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Spatial variation and distribution of anaemia among children aged 6-59 months in Madagascar: a population-based cross-sectional study

Por: Lakew · G. · Gemmechu · M. M. · Tiruneh · T. M. · Atalay · Y. A. · Yirsaw · A. N. · Bogale · E. K. · Gebeyehu · N. A. · Tekoye · T. S. · Getahun · G. K. · Seid · K. · Goshu · A. T. · Lorato · S. S. · Desalegn · M. · Gelaw · K. A. · Ashebir · Y. G. · Getahun · O. K.
Objectives

To describe the prevalence and spatial distribution of anaemia among children aged 6–59 months in Madagascar and to explore individual-level and community-level correlates using data from the 2021 Madagascar Demographic and Health Survey.

Design

A population-based cross-sectional study using secondary data from the 2021 Madagascar Demographic and Health Survey. Spatial statistical methods were used to assess geographic clustering and hotspot areas of anaemia.

Setting

The study was conducted across community and household levels throughout Madagascar, covering both rural and urban populations within the primary and secondary healthcare delivery contexts.

Participants

A weighted sample of 10 683 children aged 6–59 months was included. Sampling followed demographic health survey procedures, and only children with complete haemoglobin data were analysed.

Interventions

No interventions were applied.

Primary and secondary outcome measures

The primary outcome was anaemia, defined as haemoglobin

Results

The overall point prevalence of anaemia was 47% (95% CI 45.60 to 48.36), showing significant spatial clustering (Global Moran’s I=0.136, p

Conclusions

Anaemia among Malagasy children remains a major public health concern and shows clear geographic variation. The findings describe important differences in prevalence across regions and population subgroups, providing useful evidence for public health planning and for generating hypotheses for future analytical research.

Determinants of treatment outcomes among hospitalised patients with skin and soft tissue infections: a prospective observational study

Por: Biyazin · A. A. · Mekonnen · G. B. · Anberbr · S. S. · Tarekegn · G. Y. · Zerihun · T. E. · Getahun · A. D. · Abebe · R. B.
Objectives

The study aimed to determine treatment outcome and factors affecting treatment outcomes among hospitalised patients with skin and soft tissue infections (SSTIs) at the University of Gondar Comprehensive Specialised Hospital (UOGCSH) in Ethiopia.

Design

An institution-based prospective observational study.

Setting

UOGCSH, Northwest Ethiopia.

Participants

423 patients from all age groups with clinically diagnosed SSTIs from 25 June to 25 December 2023 at the UOGCSH were included.

Outcome measures

Primary treatment outcomes were early apparent clinical response within 48–72 hours and treatment failure after 72 hours of optimal antibiotic therapy. Secondary treatment outcomes included hospital length of stay (HLOS) and in-hospital mortality. Multiple linear regression assessed factors influencing the HLOS, and multivariable logistic regression identified predictors of treatment failure.

Results

The average HLOS was 13.46±3.01 days. Of the patients, 39.3% had an early clinical response within 48–72 hours, whereas 34.4% had treatment failure. At 0.7%, the in-hospital death rate was modest. Living in a rural area (adjusted OR (AOR) 5.54, 95% CI 2.67 to 11.37), having concurrent illnesses (AOR 2.11, 95% CI 1.10 to 4.07) and starting antibiotics later than 12 hours (AOR 0.08, 95% CI 0.04 to 0.17) were significantly associated with treatment failure. Concomitant disorders and complex comorbidities were also associated with longer HLOS, whereas higher socioeconomic level, oral step-down therapy, early antibiotic initiation and early clinical response were linked to better results and shorter hospital stays.

Conclusion

Timely antibiotic initiation, efficient source control, patient comorbidities and socio-economic considerations affect the treatment course for SSTIs. Prolonged treatment and the frequent use of ‘watch’ and ‘reserve’ antibiotics underscore the need for improved antimicrobial stewardship. In this situation, optimising clinical results and minimising HLOS requires prompt clinical evaluation and customised antibiotic therapy. However, the single-centre design and potential residual confounding may introduce bias.

Determinants of cervical cancer screening among women aged 30 to 49 years in 20 low- and middle-income countries: A multilevel analysis

by Mequanent Dessie Bitewa, Thomas Kidanemariam Yewodiaw, Aysheshim Asnake Abneh, Mikias Getahun Molla, Mulat Belay Simegn, Tadele Sinishaw Jemere, Mequannt Alemu Endayehu, Aysheshim Belaineh Haimanot, Werkneh Melkie Tilahun, Atirsaw Assefa Melikamu, Tadele Derbew Kassie

Background

Cervical cancer is preventable, yet it remains a leading cause of cancer death in women. About 90% of cases and 94% of deaths occur in low- and middle-income countries (LMICs). Limited access to screening drives high incidence and mortality. Screening is central to secondary prevention and global elimination efforts.

Objective

This study aimed to assess determinants of cervical cancer screening among women aged 30–49 years in low- and middle-income countries: a multilevel analysis.

Methods

A cross-sectional study used nationally representative data from 148,605 weighted women aged 30–49 years in 20 LMICs (2019–2024). Multilevel logistic regression identified factors associated with cervical cancer screening while accounting for cluster-level variation. Statistical significance was set at p  Result

Overall cervical cancer screening uptake was 14.03% (95% CI: 13.63–14.45%), ranging from 0.92% in Mauritania to 42.98% in Zambia. Higher screening was associated with older age 40–49 years (AOR = 1.48; 95% CI: 1.41–1.54), occupation (AOR = 1.15; 95% CI: 1.10–1.21), contraceptive use (AOR = 1.38; 95% CI: 1.31–1.44), recent health-facility visit (AOR = 1.93; 95% CI: 1.84–2.02), prior abortion (AOR = 1.28; 95% CI: 1.22–1.34), female-headed households (AOR = 1.11; 95% CI: 1.05–1.18), high community education (AOR = 1.63; 95% CI: 1.49–1.79), and high media exposure (AOR = 2.54; 95% CI: 2.30–2.80). Lower uptake was observed among individuals in high-poverty communities (AOR = 0.63; 95% CI: 0.57–0.68), higher parity (1–4 birth) (AOR = 0.86; 95% CI: 0.78–0.94); (five or more births) (AOR=0.66 95% CI: 59–0.73), and those residing in rural areas (AOR = 0.89; 95% CI: 0.82–0.97).

Conclusion

Cervical cancer screening uptake in LMICs is far below the WHO 2030 target, with wide country disparities. Socio-demographic factors, health-facility contact, and community education increase uptake, while poverty and geographic barriers reduce it. Integrating screening into routine reproductive and maternal care, strengthening community and media education, and addressing structural barriers to access are essential to improving coverage.

Time to first optimal glycaemic control and associated factors among adult patients with diabetes at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia: a retrospective cohort study

Por: Getahun · A. D. · Ayele · E. M. · Tsega · T. D. · Anberbr · S. S. · Geremew · G. W. · Biyazin · A. A. · Taye · B. M. · Mekonnen · G. A.
Objective

To assess the time to first optimal glycaemic control and its predictors among adult patients with type 1 and type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital in Ethiopia.

Design

A retrospective cohort study.

Setting

University of Gondar Comprehensive Specialized Hospital, northwest, Ethiopia.

Participants

We recruited 423 adult diabetic patients who were diagnosed between 1 January 2018 and 30 December 2022 at the University of Gondar Comprehensive Specialized Hospital.

Outcome measures

The primary outcome was the time from diagnosis to the achievement of the first optimal glycaemic control, measured in months. A Cox proportional hazards regression model was fitted to identify predictors of time to first optimal glycaemic control. Data were collected with KoboToolbox from patient medical charts and exported to Stata V.17. The log-rank test was used to determine the survival difference between subgroups of participants.

Results

Median time to first optimal glycaemic control was 10.6 months. Among 423 adult diabetic patients, 301 (71.16%) achieved the first optimal glycaemic control during the study period. Age category (middle age (adjusted HR (AHR)=0.56, 95% CI 0.41 to 0.76), older age (AHR=0.52, 95% CI 0.33 to 0.82)), comorbidity (AHR=0.52, 95% CI 0.35 to 0.76), therapeutic inertia (AHR=0.20, 95% CI 0.13 to 0.30) and medication non-compliance (AHR=0.49, 95% CI 0.27 to 0.89) were significant predictors of time to optimal glycaemic control.

Conclusion

The median time to first optimal glycaemic control was prolonged. Diabetic care should focus on controlling the identified predictors to achieve optimal glycaemic control early after diagnosis.

Syndemics of depression, sick role and activation status among newly diagnosed adults with diabetes mellitus in Bahir Dar, Ethiopia: a 6-month follow-up study protocol

Por: Awoke · W. · Alene · G. D. · Admasie · A. · Getahun · F. A.
Introduction

Diabetes mellitus (DM) and depression commonly coexist. Each condition increases the risk of developing the other and adversely affects treatment outcomes. Such complex interactions of diseases, referred to as syndemics, have not been well studied. This study aims to assess the syndemics of depression, sick role and activation status among newly diagnosed adults living with DM.

Methods and analysis

A prospective 6-month follow-up study will be conducted with 485 participants. Depression will be assessed with the 9-item Patient Health Questionnaire, applying a cut-off score of 10. The primary outcome will be glycaemic control, and the secondary outcomes will be health-related quality of life (HRQoL) and functional disability status. Depression, the primary outcome and the secondary outcomes, will be measured at baseline, 3 months and 6 months. The sick role, activation status and health system perspectives will be explored using qualitative methods following the second measurement. Data will be collected from adults living with DM, healthcare providers and healthcare managers. Qualitative sampling will continue until data saturation is reached.

Quantitative analysis will be done using STATA V.17. The prevalence of depression will be determined at baseline. Associated factors will be analysed using Poisson regression with a robust variance estimator. Incidence rate of depression, glycaemic control, HRQoL and disability status will be measured at 3 and 6 months. A multilevel mixed-effects generalised linear model will be fitted, with the three measurement time points nested within individuals, and individuals nested within health institutions. Qualitative data will be analysed thematically using NVivo V.12 software.

Ethics and dissemination

Ethics approval has been granted by the institutional review board of Bahir Dar University (protocol number 3098/25). Findings will be disseminated through peer-reviewed publications, conference presentations and local channels for community audiences.

Trial registration number

Protocol number 3098/25.

Acute gastroenteritis and associated factors among under-five children visiting public hospitals in Jigjiga City, Somali Region, Ethiopia: a hospital-based cross-sectional study

Por: Getahun · M. A. · Ayehubizu · L. M. · Ahmed · A. M. · Ali · S. Y. · Abdilahi · A. M. · Shegere · M. M.
Objective

The study aims to assess the magnitude of acute gastroenteritis and associated factors among under-five children visiting public hospitals in Jigjiga City, Somali Region, Ethiopia.

Design

A hospital-based cross-sectional study design was used to carry out the study. We then employed a systematic random sampling technique through face-to-face interviews to gather the data. A structured questionnaire consisting of socio-demographic, behavioural, environmental and clinical factors was developed after reviewing relevant literature.

Setting

The study was conducted in public hospitals located in Jigjiga City, Somali Region, Ethiopia.

Participants

A total of 353 under-five children visiting public hospitals were involved in the study.

Outcome measures

The primary outcome of the study was the prevalence of acute gastroenteritis.

Result

The 2-week prevalence of acute gastroenteritis among under-five children was 24.6% (95% CI 23.4% to 25.9%). The study found strong links between acute gastroenteritis and having a household greater than five (adjusted OR (AOR)=2.94, 95% CI 1.55 to 5.60), an unprotected source of drinking water (AOR=2.74, 95% CI 1.29 to 5.82), unimproved latrine facilities (AOR=3.15, 95% CI 1.26 to 7.78), the presence of faeces around the latrine (AOR=3.53, 95% CI 1.77 to 7.03) and mothers or caregivers’ history of diarrhoea over the past 2 weeks (AOR=6.23, 95% CI 3.22 to 12.06).

Conclusion

The overall prevalence of acute gastroenteritis in Jigjiga City was relatively high in the 2-week period. Having a household greater than five, an unprotected source of drinking water and unimproved latrine facilities was a significant predictor of acute gastroenteritis. Additionally, the presence of faeces around the latrines and the history of diarrhoea in mothers or caregivers over the past 2 weeks were strongly linked to acute gastroenteritis.

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