Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Is Ethiopian community-based health insurance affordable? Willingness to pay analysis among households in South Central, Ethiopia

Background Community-based Health Insurance (CBHI) is a voluntary prepayment mechanism that guarantees the provision of basic healthcare services without financial barriers to underserved segments of the population in developing countries. The Government of Ethiopia launched the CBHI program to protect the community from high out-of-pocket health expenditure and improve health service utilization a decade ago. However, to improve the quality of healthcare services delivery in health facilities and cover the changing costs of healthcare, the government should revise the contribution of the CBHI scheme. Therefore, we determined the willingness to pay for a CBHI scheme and associated factors among rural households of Lemu and Bilbilo district, South Central Ethiopia. Methods We conducted a community-based cross-sectional study design to assess willingness to pay for the CBHI scheme and its associated factors among households in Lemu and Bilbilo districts, South Central Ethiopia. We used a double bounded contingent valuation method to elicit households’ willingness to pay for the CBHI scheme. Data were coded, cleaned, entered into Statistical Package for Social Science (SPSS) version 25, and exported to STATA 16 for analysis. A logistic regression analysis was conducted to determine the presence of statistically significant associations between the willingness to pay for the CBHI scheme and independent variables at a p-value <0.05 and Adjusted odds ratio (AOR) values with 95% CI. Finally, we checked the fitness of the model using Hosmer and Lemeshow’s goodness-of-fit test. Results Of the 476 study participants, 82.9% (95% CI: 79.2%, 86.01%) were willing to pay for the CBHI scheme and only 62% of them can afford the average amount of 358.32ETB ($7.68) per household per annum. Primary education (AOR = 3.17; 95% CI: 1.74–5.80), secondary and above education (AOR = 4.13; 95% CI: 1.86–9.18), large family size (AOR = 2.75; 95% CI: 1.26–5.97), monthly income of 500-1000ETB (AOR = 3.75; 95% CI: 1.97–7.13) and distance to public health facilities (AOR = 2.14, 95% CI: 1.04–4.39 were significantly associated with willingness to pay for the CBHI scheme. Conclusion In this study, around 83% of respondents were willing to pay for the CBHI and meet the government expectation for 2020. The study also revealed that educational status, family size, monthly income, and distance from the health facilities were significant factors associated with WTP for the CBHI scheme. In addition, we found that a large number of the respondents couldn’t afford the average amount of money that the participants were willing to pay for the CBHI scheme. So, the government should consider the economic status of the communities while revising the CBHI scheme premium not to miss those who cannot afford the contribution.publishedVersio

Malnutrition among the aged population in Africa: A systematic review, meta-analysis, and meta-regression of studies over the past 20 years.

BackgroundNowadays, malnutrition among the advanced age (60 years and older) population is becoming a public health problem worldwide, especially in low-income countries including Africa. Hence, the prevalence in Africa is still not known. So, this review aimed to assess the pooled prevalence of under-nutrition among the advanced age population in Africa.MethodsA study search was carried out using databases (such as African Journals Online, Web of Science, Global Index Medicus, Embess, and PubMed) and gray literature following PRISMA guidelines from April 20, 2022, to May 30, 2022, with no restriction on date of publication. We used a standardized extraction format to compile eligible studies as per the inclusion criteria. Then, systematic review and meta-analysis were employed using a random effect model to obtain the pooled prevalence of malnutrition among aged population living in Africa. The counter-funnel plot and at the 5% significance level, Egger's test and Begg's test were used to check for publication bias. Furthermore, a meta-regression analysis was carried out to identify the relationship between the outcome of interest and different predictors.ResultsA total of 731 studies were identified and 28 met the inclusion criteria, which were conducted in 17 African countries. The pooled prevalence of under-nutrition in Africa was 17% (95%CI; 13.5-20.6). The prevalence of malnutrition among the elderly varied significantly across countries, ranging from 1.8% (95% CI; 0.96-2.63) in South Africa to 39.47% (95% CI; 31.70-47.24) in Kenya. According to meta-regression analysis, the likelihood of a malnutrition problem would be reduced by a factor of 9.84 (β = -9.84, 95 percent CI; _-14.97, -4.70, P = 0.00) in upper-middle income countries. In addition, based on the publication year, malnutrition has decreased by a factor of 0.75 (β = -0.75, 95%CI:-1.49, -0.01, P = 0.04) from 1998 to 2021.ConclusionThere is a high prevalence of malnutrition among the aged population. So, this underserved population should be targeted for intervention programs and/or integrated into maternal and child nutrition programs

Malnutrition among the aged population in Africa: A systematic review, meta-analysis, and meta-regression of studies over the past 20 years

Background Nowadays, malnutrition among the advanced age (60 years and older) population is becoming a public health problem worldwide, especially in low-income countries including Africa. Hence, the prevalence in Africa is still not known. So, this review aimed to assess the pooled prevalence of under-nutrition among the advanced age population in Africa. Methods A study search was carried out using databases (such as African Journals Online, Web of Science, Global Index Medicus, Embess, and PubMed) and gray literature following PRISMA guidelines from April 20, 2022, to May 30, 2022, with no restriction on date of publication. We used a standardized extraction format to compile eligible studies as per the inclusion criteria. Then, systematic review and meta-analysis were employed using a random effect model to obtain the pooled prevalence of malnutrition among aged population living in Africa. The counter-funnel plot and at the 5% significance level, Egger’s test and Begg’s test were used to check for publication bias. Furthermore, a meta-regression analysis was carried out to identify the relationship between the outcome of interest and different predictors. Results A total of 731 studies were identified and 28 met the inclusion criteria, which were conducted in 17 African countries. The pooled prevalence of under-nutrition in Africa was 17% (95%CI; 13.5–20.6). The prevalence of malnutrition among the elderly varied significantly across countries, ranging from 1.8% (95% CI; 0.96–2.63) in South Africa to 39.47% (95% CI; 31.70–47.24) in Kenya. According to meta-regression analysis, the likelihood of a malnutrition problem would be reduced by a factor of 9.84 (β = -9.84, 95 percent CI; _-14.97, -4.70, P = 0.00) in upper-middle income countries. In addition, based on the publication year, malnutrition has decreased by a factor of 0.75 (β = -0.75, 95%CI:-1.49, -0.01, P = 0.04) from 1998 to 2021. Conclusion There is a high prevalence of malnutrition among the aged population. So, this underserved population should be targeted for intervention programs and/or integrated into maternal and child nutrition programs

Time to Relapse and Relapse Predictors in Patients with Schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia

Background. Rehospitalization, treatment resistance, and impairment are all possible outcomes of a schizophrenia relapse, which has a severe impact on patients, families, and the healthcare system. However, little is known regarding the time to relapse and relapse predictors in Ethiopia and in the study settings. Therefore, the aim of this study was to determine the time to relapse and relapse predictors in patients with schizophrenia at Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Methods. A retrospective cohort study was carried out among 273 schizophrenia patients discharged from Ayder Comprehensive and Specialty Hospital between January 2015 and January 2019. The data was taken from the patient’s medical record and was chosen using a systematic random sampling procedure. A standardized data collection checklist was employed. The survival experiences of participants were compiled using a life table. Both univariate and multivariate Cox regression models were used for variable selection. Finally, after confirming the model’s diagnosis and assumptions, factors with a p value of less than 0.05 were declared to be statistically significant predictors of schizophrenia relapse. Results. In this study, the incidence of relapse was 2.9 per 100 person-months (PMs) and the median time to relapse of 13 months (interquartile range: 6–23 months). Being divorced (AHR=2.50, 95% CI: 1.18-5.28), not adhering to treatment (AHR=5.7, 95% CI: 3.03-10.74), and substance abuse (AHR=1.8, 95% CI: 1.01-3.22) were risk factors for increasing schizophrenia relapse. Age (AHR=0.65, 95% CI: 0.34-0.88) and length of first hospitalization (AHR=0.69, 95% CI: 0.57-0.86) were factors that decreased schizophrenia relapse. Conclusion and Recommendation. In this study, out of 100 patients with schizophrenia followed up for a month, three had a relapse, and the highest risk factor for relapse was treatment nonadherence, followed by being divorced and substance misuse. As a result, it is advised that all parties involved focus on early detection and taking preventive measures against schizophrenia relapse, as well as providing regular psychoeducation about the significance of treatment adherence and connecting patients with substance misuse to substance rehabilitation centers

A PRISMA flow diagram for systematic reviews, met analysis and meta-regression of included studies.

A PRISMA flow diagram for systematic reviews, met analysis and meta-regression of included studies.</p

Subgroup analysis of pooled prevalence of malnutrition among aged population in Africa.

Subgroup analysis of pooled prevalence of malnutrition among aged population in Africa.</p

PRISMA 2020 checklist.

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Linear relationship between malnutrition and selected predictors.

Linear relationship between malnutrition and selected predictors.</p

Univariate meta-regression analysis result for prevalence of malnutrition among aged population in Africa.

Univariate meta-regression analysis result for prevalence of malnutrition among aged population in Africa.</p