Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Magnitude and patterns of injuries among patients in Gondar University Hospital, northwest Ethiopia: an institutional-based study

Tadesse Awoke Ayele,1 Berihun Megabiaw Zeleke,1 Gizachew Assefa Tessema,2 Melkitu Fentie Melak3 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health sciences, University of Gondar, Gondar, Ethiopia; 2Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 3Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The World Health Organization (WHO) estimates that injuries constitute 16% of the global burden of disease. This translates into 5.8 million injury-related deaths annually, worldwide. The aim of this study was to determine the magnitude and pattern of injury in the Gondar University Hospital (GUH) in the year 2013. Methods: A retrospective study was conducted in GUH from March to April 2013. All charts of injured patients who visited the hospital from January 1 to December 30, 2012 were included in this study. A total of 616 patients’ charts were included in this study. Data were entered and cleaned using Epi Info and exported to Stata version 11 for analysis. Binary logistic regression was used, and odds ratios with 95% confidence interval were reported. Results: During the study period, a total of 84,254 patients visited the hospital, of whom 16,611 (19.7%) were surgical cases. Injury accounted for 25% of surgical emergency cases. Patients were predominantly young males (82%). Three in five (59.4%) of the injured patients were within the age range of 15–30 years. Approximately one in three, 187 (32.2%), and one in four, 141 (24.3%), of those injured patients were students and farmers, respectively. The injury mechanism for nearly half (48.9%) of students was assault, followed by 45.2% of road traffic accidents. Intentional injuries occurred among 291 (47.24%) cases, of whom 84.5% were males. Fracture (22.9%) and head injury (17.2%) were the leading outcomes of injuries. Severe injuries accounted for ~13% of all cases. Residence, physical nature of injury and place of work were found to be significantly associated with the outcome of injury. Conclusion and recommendation: The magnitude of injury in this hospital was found to be high when compared with other similar settings. Assault and road traffic accidents were the two common mechanisms of injury. Appropriate prevention strategies should be designed and implemented against assault and road traffic accidents. Keywords: road traffic accident, surgical department, University Hospital, Ethiopi

Health-care providers’ knowledge, attitudes, and practices regarding adult cardiopulmonary resuscitation at Debre Markos Referral Hospital, Gojjam, Northwest Ethiopia

Background: Cardiac arrest is one of the leading causes of death worldwide. Good knowledge, attitudes, and practices of health-care providers regarding cardiopulmonary resuscitation are vital to improve patient outcomes after cardiac arrest. This study aimed to assess knowledge, attitudes, and practices with regard to management of adult patients with cardiac arrest among health-care providers at Debre Markos Referral Hospital, Debre Markos, northwest Ethiopia in 2019. Methods: A hospital-based cross-sectional study was conducted from January to February, 2019 at Debre Markos Referral Hospital. All health-care providers who fulfilled the inclusion criteria were enrolled in the study. A pretested structured questionnaire was used for data collection. Data were entered into EpiData 3.1 and transferred to SPSS 20 for analysis. Results: Of the 352 health-care providers, 324 participated in the study for a response rate of 92%. Amajority (63%) were male. The age of male (80%) was 26–35 years old, with a mean of 29.28±4.8 years. A majority (77.8%) had inadequate knowledge about cardiopulmonary resuscitation. Almost all (97.8%) had no knowledge about cardiocerebral resuscitation. More than half (64.2%) had unfavorable attitudes toward CPR. Moreover, 288 (88.9%) had unsafe practices regarding cardiopulmonary resuscitation. The site and depth of chest compression was answered correctly by only 33 (10.2%) and 59 (18.2%) of participants, respectively. Conclusion: Health-care providers’ knowledge, attitudes, and practices were inadequate, unfavorable, and unsafe regarding the management of cardiac arrest. Training on the assessment of critically ill patients, cardiopulmonary resuscitation, and cardiocerebral resuscitation should be provided for health-care providers. Additionally, resuscitation equipment like defibrillators and emergency drugs should be available in all wards and emergency rooms