Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis: Introduction. Globally, anemia among under-five children is a serious public health problem. Even if there are pocket studies here and there, there is limited evidence on the pooled prevalence of anemia among under-five children in Africa. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia. Methods and Analysis. This systematic review and meta-analysis was done following the PRISMA guidelines. A comprehensive search was made in PubMed/MEDLINE, Cochrane Library, HINARI, and Ethiopian Journal of Health Development for studies published since 2009. It was supplemented with Google Scholar search. Study selection, data extraction, and quality of studies were assessed by eight reviewers. The Cochrane Q test and I² test statistic were used to test the heterogeneity of studies. A random-effects model of DerSimonian-Laird method was used. Result. A total of 37 articles were included in this systematic review and meta-analysis. The pooled prevalence of anemia among under-five children in Africa was 59 (95 CI: 55, 63). Being female (AOR=0.71; 95 CI: 0.57, 0.87), maternal education (AOR=1.47; 95 CI: 1.31, 1.66), residence (AOR=0.80; 95 CI: 0.67, 0.95), and family size (AOR=0.93; 95 CI: 0.89, 0.98) were the determinants of anemia among African under-five children. Conclusion and Recommendation. This pooled study revealed that anemia was a severe public health problem. Sex, maternal education, residence, and family size were the determinants of anemia. Therefore, anemia prevention strategy should include sex consideration, educating mothers through youth education, area specific intervention, and encouraging birth spacing.

Introduction: Health management information system is a building block for the health system. Even if using health facility data at all levels is critical, it is poorly practiced in developing countries. There is limited evidence about the utilization of routine health information from the health management information system in the study area. This study aimed to assess the utilization of routine health information from health management information system and associated factors among health professionals at health centers in Oromia special zone, Amhara region, Ethiopia. Methods: A facility-based cross-sectional study was conducted from February to March 2019. A total of 369 health professionals who were the focal person for each service delivery point were taken from the selected health centers. The data analysis was done using STATA version 14. A multilevel mixed-effect logistic regression model was carried out to identify factors associated with utilization of routine health information from the health management information system. Adjusted odds ratio with 95% CI was reported to show the strength of association. A P-value of < 0.05 was used to declare statistical significance. Results: The magnitude of good routine health information utilization among health care professionals was 52.8%. Training (AOR=2.40, 95% CI=1.35, 4.26), availability of standard indicator definition (AOR=2.01, 95% CI=1.13, 3.57), data analysis skills (AOR=2.59, 95% CI=1.45, 4.62), regular feedback (AOR=2.29, 95% CI=1.29, 4.05), performance evaluation (AOR=2.60, 95% CI=1.19, 5.68) and timely reporting (AOR=2.89, 95% CI=1.54, 5.42) were significantly associated with routine health information utilization. Conclusion: The overall utilization of routine health information from the health management information system was low. Therefore, the Zone health department and woreda health offices need to give training on HMIS data use, and avail standard indicator definition for all health care workers at all service delivery points.

Introduction: There is an expansion and advancement of antiretroviral therapy. However, attrition of patients from HIV care is one of the major drivers of poor performance of HIV/AIDS programs, which leads to drug resistance, morbidity and mortality. The study aimed to assess the incidence of attrition and its predictors among adults receiving first-line antiretroviral therapy. Methods: An institution-based retrospective cohort study was conducted among 634 adults receiving antiretroviral therapy, and study participants were selected using a simple random sampling technique. Data were cleaned and entered into Epi Data version 3.1 and exported to STATA 14.1 for further analysis. The predictors of attrition were identified using bivariable and multivariable Cox Proportional hazard models; then, variables at a p-value of less than 0.25 and 0.05 were included in the multivariable analysis and statistically significant, respectively. Results: The total time observed was found to be 1807.08 person-years of observation with a median follow-up time of 2.67 years (IQR 1.25− 4.67). The incidence rate of attrition was 8.36 (95% CI: 7.12− 9.80) per 100 person-years. Significant predictors of attrition were being young age [adjusted hazard ratio (AHR) =2.0, 95% CI, (1.11− 3.58)], nearest calendar year of ART initiation [AHR =2.32, 95% CI, (1.08– 5.01)], bedridden functional status [AHR=3.25, 95% CI, (1.33− 7.96)], WHO stage III [AHR=3.57, 95% CI, (1.58− 8.06)] and stage IV [AHR=5.46, 95% CI, (1.97− 15.13)], viral load result of ≤ 1000 [AHR=0.11, 95% CI, (0.06− 0.23)], disclosure status [AHR=2.03, 95% CI, (1.22− 3.37)] and adherence level of poor [AHR=3.19, 95 CI, (1.67− 6.09)]. Conclusion: The result of this study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. However, as a standard, every client who started antiretroviral therapy should be retained. Positive predictors of attrition were young age (15– 24), recent year of ART initiation, baseline functional status, advanced WHO stage III and IV, no disclosure status, fair/poor adherence whereas, viral load result of ≤ 1000 copies/mL had a preventive effect on attrition.

Background: Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia. Methods: A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach’s α coefficient and Pearson’s correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point. Results: The reliability of BMI, MUAC and CC by Cronbach’s alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96–0.99, p < 0.001), 0.94(95% CI, 0.89–0.98, p < 0.001) and 0.96(95% CI, 0.94–0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex. Conclusions: The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard.

Achieving viral load suppression is crucial for the prevention of complications and deaths related to HIV infection. Ethiopia has embraced the worldwide 95-95-95 target, but there is no national representative information regarding virological suppression. Therefore, this review aims to determine the pooled virological suppression rate and identify the pooled effect of contributing factors of viral suppression for HIV-positive patients on antiretroviral therapy in Ethiopia. We systematically searched websites and databases, including online repositories, to obtain primary studies. Two reviewers assessed the quality of the included articles using the Newcastle-Ottawa Scale appraisal checklist. Publication bias was checked using Egger's regression test, the heterogeneity of the studies was assessed using I² statistics and Q statistics, and a sensitivity analysis was performed to identify any outlier results in the included studies. The Der Simonian Laird random-effects model was used to estimate the overall proportion of viral suppression, and STATA 17 statistical software was used for all types of analysis. A total of 21 eligible articles primarily conducted in Ethiopia using HIV program data were used for this quantitative synthesis. The overall pooled virological suppression rate was 71% (95% CI, 64%–77%). The pooled effects of poor adherence to ART (adjusted odds ratio [AOR], 0.33; 95% CI, 0.28–0.40), body mass index (18.5–24.9 kg/m²; AOR, 1.8; 95% CI, 1.37–2.36), disclosure (AOR, 1.41; 95% CI, 1.05–1.89), absence of opportunistic infection (AOR, 1.68; 95% CI, 1.43–1.97), and high baseline viral load count (AOR, 0.65; 95% CI, 0.52–0.81) were identified as significant predictors of viral suppression. The overall pooled percentage of virological suppression was low compared with the global target of viral suppression and the Ethiopian Public Health Institute report. Poor adherence, normal body mass index, disclosure, absence of opportunistic infection, and high baseline viral load count were factors contributing to viral suppression in Ethiopia. Responsible stakeholders should maximize their efforts to achieve the global target of virological suppression by addressing significant predictors.

Introduction: Hyperemesis gravidarum is a condition of intractable vomiting during pregnancy that leads to fluid and electrolyte imbalance, nutrition deficiency and weight loss often requiring hospital admission. Approximately 0.3%-10.8% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. It has been associated with both maternal and fetal morbidity. There is limited evidence about the proportion of hyperemesis gravidarum and associated factors in the study area. Objective: The aim of this study was to determine the proportion of hyperemesis gravidarum and associated factors among pregnant women admitted into the obstetric ward at Akesta General Hospital, South Wollo Zone, Ethiopia. Methods: This is hospital-based cross-sectional study of 355 pregnant mothers in Akesta general hospital in northeast Ethiopia from September 1/2018- to August 30 /2020. A simple random sampling technique was used to select the patient card from the whole admission of pregnant women cards during the study period. The diagnosis of hyperemesis gravidarum include persistent vomiting not related to other causes, an objective measure of acute starvation, electrolyte abnormalities and acid-base disturbances, as well as weight loss. The data analysis was done using SPSS version 25. Bivariable and multivariable binary logistic regression analysis was conducted to identify factors associated with hyperemesis gravidarum. Adjusted odds ratio (AOR) with 95% confidence intervals (CI) was reported to show the strength of the association. Statistical significance was stated at P-value < 0.05. Results: The proportion of hyperemesis gravidarum was 11.3%. Women with previous history of hyperemesis gravidarum AOR (95%CI) = 10.9[2.46, 48.44], previous history of urinary tract infection AOR (95%CI) = 4.32[1.58, 11.86], previous history of gastrointestinal disease AOR (95% CI) = 4.12[1.40, 12.65], history of abortion AOR (95% CI) = 6.23[2.24, 17.52] were factors significantly associated with hyperemesis gravidarum. Conclusion: In this study, the overall hospital proportion of hyperemesis gravidarum was high. History of gastrointestinal disease, previous history of urinary tract infection, history of hyperemesis gravidarum, and history of abortion were the major risk factors.