Mulusew Andualem Asemahagn

Abstract Background Ethiopia has experienced a marked resurgence of malaria, with confirmed cases rising from 1.0 million in 2018 to more than 7.3 million by October 2024. This resurgence is particularly pronounced in the Amhara Region and threatens national elimination goals. This study explored perceived drivers and contextual determinants of malaria resurgence from the perspectives of frontline health workers and community members in the Amhara Region. Methods Between 1 and 28 February 2025, we conducted 28 semi-structured key informant interviews, two focus group discussions (n = 20), and 12 in-depth interviews. Participants were purposively selected based on professional roles or community leadership. Data were collected in Amharic, audio recorded, transcribed verbatim, and translated into English, then analyzed inductively using reflexive thematic analysis. The Health Belief Model, which focuses on risk perception and care-seeking behavior, was used as a sensitizing framework to interpret behavioral findings. Results Participants perceived malaria resurgence as increasingly widespread, with near year-round transmission, expansion into previously low-risk highland areas, and a rising burden among children under five years and pregnant women. Perceived ecological drivers included irregular rainfall, land use change, irrigation schemes, and construction-related water storage. Reported health system challenges included recurrent stockouts of antimalarials and diagnostics, delayed or incomplete vector control, and reliance on passive surveillance. Behavioral factors such as low perceived susceptibility and severity, reliance on traditional and religious healers, misuse of insecticide-treated nets, and weak regulation of private providers were seen to delay care-seeking and undermine prevention, particularly in conflict-affected and remote areas. Conclusions Stakeholders and community members perceived malaria resurgence in the Amhara Region as arising from interacting ecological change, health system fragility, and behavioral dynamics, exacerbated by conflict and recent public health emergencies. These hypothesis-generating findings suggest that locally tailored, equity-focused interventions, integrating behavioral insights with strengthened supply chains, surveillance, and community-centered vector control, could inform efforts to address resurgence and support Ethiopia’s elimination goals.

INTRODUCTION: Fundamental progress has been made in HIV care, and one of the major advances was the implementation of Differentiated Service Delivery (DSD) models. DSD models are important in reducing cost in resource-limited countries. However, evidence on the effectiveness of DSD models on stable Persons Living with HIV (PLWH) in comparison with conventional HIV care is limited. Thus, a systematic review and meta-analysis of randomized controlled trials was conducted to assess whether DSD models are more effective than conventional care in improving viral suppression, retention in care, and adherence among stable PLWH in Africa. METHODS: A comprehensive search was conducted using PubMed, Embase, Scopus, Cochrane, Research4Life, and Google Scholar. In this study, randomized controlled trials conducted on stable PLWH and reporting at least one of the patient's treatment outcomes (viral suppression, failure, attrition, retention in care, and adherence) were included. The quality of studies was assessed using the revised Cochrane risk of bias tool, and the heterogeneity among studies was assessed using forest plot and Cochran's Q test. RESULTS: = 90.37%, p < 0.001), and lost to follow-up (RR = 0.80, 95% CI: 0.31-2.06) between PLWH who enrolled in the DSD models and conventional care. CONCLUSION: The DSD models have a comparable effect to the conventional care in maintaining sustained viral suppression and care engagement of PLWH.

Supplementary Material 1

Additional file 1.

BACKGROUND: Facility delivery attended by skilled health professionals is a critical strategy for reducing maternal and neonatal mortality. Despite substantial efforts to expand maternal health services in Ethiopia, a large proportion of births still occur at home. This study aimed to predict facility delivery and identify its associated factors among reproductive-age women in Ethiopia using machine learning approaches. METHODS: This study used secondary data from the 2019 Performance Monitoring for Action (PMA) Ethiopia cross-sectional household and female survey. A weighted sample of 5,413 women aged 15-49 years who had a recent birth was included in the analysis. Data extraction and preprocessing were conducted using STATA version 17, while machine learning models were implemented using Python version 3.11.5. Seven supervised machine learning algorithms were developed to predict facility delivery. Model performance was evaluated using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (AUC). Data preparation included feature engineering, data splitting, handling missing values, addressing class imbalance, and outlier detection. SHapley Additive exPlanations (SHAP) were applied to interpret the contribution of important predictors to model predictions. RESULTS: Among the evaluated models, the Random Forest algorithm demonstrated the best predictive performance, achieving 74.15% accuracy, 72.58% recall, 76.27% F1-score, and 80.36% precision on test data. The most influential predictors of facility delivery included higher household wealth status, secondary or higher maternal education, television ownership, discussion of delivery location with a partner, partner encouragement for antenatal care attendance, family planning use, maternal age between 20 and 34 years, age at first sexual intercourse of 19 years or older, awareness of emergency contacts, and completion of primary education. CONCLUSIONS: Interpretable machine learning approaches can provide useful insights for identifying factors associated with facility delivery. The findings highlight key socioeconomic and behavioral characteristics that may inform targeted strategies to improve utilization of facility-based delivery services and support efforts to enhance maternal health outcomes in Ethiopia.

BACKGROUND: 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. OBJECTIVE: This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia. METHODS: 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. RESULT: 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). CONCLUSION: 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.

Abstract Background After substantial progress in malaria control, Ethiopia's Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots. Methods We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018–December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models. Results A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate–incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas. Conclusions Malaria resurgence in Amhara (2018–2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

OBJECTIVE: To assess malaria service readiness and its associated factors among health facilities that provide antenatal care (ANC) services in Ethiopia. DESIGN: Nationally representative cross-sectional facility-based study. PARTICIPANTS: A total of 1156 public and private health facilities that reported providing ANC services at the time of the survey. SETTING: Health facilities across nine regions and two city administrations of Ethiopia based on data from the 2021/2022 Ethiopia Service Provision Assessment survey. RESULTS: Only 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. CONCLUSION: Malaria 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: Malaria in pregnancy remains a major public health challenge in Ethiopia, contributing to maternal morbidity and adverse birth outcomes. Understanding its spatial distribution and service-related determinants is essential for designing equitable and targeted interventions. This study examined the spatial clustering and determinants of malaria incidence among pregnant women in the Amhara region of Ethiopia from 2018 to 2024. METHODS: A retrospective spatial analysis was conducted using routine malaria surveillance data on confirmed malaria cases among pregnant women from January 2018 to December 2024 in the Amhara region, Ethiopia. Spatial clusters were identified using SaTScan based on a discrete Poisson model. Malaria incidence (cases per population) was used as the outcome variable in regression analysis. A spatial error model (SEM) was applied to assess associations between malaria incidence and environmental and health service factors while accounting for spatial autocorrelation. Model adequacy was evaluated using diagnostic tests, including Moran’s I for residual spatial dependence. RESULTS: During the study period, 5.8 million pregnant women were under surveillance, with 53,478 confirmed malaria cases—an annual incidence of 9.2 per 1,000 populations. Seven significant high-risk spatial clusters were detected. Spatial regression analysis showed that malaria incidence was negatively associated with ANC4 utilization (IRR = 0.92; 95% CI: 0.91–0.94), soil moisture (IRR = 0.85; 95% CI: 0.80–0.90), API (IRR = 0.98; 95% CI: 0.97–0.99), and temperature (IRR = 0.65; 95% CI: 0.58–0.73), but positively associated with ANC1 utilization (IRR = 1.07; 95% CI: 1.06–1.08). CONCLUSION: Malaria in pregnancy in the Amhara region exhibits marked spatial heterogeneity influenced by environmental conditions and disparities in antenatal care utilization. Strengthening ANC services and implementing geographically targeted, climate-informed interventions are critical to reducing malaria burden among pregnant women.

BACKGROUND: Ethiopia has experienced a marked resurgence of malaria, with confirmed cases rising from 1.0 million in 2018 to more than 7.3 million by October 2024. This resurgence is particularly pronounced in the Amhara Region and threatens national elimination goals. This study explored perceived drivers and contextual determinants of malaria resurgence from the perspectives of frontline health workers and community members in the Amhara Region. METHODS: Between 1 and 28 February 2025, we conducted 28 semi-structured key informant interviews, two focus group discussions (n = 20), and 12 in-depth interviews. Participants were purposively selected based on professional roles or community leadership. Data were collected in Amharic, audio recorded, transcribed verbatim, and translated into English, then analyzed inductively using reflexive thematic analysis. The Health Belief Model, which focuses on risk perception and care-seeking behavior, was used as a sensitizing framework to interpret behavioral findings. RESULTS: Participants perceived malaria resurgence as increasingly widespread, with near year-round transmission, expansion into previously low-risk highland areas, and a rising burden among children under five years and pregnant women. Perceived ecological drivers included irregular rainfall, land use change, irrigation schemes, and construction-related water storage. Reported health system challenges included recurrent stockouts of antimalarials and diagnostics, delayed or incomplete vector control, and reliance on passive surveillance. Behavioral factors such as low perceived susceptibility and severity, reliance on traditional and religious healers, misuse of insecticide-treated nets, and weak regulation of private providers were seen to delay care-seeking and undermine prevention, particularly in conflict-affected and remote areas. CONCLUSIONS: Stakeholders and community members perceived malaria resurgence in the Amhara Region as arising from interacting ecological change, health system fragility, and behavioral dynamics, exacerbated by conflict and recent public health emergencies. These hypothesis-generating findings suggest that locally tailored, equity-focused interventions, integrating behavioral insights with strengthened supply chains, surveillance, and community-centered vector control, could inform efforts to address resurgence and support Ethiopia’s elimination goals.

BACKGROUND: Facility delivery attended by skilled health professionals is a critical strategy for reducing maternal and neonatal mortality. Despite substantial efforts to expand maternal health services in Ethiopia, a large proportion of births still occur at home. This study aimed to predict facility delivery and identify its associated factors among reproductive-age women in Ethiopia using machine learning approaches. METHODS: This study used secondary data from the 2019 Performance Monitoring for Action (PMA) Ethiopia cross-sectional household and female survey. A weighted sample of 5,413 women aged 15-49 years who had a recent birth was included in the analysis. Data extraction and preprocessing were conducted using STATA version 17, while machine learning models were implemented using Python version 3.11.5. Seven supervised machine learning algorithms were developed to predict facility delivery. Model performance was evaluated using accuracy, precision, recall, F1 score, and the area under the receiver operating characteristic curve (AUC). Data preparation included feature engineering, data splitting, handling missing values, addressing class imbalance, and outlier detection. SHapley Additive exPlanations (SHAP) were applied to interpret the contribution of important predictors to model predictions. RESULTS: Among the evaluated models, the Random Forest algorithm demonstrated the best predictive performance, achieving 74.15% accuracy, 72.58% recall, 76.27% F1-score, and 80.36% precision on test data. The most influential predictors of facility delivery included higher household wealth status, secondary or higher maternal education, television ownership, discussion of delivery location with a partner, partner encouragement for antenatal care attendance, family planning use, maternal age between 20 and 34 years, age at first sexual intercourse of 19 years or older, awareness of emergency contacts, and completion of primary education. CONCLUSIONS: Interpretable machine learning approaches can provide useful insights for identifying factors associated with facility delivery. The findings highlight key socioeconomic and behavioral characteristics that may inform targeted strategies to improve utilization of facility-based delivery services and support efforts to enhance maternal health outcomes in Ethiopia.

BACKGROUND: 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. OBJECTIVE: This study aimed to assess the delivery of integrated malaria services during ANC visit and its determinants among pregnant women in Ethiopia. METHODS: 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. RESULT: 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). CONCLUSION: 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.

Abstract Background After substantial progress in malaria control, Ethiopia's Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots. Methods We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018–December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models. Results A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate–incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas. Conclusions Malaria resurgence in Amhara (2018–2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

Abstract Background Ethiopia has experienced a marked resurgence of malaria, with confirmed cases rising from 1.0 million in 2018 to more than 7.3 million by October 2024. This resurgence is particularly pronounced in the Amhara Region and threatens national elimination goals. This study explored perceived drivers and contextual determinants of malaria resurgence from the perspectives of frontline health workers and community members in the Amhara Region. Methods Between 1 and 28 February 2025, we conducted 28 semi-structured key informant interviews, two focus group discussions (n = 20), and 12 in-depth interviews. Participants were purposively selected based on professional roles or community leadership. Data were collected in Amharic, audio recorded, transcribed verbatim, and translated into English, then analyzed inductively using reflexive thematic analysis. The Health Belief Model, which focuses on risk perception and care-seeking behavior, was used as a sensitizing framework to interpret behavioral findings. Results Participants perceived malaria resurgence as increasingly widespread, with near year-round transmission, expansion into previously low-risk highland areas, and a rising burden among children under five years and pregnant women. Perceived ecological drivers included irregular rainfall, land use change, irrigation schemes, and construction-related water storage. Reported health system challenges included recurrent stockouts of antimalarials and diagnostics, delayed or incomplete vector control, and reliance on passive surveillance. Behavioral factors such as low perceived susceptibility and severity, reliance on traditional and religious healers, misuse of insecticide-treated nets, and weak regulation of private providers were seen to delay care-seeking and undermine prevention, particularly in conflict-affected and remote areas. Conclusions Stakeholders and community members perceived malaria resurgence in the Amhara Region as arising from interacting ecological change, health system fragility, and behavioral dynamics, exacerbated by conflict and recent public health emergencies. These hypothesis-generating findings suggest that locally tailored, equity-focused interventions, integrating behavioral insights with strengthened supply chains, surveillance, and community-centered vector control, could inform efforts to address resurgence and support Ethiopia’s elimination goals.

BACKGROUND: Malaria in pregnancy remains a major public health challenge in Ethiopia, contributing to maternal morbidity and adverse birth outcomes. Understanding its spatial distribution and service-related determinants is essential for designing equitable and targeted interventions. This study examined the spatial clustering and determinants of malaria incidence among pregnant women in the Amhara region of Ethiopia from 2018 to 2024. METHODS: A retrospective spatial analysis was conducted using routine malaria surveillance data on confirmed malaria cases among pregnant women from January 2018 to December 2024 in the Amhara region, Ethiopia. Spatial clusters were identified using SaTScan based on a discrete Poisson model. Malaria incidence (cases per population) was used as the outcome variable in regression analysis. A spatial error model (SEM) was applied to assess associations between malaria incidence and environmental and health service factors while accounting for spatial autocorrelation. Model adequacy was evaluated using diagnostic tests, including Moran’s I for residual spatial dependence. RESULTS: During the study period, 5.8 million pregnant women were under surveillance, with 53,478 confirmed malaria cases—an annual incidence of 9.2 per 1,000 populations. Seven significant high-risk spatial clusters were detected. Spatial regression analysis showed that malaria incidence was negatively associated with ANC4 utilization (IRR = 0.92; 95% CI: 0.91–0.94), soil moisture (IRR = 0.85; 95% CI: 0.80–0.90), API (IRR = 0.98; 95% CI: 0.97–0.99), and temperature (IRR = 0.65; 95% CI: 0.58–0.73), but positively associated with ANC1 utilization (IRR = 1.07; 95% CI: 1.06–1.08). CONCLUSION: Malaria in pregnancy in the Amhara region exhibits marked spatial heterogeneity influenced by environmental conditions and disparities in antenatal care utilization. Strengthening ANC services and implementing geographically targeted, climate-informed interventions are critical to reducing malaria burden among pregnant women.

Additional file 1.

Supplementary Material 1

BACKGROUND: The rapid rise in the burden of non-communicable disease (NCDs) in African communities has resulted in a considerable mortality, disability, and economic burden. A comprehensive evaluation of incidence, deaths, disability-adjusted life-years (DALYs), and attributable risk factors related to NCDs by sex, and geographical location is essential for informing policy decisions aimed at controlling these diseases. METHODS: This study used a comprehensive analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 methodology to estimate the incidence, mortality, DALYs (estimated as the sum of years of life lost and years lived with disability [YLDs]), and attributable risk factors of NCDs in Africa. Data were systematically searched for and extracted from various sources, including vital registration, verbal autopsy, surveillance systems, police reports, censuses, surveys, minimally invasive tissue sampling, and sibling history. The analysis employed the Cause of Death Ensemble model, DisMod-MR 2.1, and spatiotemporal Gaussian process regression to estimate both fatal and non-fatal health metrics associated with NCDs in Africa overall, and by region and country. FINDINGS: In 2023, NCDs in Africa accounted for an estimated 2·33 billion (95% uncertainty interval 2·22-2·50) incident cases, 4·70 million (4·47-4·93) deaths, and 263 million (234-293) DALYs. Although absolute numbers increased between 1990 and 2023, age-standardised rates (per 100 000 population) decreased modestly: incidence rate by 2·7% (0·2-5·0), mortality rate by 9·0% (2·5-15·5), and DALY rate by 6·4% (1·2-12·0). The five leading Level 3 causes of death in Africa in 2023 were ischaemic heart disease (801 000 [653 000-965 000]), stroke (700 000 [544 000-863 000]), chronic kidney disease (293 000 [224 000-359 000], hypertensive heart disease (246 000 [170 000-337 000]), and diabetes (245 000 [190 000-314 000]) for all sexes and ages. Leading Level 2 causes of YLDs were mental disorders (30·9 million [22·0-42·2]) and musculoskeletal disorders (17·1 million [12·5-22·7]). Overall, 35·1% (32·4-38·2) of DALYs and 57·4% (54·2-60·4) of deaths due to NCDs were attributable to the 88 GBD 2023 risk factors. High systolic blood pressure contributed the largest proportion at 26·2% (21·6-30·9) of all NCD deaths in Africa, followed by dietary risks (14·7% [5·1-21·6]) and air pollution (14·2% [11·6-16·9]). INTERPRETATION: Our findings underscore the complex and evolving nature of the NCD burden in Africa, where modest declines in age-standardised mortality and DALY rates since 1990 have been substantially offset by rising absolute counts of deaths and DALYs-a paradox driven predominantly by rapid population growth and demographic changes. That more than half of all NCD deaths and over a third of DALYs remain attributable to modifiable risk factors-principally high systolic blood pressure, dietary risks, and air pollution-suggests that a substantial and actionable proportion of this burden is preventable through available and effective interventions, carrying urgent implications for African governments, ministries of health, and global health partners, who must take decisive action to meet health commitments. FUNDING: Gates Foundation.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

OBJECTIVE: To assess malaria service readiness and its associated factors among health facilities that provide antenatal care (ANC) services in Ethiopia. DESIGN: Nationally representative cross-sectional facility-based study. PARTICIPANTS: A total of 1156 public and private health facilities that reported providing ANC services at the time of the survey. SETTING: Health facilities across nine regions and two city administrations of Ethiopia based on data from the 2021/2022 Ethiopia Service Provision Assessment survey. RESULTS: Only 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. CONCLUSION: Malaria 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: After substantial progress in malaria control, Ethiopia's Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots. METHODS: We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018-December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models. RESULTS: A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate-incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas. CONCLUSIONS: Malaria resurgence in Amhara (2018-2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

BACKGROUND: Ethiopia has experienced a marked resurgence of malaria, with confirmed cases rising from 1.0 million in 2018 to more than 7.3 million by October 2024. This resurgence is particularly pronounced in the Amhara Region and threatens national elimination goals. This study explored perceived drivers and contextual determinants of malaria resurgence from the perspectives of frontline health workers and community members in the Amhara Region. METHODS: Between 1 and 28 February 2025, we conducted 28 semi-structured key informant interviews, two focus group discussions (n = 20), and 12 in-depth interviews. Participants were purposively selected based on professional roles or community leadership. Data were collected in Amharic, audio recorded, transcribed verbatim, and translated into English, then analyzed inductively using reflexive thematic analysis. The Health Belief Model, which focuses on risk perception and care-seeking behavior, was used as a sensitizing framework to interpret behavioral findings. RESULTS: Participants perceived malaria resurgence as increasingly widespread, with near year-round transmission, expansion into previously low-risk highland areas, and a rising burden among children under five years and pregnant women. Perceived ecological drivers included irregular rainfall, land use change, irrigation schemes, and construction-related water storage. Reported health system challenges included recurrent stockouts of antimalarials and diagnostics, delayed or incomplete vector control, and reliance on passive surveillance. Behavioral factors such as low perceived susceptibility and severity, reliance on traditional and religious healers, misuse of insecticide-treated nets, and weak regulation of private providers were seen to delay care-seeking and undermine prevention, particularly in conflict-affected and remote areas. CONCLUSIONS: Stakeholders and community members perceived malaria resurgence in the Amhara Region as arising from interacting ecological change, health system fragility, and behavioral dynamics, exacerbated by conflict and recent public health emergencies. These hypothesis-generating findings suggest that locally tailored, equity-focused interventions, integrating behavioral insights with strengthened supply chains, surveillance, and community-centered vector control, could inform efforts to address resurgence and support Ethiopia’s elimination goals.

Malaria in pregnancy (MiP) remains a major public health challenge in Ethiopia, contributing to maternal morbidity, adverse birth outcomes, and neonatal mortality. Despite intensified control efforts, evidence on temporal dynamics and key determinants remains limited. This study examined the spatiotemporal patterns, clustering, and environmental and health service-related predictors of malaria in pregnancy (MiP) in the Amhara region of Ethiopia from 2018 to 2024. A retrospective analysis was conducted using routine health facility data on MiP, linked with antenatal care coverage and district-level environmental variables. Annual incidence rates were computed. Temporal and spatiotemporal clusters were identified using SaTScan with a discrete Poisson model. Predictors, including climatic factors and malaria transmission intensity, were examined using an autoregressive moving average model with exogenous variables (ARMAX [1,0,4]). Model performance was evaluated using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and residual diagnostics. A total of 53,478 MiP cases were reported during the study period, with a mean incidence of 9.2 per 1,000 population (SD = 3.38). A significant temporal cluster was identified between 2022 and 2024 (RR = 3.74; p < 0.001). Seven spatiotemporal clusters were detected; early clusters (2018–2020) were geographically localized, whereas later clusters (2022–2024) showed marked spatial expansion. Projections indicate that MiP incidence will remain elevated through 2026. Significant predictors included malaria transmission intensity (β = 0.001; p < 0.001), temperature (β = 0.031; p = 0.019), and relative humidity (β = 0.029; p < 0.001). In contrast, soil moisture (β = −0.044; p < 0.001) and elevation (β = −0.001; p < 0.001) were negatively associated with MiP incidence. MiP in the Amhara region has increased substantially, with clear spatiotemporal clustering and persistence. The observed escalation coinciding with conflict periods underscores the need for conflict-sensitive, climate-informed, and geographically targeted malaria control strategies.

BACKGROUND: The rapid rise in the burden of non-communicable disease (NCDs) in African communities has resulted in a considerable mortality, disability, and economic burden. A comprehensive evaluation of incidence, deaths, disability-adjusted life-years (DALYs), and attributable risk factors related to NCDs by sex, and geographical location is essential for informing policy decisions aimed at controlling these diseases. METHODS: This study used a comprehensive analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 methodology to estimate the incidence, mortality, DALYs (estimated as the sum of years of life lost and years lived with disability [YLDs]), and attributable risk factors of NCDs in Africa. Data were systematically searched for and extracted from various sources, including vital registration, verbal autopsy, surveillance systems, police reports, censuses, surveys, minimally invasive tissue sampling, and sibling history. The analysis employed the Cause of Death Ensemble model, DisMod-MR 2.1, and spatiotemporal Gaussian process regression to estimate both fatal and non-fatal health metrics associated with NCDs in Africa overall, and by region and country. FINDINGS: In 2023, NCDs in Africa accounted for an estimated 2·33 billion (95% uncertainty interval 2·22-2·50) incident cases, 4·70 million (4·47-4·93) deaths, and 263 million (234-293) DALYs. Although absolute numbers increased between 1990 and 2023, age-standardised rates (per 100 000 population) decreased modestly: incidence rate by 2·7% (0·2-5·0), mortality rate by 9·0% (2·5-15·5), and DALY rate by 6·4% (1·2-12·0). The five leading Level 3 causes of death in Africa in 2023 were ischaemic heart disease (801 000 [653 000-965 000]), stroke (700 000 [544 000-863 000]), chronic kidney disease (293 000 [224 000-359 000], hypertensive heart disease (246 000 [170 000-337 000]), and diabetes (245 000 [190 000-314 000]) for all sexes and ages. Leading Level 2 causes of YLDs were mental disorders (30·9 million [22·0-42·2]) and musculoskeletal disorders (17·1 million [12·5-22·7]). Overall, 35·1% (32·4-38·2) of DALYs and 57·4% (54·2-60·4) of deaths due to NCDs were attributable to the 88 GBD 2023 risk factors. High systolic blood pressure contributed the largest proportion at 26·2% (21·6-30·9) of all NCD deaths in Africa, followed by dietary risks (14·7% [5·1-21·6]) and air pollution (14·2% [11·6-16·9]). INTERPRETATION: Our findings underscore the complex and evolving nature of the NCD burden in Africa, where modest declines in age-standardised mortality and DALY rates since 1990 have been substantially offset by rising absolute counts of deaths and DALYs-a paradox driven predominantly by rapid population growth and demographic changes. That more than half of all NCD deaths and over a third of DALYs remain attributable to modifiable risk factors-principally high systolic blood pressure, dietary risks, and air pollution-suggests that a substantial and actionable proportion of this burden is preventable through available and effective interventions, carrying urgent implications for African governments, ministries of health, and global health partners, who must take decisive action to meet health commitments. FUNDING: Gates Foundation.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

BACKGROUND: After substantial progress in malaria control, Ethiopia's Amhara Region experienced a marked resurgence since 2018. The relative contributions of climate variability, environmental context, intervention coverage, and unmeasured factors to this resurgence remain inadequately quantified. This study used a Bayesian spatiotemporal framework to estimate factor associations with malaria incidence, decompose spatial versus temporal climate effects, and identify persistent hotspots. METHODS: We conducted an ecological district-level panel analysis of 13,944 district-month observations from 166 districts (January 2018-December 2024). Monthly confirmed malaria counts (total, Plasmodium falciparum, P. vivax) were modelled using Bayesian hierarchical negative binomial regression with BYM2 spatial and AR(1) temporal random effects, fitted with integrated nested Laplace approximation. Covariates included lagged rainfall, temperature, NDVI, elevation, and programmatic indicators (ITN ownership, IRS protection, and larval source management [LSM] intensity). Climate covariates were decomposed into between-district (spatial) means and within-district (temporal) deviations. Sensitivity analyses included alternative IRS protection windows and district fixed-effects models. RESULTS: A total of 5,746,571 confirmed cases were reported (64.3% P. falciparum, 35.7% P. vivax). Mean monthly incidence increased 5.5-fold from 1.19 per 1,000 (2018) to 6.53 per 1,000 (2024), while regional mean maximum temperature showed a small declining trend over the period. In fully adjusted models, higher lagged maximum temperature and rainfall were associated with higher incidence, and elevation was protective. IRS protection, higher ITN ownership, and higher LSM intensity were each associated with lower incidence; effect directions were consistent in within-district sensitivity analyses, although residual confounding and measurement error cannot be excluded. Climate-incidence associations were predominantly spatial (between-district) rather than temporal (within-district), suggesting that geographic ecological suitability explains much of the spatial patterning, rather than temporal warming trends explaining the resurgence. Districts with persistently elevated residual spatial risk (exceedance probability of residual RR > 1.25) clustered in low-elevation western border areas. CONCLUSIONS: Malaria resurgence in Amhara (2018-2024) occurred alongside strong spatial climatic and elevational gradients and was not consistent with a temporal warming-driven explanation at the regional scale. Remaining unexplained spatiotemporal variation highlights the likely importance of unmeasured drivers (e.g., conflict-related service disruption, vector/insecticide resistance dynamics, and population mobility). Climate-informed, spatially targeted intervention packages prioritizing districts with persistently high residual risk are warranted.

BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. FUNDING: Gates Foundation.

Abstract Background Despite substantial control gains over the past 2 decades, malaria remains a major public health threat in Ethiopia. The Amhara Region has recently experienced a significant resurgence, threatening to reverse previous progress. However, comprehensive analyses of this resurgence integrating long-term trends, parasite species dynamics, and spatiotemporal patterns are limited. Therefore, this study examines trends, spatial expansion, and control challenges associated with malaria resurgence in the Amhara Region. Methods A retrospective analysis of 11 years (January 2014–December 2024) of weekly malaria surveillance data from 166 districts in the Amhara Region, Ethiopia. Joinpoint regression was employed to detect significant temporal trend changes. A resurgence threshold was defined a priori as a ≥ 20% increase in cases compared to the 3-year average baseline for the same period (Sep–Dec 2021–2023), based on an expert consensus survey. Auto-regressive integrated moving average modelling was used to characterize and forecast the test positivity rate (TPR). The Getis-Ord Gi* statistic was used to identify spatial clustering and detect transmission hotspots. Results During the study period, 7,710,733 malaria cases and 162 deaths were reported. Adults (≥ 15 years) contributed 62% of cases. A single trend inflection point occurred in late 2018, marking a shift from a significant decline (Annual Percent Change [APC]: −13.2%) to a sharp resurgence (APC: + 12.6%, 2018–2024). The Annual Parasite Incidence (API) rose from 10.9 (95% CI 10.8–11.0) per 1000 in 2018 to 74.8 (95% CI 74.72–74.93) per 1000 in 2024. Plasmodium vivax became increasingly prominent, with its contribution to the total case burden rising from 25 to 43% (χ 2 = 190,789.55, p < 0.001). Its incidence surged 11-fold between 2018 and 2024 (from 2.7 to 32.4 per 1000). TPR increased from 10% (2018) to > 50% during peak months by 2024. In 2024, a resurgence occurred in 83% of districts; hotspots expanded into urban centres and previously low-transmission highland areas. Conclusion The Amhara Region is experiencing a malaria resurgence characterized by intensified transmission, geographic expansion into urban and highland areas, and a significant shift toward Plasmodium vivax dominance. These findings exemplify an "elimination-resurgence paradox," where prior success increases vulnerability to threats such as invasive vectors, conflict, and climate shifts.

BACKGROUND: Malaria continues to pose a significant public health challenge for pregnant women in Ethiopia. This study explores the facilitators and barriers influencing malaria prevention and treatment services to this vulnerable group, emphasizing systemic, policy, and community-level factors within Ethiopia's healthcare framework. METHODS: A qualitative study engaged 49 multi-level stakeholders in the prevention and treatment services, including policymakers, programme managers, advocacy groups, and healthcare service providers from diverse geographic, socio-economic, and epidemiological contexts. Data from interviews and field notes were analysed using Open Code 4.03, with inductive thematic analysis. RESULTS: The study identified key to facilitators and barriers, reflecting multi-level influences on malaria service delivery for pregnant women. The facilitators included prioritization of pregnant women in bed net distribution, active partnerships with non-governmental organizations, increased antenatal care contact time, expanded diagnostic infrastructure, community engagement, and local leadership participation, However, barriers were multifaceted: chloroquine shortages, fragmented service delivery, staff shortages, and bed net misuse hindered prevention and care. Policy gaps, such as the absence of targeted interventions and delayed adoption of WHO-recommended intermittent preventive treatment (IPTp), further impeded progress. Critical systemic gaps included inadequate data surveillance and underreporting of asymptomatic cases, which hindered targeted resource allocation and programme evaluation. CONCLUSION: While Ethiopia demonstrates progress towards maternal services through decentralization of diagnostic services, increased antenatal care contact time, and community engagement. Persistent challenges in resource allocation, staffing, disintegrated service delivery and data surveillance hinder malaria care for pregnant women. Strengthening supply chains, adopting "one-stop-shop" ANC models, and piloting IPTp are essential. Improving digital surveillance with pregnancy-specific indicators and routine screening can guide equitable, evidence-based responses.

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: While screening service utilization is a proven strategy for early detection of noncommunicable diseases, population-based health checkup service utilization is very low in Ethiopia. This study aimed to assess the effect of health education in improving hypertension, diabetes mellitus, and cervical cancer screening service utilization in a district around Bahir Dar City, Ethiopia in 2024. METHODS: A cluster randomized controlled community trial was conducted in a district around Bahir Dar City among 214 adults in the intervention and control groups each. The intervention was health education. Trained parent-teacher association members provided a 30 min to 1 h education for the community using the existing social structures. Adults in the control group continue receiving the routine education through the health care system A structured interviewer-administered questionnaire was used to collect data. MacNemar's test was used to assess the intervention effect. Binary logistic regression was also used to assess the intervention effect after controlling confounders. RESULTS: Overall difference in knowledge level of adults between the intervention and control groups was 34.4% (P < 0.005). This difference persists after controlling potential confounders. Respondents in the intervention group had 2.2 times better knowledge about noncommunicable diseases compared with respondents in the control group [AOR = 2.22, 95% CI: (1.4, 3.4)]. The overall difference in utilization of screening services for targeted NCDs between the intervention and control groups was 28.1% (P < 0.001). This difference persists after potential confounders were controlled. Respondents in the intervention group were 4.8 times more likely to utilize screening services compared with respondents in the control group [AOR = 4.83, 95% CI: (2.7, 8.5)]. CONCLUSIONS: Health education intervention through parent-teacher association members was an effective approach to improve screening service utilization. This study suggests to use parent-teacher association members to promote screening service utilization through the existing social structures. The trial was registered in Clinical Trials.gov (NCT06639412).

BACKGROUND: Malaria has long been a global health priority, particularly in Eastern Africa, where it remains the leading cause of child mortality and a significant barrier to socioeconomic development. Despite extensive control efforts, ineffective programs, limited treatment access, and low distribution of artemisinin-based combination therapy, contribute to the persistent challenges. Understanding malaria trends is crucial for evidence-based prevention and control strategies. The objective of the study was to estimate the trend in malaria incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) in Eastern Africa Region, from 1990 to 2021. METHODS: This study is part of the 2021 Global Burden of Disease Study. The burden of malaria was assessed using age-standardized incidence, prevalence, mortality, and DALY rates, stratified by age, sex, and countries. Annual and total percentage changes were calculated to evaluate Long-term trends. Line graphs were used to compare disease burden by age and gender over time. RESULTS: Malaria incidence, mortality, prevalence and DALYs declined significantly in Eastern Africa region from 1990 to 2021. The rate of incidence, prevalence, mortality and DALYs of malaria in Eastern Africa decreased by 54%, 61.8%, 62%, and 63.8%, respectively. However malaria burden remained highest among children under five, with DALYs peaking in neonates aged 7-27 days. In 2021, South Sudan had the highest age-standardized incidence and prevalence rate whereas Uganda recorded the highest malaria mortality and DALY rate. The Comoros showed significant declined in malaria burden, whereas Ethiopia experienced an increases in all metrics from 1990 and 2021. Child underweight and stunting were the major risk factors for malaria-related DALYs and deaths in 2021. CONCLUSIONS: Despite overall progress, malaria remains a major health threat in Eastern Africa nations, with the three leading countries in the region being South Sudan, Ethiopia and Uganda. The highest disease burden persists among neonates aged 7-27 days, underscoring the urgent need for targeted interventions.

BACKGROUND: Tuberculosis (TB), despite being a preventable and curable disease, remains a leading infectious cause of death. In Eastern Africa, TB poses a significant public health challenge. This study examined TB incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. This study aims to provide evidence for policy and healthcare stakeholders in Eastern Africa. METHOD: This analysis is part of the Global Burden of Disease (GBD) Study 2021 to estimate TB incidence, prevalence, TB-specific mortality, and DALYs. The GBD study applies several analytical tools and uses data from national health surveys, vital registration systems, WHO reports, and hospital records. The results were presented by age group, sex, location, and year, accounting for 95% uncertainty intervals. RESULT: A significant decline was observed in TB burden across East African countries between 1990 and 2021. The age standardized TB incidence rate dropped by 53% (95% UI: 50.7%, 55.1%), from 518.8 per 100,000 in 1990-244 in 2021, while TB prevalence dropped by 29.1% (95% UI: 26.3%, 31.7%), from 38,577.6-27,366.1 per 100,000. TB-related deaths fell by 64.6% (95% UI: 55.0%, 71.4%), and TB related DALYs declined by 68.2% (95% UI: 60.3%, 73.6%). Despite these improvements, men consistently experienced higher TB incidence, prevalence, mortality, and DALYs compared to women. Ethiopia showed the highest reductions in terms of TB-related mortality and DALYs compared to countries in the region, with annual reduction rates of 6.0% and 6.6%, respectively. Conversely, Somalia had the highest TB burden in 2021 in terms of incidence, mortality, and DALYs. Mauritius and Seychelles maintained the lowest TB burden, attributed to strong health systems and socio-economic conditions. CONCLUSION: A significant decline was observed in TB burden across eastern African countries between 1990 and 2021. However, TB rates remain significantly higher than global and African averages. Therefore, continued investment in health systems and tailored interventions is essential to alleviate the disease burdens, specifically in high-prevalence areas.

Abstract Background Despite substantial control gains over the past 2 decades, malaria remains a major public health threat in Ethiopia. The Amhara Region has recently experienced a significant resurgence, threatening to reverse previous progress. However, comprehensive analyses of this resurgence integrating long-term trends, parasite species dynamics, and spatiotemporal patterns are limited. Therefore, this study examines trends, spatial expansion, and control challenges associated with malaria resurgence in the Amhara Region. Methods A retrospective analysis of 11 years (January 2014–December 2024) of weekly malaria surveillance data from 166 districts in the Amhara Region, Ethiopia. Joinpoint regression was employed to detect significant temporal trend changes. A resurgence threshold was defined a priori as a ≥ 20% increase in cases compared to the 3-year average baseline for the same period (Sep–Dec 2021–2023), based on an expert consensus survey. Auto-regressive integrated moving average modelling was used to characterize and forecast the test positivity rate (TPR). The Getis-Ord Gi* statistic was used to identify spatial clustering and detect transmission hotspots. Results During the study period, 7,710,733 malaria cases and 162 deaths were reported. Adults (≥ 15 years) contributed 62% of cases. A single trend inflection point occurred in late 2018, marking a shift from a significant decline (Annual Percent Change [APC]: −13.2%) to a sharp resurgence (APC: + 12.6%, 2018–2024). The Annual Parasite Incidence (API) rose from 10.9 (95% CI 10.8–11.0) per 1000 in 2018 to 74.8 (95% CI 74.72–74.93) per 1000 in 2024. Plasmodium vivax became increasingly prominent, with its contribution to the total case burden rising from 25 to 43% (χ 2 = 190,789.55, p < 0.001). Its incidence surged 11-fold between 2018 and 2024 (from 2.7 to 32.4 per 1000). TPR increased from 10% (2018) to > 50% during peak months by 2024. In 2024, a resurgence occurred in 83% of districts; hotspots expanded into urban centres and previously low-transmission highland areas. Conclusion The Amhara Region is experiencing a malaria resurgence characterized by intensified transmission, geographic expansion into urban and highland areas, and a significant shift toward Plasmodium vivax dominance. These findings exemplify an "elimination-resurgence paradox," where prior success increases vulnerability to threats such as invasive vectors, conflict, and climate shifts.

BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. FUNDING: Gates Foundation.

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: Malaria has long been a global health priority, particularly in Eastern Africa, where it remains the leading cause of child mortality and a significant barrier to socioeconomic development. Despite extensive control efforts, ineffective programs, limited treatment access, and low distribution of artemisinin-based combination therapy, contribute to the persistent challenges. Understanding malaria trends is crucial for evidence-based prevention and control strategies. The objective of the study was to estimate the trend in malaria incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) in Eastern Africa Region, from 1990 to 2021. METHODS: This study is part of the 2021 Global Burden of Disease Study. The burden of malaria was assessed using age-standardized incidence, prevalence, mortality, and DALY rates, stratified by age, sex, and countries. Annual and total percentage changes were calculated to evaluate Long-term trends. Line graphs were used to compare disease burden by age and gender over time. RESULTS: Malaria incidence, mortality, prevalence and DALYs declined significantly in Eastern Africa region from 1990 to 2021. The rate of incidence, prevalence, mortality and DALYs of malaria in Eastern Africa decreased by 54%, 61.8%, 62%, and 63.8%, respectively. However malaria burden remained highest among children under five, with DALYs peaking in neonates aged 7-27 days. In 2021, South Sudan had the highest age-standardized incidence and prevalence rate whereas Uganda recorded the highest malaria mortality and DALY rate. The Comoros showed significant declined in malaria burden, whereas Ethiopia experienced an increases in all metrics from 1990 and 2021. Child underweight and stunting were the major risk factors for malaria-related DALYs and deaths in 2021. CONCLUSIONS: Despite overall progress, malaria remains a major health threat in Eastern Africa nations, with the three leading countries in the region being South Sudan, Ethiopia and Uganda. The highest disease burden persists among neonates aged 7-27 days, underscoring the urgent need for targeted interventions.

OBJECTIVE: This study aimed to assess the proportion of nutrition-related information-seeking behaviour and its associated factors among pregnant women attending antenatal care at public hospitals in Bahir Dar City, northwest Ethiopia, 2023. METHOD: A cross-sectional quantitative supplemented with qualitative study design was conducted from March to April 2023 among 406 pregnant women. Pre-tested structured interviewer-administered and semistructured open-ended questionnaires were used to collect quantitative and qualitative data, respectively. Data were collected using the Kobo toolbox, and SPSS V.25 was used for analysis. Descriptive statistics were used to describe study subjects, and multivariate logistic regression analysis was employed to investigate the associated factors. The strength of associations was described using the OR with the corresponding 95% CI. RESULT: The study included 406 pregnant mothers with a median age of 28 with an IQR of 8 and 212 (52.2%) from rural settings. Of the total respondents, 173 (42.6%; 95% CI 37.7 to 47.6) of pregnant mothers were nutrition-related information seekers. Educational status, residence, monthly income and nutrition information literacy were significantly associated with nutrition-related information-seeking behaviour. CONCLUSION: The proportion of nutrition information seeking among pregnant mothers in Bahir Dar City public hospitals was low. Lower educational status, low nutrition information literacy level, being from a rural residence and low monthly income are significantly associated factors. RECOMMENDATION: Awareness creation for pregnant mothers from rural areas and with low educational status and improving nutrition information literacy of pregnant mothers are important activities to improve their nutrition information-seeking behaviour.

PURPOSE: This study assessed the community's level of risk perception of COVID-19, their compliance with recommended precautionary measures, and factors that influence compliance behavior. METHODS: This study is a cross-sectional online survey administered using google forms. Data were collected from 521 respondents using various social media channels, including e-mail, Facebook, messenger, telegram, and IMO. RESULTS: About 9 in 10 respondents (90.4%) perceived that they are susceptible to COVID-19. Nearly 9 in 10 participants (87.5%) perceived that COVID-19 is a serious disease. The majority of respondents (81%) got information about COVID-19 from television and social networking sites. The regression analyses revealed that compliance with preventive behaviors is differed by respondents' socio-demographic characteristics. Being female (β: 0.094, P<0.05), higher perceived effectiveness of recommended preventive measures (β: 0.367, P<0.001), and higher perceived reliability of media (β: 0.189, P<0.001) facilitated compliance with preventive measures. On the other hand, increasing age (β: -0.096, P<0.05), being single (β: -0.127, P<0.01), lower education level (β: -0.168, P<0.01), and living at a lower administrative level were barriers to be compliant with preventive measures. CONCLUSION: The majority of the respondents exercised one or more of the recommended preventive measures to avoid COVID-19 infection. Most of the respondents got information about COVID-19 from television and social networking sites. Given that about 80% of the Ethiopian population is living in rural areas without television and higher illiteracy rate to use social networking sites, concerned bodies should introduce tailored interventions to impart knowledge about COVID-19 infection and mitigating measures. LIMITATIONS: Although the sampling procedure was random through the online system, it might not be representative to study the perception and compliance of people towards COVID-19 prevention practices at a country level due to its small size. Thus, the interpretation of the study findings needs to consider this limitation.

Abstract Background Stillbirth rates are important indicators of the quality of antenatal and obstetric care in the community. In Ethiopia many neonatal deaths and almost all stillbirths are underreported. Therefore, this study aimed to determine prevalence of still birth and associated factors among immediate post-partum mothers. Methods An institution based cross-sectional study was employed at Felegehiwot comprehensive specialized hospital from March to May 2016 (n=310). A pretested structured interviewer administered questionnaire and medical chart reviews were used to collect data from immediate post-partum mothers. Data were entered using Epi Info version 3.5.4 and analyzed using SPSS version 20. Bivariate and multivariable logistic regression model was fitted to identify predictors of stillbirth. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) was computed to assess the strength of association. Variables with p-value less than 0.05 in the multivariable considered as significant predictors of stillbirth. Result The prevalence of stillbirth was 8.7% with (95%CI: 5.8, 12.4). Previous history of stillbirth; [AOR=4.7, 95%CI (1.90-24.76)], labor complications [AOR=4.9, 95%CI (1.30-18.58)], Parthogragh use [AOR=0.25, 95%CI (0.10-0.80)], and twin delivery [AOR=6.7, 95%CI (1.40-32.74)] were significant predictors of stillbirth. Conclusion The magnitude of stillbirth in this study was higher. Multiple pregnancies, previous stillbirth, and complicated labor positively associated with stillbirth. Whereas use of partograph during labor significantly reduced stillbirth. This finding suggests that proper management of labor is mandatory to reduce stillbirth.

Background: Female genital mutilation is one of the harmful traditional practices among women and girls. More than 130 million girls and women live today who have undergone female genital mutilation. In Ethiopia, a high prevalence (74.3% national and 68.5% in Amhara region) has been reported. This study was aimed to identify determinant factors of female genital mutilation practices in East Gojjam Zone, Western Amhara, Ethiopia Methods: community based cross sectional study was conducted among 730 women aged 15-49 years and having children < 5 years old in September, 2014. Data were collected using a pretested interviewer administered questionnaire. Descriptive statistics were used to describe study objectives, and bivariate and multivariate analysis to identify determinant factors to female genital mutilation. Results: 718 women and 805 daughters participated in the study. FGM prevalence was 689 (96%) and 403 (49%) among women and daughters< 5 years of age, respectively. Type1 and type 2 FGMs were common and daughters <1 years of age exhibited 91% female genital mutilation. Daughters' age, parent education level, residence, women circumcision history, culture, health education, frequent health extension workers follow up and participation in anti FGM interventions were risk factors to female genital mutilation practice. Conclusions: Female genital mutilation practices continues to be a major problem to women and daughter <5 years of age in the study area. A number of factors were associated with FGM practices including daughters’ age, parent education level, residence, health education, culture, mothers circumcision history, frequent health extensions workers follow up and participation in anti FGM interventions were determinants to higher FGM practices.

BACKGROUND: Electronic medical record systems are being implemented in many countries to support healthcare services. However, its adoption rate remains low, especially in developing countries due to technological, financial, and organizational factors. There is lack of solid evidence and empirical research regarding the pre implementation readiness of healthcare providers. The aim of this study is to assess health professionals' readiness and to identify factors that affect the acceptance and use of electronic medical recording system in the pre implementation phase at hospitals of North Gondar Zone, Ethiopia. METHODS: An institution based cross-sectional quantitative study was conducted on 606 study participants from January to July 2013 at 3 hospitals in northwest Ethiopia. A pretested self-administered questionnaire was used to collect the required data. The data were entered using the Epi-Info version 3.5.1 software and analyzed using SPSS version 16 software. Descriptive statistics, bi-variate, and multi-variate logistic regression analyses were used to describe the study objectives and assess the determinants of health professionals' readiness for the system. Odds ratio at 95% CI was used to describe the association between the study and the outcome variables. RESULTS: Out of 606 study participants only 328 (54.1%) were found ready to use the electronic medical recording system according to our criteria assessment. The majority of the study participants, 432 (71.3%) and 331(54.6%) had good knowledge and attitude for EMR system, respectively. Gender (AOR = 1.87, 95% CI: [1.26, 2.78]), attitude (AOR = 1.56, 95% CI: [1.03, 2.49]), knowledge (AOR = 2.12, 95% CI: [1.32, 3.56]), and computer literacy (AOR =1.64, 95% CI: [0.99, 2.68]) were significantly associated with the readiness for EMR system. CONCLUSIONS: In this study, the overall health professionals' readiness for electronic medical record system and utilization was 54.1% and 46.5%, respectively. Gender, knowledge, attitude, and computer related skills were the determinants of the presence of a relatively low readiness and utilization of the system. Increasing awareness, knowledge, and skills of healthcare professionals on EMR system before system implementation is necessary to increase its adoption.

to the migration of people who practiced this tradition, FGM/C is today evident in Australia, Canada, the United States and the European Union [4].The prevalence of FGM/C varied from nation to nation such as Niger (5%), Ghana (5%), Benin (17%), United Republic of Tanzania (18%), Nigeria (19%), Eritrea (89%), Sudan (90%), Egypt (97%) and Ethiopia (80%) [4,[6][7][8][9][10].According to Demographic and Health Survey report of Ethiopia, 74% of girls and women nationwide had subjected to FGM/C.The Regional distribution of FGM/C prevalence was: 91.6% in Afar, 85.1% in Harare, 68.5% in Amhara, 87.2% in Oromia, 65.7% in Addis Ababa, 97.3% in Somali, 67.6% in BenishangulGumuz, 29.3% in Tigray, 27.1% in Southern and 92.3% in Dire Dawa Region [11].The most responsible identified factors for practicing FGM/C were believes, religion, education, and tradition, gender-related factors, health and Socio-economic factors [12,13].

BACKGROUND: Universal access to information for health professionals is a need to achieve "health for all strategy." A large proportion of the population including health professionals have limited access to health information in resource limited countries. The aim of this study is to assess information needs among Ethiopian health professionals. METHODS: A cross sectional quantitative study design complemented with qualitative method was conducted among 350 health care workers in February 26-June 5/2012. Pretested self-administered questionnaire and observation checklist were used to collect data on different variables. Data entry and data analysis were done using Epi-Info version 3.5.1 and by SPSS version19, respectively. Descriptive statistics and multivariate regression analyses were applied to describe study objectives and identify the determinants of information seeking behaviours respectively. Odds ratio with 95% CI was used to assess the association between a factor and an outcome variable. RESULTS: The majority of the respondents acknowledged the need of health information to their routine activities. About 54.0% of respondents lacked access to health information. Only 42.8% of respondents have access to internet sources. Important barriers to access information were geographical, organizational, personal, economic, educational status and time. About 58.0% of the respondents accessed information by referring their hard copies and asking senior staff. Age, sex, income, computer literacy and access, patient size, work experience and working site were significantly associated with information needs and seeking behaviour. CONCLUSIONS: The health information seeking behaviour of health professional was significant. The health facilities had neither information center such as library, nor Internet facilities. Conducting training on managing health information, accessing computer and improving infrastructures are important interventions to facilitate evidence based decisions.