Early childhood care and education (ECCE) is the basis for the enduring instillationof personal habits and societal ideals. Thus, the study aimed to investigate the practiceand challenges of implementing ECCE in Bahir Dar city administration, Ethiopia. To thisend, a qualitative research approach with a multiple case study design was used. Quali-tative data were collected from 40 participants (ECCE teachers, caregivers, unit leaders,school principals, and Bahir Dar city administration education experts). Observation,interviewing, and focus group discussion were used as data collection instruments. Asa result, ECCE was poorly implemented. By and large, the finding of this study identi-fied many challenges that inhibit the successful implementation of ECCE, such as lackof teachers and caregivers’ training, poor physical environment, inadequate resources/facilities, inappropriate teacher–student ratio, and unrealistic demands of parents.These hindrances increase learning gaps that widen over time, contributing to higherdropout rates and reduced literacy levels. The study results would have importantimplications for the advancement of the ECCE program. Additionally, the findingsmight inform policymakers and educators on areas that require further developmentor intervention, ultimately contributing to improving of early childhood learningexperiences.Keywords: Caregivers, Challenges, Early childhood care and education, Practice, Teachers

Executive Summary Background and objectivesDiabetes mellitus (DM) and hypertension (HTN) are leading causes of cardiovascular disease, death, and disability, with a growing burden in developing countries. Early detection is essential, and machine learning (ML) offers powerful tools for predicting diseases risk by uncovering complex patterns in health data. At the same time, the Health Belief Model (HBM) explains preventive behaviors through constructs such as perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action. This study integrates ML-based predictive modeling with the HBM to identify individuals at risk of HTN and DM and to better understand the behavioral factors influencing prevention, employing a dataset collected in 2025. Materials and methodsData on DM and hypertension HTN were collected from 1,771 employees of Debre Markos, Injibara, and Bahir Dar universities in Northwest Ethiopia. The cross-sectional survey included demographic, health-related, and behavioral factors, with constructs from the Health Belief Model (HBM) such as perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action. RFE was applied to identify the most relevant predictors of DM and HTN. Four machine learning algorithms—Logistic Regression (LR), Random Forest (RF), Gradient Boosting Decision Tree (GBDT), and k-Nearest Neighbor (kNN) were developed using theselected features. Model performance was evaluated based on accuracy, precision, recall, the F1-score, and the area under the ROC curve. ResultsThis study found that the ensemble ML models, RF and GBDT, outperformed in predicting HTN and DM, achieving higher accuracy, precision, recall, F1-score, and area under the ROC curve. Analysis of Health Belief Model (HBM) constructs further showed that preventive behaviors were positively associated with perceived susceptibility, severity, benefits, self-efficacy, and cues to action, while perceived barriers were negatively associated. Perceived susceptibility emerged as a significant predictor of HTN and DM, and cues to action contributed to the identification of undiagnosed DM cases.

Youth unemployment in the East Gojjam Zone is a critical issue. This study focuses onidentifying the factors that influence unemployment duration and evaluating the impact ofjob creation programs on the well-being of youth in this region. We employed Cox regres-sion to analyze the determinants of unemployment duration and used propensity scorematching to assess the welfare effects of job creation initiatives. Our multistage clustersampling revealed a youth unemployment rate of 33.3% (95% CI: 27.3–39.3). Over half ofthe unemployed youth transitioned to employment within four years, with 25% securingjobs within two years. Participation in job creation programs led to an average earningsincrease of 1,069.716 birr, though retention in these programs was low at 49%. The find-ings reveal a connection between prolonged unemployment, skill mismatches, financialconstraints, limited work experience, weak social networks, low income, and a preferencefor public-sector employment. To effectively address these challenges, interventions mustfocus on improving job accessibility, aligning vocational training with labor market needs,promoting financial inclusion, and enhancing social support systems.

Backgrounds Poverty is a complex and multifaceted global public health issue, particularly prevalent in Ethiopia,including the East Gojjam Zone. Previous studies on poverty have largely relied on unidimensional measures,providing limited evidence on multidimensional poverty (MP). Therefore, this study tried to assess the prevalenceand identify the associated factors of MP among rural households in selected woredas of East Gojjam Zone, NorthernEthiopia.Methods A community-based cross-sectional study was conducted in the fall of 2020 in randomly selectedworedas of East Gojjam zone, involving 770 rural households. Multistage cluster sampling was used, and data werecollected through structured, interviewer-administered questionnaires covering eleven MP indicators. The globalmultidimensional poverty index (MPI) was applied to assess poverty status. The multivariable partial proportionalodds model (PPOM) was employed to identify the associated factors of MP, and variables with a p-value < 0.05 wereconsidered as significant.Results Among 770 rural households considered 37.27% (25.45% moderately and 11.82% severely) of them wereclassified as multidimensionally poor. The standard of living dimension accounted for the largest contribution to MP.Household head aged, 30–45years (AOR = 1.78, 95% CI: 1.01, 3.15) and those over 45 years (AOR = 2.75, 95% CI: 1.42,5.33), weather condition(Kolla) (AOR = 1.79, 95%CI: 1.05, 3.07), experiencing drought in the preceding 12 months(AOR = 1.65, 95% CI: 1.12, 2.41), dependency ratio (AOR = 1.34, 95%CI: 1.13,1.59), and adult equivalence (AOR = 1.13,95%CI: 1.07,1.19) were more likely to experience MP. Conversely, marital status (being married) (AOR = 0.36, 95%CI:0.21, 0.64), woreda, Machakel (AOR = 0.56, 95%CI: 0.36, 0.86), Sinan (AOR = 0.53, 95%CI: 0.29, 0.95), and road accessibilityin the village (AOR = 0.55, 95%CI: 0.37, 0.81) were significantly associated with lower odds of MP among ruralhouseholds in the study area.
Conclusion: Approximately 37% of rural household’s experience moderate to severe MP, and living standardsdimension accounted for the largest contribution. Various socio-demographic, agro-ecological, and related factorshave been identified to rural MP. To address this issue, stakeholders should prioritize to promote climate-resilientagriculture and strengthening drought coping mechanisms. Furthermore, it is essential to account for the variations inpoverty levels across different administrative units and ecological zones to effectively eradicate poverty among ruralhouseholds.Keywords: East Gojjam zone, Ethiopia, Multidimensional poverty, Partial proportional odds model, Rural household

Multidimensional poverty, encompassing deprivations in education, health, and living standards, is a significant challenge in rural Ethiopia. Despite various development initiatives, poverty remains pervasive in the West Gojjam Zone of northern Ethiopia. This study aims to assess the extent of multidimensional poverty in this region and identify key factors contributing to the likelihood of households experiencing it.
Methods
A cross-sectional survey was conducted in the West Gojjam Zone, involving 628 rural households selected through a multi-stage sampling approach. Descriptive statistics were used to calculate the multidimensional poverty index (MPI), focusing on poverty incidence, gap, and severity. A binary logistic regression model was applied to examine the relationship between household characteristics and the likelihood of being multidimensionally poor.
Results
The study revealed that 93.95% of households in the West Gojjam Zone experience multidimensional poverty, with an intensity of 61.17% and an adjusted multidimensional headcount ratio of 57.47%. Key factors associated with a lower likelihood of multidimensional poverty include land ownership, off-farm income, year-round road access, the frequency of agricultural extension services, and access to loans. Conversely, the age of household heads is positively associated with an increased likelihood of poverty, with older household heads being more vulnerable.
Conclusions
The findings highlight that multidimensional poverty in the West Gojjam Zone is primarily driven by limited access to land, financial services, infrastructure, and agricultural support. Furthermore, older household heads are particularly at risk. To address these challenges, the study recommends policies that focus on enhancing agricultural productivity, expanding access to financial services, improving road infrastructure, and fostering non-farm income-generating activities. Strengthening agricultural extension services is essential to enhancing household resilience and reducing poverty.

Introduction: Tungiasis is an overlooked tropical disease resulting from the penetration of the skin by sand fleas. It leads to significant suffering and can be fatal, particularly affecting school age children and elders, primarily above 60 years old, in rural and urban slums across Sub-Saharan Africa. Despite its great public health consequences, the condition remains largely under reported by the scientific communities mainly in Sub Saharan African countries.
Objective: To assess the prevalence of Tungiasis and associated factors among school-age children in Sub-Saharan Africa.
Methods and materials: This systematic review and meta-analysis was done based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). Literatures were searched from a variety of databases, including PubMed, Science-Direct, Google Scholar, Hinari, and Google. The eligible studies data were extracted using Microsoft Excel and exported to statistical software, STATA version 14 for further analysis. A random-effect model was considered to estimate the prevalence of Tungiasis. The Egger test and funnel plot were used to evaluate publication bias, whereas I2 statistic was used to measure heterogeneity. The finding of this SRMA was done using 23 selected studies with 9781 study participants.
Results: This review revealed that the pooled prevalence of Tungiasis was 37.86%% (95% CI: 30.95-44.77; I2 = 98.3%, P < 0.000). In terms of risk factors of Tungiasis, school children who lived with domestic animals (cat or dog) in their home were 2.73 times more likely to affected by Tungiasis compared to those without these pets in their home (OR: 2.73, 95% CI: 1.53-3.94). Additionally, school age children who did not wear shoes at all and wear occasionally were 11.26 (AOR: 11.26, 95% CI: 4.04, 18.49) and 7.61 (OR: 7.61, 95% CI: 3.39, 11.83) more likely to affected by Tungiasis compared to those who were regularly. Finally, school-age children who lived in mud-plastered walls were 4.97 times more likely to be affected by Tungiasis compared to those who lived in cemented wall homes (OR: 4.97, 95% CI: 2.61, 4.61).
Conclusion: Generally, this systematic review and meta-analysis disclosed that a third of school age children were affected by Tungiasis. Additionally, housing conditions, shoe-wearing practices, and the condition of living with domestic animals were factors significantly associated with Tungiasis. Hence, concerned governmental and non-governmental organizations should work to enhance behavioral modification towards prevention and control of Tungiasis. One-third of the school-aged children were affected by Tungiasis. Contributing factors included inadequate housing conditions, footwear habits, and the presence of domestic animals. Therefore, relevant governmental and non-governmental organizations should promote behavioral changes to prevent and control Tungiasis.

Flooding exacerbates health challenges by spreading waterborne diseases like diarrhea throughthe destruction of sanitation infrastructure and contamination of drinking water sources. However,evidence on the prevalence and contributing factors of diarrheal diseases among under-five childrenin the Dasenech district is limited. This study aimed to assess the prevalence of acute diarrhea andits determinants among under-five children in flood-affected areas of the South Ethiopia region. Acommunity-based cross-sectional study was conducted from July 1 to July 15, 2024, in flood-affectedareas of the Dasenech district, involving 696 under-five children. Five kebeles were purposivelyselected, followed by the proportional allocation of households, after which a systematic samplingtechnique was applied to identify study participants. Data were collected using a pretested andstructured questionnaire administered by trained interviewers. Multivariable logistic regressionanalysis was performed to identify factors associated with acute diarrhea, with statistical significanceset at p < 0.05 and a 95% confidence interval (CI). The prevalence of acute diarrhea was 31.6% (95%CI: 28.7–34.3%). Significant predictors of acute diarrhea included non-adherence to exclusivebreastfeeding (AOR: 2.14, 95% CI: 1.65–3.98), lack of latrines (AOR: 12.08, 95% CI: 9.77–13.13), unsafedisposal of child excreta (AOR: 3.86, 95% CI: 2.38–6.26), home delivery (AOR: 6.02, 95% CI: 5.53–8.82),and a recent history of diarrhea among mothers or caregivers (AOR: 3.14, 95% CI: 1.33–5.66). Acutediarrhea is highly prevalent among under-five children in the Dasenech district. The findings underscorethe need for targeted public health measures, such as improving waste management, promotingexclusive breastfeeding, constructing and utilizing latrines, and addressing maternal and caregiverhealth, to mitigate the burden of diarrheal diseases in this vulnerable population.Keywords Acute diarrhea, Dasenech district, Ethiopia, Flood-affected, Under-five childrenDiarrhea is defined as an increase in bowel movement frequency or a change in stool consistency, commonlyidentified as the passage of three or more loose or watery stools within a 24-h period1. This condition oftenresults from intestinal infections caused by bacteria, viruses, or parasites, which are closely associated withlimited access to safe water and inadequate sanitation facilities2. Inadequate water and sanitation contributeto over 94% of the four billion annual cases of diarrhea worldwide3,4. This condition claims approximately twomillion lives each year, representing 4% of global mortality. Alarmingly, 1.3 million of these deaths occur amongchildren annually5.

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

BackgroundPost-intensive Care Syndrome (PICS) is defined as various physical, psycho-logical, and cognitive, impairments that can arise during an ICU stay, continueafter leaving the ICU, or even persist following hospital discharge. It impactsboth patients and their family’s quality of life. Various primary studies worldwidehave reported prevalence of PICS among ICU survivors. However, these studiesexhibit inconsistency and wide variations. Therefore, this systematic review andmeta-analysis aimed to estimate the pooled prevalence of post intensive caresyndrome among intensive care unit survivors along with its association with ICUlength of stay.MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) 2020 checklist for this review. We searched PubMed/Medline, CINHAL,Embase, and Google scholar to retrieve articles. The Newcastle Ottawa Scale (NOS)was used for quality assessment of articles. The random effects model with I-squaredtest was used to estimate the prevalence of PICS and its association with ICU lengthof stay. To identify the source of heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger’s regression testand funnel plots for assessing publication bias. STATA version 17.0 software wasused for all statistical analyses. A p-value of < 0.05 with 95% confidence interval wasused declare statistically significant.
ResultsA total of 19 articles with a population of 10179 ICU-survivors were included in thisreview. The pooled prevalence of PICS was found to be 54.35% (95% CI = 45.54,63.15). In sub-group analysis by region, the highest prevalence was observed instudies done in south and north America with overall prevalence of 61.95% (95%CI = 28.33, 95.62). Among the three domains of PICS (physical, cognitive and mentaldomains), the highest prevalence score was observed in the physical domain withoverall prevalence of 45.99% (95% CI = 34.66, 57.31). In this meta-analysis, thosepatients who stayed more than four days in the ICU were 1.207 [95% CI = 1.119,1.295] times more likely to develop at least one among the three domains of PICS inthe post-intensive care period than their counterparts.ConclusionThis systematic review and meta-analysis demonstrate a high prevalence of PICSamong ICU survivors, and highlight the significant association between ICU lengthof stay and the development of PICS. These findings underscore the need for tar-geted interventions to mitigate the long-term effects of critical illness, particularly forpatients with prolonged ICU stays.

Introduction: Occupational health problems are the major issues of the world, particularly in developing countries. Sanitation workers are facing various health problems with little attention while conducting their day today activities. The review emphasizes the critical need for policies that ensure safety standards, provide proper protective gear, and establish regular health monitoring to protect workers' health and wellbeing.
Objective: The aim of the study was to assess the prevalence of respiratory symptoms and associated factors among sanitation workers in Sub-Saharan Africa.
Methods and materials: This systematic review and meta-analysis was done based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). Literatures were searched using various database like Google scholar, Science-Direct, Pub-Med (Medline), Hinari, and Google. From eligible studies, data was extracted using Microsoft excel and exported to STATA version 14 statistical software for analysis. The prevalence of respiratory symptom was estimated using a random effect model. Publication bias was determined using Egger test and funnel plot whereas heterogeneity was evaluated using I2. Fortunately, 13 studies were included with a total participants of 4,401.
Results: The pooled prevalence of respiratory symptoms among sanitation workers was 43.79% (95% CI: 35.26, 52.33; I 2 = 97.3%, p < 0.000). Sanitation workers with a history of respiratory illness were 4.16 times more likely to have had respiratory symptoms compared to those without a history (OR: 4.16, 95% CI: 2.67, 5.66). Additionally, sanitation workers who did not wear nose/mouse masks were 2.36 times more likely to experience respiratory symptoms compared to their counterparts (OR: 2.36, 95% CI: 1.40, 3.32). Moreover, Sanitation workers with working experiences of greater than five were 1.81 times more likely to experience respiratory symptoms than those with less than 5 years working experiences (OR: 1.81, 95% CI: 1.26, 2.39).
Conclusion: Generally, half of the sanitation workers experienced respiratory symptoms. The symptoms were associated with history of respiratory illness, utilizing of nose/ mouth face mask and working experience. Hence, awareness creation session should conducted mainly for those with history of respiratory illness and poor personal protective users.

Keywords: Sub Saharan Africa; prevalence; respiratory–epidemiology; risk factors; sanitation workers; systematic review and meta-analysis.