Addis Continental Institute of Public Health

BackgroundPrenatal Alcohol Use (PAU) has detrimental effects on mothers and their children. Robust estimates of the prevalence of PAU and associated risk factors are critical for informing interventions to reduce adverse health impacts. This study aimed to estimate the prevalence and risk factors of PAU among Aboriginal and non-Aboriginal mothers in the Northern Territory of Australia.MethodsWe used linked individual-level records from the NT perinatal register, hospital admissions, and emergency department presentations to estimate the prevalence of PAU for all 19,588 births to NT-resident women from 2013 to 2017. Permutation analysis was used to create four PAU categories: no PAU, early PAU (alcohol use in early pregnancy only), continued PAU (alcohol use in early and late pregnancy), and extreme PAU (hospital admissions/ presentations for alcohol-related diagnosis during pregnancy). Multinomial logit models explored the associations between sociodemographic and clinical factors and degrees of PAU. A relative risk ratio (RRR) with a 95% confidence interval (CI) was used to measure associations.ResultsThere were 19,588 births to 16,199 women during the study period (6,310 births to 5,207 Aboriginal women). The mean gestational age at birth for Aboriginal women was 37.8 (95% CI: 37.7, 37.9) weeks and 38.7 (38.6, 38.8) weeks for non-Aboriginal women. The overall PAU prevalence for births to Aboriginal women was 13.1% (95% CI: 12.2, 14.0), including 5.9% (95% CI: 5.2, 6.5) early PAU, 4.3% (95% CI: 3.8, 4.8) continued PAU, and 2.8% (95% CI: 2.4, 3.3) “extreme” PAU. The overall prevalence for non-Aboriginal women was 2.3% (95% CI: 2.1, 2.6), including 1.7% (95% CI: 1.5, 1.9), 0.53% (95% CI: 0.4, 0.7) and 0.1% (95% CI: 0.02, 0.1) for each category, respectively. Age, smoking, and substance misuse-related hospitalisation were associated with an increased risk of PAU among both populations. Being a victim of violence was an additional risk among Aboriginal women. More than five antenatal care (ANC) visits were associated with less PAU. However, 17.9% (n = 3520) of births had missing records related to PAU.ConclusionThe study provides refined prevalence estimates for PAU across groups with increasing risk of harm. Early identification and effective engagement with women at risk of PAU are critical for improving outcomes for mothers and their children. Targeted interventions like enhanced services that support cessation of alcohol and other drugs (AOD), strengthening families, and sustained engagement with culturally safe, trauma-informed maternity care may aid in reducing PAU. The study also highlights the critical need to enhance both the quality and completeness of the routine recording of alcohol use during pregnancy.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08216-5.

Abstract Background Despite the World Health Organization’s recommendation of offering women the option to have a birth companion of their choice, implementation of this recommendation remains limited in low- and middle-income countries, including Ethiopia, Kenya, and Nigeria. This study assessed if a tailored set of programmatic interventions targeting common barriers to birth companionship could increase the proportion of women giving birth with a companion. Methods In this cluster-randomized trial,12 facilities in Ethiopia, 24 facilities across Machakos and Murang’a counties in Kenya, and 24 facilities in Kano and Nasarawa states in Nigeria were randomized (3:1) to intervention and control arms (ClinicalTrials.gov NCT05565196). The intervention was introduced over a period of two months and was evaluated after 12 additional months of implementation. We enrolled women having vaginal births. Data were collected at baseline, quarterly, and one year, using a facility survey and qualitative interviews with women, birth companions, health workers, and unit managers. We used a cluster-weighted chi-square test to compare intervention and control arms with respect to the primary outcome, which was the proportion of women accompanied in the facility by a companion during labor, birth, and postnatal periods. Difference-in-difference analysis was also done. Findings 1,475 women in Ethiopia, 1,496 in Machakos and 1,521 in Murang’a Counties of Kenya and 1,644 in Kano and 1,249 in Nasarawa states of Nigeria were recruited. At end-line, primary outcome increased in intervention arm by 38% points (95%CI=12-66, p=0.009) in Ethiopia,15% points (95%CI=7-26, p=0.002) in Murang’a, 9% points in Machakos (95%CI=-1-20, p=0.077), 51%(95%CI=9-93, p=0.018) points in Kano state, and 53% points in Nasarawa state(95%CI=11-96, 0.014). Interpretation A tailored interventions reduced barriers to women having continuous companionship in facilities during labor, birth, and the postnatal period and has potential for use in a range of facility types and settings aiming to increase client-centered intrapartum care.

Wasting is a severe threat to children's survival and development. Attaining optimal breastfeeding practices for infants under six months of age remains a significant challenge in low-income countries. This study assessed the association between wasting and breastfeeding practices among infants under six months of age in the SNNPR and Somali regions of Ethiopia. The study used data from a large feasibility study conducted in the SNNPR and Somali regions of Ethiopia, from August-September 2021. This study involved 895 infants under six months of age with their mothers. The Poisson regression model with robust variance estimation was used to produce adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs). The prevalence of wasting was 16.5% (95% CI: 14.2, 19.2) among infants under six months of age. Non-exclusive breastfeeding (APR = 1.50; 95% CI:1.02, 2.21), delayed initiation of breastfeeding (APR = 1.52; CI:1.00, 2.30), being male infants (APR = 1.50; 95% CI:1.09, 2.07), and mothers who attained primary level (APR = 0.62; 95% CI: 0.40, 0.95) or secondary level education (APR = 0.30; 95% CI: 0.09, 0.99) were independently associated with wasting in the multivariable analysis. This study indicates a high prevalence of wasting among infants under six months of age. Non-exclusive breastfeeding and delayed initiation of breastfeeding were the modifiable factors significantly linked to infant wasting. Strengthening breastfeeding promotion and support may help reduce wasting in infants under six months.

BackgroundIdentifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs.MethodsWe used the most recent Demographic and Health Survey data sets (2010–22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989). We used generalised linear latent mixed models to compute odds ratios (ORs), and we calculated the PAFs adjusted for commonality using ORs and prevalence estimates for key modifiable risk factors.ResultsThe highest PAFs of neonatal mortality were attributed to delayed initiation of breastfeeding (>1 hour of birth) (PAF = 23.9; 95% confidence interval (CI) = 23.1, 24.8), uncleaned cooking fuel (PAF = 6.2; 95% CI = 6.4, 7.8), infrequent antenatal care (ANC) visits (PAF = 4.3; 95% CI = 3.3, 5.9), maternal lack of formal education (PAF = 3.9; 95% CI = 2.7, 5.3), and mother’s lacking two doses of tetanus injections (PAF = 3.0; 95% CI = 1.9, 3.9). These five modifiable risk factors contributed to 41.4% (95% CI = 35.6, 47.0) of neonatal deaths in the 48 LMICs. Similarly, a combination of these five risk factors contributed to 40.5% of infant deaths. Further, delayed initiation of breastfeeding (PAF = 15.8; 95% CI = 15.2, 16.2), unclean cooking fuel (PAF = 9.6; 95% CI = 8.4, 10.7), mothers lacking formal education (PAF = 7.9; 95% CI = 7.0, 8.9), infrequent ANC visits (PAF = 4.0; 95% CI = 3.3, 4.7), and poor toilet facilities (PAF = 3.4; 95% CI = 2.6, 4.3) were attributed to 40.8% (95% CI = 36.4, 45.2) of under-five deaths.ConclusionsGiven the current global economic climate, policymakers should prioritise these modifiable risk factors. Key recommendations include ensuring that women enter pregnancy in optimal health, prioritising the presence of skilled newborn attendants for timely and proper breastfeeding initiation, and enhancing home-based care during the postnatal period and beyond.

Low-and middle-income countries face a double burden of malnutrition. However, comprehensive, population-based nutritional assessments are rare, particularly across all age groups. This study aimed to assess the prevalence of malnutrition across different age groups in Addis Ababa Health and Demographic Surveillance Site (Addis-HDSS), Addis Ababa, Ethiopia. A community-based cross-sectional survey was conducted from December 2022 to January 2023 in Addis Ababa, involving residents of the Addis-HDSS sites. Mid-upper arm circumference (MUAC) was used to assess nutritional status for individuals aged 6 months to 64 years. Descriptive statistics were analyzed using STATA version 14, employing previously published age-specific cutoff points to define underweight, overweight, and obesity. A total of 37,364 individuals aged 6 months to 64 years participated. Among children aged 6-59 months, 4.2% had moderate acute malnutrition (95% CI: 3.7-4.9), and 3.0% had severe acute malnutrition (95% CI: 2.5-3.6). Overweight prevalence was 22.3% (95% CI: 20.3-24.3) in children aged 5-9 years, 25.9% (95% CI: 23.4-28.5) in adolescents aged 10-14 years, and 12.7% (95% CI: 11.5-14.0) in late adolescents aged 15-19 years. Among adults aged 20-64 years, 6.3% were underweight (95% CI: 6.0-6.6), 19.3% overweight (95% CI: 18.8-19.7%), and 21.5% obese (95% CI: 21.0-22.0). This study highlights a double burden of malnutrition in Addis Ababa, with overweight and obesity more prevalent than underweight, especially in adolescents and adults. It underscores the need for interventions targeting both undernutrition and overnutrition, emphasizing better diets and physical activity to curb nutrition-related diseases.

Contraceptives are essential for protecting women's sexual and reproductive health, as well as for reducing maternal and infant morbidity and mortality. This study aimed to identify socioeconomic factors associated with contraceptive use among married women of childbearing age in Ethiopia. We analysed cross-sectional data from 15,499 married women aged 18-49 years, collected as part of the Urban Health and Demographic Surveillance System (HDSS) in Addis Ababa. Trained interviewers conducted face-to-face interviews using structured, pre-tested questionnaires. Bivariable and multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) with 95% confidence intervals (CIs) to assess associations between socioeconomic factors and contraceptive use. The overall prevalence of contraceptive use among married women was 53.5% (95% CI: 52.7-54.4%). Women with larger family sizes (>6) (AOR: 2.1; 95% CI: 1.5-2.8), excellent self-reported health (AOR: 1.6; 95% CI: 1.3-1.9), and those in households with adequate income to meet basic needs (AOR: 1.29; 95% CI: 1.11-1.48) were more likely to use contraceptives. Women over 40 years old (AOR: 0.21; 95% CI: 0.18-0.25) and those living in female-headed households (AOR: 0.68; 95% CI: 0.61-0.76) had lower odds of using contraception. About half of urban married women of reproductive age reported using contraceptives. Factors associated with higher contraceptive use included better self-reported health and larger family sizes. Further research is needed to understand the complex dynamics of contraceptive use in low-income urban settings.

Accurate population-based data is essential for evidence-based public health decision-making. Monitoring health events and evaluating interventions through a population-based platform enables timely decisions in rapidly growing urban areas. Such platforms are rare in African countries. This paper outlines the procedures for establishing the Addis Health and Demographic Surveillance System (Addis-HDSS). The Addis-HDSS, located in Yeka sub-city of Addis Ababa, Ethiopia, conducted its first census from December 3, 2022, to January 18, 2023. Each enumeration area was identified and mapped digitally. All households in the study area were visited and geocoded. The baseline census gathered data on sociodemographic status, housing conditions, economic status, and selected health-related factors. A total of 30,533 households and a population of 107,494 were recorded. The response rate was 99.1%, reflecting high community engagement The average household size was 3.5, and the sex ratio was 81 males to 100 females. The population structure resembled a typical low-income country profile. Establishing an urban HDSS was feasible with reasonable effort due to the presence of a digital map and the willingness of the urban population. This surveillance system will be an asset to generate reliable urban health and demographic information by providing an unbiased sampling frame for health-related studies. The HDSS will also be used to test the effectiveness of population-based public health interventions.

Timely and safe blood transfusion services are crucial for saving lives in emergencies. Previous studies have focused on hospital inpatient care access but have overlooked blood transfusion service readiness. This study examined the readiness of blood transfusion services in health facilities across Ethiopia and its determinants. This study used Service Availability and Readiness Assessment (SARA) 2018 data from 632 facilities. Readiness was measured based on seven components: the presence of at least one trained staff for appropriate use of blood and safe transfusion; guidelines for appropriate use and transfusion; blood storage refrigerator; blood typing; cross-match typing; blood supply safety; and blood supply sufficiency. Data were analyzed using descriptive and inferential statistics. Facility characteristics were summarized using frequency tables and summary statistics. Bivariate and multivariable linear regression analyses examined the predictors of service readiness. Facilities offering blood transfusion services had a mean readiness score of 4.5 (out of 7), with only 5% having all items. Most facilities performed blood typing, but less than one-third conducted cross-match testing, and over half lacked guidelines and trained staff. Service readiness varied significantly across regions. Facilities in Oromia (Coef.: -0.74; 95% CI: [-1.32, -0.15]) and Somali (Coef.: -1.26; 95% CI: [-2.21, -0.31]) had lower readiness scores compared to Addis Ababa. Increased availability of medical equipment corresponded to a 49% increase in readiness scores (Coef.: 0.49; 95% CI: [0.19, 0.79]). The study highlights deficiencies in blood transfusion service readiness and regional disparities, emphasizing the need for targeted support to enhance readiness across regions.

Human monkeypox virus infection (mpox) is a reemerging viral zoonotic disease that has been occurring outside of locations where it has been endemic in Africa. To understand the shifting epidemiology of this disease and respond accordingly, increased clinical skill and professional capabilities are essential. However, there are no studies assessing the knowledge of healthcare professionals in Ethiopia on mpox. Hence, this paper aimed to assess knowledge of the infection and associated factors among healthcare providers in Addis Ababa, Ethiopia, specifically knowledge of diagnosis and treatment of mpox, from November 14, 2022 to November 25, 2022. A facility-based cross-sectional study design was used. Knowledge was assessed using a structured questionnaire, and a 70% Bloom's cutoff point was used to classify the scores. A pretest was conducted in a similar setting before data collection. Frequencies, percentages, and bivariate and multivariate logistic regression analyses were used. The majority of participants, 128 (64.6% with 95% CI), scored below 70% on knowledge questions. Professionals with experience of 5 years or less had better knowledge than those who had worked longer (adjusted odds ratio: 0.301; 95% CI: 0.149-0.609; P = 0.000). Knowledge of mpox among healthcare providers in Addis Ababa was poor across sociodemographic and professional variables. Thus, education on mpox among healthcare providers in Ethiopia is critical in preparing the workforce and limiting potential damage to the country.