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

AbstractIntroduction 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

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.

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 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

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 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

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

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