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Malnutrition is one of the most devastating problems in Ethiopia and is inextricably linked with poverty. Women in the reproductive age group and children are most vulnerable to malnutrition due to low dietary intakes, inequitable distribution of food within the household, improper food storage and preparation, dietary taboos, infectious diseases, and care. Therefore, this study aimed to assess the spatial distribution and determinants of undernutrition among reproductive age of Ethiopia. The study was based on the 2016 Ethiopian Demographic and Health Survey. The study included a total sampled weight of 15,139 women aged 15-49 years. The ArcGIS version 10.7 and SaTScan version 9.6 statistical software were used for exploring the spatial distribution of undernutrition. A multilevel logistic regression model was fitted to determine the individual and community level factors associated with women undernutrition. Finally, the factors which were significant at 95% confidence interval were reported. The spatial analysis revealed that women undernutrition was significantly varied across the country. The SaTScan analysis identified a total of 144 significant hotspot areas of maternal undernutrition with three significant spatial windows. Of these, 134 clusters were primary. The primary spatial window was identified in the southeast Tigray, northwest Afar, central and north Amhara regions (LLR = 57.48, P<0.01, RR = 1.51). Age at first marriage (AOR = 1.57: CI 1.33, 1.99), middle wealth index (AOR = 3.15: CI 1.4, 6.97), rural residence (AOR = 2.82: CI 1.22, 6.52), being in Afar region, Tigray region and Harari region (AOR = 4.88: CI 1.71, 13.91), (AOR = 4.17: CI 1.57, 11.06) and (AOR = 3.01: CI 1.05, 8.68) respectively were significantly associated with women undernutrition. In Ethiopia, undernutrition had significant spatial variations across the country. Residence, age at first marriage, wealth index and region were significantly associated with undernutrition. Therefore, public health interventions that reduce reproductive age women undernutrition and enhance women awareness towards undernutrition in hotspot areas of undernutrition is crucial.

The Ethiopian Federal government has locked down schools as one measure to contain Covid-19 pandemic. Psychological effect of COVID-19 on students is increased due to the reopening of schools. The psychological effect of the pandemic is increasing along with physical aspect of health. Therefore, this study aimed to assess the psychological impact of Covid-19 and its contributing factors of students' behavior in Ethiopia. A cross sectional design was conducted from November to December 2020. Data were collected using pre tested self- administered questionnaire from secondary school students in Gondar city North West Ethiopia. Stratified simple random sampling technique was used to select 403 secondary school students. Data were entered and cleaned with Epidata version 4.62 and exported for analysis STATA version 14. Multivariable logistic regression and multiple linear regression were used to show the association of dependent and independent variables. Independent variables in relation to dependent variable measured using odd ratios and B coefficient with 95% confidence interval for Covid-19 anxiety and preventive behavior of Covid-19 respectively were used. A total of 370 students were participated giving response rate of 92%. The prevalence of Covid-19 anxiety and obsession among secondary school students were 38.1% and 40.27% respectively. Being 11thgrade 54% (AOR = 0.46; 95%CI:0.22, 0.95) and increased knowledge16% (AOR = 0.84;95%CI: 0.77, 0.89) score associated with decreased COVID-19 anxiety while Covid-19 obsession, 14.51 times (AOR = 14.51;95%CI: 8.05, 26.17), and being female 1.6 times (AOR = 1.6; 95%CI: 1.01, 2.51) increased Covid-19 Anxiety. Furthermore, increased self-efficacy 0.5 times (B = 0.5; 95%CI: 0.28, 0.62), and increased cues to action 0.4 times (B = 0.4; 95% CI: 0.19, 0.69) increased preventive behavior of Covid-19 while perceived barrier 0.1 times (B = -0.1; 95%CI:-0.22, 0.01) decrease preventive behavior of Covid-19. Almost two individuals of five participants developed COVID-19 anxiety and COVID-19 obsession. Being grade 11th and knowledge were negatively associated with anxiety while being female and being obsessed with COVID-19 were positively associated with anxiety. No variable was associated with obsession of Covid-19. Intervention is needed to reduce anxiety among females. Furthermore, perceived barrier, self-efficacy and cues to action were significant factors of preventive behaviour of Covid-19. Therefore, to increase preventive behaviour of Covid-19, information, education and communication and behavioural change communication should be targeted on reducing barriers and increasing motivations and confidences.

BackgroundThe Ethiopian Federal government has locked down schools as one measure to contain Covid-19 pandemic. Psychological effect of COVID-19 on students is increased due to the reopening of schools. The psychological effect of the pandemic is increasing along with physical aspect of health. Therefore, this study aimed to assess the psychological impact of Covid-19 and its contributing factors of students' behavior in Ethiopia.MethodsA cross sectional design was conducted from November to December 2020. Data were collected using pre tested self- administered questionnaire from secondary school students in Gondar city North West Ethiopia. Stratified simple random sampling technique was used to select 403 secondary school students. Data were entered and cleaned with Epidata version 4.62 and exported for analysis STATA version 14. Multivariable logistic regression and multiple linear regression were used to show the association of dependent and independent variables. Independent variables in relation to dependent variable measured using odd ratios and B coefficient with 95% confidence interval for Covid-19 anxiety and preventive behavior of Covid-19 respectively were used.ResultsA total of 370 students were participated giving response rate of 92%. The prevalence of Covid-19 anxiety and obsession among secondary school students were 38.1% and 40.27% respectively. Being 11thgrade 54% (AOR = 0.46; 95%CI:0.22, 0.95) and increased knowledge16% (AOR = 0.84;95%CI: 0.77, 0.89) score associated with decreased COVID-19 anxiety while Covid-19 obsession, 14.51 times (AOR = 14.51;95%CI: 8.05, 26.17), and being female 1.6 times (AOR = 1.6; 95%CI: 1.01, 2.51) increased Covid-19 Anxiety. Furthermore, increased self-efficacy 0.5 times (B = 0.5; 95%CI: 0.28, 0.62), and increased cues to action 0.4 times (B = 0.4; 95% CI: 0.19, 0.69) increased preventive behavior of Covid-19 while perceived barrier 0.1 times (B = -0.1; 95%CI:-0.22, 0.01) decrease preventive behavior of Covid-19.ConclusionAlmost two individuals of five participants developed COVID-19 anxiety and COVID-19 obsession. Being grade 11th and knowledge were negatively associated with anxiety while being female and being obsessed with COVID-19 were positively associated with anxiety. No variable was associated with obsession of Covid-19. Intervention is needed to reduce anxiety among females. Furthermore, perceived barrier, self-efficacy and cues to action were significant factors of preventive behaviour of Covid-19. Therefore, to increase preventive behaviour of Covid-19, information, education and communication and behavioural change communication should be targeted on reducing barriers and increasing motivations and confidences.

Background Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. Methods Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model. Results Household iodized salt utilization was spatially clustered in Ethiopia (Moran’s Index = 0.076, p -value = 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Significant cold spot areas (areas with low iodized salt utilization) were found in Somali, and East Afar regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14–1.93), high community level education (AOR = 1.51, 95% CI = 1.03–2.20), middle wealth index (AOR = 1.31, 95% CI = 1.04–1.65) and high community media exposure (AOR = 1.52, 95% CI = 1.07–2.17) had higher odds of iodized salt utilization. Conclusions Household iodized salt utilization had significant spatial variation across the country . Both household and community level variables were found to be associated with household iodized salt utilization in Ethiopia. Therefore, increasing the education level, wealth status and community media exposure is recommended to improve iodized salt utilization in a country. A targeted intervention is also needed for those regions with low household iodized salt utilization.

Background Human immunodeficiency virus (HIV) counseling and testing services are vital to reduce the spread of HIV infection, and to create an opportunity for early treatment and reduction of HIV/AIDS-related mortality. However, only 12 sub-Saharan African (SSA) countries reached the first 90% target (90% of people living with HIV to know their status). Hence, this study aimed to investigate the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. Methods Ethiopian Demographic and Health Survey (EDHS 2016) data was used to identify the determinants of HIV counseling and testing among reproductive-age women in Ethiopia. A weighted sample of 14,599 reproductive age women was included in the study. A multilevel binary logistic regression model was fitted to identify the determinants of HIV counseling and testing. The odds’ ratio with a 95% Confidence Interval (CI) and the corresponding P-value ≤ 0.05 was employed to declare the statistically significant variables. Results In this study, both individual and community-level variables were significantly associated with Voluntary Counseling and Testing (VCT) uptake among women. Women aged 25–34 years (Adjusted Odds Ratio (AOR) 2.29, 95% CI 2.05, 2.56), aged ≥ 35 years (AOR 1.55, 95% CI 1.38, 1.75), attending primary education (AOR 1.68, 95% CI 1.51, 1.88), secondary education (AOR 3.07, 95% CI 2.64, 3.58), and higher education (AOR 5.15, 95% CI 4.17, 6.36), women with medium household wealth (AOR 1.56, 95% CI 1.32, 1.84), richer (AOR 1.88, 95% CI 1.58, 2.24), and richest wealth index (AOR 2.37, 95% CI 1.91, 2.94), having comprehensive knowledge (AOR 1.21, 95% CI 1.06, 1.37), ever married (AOR 3.87, 95% CI 3.46, 4.32), having sexual risky behavior (AOR 2.09, 95% CI 1.69, 2.49), women from communities with high HIV knowledge (AOR 2.03, 95% CI 1.68, 2.45), women from communities with high literacy level (AOR 1.16, 95% CI 1.05, 1.51) and women from communities with high wealth quintile (AOR 1.20, 95% CI 1.03,1.57) had higher odds of VCT uptake. However, those women having stigma (AOR 0.81, 95% CI 0.74, 0.92) had reduced odds of VCT uptake. Conclusion This study revealed that not only individual level factors but also community level factors determine the status of HIV voluntary counseling and testing. Hence, strengthening both individual and community based interventions are crucial to increase the women HIV counseling and testing practice in the country.

Background Postnatal care (PNC) visits provide a huge benefit for ensuring appropriate breastfeeding practices, to monitor the overall health status of the newborn, to timely diagnose and intervene birth-related complications, and to plan future family planning options. Despite delayed PNC attendance have a great impact on the survival of the mother and the newborn it still receives less emphasis. As a result, most mothers do not receive PNC services early. We, therefore, aimed to determine individual and community level factors associated with delayed first Postnatal Care attendance among reproductive age group women in Ethiopia. Methods We used the most recent Ethiopian Demographic and Health Survey (EDHS 2016) data to determine associated factors of delayed first PNC in Ethiopia. A weighted sample of 4308 women with a live birth in the two years preceding the survey was included. A multilevel logistic regression analysis was used to analyze the data. Variables with p-value < 0.05 in the multivariable multilevel logistic regression analysis were declared significantly associated with delayed first PNC attendance. Results In this study, both individual level and community level factors were associated with delayed PNC attendance. Among the individual level factors: having four or more antenatal care visit [Adjusted Odd Ratio (AOR) = 0.73; 95% CI: 0.59, 0.92], delivery at a health facility [AOR = 0.04; 95% CI: 0.03, 0.05], and perceiving distance from the health facility as not a big problem [AOR = 0.73; 95% CI: 0.58, 0.91] were associated with lower odds of delayed first PNC attendance. Of community level factors: being in Oromia [AOR = 2.31; 95% CI: 1.38, 3.83] and Gambela [AOR = 2.01; 95% CI: 1.13, 3.56] regions were associated higher odds of delayed first PNC attendance. Conclusions Both individual level and community level factors were found to be associated with delayed PNC attendance. Strengthening antenatal care utilization, institutional delivery, and appropriate distributions of maternal health services in each region and areas far apart from the health facility are recommended.

Introduction. Amhara region has one of the highest rates of female child early marriage in Ethiopia, with eighty percent of girls in the region being married at the age of eighteen. Therefore, this study was intended to assess the prevalence and determinants of early marriage among women, in Amhara regional state. Methods. The data were extracted from the 2016 Ethiopian Demographic and Health Survey. The study included a sample of 2887 (weighted) married women from 645 clusters in Amhara regional state. The data were collected using a two-stage cluster design that includes the selection of enumeration areas as a first stage and selection of households as a second stage. A multilevel logistic regression model was fitted to determine the individual and community-level factors associated with early marriage. Result. The study revealed that 73% [95% CI 71.38, 74.62] of women aged 15–49 years were married before 18 years old. In the multilevel multivariable model; living as a rural dweller (AOR=4.33; 95% CI: 2.17, 8.64), no education (AOR=2.52; 95% CI: 2.23, 9.51), attending only primary education (AOR=2.31; 95% CI: 1.68, 8.53), parental decision-maker when to get marriage (AOR=3.44; 95% CI: 2.20, 5.39), being poorer (AOR=1.38; 95% CI: 1.16, 4.83), and poorest wealth status (AOR=2.37; 95% CI: 2.19, 7.83) were the independent predictors of early marriage. Conclusion. The prevalence of early marriage was high in Amhara region compared to other regions of the country. Therefore, the regional government should give due attention to access to education and encourage women’s decision-making power upon the time of marriage especially those residing in rural parts of the region.

Background: Iodine deficiency disorder is a significant public health problem, affecting both developed and developing nations worldwide. It is associated with poor body growth and irreversible mental retardation. However, little is known about the spatial distribution and determinants of household iodized salt utilization in Ethiopia. Therefore, this study aimed to explore the spatial distribution and determinants of iodized salt utilization at national level. Methods : Ethiopian Demographic and Health Survey 2016 data was used to investigate the spatial distribution and determinants of household iodized salt utilization in Ethiopia. ArcGIS 10.6 and SaTScan™ version 9.6 software were used to explore the spatial distribution and detect significant clusters, respectively. We used STATA version 14 software to analyze the determinants of household iodized salt utilization. The odds ratio with its 95% confidence interval (CI) was determined for potential determinants included in the multivariable multilevel logistic regression model and the corresponding p-value ≤ 0.05 was employed to declare the statistically significant variables. Results : Household iodized salt utilization was spatially clustered in Ethiopia (Moran’s Index = 0.076, p-value= 0.01). The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Those households with higher education level ((Adjusted Odds Ratio [AOR] =1.49, 95% CI =1.14-1.93), high community level education (AOR=1.51, 95% CI=1.03-2.20), middle wealth index (AOR=1.31, 95% CI=1.04-1.65) and high community media exposure (AOR=1.52, 95% CI=1.07-2.17) had higher odds of iodized salt utilization. Conclusions : Household iodized salt utilization had significant spatial variation across the country . The significant hotspot areas with high iodized salt utilization were located in Benishangul, Amhara, Gambella, Tigray and Northwest Oromia regions. Households with higher education level, high community level education and high community media exposure and middle wealth index had higher odds of iodized salt utilization. Increasing education level, wealth status and community media exposure is recommended to increase iodized salt utilization. A targeted intervention is also needed for those regions with low household iodized salt utilization.

ObjectiveThe aim of this study was to explore spatiotemporal distribution of under-five mortality in Ethiopia using data from four (2000, 2005, 2011 and 2016) consecutive demographic and health surveys.MethodsA total of 41 498 children were included from four consecutive Ethiopian Demographic and Health Surveys. The geospatial analysis was conducted by using ArcGIS V.10.7 and saTScan V.9.6. Thus, spatial autocorrelation, hotspot analysis, spatial interpolation and spatial scan statistics were carried out for each survey separately to show the temporal pattern of geographically risk areas of under-five mortality in Ethiopia. Finally, the most under-five mortality rate (U5MR) risk areas in each survey period were mapped.ResultsUnder-five mortality was spatially clustered in Ethiopia (Moran’s Index: 0.046–0.096, p<0.01). The Benishangul-Gumuz region was consistently at a higher risk in the last two decades. Additional hotspot areas were detected at Afar and Amhara (in 2000, 2005, 2016), at Gambala (in 2011) and the South Nation Nationality and People’s (SNNP) Region (in 2016). Moreover, 160 primary clusters were identified. Of these, 85 clusters (log-likelihood ratio (LLR)=13.10, p<0.01) were from Benishangul-Gumuz and Amhara regions (in 2000); 67 clusters (LLR=12.93, p<0.01) were from Afar and Amhara regions (in 2005); 4 clusters (LLR=10.54, p<0.01) were from Benishangul-Gumuz region (in 2011); and another 4 clusters (LLR=11.85, p<0.01) were from Afar region (in 2016).ConclusionHigh-risk areas were detected mainly in the Benishangul-Gumuz and Afar regions. As a result, designing under-five population targeted intervention programmes in those high-risk geographical regions was vital to reduce under-five mortality in Ethiopia.

Because biometric data is sensitive, centralized training poses a privacy risk, even though biometric recognition is essential for contemporary applications. Federated learning (FL), which permits decentralized training, provides a privacy-preserving substitute. Conventional FL, however, has trouble with interpretability and heterogeneous data (non-IID). In order to handle non-IID biometric data, this framework adds an attention mechanism at the central server that weights local model updates according to their significance. Differential privacy and secure update protocols safeguard data while preserving accuracy. The A3-FL framework is evaluated in this study using FVC2004 fingerprint data, with each client's features extracted using a Siamese Convolutional Neural Network (Siamese-CNN). By dynamically modifying client contributions, the attention mechanism increases the accuracy of the global model.The accuracy, convergence speed, and robustness of the A3-FL framework are superior to those of standard FL (FedAvg) and static baselines, according to experimental evaluations using fingerprint data (FVC2004). The accuracy of the attention-based approach was 0.8413, while FedAvg, Local-only, and Centralized approaches were 0.8164, 0.7664, and 0.7997, respectively. Accuracy stayed high at 0.8330 even with differential privacy. A scalable and privacy-sensitive biometric system for secure and effective recognition in dispersed environments is presented in this work.