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Background: One of the most important health interventions for reducing maternal morbidity and death is the use of maternal healthcare services. In Ethiopia, maternal healthcare services are not well utilized, particularly in rural pastoralist communities, despite their significance. Therefore, the purpose of this study was to evaluate the use of maternal healthcare services and the characteristics that are related to it in the East Borena zone. Techniques: In September 2020, a community-based cross-sectional survey was carried out in Liben with 416 randomly selected mothers. Mothers who had given birth within the 12 months before the study comprised the respondents. Questionnaires given by interviewers were used to gather the data. The data were transferred to SPSS version 20 for analysis after being entered into Epi-Info version 4.1 for coding. The Kolmogorov-Smirnov, Hosmer, and Lemeshow goodness of fit tests were employed, along with descriptive statistics. Additionally, multivariate and binary logistic regression analyses were carried out. 95% CI and the odd ratio were used to examine the relationship between the outcome and predictive variables. Results: At least one prenatal visit was received by 60% of moms. Only 21.2% and 17.5% of women had given birth in a medical facility and made use of early postnatal care services. The use of antenatal care was strongly correlated with maternal education [AOR = 2.43 (95% CI: 1.22-4.89)], decision-making capability [AOR = 2.40 (95% CI: 1.3-23.3)], felt compassionate and respectful treatment [AOR = 0.30 (95% CI: 0.18-0.50)], and intended current pregnancy [AOR = 0.22 (95% CI: 0.12-0.37)]. Moms b/n ages 15-19 had a 3.7-fold higher probability of giving birth in a hospitals than moms b/n ages 35 and 49 [AOR = 1.74 (95% CI: 1.02-3.08)]. Mothers who lived far away were 1.02 times less likely to give birth at a hospital than those who could reach one within an hour (AOR = 1.74;95% CI: 1.02, 3.08). While recent use of antenatal care [AOR = 5.34 (95% CI: 1.96-8.65)], planned current pregnancy, and knowledge of using postnatal care were shown to be strongly correlated with danger indicators [AOR = 2.93 (95% CI: 1.59-5.41)], knowledge of danger signs [AOR = 3.77 (95% CI: 2.16-6.57)] and perceived compassionate and respectful care were significantly associated with institutional delivery. Conclusion: Overall the prevalence of maternal healthcare services utilization was far below the national and regional targets in the study area. Thus, promoting institutional services, raising community knowledge, empowering women to make decisions, and enhancing the infrastructure of the health sector.

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OBJECTIVE: This cross-sectional study aimed to identify the determinants of home deliveries among women in Somaliland, with the objective of informing targeted interventions to improve maternal and child health outcomes. DESIGN: A cross-sectional study design was employed, utilizing data from a nationally representative sample of 3250 women in Somaliland. A multivariate logistic regression analysis was conducted to examine the factors influencing the likelihood of home delivery. SITE: The study was conducted in Somaliland, a region where home delivery remains prevalent. PARTICIPANTS: The study included 3250 women of reproductive age in Somaliland who had given birth. INTERVENTIONS: No specific interventions were administered as part of this study. The focus was on understanding the factors associated with home deliveries. MAIN MEASUREMENTS: Sociodemographic, economic, and regional factors were examined as potential determinants of home deliveries. Education levels of women and their husbands, maternal age at first marriage and first birth, and household wealth were among the main measurements analyzed. RESULTS: The analysis revealed that higher education levels were associated with a decreased likelihood of home delivery. Women with secondary (OR: 0.42, 95% CI: 0.32-0.55) or higher (OR: 0.21, 95% CI: 0.12-0.37) education were less likely to deliver at home than those with no education. Similarly, women whose husbands had a secondary (OR: 0.55, 95% CI: 0.41-0.73) or higher (OR: 0.43, 95% CI: 0.28-0.66) education were less likely to deliver at home. Increased maternal age at first marriage (OR: 1.04, 95% CI: 1.02-1.06) and first birth (OR: 1.03, 95% CI: 1.01-1.05) were significant predictors of home delivery. Lower household wealth was also associated with a higher likelihood of home delivery. Significant regional variations were observed, with certain regions showing higher rates of home deliveries compared to others. CONCLUSIONS: The findings highlight the importance of targeted interventions to address sociodemographic and regional disparities in the utilization of institutional delivery services in Somaliland. Strategies should focus on improving access to and quality of maternal healthcare services, empowering women's decision-making, and engaging men to address gender norms within households.

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The recent popularity of home delivery meal kits (HMK) has prompted concerns about its integrity and safety. On the basis of a food safety-related information evaluation of the common US-based HMK vendors' websites, this perspective highlights opportunities for improvement with the adequacy and accessibility of relevant information on HMK websites, an important resource for communicating food safety best practices to consumers. Identified gaps in information and inadequate delivery protocols potentially increase the risk of offering unsafe food to consumers. Suggestions for future research and recommendations for vendors, policymakers, and regulators to help protect consumers from potential foodborne illness risks are also discussed.

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Background: Neonatal tetanus remains a significant threat in regions with limited healthcare access, despite being preventable through vaccination. The case-fatality rate of untreated neonatal tetanus is close to 100%. Even one case of neonatal tetanus regarded as a failure of the healthcare system, making it essential to remain mindful of this disease's relevance to public health. Two cases of neonatal tetanus are presented, highlighting the severe consequences of the disease. One infant survived after ICU treatment, while the other succumbed despite medical intervention. Conclusion: These cases underscore the critical need for clean delivery practices and Tetanus anti-toxoid vaccination for women of reproductive age. Improving access to quality antenatal healthcare and promoting clean birth practices are essential in reducing the incidence of neonatal tetanus and preventing unnecessary deaths.

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This study investigates the enhancement of the home delivery distribution network for COVID-19 Home Isolation (HI) kits during the Delta variant outbreak of the SARS-CoV-2 virus in Bangkok Metropolitan Area, Thailand. It addresses challenges related to limited resources and delays in delivering HI kits, which can exacerbate symptoms and increase mortality rates. A k-means clustering approach is utilized to optimize the assignment of service areas within the COVID-19 HI program, while discrete event simulation (DES) evaluates potential changes in the home delivery logistics network. Real-world data from the peak outbreak is used to determine the optimal allocation of resources and propose a new logistics network based on proximity to patients' residences. Experimental results demonstrate a significant 44.29 % improvement in overall performance and a substantial 40.80 % decrease in maximum service time. The findings offer theoretical and managerial implications for effective HI management, supporting practitioners and policymakers in mitigating the impact of future outbreaks.

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Neonatal tetanus (NT) remains the leading cause of death in underdeveloped countries, although it is relatively rare in developed countries. Umbilical stump sepsis in newborns born to unvaccinated mothers is a major risk factor for NT. The World Health Organization describes NT as an infection that affects infants who lose the ability to suck between 3 and 28 days of age, becoming rigid and having spasms. Limited resources in underdeveloped countries have made the management of NT difficult. In this report, we describe a fatal case of NT in a newborn born to a mother who had not received any tetanus toxoid-containing vaccine. This study aims to make neonatal health professionals aware of the symptoms of NT so that they can diagnose it early and provide the appropriate care to save lives, and stress the importance of tetanus vaccination and maintaining hygienic conditions throughout pregnancy and childbirth to prevent this disease.

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Introduction: Home delivery, which is the process of childbirth at one's residence rather than in a health facility, is a major reason for maternal mortality caused by obstetric complications, such as sepsis, hypertensive disorders, and hemorrhage. Maternal and child mortality remains high in developing countries despite efforts made to reduce these outcomes. This is mainly due to poor utilization of institution-based healthcare services. Moreover, there is a limited number of studies that have addressed the determinants of home delivery in Ethiopia, including the study area. This study aims to identify the determinants of home delivery in Bore District, East Guji Zone, Southern Ethiopia, in 2022. Methods: A community-based unmatched case-control study was conducted from 18 May to 5 July 2022 among 498 women (249 cases and 249 controls) who gave birth in Bore District. The case group included women who gave birth at home, while the control group included those who gave their last birth at health institutions. A multistage sampling technique was employed to select the study participants. Data were collected using the KoboToolbox digital software and exported to SPSS Version 26.0 for analysis. A multivariable logistic regression analysis was done to declare the statistical significance of the association of the the independent variables and home delivery. Results: The study included a total of 496 respondents with a mean age of 32.5 (SD = ±5.5) for the case group and 33.7 (SD = ±5.2) for the control group. Among the assessed determinants of home delivery were not attending antenatal care (ANC) visits [adjusted odds ratio (AOR) = 5.6, 95% CI: 2.0-15.16], missing pregnant women's conferences (AOR = 3.2, 95% CI: 1.65-8.32), not receiving health education on pregnancy-related complications (AOR = 2.2, 95% CI: 1.1-4.3), inadequate knowledge of pregnancy-related danger signs (AOR = 6.0, CI: 3.0-11.9), inadequate knowledge about pregnancy-related complications (AOR = 3.0, CI: 1.55-6.13), and unfavorable attitude (AOR = 6.9, 95% CI: 2.16-22.6). Conclusion: In this study, not attending ANC visits, missing pregnant women's conferences, not receiving health education on pregnancy-related complications, inadequate knowledge of pregnancy-related danger signs, inadequate knowledge about pregnancy-related complications, and unfavorable attitudes were identified as determinants of home delivery. The district health office and other stakeholders should work on strengthening maternal health service delivery through appropriate ANC visits and participation in pregnant women's conferences and improving community awareness about pregnancy at all levels.

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OBJECTIVE: With same day online alcohol sales increasing, there is a need to study their regulation. Test purchasing of alcohol home delivery was conducted to measure compliance with regulations for identification checks and unattended deliveries in two Australian jurisdictions (Perth, Western Australia and Geelong, Victoria), which have differing regulations. METHOD: Alcohol orders for same day or rapid (<2 hours) delivery on Friday and Saturday nights were made by research assistants aged 18-24 years in Perth (n=34) and Geelong (n=29). An observation checklist was used to record the delivery interaction, with a specific focus on checking of photo identification at time of delivery and whether deliveries were left unattended. RESULTS: Average time from order to delivery for rapid deliveries was less than one hour in both sites (Perth = 50 minutes; Geelong = 36 minutes). More than 20% of deliveries were made without an identification check in both sites (Perth = 24%; Geelong = 21%). CONCLUSIONS: This pilot study showed alcohol can be delivered to the home within one hour, and not all deliveries include an identification check at point of delivery. These findings indicate a need for policies that empower regulators and police to undertake 'mystery shopper' monitoring to reduce potential harms and improve compliance with alcohol delivery policy.

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Background: Historically and to date, women still give birth at home with the support of elderly, experienced women who live within their communities. In Lesotho, traditional birth attendants (TBAs) are sometimes the only option for pregnant women living far from facilities. Women are vulnerable during the third stage of labour; therefore, correct management is crucial to limit undesirable outcomes. Postpartum haemorrhage and postpartum sepsis remain the leading direct causes of maternal mortality. Aim: This study aimed to explore and describe how Basotho TBAs manage the third stage of labour. Setting: The study was conducted in Lesotho, at Bolahla and Sejakhosi. These villages have the highest number of women giving birth at home. Methods: An explorative and descriptive design with a qualitative approach was used. Semistructured interview guide was utilised to conduct individual in-depth interviews about how the TBAs manage the third stage of labour and their support needs concerning this phase. The TBAs were purposively sampled. The data were analysed thematically. Results: Four themes emerged: challenges TBA experience in the management of the third stage of labour, management of the placenta by Basotho traditional birth attendants, support during the management of the placenta by Basotho traditional birth attendants, and management during emergencies. Conclusion: This study demonstrated that if TBAs are supported, they can contribute to the health of the mother and baby. Contribution: This study's findings can be valuable to healthcare professionals to understand better how TBAs in Lesotho manage the third stage of labour and the support they need.

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BACKGROUND: Malaria remains a significant cause of morbidity and mortality globally and continues to disproportionately afflict the African population. We aimed to evaluate the effect of home management of malaria intervention on health outcomes. METHODS: In our systematic review and meta-analysis, six databases (Pubmed, Cochrane CENTRAL, EMBASE, CAB Abstracts and Global Health, CINAHL Complete, and BIOSIS) were searched for studies of home management of malaria from inception until November 15, 2023. We included before-after studies, observational studies, and randomised controlled trials of home management intervention delivered in community settings. The primary outcomes were malaria mortality and all-cause mortality. The risk of bias in individual observational studies was assessed using the ROBINS-I tool, whilst randomised controlled trials were judged using a revised Cochrane risk of bias tool and cluster-randomised controlled trials were evaluated using an adapted Cochrane risk of bias tool for cluster-randomised trials. We computed risk ratios with accompanying 95% confidence intervals for health-related outcomes reported in the studies and subsequently pooled the results by using a random-effects model (DerSimonian-Laird method). RESULTS: We identified 1203 citations through database and hand searches, from which 56 articles from 47 studies encompassing 234,002 participants were included in the systematic review. All studies were conducted in people living in sub-Saharan Africa and were rated to have a low or moderate risk of bias. Pooled analyses showed that mortality rates due to malaria (RR = 0.40, 95% CI = 0.29-0.54, P = 0.00001, I2 = 0%) and all-cause mortality rates (RR = 0.62, 95% CI = 0.53-0.72, P = 0.00001, I2 = 0%) were significantly lower among participants receiving home management intervention compared to the control group. However, in children under 5 years of age, there was no significant difference in mortality rates before and after implementation of home management of malaria. In terms of secondary outcomes, home management of malaria was associated with a reduction in the risk of febrile episodes (RR = 1.27, 95% CI = 1.09-1.47, P = 0.002, I2 = 97%) and higher effective rates of antimalarial treatments (RR = 2.72, 95% CI = 1.90-3.88, P < 0.00001, I2 = 96%) compared to standard care. Home malaria management combined with intermittent preventive treatment showed a significantly lower incidence risk of malaria than home management intervention that exclusively provided treatment to individuals with febrile illness suggestive of malaria. The risks for adverse events were found to be similar for home management intervention using different antimalarial drugs. Cost-effectiveness findings depicted that home malaria management merited special preferential scale-up. CONCLUSIONS: Home management of malaria intervention was associated with significant reductions in malaria mortality and all-cause mortality. The intervention could help decrease health and economic burden attributable to malaria. Further clinical studies are warranted to enable more meaningful interpretations with regard to wide-scale implementation of the intervention, settings of differing transmission intensity, and new antimalarial drugs.

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INTRODUCTION: Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery. METHODS: This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery. RESULTS: Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks). DISCUSSION AND CONCLUSIONS: Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

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INTRODUCTION: Rapid technological change will affect how people access harmful products. For example, automated delivery services are forecast to provide fast and affordable product access options for those purchasing alcohol. Information about the potential impacts of such innovations on alcohol purchase and consumption behaviors is lacking. The aim of this study was to explore how consumers may respond to future scenarios where alcohol is available via a range of autonomous alcohol delivery options. METHODS: In a two-stage process, qualitative individual interviews (n = 100) and a quantitative online survey (n = 1078) were conducted with Australians aged 18+ years. Quotas were used to achieve national representation on key demographic variables. Participants were exposed to scenarios outlining how autonomous vehicles are likely to be used for alcohol deliveries in the future and asked to discuss their intentions to use such services and their perceptions of any impacts on alcohol consumption at a societal level. RESULTS: Automated alcohol deliveries were generally considered to be highly convenient and therefore likely to be popular. Around one-third (37%) of survey respondents reported an intention to use such automated alcohol delivery services once they are available and almost half (47%) expected overall levels of alcohol consumption to increase across the population. CONCLUSION: Given potential levels of uptake, careful consideration needs to be given to the development and implementation of appropriate policy and regulatory frameworks to minimize the increased risk of alcohol-related harm associated with enhanced alcohol availability resulting from the emerging availability of autonomous delivery services.

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AIMS: Insights into the current practice of direct-to-participant (DtP) supply of investigational medicinal product (IMP) in the context of clinical trials conducted in Europe are needed, as regulations are unharmonized. This study is set out to explore how DtP IMP supply has been employed in Europe and what the advantages and disadvantages and barriers and facilitators of its implementation are. METHODS: We conducted semi-structured interviews with representatives from sponsor companies, courier services and site study staff involved in the IMP dispensing and delivery process in Europe. Interviews were conducted between May and November 2021, and data were analysed following thematic analysis. RESULTS: Sixteen respondents participated in one of the 12 interviews. Respondents had experience with different models of DtP IMP supply including shipment from the investigative site, a central pharmacy (a depot under the control of a pharmacist) and a local pharmacy-aiming to reduce trial participation burden. The respondents indicated that investigative site-to-participant shipment is not affected by regulatory barriers, but could burden site staff. Shipment from central locations was considered most efficient, but possible regulatory barriers related to maintaining participants' privacy and investigator oversight were identified. The respondents indicated that the involvement of local pharmacies to dispense IMP can be considered when the IMP is authorized. CONCLUSIONS: Several DtP IMP supply models are implemented in clinical trials conducted in Europe. In this study, three main DtP IMP models were identified, which can be referenced when describing these approaches for regulatory approval.

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Home delivery services require the attendance of the customer during delivery. Hence, retailers and customers mutually agree on a delivery time window in the booking process. However, when a customer requests a time window, it is not clear how much accepting the ongoing request significantly reduces the availability of time windows for future customers. In this paper, we explore using historical order data to manage scarce delivery capacities efficiently. We propose a sampling-based customer acceptance approach that is fed with different combinations of these data to assess the impact of the current request on route efficiency and the ability to accept future requests. We propose a data-science process to investigate the best use of historical order data in terms of recency and amount of sampling data. We identify features that help to improve the acceptance decision as well as the retailer's revenue. We demonstrate our approach with large amounts of real historical order data from two cities served by an online grocery in Germany.

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AIMS: To estimate the use of home alcohol delivery and other methods of obtaining alcohol, rates of ID checking for home alcohol delivery purchases, and associations with alcohol-related consequences. METHODS: Surveillance data from 784 lifetime drinkers participating in the 2022 Rhode Island Young Adult Survey were used. The method of obtaining alcohol (e.g. type of purchase, gifted, theft) was assessed. The Alcohol Use Disorders Identification Test, Brief Young Adults Alcohol Consequences Questionnaire, and a drinking and driving question were used to measure high-risk drinking behaviors, experiencing negative alcohol questions, and history of drinking and driving. Logistic regression models adjusting for sociodemographic variables were used to estimate main effects. RESULTS: About 7.4% of the sample purchased alcohol through a home delivery or to-go purchase; 12.1% of participants who obtained alcohol this way never had their ID checked during the purchase attempt, and 10.2% of these purchases were completed by participants under the legal purchase age. Home delivery/to-go purchases were associated with high-risk drinking. Alcohol theft was associated with high-risk drinking, experiencing negative alcohol consequences, and drinking and driving. CONCLUSIONS: Home alcohol delivery and to-go purchases may provide an opportunity for underage access to alcohol, but their current use as a method of obtaining alcohol is rare. Stronger ID checking policies are needed. Alcohol theft was linked to several negative alcohol outcomes, and home-based preventive interventions should be considered.

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INTRODUCTION: This study: (i) determined the population coverage of alcohol delivery and to-go/carryout policies (i.e., policies permitting bars/restaurants to sell individual drinks for off-site consumption) in 2019 and 2020; and (ii) identified characteristics associated with alcohol delivery and to-go purchases. METHODS: Data are from the National Alcohol Survey and Alcohol Policy Information System (n = 1677 adults, 52.1% female). Population coverage models summed state populations across state-level bar/restaurant delivery and to-go/carryout policies by beverage. Regression outcomes were past-year alcohol delivery and to-go purchases. Independent variables included demographics, excessive drinking, COVID-19 impacts and state COVID-19 bar/restaurant alcohol laws. Chi-squared tests and logistic regression models tested associations between delivery/to-go purchases and independent variables. RESULTS: Overall, 7.5% of adults had alcohol delivered and 14.5% bought alcohol to-go. From December 2019 to December 2020, the number of people living in states allowing beer/wine/spirits delivery (284%) and to-go sales (627%) rose steeply. People who were Black (vs. White; adjusted odds ratio [aOR] 2.92, p < 0.001), excessive drinkers (vs. non-excessive drinkers; aOR 2.06, p < 0.001) or lived in states allowing beer/wine/spirits to-go sales (aOR 2.20, p = 0.01) had higher odds of buying alcohol to-go. Conversely, older people had lower odds of buying alcohol to-go (aOR 0.97, p < 0.001). People with some college or more (vs. high school degree or less, aOR 2.21, p < 0.001) and a higher economic burden (vs. fewer COVID-19 impacts, aOR 2.32, p = 0.05) had higher odds of alcohol delivery. DISCUSSION AND CONCLUSIONS: A select sub-population defined by socioeconomic status, race, excessive drinking and state policies bought alcohol for delivery or to-go in the Unites States.

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BACKGROUND: Despite uptake of antenatal care (ANC), 70% of global burden of maternal and child mortality is prevalent in sub-Saharan Africa, particularly Nigeria, due to persistent home delivery. Thus, this study investigated the disparity and barriers to health facility delivery and the predictors of home delivery following optimal and suboptimal uptake of ANC in Nigeria. METHODOLOGY: A secondary analysis of 34882 data from 3 waves of cross-sectional surveys (2008-2018 NDHS). Home delivery is the outcome while explanatory variables were classified as socio-demographics, obstetrics, and autonomous factors. Descriptive statistics (bar chart) reported frequencies and percentages of categorical data, median (interquartile range) summarized the non-normal count data. Bivariate chi-square test assessed relationship at 10% cutoff point (p < 0.10) and median test examined differences in medians of the non-normal data in two groups. Multivariable logistic regression (Coeff plot) evaluated the likelihood and significance of the predictors at p < 0.05. RESULTS: 46.2% of women had home delivery after ANC. Only 5.8% of women with suboptimal ANC compared to the 48.0% with optimal ANC had facility delivery and the disparity was significant (p < 0.001). Older maternal age, SBA use, joint health decision making and ANC in a health facility are associated with facility delivery. About 75% of health facility barriers are due to high cost, long distance, poor service, and misconceptions. Women with any form of obstacle utilizing health facility are less likely to receive ANC in a health facility. Problem getting permission to seek for medical help (aOR = 1.84, 95%CI = 1.20-2.59) and religion (aOR = 1.43, 95%CI = 1.05-1.93) positively influence home delivery after suboptimal ANC while undesired pregnancy (aOR = 1.27, 95%CI = 1.01-1.60) positively influence home delivery after optimal ANC. Delayed initiation of ANC (aOR = 1.19, 95%CI = 1.02-1.39) is associated with home delivery after any ANC. CONCLUSIONS: About half of women had home delivery after ANC. Hence disparity exist between suboptimal and optimal ANC attendees in institutional delivery. Religion, unwanted pregnancy, and women autonomy problem raise the likelihood of home delivery. Four-fifth of health facility barriers can be eradicated by optimizing maternity package with health education and improved quality service that expand focus ANC to capture women with limited access to health facility.

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BACKGROUND: Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia. METHOD: Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively. RESULTS: Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking. CONCLUSIONS: Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.

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INTRODUCTION: The emergence of autonomous vehicles (AV) heralds new methods of alcohol delivery that are likely to have substantial implications for home drinking. The aim of this study was to explore the factors that have the potential to hasten or restrict widescale increases in alcohol availability resulting from AVs. METHODS: Thirty-six interviews were conducted with 44 stakeholders across diverse sectors. Interviewees discussed their perceptions of how AVs will evolve and the implications for alcohol access. The interview transcripts were analysed to develop a typology of factors that need to be addressed to minimise harms associated with greater home alcohol consumption due to AVs. RESULTS: The interviewees identified a range of demand-side (e.g., enhanced convenience for consumers) and supply-side (e.g., increased efficiency for providers) factors associated with AV home deliveries that could increase the prevalence and volume of home drinking. A third category of factors related to potential forms of regulation: suggested harm-minimisation options related to appropriate enhancements of licensing restrictions and responsible service requirements and the use of various fiscal levers to introduce price barriers. DISCUSSION AND CONCLUSIONS: The suggested strategies will require collaborative efforts across government and non-government organisations to address the potential issues arising from the advent of AV alcohol deliveries. Technological and policy solutions will be needed to ensure responsible service of alcohol. This study provides policy makers with insights into forms of intervention that may be required to minimise the harms associated with the use of AVs in alcohol home delivery systems.

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Although it has been studied extensively throughout the past 20 years, the environmental impact of e-commerce can still be considered a controversial subject. Particularly for those wondering whether online shopping constitutes a more environmentally friendly alternative to traditional store-based shopping, evidence can be found that quantitatively supports affirmative as well as opposing claims. Findings differ widely because the contexts and assumptions of the studies from which they are drawn differ widely as well. To advance our understanding of this question and inform actions that can actually reduce the environmental impact of shopping, we carried out a systematic quantitative review of environmental impact assessments that compares the carbon footprint of online and store purchases. Based on over twenty scientific studies, we compiled a dataset of 244 purchases, their estimated carbon footprint and information on the contextual, distribution, behavioral, and geographical conditions on which the calculations are based. We conclude from the reviewed studies that online purchases generally generate a lower carbon footprint than store purchases, but only in the case of car-dependent lifestyles, and possibly only because the studies largely overlook transformations in consumer behavior and in the consumption landscape.

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