BackgroundUnsafe abortion is a neglected public health problem contributing for 13% of maternal death worldwide. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. The prevalence of unsafe abortion is associated with restricted abortion law, poor quality of health service, and low community awareness. Hence, the aim of this systematic review and meta-analysis is to identify and summarize the available evidence to generate an abridged evidence on the prevalence of unsafe abortion and its associated factors in Sub-Saharan Africa.MethodsThe development of the systematic review methodology has followed the procedural guideline depicted in the preferred reporting items for systematic review and meta-analysis protocol statement. Observational studies that have been conducted from January 1, 1994, up to December 31, 2017, in Sub-Saharan African countries will be included in the systematic review and meta-analysis. MEDLINE (via PubMed), EMBASE, CINAHL, and PopLine will be searched to retrieve available studies. Relevant studies will be retrieved using the search strings applied to different sources. The Joanna Briggs Institute quality assessment tool will be used to critically appraise the methodological robustness and validity of the finding to avoid erroneous data due to confounded or biased statistics. Data extraction template will be prepared to record abstracted information from selected studies. The selection of relevant studies, data extraction, and quality assessment of studies will be carried out by two authors. Meta-analysis using Mantel–Haenszel random effects model will be carried out. The presence of heterogeneity between studies will be checked using the I2 value.DiscussionUnsafe abortion is not yet reduced significantly in Sub-Saharan Africa, and maternal death rate due to unsafe abortion remains high. Currently, there is a gap in availability of abridged evidence on unsafe abortion and this negatively influenced the current service delivery. This finding will help stakeholders to design appropriate strategy. The finding of this systematic review and meta-analysis will be helpful to inform policy-makers, programmers, planners, clinician’s decision making, researchers, and women clients at large.Systematic review registrationPROSPERO 2017: CRD42017081437.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0775-9) contains supplementary material, which is available to authorized users.

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Background Poor nutritional status of women has been a serious problem in Ethiopia. Rural women are more likely to be undernourished than urban women. Afar region is the most likely to be undernourished (43.5%). Despite the humanitarian and food aid, food insecurity and maternal underweight are very high in the region. Household food insecurity is not adequately studied in Afar region. The aim of this study was to assess the prevalence of household food insecurity and underweight status and its association among reproductive age women. Method The study was conducted in Assayita district in June 2015. Community-based cross-sectional study design was used among nonpregnant women. Household data was collected using structured questionnaire. Multistage cluster sampling procedure was applied. Two pastoral and two agropastoral Kebeles have been selected by simple random sampling. Systematic random sampling was used to select respondents. The total sample size was 549 households. Household Food Insecurity Access Scale (HFIAS) and anthropometric data were used to determine food insecurity and underweight, respectively. Multivariate regression models were used to measure associations. Results Prevalence of HFIAS was 70.4 with a mean of 7.0 (3.6 ± SD); 26.1%, 30.20%, and 14.1% were mild, moderate, and severe food insecurity, respectively. Underweight prevalence (BMI < 18.5) was 41.1% with prevalence of mild, moderate, and severe underweight being 34.5%, 3.9%, and 2.7%, respectively. Age, parity, and having >2 children below five years of age were statistically associated with household food insecurity and maternal underweight. Conclusion Household food insecurity and maternal underweight were very high. Age, parity, and having ≥2 children below five years of age were associated with household food insecurity. Maternal underweight was associated with maternal age, marital status, parity, number of children below 5 years, household food insecurity, and vocation of the respondents.

Background Ethiopia is the second most populous country in Africa, known for its high fertility and low contraceptive use. The magnitude of contraceptive use in the emerging regions of the country is below the national average. However, there is a paucity of evidence regarding the reasons for low contraceptive use in these regions. Therefore, this study aimed to assess contraceptive use and associated factors in the emerging regions of Ethiopia. Methods For the quantitative part, a community based cross-sectional study was conducted among 2891 reproductive age women who were selected by multistage sampling technique. Data were collected face to face using an open data kit software, and STATA version 14 was used for data analysis. Frequencies, percentages, summary measures and tables were used to summarize and present the data. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with contraceptive use, by computing odds ratio with 95% confidence interval. Level of significance was considered at p-value < 0.05. For the qualitative part, phenomenological study was conducted among 252 health care workers and community members who were selected purposely. The data were collected by focused group discussions, in-depth interviews and key informant interviews. The data were audio-recorded in the local languages, and then translated to English verbatim. NVivo version 11 was used to analyze the data through a thematic analysis method. Results The overall contraceptive prevalence rate was 22.2%; with 11.7, 38.6, 25.5 and 8.8% for Afar, Benshangul Gumuz, Gambela and Somali Regions, respectively. Age, religion, education, marital status, family size, ideal children, knowledge and attitude were significantly associated with contraceptive use. Additionally, the qualitative study identified three themes as barriers to contraceptive use: individual, health care system and sociocultural factors. Conclusions Contraceptive prevalence rate was low in this study compared to the national average. Age, religion, education, marital status, family size, ideal children, knowledge and attitude were significantly associated with contraceptive use. From the qualitative aspect, individual, health care system and sociocultural factors were identified as barriers to contraceptive use. Therefore, the emerging regions of Ethiopia need special focus in increasing contraceptive use through behavioral influence/change.

Background The Ethiopian health extension program (HEP) is an innovative community-based strategy aimed at disease prevention and health promotion. While health extension workers (HEWs) are its front-line workers, the involvement of clinicians remains an integral part. The goals of this study were to: (1) assess the correlation of clinician attitude with predictors and (2) assess the reliability and validity of the survey instrument. Methods A cross-sectional study design was utilized to collect data from a sample of 1239 clinicians using 28 items of attitude questions. Exploratory factor analysis (EFA) was applied to create the latent variables. Oblique Promax type rotation with factor loading (> 0.5) was used. Cronbach’s alpha was used to assess reliability, with a level of > 0.7 suggesting good reliability. Confirmatory factor analysis (CFA) was undertaken, with the values of Root Mean Square Error Administration (RMSEA) < 0.08, Standardized Root Mean Square Residual (SRMR) < 0.05, comparative fit index (CFI) 0.9–0.95, and Tucker-Lewis index (TLI) 0.9–0.95 suggesting acceptable model fit. A linear regression analysis was conducted. Results EFA produced two latent variables which explained 93.2% of the total variance. The latent variables were labeled as perceived attitude towards the skill of HEWs (F1), and perceived attitude towards the impact of HEP (F2). Internal reliability for the 28 items was reported with a Cronbach’s alpha of 0.94, and for F1 and F2 it was 0.91 and 0.90, respectively. CFA was done and RMSEA was reported at 0.04, SRMR was 0.03, and CFI and TLI were each 0.97. The value of clinician attitude increased by 3.5, 95% CI (1.5, 5.3), P-value < 0.001 for those who have been exposed to the HEP program than non-exposed. Similarly, clinician attitude was lower for degree holders compared to those with diplomas by − 2.7, 95% CI (− 4.4, − 0.94), P-value < 0.002. Conclusion Clinician attitude increased as exposure to HEP increased. Clinician attitude towards HEP has two latent variables. Furthermore, the assessment tool demonstrated good reliability and validity. In conclusion, it is worthy valued for clinicians to receive orientation about HEP, and researchers and program evaluators can use this assessment tool.

Background: Contraceptive method choice is a fundamental indicator of quality of care in a family planning program. One third of developing countries including Ethiopia have a much skewed method mix, which is risky for discontinuation, contraceptive dissatisfaction and unintended pregnancy. In Ethiopia the prevalence of contraceptive use is not only low but also highly skewed having a single contraceptive (injectable). Therefore the aim the study was to assess factors that influence modern contraceptive method preference among women of reproductive age in central zone of Tigray Region, Northern Ethiopia. Methods: A facility based descriptive cross sectional study was carried out among 602 rural and urban reproductive age women. The data was entered using EPI info 3.5.4 version and exported to SPSS 16.0 version for analysis. Bivariate and multivariate logistic regression was used to see any association between different variables. Results: Nearly three fourth (72.3%) of women prefer Injectable contraceptive. Only twenty percent of the total participants prefer Long Acting and Permanent Method (LAPM). Having more than two living children, discussion with husband, and attitude of women were significantly associated with their contraceptive preference. Conclusions: The contraceptive method mix is highly skewed to single Short Acting Contraceptive (SAC) and preference to LAPM is low. For successful family planning program strong information, education and communication focusing on long term contraceptive methods should be done.

Background Ideation refers to the ideas and views that people hold; it has been identified as an important explanation for differences in contraceptive use within and across countries. This study aimed to identify ideational factors that influence intention to use family planning (FP) methods among women of reproductive age (WRA) in the four emerging regions of Ethiopia. Methods A quantitative cross-sectional survey of 2891 WRA was carried out in the four emerging regions of Ethiopia. A multistage, stratified systematic random sampling technique was employed to select the study participants. Data were collected by trained enumerators, using tablets equipped with Open Data Kit. To assess the impact of ideation on intention to use FP, the research team used 41 items distributed across five broad ideational factors: contraception awareness, self-efficacy, rejection of myth and rumor, intra-family discussion and family support. Confirmatory factor analysis was employed to test the fit of these items into the five ideational factors. A multiple binary logistic regression analysis was employed to assess the combined effect of these ideational factors with different sociodemographic variables on intention to use contraceptive methods. In all the statistical analysis, a p-value < 0.05 was considered statistically significant. Results Different proportions of women in the four regions intended to use contraceptives in the future: 74.9% in Benishangul-Gumuz, 50.1% in Gambela, 21.8% in Afar, and 20.1% in Somali. The proportion of women who intended to use contraceptives varied with ideation scores. The multiple binary logistic regression revealed that self-efficacy was an important ideational factor of intention to use contraception in all four regions. Rejection of myth and rumor was also an important factor in all regions except in Somali. Contraception awareness and family support were significant predictors of intention to use contraception in the Afar region only. Intra-family discussion was not found significant in any region. Conclusions Regional/district health offices should focus on increasing self-efficacy for FP use. Demystifying rumors would contribute to improved intention to use FP among women in Afar, Benishangul-Gumuz, and Gambela regions. Raising contraception awareness and encouraging family support would improve intention to use FP in Afar region.