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

Introduction: One of the main complications for stroke patients is aspiration pneumonia, which is an acute lunginfection brought on by the entry of endogenous flora and various bodily substances from the gastrointestinaltract into the respiratory system. Aspiration pneumonia following a stroke was linked to older age, gender,dysarthria, denture use, cerebral atrophy, and basal ganglia-infarcted foci. Despite improvements in care, theepidemiological and prognostic effects of pneumonia associated with stroke are increasing mortality andmorbidity.Objective: To assess the pooled prevalence of aspiration pneumonia among stroke patients in Ethiopia.Methods: Several databases, including PubMed/MEDLINE, EMBASE, Scopus, Google Scholar, African JournalsOnline (AJOL), grey literature, and articles from the repository of Ethiopian universities, were examined to findavailable articles. The data were extracted and sorted in Microsoft Excel and exported to STATA/MP 17.0 foranalysis. The Newcastle-Ottawa (NOS) was employed to assess each study’s qualities. A weighted inverse vari-ance random-effects model with a 95 % confidence interval was used to examine the pooled prevalence ofaspiration pneumonia. The Galbraith plot and funnel plot were used to evaluate heterogeneity and publicationbias, respectively. To identify the possible cause of heterogeneity, subgroup analysis and meta-regression wereperformed. P-values less than 0.05 were considered statistically significant.Result: The pooled prevalence of aspiration pneumonia among stroke patients in Ethiopia was 31.65 % (95 % CI:25.30–38.01). Visual examination of the Galbraith plot reveals the presence of significant heterogeneity (I2 =96.55 %, p < 0.001). Studies conducted in Addis Ababa and Harar revealed the highest prevalence of aspirationpneumonia: 37.67 % (95 % CI: 31.56, 43.78). Similarly, articles carried out before 2020 and studies done usingcross-sectional study design revealed the highest proportion of aspiration pneumonia: 32.97 % (95 % CI: 24.96,40.98) and 36.75 (95 % CI: 32.11, 41.38), respectively.Conclusion: Nearly one-third of stroke patients developed aspiration pneumonia. The highest prevalence wasreported in Addis Ababa and Harar regions. As a result, early detection, treatment, and control of stroke areadvisable to prevent the occurrence of aspiration pneumonia.
Keywords: Aspiration pneumonia, Stroke, Cerebrovascular accident, Systematic review, Meta-analysis, Ethiopia

Background Due to the high burden of mortality from acute communicable and non-communicable diseases,emergency department’s mortality has become one of the major health indices in Ethiopia that should be evaluatedregularly in every health institution. However, there are inconsistencies between studies, and there is no systematicreview or meta-analysis study about the prevalence of mortality in the emergency department. Therefore, this studyaimed to determine the pooled prevalence of mortality and identify its determinants in the emergency departmentsof Ethiopian hospitals.Methods This systematic review was conducted according to the guidelines of Preferred Reporting Items forSystematic Reviews and Meta-Analyses (PRISMA) and has been registered with PROSPERO. A structured search ofdatabases (Medline/PubMed, Google Scholar, CINAHL, EMBASE, HINARI, and Web of Science) was undertaken. Allobservational studies reporting the prevalence of mortality of patients in emergency departments of Ethiopianhospitals, and published in English up to December 16, 2023, were considered for this review. Two reviewersindependently assess the quality of the studies using the Joanna Briggs Institute (JBI) critical appraisal tool. A meta-analysis using a random-effects model was performed to estimate the pooled prevalence. The heterogeneity ofstudies was assessed using I2 statistics, and to identify the possible causes of heterogeneity, subgroup analysis andmeta-regression were used. Egger’s test and funnel plots were used to assess publication bias. STATA version 17.0software was used for all the statistical analyses. A p-value less than 0.05 was used to declare statistical significance.Results A total of 1363 articles were retrieved through electronic search databases. Subsequently, eighteen studiescomprised 21,582 study participants were included for analysis. The pooled prevalence of mortality among patients inthe Emergency Department (ED) was 7.71% (95% CI: 3.62, 11.80). Regional subgroup analysis showed that the pooledprevalence of mortality was 16.7%, 12.89%, 10.28%, and 4.35% in Dire Dawa, Amhara, Oromia, and Addis Ababa,respectively. Moreover, subgroup analysis based on patients’ age revealed that the pooled prevalence of mortalityamong adults and children was 8.23% (95% CI: 3.51, 12.94) and 4.48% (95% CI: 2.88, 6.08), respectively. Being a ruralresident (OR; 2.30, 95% CI: 1.48, 3.58), unconsciousness (OR; 3.86, 95% CI: 1.35, 11.04), comorbidity (OR; 2.82, 95% CI:1.56, 5.09), and time to reach a nearby health facility (OR; 4.73, 95% CI: 2.19, 10.21) were determinants of mortality forpatients in the emergency departments.
Conclusion and recommendations This study found that the overall prevalence of mortality among patients inemergency departments of Ethiopian hospitals was high, which requires collaboration between all stakeholdersto improve outcomes. Being a rural resident, unconsciousness, comorbidity, and time elapsed to reach healthfacilities were determinants of mortality. Improving pre-hospital care, training healthcare providers, early referral, andimproving first-line management at referral hospitals will help to reduce the high mortality in our country.Keywords Associated factors, Emergency department, Ethiopia, Meta-analysis, Mortality

Introduction One of the most important but underappreciated roles of nurses is patient advocacy. To advocatefor patients effectively, the nurses should have a favorable attitude towards patient advocacy. Despite this fact, thenurses’ attitude towards patient advocacy was not known in Ethiopia. Thus, this study aimed to assess nurses’ attitudetowards patient advocacy and its associated factors in East Gojjam Zone Public Hospitals, Northwest in 2023.Methods Institutional-based cross-sectional study design was conducted among 385 nurses in East Gojjam ZonePublic Hospitals from March 1 to April 30, 2023. Nurses were selected using simple random sampling techniquesfrom 11 public hospitals. The data were collected in a self-administered way. Binary logistic regression was used fordata analysis. All independent variables having a P value of < 0.25 in the bivariable logistic regression were fitted intoa multivariable logistic regression. The AOR at a 95% confidence interval was used to identify the strength of theassociation, and a p value of 0.05 was used to declare it statistically significant at the final model.Result A total of 385 nurses participated in the study, for a 91% response rate. Among these, 49.9% of nurses hadan unfavorable attitude. Being working in a primary hospital [AOR = 2.3; 95% CI: (1.4–3.8)], poor cooperation ofnurses [AOR = 1.7; 95% CI: (1.1–2.8)], being unsatisfied with the job [AOR = 1.7; 95% CI: (1.1–2.7)], and poor perceivedsupervision of work [AOR = 6.2; 95% CI: (3.7–9.8)] were factors associated with nurses’ attitudes towards patientadvocacy.Conclusion The number of nurses who had an unfavorable attitude towards patient advocacy was high. Workingin a primary hospital, poor cooperation with others, being dissatisfied with the job, and having an unfavorableperception towards the supervision of work were the factors associated with the unfavorable attitude of nursestowards patient advocacy. It is recommended that all hospitals better support the nurses to increase their jobsatisfaction and have good supervision of the nurses’ activities.Keywords Advocacy, Attitude, Nurse

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.

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


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

 

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

Background: Neisseria gonorrhoeae is the causative agent of gonorrhea and accounts for the majority of sexuallytransmitted infections globally. There are few studies on the prevalence and antimicrobial susceptibility patternsof N. gonorrhoeae in Ethiopia.Objective: This study aimed to assess the prevalence, antimicrobial susceptibility patterns, and associated factorsof N. gonorrhoeae.Method: A cross-sectional study was conducted among women attending Debre Markos town health institutions;in Northwest Ethiopia from June 1, 2022 to October 30, 2022. An endocervical swab was collected and culturedon Modified Thayer Martin medium. Antimicrobial susceptibility testing was performed using the modifiedKirby-Bauer disk diffusion technique for isolates, following Clinical and laboratory standards institute guidelines.Logistic regression was applied to show the relationship between dependent and independent variables. P-value

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: In countries with a high prevalence of TB, such as Ethiopia, direct sputum smear microscopy remains the most cost-effective tool for diagnosing patients with infectious tuberculosis and monitoring their progress on treatment. However, poor-quality sputum microscopy services may lead to the failure to detect persons with active tuberculosis and may cause unnecessary anti-TB treatment for non-TB cases. Proficiency level is the percentage agreement between participants'readings and the reference panel results. The aim of this study was to assess proficiency and associated factors of laboratory professionals in sputum smear microscopy for acid-fast bacilli at selected peripheral public and private diagnostic laboratories in East Gojjam Zone, Northwest Ethiopia, in 2023.
Method: An institutional-based cross-sectional study design was conducted from March 2023 to June 2023 at selected peripheral public diagnostic laboratories in East Gojjam Zone. 65 laboratory professionals were selected randomly from 41 peripheral public diagnostic laboratories in the study area. A validated questionnaire and 10 panel slides were used as data collection tools. The panel consisted of 5 pre-stained and 5 unstained slides. Data were entered and analyzed using the Statistical Package for Social Sciences software (SPSS version 20). P values less than 0.05 were considered statistically significant when looking for associations between dependent and independent variables.
Result: The overall proficiency level of laboratory professionals in tuberculosis smear microscopy was 81.92% with 95% CI [78.46-85.38]. Previous TB smear microscopy training, work experience, and institution of education had a significant association with the overall performance of laboratory professionals in TB smear microscopy.
Conclusion: The overall TB smear microscopy performance level of laboratory professionals at peripheral diagnostic laboratories in Ethiopia, was satisfactory, indicating a good level of competence. However, notable technical errors related to smear reading and reporting were observed. Thus, higher education institutions, especially private institutions, and the Zonal Health Department, should implement educational and training interventions to address the identified gaps and ultimately contribute to the national TB control program.

Keywords:  AFB microscopy; AFB panel slide preparation; Proficiency testing; Tuberculosis.