The overlapping burden of the three leading causes of disability and death in sub-Saharan African children

Despite substantial declines since 2000, lower respiratory infections (LRIs), diarrhoeal diseases, and malaria remain among the leading causes of nonfatal and fatal disease burden for children under 5 years of age (under 5), primarily in sub-Saharan Africa (SSA). The spatial burden of each of these diseases has been estimated subnationally across SSA, yet no prior analyses have examined the pattern of their combined burden. Here we synthesise subnational estimates of the burden of LRIs, diarrhoea, and malaria in children under-5 from 2000 to 2017 for 43 sub-Saharan countries. Some units faced a relatively equal burden from each of the three diseases, while others had one or two dominant sources of unit-level burden, with no consistent pattern geographically across the entire subcontinent. Using a subnational counterfactual analysis, we show that nearly 300 million DALYs could have been averted since 2000 by raising all units to their national average. Our findings are directly relevant for decision-makers in determining which and targeting where the most appropriate interventions are for increasing child survival. © 2022, The Author(s).Funding text 1: This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation. ; Funding text 2: This study was funded by the Bill & Melinda Gates Foundation. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The non-consortium authors have no competing interests . Competing interests for consortium authors is as follows: Robert Ancuceanu reports receiving consultancy or speaker feeds from UCB, Sandoz, Abbvie, Zentiva, Teva, Laropharm, CEGEDIM, Angelini, Biessen Pharma, Hofigal, AstraZeneca, and Stada. Jacek Jerzy Jozwiak reports personal fees from Amgen, ALAB Laboratories, Teva, Synexus, Boehringer Ingelheim, and Zentiva, all outside the submitted work. Kewal Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. Walter Mendoza is a Program Analyst in Population and Development at the United Nations Population Fund-UNFPA Country Office in Peru, which does not necessarily endorse or support these findings. Maarten J Postma reports grants and personal fees from MSD, GSK, Pfizer, Boehringer Ingelheim, Novavax, BMS, Seqirus, Astra Zeneca, Sanofi, IQVIA, grants from Bayer, BioMerieux, WHO, EU, FIND, Antilope, DIKTI, LPDP, Budi, personal fees from Novartis, Quintiles, Pharmerit, owning stock options in Health-Ecore and PAG Ltd, and being advisor to Asc Academics, all outside the submitted work. Jasviner A Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, Practice Point communications, the National Institutes of Health, the American College of Rheumatology, and Simply Speaking, owning stock options in Amarin, Viking, Moderna, Vaxart pharmaceuticals and Charlotte’s Web Holdings, being a member of FDA Arthritis Advisory Committee, the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, and the Veterans Affairs Rheumatology Field Advisory Committee, and acting as Editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, all outside the submitted work. Era Upadhyay has a patent A system and method of reusable filters for anti-pollution mask pending, and a patent A system and method for electricity generation through crop stubble by using microbial fuel cells pending

Factors associated with overweight and obesity among adults in northeast Ethiopia: a cross-sectional study

 Samuel Dagne,1 Yalemzewod Assefa Gelaw,2 Zegeye Abebe,1 Molla Mesele Wassie1 1Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Objective: Currently, the growing prevalence of overweight and obesity is an emerging public health problem in middle- and low-income countries such as Ethiopia. However, the prevalence of overweight and obesity among Ethiopian adults who live in the major cities is not well documented. Therefore, the study aimed to assess the prevalence and factors associated with overweight and obesity among adults in Dessie town, northeast Ethiopia.Subjects and methods: A community-based cross-sectional study was conducted from March 15 to April 10, 2015. A total of 751 adults aged 18–64 years were included. Multistage followed by systematic random sampling method was used to select the study participants. Both bivariable and multivariable ordinal logistic regression were done. The proportional odds ratio (POR) with a 95% CI was reported to show the strength of association. A P-value <0.05 was considered statistically significant.Results: Of all participants, 19.9% (95% CI: 16.9%, 23.1%) were recorded to be overweight and 8.6% (95% CI: 6.6%, 10.9%) to be obese. The odds of being overnourished (overweight or obese) were higher among adults who had snack intake habit (POR =1.52; 95 CI: 1.04, 2.20), drank alcohol (POR =1.75; 95% CI: 1.04, 2.97), had higher wealth status (POR =2.29; 95% CI: 1.26, 4.19), and were married (POR =2.22; 95% CI: 1.49, 3.29) compared to their counterparts.Conclusion: Compared to the previous local reports, the prevalence of overweight and obesity in the study area is high; this appears to be an emerging problem in Ethiopia. Hence, there is a need to develop a control and prevention strategy on potentially modifiable risk factors of overweight and obesity. Keywords: overweight, obesity, adult, Dessie, Ethiopia&nbsp

Prevalence and associated factors of low serum zinc concentration in adolescents of Gambella city, Southwest Ethiopia

Dedessa Gemeda Megersa,1 Solomon Mekonnen Abebe,2 Fikru Mekonnen Abebe,3 Molla Mesele Wassie2 1Department of Clinical Nursing, Gambella Teachers’ Education and Health Science College, Gambella, 2Human Nutrition Department, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, 3Department of Plant Science, College of Agriculture, Wollo University, Dessie, Ethiopia Background: Zinc deficiency is a major public health problem in many developing countries. It has been linked with reduced growth and development in adolescents. The deficiency increases vulnerability to infections, immune dysfunction, hypogonadism, and abnormal neurosensory changes. However, this problem has not received due attention, especially in Ethiopia. Therefore, this study is aimed to assess the prevalence and factors associated with low serum zinc concentration in high school adolescents of Gambella city, Southwest Ethiopia. Methods: An institution-based cross-sectional study was conducted in Gambella city in April 2015. A total of 346 high school adolescents were randomly selected and invited to participate in the study. Data were gathered using a structured questionnaire after obtaining a written consent and assent. The concentration of zinc in serum was measured by atomic absorption spectrometry. Logistic regression was used for statistical analysis. Results: Three-hundred and two high school adolescents were included in the study, with a response rate of 87.3%. The mean (± standard deviation [SD]) age of the respondents was 17 (±1) years. The mean (±SD) serum zinc concentration of the respondents was 134.1 (±48) µg/dL, while the prevalence of low serum zinc concentration was 9.6% (95% confidence interval [CI]: 6.3–12.9). The prevalence of low serum zinc concentration was 11.2% (95% CI: 5.9–16.4) in females and 8.2% (95% CI: 3.9–12.5) in males. Frequency of malaria attack in the last 2 weeks preceding the study (adjusted odds ratio [AOR]=4.12; 95% CI: 1.58–10.66), increased physical activity (AOR=1.97; 95% CI: 1.43–6.39), low dietary diversity scores (AOR=4.23; 95% CI: 1.52–12.29), poor wealth status (AOR=4.68; 95% CI: 1.41–9.49), and being stunted (AOR=2.84; 95% CI: 1.29–7.46) were significantly associated with low serum zinc concentration. Conclusion: The prevalence of low serum zinc concentration was not high in the study population. The frequency of malaria attacks in the last 2 weeks, physical activity, low dietary diversity, poor wealth status, and being stunted were associated with low serum zinc concentration. Developing strategies to prevent malaria infection, enhancing physical activities, and optimizing dietary diversity scores are recommended to improve the serum zinc concentrations of adolescents. Keywords: adolescents, zinc deficiency, serum zinc concentration, Ethiopi

Anemia among adult HIV patients in Ethiopia: a hospital-based cross-sectional study

Hermela Melese,1 Molla Mesele Wassie,2 Haile Woldie,2 Abilo Tadesse,3 Nebiyu Mesfin3 1HIV Follow-up Care Clinic, Debre-Tabor Hospital, Debre‑Tabor, 2Department of Human Nutrition, Institute of Public Health, 3Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: Anemia is a major public health problem in HIV patients around the world. It has a negative effect on the quality of life of HIV patients and progression of the HIV disease. In the sub-Saharan African setting, including Ethiopia where both HIV infection and under-nutrition are expected to be high, there is a paucity of data on the matter. This study was aimed to reveal the magnitude and factors associated with anemia among adult HIV patients in Debre-Tabor Hospital, northwest Ethiopia. Methods: A hospital-based cross-sectional study was used among adult HIV patients in Debre-Tabor Hospital from April 1 to May 30, 2015. The diagnosis of anemia was made following the 2011 World Health Organization recommendation on hemoglobin cut-off points. Univariable and multivariable logistic regression was carried out to assess factors associated with anemia. Results: A total of 377 patients’ charts were reviewed. Most of the participants (n=237, 62.9%) were taking antiretroviral treatment (ART). The overall prevalence of anemia was 23% (95% CI: 19.1, 27.6). Being ART-naïve (adjusted odds ratio [AOR]: 3.37; 95% CI: 1.59, 7.14), having treatment history with anti-tuberculosis (TB) drug (AOR: 3.2; 95% CI: 1.19, 8.67), taking zidovudine (ZDV)-containing ART regimen (AOR: 2.14; 95% CI: 1.03, 4.57), and having recent CD4+ T-lymphocytes count of <200 cells/µL (AOR: 2.13; 95% CI: 1.04, 4.36) were associated with occurrence of anemia among adult HIV patients. Conclusion and recommendation: Anemia continues to be a major co-morbidity among adult HIV patients in Ethiopia. Adult HIV patients who are taking ZDV-containing ART, with a history of TB treatment, have a low CD4+T-lymphocytes count and are ART-naïve should be carefully screened and treated for anemia. Keywords: anemia, HIV/AIDS, antiretroviral treatment, ZDV toxicity, Ethiopi

Impact of age on the cumulative risk of transformation in patients with chronic myelomonocytic leukaemia

In older patients with chronic myelomonocytic leukaemia (CMML) and limited life expectancy due to age and or comorbidities, it is particularly important to consider the risk of transformation for individualised treatment decisions. There is limited information on potential differences between younger and older CMML patients regarding the cumulative risk of transformation as well as haematological, molecular and biologic characteristics. We analysed data from the Austrian Biodatabase for CMML (ABCMML) to compare these parameters in 518 CMML patients. Categorisation of patients into 3 age‐related groups: <60 years, 60‐79 years and ≥80 years, showed a significantly lower risk of transformation at higher age by competing risk analysis, with a 4‐year risk of 39%, 23% and 13%, respectively (P < .0001). The lower probability of transformation was associated with a lower percentage of blast cells in the peripheral blood (PB) of older patients. Furthermore, we provide a simple score based on age, PB blasts and platelet counts that allowed us to define subgroups of CMML patients with a different cumulative transformation risk, including a low‐risk group with a transformation risk of only 5%. Our findings may facilitate reasonable treatment decisions in elderly patients with CMML