Mesfin Abebe

Background: Effective postnatal newborn care provision is proven to be one effective strategy to reduce neonatal and under-five mortality. Despite the presence of small-scale studies that reported crude coverage of postnatal newborn care, nationwide evidence about effective postnatal newborn care coverage and evidence regarding the status of wealth-related inequality are limited in Tanzania. Therefore, this study aimed to assess the status of wealth-related inequality and determinants in effective coverage of postnatal newborn care in Tanzania. Methods: A secondary data analysis was conducted based on cross-sectional data from the 2022 Tanzania Demographic and Health Survey. 4335 weighted samples of reproductive age-women (15–49) who had given birth in the two years preceding the survey were included. The Erreygers normalized concentration index and graph approach were employed to evaluate wealth-related inequality in effective coverage of postnatal newborn care. Additionally, a decomposition analysis was used to decompose the overall wealth-related inequality by determinant factors. Results: The proportion of newborns who received effective postnatal newborn care interventions in Tanzania was 22.70% [95% CI: 21.48, 23.97]. A significant pro-rich wealth-related inequality in effective coverage of postnatal newborn care, with an Erreygers concentration index value of 0.26 (95% CI: 0.24, 0.29) (P < 0.001), was found. The decomposition result showed the most significant factors leading to the overall inequality were place of delivery (68.43%), residence (22.72%), mothers’ educational level (11.62%), region (6.84%), antenatal care follow-up (4.49), and mode of delivery (3.37%). Conclusion: The study found a low level of effective postnatal newborn care coverage, with a pro-rich distribution. Focus should be given on increasing institutional deliveries, expanding education, promoting ANC follow-up, improving wealth status, and newborns from vaginal deliveries. Furthermore, authorities and stakeholders should work on expanding health services in rural and affected regions to increase the population’s access to newborn health services.

Background: To eliminate cervical cancer as a public health problem, the WHO recommends that human papillomavirus (HPV) vaccines should be included in national immunisation programmes and should reach 90% of all girls by age 15 as primary prevention. Lesotho reintroduced the national HPV vaccine programme in 2022. Objective: To investigate the prevalence and associated factors of HPV vaccination uptake among adolescent girls in Lesotho. Design: A population-based cross-sectional study design. Setting: Lesotho. Participants: Girls aged 15–17. Primary and secondary outcome measures: A multilevel Poisson regression model with robust variance was applied to identify factors associated with HPV vaccination uptake. An adjusted prevalence ratio with a 95% CI was reported. Results: The uptake of HPV vaccination among adolescent girls in Lesotho was 52.15% (95% CI 48.43 to 55.84). Girls aged 16 and 17 and those residing in the Maseru district were significantly associated with a lower proportion of HPV vaccination uptake. While, ever heard of cervical cancer and ever heard of sexually transmitted infections (STIs) were found to be linked with a higher proportion of HPV vaccination uptake. Conclusion: HPV vaccination uptake among adolescent girls in Lesotho was far behind the WHO 2030 target. Raising awareness about cervical cancer and HPV vaccination via targeted education is vital. A comprehensive sexual health education programme that includes information on STIs and HPV can improve vaccination uptake, especially in districts with low uptake.

Background: The Hepatitis B virus (HBV) is one of the major causes of viral hepatitis that may persist and lead to complications, including cirrhosis, hepatic decompensation, and liver cancer. Numerous systematic reviews and meta-analysis have been conducted on HBV infection among people in Ethiopia, showing inconsistent findings. This umbrella review aimed to assess the pooled prevalence of HBV infection and its associated factors among people in Ethiopia. Methods: All published and unpublished systematic review and meta-analysis studies were searched on databases such as PubMed, Scopus, HINARI and Google Scholar. A measurement tool to assess systematic reviews was used for critical appraisal of the included studies. STATA software version 17 was used to conduct the analysis. I ² test were used to determine heterogeneity, whereas funnel plots and Egger’s regression tests were used to assess publication bias. To pool the prevalence of HBV infection, a random-effects model was used and presented using a forest plot. Results: Twelve systematic reviews and meta-analysis with 997,264 participants were included in this umbrella review. The pooled prevalence of the HBV infection among people in Ethiopia was 5.78% (95% CI: 5.33, 6.23). Being male, having multiple sexual partners, having a history of abortion, having body tattoos, having a history of tooth extraction, sharing sharp material, and linked to health system such as having a history of hospital admission, and blood transfusion were significant risk factors associated with HBV infection among people in Ethiopia. Conclusion: This study highlights that the prevalence of HBV infection among people in Ethiopia was relatively moderate endemicity as per WHO classification. By synthesizing evidence of prior review, this study provides specific up-to-date information for clinicians and policymakers to design evidence-based public health strategies and guide future research that enable the prevention, control, and eliminate infection of HBV. PROSPERO Registration : CRD420251160887

Background: People diagnosed with advanced HIV disease (AHD) should be provided with the World Health Organization’s (WHO) package of care to address their specific healthcare needs. Although the WHO-recommended package of care is considered feasible and effective, its implementation remains sub-optimal across many sub-Saharan African (SSA) countries. This study aimed to explore challenges in implementing the WHO-recommended package of care for advanced HIV disease in resource-constrained settings. Methods: A sequential explanatory mixed-methods study was conducted between March 1 and April 30, 2024, in the Gedeo Zone of Southern Ethiopia. The quantitative data involved extraction from medical records of 145 individuals newly diagnosed with AHD. For the qualitative inquiry, healthcare providers engaged in the HIV care continuum were purposively selected for in-depth key informant interviews. An inductive thematic analysis was conducted to identify and interpret recurrent patterns within the qualitative data. Quantitative data were analyzed using R version 4.3.3, while qualitative data were organized and managed using NVivo version 14. Results: Only about half (47.6%) of the newly diagnosed AHD cases underwent baseline CD4 count testing. All 145 individuals were screened for TB using the WHO four-symptom algorithm, and 78.6% underwent confirmatory GeneXpert® MTB/RIF testing. Among individuals with AHD, 92.4% received co-trimoxazole prophylaxis, and 14.5% received tuberculosis preventive therapy. Rapid ART initiation was implemented for 20.0% of individuals with AHD. All newly diagnosed individuals with AHD received tailored counseling to ensure optimal adherence. Qualitative data analysis identified three principal challenges to the implementation of the WHO-recommended package of care: structural and organizational obstacles, service delivery constraints, and patient-related concerns as expressed by healthcare workers. Conclusions: The implementation of the WHO-recommended package of care for individuals with AHD remains inconsistent. Although adherence support is routinely offered to all newly diagnosed individuals with AHD, the delivery of other key components is frequently hindered by a range of systemic challenges. These include the unavailability or frequent stockouts of essential medications and services for managing opportunistic infections, weak referral and linkage systems, and the absence of dedicated AHD care clinics. Such challenges underscore significant gaps in the continuum of AHD care and highlight the pressing need for targeted, system-level interventions to ensure comprehensive service delivery.

Background: Healthcare workers are a first contact for patients with infectious diseases and may be at occupational risk during hemorrhagic fever outbreaks. The Marburg virus disease (MVD) outbreak in southern Ethiopia, ongoing during data collection in December 2025, highlighted the need to assess healthcare workers’ knowledge, attitudes, and practices regarding MVD. Therefore, this study assessed knowledge, attitudes, and practices and examined factors associated with practice among healthcare work. Methods: A cross‐sectional study of 238 healthcare workers at Dilla University Teaching Hospital was conducted from December 1 to December 22, 2025. Descriptive statistics, frequencies, and percentages summarized participant characteristics and KAP responses. Binary logistic regression examined factors associated with good practice. Variables with p value ≤ 0.25 in bivariable analysis were included in the multivariable model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and significance was set at p < 0.05. Results: About 51.7%, 57.1%, and 55.0% of participants had good knowledge, positive attitudes, and good practice toward MVD, respectively, based on study‐specific cutoffs. Most identified direct contact with blood and body fluids as an MVD transmission route (92.0%). However, gaps were observed regarding environmental risk factors and MVD distribution and origin. Most recognized reporting suspected cases (91.2%), avoiding contact with infected individuals or their possessions (91.2%), and using personal protective equipment (87.8%). In multivariable analysis, modification of working habits from concern about acquiring MVD (AOR = 2.19, 95% CI: 1.21–3.99) and good MVD knowledge (AOR = 1.96, 95% CI: 1.13–3.39) were positively associated with good practice. Conclusion: Findings indicate gaps in MVD‐related knowledge and infection prevention among healthcare workers at Dilla University Teaching Hospital. Targeted competency‐based training, simulation, IPC resources, and facility‐level preparedness systems are warranted to strengthen readiness for MVD and other viral hemorrhagic fever events.

Background: Noncommunicable diseases (NCDs) are the leading causes of morbidity and mortality worldwide. The burden of NCD‐related morbidity and mortality can be reduced through the adoption of healthy lifestyle behaviors and the utilization of preventive healthcare services. Self‐efficacy plays a crucial role in maintaining healthy behavior and improving health outcomes. However, there is limited evidence regarding the magnitude of perceived self‐efficacy in the study area. Therefore, this study is aimed at assessing the magnitude of perceived self‐efficacy and its associated factors in preventing NCDs among adult residents in the Gedeo Zone, Southern Ethiopia. Methods: A community‐based cross‐sectional study was conducted from November 1, 2023, to January 1, 2024, among adult residents of the Gedeo Zone, Southern Ethiopia. A multistage sampling technique was employed to select 620 participants. Data were collected using interview‐administered structured questionnaires through KoboToolbox and exported to STATA Version 16 for analysis. Descriptive statistics were computed, and binary logistic regression analysis was performed to identify candidate variables associated with perceived self‐efficacy in preventing NCDs. Variables with p value < 0.05 in the multivariable model were considered statistically significant. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated and reported. Results: Overall, 56.5% (95% CI: 52.5%–60.3%) of participants had high perceived self‐efficacy toward engaging in NCD preventive behaviors. Middle‐aged adults (AOR = 1.81; 95% CI: 1.09, 3.01), older adults (AOR = 4.31; 95% CI: 2.08, 8.07), participants reporting good perceived general health status (AOR = 2.94; 95% CI: 1.38, 6.28), perceived benefit of health action (AOR = 5.54; 95% CI: 3.32, 9.25), and perceived cues to action (AOR = 4.35; 95% CI: 2.75, 6.88) were positively associated with high perceived self‐efficacy in preventing NCDs. However, perceived barriers to health actions (AOR = 0.58; 95% CI: 0.38, 0.88) were negatively associated with high perceived self‐efficacy. Conclusion and Recommendations: The study found that more than half of the participants demonstrated high perceived self‐efficacy in preventing NCDs. Being middle or older, having a good perceived general health status, perceiving benefits of health actions, and having cues to action were positively associated with self‐efficacy, whereas perceived barriers to health actions were negatively associated with perceived self‐efficacy. These findings suggest that policymakers and healthcare providers should strengthen community‐based health promotion and social and behavior change interventions aimed at improving individuals′ efficacy in engaging in NCD preventive behaviors.

Introduction: Unsafe abortion is a significant cause of maternal morbidity and mortality in low- and middle-income countries. Female sex workers in Ethiopia are exposed to unwanted and unplanned pregnancy and subsequent abortion. In the absence of access to quality abortion care services, the chances of experiencing unsafe abortion are high. However, limited evidence is available on female sex workers’ experience with abortion services and their exposure to unsafe abortion. Objective: To explore the lived experiences of female sex workers who underwent unsafe abortion in Gedeo Zone, Southern Ethiopia. Methods: The study was conducted among female sex workers in Gedeo Zone, Southern Ethiopia, from April to June 2024. The study was employed among female sex workers who had a history of unsafe abortion in the past 2 years. Both establishment-based and street-based female sex workers were selected using the snowball sampling method. Face-to-face in-depth interviews were conducted with participants in locations of their preference to ensure privacy. Data saturation was achieved after interviewing 18 participants. The collected data were transcribed verbatim, translated into English, and analyzed thematically using the Open Code 4.03 software. Trustworthiness was ensured throughout the data analysis process. Design: A qualitative study with a phenomenological design was employed. Results: The findings of this study revealed that poor knowledge of safe abortion services and poor socioeconomic status are the main causes for seeking unsafe abortion services by commercial sex workers. Unsafe pregnancy terminations were mainly experienced using commercial medications from private pharmacies and using traditional practices through herbal and mechanical techniques. Sex workers resorted to traditional methods and self-induced medication abortions, leading to adverse health, psychosocial, and economic consequences. Conclusion: The study highlights the poor information literacy and limited access to abortion services for sex workers, leading to unsafe practices and subsequent physical and psychological suffering. Therefore, stakeholders should collaborate to increase female sex workers’ knowledge and access to safe abortion services.

Background: Breast cancer is the leading cause of cancer-related deaths in women globally and a significant public health burden in sub-Saharan Africa, which accounts for approximately 15% of all cancer-related mortality. In sub-Saharan Africa, breast cancer incidences increased by 247% from 1990 to 2019. In Lesotho, breast cancer is the second most common cancer affecting women, a situation worsened by a fragile healthcare system and low screening rates. Despite its high morbidity and mortality, there is limited understanding of the factors influencing breast cancer screening among women of reproductive age. This study aims to identify these factors by utilizing the newly released Lesotho DHS dataset and the Anderson Behavioral Model. Methods: This study utilized a cross-sectional design with data from the recent Lesotho Demographic and Health Survey (LDHS), which employed a stratified two-stage sampling method across 400 Enumeration Areas and 9,976 households. This analysis included a weighted sample of 6,413 reproductive-age women (15–49 years) to determine factors of breast cancer screening. The predisposing, enabling, and need factors were examined using the Andersen Behavioral Model. Stata version 16 was used for a multilevel mixed-effects logistic regression model. Results were presented as adjusted odds ratios (AOR) with 95% confidence intervals, and a P-value less than 0.05 was considered statistically significant. Results: The prevalence of breast cancer screening among women of reproductive age in Lesotho was 22.20% (95% CI 21.19–23.23). Significant factors included age 25–34 (AOR = 1.54; 95% CI 1.26–1.88), age 35–49 (AOR = 2.10; 95% CI 1.71–2.58), healthcare facility visits in the past 12 months (AOR = 1.47; 95% CI 1.26–1.71), health insurance coverage (AOR = 1.86; 95% CI 1.36–2.53), high media exposure (AOR = 1.23; 95% CI 1.01–2.52), contraceptive use (AOR = 1.18; 95% CI 1.03–1.37), and parity: multiparous (AOR = 2.29; 95% CI 1.84–2.85) and grand multiparous (AOR = 1.67; 95% CI 1.16–2.40). Conclusion: This finding that 22.2% of reproductive age women in Lesotho underwent breast cancer screening highlights a pressing gap in preventive health efforts. The Andersen Behavioral Model underscores key determinants that significantly influence breast cancer screening uptake in our study. Significant factors included age, healthcare facility visits, health insurance coverage, media exposure, contraceptive usage, and parity. These findings underscore the need for targeted interventions that address model-based determinants to improve breast cancer screening uptake.

Background: Early childhood development (ECD) plays a crucial role in shaping the future development of children and it influences their lifelong outcomes. The Early childhood development index 2030 (ECDI2030) serves as an effective tool for monitoring the overall development of children aged 24–59 months at the population level. This study employed machine learning algorithms to identify the predictors of ECD across three East African countries, using the ECDI2030. Methods: Data were derived from the Demographic and Health Surveys of Kenya, Mozambique, and Tanzania. Seven supervised machine learning algorithms and an ensemble of the best performing models were utilized to predict ECD. The dataset was randomly divided into 80% training and 20% testing sets. The predictive ability of each machine learning model was evaluated using area under the curve (AUC) and the classification metrics. We used SHapley Additive exPlanations (SHAP) to explain the predictions by interpreting feature importance. Results: About 57.4% (95% CI = 56.5, 58.3) children were developmentally on track in health, learning, and psychosocial well-being. The ensemble model of extreme gradient boosting and random forest was the best algorithm with accuracy of 66% and AUC of 71%. The top three most important predictors of ECD were child age, media exposure, and maternal education level with a mean absolute SHAP value of +0.17, + 0.12, and +0.1, respectively. The beeswarm plot of SHAP revealed that children aged 24–35 months, those whose mothers were not exposed to media, or those whose mothers had completed at least secondary education were more likely to be developmentally on track. Conclusion: In East Africa, only the modest majority of children were developmentally on track. Policies should prioritize preprimary education, equitable access, and women’s education to empower mothers and improve parenting practices. Promoting appropriate media use while limiting maternal screen time can enhance children’s developmental outcomes in East Africa and other countries with similar socioeconomic contexts, including most sub-Saharan African countries.

Background: Understanding women’s fertility preferences is essential for addressing reproductive behaviors and family planning needs. In sub-Saharan Africa, fertility rates remain high, yet many women experience unrealized fertility, which is having fewer children than desired. However, the factors influencing unrealized fertility remain underexplored. This study assessed the determinants of unrealized fertility among women approaching the end of their reproductive years in sub-Saharan Africa. Methods: A secondary data analysis was conducted using phase eight Demographic and Health Surveys data from 19 sub-Saharan African countries. The weighted sample included 46,408 women aged 40–49 years. A multilevel Poisson regression model with robust variance was used to identify factors associated with unrealized fertility. Adjusted prevalence ratios with 95% confidence intervals (CI) were reported, and variables with a p value <0.05 were considered statistically significant. Results: The pooled prevalence of unrealized fertility among women aged 40–49 years was 61.43% (95% CI: 57.63%, 65.24%). Rwanda (37.40; 95% CI: 27.92%, 46.88%) and Sierra Leone (69.34; 95% CI: 60.30%, 78.38%) had the lowest and highest prevalence, respectively. Older maternal age at first birth, being employed, having no children or only children of one sex, and experiencing child death were associated with higher prevalence of unrealized fertility. Conversely, higher maternal education, the use of contraceptives, having both male and female children, and residing in rural areas were associated with lower prevalence of unrealized fertility. Conclusions: A large proportion of women nearing the end of their reproductive careers in sub-Saharan Africa have experienced unrealized fertility. Therefore, addressing cultural norms surrounding sex preference and number of children, alongside empowering women through improved access to education, healthcare, and comprehensive sexual and reproductive health services, is critical.