Taddese Zerfu

Higher altitude stunts children’s physical growth: A systematic review and meta-analysis

Digital health interventions in strengthening primary healthcare systems in Sub-Saharan Africa: Insights from Ethiopia, Ghana, and Zimbabwe

Digital Health Interventions (DHIs) refer to discrete technological functionalities designed to achieve specific objectives in addressing health system challenges. These interventions are considered tools for strengthening health systems, particularly in low- and middle-income countries. This study consolidates findings from Ethiopia, Ghana, and Zimbabwe, examining how three distinct digital health applications with varying intervention components implemented in primary healthcare settings contribute to health system strengthening. The interventions analyzed include Ethiopia’s District Health Information System 2 (DHIS2), Ghana’s District Health Information Management System (DHIMS) and the Lightwave Health Information Management System (LHIMS), and Zimbabwe’s Impilo Electronic Health Record (E-HR) system. In Ethiopia, DHIS2 enhanced health system accountability and data quality by streamlining district-level data aggregation, reporting, and performance monitoring. This led to more informed decision-making and improved resource distribution. In Ghana, DHIMSs functions as a public health-level DHI, facilitating national data-driven performance monitoring, while LHIMS operates at the patient level, supporting patient tracking and management, improving patient workflows and resource tracking. However, a lack of interoperability between these two systems has led to data duplication challenges. Zimbabwe’s Impilo E-HR, a patient-level DHI, has streamlined clinical workflows, improved information sharing, and enhanced decision-making at the point of care. Despite these successes, challenges persist across the three contexts: infrastructure limitations, high staff turnover, and insufficient user technical capacity. Interoperability issues, particularly in Ghana and Ethiopia, hinder seamless data exchange, while sustainability concerns such as funding gaps and inadequate government support undermine the systems’ full potential. The study findings demonstrate that investments in DHIs in primary healthcare may not result in health systems strengthening without addressing baseline conditions for their implementation and sustainability.

Associations between exposure to nutrition, WASH interventions and children’s academic performance in Ethiopia: A systematic review and meta-analysis

Background Poor nutrition and inadequate WASH (water, sanitation, and hygiene) practices significantly impact children’s health, nutrition, and cognitive development, especially in low-income settings. These factors further aggravate the incidence of undernutrition, weaken the immune system, increase susceptibility to illnesses and reduce cognitive performance. Evidence on the effectiveness of existing WASH interventions is needed. Objective This review evaluated the effectiveness of nutritional and WASH interventions on the academic performance of children in Ethiopia. Methods A systematic search of Cochrane, DOAJ, Google Scholar, and PubMed (2010–2024) was conducted using MeSH terms and keywords related to WASH. Two independent reviewers screened studies and extracted data. Eligible studies included cross-sectional and cohort studies on Ethiopian schoolchildren with quantifiable academic outcomes. The JBI SUMARI was used to assess bias, and the GRADE approach was used to evaluate evidence quality. The meta-analysis used a random-effects model in Stata and reported pooled RRs with 95% CIs. Subgroup and sensitivity analyses examined moderators such as study design, intervention type, and sample size. Results A total of 19 studies, 16 cross-sectional (n= 16) and three prospective (n= 3) cohort studies with a total of 9034 participants, were included. The random effects model revealed a significant improvement in academic performance among students receiving both nutrition and WASH, with a pooled large positive effect size of 2.05 (95% CI: 1.26, 2.28; I2=). In the subgroup meta-analysis, the effect of the intervention was more positive among those who skipped breakfast (3.47, 95% CI: 0.47, 6.47), chronic iodine deficiency (4.49, 95% CI: 4.08, 4.90), food insecurity (2.810, 95% CI: 1.281, 4.339), and underweight (0.61, 95% CI: 0.46, 0.75). Conclusion Despite moderate variability and some risk of bias, the evidence supports the integration of comprehensive nutrition and WASH programs into school health initiatives. Future research should focus on long-term effects and cost-effectiveness.