S. N	First author’s last name, year	Representativeness	Sample size	Response rate	Surveillance tool	Comparability	Outcome assessment	Statistical test	Quality score
1	Gurmu. T et al, 2014 [6].	1	1	1	2	1	2	1	9
2	Sewunet. A et al, 2022 [7].	1	1	1	2	1	2	1	9
3	Endalkachew.M et al, 2019 [8].	1	1	1	2	1	2	1	9
4	Girish. D et al, 2020 [9].	1	1	1	2	1	2	1	9
5	Ousman. A et al, 2023 [10].	1	1	0	2	1	2	1	8
6	Biyadgie A et al, 2017 [11].	1	1	1	2	1	2	0	8
7	Yohannes. T et al, 2021 [12].	1	1	1	2	1	2	1	9
8	Bosena T et al. 2010 [13].	1	1	1	2	1	2	1	9
9	Biniam. Met. Al. 2013 [14].	1	0	1	2	1	2	1	8

Table 1: Quality Assessment of Eligible Studies Using the Modified Newcastle-Ottawa Scale

A total of 31230 studies were identified from various electronic databases, with an additional 7 studies retrieved from other sources, resulting in a combined total of 31237 studies. During the initial screening, 5940 records were excluded as they did not meet the inclusion criteria for human studies. Subsequently, 25297 records were screened based on their titles and abstracts, leading to the exclusion of 25285 articles. Following this, 12 full-text articles were assessed for eligibility. Of these, 3 articles were excluded after a detailed full-text review. Finally, 9 studies met the inclusion criteria and were included in the final meta-analysis (see Figure 1).

Figure 1: PRISMA Flow Diagram Illustrating the Selection Process for Included Studies in the Systematic Review and Meta-Analysis.

Data collection:

The two authors (DET and HDH) independently extracted the required data from the included studies using a format prepared in Microsoft Excel. The reviewers' team resolved any differences found throughout the data extraction process by discussing them further.

Data analysis: 

The statistical analysis was performed using R version 4.2.3 and STATA version 17.0. Given the heterogeneity present in the data, a random-effects model was utilized to aggregate the results. Individual measures of utilization for post-exposure prophylaxis were calculated separately. The PRISMA guidelines reported the findings for systematic reviews and meta-analyses.

Results

Magnitude of utilization of post-exposure prophylaxis:
This analysis encompassed nine studies with a total of 1,175 participants. The overall pooled prevalence of post-exposure prophylaxis (PEP) utilization was found to be 43% (95% CI: 24 - 62) as illustrated in Figure 2.

Figure 2: Forest plot depicting the pooled utilization of post-exposure prophylaxis in Ethiopia.

Subgroup Analysis of Post-Exposure Prophylaxis Utilization:

The analysis found that the highest utilization of post-exposure prophylaxis (PEP) occurred in the Amhara region, reaching 61% (95% CI: 14 - 100%). In contrast, the Oromia region reported the lowest utilization rate at 19% (95% CI: 14 - 24%) as shown in (Figure 3).

Figure 3: Forest plot illustrating the subgroup analysis of post-exposure prophylaxis usage by region.

The funnel plot indicates the symmetrical distribution of papers, with an Egger test p-value of 0.485, excluding publication bias (Figure 4).

Figure 4: Funnel plot indicating the symmetric distribution of the studies included in the analysis

Discussion:

Healthcare workers (HCWs) face a notable risk of infection when exposed to workplace blood and body fluids (BBFs). Such exposure can lead to the transmission of bloodborne pathogens, including the hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV) [15][16][17]. This systematic review and meta-analysis aimed to assess the pooled estimate of post-exposure prophylaxes (PEP) utilization among healthcare professionals in Ethiopia. The finding revealed that the pooled estimate of post-exposure prophylaxis (PEP) utilization was determined to be 43% (95% CI: 24 - 62). This finding is higher than the study conducted in 40.1% of Africa [4],  35.3% Pakistan [18], 2.1 % Bhutan [19], 13.7% in Tanzania [20], 29 in South Africa [21], 18.9% in Cameroon [22]. Conversely, it is lower than the study done in 65.9 in Nigeria [23]. These discrepancies might arise due to variation across sociodemographic factors, wherein income influences access to healthcare resources, along with differences in setting sample size and methodology. In addition, geographical access to healthcare services often widens the differences between urban and rural areas, therefore propagating health disparities [24].

From the subgroup analyses, the use of post-exposure prophylaxis was highest in the Amhara region (61%: 95 % CI: 14-100%), while the lowest was in the Oromia region (19%: 95 % CI: 14-24%). The difference may be due to heterogeneity in sample size, and sociodemographic characteristics.

Conclusions:

The meta-analysis shows that postexposure prophylaxis utilization among healthcare professionals in Ethiopia is low, despite its proven effectiveness in preventing HIV transmission. The low overall uptake of postexposure prophylaxis shows the necessitates giving attention and intervention towards the hindering factors via creating supportive environments that mitigate stigma. Improving access to post-exposure prophylaxis medications are essential step in enhancing occupational safety for healthcare workers.

Ethical approval and consent to participate

Not applicable

Authors’ contributions statement

DET was responsible for conceptualization, searching, extraction, formal analysis, and manuscript writing. HDH and TMM contributed to the searching, extraction, and manuscript writing. ZBG and WKG were involved in the searching, extraction, analysis, and manuscript writing. All authors approved the final version of the manuscript.

Acknowledgments

Not applicable

Funding

The authors declared they didn’t receive funds for this research

Disclosure:

The authors declared that they have no competing interests.

Data availability: 

The dataset analyzed for this study's findings is available with the corresponding author and can, therefore, be assessed upon reasonable request.