IntroductionAddressing neonatal mortality is an important priority for improving the health and well-being of newborns. Almost two-thirds of infant deaths occur in the first month of life; among these, more than two-thirds die in their first week. Therefore, the aim of this study was to assess the mortality rate and predictors of mortality among neonates admitted to the neonatal intensive care unit (NICU) at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia, in 2023.MethodsAn institutional-based retrospective follow-up study was conducted using 459 neonates who were admitted to the NICU at Tikur Anbessa Specialized Hospital from January 2020 to December 2022. The data were extracted from randomly selected charts using a pretested data extraction checklist. The Nelson Alan curve with log-rank test was used to compare the presence of differences in the mortality rate of different groups over different categorical variables. The cox proportional hazards analysis model was used to identify predictors of neonatal death. The presence and absence of statistical significance was considered at a p-value of less than 0.05 and the strength of association was measured using AHR.ResultsThe neonatal mortality rate was 3.1 (95% CI: 1.3–4.9) per 1,000 neonate-days. Low birth weight (AHR = 1.44: 95% CI: 1.06–3.13), exclusive breast-feeding (AHR = 0.74: 95% CI: 0.35–0.95), and time of exclusive breast-feeding (AHR = 0.92: 95% CI: 0.49–0.99) were the identified predictors of newborn mortality.ConclusionThe neonatal mortality rate was high. Low birth weight of the neonate, exclusive breast-feeding initiation, and time of exclusive breast-feeding were independent predictors of neonatal death. Therefore, empowering mothers to exclusively breastfeed their children, which is a cost-effective, safe, and realistic option, can significantly minimize infant mortality.

INTRODUCTION:Well-organized patient pathways are essential to achieve early diagnosis and timely treatment of patients with cancer in Sub-Saharan Africa. This retrospective cohort study describes pathways and referral patterns of cancer patients in rural Ethiopia.PATIENTS AND METHODS:The retrospective study took place from October to December 2020 at 2 primary- and 6 secondary-level hospitals in southwestern Ethiopia. Of 681 eligible patients diagnosed with cancer between July 2017 and June 2020, 365 patients were included. Structured interviews on the patients' pathways were conducted by telephone. The primary outcome was successful referral, which was defined as occurring when the intended procedure was initiated at the receiving institution. Logistic regression was used to assess factors associated with successful referrals.RESULTS:Patients visited on average 3 health care institutions from their first encounter with a provider until their final treatment initiation. After diagnosis, only 26% (95) of patients were referred for further cancer treatment, of which 73% were successful. Patients referred for diagnostic tests were 10 times more likely to complete referrals successfully than patients referred for treatment. Overall, 21% of all patients remained without any therapy.CONCLUSION:We found that referral pathways of patients with cancer in rural Ethiopia were largely cohesive. The majority of patients referred for diagnostic or treatment services followed the advice. Nevertheless, an unacceptable number of patients remained without any treatment. Capacity for cancer diagnosis and treatment at primary- and secondary-level health facilities in rural Ethiopia must be expanded to enable early detection and timely care.

Background Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. In March 2021, the World Health Organization called on the global community to decrease mortality by 2.5% per year. Despite the high burden of the disease, the survival status and the predictors for mortality are not yet fully determined in many countries in Sub-Saharan Africa, including Ethiopia. Here, we report the survival status and predictors of mortality among breast cancer patients in South Ethiopia as crucial baseline data to be used for the design and monitoring of interventions to improve early detection, diagnosis, and treatment capacity. Methods A hospital-based retrospective cohort study was conducted among 302 female breast cancer patients diagnosed from 2013 to 2018 by reviewing their medical records and telephone interviews. The median survival time was estimated using the Kaplan-Meier survival analysis method. A log-rank test was used to compare the observed differences in survival time among different groups. The Cox proportional hazards regression model was used to identify predictors of mortality. Results are presented using the crude and adjusted as hazard ratios along with their corresponding 95% confidence intervals. Sensitivity analysis was performed with the assumption that loss to follow-up patients might die 3 months after the last hospital visit. Results The study participants were followed for a total of 4,685.62 person-months. The median survival time was 50.81 months, which declined to 30.57 months in the worst-case analysis. About 83.4% of patients had advanced-stage disease at presentation. The overall survival probability of patients at two and three years was 73.2% and 63.0% respectively. Independent predictors of mortality were: patients residing in rural areas (adjusted hazard ratio = 2.71, 95% CI: 1.44, 5.09), travel time to a health facility ≥7 hours (adjusted hazard ratio = 3.42, 95% CI: 1.05, 11.10), those who presented within 7–23 months after the onset of symptoms (adjusted hazard ratio = 2.63, 95% CI: 1.22, 5.64), those who presented more than 23 months after the onset of symptoms (adjusted hazard ratio = 2.37, 95% CI: 1.00, 5.59), advanced stage at presentation (adjusted hazard ratio = 3.01, 95% CI: 1.05, 8.59), and patients who never received chemotherapy (adjusted hazard ratio = 6.69, 95% CI: 2.20, 20.30). Conclusion Beyond three years after diagnosis, patients from southern Ethiopia had a survival rate of less than 60% despite treatment at a tertiary health facility. It is imperative to improve the early detection, diagnosis, and treatment capacities for breast cancer patients to prevent premature death in these women.

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Background: Cancer is one of the leading causes of death; worldwide, there were 10.0 million cancer deaths in 2020. In Ethiopia, 51,865 people died from the disease in the same year. We aimed to describe the burden of cancer mortality, the socio-demographic and other characteristics of deceased adults in Addis Ababa from 2007 to 2017. Methods: This study was part of the Addis Ababa Mortality Surveillance Programme. Based on the burial-based surveillance, there were 133,170 adult deaths from 2007 to 2017. The standard verbal autopsy questionnaire was applied to collect information on the causes of death of 10% of the randomly selected deaths. Results: Cancer accounted for 11% of all deaths studied. The median age of death in years was 60 (range = 47-70). Stomach cancer was the leading cause of cancer death (131, 13.6%), followed by breast cancer (116, 12.0%) and liver cancer (101, 10.5%). Conclusion: Cancer-related deaths accounted for a significant portion of all deaths. Premature deaths accounted for majority of the deaths. Cancer deaths were most commonly caused by stomach, breast and liver cancers. Advocating for a healthy lifestyle, effective cancer screening and effective alcohol-control regulations should be tailored to the country.

OBJECTIVE Cancer is a global public health issue that continues to increase because of aging and adoption of cancer-causing behaviours. In Ethiopia, cancer belongs to the second most common non-communicable disease. Cancer patients face a range of unmet needs in multiple aspects of their lives. Supportive care is defined as essential care that helps patients to cope with cancer. This study aims to assess the predictors of unmet supportive care needs in adult cancer patients in Ethiopia. METHODS Institution-based cross-sectional study was done from February to March 2019 in adult cancer patients. Three hundred seventy-one patients were interviewed using convenience sampling. Supportive care needs were used as outcome variables, dichotomized as 'no need' and 'unmet needs'. Variables with a p-value of <0.2 were candidates for multivariable logistic regression. RESULTS From 371 patients, 69.8% were females with a mean age of 47 years; the commonest type of cancer was gynaecological cancer. Information about diagnosis, stage of cancer, time since diagnosis, age, wealth index, employment status, gender, type of treatment, history of recurrence, type of cancer and information about diagnosis modified by the source of information were predictors of unmet supportive care needs. CONCLUSIONS The study emphasised the importance of considering sociodemographic, clinical and information-related factors when dealing with cancer patients. Programmes, guidelines and services that focus on supportive care needs should be established and/or implemented.

Objectives Supportive care needs survey short form has a total of 34 items that have 5 domains that measure the unmet needs of cancer patients. It is important to validate this tool since there are differences in culture, geographic areas, and clinical care service which influence patients’ needs. Therefore, this study aimed to assess the construct validity and reliability of the tool. Methods The study was conducted among 170 cancer patients from April 1st to 30th 2019 in Hawassa hospital, South Ethiopia. Confirmatory factor analysis was done using fit indices. Convergent and discriminant validity was evaluated using average variance extracted and maximum shared variance respectively. Known group validity was checked using the Mann-Whitney U test. The reliability of the instrument was examined using Cronbach’s alpha. Results Domains except for health system and information, and patient care and support maintained convergent and divergent validity. The remaining validity was maintained after removing items that were redundant and double loading. The average variance extracted of domains varied from 0.52–0.81. The Square of correlation between constructs was lower than the average variance extracted for the constructs. The tool had reliability r = 0.932. The root mean square error of approximation was 0.057, comparative fit index 0.954, and the other fit indices were also indicating a good fit. Known groups difference was seen by age and type of treatment taken across the different domains. Conclusion After the health system and information, and patient care, and support domain validity issues were corrected by removing 8 items, the reduced tool was found to be a valid and reliable tool. The validated tool will be valuable if included in routine cancer care in our clinical settings.

Timely care is essential to increase breast cancer survival. However, patients in Ethiopia still face multilevel barriers on their pathway to timely treatment initiation. This cross-sectional study at Tikur Anbessa Specialized Hospital Oncology Unit in Addis Ababa assessed systemic treatment initiation intervals of breast cancer patients and quantified the impact of socio-demographic and clinical factors, perceived barriers, and the patients´ perceived social support status on timely systemic treatment initiation (chemotherapy or hormonal therapy). A structured questionnaire was designed based on Pechansky´s “Concept of Access”. Applying simple and multivariate logistic regression we analysed the influence of patients´ characteristics as well as their perceived barriers on timely treatment initiation. We measured social support with the Multidimensional Score of Perceived Social Support (MSPSS) and used the Wilcoxon Rank-Sum Test to assess its relationship with timely treatment initiation. Of 196 patients included into the study, 53% received systemic treatment within 90 days of their pathological diagnosis–the median treatment initiation interval was 85 days (IQR 123.5). Older women and patients diagnosed at late stages had higher odds of timely treatment initiation. Not being able to pay for services and lack of transport were most often perceived as barriers towards timely care. However, none of the perceived barriers showed a substantial influence on timely treatment initiation in the multivariate regression model. The patients´ perceived social support was found to be high, with an average MSPSS score of 73 out of 84 (SD 13,63). No impact of the perceived social support status on timely treatment initiation was found. The percentage of breast cancer patients waiting longer than 90 days from pathological diagnosis to systemic treatment initiation in Ethiopia remains unacceptably high. While women generally feel well supported by their social environment, costs and accessibility of treatment are perceived to be major barriers towards timely treatment initiation.

BACKGROUND:Ill health associated with household air pollution (HAP) is increasingly recognized as a public health problem in sub-Saharan Africa. To date, attempts to reduce HAP have focussed on smoke from cooking fires and have ignored traditional cultural practices which generate purposely produced smoke (PPS). This study aimed to investigate PPS prevalence, reasons for use and safety perceptions.METHODS:The study was conducted in Wollo, Ethiopia, and used a mixed methods approach of quantitative surveys (analysed descriptively) and qualitative interviews with householders and healthcare workers (analysed thematically).RESULTS:PPS use was reported by 99% of survey respondents and it was considered a fundamental part of life. Although reasons for use included housekeeping, culture/religion and well-being, coffee ceremony was most commonly cited (44% of respondents). Both householders and healthcare workers appeared to assume PPS is safe, except for people with certain underlying conditions. Healthcare workers felt the lack of evidence of harm from PPS meant there was no justification for intervention.CONCLUSION:This study, the first in-depth study of PPS, has shown its use to be widespread, with many perceived benefits and thus a very important part of local culture in this sample Ethiopian community. Consequently, any public health interventions aimed at reducing HAP in this setting need to consider PPS.

Background: The COVID-19 pandemic has been a major global public health disaster causing huge number of deaths. However, there is knowledge gap in understanding the impact of COVID-19 on mortality especially in low- and middle-income countries like Ethiopia where registration systems of vital events are incomplete. This study aimed to assess excess mortality due to COVID-19 in Addis Ababa, using burial site based mortality surveillance.Methods: Mortality data from all cemeteries in Addis Ababa since 2015 was analyzed to assess whether the adult mortality during the pandemic (January 2020 to September 2020) was different from the expected mortality for that period. The analysis was stratified by sex and by age. In addition, data on COVID-19 symptoms were collected using InterVA COVID-19 rapid mortality surveillance (CRMS) tool to estimate the probability of death involved COVID-19 in the third quarter of 2020.Finding: The number of deaths (3,747) during the third quarter of 2020 was higher than the upper limit of the 99% confidence interval for the expected deaths for that period, which was 2,893 (99% confidence interval: 2522, 3263)—i.e., about 30% excess mortality. The statistically significant excess mortality (p<0.1) was higher among males and older age groups. From all deceased individuals in the third quarter of 2020, probable number of the death involved COVID-19 was 699 (95% confidence interval: 664, 735), which is 21.5%.Interpretation: This study has indicated an excess mortality in Addis Ababa likely due to the COVID-19 pandemic.Funding Statement: Addis Ababa University and Bill and Melinda Gates Foundation.Declaration of Interests: BS was supported by research funding from the Bill and Melinda gates foundation and Addis Ababa University. All other authors declare no competing interests.Ethics Approval Statement: The Institutional Review Board (IRB) of the College of Health Sciences, Addis Ababa University, approved the research.

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in over 100 countries. Despite the high burden of the problem, the survival status and the predictors for mortality are not yet determined well in Ethiopia. Therefore, we aimed to determine the survival and predictors of mortality among breast cancer patients diagnosed from 2013-2018 at Hawassa comprehensive specialized and teaching hospital and private oncology clinic in Southern Ethiopia.Methods: Hospital-based retrospective cohort study of 302 patients was conducted. Data was collected on breast cancer patients diagnosed from January, 1st, 2013 to December, 30th, 2018 using a data extraction checklist and by telephone interview. The median survival was estimated by Kaplan- Meier. Log Rank test was used to compare survival among groups. Cox proportional hazards model was used to identify predictors. Results were repaired as hazard ratio (HR) along with the corresponding 95% CI. Sensitivity analysis was done with the assumption of loss to follow-ups (LTF) might die 3 months after the last hospital visit. Results: Advanced stage diagnosis of breast cancer was found on 83.4 % of patients with breast cancer. The study participants were followed for a total of 4685.62 person-months. Their median survival was 50.61 months (IQR=18.38-50.80) which declined to 30.57 months in the worst-case analysis (WCA). The overall survival of patients at two years was 73.2% and it declines to 51.3 % in the worst-case analysis. Rural residence (AHR=2.71, 95% CI: 1.44, 5.09), travel time >7 hours (AHR=3.42, 95% CI: 1.05, 11.10), duration of symptom 7-23 months (AHR=2.63, 95% CI: 1.22, 5.64), > 23 months (AHR=2.37, 95% CI: 1.00, 5.59), advanced stage (AHR=3.01, 95% CI: 1.05, 8.59) and not taking chemotherapy (AHR=6.69, 95% CI: 2.20, 20.30) were independent predictors of death. Conclusion: Above two-third of the patients have two years of overall survival in south Ethiopia. Rural residence, advanced stage, and poor adherence to chemotherapy were independent predictors of death. Thus, Improving early detection, diagnosis, and treatment capacity of breast cancer patients are an important way-outs to avert the problem with appropriate intervention means.