those children having oneor both parents. Children who had poor ART adherence had a 2.96 (95% CI:1.66, 5.29) times higher chance of experiencing OIs than children who hadgood ART adherence. Finally, the chance of experiencing OIs amongrural children was 2.15 (95% CI: 1.63, 2.83) times higher than theircounterparts in Ethiopia.
Conclusions: Three in every 33 schoolchildren on ART developed OIs in Ethiopia.Predictors of OIs included schoolchildren without parents, those with pooradherence to ART, and rural residents. This suggests that social support,medication adherence, and access to healthcare services may play importantroles in preventing and controlling OIs among schoolchildren living with HIV inrural areas.KEYWORDS: schoolchildren, opportunistic infections, onset and predictors, children on ART, Ethiopia
 

Background: Healthcare-associated infections occur in patients under medical care, which is a major public health issue in hospitals worldwide. The prevalence is two to three folds higher in developing countries compared to developed countries. Inanimate objects used by healthcare professionals such as gowns, mobile phones, and stethoscopes are highly prone to bacterial contamination from the healthcare setting. In Ethiopia, there is a paucity of published data on the bacterial profile and susceptibility patterns of an isolates.
Objective: To determine the bacterial profile and antimicrobial susceptibility patterns from inanimate objects used by healthcare professionals and associated factors at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
Methods: A cross-sectional study was conducted at Debre Markos Comprehensive Specialized Hospital from inanimate objects from April 10, 2023 to June 30, 2023 using simple random sampling technique with lottery method. Socio-demographic data was collected using a structured questionnaire. A swab sample from healthcare professionals' gowns, mobile phones, and stethoscopes were collected and inoculated onto blood agar, chocolate and MacConkey agar. Isolates were identified and characterized by colony morphology, Gram staining and biochemical tests. Antimicrobial susceptibility testing was performed in all isolates by the disk diffusion technique on Muller Hinton agar according to CLSI, 2022 guidelines. Data was entered into EPI-Data and analyzed using SPSS version 25. Logistic regression model was used. Variables with p-value ≤ 0.25 in bivariable logistic regression was fitted to multivariate logistic regression analysis. A p-value of ≤ 0.05 with 95%CI was considered statistically significant.
Result: A total of 376 healthcare professionals' inanimate objects were included from 191 study participants. Overall, 60.1% (226/376) (95%CI: 55.1-65) inanimate objects were contaminated. The proportion of bacterial contamination was (65.1%; 82/126), (60.3%; 76/126) and (54.8%; 68/124) for mobile phones, gowns and stethoscopes, respectively. Staphylococcus aureus was the most frequent isolate accounting (22.1%; 83/376) followed by Staphylococcus epidermidis (17.0%; 64/376), Escherichia coli (8.8%; 33/376) and Pseudomonas aeruginosa (4.9%; 18/376). Working in gynecology/ obstetrics wards (AOR: 8.69; 95%CI: 1.09-69.41, P = 0.041), did not disinfect mobile phones (AOR: 2.69; 95%CI: 1.15-6.25; P = 0.021) and stethoscopes regularly (AOR: 3.06, 95%CI: 1.23-7.59; P = 0.016), carry mobile phones with patient care materials (AOR: 2.72; 95%CI: 1.18-6.29, P = 0.019) and not taken infection prevention training (AOR:3.91; 95%CI:1.71-8.93; P = 0.001) were significantly associated with bacterial contamination.Most Gram-negative bacteria were resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxacilline-clavunic acid, while Gram-positive isolates showed high level of resistant to penicillin. On the other hand, meropenem, for Gram-negative and clindamycin for Gram-positive bacteria showed lower level of resistance. Multidrug resistance among Gram-positive and Gram-negative bacteria were (62.6%; 92/147) and (75.3%; 64/85), respectively with over all MDR (67.2%, 156/232).
Conclusion:  Inanimate objects commonly used by healthcare professionals are important sources of bacterial contamination. S. aureus, S. epidermidis and E. coli were the predominant isolates. Most Gram-negative bacteria were resistant to ampicillin while Gram-positive isolates showed high level of resistant to penicillin. All healthcare professionals should regularly disinfect their inanimate objects to prevent bacterial colonization and potential spread of infection.

Background
Digital health is a new health field initiative. Health professionals require security in digital places because cybercriminals target health care professionals. Therefore, millions of medical records have been breached for money. Regarding digital security, there is a gap in studies in limited-resource countries. Therefore, surveying health professionals’ attitudes toward digital health data security has a significant purpose for interventions.


Objective
This study aimed to assess the attitudes of health professionals toward digital health data security and their associated factors in a resource-limited country.


Methods
A cross-sectional study was conducted to measure health professionals’ attitudes toward digital health data security. The sample size was calculated using a single population. A pretest was conducted to measure consistency. Binary logistic regression was used to identify associated factors. For multivariable logistic analysis, a P value ≤.20 was selected using Stata software (version 16; StataCorp LP).


Results
Of the total sample, 95% (402/423) of health professionals participated in the study. Of all participants, 63.2% (254/402) were male, and the mean age of the respondents was 34.5 (SD 5.87) years. The proportion of health professionals who had a favorable attitude toward digital health data security at specialized teaching hospitals was 60.9% (95% CI 56.0%‐65.6%). Educational status (adjusted odds ratio [AOR] 3.292, 95% CI 1.16‐9.34), basic computer skills (AOR 1.807, 95% CI 1.11‐2.938), knowledge (AOR 3.238, 95% CI 2.0‐5.218), and perceived usefulness (AOR 1.965, 95% CI 1.063‐3.632) were factors associated with attitudes toward digital health data security.


Conclusions
This study aimed to assess health professionals’ attitudes toward digital health data security. Interventions on educational status, basic computer skills, knowledge, and perceived usefulness are important for improving health professionals’ attitudes. Improving the attitudes of health professionals related to digital data security is necessary for digitalization in the health care arena.

Background: Evidence-based practice is clinical decision-making using the best evidence available in the context of individual patients' preferences and clinical expertise. It is serving as a crucial instrument for the health science disciplines to minimize the theory-practice gap although the level of practice is unknown. Thus, this study aimed to assess nurses' implementation of evidence-based practice in nursing process and its associated factors in South Wollo Zone Public Hospitals.
Methods: An explanatory sequential mixed method was employed from April 1 to May 29, 2023, among 419 nurses for the quantitative part and 15 others for the qualitative part. The data were collected using structured, pretested, self-administered questionnaires. Simple random and purposive sampling techniques were used to select participants for the quantitative and qualitative studies, respectively. The bivariable analysis was done primarily, and variables with a p-value < 0.25 were further examined using a multivariable logistic regression model to control con-founders. Then, variables having a p-value less than 0.05 with a 95% CI were used to declare significantly associated factors. The key informants were interviewed using pre-made interview guidelines, and then open code software was utilized to conduct a thematic analysis.
Result: Nurses who had poor implementation of evidence-based practice in the nursing process were 228 [54.42%; 95% CI: (49.8-59.3)]. Similarly, the key informants concluded that the implementation of evidence-based practice in the nursing process was low. Participants who were 31- 40 years old [AOR = 0.61, 95% CI: (0.38-0.99)], 41-50 years [AOR = 0.32, 95% CI: (0.15-0.65)], working at general hospitals [AOR = 3.37, 95% CI: (1.39-8.18)] and comprehensive specialized hospitals [AOR = 7.29, 95% CI: (3.06 - 17.31)], lack of training about evidence-based practice (AOR = 2.50, 95% CI: (1.36-4.56)], and lack of internet access [AOR = 2.46, 95% CI: (1.43-4.23)] were factors associated with poor levels of nurses' implementation of evidence-based practice in the nursing process. The absence of computers, libraries, and updated guidelines were other factors identified on the quality analysis.
Conclusion: Nurses' implementation of evidence-based practice in the nursing process was low. Age, working in general hospitals, and comprehensive and specialized hospitals, lack of training, and internet access were factors that had significant associations. Hence, hospital managers should give an attention to internet access and training about utilization of evidence-based practice in nursing process, particularly for those aged above thirty years old.

Keywords:  Ethiopia; Evidence-based practice; Nurses; Nursing process.

Improving maternal and perinatal outcomes can be achieved by identifying factors affecting successful vaginal delivery following induction of labor, particularly in developing countries with low rates of induction. Besides this, evidence regarding the magnitude of successful vaginal delivery following induction and associated factors is limited in Ethiopia. Therefore, this study aimed to assess the magnitude of vaginal delivery following induction and associated factors among laboring women at South Wollo Zone Public Hospitals of Ethiopia, 2023. An institutional-based cross-sectional study was conducted among 385 from April 1 to June 15, 2023. A systematic random sampling method was used to select each participant. A pretested structured interviewer-administered questionnaire and checklist were used to collect data. Epi-Data version 4.6 and SPSS version 26 software were used for data entry and analysis, respectively. Multivariable binary logistic regression was used to identify associated factors and an adjusted odds ratio with a 95% confidence interval was used to identify significant variables. Model fitness was checked using the Hosmer-Lemeshow goodness of fit test. The study reported that 75.6% of participants gave vaginal delivery following induction with a 95% CI (71.00-79.80). Mid-upper arm circumstance 23-28 cm (AOR = 2.55, 95% CI: 1.19-5.47), multiparty (AOR = 3.01, 95% CI: 1.430-6.33), favorable bishop (AOR = 3.79, 95% CI: 1.74-8.26), oxytocin with cervical ripening method (AOR = 3.74, 95% CI: 1.99-7.04), and birth weight less than 4000gram (AOR = 5.40, 95% CI: 1.54-18.91) were factors significantly associated with successful vaginal delivery following induction. Therefore, obstetric caregivers should consider pre-induction assessments such as bishop score of the cervix and fetal weight estimation and improving the nutritional status of pregnant women.

Keywords:  Associated factors; Ethiopia; Induction of labor; Vaginal delivery.

Male involvement in infant care is an effective intervention to improve infant health outcomes. However, evidence regarding male involvement in infant care and its associated factors is limited in Ethiopia. To assess the male involvement in infant care and associated factors among infants less than one year in Bibugn district of Ethiopia. A community-based cross-sectional study was conducted among 606 participants from April 1-30/2023. A systematic sampling technique was used to select each study participant. Data was collected using interviewer-administered questionnaires. Data were entered into Epi data 4.6 and analyzed using statistical Product Service and Solution (SPSS) version 2 5. Both descriptives, mean, frequency and analytical statistics were employed. Variables with a p-value of less than 0.25 in bivariate logistic regression were entered into a multivariate logistic regression to identify associated factors. Statistical significance was declared at p < 0.05. The prevalence of male involvement in infant care was 42.2% with a 95% CI (38.26-46.12). Male who did not attend formal education (AOR = 0.24, 95% CI = 0.14-0.43), having one child (AOR = 5.66, 95%CI = 2.94-10.88), having male infants (AOR = 2.51, 95% CI = 1.60-3.95), first infant order (AOR = 2.70, 95% CI = 1.36-5.39), having adequate knowledge towards infant care (AOR = 5.56,95% CI = 0.12-0.28), and having favorable attitude towards infant care (AOR = 1.70,95% CI = 0.34-0.99) were factors associated with male involvement in infant care. Less than 50% ( 50%) of males are involved in their infant care. Educational status of males, number of infants, male infants, male knowledge, and attitude towards infant care were significantly associated with involvement in infant care. Therefore, efforts should be directed at improving males' educational status, knowledge, and attitude to improve their engagement in caring for their infants.

Keywords:  Bibugn district; Ethiopia; Infant care; Male involvement.

Background Understanding the student’s perspective of their clinical learning environment (CLE) might assist todiscover solutions to improve the learning process and increase engagement. However, there is a lack of informationon this issue, particularly in Ethiopia. The purpose of this study was to assess the satisfaction of undergraduatemedical and health science students with their clinical learning environment, as well as to identify the factors thataffect it.Methods Institutional-based cross-sectional study was conducted using a self-administered questionnaire among412 medical and health science students from Debre Markos University in 2023 through a simple random samplingtechnique. Mean, median, frequencies, and percentages were used to describe the data. A multivariate logisticregression model was fitted to test the association of dependent and independent variables. The Hosmer-Lemeshowgoodness-of-fit test was used to check the fitness of the model. Variables with a p-value < 0.05 with a 95% confidenceinterval were considered statistically significant.Results The questionnaire was completed by 394 individuals in total, generating a response rate of 95.63%.Approximately half (49.7%) of the participants were satisfied with their CLE. Age (AOR = 1.12; 95%CI = 1.02, 1.22),university positive perceptions (AOR = 1.60; 95%CI = 1.04, 2.43) and curriculum positive perception (AOR = 2.70;95%CI = 1.73, 4.10) were all positively associated with CLE satisfaction.Conclusion In this study, approximately half of the respondents were satisfied with their CLE. Age, positiveperceptions of the university and positive perceptions of the curriculum were all positively associated with CLEsatisfaction. The university and clinical facilitators should work together to improve infrastructure, and the facilities
 

BackgroundAdverse drug reaction is one of the emerging challenges in antiretroviral treatment. Deter-mining the incidence rate and predictors among children on antiretroviral treatment (ART) isessential to improve treatment outcomes and minimize harm. And also, evidence regardingthe time to major adverse drug reactions and its predictors among children on antiretroviraltreatment is limited in Ethiopia.ObjectiveThis study aimed to assess the time to major adverse drug reaction and its predictorsamong children on antiretroviral treatment at selected public hospitals in Northwest Amhara,Ethiopia, 2023.MethodA retrospective cohort study was conducted among 380 children on antiretroviral treatmentwho enrolled from June 27, 2017, to May 31, 2022. Data was collected using a structureddata extraction checklist. Data were entered into Epidata 4.6 and analyzed using STATA14. The incidence rate of major adverse drug reactions was determined per person/months.The Cox proportional hazards regression model was used to identify predictors of majoradverse drug responses. A p-value less than 0.05 with a 95% CI was used to declare statisti-cal significance.
ResultThe minimum and maximum follow-up time was 6 and 59 months, respectively. The studyparticipants were followed for a total of 9916 person-months. The incidence rate of majoradverse drug reactions was 3.5 /1000 person–months. Advanced clinical stages of HIV/AIDS (III and IV) [adjusted hazard ratio = 7.3, 95% CI: 2.74–19.60)], poor treatment adher-ence [adjusted hazard ratio = 0.33, 95% CI: 0.21–0.42], taking antiretroviral treatment twiceand more [adjusted hazard ratio = 3.43, 955 CI: (1.26–9.33)] and not taking opportunisticinfection prophylaxis [adjusted hazard ratio = 0.35, 95% CI: 0.23–0.52)] were predictors ofmajor adverse drug reactions.ConclusionThe incidence rate of major adverse drug reactions among children on antiretroviral treat-ment was congruent with studies in Ethiopia. Advanced clinical stages of HIV/AIDS, poortreatment adherence, taking antiretroviral treatment medications twice or more, and not tak-ing opportunistic infection prophylaxis were predictors of major adverse drug reactions.

Background: Big health data is a large and complex dataset that the health sector has collected andstored continuously to generate healthcare evidence for intervening the future healthcare un-certainty. However, data use for decision-making practices has been significantly low in devel-oping countries, especially in Ethiopia. Hence, it is critical to ascertain which elements influencethe health sector’s decision to adopt big health data analytics in health sectors. The aim of thisstudy was to identify the level of readiness for big health data analytics and its associated factorsin healthcare sectors.Methods: A cross-sectional study design was conducted among 845 target employees using thestructural equation modeling approach by using technological, organizational, and environ-mental (TOE) frameworks. The target population of the study was health sector managers, di-rectors, team leaders, healthcare planning officers, ICT/IT managers, and health professionals.For data analysis, exploratory factor analysis using SPSS 20.0 and structural equation modelingusing AMOS software were used.Result: 58.85 % of the study participants had big health data analytics readiness. Complexity (CX),Top management support (TMS), training (TR) and government law policies and legislation(GLAL) and government IT policies (GITP) had positive direct effect, compatibility (CT), andoptimism (OP) had negative direct effect on BD readiness (BDR)Conclusion: The technological, organizational, and environmental factors significantly contributedto big health data readiness in the healthcare sector. The Complexity, compatibility, optimism,Top management support, training (TR) and government law and IT policies (GITP) had effect onbig health data analytics readiness. Formulating efficient reform in healthcare sectors, especially
or evidence-based decision-making and jointly working with stakeholders will be more relevantfor effective implementation of big health data analytics in healthcare sectors.
Keywords: Big health data, Data analytics, Data management, Health information revolution, Health sectors, Readiness