Background: Diabetes mellitus is one of the global public health problems and fasting blood sugar is an important indicator of diabetes management. Uncontrolled diabetes can lead to diabetic foot ulcers, which is a common and disabling complication. The association between fasting blood glucose level and the incidence of diabetic foot ulcers is rarely considered, and knowing its predictors is good for clinical decision-making. Therefore, the aim of this study was to determine the incidence and predictors of diabetic foot ulcers and its association with changes in fasting blood sugar among diabetes mellitus patients at referral hospitals in Northwest Ethiopia. Methods: A multicenter retrospective follow-up study was conducted at a referral hospital in Northwest Ethiopia. A total of 539 newly diagnosed DM patients who had follow-up from 2010 to 2020 were selected using a computer-generated simple random sampling technique. Data was entered using Epi-Data 4.6 and analyzed in R software version 4.1. A Cox proportional hazard with a linear mixed effect model was jointly modeled and 95% Cl was used to select significant variables. AIC and BIC were used for model comparison. Result: A total of 539 diabetes patients were followed for a total of 28727.53 person-month observations. Overall, 65 (12.1%) patients developed diabetic foot ulcers with incidence rate of 2.26/1000-person month observation with a 95% CI of [1.77, 2.88]. Being rural (AHR = 2.30, 95%CI: [1.23, 4.29]), being a DM patient with Diabetic Neuropathy (AHR = 2.61, 95%CI: [1.12, 6.06]), and having peripheral arterial disease(PAD) (AHR = 2.96, 95%CI: [1.37, 6.40]) were significant predictors of DFU. The time-dependent lagged value of fasting blood sugar change was significantly associated to the incident of DFU (α = 1.85, AHR = 6.35, 95%CI [2.40, 16.79]). Conclusion and recommendation: In this study, the incidence of DFU was higher than in previous studies and was influenced by multiple factors like rural residence, having neuropathy, and PAD were significant predictors of the incidence of DFU. In addition, longitudinal changes in fasting blood sugar were associated with an increased risk of DFU. Health professionals and DM patients should give greater attention to the identified risk factors for DFU were recommended.

Background: Female sex workers (FSWs) are marginalized groups of the population who have limited access to healthcare and a higher risk of HIV infection due to biobehavioral and structural risk factors. Although it is known that the Eastern and Southern African region is affected by the highest HIV incidence and prevalence, understanding the burden among FSWs in the region remains limited. We aimed to assess the pooled prevalence and associated factors of HIV in this vulnerable population. Methods: Relevant studies were searched on PubMed, Embase, Scopus, ScienceDirect, Hinari, African Journals Online (AJOL), Google, and Google Scholar. The searching mechanism was constructed using keywords identified by CoCoPop (Condition, Context, and Population) framework and medical subject heading terms to recruit studies published between January 1, 2015 and March 30, 2024. Observational studies that estimate the prevalence or incidence or associated factors of HIV among FSWs, even if FSWs were not the main focus of the study, were included. The quality of included studies was assessed using Joana Brigg’s Institute checklist. Data were extracted and analyzed using STATA 17 software. To estimate the pooled effect sizes with their 95% confidence intervals, a random effect model was fitted. The I² statistic was used to evaluate heterogeneity. Funnel plot and Egger’s regression test were utilized to assess the small study effect. Publication bias was managed using trim-and-fill analysis. Subgroup and sensitivity analysis were considered to handle heterogeneity among studies. Results: A total of 54 articles with 78,747 FSWs who had successful HIV biological test were included in the analysis. The pooled prevalence of HIV among FSWs in Eastern and Southern Africa was 36.0% (95% CI: 31.0%–41.0%). Regionally, the pooled prevalence was 59.0% (95% CI: 53.0%–64.0%) and 29.0% (95% CI: 25.0%–34.0%) in Southern and Eastern Africa, respectively. Age above 35 (POR = 7.35; 95% CI: 5.26, 10.28) and 25–34 years (POR = 2.91; 95% CI: 2.02, 4.21), being married (POR = 1.33; 95% CI: 1.07, 1.66), divorced (POR = 1.72; 95% CI: 1.39, 2.13), and widowed (POR = 2.70; 95% CI: 2.09, 3.49), primary education (POR = 1.29; 95% CI:1.08, 1.55), history of sexually transmitted infection (POR = 1.51; 95% CI: 1.20, 1.90), syphilis (POR = 2.57; 95% CI: 1.66, 3.98), Hepatitis B infection (POR = 2.60; 95% CI: 1.07,6.32), drinking alcohol (POR = 1.21; 95% CI: 1.01, 1.45) and injectable drug use before sex (POR = 1.75; 95% CI: 1.24, 2.47) were found significantly associated with the increased risk of HIV infection among FSWs. Conclusion: These data suggest an urgent need to improve access to HIV prevention programs for FSWs. Providing behavioral interventions including reduction of alcohol and injectable drug use before sex, initiating tailored healthcare services, strengthening the psychosocial and legal support network, and fostering partnership might reduce the burden in the region. Clinicians could facilitate early detection and treatment of STIs, and Hepatitis B virus infection. Trial registration: Protocol registration: The protocol for this systematic review and meta-analysis was registered in the PROSPERO with registration number CRD42024509200.

Introduction: Hepatitis B virus (HBV) is one of the major public health problems globally and needs an urgent response. It is one of the most responsible causes of mortality among the five hepatitis viruses, and it affects almost every class of individuals. Different studies were conducted on the prevalence of HBV among pregnant women in East African countries, but none of them showed the pooled prevalence of HBV among the pregnant women. Thus, the main objective of this study was to determine the pooled prevalence and its determinants among pregnant women in East Africa. Methods: We searched studies using PubMed, Scopus, Embase, ScienceDirect, Google Scholar and grey literature that were published between January 01/2020 to January 30/2024. The studies were assessed using the Newcastle Ottawa Scale (NOS) quality assessment scale. The random-effect (DerSimonian) model was used to determine the pooled prevalence and associated factors of HBV among pregnant women. Heterogeneity were assessed by I² statistic, sub-group analysis, and sensitivity analysis. Publication bias was assessed by Egger test, and the analysis was done using STATA version 17. Result: A total of 45 studies with 35639 pregnant women were included in this systematic review and meta-analysis. The overall pooled prevalence of HBV among pregnant women in East Africa was 6.0% (95% CI: 6.0%−7.0%, I² = 89.7%). The highest prevalence of 8% ((95% CI: 6%, 10%), I² = 91.08%) was seen in 2021, and the lowest prevalence 5% ((95% CI: 4%, 6%) I² = 52.52%) was observed in 2022. A pooled meta-analysis showed that history of surgical procedure (OR = 2.14 (95% CI: 1.27, 3.61)), having multiple sexual partners (OR = 3.87 (95% CI: 2.52, 5.95), history of body tattooing (OR = 2.55 (95% CI: 1.62, 4.01)), history of tooth extraction (OR = 2.09 (95% CI: 1.29, 3.39)), abortion history(OR = 2.20(95% CI: 1.38, 3.50)), history of sharing sharp material (OR = 1.88 (95% CI: 1.07, 3.31)), blood transfusion (OR = 2.41 (95% CI: 1.62, 3.57)), family history of HBV (OR = 4.87 (95% CI: 2.95, 8.05)) and history needle injury (OR = 2.62 (95% CI: 1.20, 5.72)) were significant risk factors associated with HBV infection among pregnant women. Conclusions: The pooled prevalence of HBV infection among pregnant women in East Africa was an intermediate level and different across countries ranging from 1.5% to 22.2%. The result of this pooled prevalence was an indication of the need for screening, prevention, and control of HBV infection among pregnant women in the region. Therefore, early identification of risk factors, awareness creation on the mode of transmission HBV and implementation of preventive measures are essential in reducing the burden of HBV infection among pregnant women.

Introduction: Breast cancer is a global public health problem among reproductive-age women, with an estimated 670,000 deaths in 2022. It’s also a pressing health challenge in Sub-Saharan African countries, driven by late-stage diagnoses and limited healthcare access, underscoring the urgent need for early screening and treatment initiatives to combat this growing epidemic. In Kenya, the burden was also significant, and multilevel factors such as individual, household, and community level factors that influence screening uptake are undermined. Furthermore, there were no nationally representative studies. Therefore, this study aimed to assess clinical breast cancer screening uptake (CBCSU) and associated factors among reproductive-age women: further analysis of Kenyan demographic and health survey (KDHS) 2022. Methods: This study used a weighted nationally representative sample of 16,649 women from the 2022 KDHS. A Multilevel mixed effects binary logistic regression analysis was performed and in the multivariable analysis, variables with a p-value less than 0.05 were considered statistically significant. The strength of the association was evaluated using Adjusted Odds Ratios (AOR) along with their corresponding 95% confidence intervals (CI). STATA version 17 software was to for data management and statistical analysis. Results: The weighted prevalence of CBCSU in Kenya was 13.91% (95% CI: 13.33, 14.44). Besides, women aged 25 to 34 years (AOR = 1.86, 95% CI: 1.57, 2.21), and 35 to 49 years (AOR = 2.87, 95% CI: 2.40, 3.42) had higher odds of CBCSU. Women with primary education (AOR = 2.14, 95% CI: 1.56, 2.94) and those with secondary or higher education (AOR = 3.09, 95% CI: 2.23, 4.28) had higher odds of CBCSU. In addition, the odds of CBCSU were higher among women with a middle (AOR = 1.41, 95% CI: 1.19, 1.67) and a rich wealth index (AOR = 2.19, 95% CI: 1.84, 2.61). On the other hand, CBCSU was lower among non-contraceptive user women (AOR 0.78, 95% CI: 0.69, 0.87). Furthermore, women in communities with a high proportion of media exposure had higher CBCSU (AOR = 1.17, 95% CI: 1.04, 1.33). Conclusion: In this study, the prevalence of CBCSU among reproductive-age women in Kenya was found to be low. Besides, factors such as age, educational status, wealth index, family planning utilization, and community media exposure were identified as significant contributors to screening uptake. Therefore, policymakers and stakeholders should design interventions that address factors contributing to low breast cancer screening uptake, particularly targeting women in areas with limited media exposure, to increase the uptake of clinical breast cancer screening.

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Introduction: Diabetes mellitus (DM) is one of the most significant public health problems. Globally, one in ten adults has diabetes, and it results in macro- or microvascular complications, such as diabetic retinopathy (DR). It is one of the most prevalent eye complications associated with DM, and it is the main cause of vision loss. Even though East African countries face a growing burden of diabetes and DR, no study depicts the regional prevalence and its associated factors. Therefore, this study aimed to estimate the pooled prevalence of DR and its associated factors among adults in East African countries. Methods: We extensively searched PubMed, Embase, Scopus, Google Scholar, and Google for relevant studies. A forest plot was used to estimate the pooled prevalence of diabetic retinopathy using DerSimonian and Laird’s random-effects model. We checked publication bias using funnel plots and Egger’s regression test. Potential heterogeneity was tested using the I-squared statistic. Subgroup analysis, sensitivity analysis, and meta-regression analysis were also performed. Furthermore, the pooled odds ratios for the associated factors were estimated. The research protocol was registered in PROSPER. Results: Among the 29 included studies, the estimated pooled prevalence of DR in East African countries was 28% (95% CI 23.0, 33.0). Besides, age ≥60 (OR = 2.88, 95% CI: 1.55, 5.32), body mass index ≥ 25 (AOR = 2.85; 95% CI: 1.69, 4.81; I2 = 85.4%, p < 0.001), and hemoglobin A1c levels ≥7 (OR = 2.48, 95% CI: 1.46, 4.23) were significantly associated with the prevalence of DR. Conclusions: The prevalence of DR in East Africa was high, with more than one in four individuals with diabetes developing DR. Besides, advanced age, higher body mass index, and elevated hemoglobin A1c levels were significant factors associated with increased DR prevalence. Therefore, comprehensive diabetes management focusing on optimal glycemic control and healthy weight maintenance is essential to mitigate the problems. Also, the Ministries of Health and policymakers should prioritize and implement targeted strategies to address the identified modifiable risk factors, aiming to reduce the prevalence of DR in the region. Trial registration: Systematic review registration: PROSPERO (2024: ID = CRD42024511437 ). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024511437.