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Khat chewing has become a highly prevalent practice and a growing public health concern in Ethiopia. Although there have been many small scale studies, very limited national information has been available in the general population. This study aimed to identify factors associated with khat chewing practice among Ethiopian adults. The study used the 2011 Ethiopian demographic and health survey data. The survey was cross-sectional by design and used a multistage cluster sampling procedure. Bivariate and multivariable logistic regression models with adjusted odds ratio (AOR) and their 95% confidence intervals (CI) were used to quantify the predictors. The overall khat chewing prevalence was 15.3% (95% CI: 14.90-15.71). Regional variation was observed with the highest in Harari [(53.2% (95% CI: 43.04-63.28)] and lowest in Tigray regional state [(1.1% (95% CI: 0.72-1.66)]. Multivariable analysis showed that Islam followers were 23.8 times more likely to chew khat as compared to Orthodox followers. Being a resident in Oromiya, South Nation, Nationalities and People (SNNP), Gambella, Harari and Dire Dawa regions had 1.9, 1.6, 3.1, 5.2 and 3.5 times higher odds of chewing khat as compared to Addis Ababa residents, respectively. Adults in the age group 45-49 years were 3.6 times more likely to chew khat as compared to 15-19 years. The middle and richest wealth quintiles were 1.3 and 1.5 times more likely to chew khat, respectively, as compared to the poorest category. Rural residents had 1.3 odds of chewing khat than urban residents. Those individuals who had occupation in sales, agriculture, service sector, skilled and unskilled manual workers were 1.6, 1.3, 2.4, 1.7 and 2.3 times more likely to chew khat, respectively, as compared to those who have no occupation. Females were 77% less likely to chew khat as compared to males. Formerly married and those experienced in child death had 1.4 and 1.2 times higher odds to chew khat as compared with those never married and never had child death, respectively. Those who attended mass media were 1.4 times more likely to chew khat compared with not attended. Khat chewing is a public health concern in Ethiopia. The highest wealth quintiles, older age group, rural residence, child death, formerly married, males, regions of Oromiya, SNNP, Gambella, Harari and Dire Dawa and Islamic followers had statistically significant association with khat chewing. Due attention needs to be given for these factors in any intervention procedures.

Background Tobacco is one of the leading preventable causes of non-communicable diseases. Previous studies gave due emphasis only for cigarette smoking with little attention given for other types of tobacco use. This study describes the prevalence of all common forms of tobacco use and identify associated factors among adults in Ethiopia. Methods The study used data from the 2011 Ethiopian demographic and health survey. An index was constructed from yes or no responses for common types of tobacco use. Bivariate and multivariate logistic regression statistical models were employed to determine associated factors with tobacco using adjusted odds ratios (AOR) and their 95 % confidence intervals (CI). Results The overall prevalence of tobacco use was 4.1 % [95 % CI: (3.93–4.37)]. The highest prevalence 16.9 % [95 % CI: (11.02–23.76)] in Gambella and the lowest 0.8 % [95 % CI: (0.48–1.29)] in Tigray regions were reported. The odds of tobacco use in the age group 20–24 and 45–49 years were [AOR = 2.3; 95 % CI: (1.60–3.21)] and [AOR = 9.1; 95 % CI: (6.06–13.54)] more likely to use tobacco, respectively, as compared to the age group 15–19 years. Traditional religion [AOR = 5.5; 95 % CI: (3.96–7.55)], Catholics [AOR = 3.40; 95 % CI: (2.03–5.69)] and Islamic followers [AOR = 2.8; 95 % CI: (2.31–3.32)] had higher odds of using tobacco as compared to Orthodox religion followers. Adults in the poorest wealth quintile were [AOR = 1.4; 95 % CI: (1.05–1.79)] more likely to use tobacco as compared to the richest wealth quintile. The odds of tobacco use among males were higher as compared to females [AOR = 13.08; 95 % CI: (10.24–16.72)]. Formerly married adults were [AOR = 1.71; 95 % CI: (1.20–2.34)] more likely to use tobacco as compared to never married. Adults who were professionally working [AOR = 0.49; 95 % CI: (0.29–0.85)] had less likely to use tobacco as compared to non-working adults. However, adults who were working in sales, skilled and unskilled occupations had [AOR = 1.6; 95 % CI: (1.18–2.24)], [AOR = 1.7, 95 % CI: (1.21–2.50)] and [AOR = 3.8 95 % CI: (2.27–6.23)] more likely to use tobacco, respectively, as compared to non-working adults. Individuals who had experience of child death were [AOR = 1.4; 95 % CI: (1.17–1.63)] more likely to use tobacco as compared to their counterparts. Conclusion The overall prevalence of tobacco use seems low in Ethiopia. However, a significant regional variation of tobacco use was observed. A tailored public health interventions targeting regions with high prevalence of tobacco use is recommended.

There is limited evidence on the burden and drivers of the co-occurrence of overweight/obesity and undernutrition at the individual level in low- and middle-income countries. This gap hinders the design of double-duty actions (DDAs) that can effectively address all forms of malnutrition. This multi-country study aimed to determine the magnitude of double burden of malnutrition (DBM) among under five children and identify household and individual level determinants in Eastern and Southern Africa (ESA) countries. We pooled data of 79,394 children aged 6–59 months, collected from Demographic and Health Surveys (DHS) conducted in 12 ESA countries between 2013 and 2016. We identified confounders a priori . A random effect logistic regression was performed to identify factors associated with the co-occurrence of Stunting and Overweight (StOw), Overweight and Anemia (OwA), and Stunting Overweight and Anemia (StOwA). The study revealed that the burden of co-occurrence of StOwA, StOw, and OwA among under-five children were 5.38%; 95% confidence interval (CI) (5.00-5.79), 4.04 (95% CI: 3.86–4.23), and 5.72% (95% CI: 5.40–6.04), respectively. South Africa had the highest burden of co-occurrence of StOwA (15.58%) and OwA (22.30%), while Namibia and Burundi had the lowest StOwA (2.19%) and OwA (2.78%), respectively. Male children were more likely than female children to experience co-occurrence of StOwA [adjusted odds ratio (AOR) (95% CI): 1.96 (1.49–2.57)], OwA [AOR = 1.51: (95% CI) (1.22, 1.86)], and StOw [AOR = 1.59: (95% CI) (1.36, 1.87)]. Children from the poorest and poorer households had higher odds of co-occurrence of StOwA, OwA, and StOw compared to those from the richest households. Compared to children born to mothers with normal body mass index, those born to mothers with overweight/obese had 60% and 39% higher risk, whereas those born to mothers who were underweight had 49% and 36% lower risk of StOw and OwA, respectively. The DBM among children poses a significant public health and economic problem in ESA countries. The DDAs approach should be strengthened in the ESA region to address all forms of malnutrition.

Adolescent overweight and obesity is a global public health problem, associated with an increased risk of metabolic syndrome. Recently, mid-upper arm circumference (MUAC) has been suggested as a screening tool to identify overweight and obesity among school-age children and early adolescents (5-14 years). However, little is known about the potential use of MUAC in the late adolescence period (15-19 years). Therefore, the present study aimed to evaluate the performance of MUAC to identify overweight (including obesity) in the late adolescence period in Ethiopia. We conducted a cross-sectional study among 851 adolescents aged 15 to 19 years. We collected anthropometric data including MUAC, weight and height with the help of trained field workers. The receiver operating characteristic (ROC) curve analysis was used to examine the validity of MUAC compared to BMI Z score in identifying adolescents with overweight or obesity. Furthermore, we calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), proportion of correctly classified, positive, and negative likelihood ratio for the proposed optimal cut-offs. MUAC was strongly correlated with BMI Z score with a correlation coefficient (r) of 0.81 (95% CI; 0.79-0.84). The optimal MUAC cut-off for identifying adolescents with overweight or obesity was 27.7 cm for males and 27.9 cm for females. The area under the ROC curve (AUC) was 0.96 (95% CI; 0.93-0.98) for males and 0.96 (95% CI; 0.94-0.98) for females. The accuracy level of MUAC to identify adolescents with overweight (including obesity) was high for both sexes (overall a sensitivity of 91.1% and a specificity of 90.3%). MUAC has relatively equivalent accuracy with BMI Z score to identify overweight and obesity in adolescents. Hence, MUAC could be used as an alternative tool for surveillance and screening of overweight in adolescents aged 15-19 years.

Treatment failure defined as progression of disease after initiation of ART or when the anti-HIV medications can't control the infection. One of the major concerns over the rapid scaling up of ART is the emergence and transmission of HIV drug resistant strains at the population level due to treatment failure. This could lead to the failure of basic ART programs. Thus this study aimed to investigate the predictors of treatment failure among adult ART clients in Bale Zone Hospitals, South east Ethiopia. Retrospective cohort study was employed in four hospitals of Bale zone named Goba, Robe, Ginir and Delomena. A total of 4,809 adult ART clients were included in the analysis from these four hospitals. Adherence was measured by pill count method. The Kaplan Meier (KM) curve was used to describe the survival time of ART patients without treatment failure. Bivariate and multivariable Cox proportional hazards regression models were used for identifying associated factors of treatment failure. The incidence rate of treatment failure was found 9.38 (95% CI 7.79-11.30) per 1000 person years. Male ART clients were more likely to experience treatment failure as compared to females [AHR = 4.49; 95% CI: (2.61-7.73)].Similarly, lower CD4 count (<100 m3/dl) at initiation of ART was found significantly associated with higher odds of treatment failure [AHR = 3.79; 95% CI: (2.46-5.84).Bedridden [AHR = 5.02; 95% CI: (1.98-12.73)] and ambulatory [AHR = 2.12; 95% CI: (1.08-4.07)] patients were more likely to experience treatment failure as compared to patients with working functional status. TB co-infected clients had also higher odds to experience treatment failure [AHR = 3.06; 95% CI: (1.72-5.44)]. Those patients who had developed TB after ART initiation had higher odds to experience treatment failure as compared to their counter parts [AHR = 4.35; 95% CI: (1.99-9.54]. Having other opportunistic infection during ART initiation was also associated with higher odds of experiencing treatment failure [AHR = 7.0, 95% CI: (3.19-15.37)]. Similarly having fair [AHR = 4.99 95% CI: (1.90-13.13)] and poor drug adherence [AHR = 2.56; 95% CI: (1.12-5.86)]were significantly associated with higher odds of treatment failure as compared to clients with good adherence. The rate of treatment failure in Bale zone hospitals needs attention. Prevention and control of TB and other opportunistic infections, promotion of ART initiation at higher CD4 level, and better functional status, improving drug adherence are important interventions to reduce treatment failure among ART clients in Southeastern Ethiopia.

Background Disordered eating behaviours (DEBs) are variations in regular eating patterns and behaviours and might include symptoms and behaviours of eating disorder with lower level of severity. Such behaviours are common during adolescence at which time several physical and psychological changes occur favouring unhealthy dietary behaviours. Although the magnitude of DEBs is high among high—income countries, similar data are limited among adolescents with diabetes in low-income countries including Ethiopia. This study aimed to assess the magnitude of DEBs and its relationship with body shape dissatisfaction among adolescents with diabetes on follow-up at selected public hospitals in Addis Ababa, Ethiopia. Methods Hospital based cross sectional study was conducted among randomly selected 395 adolescents with diabetes attending public hospitals in Addis Ababa from January to December, 2021. Data were collected using structured pretested standard diabetes eating problem survey revised (DEPS-R) questionnaire, body part satisfaction scale of 8 items, and anthropometric measurements. Descriptive statistics such as median alongside interquartile range was used to describe the continuous variables. Binary bivariable and multivariable logistic regression was used for data analysis. Mann–Whitney U-test and Kruskal–Wallis test were used to evaluate the difference between median scores of independent variables. Adjusted odds ratios (AOR) alongside 95% confidence intervals (CIs) were estimated to measure the strength of association between variables of interest. Results The magnitude of disordered eating behaviours within the last 30 days was 43.3%, [95% CI: (38%, 48%)]. In multivariable analysis, body shape dissatisfaction [AOR = 2.21, 95% CI (1.28, 3.82, p  = 0.0001)], family history of diabetes mellitus [AOR = 1.59, 95% CI (1.03, 2.47, p  = 0.038)], late adolescence period [AOR = 2.10, 95% CI (1.33, 3.34, p  = 0.002)], having diabetic complication[AOR = 2.32, 95% CI (1.43, 3.75, p  = 0.001)],and being overweight [AOR = 2.25, 95% CI (1.32, 3.82, p  = 0.003)] were significantly associated with DEBs. Conclusions The magnitude of DEBs was high among the study participants. Body shape dissatisfaction, family history of diabetes mellitus, being in late adolescence period, diabetic complication, and nutritional status of adolescents were significantly associated with DEBs. Therefore, preventive interventions need to be designed by all relevant actors working on health promotion of young population to address factors influencing DEBs among adolescent population with diabetes. Plain English summary The World Health Organization (WHO) defined adolescents as individuals in the age bracket of 10–19 years. Biologically, adolescence is a period of development that stretches from the onset of puberty through the termination of growth. This period is a critical link between childhood and adulthood, characterized by significant physical, psychological, and social transitions which carry new risks including the development of disordered eating behaviors among adolescents and opportunities that influence the immediate and future health of young people. This cross-sectional study aimed at assessing the magnitude of disordered eating behaviors and its relationship with body shape dissatisfaction among adolescents with diabetes on follow-up at selected public health facilities. The results showed that the magnitude of disordered eating behaviors is high. Body shape dissatisfaction was found to be statistically significantly associated with disorder eating behaviors during adjusted analysis alongside other attributes which have been identified to have an influence on adolescents’ eating behaviours. A better understanding of the link between individual level attributes and DEBs could help adolescents’ health programmers to launch more conducive interventions targeting the identified risks and researchers to more understand other aspects that could influence the adolescents’ eating behaviors.

Cancer is a growing public health problem worldwide. The focus of cancer treatment, in addition to curation, is improving the quality of life (QOL). This study aimed to assess the reliability and validity of Amharic version of European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) among gynecological cancer patients in Ethiopia. A facility-based cross-sectional study was conducted using the Amharic version of EORTC QLQ-C30 on 153 gynecological cancer patients in Tikur Anbassa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Descriptive statistics, correlation analysis and multivariable linear regression were employed in statistical analysis. The Amharic version of EORTC QLQ-C30 had a Cronbach's α value of 0.81. The internal consistency for each domain of EORTC QLQ-C30 was also acceptable (Cronbach's α >0.7) except for cognitive function domain (Cronbach's α = 0.29). Stepwise multivariable linear regression analysis showed that emotional functioning (p<0.001), fatigue (p<0.001) and social functioning (p = 0.004) were the determinative scales of EORTC QLQ-C30 on global health status (GHS). The clinical validity test (Known group validity) showed that there were significant differences in score for twelve out of 15 domains, between surgery and radiation scheduled patients. All items of emotional function, role function, fatigue, and GHS meet the discriminate validity criterion. The Amharic version of EORTC QLQ-C30 found to be reliable and had an acceptable validity to assess the QOL for gynecological cancer patients. We recommend further work on the validity and responsiveness of the EORTC QLQ-C30 with stronger design.

Background: The widely used nutritional assessment tool used for the elderly includes the Mini Nutritional Assessment (MNA) and Mini Nutritional Assessment-Short Form (MNA-SF) tool. These tools have not been evaluated for their validity and reliability among the elderly population of developing countries such as Ethiopia. This study aimed to evaluate the reliability and validity of the full and short form of the Mini Nutritional Assessment tool among the elderly in Ethiopia. Method: We evaluated the reliability and validity of the tools using a community-based cross-sectional study among 506 elderly individuals. Accuracy, sensitivity, specificity and cut-off point were evaluated to determine the validity of both the full MNA and MNA-SF tool. Reliability was assessed using Cronbach's α coefficient. The criterion-related validity of the MNA tool was evaluated by computing the correlation between the total MNA score and anthropometric measurements. The Youden index was used to determine best cut-off points of the full MNA and MNA-SF. Result: The mean MNA score was 19.9 ± 4.5. Cronbach's α value of the full MNA tool was 0.7. The overall accuracy of the full MNA was 91% (95% CI, 87.5%-94.9%). The sensitivity and specificity of the full MNA tool using an established cut-off point was 87.9% and 89.6% respectively. Youden index analysis showed that the best cut-off point to detect the malnourished and those at risk of malnutrition using the full MNA was 16 (sensitivity 90.4% and specificity 86.8%). The reliability of the MNA-SF as measured by Cronbach's α was 0.5. The overall accuracy of the MNA-SF was found to be 93% (95% CI, 0.90-0.96). By using the Youden index the best cut-off point for MNA-SF to detect malnutrition was 7.5 (sensitivity 85.7% and specificity 89%). Conclusion: The full MNA tool was a valid and reliable tool to identify elderly individuals who are malnourished, at risk of malnutrition and well-nourished with modulation of cut-off points. However, the short MNA tool was valid and but not reliable in this study.

Background Child undernutrition remains the major public health problem in low and middle-income countries including Ethiopia. The effects of good governance, urbanization and public health expenditure on childhood undernutrition are not well studied in developing countries. The objective of the study is to examine the relationship between quality of governance, public health expenditures, urbanization and child undernutrition in Ethiopia. Methods This is pooled data analysis with ecological design. We obtained data on childhood undernutrition from the Ethiopian Demographic and Health Surveys (EDHS) that were conducted in 2000, 2005, 2011 and 2016. Additionally, data on quality of governance for Ethiopia were extracted from the World Governance Indicators (WGI) and public health spending and urbanization were obtained from the World Development Indicators and United Nations’ World Population Prospects (WPP) respectively. Univariate and multivariate analysis were done to assess the relationship between governance, public health expenditure and urbanization with childhood undernutrition. Result Government effectiveness (adjusted odd ratio (AOR) = 20.7; p  = 0.046), regulatory quality (AOR = 0.0077; p  = 0.026) and control of corruption (AOR = 0.0019; p  = 0.000) were associated with stunting. Similarly, government effectiveness (AOR = 72.2; p  = 0.007), regulatory quality (AOR = 0.0015; p  = 0.004) and control of corruption (AOR = 0.0005; p  = 0.000) were associated with underweight. None of the governance indicators were associated with wasting. On the other hand, there is no statistically significant association observed between public health spending and urbanization with childhood undernutrition. However, other socio-demographic variables play a significant effect on reducing of child undernutrition. Conclusion This study indicates that good governance in the country plays a significant role for reducing childhood undernutrition along with other socio-demographic factors. Concerned bodies should focus on improving governance and producing a quality policy and at the same time monitor its implementation and adherence.