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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Magnitude of antenatal care service uptake and associated factors among pregnant women: analysis of the 2016 Ethiopia Demographic and Health Survey

Objective Antenatal and postnatal cares are crucial for the survival and well-being of both the mother and the child. WHO recommends a minimum of four antenatal care (ANC) visits during a pregnancy. In Ethiopia, only 38% of women in the reproductive age make a minimum of first ANC visits. This value is far below the typical rates of least developed countries. This study aimed to calculate the magnitude and identify associated factors of ANC service utilisation among pregnant women in Ethiopia.Design Cross-sectional study design.Setting Ethiopia.Participants A total of 7913 pregnant women participated in the study.Primary outcome measures Antenatal care service uptake among pregnant women.Result Only 35.5% of the pregnant mothers have used ANC services at least four times and 64.5% of the pregnant mothers have used less than three times during their periods of pregnancy. The study showed that rich women (PR=1.077, 95% CI: 1.029 to 1.127), having access to mass media (PR=1.086, 95% CI: 1.045 to 1.128), having pregnancy complications (PR=1.203, 95% CI: 1.165 to 1.242), secondary education and above (PR=1.112, 95% CI:1.052 to 1.176), husbands’ having secondary education and above (PR=1.085, 95% CI: 1.031 to 1.142) and married (PR=1.187; 95% CI: 1.087 to 1.296), rural women (PR=0.884, 95% CI: 0.846 to 0.924) and women>30 years of age (PR=1.067, 95% CI: 1.024 to 1.111) significantly associated with the ANC service uptake.Conclusion The magnitude of ANC service uptake was low. This low magnitude of ANC service utilisation calls for a need to improve community awareness about maternal health. More importantly, intensive health education is required for pregnant women to have better ANC service uptake and follow-up adherence

Inadequate dietary diversity practices and associated factors among postpartum mothers in Gambella town, Southwest Ethiopia

Abstract The shortage of diversified diets in lactating postpartum mothers is a severe problem in developing countries. The promotion of diverse diets is important to improving micronutrient nourishment and adequate energy intake for lactating mothers. To date, there is limited evidence regarding inadequate dietary diversity practices among lactating postpartum mothers in Gambella region. The study is aimed to determine inadequate dietary diversity practice and associated factors among lactating postpartum mothers in Gambella city, southwest Ethiopia. Mixed methods were employed on 407 randomly selected lactating postpartum mothers and 15 purposively selected key informants from February 28 to March 24, 2021. A pre-tested questionnaire and interview guide were used for data collection. Data were analyzed using Statistical Package for the Social Sciences version 21 software. Binary logistic regression models were used to determine the associated factors of dietary diversity. Qualitative data were analyzed manually through a thematic approach. The prevalence of inadequate dietary diversity practice was 60.2%. Having no education (AOR = 3.74, 95% CI: 1.18, 11.88), employed women(AOR = 0.37, 95% CI: 0.18, 0.75), meal frequency  30 min (AOR = 4.20, 95% CI: 2.01, 8.76), not received nutrition education (AOR = 2.0, 95% CI:1.09, 3.68), having home gardening (AOR = 0.32, 95% CI: 0.18, 0.57) and having big animals (AOR = 0.12, 95% CI: 0.05, 0.29) were significant factors of inadequate dietary diversity practice. Diet habits, food taboos, low social status of women in ownership of household assets, low family support, order of feeding, child preference for resource distribution in a polygamous family, and health care provider’s advice were the main mentioned reasons for inadequate dietary diversity practices. The prevalence of inadequate dietary diversity practices were high compared to previous studies. Having no education, employed women, meal frequency  30 min, not receiving nutrition education, having a home garden, and having big animals were significant factors of inadequate dietary diversity practice. Nutrition intervention focused on nutrition education to increase meal frequency should be provided for lactating postpartum mothers to improve inadequate dietary diversity practices

Cancers preventive practice and the determinants in Amhara regional state, Northwest Ethiopia.

BackgroundCancer is the leading cause of morbidity and mortality globally. In Ethiopia, 5.8% of deaths are attributed to cancer. Therefore, this study aimed to examine the cancers preventive practice and associated factors in North West Ethiopia, 2019.MethodsA community-based cross-sectional study was conducted among Bahir Dar city residents. A multistage sampling technique was used to select 845 study participants. Data were collected through a validated interviewer administered questionnaire. The questionnaire was adapted from the American cancer association cancer prevention toolkit. Descriptive statistics were computed and presented in charts and texts. The model fitness was checked using Hosmer and Lemeshow goodness of fit (P > 0.05). Bivariable and multivariable logistic regressions were used to identify factors associated with cancer preventive practice. A p-value ResultA total of 845 study participants took part in the study. Nearly 63% of the respondents were females. About 28% (95%CI: 24, 30) of the study participants had good preventive practice. Age ≥ 45 years (AOR = 0.31; 95%CI: 0.15, 0.62), female (AOR = 0.50, 95%CI: 0.35, 0.71) family member with cancer (AOR = 1.68, 95%CI: 1.07, 2.62) and had good knowledge (AOR = 1.66, 95%CI: 1.14, 2.42) were the identified determinants of cancer preventive practices.ConclusionThis study revealed that the level of cancer preventive practices was low. Family member with cancer, knowledge about cancer, older age, and being female were significantly associated with cancer preventive practices. This finding underscores the importance of interventions to enhance cancer preventive practices

Food Safety and hygiene practices and the Determinants among street vendors during the Chain of Food Production in Northwest Ethiopia

Background: There is mounting evidence that Ethiopia is becoming a more street-food-consuming nation. The hygienic and safety procedures, however, are not adequately evaluated. Objectives: This study aimed to determine the magnitude of food safety and hygiene practices and associated factors among street food vendors of Bahir Dar City. Method: A community-based cross-sectional study design was conducted from March 10 to April 10, 2019. The data were collected using an interviewer-administered questionnaire with an observational checklist. The collected data were entered into EPI Data and analyzed by R software. Descriptive statistics were computed. A Binary logistic regression model was fit to identify the association and strength of exploratory variables and food safety and hygiene practices at a 95 % confidence interval and p-value 2500 Birr (AOR = 4.99; 95%CI: 2.42, 10.3), work experience of >2 years (AOR = 2.05; 95%CI: 1.15, 3.65), having supervision by health professionals (AOR = 2.45; 95%CI: 1.25, 4.85), having good knowledge about food safety and hygiene (AOR = 3.84; 95%CI: 1.42, 10.36), and having a favorable attitude towards food safety and hygiene (AOR = 2.71; 95%CI: 1.12, 6.57) were determinants of food safety and hygiene practice. Conclusions: The level of good food safety and hygiene practices was low. Monthly income, work experience, supervision by health professionals, knowledge, and attitude toward food safety and hygiene were identified as the determinants of good food safety and hygiene practice

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding: Bill & Melinda Gates Foundation

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0.603 (0.400-1.00) standard drinks per day, and the NDE varied between 0.002 (0-0) and 1.75 (0.698-4.30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0.114 (0-0.403) to 1.87 (0.500-3.30) standard drinks per day and an NDE that ranged between 0.193 (0-0.900) and 6.94 (3.40-8.30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59.1% (54.3-65.4) were aged 15-39 years and 76.9% (73.0-81.3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol

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. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license