Low birth weight (LBW) is one of the major causes of neonatal mortality and morbidity in low and middle-income countries (LMICs). Despite the goal of reducing newborn morbidity and mortality by 2030, low-income countries, including Ethiopia, still confront major challenges. Although various systematic reviews and meta-analyses (SRMA) have been conducted on LBW in Ethiopia, there is notable variation among their findings. This umbrella review aimed to consolidate inconsistent findings into a single summary estimate, providing a robust synthesis of evidence from systematic reviews and meta-analyses to bolster health policy development and planning in Ethiopia.Articles were retrieved on PubMed/Medline, Science Direct, Web of Science, HINARI, and Google Scholar. Assessments of Multiple Systematic Reviews checklist scores were used to assess the quality of the included SRMA studies. A random-effects model was used to estimate the overall effect size.A total of eleven SRMA studies (5 prevalence and 6 predictors) involving 190,492 neonates with an outcome of interest were included in the analysis. The summary estimate for the prevalence of LBW was 16% (95% CI: 13, 18%). Being prematurity [POR: 7.86; 95% CI: 5.79, 10.67], not attending antenatal care (ANC) [POR: 2.4, 95% CI: 1.49, 3.88], having pregnancy-induced hypertension (PIH) [POR: 4.2; 95% CI: 2.78, 6.36], being a rural resident [POR: 2.14, 95% CI: 1.56, 2.94], having a pregnancy interval < 24 months [POR: 2.96; 95% CI: 1.79, 4.9], not having iron-folic acid supplementation (IFAS) [POR: 0.38; 95% CI: 0.29, 0.5], and being a maternal age < 20 [POR: 2.02, 95% CI: 1.41, 2.9] were significantly associated with LBW. This umbrella review revealed more than three out of twenty neonates experienced LBW in Ethiopia. Being premature, not attending antenatal care, having pregnancy-induced hypertension, being a rural resident, having a pregnancy interval < 24 months, not having iron-folic acid supplementation and being a maternal age < 20 were significant predictors of LBW. Therefore, timely diagnosis, proper treatment, and follow-up of women at risk might combat the incidence of LBW in Ethiopia.

Objective: The objective of this systematic review and meta-analysis is to assess and synthesize the global evidence on the level of nurses' knowledge and its determinants regarding the prevention of surgical site infections. Methods: This systematic review and meta-analysis were conducted following strict methodological guidelines to ensure accuracy and reliability. Adhering to the 2020 PRISMA checklist, a systematic review and meta-analysis sought to establish the pooled proportion of nurse's knowledge and its determinants regarding surgical site infection prevention globally. MeSH terms and keywords were included in the search. Data extraction, quality assessment, and analysis followed established protocols. Heterogeneity and publication bias was assessed using STATA version 17.0. Results: A total of seventeen observational studies, with sample sizes ranging from 30 to 515 participants, were included in the final analysis in a global context. In this systematic review and meta-analysis, the pooled proportion of nurses with good knowledge of surgical site infection prevention is 62% (95% CI: 50-74%) when assessed using a dichotomous scale. However, when knowledge is measured using a three-point Likert scale, the pooled proportion of those with good knowledge drops to 46% (95% CI: 21-72%), with an additional 27% (95% CI: 16-38%) demonstrating fair or moderate knowledge. Conclusion and recommendation: This systematic review and meta-analysis is the first to synthesize data on nurses' knowledge of surgical site infection (SSI) prevention. The findings reveal poor knowledge levels, highlighting the need for targeted educational interventions globally. While the pooled odds ratio is not statistically significant, training, longer service years, and higher education improve SSI prevention knowledge by enhancing critical thinking, boosting confidence, and fostering adherence to evidence-based practices. Future research should focus on identifying factors influencing nurses' knowledge, particularly through longitudinal and interventional studies. Policymakers should incorporate international guidelines such as those recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) into nursing curricula, supported by robust assessment tools and educator training, to improve knowledge transfer and implementation of best practices.

Background: Antimicrobial resistance (AMR) is a global public health concern that is fueled by the overuse of antimicrobial agents. Low- and middle-income countries, including those in Africa,. Point prevalence surveys (PPS) have been recognized as valuable tools for assessing antimicrobial utilization and guiding quality improvement initiatives. This systematic review and meta-analysis aimed to evaluate the prescription rates, indications, and quality of antimicrobial use in African health facilities. Methods: A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Embase, Hinari (Research4Life) and Google Scholar. Studies reporting the point prevalence of antimicrobial prescription or use in healthcare settings using validated PPS tools were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis was conducted to combine the estimates. Heterogeneity was evaluated using Q statistics, I² statistics, meta-regression, and sensitivity analysis. Publication bias was assessed using a funnel plot and Egger's regression test, with a p-value of < 0.05 indicating the presence of bias. Results: Out of 1790 potential studies identified, 32 articles were included in the meta-analysis. The pooled prescription rate in acute care hospitals was 60%, with significant heterogeneity (I2 = 99%, p < 0.001). Therapeutic prescriptions constituted 62% of all the prescribed antimicrobials. Prescription quality varied: documentation of reasons in notes was 64%, targeted therapy was 10%, and parenteral prescriptions were 65%, with guideline compliance at 48%. Hospital-acquired infections comprised 20% of all prescriptions. Subgroup analyses revealed regional disparities in antimicrobial prescription prevalence, with Western Africa showing a prevalence of 65% and 44% in Southern Africa. Publication bias adjustment estimated the prescription rate at 54.8%, with sensitivity analysis confirming minor variances among studies. Conclusion: This systematic review and meta-analysis provide valuable insights into antimicrobial utilization in African health facilities. The findings highlight the need for improved antimicrobial stewardship and infection control programs to address the high prevalence of irrational antimicrobial prescribing. The study emphasizes the importance of conducting regular surveillance through PPS to gather reliable data on antimicrobial usage, inform policy development, and monitor the effectiveness of interventions aimed at mitigating AMR.

Background: Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. Objective: The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Method: Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. Result: A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. Conclusion: The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.

Background: The client's satisfaction after abortion care is the key to sustaining abortion care and increasing the health status of those who had complications from abortion. Nevertheless, research conducted in Ethiopia stated that the major problem is the need for post-abortion care for females. One of the ways to improve the qualities involved in post abortion care and decrease the mortality and morbidity rates caused by unsafe abortion is by ensuring client satisfaction with abortion care. Strategy making and policy formulation based on systematic review take on the highest priority in developing countries. However, although some independent studies had been carried out in Ethiopia, their findings might not have been representative and conclusive. The main purpose of this systematic review and meta-analysis article is to establish the proportion of abortion clients who are satisfied with their abortion care and the factors that contribute to such satisfaction among clients in Ethiopia. Methods and materials: Only published articles were considered in this review. The main databases included Medline/Pubmed, Web of Science, Embase, Cinael, Med Nar, Google Scholar, Scopus, the Ethiopian University Repository Online, and the Cochrane Library. The review includes cross-sectional studies that meet the requirements and were written in English. A random effects model was used to calculate the pooled prevalence of client satisfaction with abortion care. The study heterogeneity was tested using Cochrane Q-Static and I2. Publication bias was checked using the Eggers test and funnel plot. PRISMA was used to select and direct the selection of articles for this review. Statistical analyses were conducted using STATA version 14. Result: A review of ten studies comprised 2740 women. In summary, the pooled prevalence of client's satisfaction with abortion care in Ethiopia was 56.13% [95% CI (42.35; 69.91), I2 = 99.1%, p < 0.001]. In terms of subgroup analysis, Gambella had the highest prevalence of client satisfaction with abortion care at 87.40% [95% CI: 82.38 and 91.82]. However, Amhara had the lowest: 25.00% [95% CI: 21.59, 28.41]. The review also found that client satisfaction with abortion care had a statistical correlation with the type of procedure [OR: 0.25, CI [0.07, 0.42], I2: 76.9%, p-value: 0.041] and the participant's education level [OR: 0.29, CI [0.09, 0.48], I2: 80.4%, p-value: 0.006]. Conclusion: This review found that 56% of Ethiopian women were satisfied with their abortion care. Since this requires a boost to the quality of abortion care in the health facility, understanding women's expectations and perceptions, training of health care providers, and strict monitoring of the quality of abortion care services by stakeholders like the Ethiopian government, non-governmental organizations, and high-level management of the health facility would help to improve the level of women's satisfaction with abortion care. Those factors, namely, the type of method to use for the patient and women's educational level, should be changed through improving awareness among the patients about what procedure to conduct and the health education provided to women about abortion care.

Background: Standard precautions are the minimum standard of infection control to prevent transmission of infectious agents, protect healthcare workers, patients, and visitors regardless of infection status. The consistent implementation of standard precautions is highly effective in reducing transmission of pathogens that cause HAIs. Despite their effectiveness, compliance, resources, patient behavior, and time constraints are some of the challenges that can arise when implementing standard precautions. The main objective of this meta-analysis was to show the pooled prevalence of safe standard precaution practices among healthcare workers in Low and Middle Income Countries (LMICs). Methods: A systematic review and meta-analysis was conducted for this study. We systematically searched observational study articles from PubMed Central and Google Scholar. We included articles published any year and involving healthcare workers. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The random effect model was used to estimate the pooled prevalence. The meta-analysis, sensitivity analysis, subgroup analysis, and publication bias (funnel plot, and Egger's tests) were conducted. Results: A total of 46 articles were included in this study. The pooled prevalence of standard precautions practices among healthcare workers in LMICs was 53%, with a 95% CI of (47, 59). These studies had a total sample size of 14061 with a minimum sample size of 17 and a maximum sample size of 2086. The majority of the studies (82.6%) were conducted in hospitals only (all kinds), and the remaining 17.4% were conducted in all health facilities, including hospitals. Conclusions: The pooled prevalence of standard precautions practices among healthcare workers in LMICs was suboptimal. The findings of this study can have substantial implication for healthcare practice and policy making by providing robust evidence with synthesized and pooled evidence from multiple studies. Trial registration: Registered on PROSPERO with record ID: CRD42023395129, on the 9th Feb. 2023.

Introduction: Even though skin-to-skin contact offers several advantages for the survival of the newborn, it is not often practiced in Ethiopia. For instance, hypothermia which increases the risk of neonatal mortality by five times is prevented by this practice. Despite this, there are inconsistent findings that can affect policymaking. Consequently, this metanalysis aimed to produce trustworthy national data regarding skin-to-skin care practice and its determinants among postpartum mothers in Ethiopia. Methods: A search of the publications was conducted using MEDLINE, PubMed, Embase, Scopus, Web of Sciences, and Google Scholar. The program used for cleaning and analysis was STATA version 18.2. The random-effects model was utilized to estimate the pooled prevalence, which was then presented using a forest plot with a 95 % confidence interval. We evaluated heterogeneity using I2 and Cochrane Q statistics. Moreover, a visual examination of a funnel plot and Egger's regression test were used to evaluate publication bias. Results: This study included eight studies with a total of 10410 postpartum mothers. The overall level of skin-to-skin care practices was 48 % (95%CI: 31, 65. I2=99.38 %, P = 0.001). Based on subgroup analysis by year of publication, studies published between 2017 and 2019 years showed that the level of skin-to-skin care practice among postnatal mothers was 52 % (95 % CI: 14-89, I2 = 99.19). The knowledge of mothers about skin-to-skin care was significantly associated with practicing a level of skin-to-skin care. Conclusions: The findings showed that in Ethiopia, comparatively less than half of the newborns received skin-to-skin care. Moreover, there was a substantial correlation between the mother's knowledge and practice of skin-to-skin care. Therefore, both the government and all stakeholders should take coordinated action to improve and expand skin-to-skin care practices through health education, so that all postnatal mothers can practice this vital newborn care.

Overview This is the third country strategy and programme evaluation (CSPE) conducted by the Independent Office of Evaluation of IFAD (IOE) in the Federal Democratic Republic of Ethiopia. The CSPE covers the period 2015 to 2022. The CSPE found that the Government showed strong commitment to and ownership of the IFAD-supported interventions. Such interventions closely aligned with the Government’s strategic priorities and appropriately targeted rural areas with significant livelihood vulnerabilities. The IFAD–Government partnership enabled achieving positive results in the areas of inclusive rural finance, community-driven social services, ecosystem and livelihood resilience, and addressing food insecurity. Among the challenges, the evaluation found that the programme failed to apply a pro-poor value chain approach, which led to insufficient post-production support. Rural finance regulations to ensure fair and appropriate treatment of consumers were not fully implemented. Smaller microfinance institutions still faced difficulties in sustainably accessing credit lines. The scaling up of Islamic-friendly financial services was yet to be achieved. Grassroots organizations were not fully autonomous in providing services to their members. For the future, the CSPE recommends, among other things, deployment of a pro-poor value chain development approach in IFAD’s future interventions in Ethiopia. IFAD should also foster engagement of key national microfinance actors to identify innovative solutions that address the challenges identified. Additionally, the Fund should enhance support for the sustainability of grassroots organizations. Report Details Year Published 2024 Type Country Programme Joint No Partner/s N/A Consultant name H. Kabuchu - M. Borzoni - P. Tirivanhu - T. Maru - A. Mengistu - A. Formica - A. Cesare - E. Abebe - M. Costantini Agency Focal Point Kouessi Maximin Kodjo Focal Point Email k.kodjo@ifad.org Managed by Independent Evaluation Office Yes Country/ies Ethiopia

Overview The Ethiopia Crises to Resilience (EC2R) programme was initiated on January 31, 2022. Its core aim is to provide multi-sector humanitarian assistance to meet the needs of Ethiopia’s most vulnerable populations; support poor households so they are better able to withstand disasters and shocks; and invest in the humanitarian system so it can identify risks and respond early and cost-effectively. It is a multi-sector programme, designed to enable implementing partners to support those in greatest need across health, nutrition, WASH, protection, humanitarian cash, emergency education and social protection. The purpose of the evaluation is to provide an objective assessment of EC2R progress and achievements, identify gaps and challenges, capture learnings, and highlight best practices. The findings will inform the remaining period of EC2R implementation and potentially shape the design of future phases of the programme. The primary users of the evaluation will be the implementing partners, the regional and national governments of Ethiopia, and the donoe. These stakeholders will benefit from the evaluation by gaining insights that will support more informed operational and strategic decision-making, enhance programme effectiveness, and ultimately contribute to the successful achievement of EC2R’s objectives. The findings and lessons learned will be actively disseminated and shared with all relevant stakeholders to maximise their impact. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Consultant name Dr. Mohammed Seid, Dr. Robert Poppe, Dr. Cherkos Meaza, Nolawit Teshome, Sintayehu Tilaye, Yebelay Berehan Agency Focal Point Maryamawit Solomon Assefa Focal Point Email massefa@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Ethiopia

Overview This study is part of a 5 years programme - funded by SIDA - to implement the integrated systems approach in Amhara with focus on effective CBHI/PSNP linkages, Ending Child Marriage Agenda and multiplier effects in the scope of the UPSNP and PSNP. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Consultant name Frank Otchere (Principal investigator), Essa Chanie Mussa, Kaku Attah Damoah, Valentina Mutti, and Hiwot Mekonnen Mesfin Agency Focal Point Vincenzo Vinci Focal Point Email vvinci@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Ethiopia

Overview This study is part of a 5 year programme - funded by SIDA - to implement the integrated systems approach in Addis Ababa in the scope of the UPSNP and PSNP. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Consultant name Kaku Attah Damoah (Principal Investigator), Doris Osei Afriyie, Essa Mussa Chanie, Hiwot Mekonnen Mesfin, Nyasha Tirivayi, and Frank Otchere Agency Focal Point Vincenzo Vinci Focal Point Email vvinci@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Ethiopia

Introduction: Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. Methods: We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Conclusion: Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Overview Child and forced marriage (CFM) are a human rights violation and a harmful practice that disproportionately affects women and girls globally, preventing them from living their lives free from all forms of violence. It threatens the lives and futures of girls and women around the world, robbing them of their agency to make decisions about their lives, disrupting their education, making them more vulnerable to violence, discrimination and abuse, and preventing their full participation in economic, political and social spheres. The UNSDG call for global action to end this human rights violation by 2030. Ethiopia has also outlawed child marriage, however, the prevalence of girls marrying before age 18 remains high. This is attributed to various economical, social and cultural situations. As a result, UNICEF selected End Child Marriage as a flagship prgramme to contribute to successfully implement the National Costed Roadmap to End Child Marriage and Female Genital Mutilation (2020-2024) and to accelerate progress towards achieving the Sustainable Development Goal number 5.3: Eliminate all harmful practices. The Purpose of End Child Marriage flagship result evaluation is to asses effectiveness, efficiency, relevance, coherence and sustainability of the cross-sectoral inputs. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Maryamawit Solomon Assefa Focal Point Email massefa@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Ethiopia

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG15 - Life on Land Geographic Scope Country Country/ies Ethiopia

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG15 - Life on Land Geographic Scope Country Country/ies Ethiopia

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG15 - Life on Land Geographic Scope Country Country/ies Ethiopia

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Country/ies EthiopiaUganda

Overview Meeting the 2030 Agenda and the Sustainable Development Goals is inextricably linked with the process of structural transformation. This project aimed to share experience from a country (China) with first-hand experience in the transformation process and an ambitious foreign economic policy based on cross-regional infrastructure connectivity and productive investment known as the Belt & Road initiative (BRI) with other countries in the Global South. The project identified limitations in government capacity in many partner countries – particularly in the policy areas of investment, trade, finance/debt, and technology – as potential roadblocks to the transformative impacts of the BRI (and of foreign direct investment more generally). It aimed to facilitate partner countries’ engagement with BRI-related projects by promoting a deeper understanding of China’s economic reform strategy, which was expected to enable selective policy adaptations that better reflect their own respective national development objectives. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG9 - Industry, Innovation and InfrastructureSDG17 - Partnerships for the Goals Consultant name Punit Arora Agency Focal Point Nishta Keeble Focal Point Email nishta.keeble@un.org Managed by Independent Evaluation Office Yes Country/ies EthiopiaIndonesiaSri Lanka

Overview The last round of data collection aims at collecting the findings of the endline evaluation of UNICEF Ethiopia’s Adolescent Nutrition-WASH-Education Joint Programme implemented between 2018 and 2022, across eight regions. Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Valentina Prosperi Focal Point Email vprosperi@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies Ethiopia

Report Details Year Published 2023 Type Project/Programme Joint No Partner/s N/A SDG/s SDG13 - Climate ActionSDG15 - Life on LandSDG9 - Industry, Innovation and Infrastructure Geographic Scope Country Country/ies Ethiopia