Background Asymptomatic SARS-CoV-2 infections are responsible for potentially significant transmission of COVID-19. Worldwide, a number of studies were conducted to estimate the magnitude of asymptomatic COVID-19 cases. However, there is a need for more robust and well-designed studies to have a relevant public health intervention. Synthesis of the available studies significantly strengthens the quality of evidences for public health practice. Thus, this systematic review and meta-analysis aimed to determine the overall magnitude of asymptomatic COVID-19 cases throughout the course of infection using available evidences. Methods We followed the PRISMA checklist to present this study. Two experienced review authors (MA and DBK) were systematically searched international electronic databases for studies. We performed meta-analysis using R statistical software. The overall weighted proportion of asymptomatic COVID-19 cases throughout the course infection was computed. The pooled estimates with 95% confidence intervals were presented using forest plot. Egger’s tests were used to assess publication bias, and primary estimates were pooled using a random effects model. Furthermore, a sensitivity analysis was conducted to assure the robustness of the result. Results A total of 28 studies that satisfied the eligibility criteria were included in this systematic review and meta-analysis. Consequently, in the meta-analysis, a total of 6,071 COVID-19 cases were included. The proportion of asymptomatic infections among the included studies ranged from 1.4% to 78.3%. The findings of this meta-analysis showed that the weighted pooled proportion of asymptomatic COVID-19 cases throughout the course of infection was 25% (95%CI: 16–38). The leave-one out result also revealed that the weighted pooled average of asymptomatic SARS-CoV-2 infection was between 28% and 31.4%. Conclusions In conclusion, one-fourth of SARS-CoV-2 infections are remained asymptomatic throughout the course infection. Scale-up of testing, which targeting high risk populations is recommended to tackle the pandemic.

Background Understanding the epidemiological parameters that determine the transmission dynamics of COVID-19 is essential for public health intervention. Globally, a number of studies were conducted to estimate the average serial interval and incubation period of COVID-19. Combining findings of existing studies that estimate the average serial interval and incubation period of COVID-19 significantly improves the quality of evidence. Hence, this study aimed to determine the overall average serial interval and incubation period of COVID-19. Methods We followed the PRISMA checklist to present this study. A comprehensive search strategy was carried out from international electronic databases (Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library) by two experienced reviewers (MAA and DBK) authors between the 1st of June and the 31st of July 2020. All observational studies either reporting the serial interval or incubation period in persons diagnosed with COVID-19 were included in this study. Heterogeneity across studies was assessed using the I2 and Higgins test. The NOS adapted for cross-sectional studies was used to evaluate the quality of studies. A random effect Meta-analysis was employed to determine the pooled estimate with 95% (CI). Microsoft Excel was used for data extraction and R software was used for analysis. Results We combined a total of 23 studies to estimate the overall mean serial interval of COVID-19. The mean serial interval of COVID-19 ranged from 4. 2 to 7.5 days. Our meta-analysis showed that the weighted pooled mean serial interval of COVID-19 was 5.2 (95%CI: 4.9–5.5) days. Additionally, to pool the mean incubation period of COVID-19, we included 14 articles. The mean incubation period of COVID-19 also ranged from 4.8 to 9 days. Accordingly, the weighted pooled mean incubation period of COVID-19 was 6.5 (95%CI: 5.9–7.1) days. Conclusions This systematic review and meta-analysis showed that the weighted pooled mean serial interval and incubation period of COVID-19 were 5.2, and 6.5 days, respectively. In this study, the average serial interval of COVID-19 is shorter than the average incubation period, which suggests that substantial numbers of COVID-19 cases will be attributed to presymptomatic transmission.

Background: The incidence of maternal mortality remains unacceptably high in developing countries. Ethiopia has developed many strategies to reduce maternal and child mortality by encouraging institutional delivery services. However, only one-fourth of women gave birth at health facility, in the country. This, this study aimed to identify individual level factors and to assess the regional variation of institutional delivery utilization in Ethiopia. Methods: Data were obtained from the 2016 Ethiopian demographic and health survey. In this study, a total of 7174 reproductive age women who had birth within five years were included. We fitted multilevel logistic regression model to identify significantly associated factors associated with institutional delivery. A mixture chisquare test was used to test random effects. Statistical significance was declared at p < 0.05, and we assessed the strength of association using odds ratios with 95% confidence intervals. Result: The level of institutional delivery was 38.9%. Women's who had focused antenatal care (FANC) visit (AOR = 3.12, 95% CI: 2.73-3.56), multiple gestations (AOR = 2.06, 95% CI: 1.32-3.21, and being urban residence (AOR = 7.18, 95% CI: 5.10-10.12) were more likely to give birth at health facility compared to its counterpart. Compared to women's without formal education, giving birth at health facility was more likely for women's who had primary education level (AOR = 1.77, 95% CI: 1.49-2.10), secondary education level (AOR = 3.79, 95% CI: 2.72-5.30), and higher education level (AOR = 5.86, 95% CI: 3.25-10.58). Furthermore, women who reside in rich (AOR = 2.39, 95% CI: 1.86-3.06) and middle (AOR = 1.66, 95% CI: 1.36-2.03) household wealth index were more likely to deliver at health facility compared to women's who reside poor household wealth index. Moreover, this study revealed that 34% of the total variation in the odds of women delivered at health institution accounted by regional level. Conclusion: The level of institutional delivery in Ethiopia remains low. Context specific and tailored programs that includes educating women and improving access to ANC services has a potential to improve institutional delivery in Ethiopia.

BackgroundUnintended pregnancy has significant consequences for the health and welfare of women and children. Despite this, a number of studies with inconsistent findings were conducted to reduce unintended pregnancy in Ethiopia; unavailability of a nationwide study that determines the prevalence of unintended pregnancy and its determinants is an important research gap. Thus, this study was conducted to determine the overall prevalence of unintended pregnancy and its determinants in Ethiopia. MethodsWe searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias of observational studies. The heterogeneity of studies was also assessed using I 2 test statistics. Data were pooled and a random effect meta-analysis model was fitted to provide the overall prevalence of unintended pregnancy and its determinants in Ethiopia. In addition, the subgroup analyses were performed to investigate how the prevalence of unintended pregnancy varies across different groups of studies. ResultsTwenty-eight studies that satisfy the eligibility criteria were included. We found that the overall prevalence of unintended pregnancy in Ethiopia was 28% (95% CI: 26-31). The subgroup analyses showed that the highest prevalence of unintended pregnancy was observed from the Oromiya region (33.8%) followed by Southern Nations Nationalities and Peoples' region (30.6%) and the lowest was in Harar. In addition, the pooled prevalence of unintended pregnancy was 26.4% (20.8-32.4) and 30.0% (26.6-33.6) for community-based cross-sectional and institution-based cross-sectional studies respectively. The pooled analysis showed that not communicating with one's husband about family planning was more likely to lead to unintended pregnancy (OR: 3.56, 95%CI: 1.68-7.53). The pooled odds ratio

Background. The under-five child mortality (U5CM) rate is the most important sensitive indicator of the socioeconomic and health status of a community, and the overall development of a nation. Despite the world having made substantial progress in reducing child mortality since 1990, the global U5CM rate was 41 per 1 000 in 2016. The rate is higher in Ethiopia than in several other low-and middle-income countries. Objectives. To estimate the effects of socioeconomic and demographic factors on U5CM in Ethiopia. Methods. A community-based cross-sectional study was conducted on 10 641 under-five children. The 2016 Ethiopian Demographic and Health Survey data were used for this research. Binary logistic regression was employed to identify factors affecting the U5CM rate. Results. The U5CM rate was 60 deaths per 1 000 live births. Children who were delivered at home (adjusted odds ratio (aOR) 1.30; 95% CI 1.04-1.63) and male (aOR 1.36; 95% CI 1.15-1.60) were at an increased risk of death. Children whose family size was between 1 and 3 (aOR 5.54; 95% CI 4.08-7.54), and 4 and 6 (aOR 1.94; 95% CI 1.55-2.43) were more likely to die before age 5 than those whose family size was ≥6. First-born (aOR 0.49; 95% CI 0.36-0.67), second-or third-born (aOR 0.51; 95% CI 0.39-0.67) and fourth-or fifth-born (aOR 0.71; 95% CI 0.56-0.91) children were less likely to die than those who were sixth-born and above. Similarly, singleton children (aOR 0.20; 95% CI 0.15-0.28), children residing in urban communities (aOR 0.55; 95% CI 0.40-0.76) and children whose families had protected sources of water (aOR 0.84; 95% CI 0.71-0.99) had reduced risks of death compared with their respective counterparts. Conclusions. The present study identified risk factors for under-five mortality in Ethiopia. Programmes to reduce under-five mortality in Ethiopia must focus on the place of delivery, households with unprotected sources of drinking water and families residing in rural areas.