Adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia

Background Adverse birth outcomes are major public health problems in developing countries. Data, though scarce in developing countries including Ethiopia, on adverse birth outcomes and the risk factors are important for planning maternal and child health care services. Hence, this study aimed to determine the prevalence and associated factors of adverse birth outcomes among deliveries at Gondar University Hospital, Northwest Ethiopia. Methods Institution based cross-sectional study was conducted in February 2013 at Gondar University Hospital. Data were collected by face-to-face interview of 490 women after verbal informed consent using a pretested and structured questionnaire. Gestational age was determined based on the last normal menstrual period. Birth weight was measured following standards. Multiple logistic regressions were fitted and odds ratios with their 95% confidence interval were computed to identify associated factors. Results The mean age of women was 26.2 (±5.2 SD) years. HIV infection among laboring women was 4.8%. About 23% of women had adverse birth outcomes (14.3% preterm, 11.2% low birth weight and 7.1% still births). Women having history of either preterm delivery or small baby (AOR: 3.1, 95% CI 1.1- 8.4) were more likely to have preterm births. Similarly, history of delivering preterm or small baby (AOR: 8.4, 95% CI 2.4- 29.4), preterm birth (AOR: 5.5, 95% CI 2.6- 11.6) and hypertension (AOR: 5.8, 95% CI 1.8- 19.6) were associated factors with low birth weight. Ante partum haemorrhage (AOR: 8.43, 95% CI 1.28- 55.34), hypertension (AOR: 9.5, 95% CI 2.1-44.3), history of perinatal death (AOR: 13.9, 95% CI 3.3- 58.5) and lack of antenatal care follow up (AOR: 9.7, 95% CI 2.7 - 35.8) were significantly associated with still birth. Conclusions Prevalence of adverse birth outcomes (still birth, preterm birth and low birth weight) were high and still a major public health problem in the area. Histories of perinatal death, delivering preterm or small baby, ante partum hemorrhage, lack of ante natal care follow up and hypertension were associated factors with adverse birth outcomes. Thus, further enhancements of ante natal and maternal care and early screening for hypertension are recommended

Design of a FAIR digital data health infrastructure in Africa for COVID-19 reporting and research

The limited volume of COVID-19 data from Africa raises concerns for global genome research, which requires a diversity of genotypes for accurate disease prediction, including on the provenance of the new SARS-CoV-2 mutations. The Virus Outbreak Data Network (VODAN)-Africa studied the possibility of increasing the production of clinical data, finding concerns about data ownership, and the limited use of health data for quality treatment at point of care. To address this, VODAN Africa developed an architecture to record clinical health data and research data collected on the incidence of COVID-19, producing these as human- and machine-readable data objects in a distributed architecture of locally governed, linked, human- and machine-readable data. This architecture supports analytics at the point of care and-through data visiting, across facilities-for generic analytics. An algorithm was run across FAIR Data Points to visit the distributed data and produce aggregate findings. The FAIR data architecture is deployed in Uganda, Ethiopia, Liberia, Nigeria, Kenya, Somalia, Tanzania, Zimbabwe, and Tunisia.Computer Systems, Imagery and Medi

Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000–17 : analysis for the Global Burden of Disease Study 2017

Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Hydro-geomorphological features at gully heads in the humid northern Ethiopian Highlands, Birr Watershed

The study was conducted in the Birr watershed at twelve gully heads located close to each other. The survey includes measurements of morphological features, soil properties, water table elevations and catchment characteristics including erosion at each gully head. The analysis showed that gully head morphology could be explained by the role of different gully head controlling factors. The result suggested the maximum rate of head cut retreat reaches from 0 to 22.5m. There was no head retreat recorded from the arrested heads relative to unprotected heads. Compared to semiarid highlands of northern Ethiopia, the average short term head cut retreat was 12 fold greater. From the direct shear test, angle of internal friction by far greater than the slope of gully heads which are located at flat lands. The width depth ratio showed that the shallow depth heads were controlled by fluvial erosion whereas for the deep gully heads both fluvial and mass wasting due tension cracks are operating. In this study a significant power relationship established between the volume of the gully head and the length of retreat at the active gullies with V = 4.85 L1.05 (R2 = 0.91 and P= 0.042) which is different from the relation obtained from the entire gully system as a result of varies controlling factors

Gully head retreat in the sub-humid Ethiopian Highlands: the Ene-Chilala Catchment

In the northern highlands of Ethiopia, gully erosion is severe. Despite many efforts to implement gully prevention measures, controlling gully erosion remains a challenge. The objective is to better understand the regional gully erosion processes and to prevent gully head retreat. The study was conducted in the Ene-Chilala catchment in the sub-humid headwaters of the Birr River located southwest of Bahir Dar, Ethiopia. Twelve gully heads were monitored during the 2014 and 2015 rainy monsoon phase. We measured gully head morphology and retreat length, soil shear strength, ground water table levels, and catchment physical characteristics. Two active gully head cuts were treated in 2014 and an additional three head cuts in 2015 by regrading their slope to 45° and covering them with stone riprap. These treatments halted the gully head advance. The untreated gullies were actively eroding due to groundwater at shallow depths. The largest head retreat was 22.5 m, of which about half occurred in August of the first year when the surrounding soil was fully saturated. Lowering both the water table and protecting the gully heads can play a key role in reducing gully expansion and soil loss due to gully erosion in the Ethiopian highlands

Reducing surface and subsurface water flow effect on gullies through low cost measures [Abstract only]

Gully erosion in the humid Ethiopian highlands intensified in recent decades. The study was conducted in the Birr watershed located south west of Bahir Dar the capital of Amhara regional state, Ethiopia. We studied 14 gullies having similar morphology at three sub watersheds. The watershed covers a total area of 414 ha. The monitoring continued over the 2013 to 2014 monsoon season to better understand the factors controlling gully erosion and the effectiveness of erosion control structures. Perched ground water table was measured at the gully heads and erosion pins were installed to monitor the rate of recession from uncontrolled heads. Though soil properties, ground cover, gully morphology had small contribution for the gully development; water fall effect at the head of the gully and elevated water table depth at both heads and banks played the key role. Therefore the study focused on reducing the water fall and elevated water table effect by applying two low cost gully control approaches. The first approach was regrading the gully heads and banks at 45o and the second approach follows regrading the gully heads at 45o and putting a graded type of stone rip rap. Large stones were anchored at the toe of the head maintaining the stable gully bed slope. The result shows that unprotected gully heads retreat an average of 4m which is equivalent to 37m3 volume of soil loss. The maximum and minimum head cut retreat was between 0 and 22.5m. The total area damaged by annual gully head retreat was 240m2 and total volume of soil lost was 444m3. The treated gully heads did not show any retreat during the monitoring period. Compared with simple reshaping of gully heads, integration with Stone rip rap was an effective and low cost measure in the study watershed. Plantation could not stop the upslope migration of heads though it had the potential to trap sediments down slope. Heads with stone rip rap allows fast re vegetation whereas unprotected reshaped heads and banks took longer time to re vegetate and stabilized. Time of reshaping was important for the stability of banks and heads

Rehabilitating gullies with low cost methods, in the sub humid Ethiopian highlands

Gully erosion in the highlands of Ethiopia has reduced agricultural productivity and degraded ecosystem services. To better understand the processes controlling gully erosion and design effective control measures, a study was conducted in the headwaters of the Birr watershed for three consecutive years (2013-2015). Fourteen gullies with similar morphology were studied in three adjacent sub-watersheds. Stabilization measures were applied to 5 of the 14 gully heads. Three gully control measures were compared: a) reshaping gully banks and head to a 45 degree slope with stone rip rap on the gully heads, b) controlling gully bed grade, and c) planting grasses and trees on shallow gullies (i.e., < 3 m deep). Results demonstrated that gully control measures were effective in controlling the expansion of gullies as no further retreat was observed for the 5 treated gully heads, whereas the average retreat was 3 meters with a maximum of 22.5 m for the 9 untreated gullies. The migration of untreated gully heads produced an average soil loss of 38 tons per gully. Compared with simple reshaping of gully heads, the additional integration with stone rip rap was an effective and low cost measure. Vegetative treatment by itself could not stop the upslope migration of gully heads, though it had the potential to trap sediments. Re-vegetation at gully heads stabilized with stone rip rap occurred faster than at unprotected, reshaped heads and banks. From the fourteen rehabilitation treatments, gully head protection integrated with plantation showed the largest potential in decreasing gully development in terms of labor, time and material it requires

COVID-19 in Ethiopia: A geospatial analysis of vulnerability to infection, case severity and death

Background COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. Methods Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km. Results This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples' Region. The risk of COVID-19-related death is high in the country's border regions, where public health preparedness for responding to COVID-19 is limited. Conclusion This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia