Background: Neonatal mortality remains a significant public health challenge in Ethiopia. Despite efforts to implement key evidence-based interventions, their coverage and utilization remain low. The Saving Little Lives (SLL) program aims to scale-up a Minimum Care Package (MCP) of synergistic, life-saving interventions for all liveborn neonates, with a focus on preterm and low birth weight (LBW) infants, across 290 hospitals in Ethiopia (206 primary, 69 general, and 15 referral hospitals), representing 82% of all hospitals in the country at the time of the study, and evaluate the impact on neonatal mortality. Methods: A non-randomized stepped-wedge trial will be conducted to evaluate the impact of implementing the SLL MCP interventions. Quantitative evaluation data will be collected from 36 primary hospitals, selected from 206 primary hospitals across four regions, receiving the interventions. An independent evaluation research assistant will be deployed in each of the hospitals to collect data using Open Data Kit (ODK) through interviewing mothers before discharge, on the 29th day of life if discharged, and reviewing medical records. A mixed-method, cross-sectional formative assessment will be conducted prior to implementation, employing quantitative facility assessment and qualitative interviews with mothers, healthcare providers, and facility managers. This will be followed by continuous program learning assessment once implementation begins. Descriptive data will be presented using numbers, percentages, tables, and graphs. Regression modeling and generalized estimating equations (GEEs) will be used to estimate the impact of the SLL MCP interventions. Qualitative data will be gathered through in-depth interviews, digitally recorded, transcribed, and thematically analyzed using ATLAS.ti Version 7.5 software to assess facility readiness, barriers, and enablers of implementing the SLL MCP interventions. Expected Outcome: We hypothesize that achieving 80% coverage of the SLL MCP interventions among eligible neonates will result in a 35% reduction in neonatal mortality at implementation facilities.

BACKGROUND:Premature birth is the leading cause of neonatal morbidity and mortality. Understanding perceptions, beliefs and attitudes towards preterm births, and how these factors influence care provision at health facilities and at home is crucial for improving preterm newborns' health outcomes. METHODS:We conducted an exploratory qualitative study at Batu and Meki communities in the East Shewa Zone of Oromia Region, Ethiopia. We conducted in-depth interviews (n=81) and focus group discussions (n=8) using semistructured guides. The study participants included women who had preterm births, family members, community members, healthcare workers and expert stakeholders. We audio-recorded, transcribed the interviews and coded the transcripts. We employed the socioecological model to present perceptions, beliefs and attitudes towards preterm birth at individual, interpersonal, organisational and societal levels. FINDINGS:Giving birth to a preterm newborn is often associated with fear, stress, unhappiness, concern and worry. At the individual level, preterm newborns' mothers often feel guilt and self-blame. Families tend to keep preterm birth a secret due to perceptions of 'incompleteness'. At the interpersonal level, preterm newborns are often stigmatised and families are disappointed by mothers who give birth prematurely. However, some believe that preterm newborns are accepted within the community. At the organisational level, healthcare providers find the causes of preterm birth unpredictable, they do not consider preterm births prevalent, and consider some of them as abortion. There is also a common belief that preterm infants have a low survival rate, leading to the deprioritisation of their care. At the societal level, some believe preterm births are caused by divine will as punishment for sins committed by the mother, while others think they occur naturally. Preterm newborn's death is often not acknowledged as true loss and families are discouraged from grieving. CONCLUSIONS:Our study found that the beliefs, perceptions and attitudes surrounding preterm birth, held by families, communities, healthcare providers and society at large, influence the care that preterm newborn-mother dyads receive both at home and within health facilities. Addressing these requires a multifaceted approach targeted at deeply ingrained attitudes and perceptions.

Background Synthesizing current evidence on interventions to improve survival outcomes in preterm infants is crucial for informing programs and policies. The objective of this study is to investigate the impact of topical emollient oil application on the weight of preterm infants. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. To identify relevant studies, comprehensive searches were conducted across multiple databases, including PubMed, Cochrane, Scopus, Clinical trials, ProQuest Central, Epistemonikos, and gray literature sources. The inclusion criteria were based on the PICO (Population, Intervention, Comparison, and Outcomes) format. Study quality was assessed using the Cochrane risk of bias tool for randomized trials (RoB 2.0). Data analysis was performed using StataCrop MP V.17 software, which included evaluating heterogeneity, conducting subgroup analysis, sensitivity analysis, and meta-regression. The findings were reported in accordance with the PRISMA checklist, and the review was registered with PROSPERO (CRD42023413770). Results Out of the initial pool of 2734 articles, a total of 18 studies involving 1454 preterm neonates were included in the final analysis. Fourteen of these studies provided data that contributed to the calculation of the pooled difference in mean weight gain in preterm neonates. The random effects meta-analysis revealed a significant pooled difference in mean weight gain of 52.15 grams (95% CI: 45.96, 58.35), albeit with high heterogeneity (I2 > 93.24%, p 0.000). Subgroup analyses were conducted, revealing that preterm infants who received massages three times daily with either sunflower oil or coconut oil exhibited greater mean differences in weight gain. Meta-regression analysis indicated that the type of emollient oil, duration of therapy, and frequency of application significantly contributed to the observed heterogeneity. A sensitivity analysis was performed, excluding two outlier studies, resulting in a pooled mean weight difference of 78.57grams (95% CI: 52.46, 104.68). Among the nine studies that reported adverse events, only two mentioned occurrences of rash and accidental slippage in the intervention groups. Conclusion The available evidence suggests that the application of topical emollient oil in preterm neonates is likely to be effective in promoting weight gain, with a moderate-to-high level of certainty. Based on these findings, it is recommended that local policymakers and health planners prioritize the routine use of emollient oils in newborn care for preterm infants. By incorporating emollient oils into standard care protocols, healthcare providers can provide additional support to promote optimal growth and development in preterm infants.

BACKGROUND:Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. This anomaly continues to cause considerable morbidity and mortality in Sub-Saharan Africa, presenting various concerns about how to treat esophageal atresia. Esophageal atresia-related neonatal mortality can be reduced by evaluating the surgical outcome and identifying associated factors.OBJECTIVE:This study aimed to assess the surgical outcome and identify predictors of neonates with esophageal atresia admitted at Tikur Anbesa specialized hospital.METHODS:Retrospective crossectional study design was employed on 212 neonates with esophageal atresia who were undergone surgical intervention in Tikur Anbesa specialized hospital. Data were entered into epi data 4.6 and exported to Stata version 16 software for further analysis. A logistic regression model with Adjusted odds ratio (AOR), confidence interval (CI) and p-value <0.05 were used to identify predictors of poor surgical outcome of neonates with esophageal atresia.RESULT:In this study, 25% of newborns who underwent surgical intervention at TikurAbnbesa specialized hospital had successful surgical outcomes, compared to 75% of neonates with esophageal atresia who had poor surgical outcomes. Significant predictors of the poor surgical outcome of neonates with esophageal atresia were severe thrombocytopenia (AOR = 2.81(1.07-7.34)), timing of surgery (AOR = 3.7(1.34-10.1), aspiration pneumonia (AOR = 2.93(1.17-7.38)) and related abnormalities (AOR = 2.26(1.06-4.82)).CONCLUSION:The results of this study showed that, when compared to other studies, a substantial percentage of newborn children with esophageal atresia had poor surgical outcomes. Early surgical management, aspiration pneumonia and thrombocytopenia prevention and therapy play a big part in improving the surgical prognosis for newborns with esophageal atresia.

Abstract Background: COVID-19, the disease caused by the new coronavirus SARS-CoV-2 is among the most obscure global pandemics resulting in diverse health and economic disruptions. It adversely affects the routine health care delivery and health service uptake by patients. However, its impact on care-seeking behavior is largely unknown in Ethiopia. Objective: This study was to determine the impact of the pandemic on the care-seeking behavior of patients with chronic health conditions at Tikur Anbessa Specialized Hospital in Addis Ababa. Methods: A cross-sectional hospital-based survey conducted between May and July 2020 on patients whose appointment was between March to June 2020. A sample of 750 patients was approached using phone calls and data collection was done using a pretested questionnaire. After cleaning, the data entered into the IBM SPSS software package for analysis. Results: A total of 644 patients with a median age of 25 years, and an M: F ratio of 1:1.01 was described with a response rate of 86%. A loss to follow-up missed medication and death occurred in 70%, 12%, and 1.3% of the patients respectively. In the multivariable logistic regression analysis, patients above 60 years old were more likely to miss follow-up (OR-23.28 (9.32-58.15), P<001). Patients who reported fear of COVID-19 at the hospital were 19 times more likely to miss follow-up (adjusted OR=19.32, 95% CI:10.73-34.79, P<0.001), while patients who reported transportation problems were 6.5 times more likely to miss follow-up (adjusted OR=6.11, 95% CI:3.06-12.17, P<0.001). Conclusions: COVID-19 pandemic affected the care-seeking behavior of patients with chronic medical conditions adversely and the impact was more pronounced among patients with severe disease, fear of COVID19, and transportation problems. Education on preventive measures of COVID-19, use of phone clinics, and improving chronic illness services at the local health institutions may reduce loss to follow-up among these patients.

Background: Preterm birth is the leading cause of neonatal deaths. Neonatal deaths account for 46% of all under-five deaths. Just over a third of neonatal deaths are a result of preterm-related causes. With the increasing contribution of neonatal deaths to overall child mortality, urgent action is needed to determine the major causes of preterm mortality.Methods: This was a multi-centre prospective observational study in 5 tertiary hospitals in Ethiopia over a period of nearly 2 years to determine the causes of preterm mortality. An independent panel of experts determined the primary and contributory causes of preterm mortality using data on socioeconomic status, maternal/obstetric history, clinical conditions, laboratory investigations and post-mortem examinations (both complete diagnostic autopsy [CDA] and minimally invasive tissue sampling [MITS]).Findings: A total of 4,919 preterm infants were enrolled in the study. Of these 3,852 were admitted to NICU's and of these 1109 died. The main causes of death were RDS (45%), sepsis, pneumonia and meningitis (30%) and asphyxia 14%. Hypothermia was the most common contributory cause of preterm mortality.Interpretation: Three conditions were the primary causes for 89% of all deaths: RDS - 45%, infections - 30 % and asphyxia - 14%. There is a need to scale up interventions against these conditions and in particular those specific to RDS such as continuous positive airway pressure (CPAP), and blended oxygen to contribute to neonatal mortality.Funding Statement: This study was funded by grants from the Bill & Melinda Gates Foundation (OPP1136965). We would like to acknowledge the support we received from the administrative, clinical, nursing, microbiology and pathology technical staff of all study hospitals.Declaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: The study was approved by the Institutional Review Board of each hospital and at the College of Health Sciences of the Addis Ababa University. Written consent for participation in the study was obtained, with a separate written consent for autopsy and MITS, in cases of death. Consent was obtained in English, Amharic and Oromifa languages, as appropriate. Confidentially of the information was maintained.

Background: With nearly 15 million annual preterm births globally, preterm birth is the most common cause of neonatal death. Forty to 60 % of neonatal deaths are directly or indirectly associated with preterm mortality. As countries aim to meet the Sustainable Development Goals to reduce neonatal mortality, significant reductions in preterm mortality are needed. This study aims to identify the common causes of preterm illness and their contribution to preterm mortality in low-resource settings. This article will describe the methods used to undertake the study. Methods: This is a prospective, multi-centre, descriptive clinical study. Socio-demographic, obstetric, and maternal factors, and clinical and laboratory findings will be documented. The major causes of preterm mortality will be identified using clinical, laboratory, imaging, and autopsy methods and use the national Ethiopian guidelines on management of preterm infants including required investigations to reach final diagnoses. The study will document the clinical and management protocols followed in these settings. The approach consists of clinical examinations and monitoring, laboratory investigations, and determination of primary and contributory causes of mortality through both clinical means and by post-mortem examinations. An independent panel of experts will validate the primary and contributory causes of mortality. To obtain the estimated sample size of 5000 preterm births, the study will be undertaken in five hospitals in three regions of Ethiopia, which are geographically distributed across the country. All preterm infants who are either born or transferred to these hospitals will be eligible for the study. Three methods (last menstrual period, physical examination using the New Ballard Score, and ultrasound) will be used to determine gestational age. All clinical procedures will be conducted per hospital protocol and informed consent will be taken from parents or caretakers prior to their participation in the study as well as for autopsy if the infant dies. Discussion: This study will determine the major causes of death and illness among hospitalized preterm infants in a low-resource setting. The result will inform policy makers and implementers of areas that can be prioritized in order to contribute to a significant reduction in neonatal mortality.