Factors Associated with Time to Cease Exclusive Breastfeeding Among Infants Aged 6–9 Months, Kirkos Sub-City, Addis Ababa, Ethiopia: Survival Analysis

Getachew Sale Mezgebu,1 Luladey Getachew,2 Fentaw Wassie Feleke,1,3 Rediet Kidane2 1Department of Human Nutrition, School of Nutrition, Food Science and Technology, Academic Center of Excellence in Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Ethiopia; 2Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia; 3Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, EthiopiaCorrespondence: Fentaw Wassie Feleke, Tel +251917008650, Fax +251335400643, Email [email protected]: Notwithstanding the World Health Organization’s (WHO) guideline for exclusive breastfeeding (EBF) for the first six months of an infant’s life, its prevalence remains low in both developed and developing countries. Although breastfeeding is widely practiced in Ethiopia, only 59% of the children under the age of six months were exclusively breastfed.Objective: This study aimed to assess the time to cessation of EBF and associated factors among infants aged 6– 9 months in health facilities under Kirkos sub-city, Addis Ababa, Ethiopia.Methods: An institutional-based cross-sectional study was conducted among 287 mothers attending Kirkos sub-city health facilities from September 1 to 30, 2020. Bivariable and multivariable Cox regression models were fitted to identify factors associated with the time to cessation of EBF.Results: According to this finding, the median period for EBF discontinuation was 6 months. Early cessation of EBF was 130 (45.8%) days. Mothers with average household monthly income < 15 USD [AHR, 5.31 (95% CI: 2.82, 9.99)] and 15– 30 USD [AHR, 2.59 (95% CI: 1.41, 4.77)], EBF counseling at post-natal care [AHR, 0.18 (95% CI: 0.10, 0.31)], media access [AHR, 1.67 (95% CI: 1.06, 2.63)], child comorbidity [AHR, 0.51 (95% CI: 0.29, 0.88)], bottle feeding [AHR, 3.28 (95% CI: 2.14 5.01)], unfavorable attitude towards EBF [AHR, 3.59 (95% CI: 2.02, 6.40)] were significant factors associated with the hazard of cessation of EBF.Conclusion: In this investigation, the cumulative survival probability of EBF to 6 months was 45.8%, with a median duration of 6 months (95% CI 5.83– 6.18) months. Unfavorable attitudes, child comorbidity, and bottle feeding were factors associated with earlier cessation of EBF. Media access, household monthly higher income, and EBF counseling at postnatal care were factors associated with prolonged EBF. As a result, supporting behavioral change and media access for effective communication on EBF duration practice following the established standard should be targeted during both ante-natal and post-natal care visits.Keywords: Addis Ababa, hazard ratio, postnatal care, survival analysis, time to cessation of EB

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding Bill & Melinda Gates Foundation