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

Knowledge, attitudes, and practices related to COVID-19 pandemic among adult population in Sidama Regional State, Southern Ethiopia: A community based cross-sectional study.

IntroductionCOVID-19 incidence is increasing and different measures have been adopted to control the spread of the pandemic in Ethiopia. Among these measures, enhancing the knowledge, positive attitudes, and proper practices of prevention measures about the disease is a basic strategy to control it. However, community compliance to control measures is largely dependent on their knowledge, attitudes, and practices (KAP) towards COVID-19.ObjectiveTo assess the current level of KAP towards COVID-19 pandemic and predictors among the rural dwellers in Sidama regional state, Southern Ethiopia; 2020.MethodsThis community-based prospective cross-sectional study was carried out from May 1-30, 2020 on a sample of 1,278 adult populations in Sidama regional state, Southern Ethiopia. A multi-stage sampling technique was used to choice the study participants. The data were collected using a structured interviewer-administered questionnaire. We have entered data using Epi data version 3.1 and all analyses were done using SPSS version 25. KAPs scores of study participants based on their independent variables were compared using Chi-square test, t-test or one-way analysis of variance (ANOVA) as required. Bi-variable and multivariable logistic regression analyses were used to identify factors associated with KAP. The important assumptions of the logistic regression model were checked to be satisfied. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) were calculated to assess the existence and strength of associations.ResultsFrom a total of 1,214 study participants, the overall attained knowledge, attitude and practice score about COVID-19 were 90%, 82.4% and 65%, respectively. Among these, 43.9%, 37.5%, and 24.4% of the study participants had demonstrated good knowledge, high attitude and proper practice, respectively. The mean knowledge scores were significantly different between sex, categories of marital status, educational levels, main occupation, and the monthly income quintiles of the study participants (pConclusionsThe majority of study participants had showed good knowledge and optimistic attitude toward COVID-19. But, the level of practice lower than that expected to maximize effective control measures. Further public education interventions and community sensitization campaigns are required for rural adult population in the Sidama regional state, Ethiopia

Predictors of timeliness of vaccination among children of age 12–23 months in Boricha district, Sidama region Ethiopia, in 2019

Abstract Background Traditional measurement of vaccine coverage can mask the magnitude of timely uptake of vaccine. Hence, the optimal measurement of timeliness is unclear due to variations in vaccine schedule among countries in the world. In Ethiopia, Oral Polio Virus (OPV), Pentavalent, Tetanus, H. influenza type B, Hepatitis B, and Pneumonia-Conjugate Vaccine (PCV) are basic vaccines which are taken at birth, six weeks, ten weeks, and fourteen weeks respectively. Despite its importance, information is scarce about on-time vaccination in the study area. Therefore, this study aimed to assess prevalence and factors associated with on-time vaccination among children of age 12–23 months in Boricha district, Sidama Ethiopia, in 2019. Methods A community based survey was conducted in Boricha district, Sidama region Ethiopia from January 1–30 in 2019. Study participants were selected using stratified multistage sampling technique. Kebeles were stratified based on residence. First, Kebeles were selected using random sampling. Then, systematic random sampling was employed to reach each household. Data were collected using structured and interviewer administered questionnaire. Logistic regression analysis was employed to identify factors associated with timely vaccination. Then, independent variables with p-value < 0.25 in COR were fitted further into multivariate logistic regression analysis model to control the possible cofounders. AOR with 95% CI and p-value < 0.05 was computed and reported as the level of statistical significance. Results From a total of 614 study participants, only 609 study participants have responded to questions completely making a response rate of 99.2%. Prevalence of timeliness of vaccination was 26.8% (95% CI: 25, 28) in this study. Factors like children of women with formal education (AOR = 5.3, 95%CI,2.7, 10.4), absence of antenatal care visit (AOR = 4.2,95%CI, 1.8,9.8), home delivery (AOR = 6.2,95%CI,4.0,9.3), lack of postnatal care (AOR = 3.7,95%CI,1.1,13.3), and lack of information about when vaccines completion date (AOR = 2.0, 95% CI,1.13,3.8) were factors influences timely vaccination among children of age 12–23 months. Conclusion Prevalence of on-time vaccination among children of age 12–23 months is lower than national threshold. Therefore, sustained health education on vaccination schedule and reminder strategies should be designed and implemented. Furthermore, maternal and child health care services should be enhanced and coordinated to improve on-time uptake of vaccine

Utilization and Predictors of Maternal Health Care Services among Women of Reproductive Age in Hawassa University Health and Demographic Surveillance System Site, South Ethiopia: A Cross-Sectional Study

Background. Regular utilization of maternal health care services decreases maternal morbidity and mortality. However, major predictors that influence the utilization of the existing maternal health care services are complex and differ from place to place. Therefore, assessing these predictors assists health planners to prioritize promotion strategies and is a fundamental step for intervention. This study assessed the utilization and predictors of maternal health care services among women of the reproductive age in Hawassa Health and Demographic Surveillance System site, South Ethiopia, 2019. Methods. A community-based cross-sectional study was conducted among 682 women of the reproductive age from January to February, in 2019. A two-stage stratified sampling method was utilized. Data were collected using a structured, face-to-face interviewer-administered questionnaire. The data were entered using Epi Data 3.1 and analyzed using SPSS version 20. The variables were entered into the multivariable model using the backward stepwise regression approach. Multivariable logistic regression analysis was used to identify factors associated with utilization of the maternal health care. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were computed to assess the presence and strength of associations. Result. The overall utilization of ANC, institutional delivery, and PNC was 69.1, 52.1, and 32.7%, respectively. The odds of utilizing ANC were 4.72 times higher for women who have a formal education (AOR: 4.72, 95% CI = 2.82–7.90) as compared to those who have no formal education. The odds of utilizing institutional delivery were 5.96 times higher for women who had ANC follow-up (AOR: 5.96; 95% CI = 3.88–9.18) as compared to those who had no ANC follow-up. Presence of information about the PNC (AOR: 3.66; 95% CI = 2.18–6.14) and autonomy of a woman to make decision on health issues (AOR: 6.13, 95% CI = 3.86–9.73) were positively associated with utilization of PNC. Conclusion. The utilization of maternal health care services is far below the national target in the study area. Maternal and paternal education status, autonomy of the woman to make decision on the health issues, wealth status, and having a plan on the current pregnancy were major predictors of the maternal health care service utilization. Providing information and training about the model household to the women about maternal health care service utilization using various methods of health education should be considered

Prevalence and risk factors of hypertension among civil servants in Sidama Zone, south Ethiopia.

IntroductionHypertension is the leading cause of death and disability in adult populations globally. Its prevalence is increasing rapidly in Ethiopia. Studies conducted to date address different population categories. However, there is lack of data on the prevalence and risk factors of hypertension among civil servants working in various sectors and levels.ObjectiveTo assess the prevalence and risk factors of hypertension among civil servants in Sidama Zone, south Ethiopia.Methods and materialsAn institution-based cross-sectional study was conducted from March 1-30, 2019 on a sample of 546 civil servants selected randomly from different departments of Sidama Zone Administration. Data were collected using structured, face-to-face interviewer-administered questionnaire and standard physical measurements. The data were entered using Epi Data 3.1 and analyzed using SPSS version 20. Multivariable logistic regression analysis was used to identify factors associated with hypertension. Adjusted odds ratios (AORs) with 95% confidence interval (CI) were computed to assess the presence and strength of associations.ResultsA total of 546 civil servants responded resulting in a response rate of 94.9%. The prevalence of hypertension was 24.5% [95% CI: 23.3% - 25.6%]. The identified risk factors of hypertension were male sex (AOR 4.31[95% CI: 1.84-10.09]), moderate current alcohol consumption (AOR: 4.85; [95% CI: 1.73-13.61]), current khat chewing (AOR 2.97[95% CI: 1.38-6.40]), old age (AOR: 4.41[95% CI: 1.19-16.26]), being obese (AOR 5.94 [95% CI: 1.26-27.86]) and central obesity (AOR 3.57 [95% CI: 1.80-7.07]).ConclusionsOne in four civil servants are hypertensive. Different demographic, behavioral and metabolic factors increase the odds of hypertension among civil servants. Prevention and control of hypertension shall involve promotion of healthy lifestyles such as weight management, regular physical activity and quitting or cutting down on harmful use of substances such as alcohol and khat

Additional file 1 of Predictors of timeliness of vaccination among children of age 12–23 months in Boricha district, Sidama region Ethiopia, in 2019

Additional file 1. Questionnaires

Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia.

BackgroundMaternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia.ObjectivesThis study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019.MethodsA community based cross sectional study was conducted from January 1-30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance.ResultPrevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4-0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67-8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08-8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4-4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service.ConclusionPrevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service

Prevalence of soil-transmitted helminthes and its association with water, sanitation, hygiene among schoolchildren and barriers for schools level prevention in technology villages of Hawassa University: Mixed design.

BackgroundSoil-transmitted helminths (STH) remain one of the most common causes of morbidity among children in Ethiopia. Assessment of the magnitude of STH and its association with water, sanitation, and hygiene (WASH) and identify barriers for school-level prevention assist public health planners to prioritize promotion strategies and is a basic step for intervention. However, there is a lack of evidence on the prevalence of STH and its association with WASH and barriers for school-level prevention among schoolchildren.ObjectiveTo assess the prevalence of STH and its association with WASH and identify barriers for school level prevention in technology village of Hawassa University; 2019.MethodsAn institution-based analytical cross-sectional study was conducted on a sample of 1080 schoolchildren from September 5 to October 15, 2019. A two-stage cluster and purposive sampling technique were used to draw the study participants. A pretested, structured questionnaire, observation checklist, and in-depth interview were used to collect the data. Two grams of stool samples were collected from each study participant and examined using direct wet mount and Kato-Katz technique. Data were entered into Epi Info version 7 and analyzed using SPSS version 25. Both bi-variable and multivariable logistic regression analyses were done. Qualitative data were analyzed using thematic content analysis method by Atlas-Ti software and presented in narratives.ResultsThe overall prevalence of STHs was 23.1% (95% CI = 21.4, 27.6). The identified predictors of STHs were large family size (AOR = 2.03; 95% CI = 1.53-3.99), absence of separate toilet room for male and female (AOR = 3.33; 95% CI = 1.91-5.79), toilet not easy to clean (AOR = 2.17; 95% CI = 1.44-3.33), inadequate knowledge about STHs (AOR = 2.08; 95% CI = 1.07-3.44) and children who had travelled greater than 100 meters to access toilet (AOR = 3.45; 95% CI = 2.24-8.92). These results were supported by the individual, institutional, socio-economic and cultural qualitative results.ConclusionThe STHs was moderate public health concerns. Reinforcing the existing fragile water, sanitation and hygiene programs and regular deworming of schoolchildren may support to reduce the burden of STHs. Also, increasing modern family planning methods utilization to decrease family size is recommended

Maternal Mortality in Africa: Regional Trends (2000&ndash;2017)

Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa&rsquo;s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children&rsquo;s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of &minus;3.0% (95% CI &minus;2.9; &minus;3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations&rsquo; sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations&rsquo; target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel