Maternal near miss in Ethiopia:Protective role of antenatal care and disparity in socioeconomic inequities: A systematic review and meta-analysis

Background: The burden of maternal near miss (MNM) is an important public health problem in low and middle income countries including Ethiopia despite ongoing initiatives both at regional and national levels. Intricate and persistent socioeconomic inequities as well as poor health care seeking behavior contribute to MNM, although extant evidence is inconsistent and inconclusive. This systematic review and meta-analysis was therefore aimed to estimate the pooled national burden of MNM and contributing factors in Ethiopia. Methods: This systematic review and meta-analysis pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and was registered on PROSPERO (CRD42018105518). An extensive search of databases including Pub Med, Web of Science, CINHA and African Journals Online was conducted to retrieve potential published articles. The Newcastle-Ottawa quality assessment tool was used to assess the quality of eligible studies. Inverse variance test was used to assess heterogeneity and publication bias was checked by the funnel plot and Egger's test. STATA version 14 was used to carry out the meta-analysis, and estimate the magnitude and associated factors of MNM using a random-effects model. Results: Eleven studies, with a total of 98,268 women, were included in the meta-analysis. The pooled burden of MNM was 12.57% (95%CI: 10.26, 14.88). The highest and lowest burden was observed in Amhara region (26.75% (95%CI: 22.46–31.05) and Addis Ababa; (0.8% (95%CI: 0.7, 0.9), respectively. Mothers who had antenatal care visit were 67% less likely to experience MNM [OR = 0.33, 95%CI: 0.22, 0.49]. Notwithstanding, women who were rural residents [OR = 2.7, 95%CI: 1.39, 5.25], did not have formal education [OR = 2.48, 95% CI: 1.58, 3.89] and were unmarried [OR = 1.69, 95%CI: 1.03, 2.78] had higher odds of MNM. Conclusions: One out of eight women experience MNM in Ethiopia. Antenatal care visit is a protective factor to MNM, although disadvantaged socioeconomic conditions contribute to two fold of the near misses. Improving the maternal health care services utilization and women empowerment would reduce the burden of MNM.</p

Prevalence of medication non-adherence and associated factors among diabetic patients in a tertiary hospital at Debre Markos, Northwest Ethiopia

BACKGROUND: Non-adherence to prescribed medications is possibly the most common reason for poor treatment outcomes among people with diabetes although its rate is highly variable. Data on the magnitude of medication non-adherence and associated factors are scarce in the study area. This study aimed to assess the rate of non-adherence and associated factors among diabetic patients at Debre Markos Comprehensive Specialized Hospital.METHODS: A cross-sectional study was conducted from June 17 to July 17, 2021. Study participants were selected using a simple random sampling technique. Data were collected with a pre-tested structured questionnaire and entered into SPSS version 25. Logistic regression was utilized to determine predictors of medication non-adherence at a significance level of ≤ 0.05.RESULTS: A total of 176 study participants were enrolled in the study. About 59% of the study participants had type-2 diabetes mellitus. The prevalence of non-adherence to anti-diabetic medications was found to be 41.5%. Male sex, rural residence, being divorced, being merchant, self- or family-borne medical cost, and presence of comorbidities were significantly associated with increased rate of non-adherence to anti-diabetic medications.CONCLUSION: The prevalence of non-adherence to medications among diabetic patients is significantly high in the study area. Public health measures should be strengthened to decrease nonadherence among diabetic patients

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Global pattern, trend, and cross-country inequality of early musculoskeletal disorders from 1990 to 2019, with projection from 2020 to 2050

BackgroundThis study aims to estimate the burden, trends, forecasts, and disparities of early musculoskeletal (MSK) disorders among individuals ages 15 to 39 years. MethodsThe global prevalence, years lived with disabilities (YLDs), disability-adjusted life years (DALYs), projection, and inequality were estimated for early MSK diseases, including rheumatoid arthritis (RA), osteoarthritis (OA), low back pain (LBP), neck pain (NP), gout, and other MSK diseases (OMSKDs). FindingsMore adolescents and young adults were expected to develop MSK disorders by 2050. Across five age groups, the rates of prevalence, YLDs, and DALYs for RA, NP, LBP, gout, and OMSKDs sharply increased from ages 15–19 to 35–39; however, these were negligible for OA before age 30 but increased notably at ages 30–34, rising at least 6-fold by 35–39. The disease burden of gout, LBP, and OA attributable to high BMI and gout attributable to kidney dysfunction increased, while the contribution of smoking to LBP and RA and occupational ergonomic factors to LBP decreased. Between 1990 and 2019, the slope index of inequality increased for six MSK disorders, and the relative concentration index increased for gout, NP, OA, and OMSKDs but decreased for LBP and RA. ConclusionsMultilevel interventions should be initiated to prevent disease burden related to RA, NP, LBP, gout, and OMSKDs among individuals ages 15–19 and to OA among individuals ages 30–34 to tightly control high BMI and kidney dysfunction. FundingThe Global Burden of Disease study is funded by the Bill and Melinda Gates Foundation. The project is funded by the Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital (2022QN38).This study was produced as part of the GBD Collaborator Network and in accordance with the GBD Protocol (IHME ID: 4241-GBD2019). For GBD studies, a waiver of informed consent was reviewed and approved by the Institutional Review Board of the University of Washington. The Global Burden of Disease study is funded by the Bill and Melinda Gates Foundation. The project is funded by the Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital (2022QN38). Y.J. and C.G. were joint first authors who contributed equally to the manuscript. L.-s.T. and D.W. were joint senior authors. Y.J., C.G., L.-s.T., and D.W. were writing authors of the manuscript

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Time To Recovery And Its Predictors Among Severe Community Acquired Pneumonia Patients Admitted To Pediatric Ward, Debre-markos Referral Hospital, North West Ethiopia, Retrospective Follow-up Study, 2019

Abstract Background - Globally, pneumonia is a major cause of morbidity and mortality among children which affects 151.8 million each year. It leads over 156 million episodes and 14.9 million hospitalizations per year. Besides this fact, the recovery time and predictors of children’s hospitalization related to severe community acquired pneumonia is not well known. Objective -The aim of this study was to estimate the median time to recovery and its predictors among severe community acquired pneumonia patients admitted to pediatric ward, Debre Markos Referral Hospital, North West Ethiopia. Methods - An institution based retrospective follow up study was employed among 352 records of children who were admitted starting from January 2016 to December, 2018. Patients chart were retrieved using a structured data extraction tool. Data was entered using Epi-Data version 3.02 and analyzed using STATA version 14 statistical software. The Kaplan Meier survival curve and log rank tests were used. Cox proportional hazard model assumption and model fitness were checked. Stratified Cox regression was fitted as a final model. Hazard ratio with its 95% confidence interval was used and P-value &lt; 0.05 was considered as statistically significant association. Result- The overall median recovery time was 4 days IQR (3-7). Recovery rate from severe community acquired pneumonia was 16.25 (95% CI: 14.54–18.15) per 100 person day observation. Age (AHR; 0.94 95% CI (0.90-0.98)), being stunted (AHR; 0.62 95% CI (0.43-0.91)), presence of danger sign at admission (AHR; 0.61 95% CI ((0.40-0.94)), late presentation to seek care (AHR; 0.64 95% CI (0.47-0.88)) and co-morbidity (AHR; 0.45 95% CI ((0.45(0.35-0.58)) were significant predictors of recovery time. Conclusion: The median recovery time from severe community acquired pneumonia was long. Measures to reduce recovery time should be strengthened. Key words:-pediatrics, predictors, severe community acquired pneumonia and time to recovery.</jats:p

Clinical Outcomes and Predictors of Patients with Fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia: A Prospective Cohort Study

Background. Fracture continues to be a major public health concern in many parts of the developing world that results in several consequences and complications including lifelong morbidity and mortality. This study aimed to assess clinical outcomes of patients following fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia. Methods. An institution-based prospective cohort study was conducted from November 2020 to July 2021 among 207 fracture patients (69 visited traditional bone setter and 138 did not visit traditional bone setter). Data were collected through face-to-face interviews, physical examinations, and radiological investigations. Data were entered using Epi-Data version 3.1 and analysis was done using STATA 14 statistical software. Descriptive statistics were summarized using mean, median, standard deviation, and percentage and presented in tables and figures. The generalized linear model was fitted to identify the risks of the outcome variable. Risk Ratio with its 95% confidence interval was used and factors with a P-value less than 0.05 were considered as a statistically significant association. Result. The mean age of the participants was 37.5 ± 13.6 years and two-thirds of the participants were males. Nearly half of the patients 92 (44%), 50 (54%) from the exposed and 42 (46%) from the nonexposed group, were delayed getting treatment from the hospital. The majority of the patients had been treated with Plaster of Paris immobilization (55%) followed by fixation (15%) and a combination of both (12%). Nearly half of the participants (48%), 74% from the exposed and 35% from the nonexposed group, developed complications during the follow-up period. The commonest complication was joint stiffness (45%) followed by osteoarthritis (21%). The risk of fracture-related complications among patients who did not visit traditional bone setter was decreased by 54% as compared to visitors (RR 0.46; 95% CI: (0.35, 0.60)) Conclusion. The magnitude of complications following the fracture is found to be high and the risk of complications among patients who visited traditional bone setters increased significantly. Therefore, prevention measures should be strengthened and integration between hospitals and traditional bone setters should be made so that basic training on fractures management will be given

Clinical Outcomes and Predictors of Patients with Fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia: A Prospective Cohort Study

Background. Fracture continues to be a major public health concern in many parts of the developing world that results in several consequences and complications including lifelong morbidity and mortality. This study aimed to assess clinical outcomes of patients following fracture in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia. Methods. An institution-based prospective cohort study was conducted from November 2020 to July 2021 among 207 fracture patients (69 visited traditional bone setter and 138 did not visit traditional bone setter). Data were collected through face-to-face interviews, physical examinations, and radiological investigations. Data were entered using Epi-Data version 3.1 and analysis was done using STATA 14 statistical software. Descriptive statistics were summarized using mean, median, standard deviation, and percentage and presented in tables and figures. The generalized linear model was fitted to identify the risks of the outcome variable. Risk Ratio with its 95% confidence interval was used and factors with a P-value less than 0.05 were considered as a statistically significant association. Result. The mean age of the participants was 37.5 ± 13.6 years and two-thirds of the participants were males. Nearly half of the patients 92 (44%), 50 (54%) from the exposed and 42 (46%) from the nonexposed group, were delayed getting treatment from the hospital. The majority of the patients had been treated with Plaster of Paris immobilization (55%) followed by fixation (15%) and a combination of both (12%). Nearly half of the participants (48%), 74% from the exposed and 35% from the nonexposed group, developed complications during the follow-up period. The commonest complication was joint stiffness (45%) followed by osteoarthritis (21%). The risk of fracture-related complications among patients who did not visit traditional bone setter was decreased by 54% as compared to visitors (RR 0.46; 95% CI: (0.35, 0.60)) Conclusion. The magnitude of complications following the fracture is found to be high and the risk of complications among patients who visited traditional bone setters increased significantly. Therefore, prevention measures should be strengthened and integration between hospitals and traditional bone setters should be made so that basic training on fractures management will be given.</jats:p