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Item Prevalence of Undernutrition and its Association with Maternal Depression among Economically Disadvantaged Women with Children Aged 12-36 Months in Selected Urban Areas of Ethiopia(Addis Ababa University, 2025-06) G/melak,Sitota; Darge,Tefera(PhD); Egata,Gudina(PhD)Background: Undernutrition remains a global pressing public health issue, but few studies in Ethiopia have examined how maternal depression related to child undernutrition. We estimated the prevalence of child undernutrition and examined how undernutrition was associated with maternal depression in urban Ethiopia. Objective: To assess the prevalence of undernutrition and its association with maternal depression among economically disadvantaged children aged 12-36 months in selected urban areas of Ethiopia. Method: This study used extracted data from the baseline household survey conducted from June to September 2022 as part of the Growth and Economic Opportunities for Women (GrOW) Africa project. A cross-sectional design was computed among 627 mother-child pairs. Child undernutrition was assessed using anthropometric measures and maternal depression was assessed using the Patient Health Questionnaire-9(PHQ-9). The anthropometric indices were derived from WHO 2006 Child Growth Standard. The association between child undernutrition (stunting and underweight) and maternal depression was analyzed separately using binary logistic regression. However, regression analysis was not conducted for wasting due to its low prevalence, which could lead to unreliable results. Adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) were estimated to measure the strength of the association. Result: The prevalence of stunting, underweight, and wasting was 52.7% (95% CI: 48.7–56.5), 14.0% (95% CI: 11.3–16.7), and 3.6% (95% CI: 2.1–5.0), respectively. Maternal depression affected one in every six mothers (16.0%) (95% CI: 13.1–18.9). Maternal depression was significantly associated with stunting [AOR = 2.21; 95% CI: 1.11–2.15] but not with underweight, after controlling for possible confounding variables. Conclusion: Undernutrition, mainly stunting and underweight are still alarming public problem in this study area. Maternal depression has significant association with stunting. Hence, integrating maternal mental health into child health program could enhance effort to combat child undernutrition.Item Evaluation of Medical Ethics Education in Public Medical Schools in Addis Ababa: a Mixed-Methods Study(Addis Ababa University, 2025-05) Yigremachew,Simon; Getachew,Sefonias(MPH, PhD); Addissie,Adamu(MD, MPH, MA, PhD)Background: Medical ethics education plays a crucial role in equipping physicians to manage the ethical challenges encountered in patient care. Although medical ethics has been formally integrated into the curricula of most Ethiopian medical schools, the quality, consistency, and impact of its implementation remain insufficiently explored. Objective: The objective of this study is to assess how medical ethics education is implemented in public medical schools in Addis Ababa. Methods: A mixed-methods cross-sectional design was utilized. Quantitative data were obtained from 302 students using a structured questionnaire administered via face-to-face interviews. Stratified random sampling was used to select participants, ensuring representation across academic years and institutions. Twelve key informants participated in interviews guided by a semi-structured tool. Quantitative data were analyzed using SPSS version 27, employing descriptive statistics, independent t-tests, ANOVA, and multiple regression analysis. Qualitative data were thematically analyzed using Dedoose version 10. Results: Composite scores (on a 5-point Likert scale) indicated strong understanding of ethical principles (Mean = 3.98/5) and professional behavior (Mean = 4.01/5), but only moderate preparedness to manage ethical challenges (Mean = 3.48/5). Regression analysis revealed that preparedness was significantly associated with content coverage (β = 0.325, p < 0.001), ethical reasoning skills (β = 0.146, p = 0.023), and clarity of instruction (β = 0.144, p = 0.010). Qualitative findings highlight gaps in curriculum integration, limited faculty training, and a lack of experiential learning. Both students and faculty emphasized the need for longitudinal teaching, participatory methods, and standardized national guidance. Conclusions: While students possess strong ethical knowledge, they feel only moderately prepared to navigate ethical dilemmas in clinical practice. Ethics education must evolve from theory-driven instruction to applied, contextually relevant, and clinically integrated learning.Item Exclusive Breast Milk Feeding at Discharge and Associated Factors Among Preterm Neonates in Public Hospital Neonatal Intensive Care Units in Addis Ababa, Ethiopia(Addis Ababa University, 2025-06) Shimelis,Hanna; Shikur,Bilal(MD, PhD); Getnet,Yalemwork(MPH, PhD Candidate)Background: Globally, there are about 15 million preterm babies, born before 37 weeks of gestation. It is recommended that term babies be breastfed within the first hour. Unfortunately, preterm infants have lower proportions of breastfeeding, especially in low resource settings. Despite these recommendations, evidence on the determinants of this gap, particularly in low resource settings, is lacking. The objective of this study was to explore the factors that affect preterm infants breast milk feeding in Addis Ababa. Objective: This study aimed to investigate exclusive breast milk feeding at discharge and the factors influencing it among mothers of preterm infants in neonatal intensive care units of public hospitals in Addis Ababa. Methods and Materials: Institution based cross sectional study was carried out in Addis Ababa public hospitals. Data collection was carried out from November 15, 2024, to January 15, 2025. Data were collected using a pretested structured questionnaire through the Open Data Kit (ODK) and later exported to Stata version 17 to be analyzed. Bivariate analysis was carried out to identify the association of each independent variable with the exclusive breast milk feeding at discharge. Variables with p-values < 0.2 were included in the multivariable logistic regression model for final analysis, and those with p-value < 0.05 were considered statistically significant. Results: In 341 preterm neonates, exclusive breast milk feeding at discharge from NICU was 82.99%.Lower exclusive breastfeeding factors were late initiation after 48 hours (AOR = 5.19, 95% CI: 2.11–12.77), no rooming-in (AOR = 4.34, 95% CI: 1.86–10.13), Cesarean section (AOR = 2.99, 95% CI: 1.43–6.25), and lack of prior breastfeeding experience (AOR = 2.96, 95% CI: 1.41–6.23). Conclusion: The rate of exclusive breastfeeding among preterm infants at NICU discharge was favorable. However, late initiation of breastfeeding, lack of rooming-in, no prior maternal breastfeeding experience, and cesarean section delivery were significant factors reducing the likelihood of exclusive breastfeeding.Item Risk of Nephrotoxicity among Dry Cleaning Workers Exposed to Perchloroethylene in Addis Ababa, Ethiopia(Addis Ababa University, 2025-06) Mohammed,Philemon; Abegaz,Teferi(PhD); Gezu,Meaza(PhD)Background: Perchloroethylene, a solvent commonly used in dry cleaning, have an impact on kidney’s health. As the dry-cleaning industry grows in Addis Ababa, it presents an occupational hazard. Limited global research and a lack of African studies on this issue highlight this study to inform policymakers and promote worker health and safety. Objective: The objective of this study is to measure selected urinary and blood nephrotoxic biomarkers among dry cleaners in Addis Ababa and compare them with hotel laundry workers to see the impact of perchloroethylene on kidney health. Method: A multi-center comparative cross-sectional study was carried out in 17 dry-cleaning shops and 21 hotel laundries in Addis Ababa, involving 70 participants from each group. The study assessed nephrotoxic biomarkers such as urinary protein, creatinine, calcium, sodium, blood urea nitrogen, and serum creatinine. Data collection involved both biological samples and structured questionnaires administered via Open Data Kit (ODK), with data analysis conducted using SPSS. Statistical methods included t-tests, chi-square tests, correlation and multivariable regression with significance determined at p < 0.05. Result: The result showed that majority of the employees were females in both groups and the risk of nephrotoxicity was higher in dry cleaners as compared to hotel laundry workers, where 88.2% of the abnormal proteinuria, 76.9% of the abnormal creatinine and 38.5% and 62.5% of the abnormal urinary calcium and sodium values were found in dry cleaners respectively. We found a significant mean difference in three biomarkers namely, Total Protein (TPU) with a Median & IQR value of (102 mg/dl &70.75 mg/dl) and (54.5 mg/dl &27.25 mg/dl), Urinary creatinine with a Median & IQR value of (193 mg/dl & 111.06 mg/dl) and (142.93 mg/dl & 78.17 mg/dl) and Urinary Calcium with a Median & IQR value of (2.60 mmol/l & 2.94 mmol/l) and (0.835mmol/l & 0.79 mmol/l) for the exposed and the control groups respectively. However, a significant difference was not found in urinary sodium, Blood urea nitrogen and S. creatinine between the two groups, but higher value of sodium above range and higher BUN within range was observed in dry cleaners. The Log10 transformed TPU and raw BUN showed a significant association with experience of PCE spillage, r (140) = 0.201, p = 0.017 and r (24) = 0.536, p = 0.007, respectively. Conclusion: The study concluded that dry cleaners faced the highest risk and abnormalities in kidney biomarkers, with factors such as duration of employment, PCE spillage, sex, frequency of handling PCE, and poor ventilation positively correlating with immediate symptoms. Although the absence of precise exposure measurements limited definitive conclusions, the findings indicated that dry cleaners are the most vulnerable group. Therefore, strong safety protocols and regular medical checkups are recommended for workers frequently exposed to PerchloroethyleneItem Association Between Problematic Internet Use and Overweight and Obesity among in School Adolescents in Addis Ababa,Ethiopia(Addis Ababa University, 2025-06) Abera,Melkamu; Haidar,Jemal(Prof.); Shikur,Bilal(MD, MPH, PhD)Introduction: Overweight and obesity among adolescents is one of the most serious public health concerns worldwide in the 21st century. Several epidemiological studies have explored the association between problematic internet use and overweight/obesity and reported inconsistent findings. The majority of the studies in this regard were from developed nations and there are limited studies from developing countries including Ethiopia. Objectives: The study is aimed to assess the association between problematic internet use and overweight and obesity among secondary school adolescents in Addis Ababa, Ethiopia Methods: A school-based cross-sectional study was conducted among adolescents 13-19 years old. Three-stage random sampling technique was used to select the study participants. Self administered questionnaire were used to collect data .The height and weight of adolescents was measured by trained data collectors.Body Mass Index (BMI) for age Z-score was compared to WHO 2007 growth reference standards using WHO Anthro plus version 3.2.2 software. Data were entered and cleaned using epi data version 3.1 and all statistical tests were done using SPSS 20 software. Descriptive statistical tests, bivariate and multivariate logistic regression analysis was done to identify factors associated with overweight and obesity. Results: Based on internet addiction test score respondents who have internet addiction test >50 was 31.5%.Adolescents who had Internet addiction test score 31-49,50-79 and 80-100 were 8.835,8.65 and 3.3968 times higher odds of overweight or obesity as compared to those who had internet addiction test of 0-31 score .(AOR=8.835,95% CI(2.99-26.103)), (AOR=8.65,95% CI (2.811-26.616)), (AOR=3.968,95%CI(1.36-11.574)) respectively Conclusion and recommendation: Finding of this study revealed that strong association between problematic internet use and overweight and obesity among inschool adolescents in Addis Ababa. Parents should encourage their children for managing their children’s internet use and promoting healthier lifestyles at homeItem Gratitude for Living Off a Machine: Lived Experiences of Patients Aged 18 to 40 years with chronic kidney disease on Hemodialysis treatment: A phenomenological Study(Addis Ababa University, 2025-06) Bekele,Yonatan; Molla,Mitike(PhD); Solomon,Kalkidan(PhD candidate)Background : Chronic kidney disease (CKD) affects about 12.1% of the global population where the prevalence is higher in Africa at 15.8% (2018). In Ethiopia, the prevalence of CKD was 12.2% where the prevalence among adults aged 35 and less was estimated to be around 41% in 2018. CKD progress to end stage renal disease (ESRD) where patients will be forced to undergo dialysis or kidney transplant. With the latter being difficult to access, most patients will be put on dialysis. Dialysis interferes with daily life, causing feelings of isolation, depression, frustration apart from its high cost. Despite these challenges, in Ethiopia, little is known about the lived experiences of patients who are living with CKD especially at their productive age. Objectives: To explore the lived experiences of patients aged 18 to 40 years old, with chronic kidney disease on hemodialysis treatment. Methods: phenomenological qualitative research was employed to explore the lived experiences of dialysis patients. Data were generated using a semi structured in-depth interview guide among 17 purposively selected participants. The interview was then transcribed verbatim and translated to the English language and coded using open code software version 4.03 and data were analyzed thematically. Efforts were made to uphold the qualitative study's credibility, dependability, transferability, and confirmability. Results: Six major themes and 12 sub-themes emerged from the data. This study showed that adults aged 18-40 years face unique burdens while undergoing dialysis including career disruption and social alienation, physical changes, emotional challenges such as depression and anxiety. In addition, the need for adaptive strategies centered on peer networks, self-discipline, and external support systems were eminent findings. Conclusion: The findings revealed complex interplay of physical, emotional, economic, and social struggles, and coping mechanisms of patients. Following the findings, a shift from clinical management to a holistic approach addressing the physical, social, emotional and financial needs, need to be put in place.Item Growth Monitoring and Promotion Program For Improving Dietary Diversity of Infants: Evidence From Performance Monitoring For Action- Ethiopia Study(Addis Ababa University, 2025-04) Tesfaye,Bezawit; Shiferaw,Solomon(MD, MPH, PHD); Darge,Tefera(MSc, MPHM, PHD)Background: Child malnutrition and inadequate feeding practices continue to be significant challenges in Ethiopia. The Growth Monitoring and Promotion (GMP) program aims to address these concerns by empowering mothers to provide appropriate childcare. Despite the program's longstanding implementation in Ethiopia over sixteen years as nutrition specific intervention to prevent malnutrition, there is limited data and understanding of its effects on child feeding practices. The study examined the role of GMP in improving dietary diversity of infants aged 6 to 12 months in selected regions of Ethiopia. Methods: A weighted community-based retrospective cohort study was conducted from January 2024 to May 2025 using secondary data from the PMA-Ethiopia panel survey. A weighted sample size of 915 children’s with complete dietary diversity data at one year postpartum follow up survey were included in this study. Data was cleaned and analyzed using STATA version 18. A longitudinal panel survey design-based bi-variable and multivariable logistic regression analysis was used to determine the role of GMP in improving dietary diversity of infants, while controlling for possible confounders. Adjusted odds ratio (AOR) alongside 95% confidence intervals (CIs) was estimated to measure the strength of the association between variables of interest. Results: In this study, only 29.2% of mothers (95% CI: 24.7%, 34.0%) reported utilizing GMP services for their child since delivery, and just 18.5% of infants (95% CI: 14.7%, 23.1%) achieved the minimum recommended dietary diversity. Utilization of GMP services was not significantly associated with dietary diversity both in the bivariate and multivariate analyses [AOR: 0.96(0.85, 1.50); p=0.846]. Although a slightly higher proportion of children who participated in GMP had sufficient dietary diversity, the difference was not statistically significant. Conclusion: This study found a low prevalence of adequate dietary diversity among infants, with no statistically significant association between participation in GMP services and achieving minimum dietary diversity. The findings underscore the need for quality nutritional counseling and sustained behavior change communication alongside GMP services.Item Chronic Energy Deficiency and its Predictors Among Older Adults in Addis Ababa, Ethiopia: a Cross-Sectional Study.(Addis Ababa University, 2025-06) Bekele,Obsa Abebe; Shiferaw,Solomon(MD, MPH. PhD); Desalegn,Yakob(MD, MPH)Background: The likelihood of malnutrition grows as individuals age and as their need for care becomes more intensive. Approximately 40% of fatalities in developing nations are associated with chronic energy deficiency. However, studies on chronic energy deficiency(CED) which is one form of nutritional deficiency and an important public health problem are quite limited in Ethiopia, which makes it difficult to identify their nutritional need. Objectives: This study aimed to assess chronic energy deficiency and its predictors among the population of older adults (defined as 50 years and above) in Addis Ababa, Ethiopia. Methods: A Community based cross-sectional study was conducted among older adults 50 years and above from February 12-22, 2025. Data from 635 individuals were collected through interviewer-administered questionnaires using the open-source mobile based Kobo toolbox. Data were downloaded, merged and cleaned on Excel 2019 and then exported to SPSS V27. A bi-variable and multivariable logistic regression model was used to determine associations between the outcome variable and its predictors. Result: A total of 635 older adults were interviewed with mean age of the participants was 64.7 (50 to 91 years) years with higher percentage of males (58.4%) represented. The study revealed that prevalence of chronic energy deficiency (CED) in older adult population was 10.1% (CI:7.9%-12.6%).Respondents in the age between 50 and 65 [AOR=3.9,95% CI:(1.6,9.3)], those having infrequent meal [AOR=3.9,95% CI: (1.7,8.8)],irregular meal pattern [AOR=2.4,95% CI:( 1.3,4.6)],insomnia [AOR=3.1,95% CI:(1.5,6.6)], Inadequate or poor dietary diversity [AOR=2.8, 95% CI:(1.5,5.3)] and household with food insecurity [AOR=6.2,95% CI (3.2,12.2)] were significantly more likely to have CED compared to their counterparts. Additionally, the study revealed that 1.4% of population were mis-classified on their CED status whenever physical activity level of the population was not considered for classification of chronic energy deficiency Conclusion: The prevalence of chronic energy deficiency was substantial in the study area. It was significantly associated with age between 50 and 65, poor dietary diversity score, infrequent meal and irregular meal pattern, insomnia and household food insecurity at 95% CL and P value<0.05. Therefore, efforts to combat CED should focus on supporting the most vulnerable groups indentified in this study. Raising awareness within communities on meal frequency and meal pattern is also crucial.Item Minimum Meal Frequency and its Association With Underweight among Non-Breastfed Infants and Young Children Aged 6 to 23 Months in Hawassa City, Ethiopia.(Addis Ababa University, 2025-07) Wolde,Lidetash; Shiferaw,Samson(PhD); Yirgu,Robel(BSC, MPH, PHD)Background: The increasing practice of non-breastfeeding is a major concern, particularly in urban areas. Meal frequency measurement has different standards among non-breastfed children. However, the primary focus of nutrition studies has been on breastfeeding, leading to a lack of comprehensive data on meal frequency and its association with underweight status among non-breastfed infants. Objective: This study was aimed at assessing the minimum meal frequency and its association with underweight among non-breastfed infants and young children aged 6 to 23 months in Hawassa city, Ethiopia, from May 12, 2024, to July 08, 2024. Methods: A community-based cross-sectional study was conducted among 423 non-breastfed children aged 6 to 23 months in Hawassa City. First, the estimation was made to know whether there is an adequate sample of non-breastfed or not in the community. Then, the sample was allocated proportionally to all sub-cities based on population size. After that, one of the sub-cities was chosen at random, and the first non-breastfed child from that sub-city was identified. Finally, the collection process began with the identified child and proceeded using consecutive sampling. Data was collected using Kobo Collect-enabled mobile phones, an interviewer-administered questionnaire, and a weight scale. The association between underweight and explanatory variables was assessed using binary logistic regression. Result: A total of 420 respondents participated in the study. The percentage of non-breastfed children who fulfilled minimum meal frequency (MMF) was 62.9%, and the prevalence of underweight was 10%. Non-breastfed children who did not fulfill the MMF were 5.2 times more likely to be underweight compared to those who met the requirement per day (p= <.001, AOR; 5.2, 95% CI: 2.5, 11.0). Compared to the children whose mothers’ age was above 35, those children whose mothers’ age was between 15 and 24 and between 25 and 34 had a lower risk of being underweight (p=0.04, AOR; 0.15, 95% CI: 0.02, 0.93) and (p=0.03, AOR; 0.15, 95% CI: 0.03, 0.8), respectively. Conclusion: The findings of our study indicated that about three out of five children were fed with meal frequency according to World Health Organization recommendations. Adherence to the recommendation of meal frequency might reduce the risk of being underweight. Studies incorporating qualitative approaches might be helpful in generating in-depth information to address the issue related to the causes of having lower meal frequency among non-breastfed IYC.Item Assessment of Work-Related Musculoskeletal Disorders and Associated Factors among Workers in Flower Farms in Southwest Shoa Zone of Oromia, Ethiopia(Addis Ababa University, 2025-06) Jebessa,Tsiyon Abera; Gezu,Meaza(PhD); Abegaz,Teferi(PhD)Background: Musculoskeletal disorders (MSDs) are prevalent in workplaces, especially in agriculture and floriculture. Working on flower farms presents significant risks for WRMSDs due to extended postures and repetitive tasks such as cutting, packing, storing flowers, and loading/unloading boxes. Objective: This study assessed the prevalence of self-reported work-related musculoskeletal disorders and their associated factors among flower farm workers in the Southwest Shoa Zone of Oromia, Ethiopia. Methods: This cross-sectional study examined WRMSDs and associated factors among 423 flower farm workers in Southwest Shoa, Oromia, from January to June 2024. Data were collected using the Nordic Musculoskeletal Questionnaire and analyzed with descriptive statistics and Chi-square tests (p < 0.05). Ethical approval was granted by the Research Ethics Committee of Addis Ababa University’s School of Public Health. Results: This cross-sectional study (Jan–Jun 2024) in Southwest Shoa Zone, Oromia, examined WRMSD prevalence and predictors among flower farm workers using interview data and logistic regression (OR, 95% CI, p < 0.05). The prevalence of WRMSDs was 63.36% (95% CI: 58.77–67.95%). Significant factors included age 25–35 years (AOR: 2.09; 95% CI: 1.07–4.08), being married (AOR: 2.09; 95% CI: 1.12–3.91), divorced/widowed (AOR: 5.00; 95% CI: 1.19–21.05), and basic literacy (AOR: 0.28; 95% CI: 0.11–0.67). Occupational and psychosocial factors—such as working in packhouses (AOR: 4.37; 95% CI: 1.51–12.69), awkward bending or twisting (AOR: 18.98; 95% CI: 1.62–221.96), job stress (AOR: 3.67; 95% CI: 1.55–8.64), and job dissatisfaction (AOR: 3.12; 95% CI: 1.56–6.23)—were also significantly associated. Conclusion: Flower farm workers in Southwest Shoa, Oromia, Ethiopia, exhibited a high prevalence of WRMSDs. Significant factors included age (25–35 years), marital status, literacy level, packhouse work, awkward postures, job stress, and dissatisfaction. These findings underscore the multifactorial nature of WRMSDs and the need for integrated ergonomic and psychosocial interventions.Item Prevalence of Common Mental Disorders and Factor Affecting among Patients of Health Facilities in Bishoftu, Ethiopia.(Addis Ababa University, 2025-06) Yifter,Nega; Nega,Adiam(MPH)Background: Common mental disorders are disorders like depression, anxiety and somatic manifestations in addition to non-psychotic symptoms like fatigue, memory problem a major public health concern in low and middle income countries, including Ethiopia. However, limited evidence exists on their prevalence and associated factors among general outpatient patients in local health facilities. Objective: To assess the prevalence of common mental disorders and associated factors among patients attending public health facilities in Bishoftu, Ethiopia. Methods: A facility-based cross-sectional study was carried out between June 1 and July 24, 2024, in one general hospital and seven health centers located in Bishoftu.. A total of 560 patients aged >15 years excluding those with known psychiatric illness were selected using simple random sampling. Data were collected through a structured interviewer-administered questionnaire, including the Self-Reporting Questionnaire (SRQ-20) to screen for CMDs. Multivariable logistic regression analysis was used to identify factors associated with CMDs, with statistical significance set at p<0.05. Results: The prevalence of common mental disorders among the study participants was 40.4%, which is higher than some national and regional estimates. Statistically significant associated factors included monthly income ≤1000 ETB (AOR=2.645, 95% CI: 1.032–3.779), diabetes (AOR=3.219, 95% CI: 1.595–8.029), hypertension (AOR=3.219, 95% CI: 1.595–8.029), cardiac illness (AOR=2.524, 95% CI: 1.163–5.477), moderate social support (AOR=3.415, 95% CI: 1.792–6.507), and poor social support (AOR=21.980, 95% CI: 11.590–41.685). Conclusion: This study found a high burden of common mental disorders in Bishoftu, exceeding regional and national averages. Chronic medical conditions, low income, and inadequate social support networks were strong predictors of CMDs. The findings underscore the need for integrating mental health services into primary care and tailoring interventions to local contexts.Item Self-Medication Practice and Associated Factors among Pregnant Women Attending Antenatal Care in Selected Public Hospitals in Addis Ababa, Ethiopia(Addis Ababa University, 2025-08) Fitsumberhane,Sofia; Assegid,Meselech(PhD); Getachew,Hewan(MD, MPH)Background: - Self medication practice among pregnant women refers to the use of traditional and over the counter medications with out guidance from health professionals. This practice poses significant health risks to both the mother and the unborn fetus.Lack of contextual studies regarding the reasons,factors and patterns of the practice is the significant gaps observed in Ethiopian studies. This study aims to bridge this knowledge gap by investigating self-medication and its associated factors among pregnant women. Objective: -The objective of the study was to determine prevalence and contributing factors of self- medication among pregnant women attending antenatal care in public Hospitals. Method: - Facility based cross-sectional study was conducted in six public hospitals in Addis Ababa from February 14 to April, 14,2025. A total of 545 pregnant women attending antenatal care units were included in the study. The study pariticipants wete selected using systematic random sampling. An interview administered structured questionnaire using KOBO Toolbox was used for data collection and analyzed using SPSS version 24. Descriptive (percent and frequency) and inferential data analysis (Bivariate and multivariate regression) techniques were used. The thesis of this study was submitted and presented to Addis Ababa University, College of Health Sciences School of Public Health. Results: - The study found that, self-medication practice among pregnant women was 79.8% (CI,95 %).It also indicated that monthly income with high income (AOR = 5.32, 95% CI: 1.09–25, p = 0.03), social support with strong social support (AOR = 1.95, 95% CI: 1.1–3.5, p = 0.02),educational attainment with secondary education (AOR = 0.35, 95% CI: 0.18–0.66, p = 0.001), past medication use(AOR = 2.24, 95% CI: 1.27–3.97, p = 0.006) and the health care access (AOR = 0.43, 95% CI: 0.22–0.84, p = 0.01) are important predictors. Conclusions The study found high prevalence of self medication practice.Pregnant women with Higher Monthly income,strong social support,higher educational level and previous medication use were found to be likely engaged in self medication practices while those with better access to health care providers less likely engage in self medication practices.Strengthening antenatal counseling ,Cretion of awareness,Promoting access to health care facility were recommended.Item Prevalence of Sexually Transmitted Infections and its Association with Emergency Contraceptive Use among Regular Female Students at Addis Ababa University(Addis Ababa University, 2025-08) Mesfin,Rediet; Molla,Mitike(PhD); Tadesse,Yordanos(BSc, MPH)Background: Emergency contraceptive (EC) use after unprotected sexual intercourse has become increasingly common among female university students. However, its repeated and sole use as a pregnancy prevention method exposes users to sexually transmitted infections (STIs), including HIV, due to risky sexual behaviors and inconsistent use of preventive measures like condoms. Despite its widespread use, there is a paucity of evidence about EC use and STI status among female university students in Ethiopia. Objectives: This study aims to assess the prevalence of STI, emergency contraceptive use and its association with STIs among female regular undergraduate university students at AAU. Methods: An institutional-based cross-sectional study was conducted using a multistage sampling method from randomly chosen departments within each college. Data were collected using a self-administered structured online questionnaire from 793 students, exported to STATA, and descriptive analysis, bivariate, and multivariate logistic regression were done. Results: The study shows there is high EC use and STI prevalence among the participants where 52.3% was using EC in the past year and out of those 81% using it repeatedly. A little less than half (43.7%) of the students had STI in the past year, and the number rises to 63.7% among EC users. Only 31.5% had persistent use of condoms. There is a strong association between EC use and STI status with AOR of 17.71 (SE=8.10, 95%CI) after adjustment. Conclusions: The strong association between EC use and STI status can indicate EC use is associated with unprotected sex and risky sexual behaviors. In addition, the results show students are more concerned about pregnancy than STI risk. Thus there is a need for comprehensive reproductive and sexual health education emphasizing on integrated STI and pregnancy prevention. Further research is required to explore the facilitators and barriers behind EC use over other contraceptive methods.Item Mothers' readiness at hospital discharge for home based preterm infant care and its association with the quality of hospital discharge education in selected public hospitals in Oromia regional state, Ethiopia(Addis Ababa University, 2024-06) Ebrahim,Munira; Seifu,Abiy(Ass.Prof.)Background: Preterm births contribute to 35% of all neonatal deaths. Apart from health facility-based intervention, improving mothers’ readiness during their hospital stay to continue preterm infant care at home improves neonatal health outcomes. Objective: To assess the level of mothers' readiness at hospital discharge for home-based preterm infant care and its association with the quality of hospital discharge education in selected public hospitals in Oromia regional state, Ethiopia. Methods: An institution-based cross-sectional study was conducted at public hospitals in the Oromia region. A total of 403 women who had preterm births and received neonatal care in selected public hospitals were included in the study. Data was collected by four female and one male BSc degree holders using the ODK platform. A descriptive analysis was conducted by computing frequency and mean. The association between readiness at hospital discharge and the quality of hospital discharge education and other covariates was investigated using logistic regression analysis. The P-value of < 0.05 was considered statistically significant. Results: The findings of this study showed that 54.48% of the mothers were ready to be discharged from the hospital. Having good quality of discharge education was associated with a 2.43 (adjusted odds ratio [AOR]: 2.43; 95% confidence interval [CI] 1.32,4.48) fold increase in the odds of being ready for discharge. Other variables that were independently associated with readiness include residence (AOR: 4.87; 95%CI: 2.34,10.12), marital status (AOR: 2.34; 95%CI: 1.20,4.59), parity(AOR: 2.82; 95%CI: 1.43,5.54)], mode of delivery (AOR: 6.69; 95%CI: 2.64,16.96), hospital length of stay(AOR: 3.36; 95%CI: 1.79,6.31) and education in mother tongue language (AOR: 5.92; 95%CI: 2.33,15.09). Conclusion and recommendations: In this study, the level of readiness at hospital discharge among mothers of preterm infants was suboptimal. Good quality of discharge education is significantly associated with higher readiness at hospital discharge. Therefore, providing high quality discharge education to mothers of preterm infants during their hospital stay and educating them in their mother tongue could help increase readiness at hospital discharge.Item Digital Health Literacy and Practice among Physicians in Government Teaching Hospitals of Addis Ababa: A Cross-Sectional Study(Addis Ababa University, 2025-06) Arefine,Semhal; Assefa,Demeke(MD, MA); Asrat,Gashaye(MPH)Background: Digital health is becoming crucial for improving health outcome and providing patient centered care. World nations are integrating digital health policies and strategies to achieve digitalization of health care. However utilization and successful adoption of these technologies require physicians’ literacy, but there is limited study on digital health literacy of physicians and its influence on digital health practices. Objective: This study aimed to assess the digital health literacy and practice among physicians in government teaching hospitals in Addis Ababa. Methods: A cross-sectional study was conducted from March to April 2025. A representative quantitative data from government teaching hospitals in Addis Ababa collected through structured questionnaire among 394 physicians. Data was entered and cleaned in excel then exported to SPSS 26.0 for analysis. Descriptive statistics, Binary and multivariable logistic regression were carried out and P value of < 0.05, adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to determine variables significantly associated with digital health practices. Result: In this study, out of all respondents 50.3% of physicians had high digital health practice and digital health literacy of 58.2%. Higher digital health literacy (AOR=2.05 95% CI: 1.27-3.3), limited access to digital tools at workplace (AOR= 0.18, 95% CI: 0.06-0.5), training on digital health (AOR=2.05, 95% CI: 1.16-3.6), being general practitioner (AOR= 0.26, 95% CI: 0.1-0.6) were found to be significant factors associated with digital health practice. Conclusion: Although more than half of the physicians had high digital health literacy, the practical use in clinical service was low and limited to facility based digital tools and technologies. To enhance digitalization of health care, for future adoption and implementation, stakeholders including Ministry of Health, Ministry of Education and health facilities should take appropriate measures in implementing guidelines, platforms and strategies for physicians with pre-service training and in-service professional development programs.Item Frequency of Fast-Food Consumption and Its Association With Metabolic Syndrome Among Adults in Addis Ababa, Ethiopia(Addis Ababa University, 2025-06) Wondatir,Kalkidan; Egata,Gudina(Dr.); Yirgu,Robel(Dr.); Gebremedhin,Samson(Dr.)Background: With the rise of urbanization and the growing influence of Western diets, particularly fast foods, the prevalence of metabolic syndrome has increased globally. In Ethiopia, the consumption of fast food is a growing public health concern in urban settings yet its association with metabolic syndrome remains understudied. Objective: This study aimed to determine the frequency of fast-food consumption and its association with metabolic syndrome among adults in Addis Ababa. Methods: A cross-sectional study was conducted using data from the 2021 Surveillance of Non-communicable Diseases in Addis Ababa survey among 600 adults aged 18–64. Fast food consumption was assessed via food frequency questionnaires, while Metabolic syndrome was diagnosed using the Adult Treatment Panel (ATP) III criteria. The analysis for fast food consumption included sugar-sweetened beverages/energy drinks, chocolate or other sweet spreads, store-bought ice cream, fruit juice (preserved), deeply fried foods (French fries, chicken fries..), burgers or sandwiches, store-bought pizza, chips, French fries, store-bought pastries or sweet breads and cookies or biscuits. Bivariable and Multivariable logistic regression analyses were used to identify factors associated with Metabolic syndrome. Adjusted odds ratios, along with the corresponding 95% confidence interval were estimated to measure the strength of the association between dependent and independent variables. A P-value of less than 0.05 was considered statistically significant. Results: Out of 600 participants, 10.4% frequently consumed fast food, with sugar-sweetened beverages being the most commonly consumed item. The prevalence of metabolic syndrome was also 24.3%, 95% CI: (20.59%, 27.41%). While unadjusted analysis showed a significant association between frequent fast-food consumption and metabolic syndrome, this association turned statistically insignificant after adjusting for confounders [AOR= 1.606, (95% CI: 0.237, 10.889)], p=0.627. Conclusion: Although fast food consumption is not found to be statistically significant with metabolic syndrome, public health interventions should target dietary habits to mitigate metabolic syndrome risk.Item Cost effectiveness analysis of Performance Based Financing in Maternal and Child Health in Borana Zone(Addis Ababa University, 2024-06) Temesgen,Zeweter; Molla,Meseret (PhD); Melka,Adane(PhD)Performance-Based Financing has been adopted as a strategic health financing model across many countries in sub-Saharan Africa and has been implemented in Ethiopia since 2015. The primary objective is to enhance the quality, coverage, and efficiency of healthcare service delivery, particularly in the area of maternal and child health. This study aims to evaluate cost-effectiveness of Performance-Based financing in improving maternal and child health services in the Borana region of Ethiopia. A quasi-experimental research design was employed to compare Performance-Based Financing with traditional Input-Based Financing model. Secondary data on the utilization of maternal and child health services and the costs associated with providing those services were collected from CORDAID, the Oromia Regional Health Bureau, and the District Health Information System, retrospectively for the period between January and December 2022. A stratified random sampling was used to sample health facilities of Borana and the sample size was calculated as 4 hospitals and 35 health centers. Cost-effectiveness was assessed using the Incremental Cost-Effectiveness Ratio, and the health impact was estimated using the Lives Saved Tool, a component of the Spectrum software. The maternal and child health services analyzed in this study included the first and fourth antenatal care visits, skilled birth attendance, and postnatal care. The study found significant increase in the coverage of antenatal care and skilled birth attendance under the Performance-Based Financing model. Compared to the Input-Based Financing model, Performance-Based Financing resulted in an estimated 228 additional lives saved, while Input-Based Financing led to only 10. The cost per disability-adjusted life year averted was 8,735 for Performance-Based Financing and 383 for Input-Based Financing. These results suggest that Performance-Based Financing is a cost-effective strategy for improving maternal and child health service coverage and health outcomes in the Borana region of Ethiopia.Item Assessment of the Magnitude and Determinants of Psycological Distress among Women Who Tested positive for HPV During Cervical Cancer Screening in Addis Ababa ,Ethiopia ,2025.(Addis Ababa University, 2025-06) Terefe,Tigest; Gizaw,Muluken(Dr.)Background: Cervical cancer is a major public health cocern and remains the leading cause of cancer-related deaths among women in developing countries. In Ethiopia, HPV testing was first introduced in 2021 for women living with HIV and is expected to become the primary screening method for all women in future national guidelines. While HPV testing is highly sensitive, it has a low positive predictive value. Consequently, the test often identifies many women as HPV-positive even in the absence of precancerous lesions. Being informed of an HPV infection can cause significant psychological distress, as many women may associate the diagnosis directly with cervical cancer. Objective: To assess the magnitude of psychological distress and its associated factors among women who tested positive for HPV, including both women living with HIV (WLHIV) and those in the general population in Addis Ababa. Method: An explanatory sequential mixed-methods study was conducted from February to May 2025 in selected HPV screening facilities in Addis Ababa, Ethiopia. For the quantitative component, a facility-based cross-sectional study design was employed. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10), with scores calculated by summing the values of 10 individual responses, yielding a total score ranging from 10 to 50. Cut-off points of <20, 20–24, 25–29, and ≥30 were used to categorize psychological distress as likely to be well, mild, moderate, and severe, respectively. Descriptive statistics and logistic regression analyses were performed to identify factors associated with psychological distress. Thematic analysis was used for qualitative data analysis. Result : From a total of 423 participants, 146(34.5%) were found to have severe mental distress while 63 (14.9%) had moderate mental distress, 40 (9.4%) had mild mental distress and 174 (41.1%) were likely to be well. The respondants who had poor knowledge about HPV (AOR = 5.26, 95% CI: 2.82-9.80), negative social and cultural perception associated with HPV (AOR = 1.91, 95% CI: 1.0–3.6) , lack of support from their partners (AOR = 4.59, 95% CI: 2.43-8.71) and negative experience during screening and follow up services experience (AOR = 2.63, 95% CI:1.43-4.83) were found to be significantly associated with mental distress among HPV positive women. The qualitative findings revealed that some of the emotional reactions to an HPVpositive screening included fear of stigma,blame and abandonment which inturn resulted fear of reporting the result to partners or family. Follow-up care difficulty was also reported, such as access barriers, vague information, and emotional resistance to return for reassessment. Conclusion and Recommendation : The study reveals that a significant proportion of HPV-positive women experienced mild to severe psychological distress following their screening results. knowledge gaps, sociocultural stigma, limited partner support, and negative experiences with screening and follow-up services have been negatively associated with the psychological conditions after the screening. Addressing these factors through improved health education, strengthened social support systems, and the integration of mental health care into screening programs is essential to mitigate the psychological impact associated with HPV positive results after screening.Item Cost-effectiveness Analysis of Inpatient versus Outpatient Treatment Centers for Substance Use Disorder in Ethiopia(Addis Ababa University, 2025-06) Belete,Addisu Tsehay; Wussobo,Adane Melka; Mebratie,Anagaw DersehBackground: Substance use disorders are a growing burden in Ethiopia, accounting for 34% of NCDs burden and higher indirect costs (86%). The treatment of SUD in Ethiopia, which is traditionally facility based, Inpatient (ITC) and outpatient (OTC) interventions are the two treatment modalities, yet their cost-effectiveness remains uncertain. This study aims to evaluate the cost-effectiveness of Inpatient (ITC) versus Outpatient (OTC) treatment for SUD in Ethiopia. Methods: A retrospective cohort study design was used for conducting a full economic evaluation using a Markov model to assess the cost-effectiveness of SUDs treatment at inpatient (ITC) and outpatient (OTC) treatment centers in Addis Ababa, Ethiopia. A total of 282 SUD patients aged 18 and above was selected by simple random sampling. A bottom-up ingredient micro costing approach was employed to collect a relevant cost data. The primary cost and effectiveness data were collected from inpatient (ITC), outpatient (OTC) treatment centers and patient interviews to inform the Markov Model. Costs were evaluated from a societal perspective, and effectiveness was measured in terms of DALY averted, with both costs and effects discounted at 3%. The model, developed in Microsoft Excel, included six health states with start age of 18, and a one-year cycle length with a lifetime horizon. Data entry and analysis was also undertaken using Microsoft Excel. Caregiver costs were excluded due to data reliability concerns. Results: The estimated life time costs of SUD treatment was USD 33,626 for ITC and USD 27,036 for OTC. The Average Cost Effectiveness Ratio (ACER) indicates that USD 102 per DALY averted is required for ITC, while only USD 82 per DALY averted is needed for OTC. In this regard, OTC is deemed the preferred option. The analysis further revealed that SUD treatment at ITC is not a cost-effective, with an ICER of USD 3710 per DALY averted, exceeding Ethiopia’s cost-effectiveness threshold of one to three times the GDP per capita. In contrast, the study identified SUD treatment at OTC as a cost-effective alternative. Conclusion: The SUD treatment in Ethiopia is associated with a significant financial burden. While outpatient care (OTC) is more cost-effective than inpatient (ITC), it remains largely inaccessible and unaffordable. Integrating SUD services into primary health care could enhance access and reduce costs, with specialized care reserved for severe and complex cases.Item Arts-Based Approach to Improve Children’s Knowledge of Hypertension and Diabetes in Addis Ababa, Ethiopia(Addis Ababa University, 2025-08) Tsega,Mliete; kaba,Mirgissa(Prof.); ketema,Bezawit(Dr.)Background: Non-communicable diseases (NCDs) are a global public health challenge. In Ethiopia, NCDs accounted for 46% of total deaths in 2023. Despite this burden, inadequate knowledge about NCDs contributes to late diagnosis and poor treatment outcomes. Although effective health education intervention is believed to improve early diagnosis and treatment of NCDs, there is limitation in reaching to the public with appropriate information and channel. This study aims to bridge this gap by evaluating the effectiveness of storybooks as a health education tool to improve knowledge about hypertension and diabetes among school children, while also exploring areas of improvement of the storybooks. Methods: This study employed a sequential mixed method design. The study was conducted from January 2025 to March 2025 in two primary schools in Nifas Silk Lafto sub-city, Addis Ababa. For quantitative part, pre-post study design was conducted with 449 randomly selected students aged 12-19 years. Self-administered structured questionnaire was adapted from previously published research and used to measure the knowledge of children regarding hypertension and diabetes before and after disseminating the storybooks. The data were entered in to Epi-Data version 3.1 and analyzed using SPSS version 26. Paired t-test was used to compare the mean knowledge score of children before and after the intervention. A p-value less 0.05 considered statistically significant. For qualitative part, eight focus group discussions were conducted to explore areas of storybook improvement. The data were transcribed verbatim, translated in to English and coded, then thematic analysis was done, which was facilitated by MAXQDA-24. Result: The overall mean knowledge score increased from 10.41 ± 5.50 to 14.48 ± 5.24 for hypertension and 12.02 ±5.19 to 14.32 ±4.84 for diabetes at end-line (P < 0.001). Knowledge gain was varied significantly by grade level (P = 0.025). The key areas for improvement of the storybooks that children suggested include simplifying the vocabulary, enhancing visual quality with brighter images, larger fonts, and increased line spacing as well as including more detailed health information. Conclusion: Storybooks are an effective tool for improving children’s knowledge of hypertension and diabetes. Health messages should be presented in simple, easily understandable and visually attractive way. Future interventions should focus on refining these storybooks and expanding their distribution to improve health outcomes.