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Routine cervical screening has been shown to greatly reduce both the number of new cervical cancers diagnosed each year and the number of deaths resulting from the disease. Nevertheless, cervical screening knowledge and screening uptake is very low in developing countries. In Ethiopia, the coverage of cervical cancer screening is only 1%. In this study, we aimed to assess cervical cancer screening knowledge and barriers for screening uptake among women in Addis Ababa Ethiopia. A facility-based cross-sectional study was conducted from February to March 2015 in Addis Ababa, Ethiopia. A total of 520 women were selected by a multi-stage sampling procedure. Interview based questioner was used to collect the data. Descriptive statistics was used to describe the socio-demographic and clinical profiles of the women. Multivariate logistic regression using adjusted odds ratio (AOR) and 95% confidence interval (CI) was used to identify independent predictors for cervical screening knowledge. A p-value of <0.05 was set to determine level of statistical significance. Among all women, 42.7% had heard of cervical cancer screening and 144 (27.7%) women had adequate knowledge of cervical cancer screening. The mean (±SD) age of women was 27.7 (±5.49) years. In total, a quarter (25%) of eligible women had experience of cervical cancer screening. Not being married (adjusted odds ratio (AOR) = 1.8, 1.1-3.3), having an awareness of cervical cancer (AOR = 5.0, 2.7-9.1) and receiving information from health professionals (AOR = 1.9, 1.1-3.2) were the predictors for good cervical cancer screening knowledge. An absence of symptoms (57%), a lack of knowledge about screening (56.3%) and the lack of a screening service in their living area (42.2%) were the perceived barriers for screening uptake. Cervical screening knowledge was low among women and less than half had heard of screening. Women also had low experience of screening. The lack of a screening service, the absence of symptoms and not knowing about screening were the perceived reasons for the low uptake. Hence, awareness campaigns and education should be undertaken by health professionals. Access and availability of screening service is also essential to improve screening uptake.

Public health and social interventions are critical to mitigate the spread of the coronavirus disease 2019 (COVID-19) pandemic. Ethiopia has implemented a variety of public health and social measures to control the pandemic. This study aimed to assess social distancing and public health preventive practices of government employees in response to COVID-19. A cross-sectional study was conducted among 1,573 government employees selected from 46 public institutions located in Addis Ababa. Data were collected from 8 th to 19 th June 2020 using a paper-based self-administered questionnaire and analyzed using SPSS version 23.0. Descriptive statistics were used to summarize the data. Binary logistic regression analyses were used to identify factors associated with outcome variables (perceived effectiveness of facemask wearing to prevent coronavirus infection, and COVID-19 testing). Majority of the participants reported facemask wearing (96%), avoiding close contact with people including handshaking (94.8%), consistently followed government recommendations (95.6%), frequent handwashing (94.5%), practiced physical distancing (89.5%), avoided mass gatherings and crowded places (88.1%), restricting movement and travelling (71.8%), and stayed home (35.6%). More than 80% of the participants perceived that consistently wearing a facemask is highly effective in preventing coronavirus infection. Respondents from Oromia perceived less about the effectiveness of wearing facemask in preventing coronavirus infection (adjusted OR = 0.27, 95% CI:0.17–0.45). About 19% of the respondents reported that they had ever tested for COVID-19. Respondents between 40–49 years old (adjusted OR = 0.41, 95% CI:0.22–0.76) and 50–66 years (adjusted OR = 0.43, 95% CI:0.19–0.95) were less likely tested for coronavirus than the younger age groups. Similarly, respondents from Oromia were less likely to test for coronavirus (adjusted OR = 0.26, 95% CI:0.12–0.56) than those from national level. Participants who were sure about the availability of COVID-19 testing were more likely to test for coronavirus. About 57% of the respondents perceived that the policy measures in response to the pandemic were inadequate. The findings showed higher social distancing and preventive practices among the government employees in response to COVID-19. Rules and regulations imposed by the government should be enforced and people should properly apply wearing facemasks, frequent handwashing, social and physical distancing measures as a comprehensive package of COVID-19 prevention and control strategies.

Background Malaria remains a major public health concern in many low-income nations, including Ethiopia. Monitoring malaria trends through surveillance data is critical for informing control efforts and guiding stakeholders. As a result, we analyzed the five-year trend of malaria morbidity and mortality, distribution of malaria cases by Plasmodium species, demographic characteristics, and geographic areas, and identified potential gaps in malaria control efforts in the former Southern Nations, Nationalities, and Peoples’ Region (SNNPR), Ethiopia, from 2017 to 2021 retrospectively. Objective This study aimed to conduct a retrospective analysis of malaria surveillance data in the former SNNPR, Ethiopia (2017–2021). Methods A retrospective analysis of malaria surveillance data from the former SNNPR was conducted from February 1 to 28, 2022. Data were collected, entered, cleaned, and analyzed using Microsoft Excel 2016. Descriptive analysis was performed, and results were presented using figures and maps. Results Overall, 6,292,147 suspected malaria cases were tested, with 999,687 (15.89%) confirmed positive in the laboratory and treated. Among confirmed malaria cases, 679,787 (68%) were caused by Plasmodium falciparum and 319,900 (32%) by Plasmodium vivax . Additionally, 16,023(1.6%) were clinically diagnosed without laboratory confirmation. Malaria cases increased from 214,095 (13 per 1,000) in July 2021 to 270,274 (16 per 1,000) in December 2021. Over the five years, the highest malaria cases were reported in South Omo (22%), Gamo (19%), Wolaita (17%), Gofa (10%), and Hadiya (5%) zones. On average, 206,942 malaria cases were reported annually, with an incidence rate of 12 cases per 1,000 population, indicating a moderate risk level for the region. The malaria burden strata of the former SNNPR showed that transmission levels were moderate (annual parasite incidence (API) 10–100 cases per 1000) [Basketo, South Omo, Gofa, Konso, Gamo, Derashe, Ale, Wolaita, and Burji]; low (API 1–10 cases per 1,000) [Halaba, Amaro, Kambata, Silte, Hadya, Gedeo, and Gurage]; and very low or pre-elimination (API < 1 case per 1,000) [Yem special district]. Conclusion Malaria continues to be a significant health challenge in the former SNNPR, with ongoing transmission in South Omo, Basketo, Gofa, Gamo, Derashe, Ale, Wolaita, and Burji. Seasonal peaks and increasing trends in 2021 highlight the need for action. We recommend enhancing surveillance, focusing on high-burden regions, and expanding vector control and community education, especially before peak seasons, to reduce transmission and achieve elimination goals.

Abstract Introduction Many women in rural Ethiopia do not receive adjuvant therapy following breast cancer surgery despite the majority being diagnosed with estrogen-receptor-positive breast cancer and tamoxifen being available in the country. We aimed to compare a breast nurse intervention to improve adherence to tamoxifen therapy for breast cancer patients. Methods and Materials The 8 hospitals were randomized to intervention and control sites. Between February 2018 and December 2019, patients with breast cancer were recruited after their initial surgery. The primary outcome of the study was adherence to tamoxifen therapy by evaluating 12-month medication-refill data with medication possession ratio (MPR) and using a simplified medication adherence scale (SMAQ) in a subjective assessment. Results A total of 162 patients were recruited (87 intervention and 75 control). Trained nurses delivered education and provided literacy material, gave additional empathetic counselling, phone call reminders, and monitoring of medication refill at the intervention hospitals. Adherence according to MPR at 12 months was high in both the intervention (90%) and control sites (79.3%) (P = .302). The SMAQ revealed that adherence at intervention sites was 70% compared with 44.8% in the control sites (P = .036) at 12 months. Persistence to therapy was found to be 91.2% in the intervention and 77.8% in the control sites during the one-year period (P = .010). Conclusion Breast nurses can improve cost-effective endocrine therapy adherence at peripheral hospitals in low-resource settings. We recommend such task sharing to overcome the shortage of oncologists and distances to central cancer centers. In Ethiopia, most patients are estrogen-receptor-positive and could benefit from an endocrine therapy such as tamoxifen; however, endocrine therapy is under-utilized in the country. This article describes a trained breast nurse intervention that was implemented to improve adherence to tamoxifen therapy.

Background In Ethiopia, the Human Papillomavirus (HPV) type distribution is still not well characterized among women with Human Immunodeficiency Virus (HIV). This study aimed to assess the prevalence of HPV infection, determine the distribution of HPV genotypes, and examine the rate of abnormal findings from visual inspection with acetic acid (VIA) among HPV-positive women living with HIV (WWH) in Addis Ababa, Ethiopia. It also analyzed the factors associated with these findings. Methodology A retrospective record review was conducted at 16 HPV-DNA testing health facilities in Addis Ababa, Ethiopia. A total of 3303 WWH were screened for HPV infection through self- and clinician-based cervical swab collection from April 2021 to January 2022, all were included in the study. WWH were offered HPV testing at antiretroviral therapy (ART) clinics. Trained nurses invited women positive for high-risk HPV (hrHPV) types for VIA screening. Women with suspicious lesions were referred to gynaecologic centres, and others were appointed for a follow-up visit after one year. Associations between independent variables and HPV-DNA as well as VIA positivity were assessed using Binary logistic regression. Result The prevalence of hrHPV infection was 28.7% (95% CI: 27.2, 30.3%). Of those, 145 (15.3%) had HPV 16, and 38 (4%) had HPV 18 and the rest larger proportion was “other high-risk HPV” accounted for 695 (73.3%). The data showed that 70 (7.4%) women had multiple hrHPV infection, meaning ≥ 2 HPV DNA types were found in a single sample. This study found that the odds of women aged 25–29 being infected with hrHPV was 68% higher than those of women aged 40–49 (Adjusted Odds Ratio (AOR) = 1.68, 95% CI 1.26, 2.22). Women who were married and widowed had lower odds of hrHPV infection as compared to divorced women. Out of 948 hrHPV-positive clients, 786 (82.9%) had a follow up VIA screening, of which 15.5% (122) were found to be VIA positive. A history of STI was significantly associated with VIA positivity (AOR = 1.69, 95% CI 1.12, 2.54). Conclusion The prevalence of hrHPV in WWH was high as compared to other studies done in Ethiopia, particularly that of HPV 16 and “other hrHPV”. Prevalence of cervical lesion based on VIA was higher as compared to other studies that did not initially screen for hrHPV infection. This underlines the need to offer screening services to WWH and further characterize the other hrHPV. Screening for cervical lesions is of particular importance in women who report a history of STIs.

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. 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. 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). 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.

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. Disorganized patient referral pathways may cause delays in cancer diagnosis and treatment. This article describes referral patterns and pathways of patients diagnosed at primary and secondary hospitals in rural Ethiopia and assesses factors that contributed to the successful completion of referrals. Opportunities to increase early cancer diagnosis and treatment are identified.

Background Early diagnosis is a key determinant of breast cancer prognosis and survival. More than half of breast cancer cases are diagnosed at an advanced stage in Ethiopia, and the barriers to early diagnosis in this country are not well understood. We aimed to identify the perceived barriers to early diagnosis of breast cancer from the perspective of patients and health care providers in south and southwestern Ethiopia. Methods A qualitative study was conducted from March to April 2018 using in-depth interviews of breast cancer patients and breast cancer health care providers from six public hospitals located in urban and rural areas of south and southwestern Ethiopia. All participants provided verbal consent before participating. A thematic analysis was performed using Open Code 4.02. Results Twelve breast cancer patients and thirteen health care providers were included in the study. Patient and health-system related barriers to early diagnosis of breast cancer were identified. Patient-related barriers were lack of knowledge and awareness of breast cancer, belief in traditional medicine and religious practices for treatment, and lack of social and financial support to seek care at a medical facility. Health-system related barriers were misdiagnosis of breast cancer, long distance to referral facilities, high cost of diagnostic services, long waiting time for diagnostic tests, and lack of screening and diagnostic tests in local facilities. Conclusions Early diagnosis of breast cancer is affected by multiple barriers in south and southwestern Ethiopia. Awareness campaigns and education about the disease, prevention, and early detection are needed to increase early diagnosis of breast cancer. Opportunities exist to improve early diagnosis and timely treatment in rural areas.

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.

Shisha smoking is also known as hookah, water pipe, goza, and nargile. Shisha use among the young is increasing globally. Shisha smoke results in a high concentration of carbon monoxide, tar, nicotine, and heavy metals which can be toxic to humans, especially with chronic exposure. This study aims to determine the prevalence and risk factors of shisha smoking among in-school adolescents in Ethiopia. Four regional states in Ethiopia (Oromia, Amhara, Southern Nations, Nationalities, and Peoples’ Region, Tigray) and the capital city (Addis Ababa) were the study areas. A two-stage cluster sampling approach was employed to produce a representative sample. From the sampling frames in the study areas, 36 high schools were selected randomly. A multi-level logistic regression analysis was used to account for cluster-specific random effects, the effect of individuals’, and school-level variables for ever-use of shisha. A total of 3355 secondary school grade 9 and 10 students aged between 13 and 22 years took part in this study. A total of 86 (2.6%) and 20 (0.6%) of the study participants, reported that they had ever smoked or were current smokers of shisha, respectively. Of all study participants, 38.6% perceived shisha as less harmful than cigarettes and 48.5% reported that they do not know which was more harmful to health. Students were more likely to ever use shisha if they had friend/s who smoke shisha (AOR = 16.8, 95% CI: 6.4–44.3), ever smoked cigarettes (AOR = 8.2, 95% CI: 3.4–19.8), ever used khat (AOR = 4.2, 95% CI: 1.9–10.4), ever used marijuana (AOR = 3.9, 95% CI: 1.4–11.1), ever used smokeless tobacco (AOR = 3.1 95% CI: 1.1–8.4), and students had received income from their parents (AOR = 3.1 CI: 1.1–8.8). Prevalence of ever and current use of shisha among high school students is low in Ethiopia compared to many countries in Africa. The majority of adolescents perceived shisha as less harmful to health than cigarette smoking. Health education about the harmful effects of shisha should be delivered to adolescents, along with information on other substances like khat, cigarettes, marijuana, and smokeless tobacco to prevent initiation of substance use.