Background Microcephaly and macrocephaly, which are abnormal congenital markers, are associated withdevelopmental and neurologic deficits. Hence, there is a medically imperative need to conduct ultrasound imagingearly on. However, resource-limited countries such as Ethiopia are confronted with inadequacies such that access totrained personnel and diagnostic machines inhibits the exact and continuous diagnosis from being met.Objective This study aims to develop a fetal head abnormality detection model from ultrasound images via deeplearning.Methods Data were collected from three Ethiopian healthcare facilities to increase model generalizability.The recruitment period for this study started on November 9, 2024, and ended on November 30, 2024. Severalpreprocessing techniques have been performed, such as augmentation, noise reduction, and normalization.SegNet, UNet, FCN, MobileNetV2, and EfficientNet-B0 were applied to segment and measure fetal head structuresusing ultrasound images. The measurements were classified as microcephaly, macrocephaly, or normal using WHOguidelines for gestational age, and then the model performance was compared with that of existing industry experts.The metrics used for evaluation included accuracy, precision, recall, the F1 score, and the Dice coefficient.Results This study was able to demonstrate the feasibility of using SegNet for automatic segmentation,measurement of abnormalities of the fetal head, and classification of macrocephaly and microcephaly, with anaccuracy of 98% and a Dice coefficient of 0.97. Compared with industry experts, the model achieved accuracies of92.5% and 91.2% for the BPD and HC measurements, respectively.Conclusion Deep learning models can enhance prenatal diagnosis workflows, especially in resource-constrainedsettings. Future work needs to be done on optimizing model performance, trying complex models, and expandingdatasets to improve generalizability. If these technologies are adopted, they can be used in prenatal care delivery.Clinical trial number Not applicable.Keywords Microcephaly, Macrocephaly, Congenital abnormality, HC, BPD

Background: Children on the streets are still vulnerable to early and unsafe sexual experiences. Having multiple sexual partners and the limited use of condoms were major risk factors for the spread of sexually transmitted diseases among youths in Ethiopia.
Objective: This study aimed to explore the risk factors of sexual and reproductive health problems, service utilization, and challenges among street youths in the East Gojjam Zone.
Method: A phenomenological study design was employed on street youths residing in the East Gojjam Zone. Study participants were purposively recruited from four town administrations in the East Gojjam Zone. The primary study unit was street youths who live in the zone. Eight in-depth interviews and eight focus group discussions were conducted. The data were audio recorded and analyzed using inductive thematic analysis.
Results: In this study, the risk factors that exposed street youths to sexual and reproductive health problems included low perceived susceptibility, lack of awareness of sexual and reproductive health, having multiple sexual partners, exposure to pornographic films, and utilization of alcoholic drinks and substances. Mainly, those street youths who were engaged in transactional sexual relationships were utilizing condoms consistently and had regular HIV screening tests. In addition, few street youths ever utilized maternal and child health services. The unsupportive behavior of health professionals, the absence of exact data, the health system, and lack of specific responsible organization on the sexual and reproductive health of street youths were considered major challenges.
Conclusion and recommendation: Most of the street youths were not utilizing reproductive health services. Limitation on the accessibility of sexual and reproductive health services to this segment of the population was the main contributing factor. So, the health system and policy should take front-line responsibility for the sexual and reproductive health of street youths and consider convenient reproductive health service programs for them.

Keywords:  Risk factors; Sexual and reproductive health service utilization; Street youths.

Background Despite global efforts to mitigate COVID-19 infection through vaccination and therapeutic interven-tions, morbidity and mortality rates continued at variable rates. Although mortality risk and clinical features of COVID-19 are well-documented, recovery patterns and prognostic factors post-admission remain inconclusive, particu-larly in resource-limited settings like Ethiopia. This systematic review and meta-analysis (SRM) aimed to estimatethe pooled incidence rate of recovery and predictors among hospitalized COVID-19 patients in Ethiopia.Methods We searched (N = 1,191) articles using Preferred Reporting Items for Systematic Reviews and Meta-Anal-yses (PRISMA) guideline from PubMed/MEDLINE (N = 755), Scopus (N = 137), Web of Science (N = 84), Science Direct(N = 148), Cochran (N = 25), and Google Scholar searching (N = 42) from December 2019 to February 2024. The datawere extracted using a Microsoft Excel spreadsheet and exported to Stata TM version 17.0 for further analysis. The Arti-cle quality was assessed using the Joanna Briggs Institute checklist. The pooled incidence rate of recovery was esti-mated using a weighted inverse variance random-effects meta-regression. Heterogeneity among studies was evalu-ated using the I2 statistic. Subgroup analyses and sensitivity tests were also conducted to explore publication bias. Thisfile is registered in international Prospero with ID (CRD42024518569).Result Sixteen (N = 16) published studies with 7,676 hospitalized COVID-19 patients were included in the finalreport. The mean age of participants ranged from 29 (± 17) to 57.5 (± 3) years, with male patients constitutingthe largest proportion of participants, 4,491(58.5%). During recovery screening, 6,304(82.21%) cases were dischargedas improved, 159 (2.1%) attriters, and 818 (10.6%) died during inpatient treatment. The pooled incidence of recovery,mortality, and attrition rates were found to be 82.32% (95% CI: 78.81–85.83; I 2 = 94.8%), 14.3% (I2 = 98.45%), and 2.7%(I 2 = 81.34%), respectively. Incidence of recovery rate varied across regions and epidemic phases, with the highest rateobserved in Addis Ababa (89.94%, I 2 = 78.33%) and the lowest reported in the Tigray region (59.7%, I2 = 0.0%). Acrossepidemic phases, the recovery rate was 88.05% (I 2 = 29.56%) in Phase II, 84.09% (I2 = 97.57%) in Phase I, and 78.92%(I 2 = 96.9%) in Phase III, respectively. Factors included being aged 15–30 years (pooled OR = 2.01), male sex (pooledOR = 1.46), no dyspnea (pooled OR = 2.4; I 2 = 79%), and no baseline comorbidities (pooled OR = 1.15; I2 = 89.3%) werepredictors for recovery.Conclusion and recommendation In Ethiopia, more than eight out of ten hospitalized COVID-19 patientsrecovered after inpatient treatment. However, the incidence of recovery rates varied significantly across epidemicphases, study settings, and regions. Factors including younger age, male sex, no dyspnea (shortness of breathing), and no underlying comorbidity heightened recovery. It is highly recommended those inpatients cares should focuson high-risk groups (older adults) and implement standardized treatment protocols in each study setting. Regionswith lower recovery rates need aid in logistical support and training for healthcare providers.Keywords Admitted patients, COVID-19 infection, Ethiopia, SARS-CoV- 2 cases

Background Providing timely first-aid by trained responders can reduce deaths and disabilities from road trafficaccidents, a leading global cause of death. Ethiopia ranks 19th worldwide and 4th in Africa. Therefore, this studyassesses the knowledge and, attitudes toward emergency first aid, and its factors among public transport drivers inInjibara, Ethiopia.Objective To assess the Knowledge, and Attitude towards first-aid utilization and its associated factors among PublicTransport Service Drivers in Injibara, Northwest Ethiopia, 2023.Methods A cross-sectional study was conducted involving 419 public transport drivers, selected systematicallybased on vehicle side numbers, starting with a random choice for the first respondent. Subsequent participants werechosen at every second interval (k = 2). A structured questionnaire was used to collect relevant data. Binary logisticregression was performed using SPSS V.26 to assess the associations between independent and dependent variables.The strength of these associations was measured using odds ratios and 95% confidence intervals, with a P-value < 0.05deemed statistically significant.Result The study revealed that the prevalence of good knowledge and favorable attitudes toward first-aid utilizationwas 33.2% and 38.2%, respectively. Participation in first-aid training (AOR = 0.566, p = 0.027), access to a first-aid kit(AOR = 1.65, p = 0.027), and prior experience using first-aid at accident scenes (AOR = 0.476, p = 0.014) were factorsassociated with better first-aid utilization. Drivers who had used a first-aid kit (AOR = 0.476, p = 0.014) and thoseexposed to training (AOR = 0.486, p = 0.034) demonstrated more positive attitudes toward first aid.Conclusion The knowledge and attitude toward first-aid utilization remain low. Participation in first-aid training,access to first-aid kits, and experience using them during accidents were factors associated with improvedknowledge. Additionally, drivers who have used first-aid kits and received training tend to have a favorable attitude
toward their use. Therefore, relevant authorities must enhance the availability of first-aid kits, increase the exposure ofdrivers, and provide training to drivers to increase their knowledge and favorable attitude towards first-aid utilization.Clinical trial number Not applicable.Keywords Knowledge, Attitude, First aid, Transport service, Ethiopia

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 Stataâ„¢ 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

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 Inadequate glycemic management in type 2 diabetes Mellitus patients is a serious public healthissue and a key risk factor for progression as well as diabetes-related complications. The main therapeutic goal ofpreventing organ damage and other problems caused by diabetes is glycemic control. Knowing when to modifyglycemic control in type 2 diabetes Mellitus is crucial for avoiding complications and early drug intensifications.Methods An institutional based retrospective follow-up study was undertaken among 514 eligible adult diabetespatients in Amhara region Comprehensive Specialized Hospitals, Northwest Ethiopia, from January 2017 to January2022. Simple random sampling technique was used to select study participants. The Kaplan Meier curve was usedto assess the survival status of categorical variables, and the log-rank test was used to compare them. The coxproportional hazard model was fitted to identify the predictors of time to first optimal glycemic control. Variables witha p-value < 0.05 were considered to be statistically significance at 95% confidence interval.Results A total of 514 patient records (227 males and 287 females) were reviewed in this study. The median time tofirst optimal glycemic control among the study population was 8.4 months IQR (7.6–9.7). The predictors that affect thetime to first optimal glycemic control were age group ((AHR = 0.63, 95% CI = 0.463, 0.859 for 50–59 years), (AHR = 0.638,95% CI = 0.471, 0.865 for 60–69 years), and (AHR = 0.480, 95% CI = 0.298, 0.774 for > = 70 years)), diabetes neuropathy(AHR = 0.629, 95% CI = 0.441,0.900), hypertension (AHR = 0.667, 95% CI = 0.524, 0.848), dyslipidemia (AHR = 0.561, 95%CI = 0.410, 0.768), and cardiovascular disease (AHR = 0.681, 95% CI = 0.494, 0.938).Conclusion The median time to initial optimal glycemic control in type 2 diabetes Mellitus patients in this study wasshort. Age between 50 and 59 years and 60–69, diabetes neuropathy, hypertension, dyslipidemia, and cardiovascular
disease were predictor’s of time to first glycemic control. Therefore, health care providers should pay extra attentionfor patients who are aged and who have complications or co-morbidities.Keywords:  Adults, First optimal glycemic control, Type 2 diabetes mellitus, Ethiopia

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: 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

EXECUTIVE SUMMARY  Agricultural financing plays a critical role in enhancing crop productivity and fostering rural development, particularly in agrarian economies. This study aims to empirically investigate the impact of agricultural financing on the crop productivity of smallholder farmers and assess its implications on income inequality. To achieve this objective, a mixed research approach was adopted, integrating both qualitative and quantitative methodologies. An explanatory research design was employed to explore the causal relationship between access to agricultural financing and crop output. Primary data were collected from a sample of 800 crop-producing households using structured questionnaires, interview schedules, and focus group discussions, selected through simple random sampling. Secondary data were obtained through document reviews from relevant institutional sources. The data were analysed using descriptive statistics and econometric modelling techniques, specifically Propensity Score Matching (PSM), to estimate the Average Treatment Effect on the Treated (ATT). A binary logit model was used to identify the determinants of access to agricultural financing. The results revealed that age, seed cost, labor cost, tractor access (as a proxy for infrastructure), education level, and farming experience significantly influenced whether a household received agricultural financing. Conversely, variables such as plant protection, fertilizer use, and landholding size were found to have an insignificant effect. The covariate balancing indicators and balance plots confirmed that the matching algorithms were successful in reducing selection bias, with mean standardized bias decreasing by up to 77.5% and pseudo R² values dropping significantly post-matching. The common support condition was also satisfied, ensuring the reliability of the PSM estimates. The PSM results confirmed that agricultural financing had a statistically significant and positive impact on crop productivity. On average, farmers with access to financing produced ETB 3,942.53 to ETB 6,251.01 more per season compared to those without access, depending on the matching algorithm used (NNM-1, NNM-5, and KBM). The study concludes that agricultural financing significantly enhances crop productivity but may unintentionally exacerbate income inequality. It recommends targeted financial inclusion strategies to ensure equitable access to credit. Furthermore, it advocates for practical, hands-on training programs tailored to farmers‘ realworld needs, rather than theoretical lectures. Such capacity-building initiatives should focus on improving technical expertise, efficient input utilization, and financial literacy, thereby maximizing the benefits of agricultural financing for sustainable rural development. Keywords: Agricultural Financing, Crop Productivity, Propensity Score Matching, Logit, Gini