Firew Tiruneh Tiyare

Background: The postnatal period is a critical phase for maternal and newborn survival, during which many preventable complications and deaths occur, yet postnatal care (PNC) use remains low in Ethiopia. Care-seeking and postpartum practices are shaped by knowledge and also by interacting cognitive, interpersonal, sociocultural, and environmental determinants, including perceived risk, self-efficacy, family influence, social norms, and culturally embedded beliefs. Existing educational interventions largely prioritize information provision and insufficiently address these determinants, limiting the translation of knowledge into timely PNC use and safe maternal and newborn care practices. Objective: This study aims to evaluate the effectiveness of a culturally tailored educational intervention for pregnant women, informed by Social Cognitive Theory (SCT) and the Theory of Planned Behavior (TPB), in improving PNC use and promoting safe maternal and newborn care practices in Ethiopia. Methods: A 2-arm, assessor-blinded, open-label, matched-pair cluster randomized controlled trial was conducted across 14 woredas in Jimma Zone, Ethiopia. A total of 28 health facilities were randomly allocated in a 1:1 ratio to the intervention and control arms. Pregnant women at 20 to 24 weeks of gestation were recruited from kebeles within the randomized health-facility clusters. Participants in the intervention arm received the educational intervention delivered by trained health extension workers, whereas those in the control arm received routine antenatal health education. The primary outcome was PNC use; secondary outcomes were newborn-care knowledge and practices. Primary analyses will follow the intention-to-treat principle. Mixed-effects regression models with random intercepts for health-facility clusters will be used to estimate intervention effects while accounting for intracluster correlation. Results: The study was funded by the Eckenstein-Geigy Professorship in June 2025. From November 2025 to January 2026, 945 pregnant women were enrolled across 28 health facilities in Jimma Zone, Ethiopia. The intervention was delivered from December 2025 to May 2026, with follow-up conducted from December 2025 to July 2026. Follow-up data collection was completed in July 2026, and data cleaning and statistical analysis began in the same month. The primary and secondary analyses are scheduled for completion in fall 2026, and the trial findings are expected to be submitted for publication in fall 2026. The mean age of participants was 26.84 years (SD 5.23), with the majority residing in rural areas (n=834, 88.3%) and being married (n=937, 99.2%). Baseline characteristics were generally similar between trial arms regarding age, residence, marital status, and obstetric history, although notable differences were observed in maternal occupation, educational attainment, and household income. Conclusions: This trial will provide evidence on whether a culturally tailored, behavioral theory–informed educational intervention delivered during pregnancy can improve PNC use and promote safe maternal and newborn care practices in Ethiopia. The findings may inform the design and integration of context-responsive maternal and newborn health education within community-based health services.

Background: Long-lasting insecticidal nets (LLINs) have significantly reduced the malaria burden in recent decades, and this malaria prevalence reduction has been achieved through the upgrading of pyrethroid long-lasting insecticidal nets. However, this reduction has stalled due to many factors, including rapidly developing pyrethroid resistance. Method: The protocol was registered in PROSPERO, and we used Cochrane methodology to assess bias and evidence quality. Three reviewers extracted data from individual studies, and a meta-analysis was performed using Excel and STATA version 17, expressing the data as a risk ratio. Result: A study involving 21,916 households from 11 randomized controlled trials showed that the chlorfenapyr treatment group had a 10% reduction in malaria infection risk, with a pooled overall prevalence of 25.96 per 100 children in the chlorfenapyr group and 32.38 per 100 children in the piperonyl butoxide group, compared to 41.60 per 100 children in the control (pyrethroid-only) group. This meta-analysis determined that the entomological outcomes of effectiveness and efficacy showed that these treatments effectively reduced vector density per household per night and mean inoculation rates, with a 23% reduction in chlorfenapyr, a 7% reduction in pyrethroid-only treatments, and a 12% reduction in piperonyl-butoxide-treated groups. This study shows that chlorfenapyr (CFP) and pyriproxyfen (PPF) LLINs are highly effective and more efficacious in reducing malaria infection, case incidence, and anemia among children, as well as in reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate, compared to pyriproxyfen (PPF) LLINs in Africa. Conclusions: This study found that chlorfenapyr (CFP) LLINs are highly effective and more efficacious in reducing malaria infection, case incidence, and anemia among children in Africa. Therefore, policymakers and health planners should place strong emphasis on addressing the effectiveness, efficacy, and resistance management of LLINs as part of their current public health agenda to eliminate malaria.

Type 2 diabetes mellitus is a serious metabolic disease that is often associated with vascular complications. The increasing prevalence of type 2 diabetes mellitus poses significant public health challenges, particularly in Low and Middle-Income Countries where healthcare resources are often limited. In Africa, the burden of T2DM is rising rapidly, leading to a consequential increase in macrovascular complications such as cardiovascular disease and stroke. These complications not only affect the quality of life but also significantly contribute to morbidity and mortality among affected individuals. The main objective of this study was to assess the time to development of macrovascular complications and identify its predictors among type 2 diabetes mellitus patients in Jimma University medical center from 2018–2022. Institutional-based retrospective follow-up study was conducted in Jimma University Medical Center among newly diagnosed type 2 diabetes mellitus patient from 2018, to 2022. A systematic sampling technique was used to recruit 452 records of type 2 diabetes mellitus patients. The Kaplan–Meier curve and the log-rank tests were used to determine the time to macro-vascular complications, and evaluate the significant difference in survival probability among predictors respectively. The overall goodness of the Cox proportional hazard model was checked by Cox-Snell residuals. Bivariable and multivariable cox-proportional hazard regression were used to identify the association between the variables and survival time. The median survival time to development of macro vascular complications was 24 months. Urban residence [(Adjusted hazard ratio = 2.02; 95% CI: (1.33, 3.05)], having hypertension at start of diabetic treatment [(AHR = 1.52; 95% CI: (1.06, 2.13)], baseline age ≥ 60 years [(AHR = 4.42; 95% CI: (1.72, 11.29)], having dyslipidemia at baseline [(AHR = 1.82; 95% CI: (1.13, 2.93)], High density lipoprotein cholesterol levels < 40 mg/dl [(AHR = 2.11; (1.16, 3.81)], triglycerides > 150 mg/dl [(AHR = 1.48; 95% CI:( 1.02, 2.13)], Hemoglobin A1C level > 7% [(AHR = 1.49; 95% CI: (1.04, 2.14)], and Oral hypoglycemic agents + insulin [(AHR = 2.73; 95% CI: (1.81, 4.09)] were the significant predictors of the time to development of macro vascular complications. Findings in this study indicated that the median time to development of macro vascular complications among type 2 diabetes mellitus patients was 24 months. Baseline age category in years, residence, presence of hypertension, presence of dyslipidemia, High density lipoprotein-cholesterol level < 40 mg/dl, triglyceride > 150 mg/dl, HgbA1C > 7% at baseline, and medication regimens were identified as independent significant predictors of the time to development of macro vascular complications among type 2 diabetes mellitus patients. The findings call attention to the role of treatment regimens, particularly the use of combination therapies involving oral hypoglycemic agents and insulin, which were associated with increased hazards for complications. High incidence of macrovascular complications within a short follow-up period underscores the need for proactive, individualized care strategies in T2DM management. By focusing on early identification of at-risk patients and tailoring treatment plans accordingly, healthcare providers can potentially improve outcomes and reduce the burden of macro vascular complications in this population.

The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) survey that will recruit women in health facilities at their first antenatal care (ANC) visit. Women will be followed via phone survey until 10-12 weeks postpartum. User-reported information will be complemented with data from physical health assessments at baseline and endline, extraction from MNH cards, and a brief facility survey. The final MNH eCohort instrument is centered around six key domains of high-quality health systems including competent care (content of ANC, delivery, and postnatal care for the mother and newborn), competent systems (prevention and detection, timely care, continuity, integration), user experience, health outcomes, confidence in the health system, and economic outcomes. The eCohort combines the maternal and newborn experience and, due to its longitudinal nature, will allow for quality assessment according to specific risks that evolve throughout the pregnancy and postpartum period. Detailed information on medical and obstetric history and current health status of respondents and newborns will allow us to determine whether women and newborns at risk are receiving needed care. The MNH eCohort will answer novel questions to guide health system improvements and to fill data gaps in implementing countries.

Background Malaria, a parasitic disease that is transmitted by the bite of a female Anopheles mosquito, can also be contracted through exposure to infected blood products or congenitally. Long-lasting insecticidal nets have significantly reduced the malaria burden in the past decade and this malaria prevalence reduction has been achieved through the upgrading of pyrethroid long-lasting insecticidal nets (LLINs), but the reduction has stopped due to pyrethroid fast resistance. The World Health Organization (WHO) recommends new LLINs with two active ingredients for areas with malaria vectors resistant to pyrethroids. Malaria control in Africa faces threat from pyrethroid resistance, prompting the development of new long-lasting insecticidal nets (LLINs) with dual active ingredients to interrupt transmission in pyrethroid-resistant areas. A study aimed to evaluate the effectiveness and efficacy of different mixtures of active-ingredient LLINs compared to standard pyrethroid LLINs against pyrethroid-resistant malaria vectors showed no reduction in the density of Mansonia spp. in the pyrethroid pyriproxyfen LLIN arm outdoors. Therefore, the objective of this systematic review and meta-analysis is to pool estimates of the effectiveness and efficacy of pyriproxyfen, chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets (LLINs) with pyrethroid-only LLINs for malaria control in African. This study also evaluated the effectiveness and efficacy of chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets compared to pyriproxyfen LLINs. Method The protocol was registered in PROSPERO with the protocol number: CRD42024499800. This review used Cochrane methodology to assess risk of bias and evaluate evidence quality. It included cluster randomized or prospective clinical trials comparing long-lasting insecticidal nets (LLINs) of Pyriproxyfen, Chlorfenapyr, and/or Piperonyl Butoxide for malaria control (test arm) and pyrethroid-only standard LLINs (control arm) for malaria control. Three reviewers independently read each preprint or publication and extracted relevant data from individual studies. The search was conducted from 2000 to 2024, and meta-analysis was performed using Excel and STATA 17. The extracted data from eligible studies were pooled using the random effects model and expressed as a risk ratio (RR) with a 95% confidence interval (CI). Result A total of 11 cluster randomized controlled trials with 21,916 households, 1,145,035 people, and 34,327 children across all of the studies reporting sample size. This study found that the pooled prevalence of post-intervention malaria infection among children using chlorfenapyr, piperonyl butoxide, and pyriproxyfen long-lasting insecticidal nets was 25.58 per 100 children, 32.38 per 100 children, and 33.70 per 100 children, respectively, compared to the control group/pyrethroid-only long-lasting insecticidal nets of 40.84% per 100 children in Africa, which is higher in the control group. The study found that the post-intervention pooled mean indoor vector density per household per night in the control group/pyrethroid-only long-lasting insecticidal nets was higher than in the intervention groups, with pyrethroid-only nets having the highest density at 8.04 per household per night, compared to other insecticidal nets (7.74 per 100 households in pyriproxyfen, 5.53 per 100 households in chlorfenapyr, and the lowest 1.9 per 100 households per night in piperonyl butoxide) in Africa. The study determined that the post-intervention pooled sporozoite rate per mosquito in the control group/pyrethroid-only long-lasting insecticidal nets was almost two to three times higher than in the intervention groups, with pyrethroid-only nets having the highest sporozoite rate per mosquito at 227 per 100 anopheles, compared to other interventional long-lasting insecticidal nets (165 per 100 anopheles in pyriproxyfen, 172 per 100 anopheles in piperonyl butoxide, and the lowest 79 per 100 anopheles in chlorfenapyr) in Africa. A meta-analysis found that pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) effectively reduce indoor vector density by 1%, entomological inoculation rate by 7%, and sporozoite rate of malaria parasites by 15% compared to pyrethroid-only LLINs in Africa, despite no significant difference in malaria infection, case incidence, and anemia reduction among children. The study found that piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection by 1%, case incidence by 2%, and anaemia by 3% among children, as well as reducing indoor vector density by 3%, the mean entomological inoculation rate by 12%, and the sporozoite rate by 10% in Africa as compared to pyrethroid-only LLINs in Africa. The study found that chlorfenapyr (CFP) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection by 1%, case incidence by 1%, and anaemia by 4% among children, as well as reducing indoor vector density by 4%, the inoculation rate by 23%, and the sporozoite rate by 9% in Africa as compared to pyrethroid-only LLINs in Africa. The study compared the effectiveness and efficacy of chlorfenapyr (CFP) and pyriproxyfen long-lasting insecticidal nets in Africa. Results showed that CFP nets were highly effective, and efficacious in reducing malaria infection, case incidence, indoor vector density, inoculation rate, and sporozoite rate by 1%, 15%, and 7%, respectively, compared to pyriproxyfen nets long-lasting insecticidal nets for malaria control in Africa. The evidence evaluating the effectiveness and efficacy of piperonyl butoxide (PBO) compared with pyriproxyfen long-lasting insecticidal nets found that piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection by 0.0%, case incidence by 2% among children, indoor vector density by 4%, inoculation rate by 5%, and sporozoite rate by 1% in piperonyl butoxide (PBO) as compared to pyriproxyfen long-lasting insecticidal nets for malaria control in Africa. Critical appraisal of individual randomized control trials revealed that 100% of the studies scored high quality, and Cochrane methodology was used to assess the risk of bias and evaluate evidence quality, which was graded as high. This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different is low. Conclusion This generated evidence was evaluated the effectiveness and efficacy of pyriproxyfen, chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets against the pyrethroid-only LLINs. This study found that PYR-only LLINs (control arm) had higher pooled prevalence of malaria infection, case incidence, anaemia, mean indoor vector density, inoculationrate, and sporozoite rate as compared to intervention group (PPF, CFP, and PBO LLINs The evidence generated from this meta-analysis reveals that pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) have no significant difference in malaria infection, case incidence, or anemia reduction among children as compared to pyrethroid-only LLINs. However, this study found that Pyriproxyfen (PPF) LLINs effectively and efficaciously reduce indoor vector density, entomological inoculationrate, and sporozoite rate of malaria parasites compared to pyrethroid-only LLINs. The study found that chlorfenapyr (CFP) and piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection, case incidence, and anaemia among children, as well as reducing indoor vector density, inoculation rate, and sporozoite rate in Africa as compared to pyrethroid-only LLINs. The evidence generated found that piperonyl butoxide (PBO) long-lasting insecticidal nets effectively and efficaciously reduce indoor vector density, entomological inoculation rate, and sporozoite rate of malaria parasites compared to Pyriproxyfen (PPF) LLINs, but no significant difference was found in malaria infection reduction among children who use piperonyl butoxide (PBO) versus Pyriproxyfen (PPF) long-lasting insecticidal nets in Africa. The study found that chlorfenapyr (CFP) long-lasting insecticidal nets (LLINs) are highly effective and superiorly efficacious in reducing malaria infection, case incidence, and anemia among children, as well as reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate compared to pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) in Africa. Therefore, policymakers and health planners should give a great deal of emphasis on addressing the effectiveness, efficacy, and resistance management of long-lasting insecticidal nets (LLINs) as part of their current public health agenda to eliminate malaria.

Background: Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. Objective: This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. Method: We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran’s Q test. In the presence of moderate heterogeneity ( I² more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger’s regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. Results: The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%−68.98%) ( I² = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37–3.84), family wealth index (AOR = 2.72, 95% CI: 1.89–3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24–3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95–7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: −0.36 to −4.82). Conclusions: The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

Background: Worldwide, quality education is one of the important tools to improve healthcare quality. Healthcare practitioners must be competent in their clinical judgement to meet clients’ need. However, poor clinical judgment skill accounts for almost one-third of all patient problems in health care. Expert patient simulation has been used as a training method for clinical judgement skill. However, according to empirical studies, using expert patients to develop clinical judgement skill is unclear. The method is effective in one situation but not in another. Objective: To examine the effect of expert patient simulation on the clinical judgment skill of health science students of Mizan-Tepi University. Methods: A pre-test/post-test quasi-experimental design was used on 92 randomly selected samples from the graduating cohort of midwifery students. The research subjects who took part in the experiment were picked at random. Tools included the Creighton Competency Evaluation Instrument (C-CEI^®), the Learning Satisfaction and Self-Confidence Questionnaire, and the Kolb Learning Style Inventory (LSI). The Wilcoxon-signed rank test was utilized to compare the self-confidence scores among intervention and control group of students, and the paired sample test was used to compare clinical judgment scores. Cohen’s d was used to assess the effect size, and Spearman correlation was used to explore the association. Results: Clinical decision-making ability and self-confidence measures revealed statistical and practical differences between before and after simulation. There was a mean difference of 2.28 (95% CI, 1.78, 2.79), t (45)=9.13, p 0.001, and an effect size of 1.3, p 0.001. A pre-and post-simulation self-confidence measure showed statistically significant improvement after simulation (W = 1, Z = − 3.57, P 0.001). A moderately significant positive connection (r = 0.419, p 0.004) was also discovered. Conclusion: The study found that human expert patient simulation is a tremendous clinical training technique for improving students’ clinical decision-making skill competency and self-confidence.

Back Ground: Globally, 2.6 million children died in their first month of life—approximately 7 000 newborn deaths per day—with approximately one million dying on the first day and nearly one million dying within the next six days. Perinatal asphyxia plays a significant role in this mortality. Even those who survive will suffer from mental retardation and other complications. One programme to save the lives of asphyxiated newborns is “Helping Baby Breathe.” However, it has yet to be successful in Ethiopia. Objective: To assess the status of implementation of helping baby breath and to design alternative best way to improve the service, in public hospitals of Bench-Maji, Kaffa and Sheka zones. Methods: Concurrent triangulation was used in the design. We used a phenomenological and descriptive cross-sectional study design. The subjects of the study were key informants, postnatal mothers, and health care providers in the delivery ward. Atlas Ti and SPSS software were used to analyze qualitative and quantitative data, respectively. Results: We reported on the knowledge and skills of health care providers in neonatal resuscitation in this study. The findings revealed that participants with good knowledge and skill were 54% and 27%, respectively. A number of contextual factors that may be impeding neonatal resuscitation were also identified qualitatively. Conclusion: The majority of health care providers’ skill and knowledge of neonatal resuscitation were far below the minimum expected competency.

Background: In much epidemiological HIV research, patients are often followed over a period of time to predict their survival on the basis of repeatedly measured CD4 status. To predict survival, statistical models of the association between mortality and longitudinal CD4 measurement have been conducted widely using time-varying Cox models. However, in the presence of repeated measure, this approach leads to biased estimates. In view of the limitation of time-varying Cox models, in the present study, we considered joint modeling to predict the association of longitudinal CD4 measurement and time to death among patients initiated on ART. Methods: A retrospective cohort study was employed for five years from 2009 to 2014 on a randomly selected 358 samples. Data were collected from patients' ART and pre-ART follow-up registration book, database and other clinical records. Data were analyzed using joint latent class modeling of repeated CD4 measurement and time-to-event (HIV death). Results: We have studied a total of 358 HIV-positive patients. The median and interquartile ranges of the age of patients were 30.31 years and 13.82, respectively. Males constitute the larger proportion, 51.68%. The square root of CD4 count has declined on average over time. This has been indicated with the negative sign of the coefficient for the time effect. The deterioration of health of individuals is severe in class 1, it has been observed with a worse decline in CD4 cell counts over time in this class than other classes (beta= -0.488). Women had a larger risk rate than men (beta=-2.475, p-value=0.013). Besides, the CD4 counts measurement of patients has been revealed to decrease as age increases (beta= -0.016, p=0.008). Conclusion: The finding indicated that the square root CD4 cell measurement dropped over time in the three classes. This clearly suggested deterioration in the health of individuals. Women were found to have a higher hazard rate than men.