Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding: Bill & Melinda Gates Foundation

Prevalence and Associated Factors of Suicidal Ideation and Attempt among People Living with HIV/AIDS at Zewditu Memorial Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background. Human Immune Deficiency Virus (HIV/AIDS) continues to be an underrecognized risk for suicidal ideation, suicidal attempt, and completion of suicide. Suicidal ideation and attempt in HIV/AIDS is not only a predictor of future attempted suicide and completed suicide. Methods. An institution based cross-sectional study was conducted among HIV-positive patients attending HIV care at Zewditu Memorial Hospital. Systematic random sampling technique was used to recruit 423 participants from April to May 2014. Composite International Diagnostic Interview was used to collect data. Multivariable logistic regression was computed to assess factors associated with suicidal ideation and attempt. Result. Suicidal ideation and suicidal attempt were found to be 22.5% and 13.9%, respectively. WHO clinical stage of HIV, not being on HAART, depression, family history of suicidal attempt, and perceived stigma were associated with suicidal ideation. WHO clinical stage, being female, not being on HAART, use of substance, and depression were associated with suicidal attempt. Conclusion. Early diagnosis and treatment of opportunistic infections, depression, and early initiation of ART need to be encouraged in HIV-positive adults. Furthermore, counseling on substance use and its consequences and early identification of HIV-positive people with family history of suicidal ideation have to be considered

The magnitude of anemia and associated factors among adult diabetic patients in Tertiary Teaching Hospital, Northern Ethiopia, 2019, cross-sectional study.

BackgroundPatients with Diabetic Mellitus are at higher risk of different complications. Many previous studies show that anemia among diabetic patients is poorly diagnosed.ObjectiveThis study aimed to assess the magnitude and associated factors of anemia among adult diabetes patients having regular follow up at the diabetic clinic of Ayder Comprehensive Specialized Hospital, Tigray, 2018/19.MethodsThis study was conducted the Diabetic clinic of Ayder comprehensive specialized hospital, Tigray regional state, Northern Ethiopia from January to March 2019. A systematic random sampling technique was used to select study participants. About 5 ml of venous blood was collected by experienced laboratory technologists under a complete aseptic technique. Two ml of the venous blood was used for hemoglobin determination. And three ml of the venous blood was used without any anticoagulant for creatinine determination. The association of variables was assessed using bivariate and multivariable analysis in the logistic regression model with p-value, odds ratio, and 95% CI in the SPSS version 24 software.ResultsFrom a total of 262 diabetes patients, forty-seven (17.9%) were found to be anemic (6.7% males and 11.5% females). Among the related factors, residency (Adjusted Odds Ratio, 7.69, 95% CI, 2.060, 28.69, p = 0.002,), age of the patients (Adjusted Odds Ratio, 4.007, 95%CI, 1.53-10.51, p = 0.005,) and sex (Adjusted Odds Ratio, 3.434, 95% CI, 1.582, 7.458, p = 0.042,) were significantly associated with anemia.ConclusionAccording to this study, the magnitude of anemia is high among diabetic patients. Occupation of the participants, residency, HIV status, being female, and age was significantly associated with anemia

Depression among Adult HIV/AIDS Patients Attending ART Clinics at Aksum Town, Aksum, Ethiopia: A Cross-Sectional Study

Background. Depression is consistently associated with increased risk of Human Immunodeficiency Virus infection and poor antiretroviral treatment adherence. Though many factors have been reported as determinant factors of depression, site-specific evidence is needed to identify factors associated with depression among adults on antiretroviral treatment. Methods. An institution based cross-sectional study was carried out from March to May 2015 among 411 adults HIV/AIDS patients on ART clinic follow-up. Participants were selected using systematic random sampling techniques. Data were collected using chart review and interviewer- administered techniques. Both bivariable and multivariable logistic regressions were used to compute the statistical test associations by SPSS version-20. Variables with p value < 0.05 were considered as statistically significant. Results. Four hundred eleven patients with a mean age ± Standard Deviation of 36.1±9.2 years and with a total response rate of 97.6% were enrolled in the study. The prevalence of depression was 14.6% (95% CI, 10.90-18.2). Factors independently associated with depression were nonadherence to ART, eating two meals per day or less, having side effect of ART medication, being in the WHO Stage II or above of HIV/AIDS, and living alone with AOR (95% CI) of 3.3 (1.436, 7.759), 2.8 (1.382, 5.794), 4.7 (1.317, 16.514), 2.8 (0.142, 0.786), and 2.4 (1.097, 5.429), respectively. Conclusion. Though the magnitude of depression was found relatively low, it was commonly observed as a mental health problem among adult patients with HIV/AIDS on ART. Programs on counseling and close follow-up of adherence to ART, drug side effects, and nutrition should be strengthened. Health facilities should link adult patients with HIV/AIDS who live alone to governmental and nongovernmental social supporter organizations

Determinants of Cesarean Section Deliveries in Public Hospitals of Addis Ababa, Ethiopia, 2018/19: A Case-Control Study

Objective. The objective of this study was to assess the determinants of cesarean section deliveries in public hospitals of Addis Ababa, Ethiopia, 2019. Method. A hospital-based unmatched case-control study was conducted to study 780 (260 cases and 520 controls) women who delivered in public hospitals of Addis Ababa from August 22 to September 20, 2019. The cases were all mothers who delivered through caesarean section, and controls were all mothers who delivered vaginally in the same time in the study area. Data were collected from the randomly selected women and looking into their cards. Data were entered on EpiData 3.1 and exported to SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of caesarean section. Results. Majority of the study participants were in the age category 20–34 years. Nearly more than 1/3rd of the participants (32.7% cases and 34.6% controls) have attended primary school. Most of the cases 217 (83.5%) and few of the controls 21 (4%) possess previous caesarean section. One hundred three (52.3%) of the cases and 329 (63.6%) controls were multi-parous. Previous caesarean delivery (AOR = 6.93, 95% CI; (3.39, 14.16)), singleton pregnancy (AOR = 0.34, 95% CI; (0.12, 0.83)), birth weight less than 2500 gm (AOR = 0.29, 95% CI; (0.18, 0.92)), birth weight greater than 4000 gm (AOR = 16.15 (8.22, 31.74)), completely documented partograph (AOR = 0.13, 95% CI; (0.078, 0.23)), and pregnancy-induced hypertension (AOR = 2.44, 95% CI; (1.46, 4.08)) were significant determinants of caesarean delivery in this study. Conclusion. Previous caesarean section, number of delivery, birth weight, partograph documentation, and pregnancy-induced hypertension had significant association with caesarean section delivery in this study

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. Funding: Bill & Melinda Gates Foundation

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. Funding: Bill & Melinda Gates Foundation