Effect of Interpregnancy Interval on Low Birth Weight in Gondar and Bahir Dar Referral Hospital: A Case Control Study from North West Ethiopia

Background: Study findings on interpregnancy interval and its effect on low birth weight are contradictory. Some studies report that it is a risk factor for low birth weight while others say it has no association. Still less attention has been given to the way in which changes in family planning related behavior may affect low birth weight. Identifying the interpregnancy interval at which risk of low birth weight is occurred may benefit developing countries to prioritize family planning services.Methods: unmatched case control study design was used in a sample of 453 mothers (88 cases and 365 controls) who gave birth two or more times in Gondar and Bahir Dar teaching-referral hospital, Ethiopia. Cases were mothers who gave birth to low birth weight and controls were mothers who gave normal birth weight. Data was processed and analyzed using EPI Info and SPSS statistical software. A logistic regression was performed to identify the independent effect of interpregnancy interval on low birth weight.Result: The median of interpregnancy interval for cases and controls were 30 and 38 months respectively. The odd of low birth weight was 2.67 (95% CI = 1.36, 5.01) when interpregnancy interval was less than 24 months compared to the interval 24 and above months. Multivariate analysis showed that women who had interpregnancy interval less than 24 months were about 2.7 times more likely in delivering low birth weight infant compared to the interval 24 and above. Likewise women who were age of 20 or less, daily laborer, being moderately or severely food insecure and having pregnancy complication had a significant effect on low birth weight. Conclusion: interpregnancy interval less than 24 months had a significant effect on low birth weight. So mothers at the study area; not be pregnant before 24 months of the birth preceding child. Keywords: birth weight, interpregnancy interval, referral hospital, Ethiopi

Fetal Outcome after Vacuum Assisted Vaginal Delivery in Arba Minch General Hospital, Southern Ethiopia

Background: Vacuum assisted delivery (VAD) is one of the interventions used to reduce life-threatening complications for mothers and their babies. However, the effect of vacuum use on fetal outcomes was not well understood in low resource settings like Ethiopia. Objective: The objective of this study was to assess fetal outcome after vacuum assisted vaginal delivery in Arba Minch general hospital, southern Ethiopia.Method: A facility based cross sectional study was conducted among selected mothers who gave birth by vacuum assisted vaginal delivery from January 2013 to December 2014 at Arba Minch general hospital, southern Ethiopia.  A total of 208 mothers record were traced from labor and delivery ward log book in January 2015.  Data was collected by three intern medical doctors. Then it was entered into Epi data version 3.1 and exported to SPSS 20 statistical software for analysis. Descriptive statistics were done to display variables. Then bivariate and multivariate analysis was employed to determine independent predictors for favorable fetal outcome. Odds ratio with 95% CI were used to declare statistically significant association with outcome variables. Results: The proportion of favorable fetal outcome in the study area was 158(76%). While controlling for confounding variables during multivariate analysis, shortened duration of second stage of labor [AOR = 12.04(95% CI = 5.23, 27.74)] and non- application of episiotomy [AOR = 4.07(95% CI = 1.81, 9.13)] had shown positive association with favorable fetal outcome. Conclusion: The proportion of favorable fetal outcome in the study area was satisfactory. Early and appropriate management of second stage of labor were major predictors for favorable fetal outcome. Thus, government and organizations working on newborns health care should focus on factors enhancing shortened second stage of labor and avoid routine use of episiotomy during labor. Keywords: Vacuum assisted delivery, fetal outcome, fetal complication, Arba Minch, southern Ethiopia

Incidence and Predictors of Tuberculosis Among Adult PLWHA at Public Health Facilities of Hawassa City

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important

The potential critical success factors of full-fledged interest-free banks in Ethiopia

Abstract. The role of interest-free banking (IFB) is vital to enhance the financial inclusion rate of a country like Ethiopia that has a substantial number of Muslims and unbanked population. Although IFB windows have been operating in Ethiopia since 2013, the country allowed a full-fledged IFBs recently. Accordingly, two banks have already fulfilled all the requirements and are expected to operate soon while another 2 – 4 banks are under formation. The aim of this paper is, therefore, to assess the potential critical factors that will determine the success or failure of the newly establishing full-fledged IFBs in Ethiopia based on globalexperiences and specific bank cases from more than 14 countries using the concept of Critical Success Factors (CSFs). The outcomes of our analysis indicate three things. First, every country has its unique success and failure factors, thus, benchmarking should consider these factors. Second, based on the current circumstances, the most important CSFs which can determine the fate of the full-fledged IFBs in Ethiopia in the near future will be an adequate legal, regulatory and institutional framework; management skills and capacity; good reputation and image; product innovation and investment alternatives; unconflicting Shariah verdicts and availability of central Shariah supervisory body; and entrepreneurial discipline and ethical values. Third, full-fledged IFBs in Ethiopia will confront severe competition from the existing window banks that has big potential, better experience, and flexible Shariah controls.The study suggests that the government’s regulatory intervention to introduce guidelines and banking regulations specific to the full-fledged IFBs.Keywords. Interest-free bank, Shariah compliance, Critical success factors, Ethiopia.JEL. G21, G41, Z12

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. results For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum

Epidemiology of injuries from fire, heat and hot substances : global, regional and national morbidity and mortality estimates from the Global Burden of Disease 2017 study

Background Past research has shown how fires, heat and hot substances are important causes of health loss globally. Detailed estimates of the morbidity and mortality from these injuries could help drive preventative measures and improved access to care. Methods We used the Global Burden of Disease 2017 framework to produce three main results. First, we produced results on incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years from 1990 to 2017 for 195 countries and territories. Second, we analysed these results to measure mortality-to-incidence ratios by location. Third, we reported the measures above in terms of the cause of fire, heat and hot substances and the types of bodily injuries that result. Results Globally, there were 8 991 468 (7 481 218 to 10 740 897) new fire, heat and hot substance injuries in 2017 with 120 632 (101 630 to 129 383) deaths. At the global level, the age-standardised mortality caused by fire, heat and hot substances significantly declined from 1990 to 2017, but regionally there was variability in age-standardised incidence with some regions experiencing an increase (eg, Southern Latin America) and others experiencing a significant decrease (eg, High-income North America). Conclusions The incidence and mortality of injuries that result from fire, heat and hot substances affect every region of the world but are most concentrated in middle and lower income areas. More resources should be invested in measuring these injuries as well as in improving infrastructure, advancing safety measures and ensuring access to care.Peer reviewe

Maternal mortality and morbidity burden in the Eastern Mediterranean region : findings from the Global Burden of Disease 2015 study

Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life

Quantifying risks and interventions that have affected the burden of diarrhoea among children younger than 5 years : an analysis of the Global Burden of Disease Study 2017

Background Many countries have shown marked declines in diarrhoea! disease mortality among children younger than 5 years. With this analysis, we provide updated results on diarrhoeal disease mortality among children younger than 5 years from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) and use the study's comparative risk assessment to quantify trends and effects of risk factors, interventions, and broader sociodemographic development on mortality changes in 195 countries and territories from 1990 to 2017. Methods This analysis for GBD 2017 had three main components. Diarrhoea mortality was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive, Bayesian, ensemble modelling tool; and the attribution of risk factors and interventions for diarrhoea were modelled in a counterfactual framework that combines modelled population-level prevalence of the exposure to each risk or intervention with the relative risk of diarrhoea given exposure to that factor. We assessed the relative and absolute change in diarrhoea mortality rate between 1990 and 2017, and used the change in risk factor exposure and sociodemographic status to explain differences in the trends of diarrhoea mortality among children younger than 5 years. Findings Diarrhoea was responsible for an estimated 533 768 deaths (95% uncertainty interval 477 162-593 145) among children younger than 5 years globally in 2017, a rate of 78.4 deaths (70.1-87.1) per 100 000 children. The diarrhoea mortality rate ranged between countries by over 685 deaths per 100 000 children. Diarrhoea mortality per 100 000 globally decreased by 69.6% (63.1-74.6) between 1990 and 2017. Among the risk factors considered in this study, those responsible for the largest declines in the diarrhoea mortality rate were reduction in exposure to unsafe sanitation (13.3% decrease, 11.2-15.5), childhood wasting (9.9% decrease, 9.6-10.2), and low use of oral rehydration solution (6.9% decrease, 4-8-8-4). Interpretation Diarrhoea mortality has declined substantially since 1990, although there are variations by country. Improvements in sociodemographic indicators might explain some of these trends, but changes in exposure to risk factors-particularly unsafe sanitation, childhood growth failure, and low use of oral rehydration solution-appear to be related to the relative and absolute rates of decline in diarrhoea mortality. Although the most effective interventions might vary by country or region, identifying and scaling up the interventions aimed at preventing and protecting against diarrhoea that have already reduced diarrhoea mortality could further avert many thousands of deaths due to this illness

Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years : an analysis for the Global Burden of Disease Study 2017

Background Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65.4% decrease, 61.5-68.5) and in mortality rate (from 362.7 deaths [3304-392.0] per 100 000 children to 118.9 deaths [109.8-128.3] per 100 000 children; 67.2% decrease, 63.5-70.1). LRI incidence dedined globally (32.4% decrease, 27.2-37.5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11.4% decrease, 0.0-24.5), increased pneumococcal vaccine coverage (6.3% decrease, 6.1-6.3), and reductions in household air pollution (8.4%, 6 8-9.2). Interpretation Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths