Exclusive breastfeeding practice in Ethiopia and its association with antenatal care and institutional delivery: a systematic review and meta-analysis

Abstract Background Despite the World Health Organization recommendation of exclusive breastfeeding (EBF) for the first six months of life, the rate remains low both in developed and developing countries. In Ethiopia, findings regarding the prevalence of EBF have been highly variable. Antenatal care and institutional delivery are the most important factors contributing to the practice of EBF however; their effect has not been investigated in Ethiopia. Methods In this systematic review and meta-analysis, international databases were systematically searched. All observational studies reporting the prevalence of EBF and its association with antenatal care and institutional delivery in Ethiopia were considered. Two authors independently extracted all necessary data using a standardized data extraction format. A random effects meta-analysis model was computed to estimate the pooled prevalence of exclusive breastfeeding. Moreover, the association of antenatal care and institutional delivery with EBF was determined. Results After reviewing 619 studies, 32 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of EBF in Ethiopia was 59.3% (95% Confidence Interval [CI] 53.8, 64.8). The subgroup analysis indicated that the highest prevalence was observed in Afar region (65.6%), followed by SNNP (63.8%), and then by Oromia (61.8%). Additionally, mothers who attended antenatal visits were 2.1 times more likely to practice EBF compared to their counterparts (Odds Ratio [OR] 2.1; 95% CI 1.5, 2.8). Moreover, mothers who gave birth at a health institution were 2.2 times more likely to practice EBF compared to mothers who gave birth at home (OR 2.2; 95% CI 1.3, 3.5). Conclusions Exclusive breastfeeding in Ethiopia was significantly lower than the global recommendations. There was evidence that mothers who attended antenatal visits and who gave birth at health institutions had better EBF practices. Based on our findings, we strongly recommended that the utilization of antenatal care and institutional delivery should be improved through health extension workers

Nearly one in every six HIV-infected children lost from ART follow-up at Debre Markos Referral Hospital, Northwest Ethiopia: A 14-year retrospective follow-up study.

BackgroundAlthough antiretroviral therapy (ART) significantly improves the survival status and quality of life among human immunodeficiency virus (HIV)-infected children, loss to follow-up (LTFU) from HIV-care profoundly affecting the treatment outcomes of this vulnerable population. For better interventions, up-to-date information concerning LTFU among HIV-infected children on ART is vital. However, only a few studies have been conducted in Ethiopia to address this concern. Thus, this study aims to identify the predictors of LTFU among HIV-infected children receiving ART at Debre Markos Referral Hospital.MethodsAn institution-based retrospective follow-up study was done among 408 HIV-infected children receiving ART at Debre Markos Referral Hospital between 2005 and March 15, 2019. Data were abstracted from the medical records of HIV-infected children using a standardized data abstracted checklist. We used Epi-Data Version 3.1 for data entry and Stata Version 14 for statistical analysis. The Kaplan-Meier survival curve was used to estimate the survival time. A generalized log-rank test was used to compare the survival curves of different categorical variables. Finally, both bi-variable and multivariable Cox proportional hazard regression models were used to identify the predictors of LTFU.ResultsOf 408 HIV-infected children included in the final analysis, 70 (17.1%) children were LTFU at the end of the study. The overall incidence rate of LTFU among HIV-infected children was found to be 4.5 (95%CI: 3.5-5.7) per 100-child years of observation. HIV-infected children living in rural areas (AHR: 3.2, 95%CI: 2.0-5.3), having fair or poor ART drug adherence (AHR: 2.3, 95%CI: 1.4-3.7), children started ART through test and treat approach (AHR: 2.7, 95%CI: 1.4-5.5), and children started protease inhibiter (PI)-based ART regimens (AHR: 2.2, 95%CI: 1.1-4.4) were at higher risk of LTFU.ConclusionThis study found that one in every six HIV-infected children lost form ART follow-up. HIV-infected children living in rural areas, having fair or poor ART drug adherence, started ART based on test and treat approach, and taking PI-based ART regimens were at higher risk of LTFU

Subgroup prevalence of diarrhea among under-five children in Ethiopia, 2017 (n = 31).

<p>Subgroup prevalence of diarrhea among under-five children in Ethiopia, 2017 (n = 31).</p

Related factors with heterogeneity of diarrheal prevalence among under-five children in the current meta-analysis (based on univariate meta-regression).

<p>Related factors with heterogeneity of diarrheal prevalence among under-five children in the current meta-analysis (based on univariate meta-regression).</p

Flow chart of study selection for systematic review and meta-analysis of the prevalence and determinants of diarrhea among under-five children in Ethiopia.

<p>Flow chart of study selection for systematic review and meta-analysis of the prevalence and determinants of diarrhea among under-five children in Ethiopia.</p

The pooled odds ratio of the association between maternal education and childhood diarrhea in Ethiopia.

<p>The pooled odds ratio of the association between maternal education and childhood diarrhea in Ethiopia.</p

The pooled odds ratio of the association between maternal hand washing practices and childhood diarrhea in Ethiopia.

<p>The pooled odds ratio of the association between maternal hand washing practices and childhood diarrhea in Ethiopia.</p

Forest plot of the pooled prevalence of diarrhea among under-five children in Ethiopia.

<p>Forest plot of the pooled prevalence of diarrhea among under-five children in Ethiopia.</p

The pooled odds ratio of the association between residence and childhood diarrhea in Ethiopia.

<p>The pooled odds ratio of the association between residence and childhood diarrhea in Ethiopia.</p

The pooled odds ratio of the association between latrine availability and childhood diarrhea in Ethiopia.

<p>The pooled odds ratio of the association between latrine availability and childhood diarrhea in Ethiopia.</p