Zenawi Hagos Gufue

Background: The cost of acute stroke data is scarce in developing countries, especially Ethiopia, despite its significance for public health. This study aimed to assess the total cost of acute stroke care per patient per year among acute stroke patients admitted to tertiary hospitals in Addis Ababa, Ethiopia. Methods: An incidence-based, prospective, cross-sectional cost-of-illness study was conducted among 99 acute stroke survivors admitted to two specialized hospitals in Addis Ababa. A micro-costing technique was applied to pinpoint cost-generating elements and assign the proper unit costs for the two cost categories, direct and indirect. A multivariable generalized linear model was employed to identify predictors of acute-phase costs among stroke patients. Results: The median cost of acute stroke care per patient per year was $286, with direct and indirect costs of $193.77 and $74, respectively. Between-group cost differences were primarily driven by delayed hospital presentation (arrival >4.5 h after symptom onset; adjusted cost ratio [CR] 1.78), ICU admission (CR 1.56), older age (CR 1.27), at least one comorbid condition (CR 1.27), and rural residence (CR 1.40). Conclusion: The costs of acute stroke care in public tertiary hospitals in Ethiopia are very high, with over 30% of GDP per capita spent on acute stroke care. Understanding the cost of stroke in Ethiopia is critical for planning the implementation of acute care services, including stroke treatments, under universal health coverage, ensuring that all stroke patients benefit.

Background and Aims: Hypertension is becoming a major public health issue in Ethiopia. However, there is limited comprehensive evidence on hypertension care, including service availability, utilization, and care quality. This study aimed to determine the effect of the NORAD‐WHO‐NCD intervention in improving the availability, utilization, and quality of hypertension care in public healthcare facilities.Methods: A multicenter, quasi‐experimental study comprising 31 interventions and 62 control public healthcare facilities was conducted across Ethiopia's six regions and one city administration between November 12 and December 31, 2023. A data abstraction form was used to collect relevant data spanning 54 months from various departments. To determine the independent effects of the intervention, a differences‐in‐difference regression model was used and p < 0.05 was used to indicate statistical significance.Results: From 2019 to 2023, the percentage of healthcare facilities treating hypertension increased to 93.6% for intervention facilities and 90.3% for control facilities. The average monthly number of screenings performed in 2023 was 682 (95% CI 592, 772) among intervention and 278 (95% CI 238, 318) among control health facilities. In 2023, the average monthly number of newly diagnosed patients was 6 (95% CI 5, 7) by intervention and 4 (95% CI 3, 5) by control health facilities. Similarly, the average monthly number of patients receiving pharmacologic treatment was 138 (95% CI 103, 173) in intervention and 49 (95% CI 41, 57) in control facilities. In the intervention and control facilities, the average monthly number of patients with controlled blood pressure was 121 (95% CI 89, 154) and 49 (95% CI 40, 58), respectively. The intervention led to a monthly average increase of 425 hypertension screenings across all age groups (95% CI 131, 719, p = 0.04).Conclusions: While intervention facilities showed notable improvements, hypertension care services remain limited nationwide, underscoring the need for scalable interventions to address regional disparities.

Introduction: Healthy dietary choices have an important role in preventing chronic diseases such as cardiovascular disease (CVD). Increasing evidence suggests micronutrient intake (essential minerals and vitamins) is associated with abdominal aortic calcification (AAC), which is an advanced marker of CVD. However, the existing reports seem inconsistent. Some studies reported micronutrients are associated with a lower risk of AAC, while others have reported an increased risk. Therefore, this systematic review and meta-analysis sought to summarise the available evidence on the association of dietary micronutrient intake on AAC. Methods and analysis: A comprehensive systematic search of the PubMed/MEDLINE, EMBASE, Web of Science and Google Scholar databases from their inception up to September 1, 2024, will be conducted. All clinical studies that report eligible exposure/s (dietary micronutrient intake) and outcome/s (presence/severity of AAC) will be included, and this systematic review and meta-analysis protocol will be reported following the revised Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. The risk of bias for observational studies will be assessed using the Newcastle-Ottawa Scale and publication bias will be evaluated through visual inspection of funnel plots and the Egger’s and Begg’s regression tests. The Der Simonian and Laird random-effects model meta-analysis will be calculated to provide pooled results, and the weighted risk ratio with their 95% confidence intervals will be presented. Ethics and dissemination: The results will be disseminated through publishing in a peer-reviewed journal and public presentations at relevant local, national and international conferences, workshops and symposiums. Ethical approval is not required as this is a systematic review of publicly available data. PROSPERO registration number CRD42024575902

Globally, colorectal cancer (CRC) is the third most common type of cancer and the second most deadly. CRC significantly impairs patients’ overall and health-related quality of life, as well as their psychological and physical function. However, in Ethiopia, there is insufficient local evidence about the quality of life of patients with colorectal cancer. Hence, this study aimed to assess the quality of life of adult colorectal cancer patients who have follow-ups at the cancer center in Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. An institutional-based cross-sectional study was conducted among 159 colorectal cancer patients attending the Tikur Anbessa Specialized Hospital Cancer Center from February to April 2019. The validated Amharic version of the European Organisation for Research and Treatment of Cancer Core 30 questionnaire (EORTC QLQ C-30) and the disease-specific colorectal cancer questionnaire (EORTC QLQ CR-29) were used. A binary logistic regression model was used to identify the factors associated with quality of life. The adjusted measure of effect (AOR) with a 95% CI was presented and P < 0.05 was used to declare statistical significance. There were 159 colorectal cancer patients, 89 of whom were male, and the median time from diagnosis was 12.5 months. The patients had a low global health status score with a mean (± SD) of 52.88 ± 21.02. Being employed (AOR = 3.41; 95% CI 1.15, 10.17), early-stage clinical diagnosis (AOR = 4.98; 95% CI 1.51, 16.4), physical functioning (AOR = 1.04, 95% CI 1.01, 1.06), and social functioning (AOR = 1.02; 95% CI 1.01, 1.04) were associated with good quality of life. Whereas, being female (AOR = 0.16; 95% CI 0.05, 0.52), having financial difficulty (AOR = 0.98; 95% CI 0.96, 0.99), and having blood and mucus in the stool (AOR = 0.94; 95% CI 0.91, 0.96) were associated with poor quality of life. In our study, half of our study participants had poor quality of life. The responsible stakeholders should identify and address the patients’ respective symptoms. Female patients, those in severe clinical stages, unemployed patients, those experiencing financial difficulties, and those with blood and mucus in their stool should receive due attention.

Introduction: Women with adequate antenatal care (ANC) experience more reduction in adverse maternal and perinatal outcomes compared to those with insufficient care. However, the conventional individualized ANC models have not significantly improved perinatal outcomes. Comprehensive, woman-centered group ANC (G-ANC) interventions, integrating medical care with education, demonstrate positive effects on maternal and newborn health. While promising evidence exists in sub-Saharan Africa, the feasibility, acceptability, and effectiveness of G-ANC in resource-limited settings require further investigation. The variability in current studies further indicated the need for meta-analyses and systematic reviews to consolidate findings and clarify the overall effectiveness of G-ANC interventions. This synthesis aims to provide comprehensive evidence supporting the implementation of group prenatal care models in low-resource settings. Ultimately, it seeks to establish robust evidence to guide policy and practice, contributing to reduced maternal and perinatal mortality in the region. Methods and analysis: This systematic review and meta-analysis protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. A comprehensive literature search will be conducted across multiple electronic databases, including PubMed/MEDLINE, Web of Science, EMBASE, and CINHAL, to identify pertinent articles published from January 1, 2016, to June 30, 2024. Experimental studies (pre-post, quasi-experimental study, cluster randomized controlled trial), prospective cohort design, prospective comparative study, and qualitative and mixed method designs will be included in the review. The Abstract and full-text screening will be conducted by three reviewers using Covidence, according to the eligibility criteria set. The Joanna Briggs Institute (JBI) Critical Appraisal Tools, specifically designed for JBI Systematic Reviews, will be utilized to assess the methodological quality of the included studies. Statistical heterogeneity will be assessed using the Higgins test. Meta-analysis will be conducted using R statistical software version 4.4.2, which will implement random effects models to determine the weights. Pre-specified subgroup analysis and sensitivity analysis will be performed as needed. The study results will be reported in order, starting with primary outcomes and then secondary outcomes and important subgroup outcomes analyses. Ethics and dissemination: Ethical approval is not applicable as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations. PROSPERO registration number: CRD42024565501

Background: Khat chewing has become a global phenomenon, resulting in significant physical and mental health issues as well as socioeconomic crises. However, evidence is scarce on Ethiopian youths’ behavioral intentions toward khat chewing, particularly in the Raya-Azebo district of the southern zone of the Tigray region. As a result, this study aimed to assess the intention to chew among youths in Raya-Azebo district, Southern Tigray, Ethiopia.Methods: A community-based cross-sectional survey was conducted among 627 youths in northern Ethiopia’s Raya-Azebo district. Data were collected using a structured, interviewer-administered questionnaire. A multivariable linear regression model was used to predict the contribution of independent variables and identify variables strongly associated with chewing among youths.Results: A considerable proportion, 192 (30.62%) of youths, had the intention to chew khat in the next 6 months. The component of the theory of planned behavior independently explained the variance in intention to chew by 83%. The strongest predictors of intention to chew were attitude (β = 0.35, p < 0.001), subjective norm (β = 0.297, p < 0.001), and perceived behavioral control (β = 0.15, p = 0.01).Conclusion: Behavioral intention toward khat chewing was a function of attitude, subjective norm, and perceived behavioral control toward khat chewing. Strategies to empower youths to change a positive attitude toward khat chewing, programs targeted at resisting social pressures, and increasing self-efficacy to combat chewing are needed.

The Ethiopian government, supported by NORAD, the WHO, and other partners, is decentralizing diabetes care to primary health units via a task-shifting approach. Despite substantial investment, there is still a lack of up-to-date information on diabetes screening, diagnosis, treatment, and medication availability in the country. This study assessed the effects of the NORAD-WHO intervention on diabetes care services, data quality, and the availability of infrastructure and medical supplies in Ethiopia. A quasiexperimental study was conducted across 31 NORAD-WHO project facilities and 62 control facilities in six regions of Ethiopia and Addis Ababa. We used descriptive statistics to assess diabetes screening, diagnosis, treatment services, medication availability, and data quality over 54 months from January 2019 to June 2023. Additionally, we performed a difference-in-differences (DID) regression analysis comparing data from two periods: before the intervention (January to December 2019) and after the intervention (July 2022 to June 2023). This study revealed a notable increase in diabetes services, with over 82% of facilities offering screening, early diagnosis, and treatment. Written treatment guidelines are present in three quarters of the facilities. The proportion of trained staff increased from 58% in 2019 to 100% in 2023 across all the evaluated facilities. Intervention facilities had significantly more functional glucometers than did control facilities, averaging four (95% CI: 3.4, 4.6) per month in 2023 compared with 2.5 (95% CI: 2.1, 2.9) in 2019. However, hemoglobin A1C testing remains uncommon. Despite improvements in diabetes service data, issues with missing records, overreporting, and timeliness persist, with an average reporting rate of 99.2% and on-time reporting rate of 51.5%. The NORAD-WHO intervention notably increased the average number of fasting blood sugar tests by 17 per month (95% CI: 12.2–21.8, p = 0.014). This midterm evaluation revealed a significant increase in the availability of fasting blood sugar tests in the intervention facilities. Additionally, the availability of medical equipment, laboratory services, and medications has improved over the years. Intervention facilities, with more trained healthcare professionals and better resources, outperform control facilities in screening, diagnosing, treating, and managing high blood sugar levels. Notably, intervention facilities screened more clients for diabetes and showed that patients receiving follow-up care achieved better glycemic control than did those at control facilities. While there has been progress in diabetes service data availability, addressing issues such as missing data, overreporting, and reporting timeliness is essential for further improving the quality of diabetes services. Not applicable.

Introduction: In sub-Saharan Africa, the predominant model of individualized, one-on-one antenatal care has not significantly improved perinatal outcomes. Although the benefits of group antenatal care have been demonstrated in developed countries, its feasibility, acceptability, and effectiveness in resource limited settings, particularly in sub-Saharan African countries, have yet to be fully investigated. However, pilot studies show promising evidence of its effectiveness in these areas. This systematic review and meta-analysis will, therefore, review and summarize available studies and provide comprehensive and robust evidence that tends to contribute to the ongoing efforts to implement group prenatal care models in low-resource settings. Methods and analysis: This systematic review protocol adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. A comprehensive literature search will be conducted across multiple electronic databases, including PubMed/MEDLINE, Web of Science, EMBASE, and CINHAL, to identify pertinent articles published from January 1, 2016, to June 30, 2024. Experimental studies (pre-post, quasi-experimental study, cluster randomized controlled trial), prospective cohort design, prospective comparative study, and qualitative and mixed method designs will be included in the review. Abstract and full-text screening will be conducted by three reviewers using Covidence, according to the eligibility criteria set. The Joanna Briggs Institute (JBI) Critical Appraisal Tools, specifically designed for JBI Systematic Reviews, will be utilized to assess the methodological quality of the included studies. Statistical heterogeneity will be assessed using the Higgins test. Meta-analysis will be performed using R version 3.6.1 software and STATA version 16; applying random effects models to determine the weights. Pre-specified subgroup analysis and sensitivity analysis will be conducted as necessary. The study results will be reported sequentially, beginning with the primary outcomes, followed by secondary outcomes, and important subgroup analyses. Ethics and dissemination: Ethical approval is not applicable as no original data will be collected. The findings of this review will be disseminated through publication and conference presentations. PROSPERO registration number CRD42024565501.