Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : a novel analysis from the Global Burden of Disease Study 2015

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r= 0.88), an index of 11 universal health coverage interventions (r= 0.83), and human resources for health per 1000 (r= 0.77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28.6 to 94.6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40.7 (95% uncertainty interval, 39.0-42.8) in 1990 to 53.7 (52.2-55.4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21.2 in 1990 to 20.1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73.8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-systemcharacteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Livelihood options of landless rural households in Tigrai Region, Northern Ethiopia: evidence from selected districts

Abstract Background The livelihood of rural households in Ethiopia, like in most developing countries, largely depends on land resource. However, nowadays most rural households are denied access to arable land in the highland of Ethiopia due to high population growth and shortage of arable land. Landlessness is, therefore, becoming a serious social and economic problem in the rural highland areas of Ethiopia in general and Tigrai region in particular. This study, therefore, intends to explore the choice of livelihood strategies of landless rural households and assess the challenges and opportunities of the livelihoods of landless rural households in selected districts of Tigrai region. Methods This study is conducted in three randomly selected districts of Tigrai region, namely, Kilte-Awlaelo, Degua-Tembien, and Hintalo-Wajerat districts. For the purpose of this study, two Tabias were randomly chosen from each districts. Then, afterward, both primary and secondary data sources were consulted to address the specific objectives of this study. The primary data were collected from 258 randomly selected households and six focus group discussions. This study used Multivariate Probit and Negative Binomial Regression to analyze factors influencing the choice of livelihood strategies and the number of livelihood options adopted by the landless rural households, respectively. Results This study finds that the livelihood sources of the landless rural households in the study area include farm (90%), non-farm (72%), and off-farm (41%) economic activities. The result of the Multivariate Probit regression indicates that household head characteristics, human capital, social capital, physical capital, financial capital, and institution-related factors were significantly influencing the choice of livelihood strategies of the landless rural households. The results of the negative binomial regression model, on the other hand, assert that household head-related factors, social capital, and institution-related factors were significantly influencing the number of livelihood options adopted by the landless rural households. This study affirms that stone or sand selling, dairy farming, poultry production, animal fattening, and bee keeping are the major opportunities to improve the livelihood of the landless rural households. Moreover, this study also identifies that shortage of arable land, youth unemployment, lack of access to infrastructure, poor land administration, and lack of access to financial capital were the major challenges facing the landless rural households. Concluding remarks This study concludes that all stakeholders efforts to address the problem of landlessness need to be geared to enhance access of landless rural households to different livelihood capitals, such as human, social, financial, physical, and natural capitals. Moreover, rural township and village enterprises could enhance the access of landless rural households to market and job opportunities

Influences of rootstock and agro-climatic condition on physico-chemical and bioactive compounds of Gunda Gundo orange (Citrus sinensis L. Osbeck) in the Northern Ethiopia

Rootstocks have a significant influence on adaptation to biotic and abiotic stress conditions and quality of fruit. So, choice of rootstock for a specific growing region is an important decision for a grower to make when establishing a commercial citrus orchard. This study was undertaken to assess effects of rootstock and location on quality of orange fruit. The study was conducted over two consecutive years (2017/18 and 2018/19). Scions from the Gunda Gundo orange grove were grafted on rough lemon and sour orange rootstocks and planted in Tigray and Afar, Ethiopia at four sites (Abala, Agulae, Adiha and Rama). The experiment was laid out in Randomized Complete Block Design (RCBD) with four replications. Data on different physico-chemical and bioactive compounds were collected and analyzed using R software (version 4). Compared to sour orange, rough lemon rootstock revealed higher fruit mass (151.96 g, 195.38 g), fruit length (62.27 mm, 68.88 mm) and fruit diameter (65.58 mm, 71.3 mm), in 2017/18, 2018/19, respectively. Among the four locations (Abala, Agulae, Adiha and Rama), higher juice percentage was found in Adiha (43.47% in 2017/18) and Abala (49.87%, in 2018/19). In 2017/18 higher total soluble solid (TSS, 13.87%), TSS/acid ratio (19.18) and fruit rag (32.77%), were obtained at the Rama site. On the one hand, higher vitamin C (826.6 mg·kg−1) and total phenolic content (208 mg·kg−1 GAE) were recorded at Agulae than Abala, Adiha and Rama sites from sour orange rootstock. High TSS, TSS/acid ratio and antioxidant were recorded from orange fruits at Rama site. This was expected to have resulted from hot climate conditions at the site. Besides, at a relatively cooler condition of the Agulae site, high phenolic, reduced ferric power and high vitamin C were recorded. Rough lemon rootstock improved fruit size, while rootstock did not affect the contents of TSS, TSS/acid ratio across the sites in both harvesting years

Knowledge, Attitude, and Practices on Water, Sanitation, and Hygiene among Rural Residents in Tigray Region, Northern Ethiopia

Background. Poor hygienic practices, inadequate water supply, and poor sanitary conditions play a major role in the spread of infectious diseases. Lack of knowledge, attitude, and practices (KAP) on WASH is one of the most imperative causes for transmission of infectious diseases. Therefore, the aim of this study was to assess knowledge, attitude, and practice of rural residents on water, sanitation, and hygiene in Tigray, Ethiopia. Methods. A community-based cross-sectional study was conducted from June to July 2018. Multistage cluster sampling technique was used to collect data from 759 households in Tigray region, Northern Ethiopia. A standardized questionnaire was used to collect data on knowledge, attitude, and practice on water, sanitation, and hygiene (WASH). Descriptive data analysis was done to present the study findings. Results. The response rate was 99.6%, and 574 (75.9%) of the respondents were females. Good knowledge, favorable attitude, and good practice on WASH were observed in 42.2% (95% CI: 38.7%, 45.7%), 48.5% (95% CI: 44.9%, 52.0%), and 49.2% (95% CI: 45.6%, 52.7%) of the respondents, respectively. Conclusions. Poor knowledge, unfavorable attitude, and poor practice on WASH were common amongst the residents in rural Tigray, Northern Ethiopia. Therefore, the health extension programs at primary health care should be revitalized in a way that can enhance the interventional measures to improve knowledge, attitude, and practice on WASH

Neonatal septicemia at intensive care unit, Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Bacteriological profile, drug susceptibility pattern, and associated factors.

BackgroundNeonatal septicemia is a life threatening medical emergency that requires timely detection of pathogens with urgent rational antibiotics therapy.MethodsA cross-sectional study was conducted between March 2017 to September 2018 among 317 septicemia suspected neonates at neonatal intensive care unit, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, North Ethiopia. A 3 mL of blood was collected from each participant. Identification of bacterial species was done using the standard microbiological techniques. Antibiotic sensitivity test was done using disk diffusion method. Data were entered and analyzed using computer software SPSS version 22. Bivariate and multivariate regression analysis was applied to determine the association between variables.ResultsOf the 317 (190 male and 127 female) neonates, 116 (36.6%) were found to be with culture proven septicemia. Klebsiella species were the predominant etiologic agents. Length of hospital stay (AOR (adjusted odds ratio) = 3.65 (2.17-6.13), p ConclusionNeonaltal septicemia is found to be significantly high in the present study. As most of the isolates are potentially related to hospital acquired infections, prevention and control policy should have to be more strengthening in the neonatal intensive care unit