Background: An estimated 75.8 under-five deaths per 1000 live births occurred in sub-Saharan Africa. This study aimed to investigate the prevalence and factors associated with under-five mortality in Sub-Saharan Africa. Methods: This study was based on secondary data sources from 33 Sub-Saharan countries’ recent Demography and Health surveys from 2010 to 2020. A weighted sample of 360,397 under-five children was included in the study. Bayesian multilevel binary logistic regression was fitted using the brms R package. Besides, leave one out information criteria was used for model comparison. The adjusted odds ratio (AOR) and its 95% credible interval (CrI) were reported for significant factors associated with under-five mortality. Clinical trial number: not applicable. Results: The prevalence of under-five mortality in sub Saharan Africa was 62 per 1000 live births (95%CI (56.29, 68.29). In sub region of SSA, it was 65 in central, 52 in eastern, 50 in southern and 73 in western region per 1000 live births. Multiple birth (AOR = 5.27; 95%CrI: 4.72, 5.87), number of under-five children 3 to 5 (AOR = 3.31; 95%CrI: 3.01, 3.60), caesarean section delivery (AOR = 1.64; 95%CrI: 1.47, 1.83), being unmarried (AOR = 1.16; 95%CrI 1.08, 1.26), using unimproved toilet (AOR = 1.08;95%CrI: 1.02, 1.16), birth order of 4th to 6th (AOR = 1.18; 95%CrI:1.1, 1.25),were risk factors of under-five mortality. Whereas, being female (AOR = 0.86; 95%CrI: 0.82, 0.91), preceding birth interval of 24–35 months (AOR = 0.61; 95%CrI: 0.57, 0.65) and above 36 months (AOR = 0.48; 95%CrI: 0.43, 0.49), ANC visit (AOR = 0.80; 95%CrI: 0.74 0.86), contraceptive use (AOR = 0.57; 95%CrI: 0.53, 0.61), were preventive factors of under-five mortality. Conclusion: Under-five mortality remains the highest in sub-Saharan Africa. Most of the risk factors of under-five mortality were found to be preventable. Policymakers and other stakeholders should enhance maternal education, lengthen birth interval, ANC visit, improved toilet facilities and, giving special attention to small size child and cesarean section delivery to reduce under-five mortality. Keywords: Under-five mortality, Associated factors, Bayesian, Sub-saharan Africa, DHS

Background: Despite progress in reducing neonatal mortality rates in Ethiopia, the country still has a high neonatal mortality rate compared with the global average. Primary hospitals are critical in delivering basic neonatal care, particularly in rural areas. However, data on neonatal mortality and contributing factors in these settings are scarce. This study aimed to determine the survival status and predictors of neonatal mortality among neonates admitted to Bichena Primary Hospital, Northwest Ethiopia.
Methods: A retrospective cohort study was conducted among 638 neonates admitted to the Bichena Primary Hospital neonatal intensive care unit from January 1, 2021, to April 30, 2023. Neonates were selected via a consecutive sampling method. Data were collected from medical records using a pretested checklist. A Kaplan-Meier survival curve was used to estimate the neonatal survival time, and a Cox proportional hazard regression model was used to identify independent predictors of neonatal mortality.
Results: Of the 638 neonates followed, 21.5% died during the study period. The overall incidence rate of death was 66.69 per 1,000 neonate days. Hypothermia, birth injury, perinatal asphyxia, preterm birth, maternal history of abortion, low birth weight, and neonatal hypoglycemia were independent predictors of neonatal mortality.
Conclusion and recommendation: The study found a high rate of neonatal mortality, exceeding rates reported in other regions of Ethiopia. Most predictors were preventable and treatable. Therefore, early identification of obstetric complications, immediate interventions and postnatal care are crucial to reduce neonatal mortality and enhance overall neonatal outcomes.
Keywords: Ethiopia; neonate; predictors; primary hospitals; survival status.

Introduction: Growth monitoring and promotion services are strategies to promote child health and reduce child mortality. Even though Ethiopia is attempting different strategies to cope with the low rate of GMP utilization, the problem is still unresolved.
Objective: Determine the pooled proportion of GMP utilization and its contributing factors among children less than two years in Ethiopia.
Method: The review protocol was registered with PROSPERO, number CRD42023472746. The PRISMA-2020 statement guided the conduct of this review. Electronic databases and grey literature were used. Heterogeneity was evaluated using I2. Subgroup analysis was conducted. The random effect model was used to summarize the pooled effect sizes with their respective 95% CI with STATA version 17. To test the small study effect, the funnel plot and Egger’s test were applied.
Result: A total of seven (7) studies with 4027 participants were considered in this meta-analysis. The pooled proportion of GMP utilization reported by seven studies was 25.71% (95%CI: 24.39, 27.04). ANC follow-up (AOR = 2.11; 95% CI: 1.47, 2.76), PNC follow-up (AOR = 1.96; 95% CI: 1.44, 2.49), counseling (AOR = 2.88; 95% CI: 2.09, 3.68), maternal education (AOR = 2.89; 95% CI: 1.66, 4.13), paternal education (AOR = 3.78; 95% CI: 2.25, 5.32), family health card (AOR = 2.31; 95% CI: 1.67, 2.96), and mothers good knowledge towards GMP (AOR = 2.90; 95% CI: 1.72, 4.07) variables were positively associated with GMP service utilization.
Conclusion and recommendation: The pooled proportion of GMP remains low in Ethiopia. ANC and PNC follow-up, counseling, maternal and paternal education, family health cards, maternal knowledge towards GMP were significantly associated. Findings are essential for evidence-based policy making, intervention, and input for ongoing research.

Abstract Background: Hospitals usually encounter human, capital, and financial resource constraints which alerts the efficient use of allocated resources more than ever. Health system managers are required to identify inefficient hospitals and the drivers of the inefficiencies. Although there are multiple studies examining the efficiency of public hospitals in East Africa, their findings are often variable and inconsistent. Therefore, this study aimed to review published articles on technical efficiency of public hospitals in East African countries. Methods: A systematic search of published articles on the technical efficiency of public hospitals was employed using Pubmed, Cochrane library, and google scholar and thirteen studies were included to this review. The studies were described in terms of their publication year, sample size, inputs and outputs used in the efficiency analysis, and the technical efficiency levels. Finally, we assessed their quality and estimate the mean technical efficiency using meta-analysis. Results: The technical efficiency score of public hospitals varied across countries in east Africa which ranged from 0.64 ± 0.34 in Tanzania to 0.99 ± 0.03 in Ethiopia. The mean technical efficiency was 0.82 (95% CI = 0.56, 1.07) for primary hospitals and 0.88 (95% CI = 0.82, 0.95) for secondary level hospitals. Technical efficiency of public hospitals was negatively correlated with the number of hospitals (the sample size) and positively correlated with the number of inputs and outputs included in the efficiency analysis. Conclusions: This review revealed that the technical efficiency of public hospitals in east Africa requires an improvement. To enable effective and efficient hospital management and improvement in hospital efficiency, health man-agers and policymakers must identify the drivers of hospital inefficiency. Systematic reviews on public hospital efficiency, which are currently rare in Africa, should be conducted on a much larger scale in order to create more, and validated information for use in policy-making. Trial registration: This review protocol was registered and approved by the international prospective register of systematic reviews with a Protocol ID: CRD42023444729. Keywords: Technical efficiency, Hospitals, Data envelopment analysis, East Africa, Systematic review

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 Stata™ 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

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