Table_3_The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundAlthough surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia.MethodsWe searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out.ResultsTwenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96–16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15–3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24–2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45–6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22–2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54–4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93–5.92) were independent risk factors for surgical site infections.ConclusionMore than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.</p

Table_2_COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundThe COVID-19 mortality rate continues to be high in low-income countries like Ethiopia as the new variant’s transmission expands and the countries’ limited capacity to combat the disease causes severe outcomes, including deaths. The aim of this study is to determine the magnitude of the COVID-19 mortality rate and its determinants in Ethiopia.MethodsThe main electronic databases searched were PubMed, CINAHL, Google Scholar, and African journals online. The included studies’ qualities were assessed independently using the Newcastle-Ottawa scale. The data was extracted in Microsoft Excel spreadsheet format. The pooled effect size and odds ratios with 95% confidence intervals across studies were determined using the random-effects model. I2 is used to estimate the percentage of overall variation across studies due to heterogeneity. Egger’s test and funnel plot were used to find the published bias. A subgroup analysis was conducted. The effect of a single study on the overall estimation was determined by sensitivity analysis.ResultsA total of 21 studies with 42,307 study participants were included in the final analysis. The pooled prevalence of COVID-19 mortality was 14.44% (95% CI: 10.35–19.08%), with high significant heterogeneity (I2 = 98.92%, p ConclusionA significant number of COVID-19 patients died in Ethiopia. COVID-19 patients with comorbidities, particularly those with cardiovascular disease, should receive special attention to reduce COVID-19 mortality.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, registration identifier (ID) CRD42020165740.</p

Table_4_The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundAlthough surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia.MethodsWe searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out.ResultsTwenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96–16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15–3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24–2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45–6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22–2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54–4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93–5.92) were independent risk factors for surgical site infections.ConclusionMore than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.</p

Table_1_The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundAlthough surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia.MethodsWe searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out.ResultsTwenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96–16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15–3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24–2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45–6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22–2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54–4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93–5.92) were independent risk factors for surgical site infections.ConclusionMore than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.</p

Table_3_COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundThe COVID-19 mortality rate continues to be high in low-income countries like Ethiopia as the new variant’s transmission expands and the countries’ limited capacity to combat the disease causes severe outcomes, including deaths. The aim of this study is to determine the magnitude of the COVID-19 mortality rate and its determinants in Ethiopia.MethodsThe main electronic databases searched were PubMed, CINAHL, Google Scholar, and African journals online. The included studies’ qualities were assessed independently using the Newcastle-Ottawa scale. The data was extracted in Microsoft Excel spreadsheet format. The pooled effect size and odds ratios with 95% confidence intervals across studies were determined using the random-effects model. I2 is used to estimate the percentage of overall variation across studies due to heterogeneity. Egger’s test and funnel plot were used to find the published bias. A subgroup analysis was conducted. The effect of a single study on the overall estimation was determined by sensitivity analysis.ResultsA total of 21 studies with 42,307 study participants were included in the final analysis. The pooled prevalence of COVID-19 mortality was 14.44% (95% CI: 10.35–19.08%), with high significant heterogeneity (I2 = 98.92%, p ConclusionA significant number of COVID-19 patients died in Ethiopia. COVID-19 patients with comorbidities, particularly those with cardiovascular disease, should receive special attention to reduce COVID-19 mortality.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, registration identifier (ID) CRD42020165740.</p

Table_2_The incidence of surgical site infection and its predictors among women delivered via cesarean sections in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundAlthough surgical wound infection remains a serious issue worldwide, the disease burden is greater in developing countries, including Ethiopia. Even though there were primary studies conducted at district levels in Ethiopia, there is little evidence about the pooled incidence of surgical site infections at the national level. Thus, this systematic review and meta-analysis determined the pooled incidence of surgical site infection and its associated factors among cesarean-delivered women in Ethiopia.MethodsWe searched PubMed, CINAHL, African Journals Online, Google Scholar, and higher educational institutional repositories. A random-effects model was used to estimate the pooled effect size with 95% confidence intervals (CIs). Funnel plot and egger tests were computed to determine the existence of publication bias. A subgroup analysis was carried out.ResultsTwenty-three studies were included in the final analysis. The pooled incidence of surgical site infection among women delivered via cesarean section was 12.32% (95% CI: 8.96–16.11%). Rural residence (AOR = 2.51, 95% CI: 1.15–3.87), membrane rupture (AOR = 2.04, 95% CI: 1.24–2.85), chorioammionitis (AOR = 4.13, 95% CI: 1.45–6.8), general anesthesia (AOR = 1.99, 95% CI: 1.22–2.75), post-operative Hgb level less than 11 mg/dL (AOR = 3.25, 95% CI: 1.54–4.96) and membrane rupture greater or equal to 12 h (AOR = 3.93, 95% CI: 1.93–5.92) were independent risk factors for surgical site infections.ConclusionMore than one in 10 women delivered via cesarean section developed surgical site infections in Ethiopia. Women living in rural areas and those with a membrane rupture, chorioammionitis, or anemia should be given special attention. General anesthesia should not be a mandatory procedure.</p

Table_4_COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis.DOCX

BackgroundThe COVID-19 mortality rate continues to be high in low-income countries like Ethiopia as the new variant’s transmission expands and the countries’ limited capacity to combat the disease causes severe outcomes, including deaths. The aim of this study is to determine the magnitude of the COVID-19 mortality rate and its determinants in Ethiopia.MethodsThe main electronic databases searched were PubMed, CINAHL, Google Scholar, and African journals online. The included studies’ qualities were assessed independently using the Newcastle-Ottawa scale. The data was extracted in Microsoft Excel spreadsheet format. The pooled effect size and odds ratios with 95% confidence intervals across studies were determined using the random-effects model. I2 is used to estimate the percentage of overall variation across studies due to heterogeneity. Egger’s test and funnel plot were used to find the published bias. A subgroup analysis was conducted. The effect of a single study on the overall estimation was determined by sensitivity analysis.ResultsA total of 21 studies with 42,307 study participants were included in the final analysis. The pooled prevalence of COVID-19 mortality was 14.44% (95% CI: 10.35–19.08%), with high significant heterogeneity (I2 = 98.92%, p ConclusionA significant number of COVID-19 patients died in Ethiopia. COVID-19 patients with comorbidities, particularly those with cardiovascular disease, should receive special attention to reduce COVID-19 mortality.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, registration identifier (ID) CRD42020165740.</p

Table_1_COVID-19 mortality rate and its determinants in Ethiopia: a systematic review and meta-analysis.docx

BackgroundThe COVID-19 mortality rate continues to be high in low-income countries like Ethiopia as the new variant’s transmission expands and the countries’ limited capacity to combat the disease causes severe outcomes, including deaths. The aim of this study is to determine the magnitude of the COVID-19 mortality rate and its determinants in Ethiopia.MethodsThe main electronic databases searched were PubMed, CINAHL, Google Scholar, and African journals online. The included studies’ qualities were assessed independently using the Newcastle-Ottawa scale. The data was extracted in Microsoft Excel spreadsheet format. The pooled effect size and odds ratios with 95% confidence intervals across studies were determined using the random-effects model. I2 is used to estimate the percentage of overall variation across studies due to heterogeneity. Egger’s test and funnel plot were used to find the published bias. A subgroup analysis was conducted. The effect of a single study on the overall estimation was determined by sensitivity analysis.ResultsA total of 21 studies with 42,307 study participants were included in the final analysis. The pooled prevalence of COVID-19 mortality was 14.44% (95% CI: 10.35–19.08%), with high significant heterogeneity (I2 = 98.92%, p ConclusionA significant number of COVID-19 patients died in Ethiopia. COVID-19 patients with comorbidities, particularly those with cardiovascular disease, should receive special attention to reduce COVID-19 mortality.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, registration identifier (ID) CRD42020165740.</p

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

Background: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. Funding: Bill & Melinda Gates Foundation

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017

Background: Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods: We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings: The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation: By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. Funding: Bill & Melinda Gates Foundation