Diarrheal disease is a significant public health concern, especially among children under the age of five. Its burden is particularly high in low-income countries, including Ethiopia. However, there is a lack of recent, nationally representative studies that adequately identify individual and community-level factors to inform effective interventions. Hence, this study aimed to fill this gap. This study utilized data from the national representative Health Equity Survey, conducted in all regional states and two city administrations of Ethiopia. A total of 8,747 mothers with children under five were selected using a two-stage stratified cluster sampling. Data were collected through face-to-face interviews. Descriptive statistics were computed, and mixed- effect multilevel logistic regression identified factors associated with diarrheal disease. Significance was set at p-value of < 0.05, with results reported as AORs and 95

Background Expectations for health-care quality affect how populations rate primary care, influencing tolerance of poor-quality care and demand for improvement, yet how expectations align with standards of practice remains poorly understood. We aimed to measure population expectations of primary care and their determinants within and across countries. Methods In this cross-sectional analysis, we used nationally representative data from the People's Voice Survey collected between May 9, 2022, and Dec 21, 2023, in Ethiopia, Nigeria, Kenya, South Africa, Colombia, Peru, Mexico, Argentina (Province of Mendoza), Uruguay, Laos, India, China, South Korea, Romania, Greece, Italy, the UK, and the USA. Adults aged 18 years and older with at least one health-care visit in the past 12 months were included. Expectations were assessed using two anchoring vignettes, one depicting poor-quality primary care and one depicting adequate-quality primary care, administered via a mobile telephone survey, household interview, or nationally representative web panels. Respondents rated each vignette on a Likert scale: poor, fair, good, very good, or excellent. Low expectations were defined as rating the poor-quality care vignette as fair, good, very good, or excellent, and high expectations were defined as rating the adequate-quality care vignette as poor, fair, or good. Multivariable logistic regression models identified determinants of expectations, including covariates covering demographics, health status, care utilisation and experience, and system competence. Findings Among 18 312 respondents (10 000 [54·6%] female and 8312 [45·4%] male; mean age 44 years [SD 17]), 2955 (16·1%) rated poor-quality primary care as fair or better and 11 787 (64·4%) rated adequate-quality primary care as less than very good. The proportion of respondents with low expectations of primary care ranged from 70 (6·3%) of 1112 in the UK to 530 (41·1%) of 1290 in South Korea. The proportion of respondents with high expectations of primary care ranged from 563 (40·1%) of 1404 in Nigeria to 494 (85·0%) of 581 in Italy. Older age, female gender, higher educational attainment, higher income, and use of private care (vs public care) were all associated with reduced odds of low expectations. Respondents with higher self-rated health had higher odds of low expectations (vs those with poor self-rated health). Activated patients (ie, those who were confident in raising concerns with their provider and that they were responsible for managing their own health) had lower odds of low expectations and lower odds of high expectations (vs non-activated patients). And positive perceptions of government management of COVID-19 were associated with high odds of low expectations and low odds of high expectations. Interpretation Populations can often misjudge primary care quality, with substantial cross-national variation. Recognising and measuring expectations are essential for accurately interpreting health system ratings and guiding efforts to improve primary care. Policy makers should invest in strategies that strengthen health literacy and patient activation, empowering populations to recognise and demand high-quality primary care. Funding Bill & Melinda Gates Foundation, the Swiss Federal Department of Foreign Affairs, Merck Sharp & Dohme, Inter-American Development Bank, the Eckenstein-Geigy Professorship, Initiative on the Future of Health and Economic Resiliency in Africa, National Natural Science Foundation of China, WHO Regional Office for Europe, and the Taejae Foundation.

Introduction Self-report is one of the easiest, cheapest and most widely used methods of collecting data about individuals’ health and risk factor status. Many health studies use self-reported data to assess the prevalence of given risk factors or health behaviors in the community. The objective of this study was to determine the level of perceived morbidity, treatment seeking behavior and associated factors using nationally representative self-reported morbidity data. Methods This study was embedded from a community based, national representative survey which was conducted from September 27 and December 20, 2022 in ten regions and two city administrations. Data collection in the eleventh region, i.e., Tigray region, was carried out separately from December 28, 2023 to February 14, 2024, due to contextual constraints. The survey covered 441 enumeration areas within 11 regional states and two city administrations. A two-stage stratified cluster sampling was employed to select the eligible households and a total of 9,157 household were selected. Data were collected through face-to-face interview with structured questionnaires. Descriptive statistics such as frequency with percentages and mean with standard deviations were employed to describe participants’ characteristics. Bivariate analysis was conducted to assess the association between treatment seeking behavior and independent variables. Mixed effects logistic regression was employed to determine predictors of treatment seeking behavior. Results A total of 2030 (18.02%) household heads experienced at least one perceived morbidity in the past 12 months prior to the survey date. Of these, 776(16.21%) were urban and 1254(18.71%) were rural residents. About 1793(89.4% with 95%CI: 3.76, 3.80) sought treatment to their perceived morbidity. In the multivariable analysis, Afar (AOR=0.47; 95%CI: 0.35, 0.64), Amhara(AOR=0.45; 95%CI: 0.33, 0.61), Oromia(AOR=0.26; 95%CI:0.18, 0.38), Ethiopia Somali(AOR=0.31; 95%CI: 0.21, 0.46), Benishangul-Gumuz (AOR=0.13; 95%CI: 0.09, 0.19), SNNPR(AOR=0.51; 95%CI: 0.37, 0.70), Sidama(AOR=0.59; 95%CI: 0.40, 0.87), South west-Ethiopia(AOR=0.23; 95%CI: 15, 35), Harari(AOR=0.29; 95%CI: 19, 45), and Dire Dawa(AOR=0.80; 95%CI: 0.53, 1.00) were found to be less likely to seek treatment to their perceived morbidity compared to Tigray regional state while Gambela was 2.7 (95%CI:2.07, 3.63) times more likely to seek treatment compared to Tigray regional state. Other factors associated with treatment seeking behavior were being male (AOR, 1.2; 95%CI: 1.00, 1.37), own agricultural land (AOR=1.6; 95%CI: 1.37, 1.80), safety net beneficiaries (AOR=1.5; 95%CI: 1.27, 1.86), self-rated health status (very poor, AOR=2.4; 95%CI: 1.53, 3.90; poor, AOR=5.6; 95%CI: 4.28, 7.44; Neutral, AOR=2.9; 95%CI: 2.21, 3.68; Good, AOR=1.9; 95%CI: 1.55, 2.40) showed statistically significant association. Conclusion This study revealed that majority of the participants sought treatment from health facility for their perceived illness. However, there were significant disparities across the regions and participant characteristics. Thus, the study finding underscores the need for targeted interventions to address inequalities and identified barriers to enhance equitable health care utilization across the regions.

Moringa stenopetala is a highly versatile plant that has long been utilized as food and traditional medicine by communities in the southern and southwestern regions of Ethiopia. The plant is characterized by its dark green similar to cabbage. Its leaves used to prepare by mixing with various cereal flours and incorporated into the traditional cultural diet of the community. Despite its widespread consumption and recognized nutritional value, the dietary contribution of Moringa stenopetala on vitamin A deficiency and serum retinol levels has not been sufficiently investigated at the community level. Therefore, the present study was conducted to assess the long-term effects of dietary Moringa stenopetala consumption on vitamin A deficiency and serum retinol concentration among adults residing in Moringa stenopetala-consuming and non-consuming areas of Southern Ethiopia. Data were collected from study participants using a structured questionnaire designed to obtain information on socio-demographic characteristics and dietary consumption of Moringa stenopetala. The survey data were collected using digital tablets programmed with the Cispro data collection application. In addition, venous blood samples (5–8 mL) were drawn from the antecubital vein using evacuated yellow-top tubes for the analysis of serum vitamin A parameters. The collected data were exported to SPSS version 25 for statistical analysis. A one-way Analysis of Variance (ANOVA) was employed to assess the mean differences in serum retinol levels between participants who consumed Moringa stenopetala and those who did not consuming group. The F-test and corresponding P-values were used to determine the statistical significance of the observed differences between the two groups. The prevalence of vitamin A deficiency among adults who consumed Moringa stenopetala was 10.18

Moringa stenopetala is a multi-purpose tree known for its significant nutritional and medicinal properties. Existing investigational reports on the effects of Moringa stenopetala on lipid profile, blood pressure, and fasting blood glucose levels are exclusively based on laboratory studies utilizing experimental animal models. However, there is a lack of scientific evidence from either placebo-controlled randomized clinical trials or community- or health facility-based follow-up studies. Therefore, this follow-up study was undertaken to evaluate the effect of dietary Moringa stenopetala consumption on biochemical markers and clinical parameters for the management of diabetes and hypertension in adult patients. A facility-based prospective cohort study was conducted among patients with diabetes and hypertension receiving chronic care follow-up. The exposure group comprised patients who consumed Moringa stenopetala as a dietary component at Gidolie District Hospital, while the non-exposed group consisted of those who did not consume it at Chencha District Hospital. Blood samples (4–5 mL) was collected for serum lipid profile determination. Independent t-tests and one-way ANOVA were used to assess the mean differences in biochemical markers and clinical parameters. A P-value of less than 0.05, with a 95% confidence level, was considered to indicate a statistically significant effect. For participants on the Moringa stenopetala consuming based diet, mean serum cholesterol levels were 126.03 (95% CI: 118.49, 133.56), low-density lipoprotein (LDL) levels were 71.47 (95% CI: 65.80, 77.13), and triglyceride levels were 109.40 (95% CI: 102.66, 116.14). In contrast, participants on the non-moringa diet exhibited mean serum cholesterol levels of 145.59 (95% CI: 135.25, 155.93), LDL levels of 74.39 (95% CI: 71.02, 77.77), and triglyceride levels of 116.27 (95% CI: 110.61, 121.93). The differences in these lipid parameters between the two diet groups were statistically significant (p = 0.001). Regarding blood pressure, participants on the moringa diet had a mean systolic blood pressure of 127.83 (95% CI: 123.85, 131.80) and a mean diastolic blood pressure of 78.26 (95% CI: 76.14, 80.38). In comparison, participants on the non-moringa diet had a mean systolic blood pressure of 133.71 (95% CI: 129.50, 137.91) and a mean diastolic blood pressure of 81.24 (95% CI: 79.02, 83.45). These differences in blood pressure were also statistically significant (p < 0.001). Moringa stenopetala consumption as a diet can have a beneficial effect in the management of diabetes and hypertension when frequently taken together with standard therapies. Further studies like randomized clinical trials are recommended to determine the medicinal value of moringa stenopetala in the management of diabetes and hypertension.

Noncommunicable diseases (NCDs) such as cardiovascular disease, hypertension, and diabetes are a major and growing global health burden, particularly in low- and middle-income countries including Ethiopia. However, evidence on their distribution and associated individual- and community-level factors remains limited. Therefore, this study aimed to address this gap and generate evidence to inform prevention strategies and public health policy. Nationally representative cross-sectional study was conducted. Data were collected using the standardized WHO STEPwise approach. A multistage, stratified cluster sampling method was employed. In the first stage, 728 enumeration areas (EAs) were selected as primary sampling units. In the second stage, a new listing of households was collected from each EA. From these updated lists, 15 households were randomly selected, and one individual aged 18–69 years was subsequently selected at random from each household. Among the 34,594,270 weighted households included in the study, 29,546,369 completed interviews and were included in the analysis. Multilevel logistic regression analysis was employed to identify factors associated with noncommunicable diseases. A series of four models were fitted, and the model with the lowest Bayesian Information Criterion (BIC), and Akaike’s Information Criterion (AIC) values was selected as the best-fitting model for interpretation. In this study, the prevalence of self-reported history of cardiovascular disease, hypertension, and diabetes was 5.4

Effective coverage measurement has emerged as a tool to help understand health system performance for the provision of high-quality health care. Using a cascade approach that combines data on demand- and supply-side steps, effective coverage measures highlight where gaps in the health system exist and how improvements might be made so that more people benefit from the potential of the health services available to them. In practice, however, there are challenges in making this work. This analysis paper aimed to highlight those challenges in calculating effective coverage in Ethiopia, using antenatal care as a test case, and propose a solution.In Ethiopia, government leaders are committed to taking a data-informed approach to improving health care quality. To support this, an effective coverage technical working group was formed of individuals with experience of effective coverage analysis in Ethiopia to share knowledge and create learning for a way forward.Through methods analysis of one common indicator, the effective coverage of antenatal care, four key challenges were identified by the group: (1) features of the data sources used, (2) the number of cascade steps included in the effective coverage calculations, (3) the data elements included within cascade steps and (4) the methods applied to generate composite indicators.Multiple small differences were observed to have an influence on the usability of effective coverage measures for decision-making. The group concluded that greater transparency in reporting effective coverage measures was urgently needed and proposed and discussed the use of a reporting checklist for this purpose.

Acute respiratory infection (ARI) remains the leading cause of morbidity and mortality among children under five years worldwide. However, in Ethiopia, evidence on the distribution and determinants of ARI is limited. This study aimed to assess the geographical distribution and determinants of ARI among Ethiopian children under five years. A nationwide community-based cross-sectional study was conducted from September to December 2022. Mothers with at least one child under five years were selected using a two-stage stratified cluster sampling approach. Data were collected through face-to-face interviews using structured questionnaires. A total of 8747 mothers were included in the analysis. Multilevel logistic regression was employed to identify determinants of ARI. Four models were fitted, and the model with the lowest Deviance Information Criterion (DIC) and Akaike Information Criterion (AIC) values was selected as the best-fitting model. The 2-week prevalence of ARI among children under five was 21.3

Malaria remains a major public health challenge in Ethiopia, affecting more than two‑thirds of the population living in endemic regions. Although local studies have explored community perceptions, nationally representative evidence on household‑level malaria risk perception is limited. To examine socioeconomic and geographic correlates of household malaria risk perception in Ethiopia. We analyzed data from 9,157 households in the 2022–2023 Ethiopian National Health Equity Survey (NHES) using multilevel mixed‑effects logistic regression to account for clustering at region, zone, and woreda‑levels. Spatial analysis was conducted using Global Moran's I, and Getis Ord Gi* was used to identify geographic patterns. Overall, 76.4

Thyroid hormones, including triiodothyronine (T3) and thyroxine (T4), are synthesized by the thyroid gland and play essential roles in regulating metabolism, growth, and neurodevelopment. Prolonged consumption Moringa stenopetala based diet has been suggested as a potential risk factor for goiter; however, scientific evidence regarding its effects on thyroid hormone levels and urinary iodine concentration remains limited. Therefore, this multicenter comparative cross-sectional study was conducted to assess the association between Moringa stenopetala-based dietary consumption and thyroid hormone profiles, as well as urinary iodine concentrations among adults in Southern Ethiopia. A multicenter comparative cross-sectional study was conducted among 732 randomly selected adults from Moringa stenopetala-consuming and non-consuming areas of Southern Ethiopia. Data was collected using a structured questionnaire and clinical examination for goiter assessment. Thyroid function tests, urinary iodine concentration, and household salt iodine content were determined using standard laboratory procedures. Data were entered and analyzed using SPSS version 25. Independent samples t-test and one-way analysis of variance (ANOVA) were employed to compare mean thyroid hormone levels between groups. The chi-square test was used to compare urinary iodine status between the two groups. Multiple linear regression analysis was conducted to identify factors associated with thyroid hormone levels from potential explanatory variables. Statistical significance was declared at p < 0.05 with a 95% confidence interval. The mean values of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) among Moringa stenopetala-consuming participants compared to non-consuming participants were 1.35 vs. 1.43 nmol/L, 9.23 vs. 8.21 mg/dL, and 1.41 vs. 1.47 mIU/mL, respectively. There was no statistically significant differences in mean score of T3 and TSH between the two groups (P = 0.30 and P = 0.115, respectively). Additionally, clinical examination revealed that more than 95% of participants in both groups showed no evidence of thyroid gland enlargement. Consumption of a Moringa stenopetala based dietary consumption is not likely to be associated with alterations in thyroid hormone levels or the occurrence of goiter. This finding suggests that the plant may consumed for its nutritional benefits without affecting on thyroid function.

The World Health Organization initially recommends a minimum of four antenatal care (ANC) visits during pregnancy. However, the utilization of Focused antenatal care (FANC) services remains low in many low- and middle-income countries, including Ethiopia. Therefore, this study aimed to investigate the magnitude and determinants of FANC utilization among Ethiopian women aged 15 to 49. A nationwide community-based cross-sectional study was conducted between September and December 2022. Respondents were selected using a two-stage stratified cluster sampling method. Data were collected through face-to-face interviews using structured questionnaires. A total of 5,358 weighted samples were included in the analysis. Multilevel logistic regression analysis was conducted to measure the strength of associations and identify determinants of FANC utilization. Four models were fitted, and the model with the lowest values of the Deviance Information Criterion (DIC) and Akaike’s Information Criterion (AIC) was chosen. In this study, 59.9

High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey-a nationally representative survey conducted in 14 highincome, middle-income, and low-income countries-to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility. We disaggregated the data by high-need and underserved groups. The proportion of respondents rating their most recent visit as high quality ranged from 25% in Laos to 74% in the USA. The mean facility recommendation score was 7 center dot 7 out of 10. Individuals with high needs or who are underserved reported lower-quality services on average across countries. Countries with high health expenditure per capita tended to have better care ratings than countries with low health expenditure. Visit quality factors explained a high proportion of variation in facility recommendations relative to facility or demographic factors. These results show that user-reported quality is low but increases with high national health expenditure. Elevating care quality will require monitoring and improvements on multiple dimensions of care quality, especially in public systems.

The MNH eCohort was developed to fill gaps in maternal and newborn health (MNH) care quality measurement. In this paper, we describe the survey development process, recruitment strategy, data collection procedures, survey content and plans for analysis of the data generated by the study. We also compare the survey content to that of existing multi-country tools on MNH care quality. The eCohort is a longitudinal mixed-mode (in-person and phone) survey that will recruit women in health facilities at their first antenatal care (ANC) visit. Women will be followed via phone survey until 10-12 weeks postpartum. User-reported information will be complemented with data from physical health assessments at baseline and endline, extraction from MNH cards, and a brief facility survey. The final MNH eCohort instrument is centered around six key domains of high-quality health systems including competent care (content of ANC, delivery, and postnatal care for the mother and newborn), competent systems (prevention and detection, timely care, continuity, integration), user experience, health outcomes, confidence in the health system, and economic outcomes. The eCohort combines the maternal and newborn experience and, due to its longitudinal nature, will allow for quality assessment according to specific risks that evolve throughout the pregnancy and postpartum period. Detailed information on medical and obstetric history and current health status of respondents and newborns will allow us to determine whether women and newborns at risk are receiving needed care. The MNH eCohort will answer novel questions to guide health system improvements and to fill data gaps in implementing countries.

Background This study aimed to enhance insights into the key characteristics of maternal and neonatal mortality declines in Ethiopia, conducted as part of a seven-country study on Maternal and Newborn Health (MNH) Exemplars.Methods We synthesised key indicators for 2000, 2010 and 2020 and contextualised those with typical country values in a global five-phase model for a maternal, stillbirth and neonatal mortality transition. We reviewed health system changes relevant to MNH over the period 2000-2020, focusing on governance, financing, workforce and infrastructure, and assessed trends in mortality, service coverage and systems by region. We analysed data from five national surveys, health facility assessments, global estimates and government databases and reports on health policies, infrastructure and workforce.Results Ethiopia progressed from the highest mortality phase to the third phase, accompanied by typical changes in terms of fertility decline and health system strengthening, especially health infrastructure and workforce. For health coverage and financing indicators, Ethiopia progressed but remained lower than typical in the transition model. Maternal and neonatal mortality declines and intervention coverage increases were greater after 2010 than during 2000-2010. Similar patterns were observed in most regions of Ethiopia, though regional gaps persisted for many indicators. Ethiopia's progress is characterised by a well-coordinated and government-led system prioritising first maternal and later neonatal health, resulting major increases in access to services by improving infrastructure and workforce from 2008, combined with widespread community actions to generate service demand.Conclusion Ethiopia has achieved one of the fastest declines in mortality in sub-Saharan Africa, with major intervention coverage increases, especially from 2010. Starting from a weak health infrastructure and low coverage, Ethiopia's comprehensive approach provides valuable lessons for other low-income countries. Major increases towards universal coverage of interventions, including emergency care, are critical to further reduce mortality and advance the mortality transition.

Background: Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence. Objective: This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity. Method: We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran’s Q test. In the presence of moderate heterogeneity ( I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger’s regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables. Results: The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%−68.98%) ( I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37–3.84), family wealth index (AOR = 2.72, 95% CI: 1.89–3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24–3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95–7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: −0.36 to −4.82). Conclusions: The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey—a nationally representative survey conducted in 14 high-income, middle-income, and low-income countries—to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility. We disaggregated the data by high-need and underserved groups. The proportion of respondents rating their most recent visit as high quality ranged from 25% in Laos to 74% in the USA. The mean facility recommendation score was 7·7 out of 10. Individuals with high needs or who are underserved reported lower-quality services on average across countries. Countries with high health expenditure per capita tended to have better care ratings than countries with low health expenditure. Visit quality factors explained a high proportion of variation in facility recommendations relative to facility or demographic factors. These results show that user-reported quality is low but increases with high national health expenditure. Elevating care quality will require monitoring and improvements on multiple dimensions of care quality, especially in public systems.

Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.

Introduction Prevention of mother-to-child transmission contributes to avert nearly 4000 new HIV infections in 2022. HIV testing and counselling (HTC) during antenatal care (ANC) is an effective strategy to reduce the vertical transmission of HIV. While the utilisation of HTC services in Ethiopia has been explored, there is limited evidence exploring the effective coverage of HTC during ANC. We aimed to assess the quality-adjusted (effective) coverage of HTC during ANC in Ethiopia.Methods We linked the 2016 Ethiopian Demographic Health Survey and the 2021-2022 Ethiopian Service Provision Assessment (ESPA) surveys to determine the crude coverage and assess the quality of HTC provision. The ESPA service quality framework, which has structural and process-related components, was used. We used a weighted additive approach of 61 indicators (38 structural and 23 process) to estimate the quality of care score. Administrative boundary linkage was used to link the two datasets. The effective coverage was calculated as the product of crude coverage and the quality of care score.Results During ANC contacts/visits, 17.2% (95% CI 16.0 to 18.4) of women received HTC. The effective coverage of HTC during ANC was 10.8 (95% CI 9.8 to 11.8), with substantial disparities among administrative regions, ranging from 1.6% (95% CI 1.3, 2.0) in the Somali region to 55.5% (95% CI 53.5 to 57.5) in Addis Ababa. The overall service quality was 45.2% (95% CI 42.8 to 47.1). Health facilities in Harari (31.4% (95% CI 19.0 to 43.8)), Somali (34.1% (95% CI 26.8 to 41.6)) and Dire Dawa (34.9% (95% CI 24.71 to 45.0)) demonstrated low-quality service provision. Health posts (5.8%, SD=8.4), health facilities located in rural areas (30.6%, SD=27.3) and public health facilities (44.2%, SD=29.4) had low-quality HTC provision.Conclusion Nearly 9 in 10 women did not receive quality HTC during ANC provision. The crude coverage, quality of services provision and effective coverage significantly vary across administrative regions. Afar and Somali regions lagged behind the Addis Ababa and Amhara administrative regions. To effectively mitigate mother-to-child transmission of HIV, policymakers need to prioritise enhancing the quality of care in HTC during ANC and expanding service delivery.

Background: Every year, 10.9 million people die around the world. More than two-thirds of deaths were associated with inappropriate feeding practices. Within the first three days after birth, nearly two out of every five newborns are given fluids other than breast milk. The aim of this study was to assess the determinants of pre-lacteal feeding practice in Ethiopia among mothers who had a live birth child under the age of 24 months. Methods: Secondary data from Ethiopia's 2019 Mini Demographic and Health Survey (MDHS) were used. A stratified, two-stage cluster sampling method was employed in the MDHS. A total of 8,885 reproductive-age women were interviewed in the survey, but only 2,061 women with a live birth child under the age of two years were included. Our study focused on the details obtained for these 2,061 women. Logistic regression analysis was used to identify factors associated with pre-lacteal feeding practices among them. A Hosmer-Lemeshow goodness of fit test was used to check the model fitness and a multicollinearity test was used to diagnosis collinearity between independent variables. Results: The results revealed that 12.1% (95%CI; 10.30%, 13.9%) of the women practiced pre-lacteal feeding. Mothers who lived in pastoralist regions (AOR:3.2; 95%CI: 1.5-6.84), who hadn’t attended antenatal care (ANC) visits (AOR:3.83; 95%CI: 1.55-6.27), who had attended 1-3 visits (AOR:1.65; 95%CI: 1.15-3.94), who delivered at home (AOR:1.72, 95%CI: 1.20-2.43), those who delivered by Caesarean section (AOR:3.72; 95%CI: 2.32-5.96), mothers who started breastfeeding after one hour (AOR:4.41; 95%CI: 3.23-6.02) were identified as the groups most associated with pre-lacteal feeding. Conclusions: Pre-lacteal feeding was practiced by a significant number of women in this study. Living in a pastoralist region, attending 1-3 ANC visits, home delivery, caesarean section delivery, and late initiation of breastfeeding were the determinant factors of prelacteal feeding among the women.

•The leaves of M. stenopetala may have potential to raise levels of male sex hormones.•It may not have toxicity on the histology of male reproductive organs in rats.•It reduced glucose levels at higher doses, which may indicate antidiabetic benefits.