Merhawi Gebremedhin

Background: The pregnancy rate among adolescents is increasing, particularly in developing countries, with higher adverse health outcomes. There are limited studies conducted to assess the adverse neonatal birth outcomes of adolescent pregnancy and associated factors for newborns in Ethiopia. Objective: To assess the adverse neonatal birth outcomes and associated factors among babies born to adolescent mothers in Hospitals of East Hararghe Zone, Eastern Ethiopia from 21/01/ 2023 to 20/01/2024. Methods: A cross-sectional study was conducted on 532 medical recordsof adolescent delivery mothers using a single population and double -proportion formula to identify factors associated with adverse neonatal birth outcomes. Data was collected using Kobo, EPI INFO version 3.2, and analyzed using STATA version 17, Bivariate and multivariable binary logistic regression, and Hosmer-Lemeshow tests, with significance reported at a value < 0.05. Result: Data were extracted from 532 single-tone chart mothers. The prevalence of adverse birth outcomes in neonates born to adolescent mothers was 37.22(95% CI: 33.1–43.1). Spontaneous vaginal delivery (AOR = 0.35,95% CI:0.19–0.65), Low Hgb (AOR = 1.71, 95% CI: 1.04–2.81), APGAR scores first minute < 7 (AOR = 0.55, 95% CI:0.45–0.66), APGAR scores five minute < 7 (AOR = 1.11,95% CI:1.00-1.22), induced for labor (AOR = 3.5, 95% CI: 1.11–11.11), poor maternal nutrition (AOR = 0.107, 95% CI: 0.018–0.63), and mother with Eclampsia (AOR = 6.3,95%CI:1.74–22.75), had a significantly higher risk for adverse birth outcomes. Conclusion: The overall prevalence of adverse neonatal outcomes reported in this study was relatively high compared to findings reported in previous studies, such as those in Nigeria and Turkey. Adolescent mothers with spontaneous vaginal delivery, low Hgb levels, eclampsia, nutritional status, induced delivery during delivery, and Apgar scores in the 1st and 5th minutes were all significantly associated with adverse neonatal outcomes. Addressing factors like maternal nutrition, access to prenatal care, and proper delivery management could help reduce these adverse outcomes and improve overall maternal and neonatal health for adolescent mothers.

Health extension workers (HEWs) are the primary implementers of the health extension program (HEP) – a government-led community-based health-care program, but clinicians are anticipated to play a critical part in providing extensive support, thus, this study aimed to assess clinicians’ knowledge and perceptions of HEP, a cross-sectional study was conducted with 1239 clinicians. A set of 54-item questions was created based on HEP guidelines and relevant literature. Exploratory factor analysis (EFA) identified latent variables with Eigenvalues matrix >1. Cluster variables were derived through orthogonal varimax factor rotation, and internal reliability was evaluated using Cronbach’s alpha coefficient. A composite score was generated for each constructed factor, and the associations between variables were determined using a one-way analysis of variance. Multiple linear regression analysis was conducted to eliminate confounders, with statistical significance set at P < 0.05. EFA provides three factors explaining 91% of the total variance and labeled as “clinician-perceived attitude towards the skill of HEWs” (F1), “clinician knowledge on HEP activities” (F2), and “clinician-perceived attitude towards the impact of HEP” (F3). Internal reliability for the 54 items was 0.96, and it was 0.93, 0.90, and 0.89 for F1, F2, and F3, respectively. 75.5% and 76.2% of clinicians had favorable attitudes toward F1 and F3, respectively, and 70.2% had good knowledge of F2. F1 was positively correlated with participation in HEP review meetings, home visits, HEP outreach, and willingness to work in HEP but negatively correlated with degree holders. F2 was positively correlated with participation in HEP review meetings, home visits, being married, and non-medical doctors but negatively correlated with willingness to work in HEP, older age, female, and degree holder clinicians. Three factors, focusing on knowledge, skill, and the impact of HEP, were found and fall under the second-generation HEP framework. Therefore, strengthening HEP guidelines is essential to ensuring the delivery of sustainable and pro-poor HEP.

Background: Ethiopia is one of the developing countries hit by the double burden of malnutrition both under and over nutrition. Inappropriate food choice decisions are among the reasons for the problem, which are poorly investigated in the country, and it is concerned with providing information about the drivers of food choice decision-making process behavior that reflects the behavior of the young population, particularly in college students, which provides a window of opportunity for nutritional interventions. Therefore, this study aims to assess drivers of food choice among college students in Addis Ababa, Ethiopia. Methods and Materials: An institution-based cross-sectional study was conducted among 330 students who were selected using multistage sampling. For analysis, data were input into Epi Info version 7 and exported to STATA version 16.0. To summarize the data, descriptive measures such as frequencies, percentages, and summary measures were employed. Exploratory and confirmatory factor analyses were performed using a structural equation model to identify the driving factors of food choice. Results: Mood, health concern, sensory appeal, price, convenience, and familiarity were identified as drivers of food choice with significant factor loadings (p < 0.001) and acceptable internal consistency of items (α=0.91). However, the naturalness of the dietary composition and weight concerns have received the least attention. Conclusion: The study identified various biological, social, and economic factors that drive food choice decisions. Effective nutrition education and preventive interventions should be implemented to reduce unhealthy food decisions among college students through promoting favorable food choice decisions.

Background: The Ethiopian health extension program (HEP) is an innovative community-based strategy aimed at disease prevention and health promotion. While health extension workers (HEWs) are its front-line workers, the involvement of clinicians remains an integral part. The goals of this study were to: (1) assess the correlation of clinician attitude with predictors and (2) assess the reliability and validity of the survey instrument. Methods: A cross-sectional study design was utilized to collect data from a sample of 1239 clinicians using 28 items of attitude questions. Exploratory factor analysis (EFA) was applied to create the latent variables. Oblique Promax type rotation with factor loading (> 0.5) was used. Cronbach’s alpha was used to assess reliability, with a level of > 0.7 suggesting good reliability. Confirmatory factor analysis (CFA) was undertaken, with the values of Root Mean Square Error Administration (RMSEA) < 0.08, Standardized Root Mean Square Residual (SRMR) < 0.05, comparative fit index (CFI) 0.9–0.95, and Tucker-Lewis index (TLI) 0.9–0.95 suggesting acceptable model fit. A linear regression analysis was conducted. Results: EFA produced two latent variables which explained 93.2% of the total variance. The latent variables were labeled as perceived attitude towards the skill of HEWs (F1), and perceived attitude towards the impact of HEP (F2). Internal reliability for the 28 items was reported with a Cronbach’s alpha of 0.94, and for F1 and F2 it was 0.91 and 0.90, respectively. CFA was done and RMSEA was reported at 0.04, SRMR was 0.03, and CFI and TLI were each 0.97. The value of clinician attitude increased by 3.5, 95% CI (1.5, 5.3), P-value < 0.001 for those who have been exposed to the HEP program than non-exposed. Similarly, clinician attitude was lower for degree holders compared to those with diplomas by − 2.7, 95% CI (− 4.4, − 0.94), P-value < 0.002. Conclusion: Clinician attitude increased as exposure to HEP increased. Clinician attitude towards HEP has two latent variables. Furthermore, the assessment tool demonstrated good reliability and validity. In conclusion, it is worthy valued for clinicians to receive orientation about HEP, and researchers and program evaluators can use this assessment tool.

Background: Ideation refers to the ideas and views that people hold; it has been identified as an important explanation for differences in contraceptive use within and across countries. This study aimed to identify ideational factors that influence intention to use family planning (FP) methods among women of reproductive age (WRA) in the four emerging regions of Ethiopia. Methods: A quantitative cross-sectional survey of 2891 WRA was carried out in the four emerging regions of Ethiopia. A multistage, stratified systematic random sampling technique was employed to select the study participants. Data were collected by trained enumerators, using tablets equipped with Open Data Kit. To assess the impact of ideation on intention to use FP, the research team used 41 items distributed across five broad ideational factors: contraception awareness, self-efficacy, rejection of myth and rumor, intra-family discussion and family support. Confirmatory factor analysis was employed to test the fit of these items into the five ideational factors. A multiple binary logistic regression analysis was employed to assess the combined effect of these ideational factors with different sociodemographic variables on intention to use contraceptive methods. In all the statistical analysis, a p-value < 0.05 was considered statistically significant. Results: Different proportions of women in the four regions intended to use contraceptives in the future: 74.9% in Benishangul-Gumuz, 50.1% in Gambela, 21.8% in Afar, and 20.1% in Somali. The proportion of women who intended to use contraceptives varied with ideation scores. The multiple binary logistic regression revealed that self-efficacy was an important ideational factor of intention to use contraception in all four regions. Rejection of myth and rumor was also an important factor in all regions except in Somali. Contraception awareness and family support were significant predictors of intention to use contraception in the Afar region only. Intra-family discussion was not found significant in any region. Conclusions: Regional/district health offices should focus on increasing self-efficacy for FP use. Demystifying rumors would contribute to improved intention to use FP among women in Afar, Benishangul-Gumuz, and Gambela regions. Raising contraception awareness and encouraging family support would improve intention to use FP in Afar region.

Background: The Health Extension Program (HEP) is Ethiopia’s flagship community health program, launched in 2003. Health Extension Workers (HEWs) are key vehicles for the delivery of the HEP. While it is believed that there is high attrition among HEWs, the magnitude of or reasons for attrition is unknown. Their intention to leave their jobs in the next 5 years has also never been investigated on a national scale. This study aimed to assess the magnitude of, and factors affecting HEWs’ attrition and intention to leave in Ethiopia. Methods: The study used mixed methods to address the research objectives. Using stratified random sampling and regions as strata, 85 districts from nine regions were randomly selected in Ethiopia. Within each study district, six kebeles (village clusters) were randomly selected, and all HEWs working in these kebeles were interviewed to capture their 5-year intention to leave. The study team developed a data-extraction tool for a rapid review of district-level documents covering the period June 30, 2004 through June 30, 2019 to gather their attrition figures. We used survival analysis to model attrition data and checked model goodness-of-fit using the Cox–Snell residual test. We additionally collected qualitative data from HEWs who had left their positions. Results: The attrition of HEWS over the lifespan of the HEP was 21.1% (95% CI 17.5–25.3%), and the median time to exit from HEWs workforce was 5.8 years. The incidence rate was 3.1% [95% CI 2.8–3.4]. The risk of attrition was lower amongst HEWs with level four certifications, with children, and among those working in urban settings. By contrast, HEWs who were not certified with a certificate of competency (COC), who were deployed after 2008, and those who were diploma/degree holders were more likely to exit the HEWs workforce. The magnitude of intention to leave was 39.5% (95% CI 32.5–47%) and the primary reasons to leave were low incentives, dearth of career development opportunities (50.8%), high workload (24.2%), and other psychosocial factors (25%). Conclusion: Although the magnitude of attrition is not worryingly high, we see high magnitude in HEWs’ intention to leave, indicating a dissatisfied workforce. Multiple factors have contributed to attrition and intention to leave, the prevalence of many of which can be reduced to fit the needs of this workforce and to retain them for the sustained delivery of primary healthcare in the country. Ensuring HEWs’ job satisfaction is important and linked with their career development and potentially higher rates of retention.

Background: Despite recent improvements in the use of contraceptives amongst married women in Ethiopia, the utilization rates are still far below the national figures in the emerging regions of the country. Therefore, there is a need to assess the level of knowledge and attitudes towards family planning, and associated factors among reproductive-age women in the four emerging regions of Ethiopia. Methods: A community-based cross-sectional study was conducted among 2891 reproductive-age women from 01 to 30 June, 2017. The data were collected by open data equipped tablets with kit software using structured questionnaire. The collected data were exported to STATA version 14 for analysis. Knowledge and attitude were assessed using tools containing 12 and 9 questions, respectively. Mean scores were used as cut-off points. Internal consistency of the tool was checked using Cronbach alpha coefficient, and it was 0.87 for knowledge and 0.78 for attitude questions. Bivariate and multivariate analyses were done, and statistical significance was declared at p-value ≤ 0.05. Results: Less than half, 1254 (43.4%), of the participants had good knowledge and 1511 (52.3%) had favorable attitude towards FP. Positive predictors of good knowledge of family planning were: being from Benishangul-Gumuz region, urban residence, older age, high level of education, being Christian and merchant, high household monthly income, and listening/watching radio/TV. On the other hand, high family size and ideal desired children were negative predictors. For a favorable attitude, the positive predictors include older age, high level of partner education, listening/watching radio/TV, being from BG region and having a good knowledge of FP. Desiring high number of ideal children and being a student by occupation were negatively associated with a favorable attitude. Conclusion: The study revealed that significant number of women had poor knowledge and attitude towards FP. Multiple socio-demographic factors contributed to knowledge and attitude of FP. Therefore, the health sectors of the regions and other stakeholders should strengthen the health extension program to disseminate messages related to FP to improve the knowledge and attitude of women.

Unsafe abortion is a neglected public health problem contributing for 13% of maternal death worldwide. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. The prevalence of unsafe abortion is associated with restricted abortion law, poor quality of health service, and low community awareness. Hence, the aim of this systematic review and meta-analysis is to identify and summarize the available evidence to generate an abridged evidence on the prevalence of unsafe abortion and its associated factors in Sub-Saharan Africa. The development of the systematic review methodology has followed the procedural guideline depicted in the preferred reporting items for systematic review and meta-analysis protocol statement. Observational studies that have been conducted from January 1, 1994, up to December 31, 2017, in Sub-Saharan African countries will be included in the systematic review and meta-analysis. MEDLINE (via PubMed), EMBASE, CINAHL, and PopLine will be searched to retrieve available studies. Relevant studies will be retrieved using the search strings applied to different sources. The Joanna Briggs Institute quality assessment tool will be used to critically appraise the methodological robustness and validity of the finding to avoid erroneous data due to confounded or biased statistics. Data extraction template will be prepared to record abstracted information from selected studies. The selection of relevant studies, data extraction, and quality assessment of studies will be carried out by two authors. Meta-analysis using Mantel–Haenszel random effects model will be carried out. The presence of heterogeneity between studies will be checked using the I2 value. Unsafe abortion is not yet reduced significantly in Sub-Saharan Africa, and maternal death rate due to unsafe abortion remains high. Currently, there is a gap in availability of abridged evidence on unsafe abortion and this negatively influenced the current service delivery. This finding will help stakeholders to design appropriate strategy. The finding of this systematic review and meta-analysis will be helpful to inform policy-makers, programmers, planners, clinician’s decision making, researchers, and women clients at large. PROSPERO 2017: CRD42017081437 .

Contraceptive method choice is a fundamental indicator of quality of care in a family planning program. Contraceptive choice is one component of quality in family planning and offering minimum of three modern methods of contraceptives is a critical indicator. One-third of developing countries have many skewed method mixes, which is a risky for discontinuation, contraceptive dissatisfaction and unintended pregnancy. In Ethiopia, the prevalence of contraceptive is highly skewed, 76% for injectable. Therefore, the purpose of qualitative study was to assess determinants of modern contraceptive preference among reproductive age (15-49 years) in Central Zone of Tigray. Methodology: the study was conducted in the central zone of Tigray and community, and facility based qualitative cross-sectional study was applied. Six focus group discussion entails of reproductive age mothers and 15 In-depth Interview with health workers constitutes the sample. Data was first transcribed and then translated into English language. Open code software was applied to analyze data and data was coded segment by segment then categorized using thematic analysis to give meaning. Result: community’s awareness and acceptance to use modern contraceptives have improved from time to time. Contraceptive preference is determined by community acceptance, health care system problem, individual context and socio-cultural problem. For majority of respondents, preference to long acting contraceptive is mainly influenced by husband. Conclusion: currently, women are preferring short-acting contraceptive preferably injectable than long acting.Implanon is preferred next to injectable. A strong information, education and communication that address all portions of the population and able to change the community’s attitude should do at the grass root level. Contraceptive method choice is a fundamental indicator of quality of care in a family planning program. Contraceptive choice is one component of quality in family planning and offering minimum of three modern methods of contraceptives is a critical indicator. One-third of developing countries have many skewed method mixes, which is a risky for discontinuation, contraceptive dissatisfaction and unintended pregnancy. In Ethiopia, the prevalence of contraceptive is highly skewed, 76% for injectable. Therefore, the purpose of qualitative study was to assess determinants of modern contraceptive preference among reproductive age (15-49 years) in Central Zone of Tigray. Methodology: the study was conducted in the central zone of Tigray and community, and facility based qualitative cross-sectional study was applied. Six focus group discussion entails of reproductive age mothers and 15 In-depth Interview with health workers constitutes the sample. Data was first transcribed and then translated into English language. Open code software was applied to analyze data and data was coded segment by segment then categorized using thematic analysis to give meaning. Result: community’s awareness and acceptance to use modern contraceptives have improved from time to time. Contraceptive preference is determined by community acceptance, health care system problem, individual context and socio-cultural problem. For majority of respondents, preference to long acting contraceptive is mainly influenced by husband. Conclusion: currently, women are preferring short-acting contraceptive preferably injectable than long acting.Implanon is preferred next to injectable. A strong information, education and communication that address all portions of the population and able to change the community’s attitude should do at the grass root level.