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.

Introduction: Barber-related infections, including hepatitis B virus (HBV), continue to be a major cause of illness and death. Numerous beauticians use razors and scissors on multiple customers without adequately sanitizing these tools. There is a lack of published research on the prevention practices and associated factors of hepatitis B virus infection among barbers in Ethiopia. Therefore, this study aimed to assess the practice and associated factors of hepatitis B virus infection among barbers.
Method: A cross-sectional study was carried out involving 411 barbers selected through simple random sampling. Data collection was performed using an interviewer-administered questionnaire and an observational checklist. The collected data were first cleaned and entered into EpiData version 4.6 and then exported to SPSS version 25 for analysis. Model fitness was assessed using the Hosmer-Lemeshow test, and multicollinearity was evaluated with the variance inflation factor. A binary logistic regression model was employed for the analysis. To address confounding factors, explanatory variables with a p-value of less than 0.25 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Factors with a p-value of less than 0.05 in the multivariable analysis were considered statistically significant.
Results: Among the 411 participants, 328 (79.8, 95% CI: 75.6-83.6%) exhibited unsafe hepatitis B virus infection prevention practices. Unsafe practices were significantly associated with barbers who could not read or write (AOR 3.75, 95% CI: 1.39-10.12); primary and secondary education (AOR 3.44, 95% CI: 1.89-6.27) compared to those with college education and above; not using ultraviolet sterilizers (AOR 2.85, 95% CI: 1.30-6.27); insufficient knowledge (AOR 4.23, 95% CI: 2.13-8.40); unfavorable attitudes toward infection control (AOR 2.40, 95% CI: 1.34-4.31); and working hours of less than 8 h (AOR 0.27, 95% CI: 0.15-0.50).
Conclusion: Nearly four-fifths of barbers exhibited unsafe practices in preventing hepatitis B virus infection. Low education levels, not utilizing UV sterilizers, lack of knowledge, working fewer hours, and negative attitudes toward infection prevention were all strongly associated with unsafe practices in the prevention of hepatitis B virus among barbers. Consequently, these findings underscore the need for targeted educational programs, improved access to sterilization tools, and policy changes to promote safer practices.

Keywords:  Ethiopia; barber; factors; hepatitis B virus; prevention practices.

Introduction: The magnitude of poor sleep quality among people with asthma is widespread and has detrimental consequences, including a higher chance of having poor work performance, an increase in the frequency of asthma attacks, an increase in the need for overnight hospitalization, and a worse health related quality of life. However, it has not been well studied, especially in low-income countries like Ethiopia. This study's objective was to assess the degree of sleep quality and related factors among people with asthma who had follow-up visits at public hospitals in the East Gojjam Zone.
Methods: An institutional-based cross-sectional study design was conducted among 406 people with asthma through consecutive sampling techniques at public hospitals in East Gojjam Zone from June 6 to July 1, 2022. Sleep quality was measured by the Pittsburgh Sleep Quality Index through a face-to-face interview, and the collected data were entered into Epi Data version 4.4.2 and exported to SPSS version 25 for analysis. Logistic regression was fitted to assess the association between dependent and independent variables. Variables with a P-value

Background: Community-based health insurance (CBHI) is an emerging form of microhealth insurance that relies on theprinciple of solidarity, with community members pooling money to help with medical expenses. The level of household heads’satisfaction with CBHI schemes is more likely to affect their decision to remain enrolled and the entrance of new members.However, studies regarding household heads’ satisfaction with the CBHI schemes are scarce in Ethiopia. Therefore, this studyaimed to determine the level of satisfaction with CBHI schemes and associated factors among heads of households inNorthwest Ethiopia.Methods: A community-based cross-sectional study was conducted from March 1–30, 2022. A stratified random samplingtechnique with multistage sampling was used to select 604 study participants. A face-to-face interview was conducted using apretested structured questionnaire. Both bivariable and multivariable logistic regression analyses were conducted. An adjustedodds ratio (AOR) with 95% confidence intervals (CIs) was computed to evaluate the strength of the association, and variableswith a p value < 0 05 at a 95% CI were considered statistically significant.Results: This study found that about 56.1% of household heads were satisfied with the CBHI schemes. Being older age(AOR = 1 85; 95% CI: 1.17, 2.94), rural residence (AOR = 4 13; 95% CI: 2.24, 7.62), visited only health center (AOR = 0 34;95% CI: 0.20, 0.55), distance from a health facility (AOR = 3 18; 95% CI: 1.82, 5.55), agreement with prescribed drugs(AOR = 2 31; 95% CI: 1.36, 3.92), friendliness with healthcare provider (AOR = 3 65; 95% CI: 2.18, 6.10), and had a goodknowledge of benefit packages (AOR = 3 00; 95% CI: 1.93, 4.67) were significantly associated with household head satisfaction.Conclusion: The overall satisfaction of household heads with the CBHI schemes was good. The type of health facility visited,residence, age, distance from health facilities, relationship with healthcare providers, agreement with prescribed medications,and knowledge of community based health insurance were significantly associated with participants’ satisfaction. Thus, thesefindings suggest that improving access to healthcare services, fostering better relationships between healthcare providers andbeneficiaries, and enhancing awareness of CBHI benefits could further increase satisfaction levels among households.Keywords: community-based health insurance (CBHI); Ethiopia; household; satisfaction

Introduction: Stillbirth is still a major public health problem in middle- and low-income countries. However, there has been limited research conducted to identify determinants of stillbirth in Ethiopia. Therefore, this study aimed to identify the determinants of stillbirth among women who gave birth in public hospitals in the West Gojjam Zone, Northwest Ethiopia.
Methods: An unmatched case-control study was conducted among 418 mothers who gave birth from March 1-30, 2022. Consecutive and systematic sampling techniques were used to select the cases and controls, respectively. The collected data were entered into Epidata and exported into SPSS version 16 for analysis. Numerical descriptive statistics were expressed by using the mean with standard deviation (SD) and/or median with interquartile range (IQR), whereas categorical variables were expressed by proportions. Bivariable and multivariable binary logistic regression analyses were used to identify determinants of stillbirth. The model goodness of fit test was checked using the Hosmer-Lemeshow test. Variables having a P-value ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis model. Adjusted odds ratio with 95% confidence intervals (CIs) was used to report the strength of association, and variables with a P-value < 0.05 were considered statistically significant.
Results: A total of 105 cases and 313 controls were included in this study. The odds of having stillbirth were higher among women who were illiterate (AOR: 1.6, 95% CI: 1.34, 7.55), had first ANC visit in the second trimester (AOR: 11.4, 95% CI: 2.99, 43.71), had an induced mode of delivery (AOR: 8.7, 95% CI: 2.10, 36.03), history of stillbirth (AOR: 1.5, 95% CI: 1.45, 4.90), bad obstetric history (AOR: 4.8, 95% CI: 1.44, 15.89), history of preterm (AOR: 7.6, 95% CI: 1.57, 37.21), not vaccinated for TT (AOR: 8.8, 95% CI: 2.23, 35.17), labor not followed by using partograph (AOR: 3.1, 95% CI: 1.10, 8.42), and history of abortion (AOR: 11, 95% CI: 2.91, 41.31).
Conclusion: The determinants of stillbirth included women who were illiterate, started ANC visits in the second trimester, had an induced mode of delivery, history of stillbirth, bad obstetric history, history of preterm, history of abortion, not vaccinated for TT, and not followed by partograph. It is better to improve partograph utilization during intrapartum care and screen mothers who had a higher risk of adverse birth outcomes during their pregnancy to avert the problem.

Keywords:  Cases; Controls; Determinants; Ethiopia; Stillbirth.

Background Ethical dilemmas in emergency and critical care nursing often involve complex decision-makingthat impacts patient outcomes, emotional well-being of healthcare providers, and team dynamics. Understandingthese dilemmas and the decision-making processes involved is crucial for improving nursing practices and patientoutcomes in this context.Objective This study aims to explore the ethical dilemmas and decision-making processes of emergency and criticalcare nurses, using the Four Box. Method ethical decision-making framework.Methods A multi-method qualitative approach was employed, incorporating in-depth individual interviews(IDI), focus group discussions (FGD), and case studies to capture diverse perspectives. Data were collected from28 nurses working in emergency and critical care settings at Tibebe Ghion Specialized Hospital and Felege HiwotComprehensive Specialized Hospital through purposive sampling. The interviews and focus groups were audiorecorded, transcribed verbatim in Amharic, translated into English, and entered into OpenCode software for analysis.Inductive thematic analysis method was applied to analyze the data.Results The study revealed several key ethical dilemmas faced by nurses, including balancing patient autonomywith beneficence, and the allocation of limited resources during crises, opioid administration for pain managementvs. respiratory depression, and conflicts regarding informed consent. Nurses reported emotional and professionalimpacts from these dilemmas, contributing to moral distress, burnout, and ethical fatigue. Nurses emphasizedthe importance of interdisciplinary collaboration and structured decision-making frameworks to navigate thesechallenges. However, the lack of consistent access to ethics consultations and peer support during critical momentswas noted as a significant barrier.Conclusion and recommendation Nurses encounter complex ethical dilemmas that impact their emotional well-being and job satisfaction. Effective decision-making requires applying ethical principles, adhering to guidelines,and consulting peers. The study reveals the need for improved support systems, including more frequent and
comprehensive ethics training, better access to ethics consultations, and structured frameworks to guide decision-making in high-pressure situations.Clinical trial registration The study is not a clinical trial, a clinical trial number is not applicable.Keywords Ethical dilemma, Decision making, Emergency and critical care, Nursing

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.

BackgroundIn the intensive care unit (ICU), mechanical ventilation (MV) is a typical way of respiratorysupport. The severity of the illness raises the likelihood of death in patients who require MV.Several studies have been done in Ethiopia; however, the mortality rate differs among them.The objective of this systematic review and meta-analysis is to provide a pooled prevalenceof mortality and associated factors among ICU-admitted patients receiving MV in Ethiopianhospitals.MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) 2020 criteria to conduct a comprehensive systematic review and meta-analysisin this study. We searched PubMed/Medline, SCOPUS, Embase, Hinari, and Web of Sci-ence and found 22 articles that met our inclusion criteria. We used a random-effects model.To identify heterogeneity within the included studies, meta-regression and subgroup analy-sis were used. We employed Egger’s regression test and funnel plots for assessing publica-tion bias. STATA version 17.0 software was used for all statistical analyses.ResultsIn this systematic review and meta-analysis, the pooled prevalence of mortality among 7507ICU-admitted patients from 22 articles, who received MV was estimated to be 54.74% [95%CI = 47.93, 61.55]. In the subgroup analysis by region, the Southern Nations, Nationalities,
and Peoples (SNNP) subgroup (64.28%, 95% CI = 51.19, 77.37) had the highest preva-lence. Patients with COVID-19 have the highest mortality rate (75.80%, 95% CI = 51.10,100.00). Sepsis (OR = 6.85, 95%CI = 3.24, 14.46), Glasgow Coma Scale (GCS) score

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
 

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.