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Inadequate adherence to infection prevention and control standards places millions of patients and healthcare workers at risk of infectious diseases worldwide, including healthcare acquired infections. Effective infection prevention and control measures and interventions have been done after the occurrence of the COVID-19 pandemic; however, there is no data that shows infection prevention and control practice of healthcare professionals in West Gojjam zone hospitals. To assess infection prevention practice and associated factors among healthcare professionals in West Gojjam Zone public hospitals. A mixed institutional-based cross-sectional study was conducted among healthcare professionals in West Gojjam Zone public hospitals from March 10 to April 10, 2023. A simple random sampling technique was used to select 454 participants. A structured self-administered questionnaire, key informant interview guide, and observational checklist were used to gather the information. The collected data was entered into Epi-data 4.6 and exported into SPSS version 27 for analysis. For quantitative data, bivariate and multivariate generalized estimating equation analysis was computed, considering p < 0.05 to be statistically significant at the final model. The qualitative data was transcribed, translated, coded, and analyzed thematically. Finally, the qualitative data triangulated with quantitative data. Four hundred thirty-four (95.6%) healthcare professionals participated in the study. The overall infection prevention practice of healthcare professionals in West Gojjam zone hospitals was 32.7% (95% CI: 28.29%-37.15%). Knowledge of participants (1.95, 95% CI: 1.19-3.19), attitude (AOR = 1.96, 95%CI: 1.24-3.12), profession of midwives (AOR = 0.467, 95%CI: 0.24-0.92), and working in Adet, Dembecha, Durbete, Feresbet, Finote Selam, and Liben hospitals, respectively, were the significant factors of infection prevention practice and training. Infrastructure, budget, supplies, and attitude were the challenges of infection prevention supplemented by the qualitative data. The study revealed that overall infection prevention practice was poor. Participant's knowledge, participant's attitude, and participant's profession were significant factors for infection prevention practice, and there was variation in infection prevention practice between hospitals. The identified modifiable factors are the area of intervention to improve infection prevention practices.

In Ethiopia, there are limited studies on age-appropriate vaccinations that children received at the recommended specific ages. Therefore, we assessed age-appropriate vaccinations coverage and its associated factors among children 12 to 23 months of age in Menz Lalo district, northeast Ethiopia. A community-based cross-sectional study was conducted in Menz Lalo district from March to April/2018 among 417 mothers/caregivers with children 12 to 23 months of age using simple random sampling technique. Data were collected using a pretested structured questionnaire. Information about children's vaccination status was collected from vaccination cards. Age-appropriate vaccination coverage was measured using World Health Organization vaccination schedule recommendation. Data was entered into Epi-Info7 software and exported to SPSS-20 for analysis. Four consecutive logistic regression models were performed to identify factors associated with age-inappropriate vaccinations. A P-value of ≤ 0.05 was considered to state statistically significant associations. Age-appropriate vaccination coverage was 39.1% (95% CI: 34.3 to 44) for pentavalent 1, 36.3% (95% CI: 31.6 to 41.5) for pentavalent 2, 30.3% (95% CI: 25.6 to 35) for pentavalent 3 and 26.4% (95% CI: 21.7 to 31) for measles vaccine doses. Age-inappropriate pentavalent 1-3 vaccinations was associated with being male sex (AOR: 0.47, 95% CI: 0.29-0.74), lack of telephone (AOR: 2.2, 95% CI: 1.4-3.6), lack of usual caretaker (AOR: 2.6, 95% CI: 1.3-5.2), unplanned pregnancy (AOR: 1.9, 95% CI: 1.1-3.5), missing pregnant women's conference (AOR: 2.7, 95% CI: 1.3-5.7), decreasing birth order (AOR: 0.34, 95% CI: 0.17-0.68) and insufficient knowledge (AOR: 2.7, 95% CI: 1.6-4.4). The proportions of age-appropriate vaccination coverage were low in the study area. Modifiable factors were associated with age-inappropriate vaccinations. Vaccination interventions should consider identified modifiable factors to improve age-appropriate vaccinations coverage.

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.

In Ethiopia, malaria remains a major public health problem. To eliminate malaria, parasite clearance interventions were implemented in six kebeles (the lowest administrative unit) in the Amhara region. Understanding the spatiotemporal distribution of malaria is essential for targeting appropriate parasite clearance interventions to achieve the elimination goal. However, little is known about the spatiotemporal distribution of malaria incidence in the intervention and non-intervention areas. This study aimed to investigate the spatiotemporal distribution of community-based malaria in the intervention and non-intervention kebeles between 2013 and 2018 in the Amhara Regional State, Ethiopia. Malaria data from 212 kebeles in eight districts were downloaded from the District Health Information System2 (DHIS2) database. We used Autoregressive integrated moving average (ARIMA) model to investigate seasonal variations; Anselin Local Moran's I statistical analysis to detect hotspot and cold spot clusters of malaria cases; and a discrete Poisson model using Kulldorff scan statistics to identify statistically significant clusters of malaria cases. The result showed that the reduction in the trend of malaria incidence was higher in the intervention areas compared to the non-intervention areas during the study period with a slope of -0.044 (-0.064, -0.023) and -0.038 (-0.051, -0.024), respectively. However, the difference was not statistically significant. The Global Moran's I statistics detected the presence of malaria clusters (z-score = 12.05; p<0.001); the Anselin Local Moran's I statistics identified hotspot malaria clusters at 21 locations in Gendawuha and Metema districts. A statistically significant spatial, temporal, and space-time cluster of malaria cases were detected. Most likely type of spatial clusters of malaria cases (LLR = 195501.5; p <0.001) were detected in all kebeles of Gendawuha and Metema districts. The temporal scan statistic identified three peak periods between September 2013 and November 2015 (LLR = 8727.5; p<0.001). Statistically significant most-likely type of space-time clusters of malaria cases (LLR = 97494.3; p<0.001) were detected at 22 locations from June 2014 to November 2016 in Metema district. There was a significant decline in malaria incidence in the intervention areas. There were statistically significant spatiotemporal variations of malaria in the study areas. Applying appropriate parasite clearance interventions is highly recommended for the better achievement of the elimination goal. A more rigorous evaluation of the impact of parasite clearance interventions is recommended.

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.

Young person's susceptibility to sexually transmitted infection has been consistently linked to intractable work places. In Ethiopia, different behavior related interventions had carried out to raise awareness of risky sexual behaviors and their consequences. However, there is still limited information on risky sexual practices. A cross-sectional study was conducted among the big construction site daily laborers from April 1, 2019 to May 30, 2019. A pre-tested questionnaire was used for data collection, and data were entered into Epidata and transported to SPSS for analysis. Independent variables with p < 0.05 in the multivariate analysis were considered to have a statistically significant association with risky sexual practice. Among 627 sample respondents, the magnitude of risky sexual practice was found to be 24.2%. Labor workers who had a history of an STIs (AOR = 4.29; 95% CI: 2.56, 7.19), those who enjoy in the nightclubs (AOR = 2.33; 95% CI: 1.34, 4.08), those who started sex by peer pressure (AOR = 3.42; 95% CI: 2.06, 5.68), substance users (AOR = 2.03; 95% CI: 1.08, 3.82), those who were unable to read and write (AOR = 3.65; 95% CI: 1.41, 9.67), living independently (AOR = 3.71; 95% CI: 1.78, 7.77) and living with relatives (AOR = 3.12; 95% CI: 1.06, 9.20) were statistically associated with risky sexual practice. The magnitude of risky sexual practice among big constriction daily laborers was high in Bahir Dar City likely to increase their vulnerability to HIV. The findings of this study show the need of targeted HIV prevention plan to give due attention for daily laborers who had a history of an STI, enjoy in the night clubs, peer pressure, substance users, educational status and living arrangement. The Amhara Education Bureau and the city education department have to design ways to deliver at least a high school education.

Background: Wastewater treatment is crucial to protecting public health and the environment by removing Biohazards. In Ethiopia, however, significant research gaps limit progress, especially regarding the efficiency of Biohazard removal in existing treatment facilities. This review evaluates the effectiveness of current treatment methods for Biohazard removal, highlights key challenges, and offers recommendations. Methods: This scoping review followed PRISMA guidelines, systematically searching databases like NLM. Science Direct, HINARI and Scopus for Biohazard removal studies in Ethiopia, with independent reviewers screening and analyzing relevant data to identify key challenges. Results: Out of 1218 studies initially recorded by title and abstract, only 11 articles were selected for analysis. The Activated Sludge Process emerged as a highly effective system, achieving 85% to 95% removal of antimicrobial resistance (AMR) and total coliforms. Other methods, such as the Conventional Activated Sludge, and Anaerobic-Aerobic Reactors, demonstrated promising results but were found only in select locations. However, the widely adopted Oxidation Ponds, Ethiopia’s most common wastewater treatment system, showed the lowest AMR removal efficiency, at just 30% to 50%. Significant challenges, including inadequate infrastructure, high operational costs, and weak regulatory enforcement. Conclusions and recommendations: The review underscores the need for affordable wastewater treatment in Ethiopia, highlighting challenges such as inadequate infrastructure and high costs. To enhance effectiveness and reduce public health risks from Biohazards like AMR, recommendations include adopting cost-effective treatment technologies, strengthening regulatory frameworks, increasing public awareness, promoting corporate responsibility, and investing in infrastructure for sustainable wastewater management. This scoping review highlights the Activated Sludge Process and Anaerobic-Aerobic Reactors as effective methods, achieving 85% to 95% AMR removal. In contrast, Oxidation Ponds, commonly used in Ethiopia, show only 30% to 50% efficiency. Addressing challenges like inadequate infrastructure and costs is crucial, necessitating low-cost technologies for sustainable wastewater management. Graphical Abstract

Understanding spatial, temporal, and spatiotemporal variations of chronic respiratory disease (CRD) is significant for the early prevention of the disease and efficient allocation of scarce healthcare resources. However, this is not well known in the Ethiopian context, particularly in charcoal-producing areas. Thus, this study aimed to assess the spatial, temporal, and spatiotemporal variations of CRD in northwest Ethiopia from 2012/13 to 2018/19. This study was conducted in three zones (Awi, East Gojjam, and West Gojjam), Amhara Region, Ethiopia. These zones are known for charcoal production. Data on CRD among those aged 15 years and above were obtained from 44 districts for seven years from the three zonal health departments’ annual records. Scan statistics with a discrete Poisson model was used to identify statistically significant clusters using SaTScan version 10.1. Global Moran’s I and Getis-Ord Gi statistics were employed to assess the spatial heterogeneity and hot spot areas of CRD respectively. To display maps of cluster locations, ArcGIS version 10.8 was used. The annual morbidity rate of CRD was remarkably varied from 305 to 731per 100,000 population in 2012/13 and 2018/19 respectively. The highest annual morbidity rate, 6508/100,000 population, was observed in the Awi zone. The global spatial autocorrelation (Moran’s I = 0.2772, Z-score = 3.6597, and P-value < 0.001) shows a strong clustered distribution. The most likely purely spatial and spatiotemporal clusters were detected in eleven districts, and eight of these were in the Awi zone. The cluster center/radius was 10.967700 N, 36.925500 E/ 48.37 km, and RR = 4.37, p-value < 0.001. People living in the highest risk areas had a 4.37 times greater chance of developing CRD than those in the lowest risk areas. The Getis-Ord Gi hot spot analysis detected that hot spot clusters were primarily located in the northwest and southwest parts of the study area . The spatial, temporal, and spatiotemporal variations of CRD were non-random and clustered in high charcoal production areas. The identified high-risk clusters are the priority areas for target intervention. Further research is recommended to identify risk factors for higher clusters of CRD morbidity in these areas.

menstruation significantly affects schoolgirls' academic attendance and performance. This study aims to explore the relationship between monthly menstruation along with the availability of water, sanitation and hygiene services, and school attendance among schoolgirls. a mixed-method cross-sectional study was conducted between March 2022 and August 2023. Study participants were selected using systematic random and purposive sampling techniques for quantitative and qualitative, respectively. A self-administered questionnaire was used to collect information from students. Focus group discussions were conducted among mothers of schoolgirls and interreligious council members, and in-depth and key informant interviews were used to gather information from parent-teacher-student association chairpersons and the vice head and head of the Education and Health department offices, respectively. Quantitative data were analyzed using SPSS version 27, and qualitative data used ATLAS.ti. The Chi-square test and binary logistic regression were used to assess the statistical significance of the relationship among variables, ensuring the thoroughness and validity of the research. in this study, more than half of the schoolgirls, 389 (55.50%), missed school days due to menstruation and related factors, and on average, the schoolgirls missed 2.08 (±0.87) days per month. Factors such as WASH facilities (χ = 46.78, p<0.0001; OR= 0.350, p<0,0001), accessibility with menstrual absorbent materials (χ =5.42, p=0.02; OR=0.634, p=0.012), menstrual hygiene management rooms (OR=0.669, p=0.029), socio-cultural constraints (χ = 22.08, p<0.0001; OR=0.539, p=<0.0001), menstrual-related pain (χ =5.9, p=0.015), fear (χ =36.32, p<0.0001; OR=2.505, p<0.0001), and teasing (χ =13.66, p-<0.0001; OR=1.754, p<0.0001), were significantly associated with school absenteeism. A qualitative study identified four themes that influence school attendance: inadequate water and sanitation facilities, lack of access to menstrual absorbent materials, sociocultural constraints, menstrual-related pain, and fear. in the study area, a significant number (55.50%) of schoolgirls missed school days due to menstrual-related factors. The identified factors in the quantitative study were also supported by the themes emerging from the qualitative study. The identified modifiable factors are the areas of intervention that can increase schoolgirls´ school attendance.

Background Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC. Methods The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI’s) critical appraisal tools. Publication bias was checked using a funnel plot, Egger’s regression test, and Begg’s test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17. Results After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn’t animal exposure (OR: 1.95, 95%CI: 1.25, 2.66). Conclusions and recommendations This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment.