Assessment of Adult Patients’ Perception of Nursing Care and Its Contributing Factors at Ayder Referral Hospital, Mekelle, Ethiopia, 2016

Background: Patients satisfaction measures have developed tremendous attractions in the sector of health care delivery services for the purpose of ascertaining the quality of health care services in general and nursing care in particular. It is everyone’s most common experience to witness significant patient/ client complaints and dissatisfactions with respect to hospital healthcare deliveries, particularly nursing care services. thus the objectives of this study was to determine adult patients’ perception  and associated factors with nursing care at Ayder referral hospital ,Tigray ,Ethiopia. Methods: Institutional- based cross-sectional study was conducted from February1 to march 30, 2016. Systematic random sampling technique was employed and 374 patients were selected from the study wards of the hospitals. A 25 items questionnaire, which involved a 5-point Likert scale, was employed to collect the data. Data were collected by trained data collectors using pretested standardized questionnaires. Data were checked for completeness, consistency, coded and entered into SPSSversion20foranalysis. Bivariate and multivariate logistic regression analysis was computed to test the strength of association and level of significance. P-value <0.05 was considered as statistical significant. Results: The overall satisfaction was found to be50.3%. Among the respondents nearly 54% were females and residing in rural. The mean age of the respondents was 37.3 with standard error of 15.6. Educational level and room of admission were found statistically significant with the outcome variable. Among the study participants, those with higher level of education perceived as obtaining poor nursing care in Ayder referral hospital. Moreover, those admitted in private room were found to be perceived as getting good nursing service in the hospital. Conclusions: Nearly half of study participants (49.7%) perceived poor nursing care services. Being educated and admitted in private room were found associated with perception of nursing care. Further study is needed to understand the overall patients feeling using qualitative study and the care providers’ perceptions should be examined. Keywords: Adult Patients’ Perception of Nursing Care and Its Contributing Factors

Outcome Level Assessment of In-Service Training Program in Tigrai Region, Ethiopia

Background: Despite IST centers reports of programmatic output level results that can be expressed in terms of total number of trained health care workers, and the number of trainings and the training topics covered, there are no empirical evidences that clearly shows the effectiveness of the in-service training program in improving health outcomes, health care workers performance and patient or customer satisfaction. Therefore, it is with this background that TRHB has initiated this rapid outcome level assessment of the IST program being implemented in three partner universities [Mekelle, Adigrat & Aksum universities] of the region.Methods: The assessment followed a facility based cross sectional qualitative study approach to assess and understand the outcome of the in-service trainings provided by universities IST centers in Tigrai region. The sample for this rapid assessment is drawn from 43 public health facilities [35 HCs, 4 general hospitals, & 4 primary hospitals] located in 24 Woredas/Districts of the region and received in-service trainings from the three IST providing universities in Tigrai region. The analysis and interpretation process was completed by using tabulations (to show the frequency distribution of the respondents), by utilizing percentage (in order to compare the data), and qualitative description was dominantly used.Results: The assessment highlighted that majority of the participants [134:84%] reported that the in-service trainings they received were very relevant to their present job function or duty while the remaining [22:14% & 4:3%] of the participants rate the trainings as “somewhat relevant” and “not relevant at all” to their present job function. The average score of the performance rating showed that participants rate themselves that they had a good performance before the training and they considered that the in-service trainings they took resulted in very good performance improvement.Conclusion: The rapid outcome level assessment of the IST program revealed that the program has significantly contributed for improvement in knowledge, skill and attitude among health care and non-health care professionals attended the HIV related IST trainings. However, the assessment due to methodological limitations does not adequately reflect patient level outcomes or improvements. Keywords:Outcome Level Assessment of In-Service Trainin

Central obesity and its associated factors among cancer patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

PurposeObesity, especially the hidden type of obesity (central obesity), has been believed to be the major risk factor for developing and progressing non-communicable diseases, including cancers. However, there are limited studies regarding the issue in Ethiopia and the study area. Therefore, this study aimed to evaluate the magnitude of central obesity and its associated factors among cancer patients visited the oncology unit of the University of Gondar Comprehensive Specialized Hospital.MethodsAn institutional-based cross-sectional study was conducted from January 10 to March 10, 2021. A total of 384 study participants were enrolled using a systematic sampling technique. The data were collected using a semi-structured interviewer-administered questionnaire and were pretested to address the quality of assurance. The weight of the participants was assessed using body mass index (BMI) and central obesity. Both bivariate and multivariate logistic regressions were conducted to identify the factors associated with central obesity, and p-values less than 0.05 with multivariate were considered statistically significant associations.ResultMost respondents (60.16%) were stage I cancer patients. The study found that about 19.27% of the participants were prevalent central obesity, and none of them were obese by body mass index (BMI) categorization criteria. However, about 12.24% and 7.03% of the participants were found to be underweight and overweight, respectively. The variables associated with central obesity were sex (AOR=14.40; 95% CI: 5.26 - 39.50), occupation (AOR=4.32; 95%CI: 1.10 - 17.01), and residency (AOR=0.30; 95% CI: 0.13 - 0.70).ConclusionA significant number of the respondents (19.27%) were centrally obese. Being female, urban residency and having an occupation other than a farmer, merchant, and governmental were the factors associated with central obesity. Hence, cancer patients may be centrally obese with average body weight

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

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

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Prevalence of new born care practice and its associated factors among women who gave birth in the last one year in Adigrattown, Adigrat, Tigray, Ethiopia, 2018/19

Background: Newborn care is a set of comprehensive recommendations designed by the World Health Organization to improve health of the newborn through intervention before conception, during pregnancy, soon after birth and during the postnatal period. Lack of effective use of the recommendations of the health care providers may lead to increased neonatal mortality. The first hours are crucial because multiple organ system is making the transition from intrauterine to extra uterine functions. The care given immediately after birth is simple but important.Objective: To assess practice of new born care and its associated factors among women who gave birth in the last 12 months in Adigrat Town, Adigrat ,Tigray ,Ethiopia, 2019.Methods and materials: Community based Cross-sectional study was conducted from Nov 2018 to January 2019 in Adigrat Town. We used a Systematic random sampling technique and 389 were selected for the study area. 35 items standard questionnaires were used and three grade twelve students were employee to collect the data. Data was checked for completeness, consistency, coded and entered in to SPSS version 22 for analysis and we got ethical clearance from the Adigrat University College of medical health science.&nbsp;Result:-A total of 389 women responded to the questionnaire and its response rate was 100%. And the mean age and standard deviation was 27 (+SD 5.9) years. Majority 319(82%)of them were married.39.8 % of mothers knew the normal (8-10) breastfeeding practice and 96.9% mothers initiated breast feeding with in the first one hour. 96.1 % used new blade to cut the umbilical cord and only 54.2% correctly reported that umbilical stump should be uncovered. 96.6% applied substances identified by the mothers were butter.55% of mothers reported that baby should be bath after 24 hours of delivery. the modes of keeping the baby warmed by cloth before the expulsion of the placenta was 89.5%.&nbsp;Conclusion and recommendation:-Marital status, gravidity and parity have significant association with newborn care. The Town health office should use multi-gravida mothers to share their experience on newborn care practice for primi-gradiva as health development army.</p

Enhancing health facility-based data quality and use for decision making at primary health care units to improve health service delivery of maternal newborn child and adolescent health, Tigray Ethiopia 2018

Objective: information use is fundamental for evidence based decision making but data quality and information use in health facility is limited in low and middle income countries. Therefore, a facility based cross sectional using mixed approach was conducted to assess data quality and use for decision making in 12 selected health facilities of Tigray, Ethiopia, 2018.Results: District Health Information System 2 (DHIS2) software was practiced in 12 of the facilities. Completeness and consistency rate of register and reports was 53.5%, 56.3%, and 38.9%. Respectively. The lot of quality assurance system of service and disease report was 7(61.1%). The performance monitoring team is established decision-making rate on key coverage indicators was 42.9%. Comparisons of performance in a district /national targets were 5(41.5a high rate of incompleteness, inconsistencies, low lots of data assurance and low use of data for decision making. Therefore, DHIS2 tool needs to be used to generate a report, use data and disseminating platforms both inside and outside health facilities using the website and other channels.&nbsp;</p