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Background Healthcare workers (HWs) are at the highest risk of getting CIVID-19. This study aimed to assess factors determining the knowledge and prevention of HWs towards COVID-19 in the Amhara Region, Ethiopia. Methods A cross-sectional online survey was conducted among 442 HWs using email and telegram addresses. The knowledge and practice of HWs were estimated using 16 knowledge and 11 practice questions. A multivariable logistic regression analysis was used on SPSS version 25 to identify factors related to the knowledge and prevention practice of HWs on COVID-19. Significance was determined at a p value of < 0.05 and association was described by using odds ratio at 95% CI. Results Of 442 HWs, 398 (90% response rate) responded to the online interview questionnaire. From 398 HWs, 231(58%), 225(56%), 207(53%), and 191(48%) were males, from rural area, aged ≥ 34 years and nurses, respectively. About 279(70%) HWs had good knowledge of COVID-19 followed by 247(62%) good prevention practices. Age < 34 years (AOR = 2.14, 95% CI = 1.25–3.62), rural residence (AOR = 0.44, 95% CI = 0.26–0.70), access to infection prevention (IP) training (AOR = 2.4, 95% CI = 1.36–4.21), presence of IP guideline (AOR = 2.82, 95% CI = 1.64–4.62), and using social media (AOR = 2.51, 95% CI = 1.42–4.53) were factors of knowledge about COVID-19. Whereas, rural residence (AOR = 0.45, 95% CI = 0.31–0.75), facility type (AOR = 0.40, 95% CI = 0.28–0.89), access to IP training (AOR = 2.32, 95% CI = 1.35–4.16), presence of IP guidelines (AOR = 2.10, 95% CI = 1.21–3.45), knowledge about COVID-19 (AOR = 2.98, 95% CI = 2.15–5.27), having chronic illnesses (AOR = 2.0, 95% CI = 1.15–3.75), lack of protective equipment (PPE) (AOR = 0.42, 95% CI = 0.32–0.74), and high workload (AOR = 0.40, 95% CI = 0.36–0.87) were factors of COVID-19 prevention. Conclusion In this study, most of the HWs had good knowledge but had lower prevention practice of COVID-19. Socio-demographic and access to information sources were factors of knowledge on COVID-19. Similarly, residence, shortage of PPE, high workload, comorbidities, knowledge, and access to IP training and guideline were factors limiting prevention practices. Thus, a consistent supply of PPE and improving health workers’ knowledge, making IP guidelines and information sources available, and managing chronic illnesses are crucial to prevent COVID-19 among HWs.

ObjectiveTo assess malaria service readiness and its associated factors among health facilities that provide antenatal care (ANC) services in Ethiopia.DesignNationally representative cross-sectional facility-based study.ParticipantsA total of 1156 public and private health facilities that reported providing ANC services at the time of the survey.SettingHealth facilities across nine regions and two city administrations of Ethiopia based on data from the 2021/2022 Ethiopia Service Provision Assessment survey.ResultsOnly 15.7% (95% CI 13.8 to 18.0) of facilities demonstrated full malaria service readiness, while 14.3% had none of the key components. Substantial regional variation was observed: facilities in Somali region were more likely to be ready (adjusted OR (AOR)=1.53; 95% CI 1.19 to 1.95), whereas readiness was significantly lower in several regions, including Amhara, Oromia, Gambella, Harari, Addis Ababa, Dire Dawa and Sidama, compared with Southern Nations, Nationalities and Peoples’ Region. Governance-related factors were strong predictors of readiness—the presence of a client suggestion box (AOR=1.60; 95% CI 1.12 to 2.29), recent report submission (AOR=2.79; 95% CI 1.15 to 6.76) and monthly staff meetings (AOR=1.64; 95% CI 1.26 to 2.14) were associated with higher readiness.ConclusionMalaria service readiness in Ethiopian health facilities providing ANC services is low and unevenly distributed across regions. Strengthening supply chains, staff training and governance systems may improve facility preparedness and support more effective malaria service delivery for pregnant women.

Background Sputum smear conversion is a key indicator of treatment response and reduced infectivity among bacteriologically confirmed pulmonary tuberculosis (PTB) patients. This study aimed at estimating sputum smear conversion and identifying factors hindering sputum smear conversion among bacteriologically confirmed PTB cases in East Gojjam Zone, Northwest Ethiopia. Methods A total of 282 bacteriologically confirmed PTB patients were followed for 22 weeks through weekly sputum smear examination. Due to the absence of sputum culture and rapid diagnostic services, sputum smear conversion evaluation was conducted microscopically using acid-fast-bacilli staining technique of sediments from a 5% sodium hypochlorite concentration technique. Data on socio-demographic, clinical profile and personal behavior variables were collected using a pretested interviewer-administered questionnaire. Various descriptive statistics including mean, median with interquartile range (IQR), and proportions were computed to describe study objectives. Factors of sputum smear conversion were identified by multivariable logistic regression analysis and statistical significance was determined at a p value < 0.05. Results Over half, 166 (59%) of bacteriologically confirmed PTB patients were males and 147 (52%) were rural dwellers. The mean age of respondents was 35 ± 5 SD years. About 88 (31.2%) of bacteriologically confirmed PTB patients had comorbidities, 102 (36.2%) faced stigma, and 54 (19%) history of cigarette smoking. The median sputum smear conversions during the intensive phase and 5th  months of treatment follow up were 35 dyas (IQR: 21-56 days) and 53 days (IQR: 28-82 days), respectuvely. The majority, 85% (95% CI 76–93%) and 95% (95% CI 85–99%) of bacteriologically confirmed PTB patients underwent sputum smear conversion at the end of 2nd and 5th months of treatment, respectively. Poor knowledge on TB, being HIV positive, higher smear grading, having diabetes mellitus, undernutrition, cigarette smoking, facing societal stigma, and TB service delays were positively associated with the length of sputum smear conversion ( p value < 0.05). Conclusion Based on this study, the median sputum smear conversion time was higher compared to TB program expectations and findings from former studies. The study also identified important factors associated with sputum smear conversion time. Improving health literacy of the community by revising the existing community awareness strategies is essential to enhance treatment adherence and lower infectiousness after treatment initiation.

Hepatitis B virus(HBV) and hepatitis C virus(HCV) are the main causes of cirrhosis, liver cancer, and death. This study aimed to determine the seroprevalence and associated factors of HBV surface antigen(HBsAg) and anti-HCV among patients screened for surgery at Felegehiwot referral hospital, Northwest Ethiopia. A hospital-based cross-sectional study was conducted among 433 patients in 2018. Data on socio-demographic and risk factors were collected by an exit interview using a pretested structured questionnaire. A venous blood sample of 5ml was collected from each participant, and serum was tested for HBsAg and anti-HCV using one-step rapid test kits and enzyme-linked immunosorbent assay. Multivariable logistic regression analysis was computed to identify factors associated with HBV and HCV infections. The odds ratio with 95%CI was used to describe the strength of association and statistical significance. A total of 422 patients gave data and included in the analysis. The mean age of patients was 36±5 years. About two-thirds, 269(64%) and 274(65%) patients were males, and from rural areas, respectively. The seroprevalence of HBsAg was 34(8%) followed by 18(4.3%) anti-HCV and 4(0.9%) co-infections. Being single(AOR = 1.96, 95%CI = 1.12-3.10), rural residence (AOR = 2.68, 95%CI = 1.28-5.61), ever heard about HBV (AOR = 2.41, 95%CI = 1.18-5.20), having multiple sexual partners(AOR = 2.85, 95%CI = 1.30-5.58), HIV positive(AOR = 3.14, 95%CI = 1.31-7.61), history of tooth extraction(AOR = 3.0, 95%CI = 1.40-6.56), hospitalization history(AOR = 2.95, 95%CI = 1.26-5.81), sharing of sharp instruments (AOR = 3.86, 95%CI = 1.82-8.79), and had blood contact(AOR = 2.64, 95%CI = 1.14-5.42) were statistically significant factors to HBV infection. Similarly, sharing of sharp instruments(AOR = 4.65, 95%CI = 1.32-15.1), tooth extraction practice(AOR = 2.81, 95%CI = 1.12-6.56), surgical history (AOR = 3.68, 95%CI = 1.64-9.82), hospitalization history(AOR = 4.51, 95%CI = 1.62-8.35) and had blood contact(AOR = 3.2, 95%CI = 1.56-8.51) were significant factors to HCV infection. The seroprevalence of HBsAg and ant-HCV was high compared to WHO and previous study findings. Giving special attention to awareness creation, rural settings, improving personal behaviors, infection prevention activities of health facilities, quality of healthcare procedures is crucial to prevent viral hepatitis infection.

In developing countries like Ethiopia, medicines wastage becomes a major healthcare system challenge. However, data that displayed the type, extent, and contributing factors of medicines wastage were limited. A health facility-based explanatory sequential mixed study was conducted from December 2021 to February 2022. One drug and therapeutics committee (DTC) and one store man per health facility, working during the study period were included for their perception of medicines wastage and possible causes. As key informants, 1 Chief Executive Officer (CEO) and 1pharmacy head were also included per facility. In total, 80 participants were included in this study. The quantitative data to determine the magnitude of medicine wastage were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 25. The overall medicines wastage in the three consecutive years was 6.3%. The trend over the three years indicated that medicines wastage is 6.5%, 5.9%, and 6.5% in 2011, 2012, and 2013 Ethiopian Fiscal Year (EFY), respectively. The medicine wastage rate has been increasing nearly by 3% between 2011/2012 and 2012/2013. The main sources of wastage of medicines were expiry (99.3%). The perceived reasons for such medicine's wastage were near-expiry medicines (<6 months) being delivered to the health facilities by suppliers, poor communication and coordination with key stakeholders, and the presence of overstocked medicines due to improper forecasting of need in the facilities. There is an excessive rate of medicines wastage which needs immediate mitigation by exchanging nearly expired medicines with other health facilities, communicating with suppliers and even prescribers, using auditable pharmaceutical transactions and services (APTS), providing continuous training, pursuing quality and safety medicines reuse scheme, implementation of pharmacist waste-reducing activities in all stages of the pharmaceutical supply chain, reducing medication amounts in stock, and through the use of electronic stock management tools.

Despite advances in information technology, the adoption of electronic medical records (EMRs) in healthcare remains limited, and usage rates are still low. Understanding the current utilization of EMR systems in private health facilities is crucial for guiding future digital health integration, enhancing interoperability, and building the capacity of the health workforce. However, the use of EMR systems in private hospitals in the Amhara region has not been well documented. This study therefore aimed to assess the utilization of EMR systems and identify associated factors among health professionals working in private hospitals in Bahir Dar city, Ethiopia. An institution-based cross-sectional study was conducted from February 13 to March 20, 2023, among 367 health professionals. Participants were selected through simple random sampling using computer-generated numbers from hospital-specific sampling frames via Open Epi software. Bivariate logistic regression was first performed, and variables with p < 0.25 were included in the multivariable analysis. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), and statistical significance was set at p < 0.05. A total of 351 respondents participated, yielding a response rate of 95.6%. Overall, 45.3% (95% CI: 41–50%) of health professionals reported utilizing the EMR system. Factors significantly associated with EMR utilization included access to basic EMR training (AOR = 2.22, 95% CI: 1.04–4.72), overall satisfaction of health care providers (AOR = 2.64, 95% CI: 1.39–6.09), and a user-friendly EMR interface (AOR = 2.14, 95% CI: 1.12–4.13). The utilization of EMR systems by healthcare professionals in private health facilities was found to be suboptimal. Key factors influencing EMR use included lack of access to training, user satisfaction, and the system’s interface usability. EMRs have the potential to improve health service performance if supported by continuous technical assistance and commitment to optimize their use. Developing EMR software tailored to local needs and conditions, along with sustained efforts to address barriers, is essential to ensure widespread and effective adoption and to fully realize the benefits of digital health records.

Background: Although electronic health management information systems (eHMIS) have been applied in the Ethiopian healthcare system since 2006, the functionality status and challenges are not assessed yet. Methods: A facility based cross sectional study was conducted in April 2017 to assess the eHMIS adoption rate, functionality status, and challenges in public health centres from Amhara Region, Ethiopia. Data were collected through phone interviewing of HMIS focal persons and data extraction from eHMIS databases. Data were analysed using SPSS version 23 software. Different descriptive statistics were computed to describe study objectives. Multivariable logistic regression analysis was used to identify factors affecting eHMIS functionality and variables showing p-value of less than 0.05 were considered as statistically significant. Results: The eHMIS adoption rate in the study area was 87.3% (733 from 839 health centres). Two third (66.6%) of the respondents were health information technicians (HIT). The majority, 653 (89.0) of the respondents took training on eHMIS. About 213 (29.0%) of the eHMIS focal persons were non health information technician staffs. More than half, 430 (58.7%) of health centres have functional eHMIS. Being HIT eHMIS focal person, absence of training, system failure, skill gaps, computer problems, and electric power interruption were variables showing statistical significant on the eHMIS functionality. Conclusions: This study revealed relatively high eHMIS adoption rate, but lower functionality status for various reasons. Improving training access, maintenance service, electric power, and recruiting adequately trained staffs is needed to improve eHMIS adoption and functionality.

Malaria in pregnancy poses significant health risks to mothers and their, fetuses, and newborns children in Tropical and subtropical countries including Ethiopia. The delivery of integrating essential malaria services into routine antenatal care is crucial for effective prevention and control. However, evidence on the extent and determinants of this integration in Ethiopia remains limited. This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia. We conducted a secondary analysis of the Ethiopia Service Provision Assessment Survey 2021/22, a nationally representative cross‑sectional study. The final sample included 4273 pregnant women nested across 662 health facilities. Factors were identified based on the WHO Malaria in Pregnancy framework. Multilevel logistic regression models were applied to identify significant factors influencing integrated service uptake. Only 7.9% of pregnant women attended ANC visits where all components of integrated malaria services were delivered concurrently, with substantial regional disparities. At the client level, women with two previous pregnancies (AOR = 1.67, 95% CI: 1.06-2.62), attending three or more ANC visits (AOR = 1.58, 95% CI: 1.04-2.40) and client who received an Insecticide-Treated Net during ANC (AOR = 2.81, 95% CI: 1.29-6.12) were more likely to attend ANC visits in which integrated malaria services were delivered. Furthermore, clients attending facilities with malaria-trained providers were more likely to receive integrated malaria services during ANC than those attending facilities without such training (AOR = 4.24, 95% CI: 1.80-10.00). Rural facility attendance was also positively associated with integrated malaria service delivery compared with urban facility attendance (AOR = 2.73, 95% CI: 1.04-7.19). Integrated malaria service delivery during ANC remains unacceptably low in Ethiopia, constrained by regional disparities and multilevel factors. Strengthen continuity of ANC follow up, updating policy on ITN distribution, strengthening providers' capacity, and addressing geographic disparities to accelerate progress toward WHO maternal health targets.

Tuberculosis (TB) remains a key health menace in Ethiopia and its districts. This study aimed to assess the spatial-temporal clustering of notified pulmonary TB (PTB) cases in East Gojjam Zone, Northwest Ethiopia. A retrospective study was conducted among all PTB cases reported from 2013-2019. Case notification rates (CNRs) of PTB cases at Kebele (the lowest administrative unit), woreda, and zone levels were estimated. The PTB clustering was done using global Moran's I statistics on Arc GIS 10.6. We used Kulldorff SaTScan 9.6 with a discrete Poisson model to identify statistically significant spatial-temporal clustering of PTB cases at Kebele level. Similarly, a negative binomial regression analysis was used to identify factors associated with the incidence of PTB cases at kebele level. A total of 5340 (52%) smear-positive and 4928 (48%) smear-negative PTB cases were analyzed. The overall mean CNR of PTB cases at zone, woreda and Kebele levels were 58(47-69), 82(56-204), and 69(36-347) per 100,000 population, respectively. The purely spatial cluster analysis identified eight most likely clusters (one for overall and one per year for seven reporting years) and 47 secondary clusters. Similarly, the space-time scan analysis identified one most likely and seven secondary clusters. The purely temporal analysis also detected one most likely cluster from 2013-2015. Rural residence, distance from the nearest health facility, and poor TB service readiness were factors (p-value <0.05) to PTB incidence at kebele level. The distribution of PTB cases was clustered. The PTB CNR was low and showed a decreasing trend during the reporting periods. Rural residence, distance from the health facilities, and poor facility readiness were factors of PTB incidence. Improving accessibility and readiness of health facilities mainly to rural and hotspot areas is vital to increase case detection and reduce TB transmission.

Ethiopia has experienced a marked malaria resurgence in recent years, with the Amhara Region disproportionately affected. Although Ethiopia's national strategy emphasizes test-before-treat and a public-private mix, implementation fidelity of the malaria test-and-treat guideline during resurgence has not been well characterized. This study assessed fidelity to malaria diagnosis and treatment guidelines in public and private health facilities in the Amhara Region within this resurgence context. We conducted a convergent parallel mixed-methods study from February to March 2025 in 53 health facilities (38 public, 15 private) in Amhara Region. The facility was the unit of analysis; one provider primarily responsible for malaria case management was interviewed per facility (n = 53). Implementation fidelity was operationalized using Carroll's framework across three domains: content (adherence to key diagnostic/treatment steps), coverage (proportion of suspected cases tested before treatment, extracted from facility registers), and frequency (self-reported consistency of testing for febrile patients in the preceding month). Domain scores were standardized to 0-100 and averaged with equal weights to form a composite fidelity score; ≥ 75% indicated high fidelity. To explain quantitative patterns, we conducted 32 in-depth interviews and analyzed data using inductive thematic analysis with CFIR-informed interpretation. Quantitative analysis used nonparametric tests and parsimonious multivariable linear regression, with prespecified sensitivity analyses excluding the self-reported frequency domain. Overall mean implementation fidelity was 64.3% (SD 12.1); 40% of facilities had high fidelity (≥75%), and 13% scored <50%. Public facilities had higher fidelity than private facilities (median 67% [IQR 60-77] vs 63% [IQR 56-70]; Wilcoxon rank-sum p = 0.041). In multivariable analysis, higher fidelity was associated with higher participant responsiveness (β = 3.4, p < 0.001), stronger facilitation strategies (β = 2.8, p < 0.001), and lower perceived intervention complexity (reverse-coded; β = 2.1, p < 0.001). Interviews indicated that fidelity gaps were driven by diagnostic and treatment deviations (including non-species-specific prescribing), inconsistent counseling and follow-up mechanisms, supply constraints, and patient pressure, with challenges more frequently emphasized in private facilities. Implementation fidelity to Ethiopia's malaria test-and-treat guideline in Amhara during resurgence was moderate, with lower fidelity in private facilities. Provider responsiveness, facilitation strategies, and lower intervention complexity were identified as factors associated with implementation fidelity. Strengthening supportive supervision and mentorship with explicit inclusion of private facilities, improving supply reliability, and simplifying decision supports may improve adherence during resurgence.