Determinants of fertility in Ethiopia

Background: The most important elements to determine the rate of population growth is fertility. Fertility is the main element to affect the welfare of mother. The survival of a child can be affected by high fertility and shorter birth intervals. Methods: For this study, the linear mixed model was used to determine factors affecting fertility status of women in Ethiopia. The 2011 Ethiopian demographic and health survey data was used for this study. Results: From the result, materials used for roof, wall and floor were found to have a significant relation to fertility level of women in the last five years. Moreover, family size and births in the last five years were found to have a significant relationship. Conclusion: Significant variation in fertility level was observed among rural and urban residents of Ethiopia. To reduce the gap of fertility between rural and urban population, it is important to modernize different factors. These factors could be access to education, media, and providing employment opportunities in the modern economic sector. Besides this, it is important to develop and maintain the access of family planning services

Longitudinal analysis of the effect of climatic factors on the wood anatomy of two eucalypt clones

Eucalypt trees are one of tree species used for the manufacturing of papers in South Africa. The manufacturing of paper consists of cooking the wood with chemicals until obtaining a pulp. The wood is made of different cells. The shape and structure of these cells, called wood anatomical characteristics are important for the quality of paper. In addition, the anatomical characteristics of wood are influenced by environmental factors like climatic factors, soil compositions etc…. In this study we investigated the effects of the climatic factors (temperature, rainfall, solar radiation, relative humidity, and wind speed) on wood anatomical characteristics of two Eucalyptus clones, a GC (Eucalyptus grandis × camuldulensis) and a GU (Eucalyptus grandis × urophylla). Nine trees per clone have been selected. Two sets of data have been collected for this study. The first set of data was eleven anatomical characteristics of the wood formed daily over a period of five years. The second set of data was the daily measurement of temperature, rainfall, solar radiation, relative humidity and wind speed in the experimental area. Wood is made of two kinds of cell, the fibres and the vessels. The fibres are used for the strength and support of the tree and the vessels for the nutrition. Eleven characteristics related to those cells have been measured (diameter, wall thickness, frequency). These characteristics are highly correlated. To reduce the number of response variables, the principal component analysis was used and the first four principal components accounts for about 95% of the total variation. Based on the weights associated with each component the first four principal components were labelled as vessel dimension (VD), fibre dimension (FD), fibre wall (FW) and vessel frequency (VF). The longitudinal linear mixed model with age, season, temperature, rainfall, solar radiation, relative humidity and wind speed as the fixed effects factors and tree as random effect factor was fitted to the data. From time series modelling result, lagged order of climatic variables were identified and these lagged climatic variables were included in the model. To account for the physical characteristic of the trees we included the effect of diameter at breast height, stem radius, daily radial increment, and the suppression or dominance of the tree in the model. It was found that wood anatomical characteristics of the two clones were more affected by climatic variables when the tree was on juvenile stage as compared to mature stage.Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2010. School of Statistics and Actuarial Science

Use of statistical modelling and analyses of malaria rapid diagnostic test outcome in Ethiopia.

Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.The transmission of malaria is among the leading public health problems in Ethiopia. From the total area of Ethiopia, more than 75% is malarious. Identifying the infectiousness of malaria by socio-economic, demographic and geographic risk factors based on the malaria rapid diagnosis test (RDT) survey results has several advantages for planning, monitoring and controlling, and eventual malaria eradication effort. Such a study requires thorough understanding of the diseases process and associated factors. However such studies are limited. Therefore, the aim of this study was to use different statistical tools suitable to identify socioeconomic, demographic and geographic risk factors of malaria based on the malaria rapid diagnosis test (RDT) survey results in Ethiopia. A total of 224 clusters of about 25 households were selected from the Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia. Accordingly, a number of binary response statistical analysis models were used. Multiple correspondence analysis was carried out to identify the association among socioeconomic, demographic and geographic factors. Moreover a number of binary response models such as survey logistic, GLMM, GLMM with spatial correlation, joint models and semi-parametric models were applied. To test and investigate how well the observed malaria RDT result, use of mosquito nets and use of indoor residual spray data fit the expectations of the model, Rasch model was used. The fitted models have their own strengths and weaknesses. Application of these models was carried out by analysing data on malaria RDT result. The data used in this study, which was conducted from December 2006 to January 2007 by The Carter Center, is from baseline malaria indicator survey in Amhara, Oromiya and Southern Nation Nationalities and People (SNNP) regions of Ethiopia. The correspondence analysis and survey logistic regression model was used to identify predictors which affect malaria RDT results. The effect of identified socioeconomic, demographic and geographic factors were subsequently explored by fitting a generalized linear mixed model (GLMM), i.e., to assess the covariance structures of the random components (to assess the association structure of the data). To examine whether the data displayed any spatial autocorrelation, i.e., whether surveys that are near in space have malaria prevalence or incidence that is similar to the surveys that are far apart, spatial statistics analysis was performed. This was done by introducing spatial autocorrelation structure in GLMM. Moreover, the customary two variables joint modelling approach was extended to three variables joint effect by exploring the joint effect of malaria RDT result, use of mosquito nets and indoor residual spray in the last twelve months. Assessing the association between these outcomes was also of interest. Furthermore, the relationships between the response and some confounding covariates may have unknown functional form. This led to proposing the use of semiparametric additive models which are less restrictive in their specification. Therefore, generalized additive mixed models were used to model the effect of age, family size, number of rooms per person, number of nets per person, altitude and number of months the room sprayed nonparametrically. The result from the study suggests that with the correct use of mosquito nets, indoor residual spraying and other preventative measures, coupled with factors such as the number of rooms in a house, are associated with a decrease in the incidence of malaria as determined by the RDT. However, the study also suggests that the poor are less likely to use these preventative measures to effectively counteract the spread of malaria. In order to determine whether or not the limited number of respondents had undue influence on the malaria RDT result, a Rasch model was used. The result shows that none of the responses had such influences. Therefore, application of the Rasch model has supported the viability of the total sixteen (socio-economic, demographic and geographic) items for measuring malaria RDT result, use of indoor residual spray and use of mosquito nets. From the analysis it can be seen that the scale shows high reliability. Hence, the result from Rasch model supports the analysis carried out in previous models

Factors affecting child malnutrition in Ethiopia

Background: One of the public health problems in developing countries is child malnutrition. An important factor for children’s well-being is good nutrition. Therefore, the malnutrition status of children under the age of five is an important outcome measure for children’s health. This study uses the proportional odds model to identify risk factors associated with child malnutrition in Ethiopia using the 2016 Ethiopian Demographic and Health Survey data.Methods: This study uses the 2016 Ethiopian Demographic and Health Survey results. Based on weight-for-height anthropometric index (Z-score) child nutrition status is categorized into four levels namely- underweight, normal, overweight and obese. Since this leads to an ordinal variable for nutrition status, an ordinal logistic regression (OLR)proportional odds model (POM) is an obvious choice for analysis.Results: The findings and comparison of results using the cumulative logit model with and without complex survey design are presented. The study results revealed that to produce the appropriate estimates and standard errors for data that were obtained from complex survey design, model fitting based on taking the survey sampling design into account is better. It has also been found that for children under the age of five, weight of a child at birth, mother’s age, mother’s Body Mass Index (BMI), marital status of mother and region (Affar, Dire Dawa, Gambela, Harari and Somali) were influential variables significantly associated with underfive children’s nutritional status in Ethiopia.Conclusion: This child’s age of a child, sex, weight of child at birth, mother’s BMI and region of residence were significant determinants of malnutrition of children under five years in Ethiopia. The effect of these determinants can be used to develop strategies for reducing child malnutrition in Ethiopia. Moreover, these findings show that OLR proportional odds model is appropriate assessing thedeterminants of malnutrition for ordinal nutritional status of underfive children in Ethiopia.Keywords: BMI, Ethiopian Demographic and Health Survey (EDHS), malnutrition, proportional odds model

Factors affecting child malnutrition in Ethiopia

Background: One of the public health problems in developing countries is child malnutrition. An important factor for children\u2019s well-being is good nutrition. Therefore, the malnutrition status of children under the age of five is an important outcome measure for children\u2019s health. This study uses the proportional odds model to identify risk factors associated with child malnutrition in Ethiopia using the 2016 Ethiopian Demographic and Health Survey data. Methods: This study uses the 2016 Ethiopian Demographic and Health Survey results. Based on weight-for-height anthropometric index (Z-score) child nutrition status is categorized into four levels namely- underweight, normal, overweight and obese. Since this leads to an ordinal variable for nutrition status, an ordinal logistic regression (OLR)proportional odds model (POM) is an obvious choice for analysis. Results: The findings and comparison of results using the cumulative logit model with and without complex survey design are presented. The study results revealed that to produce the appropriate estimates and standard errors for data that were obtained from complex survey design, model fitting based on taking the survey sampling design into account is better. It has also been found that for children under the age of five, weight of a child at birth, mother\u2019s age, mother\u2019s Body Mass Index (BMI), marital status of mother and region (Affar, Dire Dawa, Gambela, Harari and Somali) were influential variables significantly associated with underfive children\u2019s nutritional status in Ethiopia. Conclusion: This child\u2019s age of a child, sex, weight of child at birth, mother\u2019s BMI and region of residence were significant determinants of malnutrition of children under five years in Ethiopia. The effect of these determinants can be used to develop strategies for reducing child malnutrition in Ethiopia. Moreover, these findings show that OLR proportional odds model is appropriate assessing thedeterminants of malnutrition for ordinal nutritional status of underfive children in Ethiopia. DOI: https://dx.doi.org/10.4314/ahs.v19i2.13 Cite as: Yirga AA, Mwambi HG, Ayele DG, Melesse SF. Factors affecting child malnutrition in Ethiopia. Afri Health Sci.2019;19(2): 1897-1909. https://dx.doi.org/10.4314/ahs.v19i2.1

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Determinants of Under-Five Children Body Mass Index in Sudan; Application of Quantile Regression: A Systematic Review

Background: One of the health challenges in Sub-Saharan countries is child malnutrition. Body Mass Index (BMI) can be defined as a measure of nutritional status. Examining the determinants of under-five children’s BMI is a significant subject that needs to be studied. For this study, quantile regression was used to identify the determinants of under-five children's BMI in Sudan. Methods: We used the 2014 Sudan Multiple Indicator Cluster Survey (MICS) conducted by the Central Bureau of Statistics. Quantile regression was used. Results: Place of residence, state, mother’s educational level, gender, age of the child, and wealth index were an important effect significantly affecting under-five children’s BMI at different quantile levels. Conclusion: Taking measures on the nutritional status of mothers will accordingly resolve the nutritional status of their children. Therefore, the focus of policymakers should be on the influential significant factors which were found across all quantile levels to plan and develop strategies to enhance the normal or healthy weight status of under-five children in Sudan

Sorghum production systems and constraints, and coping strategies under drought-prone agro-ecologies of Ethiopia

Sorghum is one of the most important cereal crops worldwide after wheat, rice, maize and barley. Examining the present socio-economic conditions of sorghum-producing farmers in different agro-ecologies in Ethiopia is of importance for the design of improvement strategies. The objectives of this study were to evaluate the sorghum production system and patterns, major production constraints and related coping strategies in north-eastern Ethiopia. Twelve sorghum-growing villages in the North Welo, South Welo and Waghemra districts were surveyed. Descriptive statistics and a generalised additive model were used for data analysis. Constraints affecting the productivity of sorghum include moisture stress, insect pests, striga, farmland shortage, poor soil fertility, diseases, and low-yielding local cultivars. Among the constraints, drought at the grain-filling stage was identified as the most important production problem in the target region. The productivity of sorghum was also hindered by the use of local drought-tolerant but low-yielding landraces, because farmers had been forced to abandon high-yielding and late-maturing landrace cultivars because of the frequent occurrence of drought. To enhance sorghum productivity, farmers’ knowledge and practices, and production constraints need to be integrated from the initial stages of breeding and technology development.Keywords: generalised additive model, moisture stress, participatory rural appraisal, production constraint, sorghu

Active management of the third stage of labour in Ethiopia: A systematic review and meta-analysis.

BackgroundPost-partum haemorrhage occurs in over 10% of all births and is the leading cause of maternal mortality, accounting for 25% of all maternal deaths worldwide. Active management of the third stage of labor is the most important intervention for reducing maternal morbidity and mortality by preventing postpartum hemorrhage. Previously, documented primary studies had been great discrepancy, inconsistent results, and there is a lack of comprehensive study. Hence, this systematic review and meta-analysis were intended to assess the prevalence and associated factors of the practice of active management of the third stage of labour among obstetric care providers in Ethiopia.MethodCross-sectional studies were systematically searched from January 01, 2010, to December 24, 2020, using PubMed, Google Scholar, HINARI, Cochrane Library, and grey literature. The pooled prevalence of active management of the third stage of labour practice and associated factors was estimated using DerSemonial-Laird Random Effect Model. Stata (version 16.0) was used to analyze the data. The I-squared statistic was used to assess the studies' heterogeneity. A funnel plot and Egger's test were used to check for publication bias. A subgroup analysis was performed to minimize the underline heterogeneity depending on the study years and the sample sizes.ResultsSeven hundred fifty articles were extracted. The final ten studies were included in this systematic review, including 2438 participants. The pooled prevalence of practices of active management of the third stage of labour among obstetric care providers in Ethiopia was 39.65% (30.86, 48.45%). Educational status (OR = 6.11, 95%CI, 1.51-10.72), obstetric care training (OR = 3.56, 95% CI: 2.66, 4.45), work experience (OR = 2.17, 95%CI, 0.47, 3.87) and knowledge of active management of the third stage of labour (OR = 4.5, 95% CI: 2.71, 6.28) were significantly associated with active management of the third stage of labour practices.ConclusionThe practice of active management of the third stage of labour in Ethiopia was low. This study showed that educational status, taking obstetric care training, knowledge of AMTSL, and work experience of obstetric care providers were associated with of practices of active management of the third stage of labour. Therefore, obstetric care professionals should improve their academic level, knowledge, and skills in order to provide useful service to AMTSL and save mothers' lives. All obstetric care providers should get obstetric care training. Furthermore, the government should increase obstetric care professionals' educational level