Prevalence of Hepatitis C Virus and HIV Infection Among Pregnant Women Attending Antenatal Care Clinic in Western Ethiopia

Background:Hepatitis C virus (HCV) and HIV infection remain a major public health challenge in Sub-Saharan Africa. The HCV and HIV infection among pregnant women have a serious outcome on maternal and newborn health. There is limited information in this regards in West part of Ethiopia. This study aims to identify the sero- prevalence and predictor factors of HCV and HIV infection among pregnant women attending antenatal care (ANC) in Western Ethiopia.Methods: An institutional based cross-sectional study was conducted from July to September, 2014 among 421 pregnant women's attending ANC services in purposively selected health facilities of western Ethiopia. The HCV and HIV infections were diagnosed by detection antibodies from aseptically collected serum sample. HCV was identified using an enzyme linked immune sorbent assay (ELISA) while HIV infection was tested with rapid HIV tests following the national HIV test algorithm. The pretested and structured questionnaire was used to collect socio-demographic data, and potential predictor factors of HCV and HIV infection. The collected data were analyzed using SPSS version 20.0 statistical software.Result: The overall sero-prevalence of HCV and HIV among the study population was 8.1% and 1.0%, respectively. The prevalence of HCV/HIV co-infection was 0.23% (1/421). Among HIV infected women, the prevalence of HCV infection was 25% (1/4). The risk of HCV infection was significantly low for urban residents (AOR = 0.38, 95%CI: 0.16-0.90) and illiterate (AOR = 0.24, 95%CI: 0.06-0.85). However, the history of blood transfusion was significantly increases the risk of HIV infection (AOR = 19.52, 95%CI: 1.80-150.6).Conclusion: Our study confirms public health importance of HCV and HIV infections among pregnant women in the study area. The study suggests need of attention for rural residents and educated segment of the population for HCV prevention, and national blood blank to check HIV test method used for blood transfusion

Prevalence and Determinants of Timely Initiation of Breastfeeding among Lactating Mothers of Urban Dwellers in Western Ethiopia: A Community Based Cross Sectional Study

Background: Timely initiation of breastfeeding is not only the easiest, cost effective and most successful intervention; it also tops the table of life-saving interventions for the health of the newborn. Twenty two percent of neonatal deaths could be prevented, if all infants are put to the breast within the first hour of birth. Thus, the study was designed to assess prevalence of timely initiation of breastfeeding and associated factors among lactating mothers less than twenty four months children in urban dwellers of Western Ethiopia.Methods: A community-based cross-sectional study was conducted from January to February, 2014 on 182 mothers who had child less than 24 month. The study participants were randomly selected from mother’s identity number registration book of health extension workers of the sub cities. A multivariable logistic regression analysis was fit to identify independent predictors of early initiation of breastfeeding after controlling for confounding variables.Result: In this study, the prevalence of timely initiation of breastfeeding was found to be 88.5%. In multivariable analysis, advice given to mother on breast feeding during antenatal care visit (AOR (95% CI) = 0.094 (0.03-0.35)) and knowing importance of colostrum (AOR (95% CI) = 0.19 (0.05-0.69)) were positively associated with timely initiation of breastfeeding. Those mothers who had poor child attachment to breast were 3.6 times more likely to initiate breastfeeding after one hour delivery compared to mothers who had good child attachment to breast (AOR (95% CI) = 3.64 (1.05-12.6)).Conclusion: The study showed that the prevalence of timely initiation of breastfeeding was good. Advice during antenatal care visit, child attachment to breast and knowing importance of colostrum were important predictors for timely initiation of breastfeeding. Thus, the ongoing antenatal care advising on breast feeding practice should be strengthening and more close attention is needed on breast attachment practice of lactating mothers. Keywords: Timely initiation, breastfeeding, Western Ethiopi

Patients Satisfaction on Clinical Laboratory Services at Nekemte Referral Hospital, Oromia, Ethiopia

Background: Satisfaction is the extent to which the clients feel their needs are fulfilled and their expectations are being met by the service provider. Furthermore, understanding the level of client satisfaction and identifying the factors hindering client satisfaction are the most important base lines to improve the quality of service being delivered. Objective: to assess the extent to which patients were satisfied on clinical laboratory services provided at  Nekemte Referral Hospital   (NRH) . Method: A Hospital based cross sectional study was conducted on randomly selected 422 Patients requested for clinical laboratory service at NRH from March to April 2014. Data were collected using structured, pretested, interviewer-administered questionnaire. Data analysis was performed using SPSS for windows version 20. Result: Among the 422 patients, 255 (60.4%) were satisfied, 75 (17.8%) were neutral and 92(21.8%) were dissatisfied with the laboratory services given in Nekemte Referral Hospital. There was no significant association between socio-demographic characteristics and level of satisfaction of patients (P- value > 0.05).In Likert Scale, the overall mean rate of satisfaction of patients with laboratory services in Nekemte referral hospital was 3.65 out of the 5 points. The lowest mean rating of satisfaction were given for Cleanness of latrine and location of the laboratory in the hospital with mean rating of 2.15 and 2.17 respectively. Conclusion: The overall degree of patient  customers’ satisfaction with the laboratory services at Nekemte Referral Hospital was 60.4% .patients were dissatisfied in cleanness and location of latrines in the hospital. Therefore; hospital administration and the laboratory department of  Nekemte referral Hospital should strive more to enhance patients’ satisfaction, particularly in sanitation and location of the latrine in the hospital. Key Words: patients’ Satisfaction, Clinical Laboratory Services, Nekemte Referral Hospita

Prevalence of Anaemia in Pregnant Womens and Associated Risk Factors in Western Ethiopia

Background: Anaemia is a global public health problem which has an eminence impact on pregnant mother. The aim of thisstudy was to assess the prevalence and associated risk factor of maternal anemia.Method:A cross-sectional study design was conducted from April to May, 2014 on 286 pregnant women attending antenatal care in Nekemte Referral Hospital, Western Ethiopia. Hemoglobin level was determined by using HemoCue photometer, and interviewer administered questionnaire was used to collect associated risk factors. Data were cleaned, coded and fed into SPSS version 20.0 for analysis. Result:Among the 286 study participants, 29% were anaemic. Out of these majorities were mild types 72.20%. Pregnant woman who were HIV sero-reactive(Adjusted odds ratio (AOR)= 20.930, 95% CI =2.441-179.428), low family income(AOR= 17.384, 95% CI =3.757-80.443), having low dietary level (AOR =19.041, 95% CI=1.767-205.213)  and body mass index (AOR =7.39, 95% CI=0.994-55.047), and infected with soil transmittedHelminth(STH)(AOR=33.555, 95% CI= 5.748-195.894) had higher odds of being anaemic with comparing to their counterpart but gestational age of first (AOR=0.07, 95% CI=.008-0.61) and second AOR =0.29, 95% CI= 0.09-0.918) trimester has lower odds of being anaemic when comparing to the third trimester. Conclusion:The prevalence of anemia was high; mild type anaemias were dominant. Low family income, having low dietary level and body mass index, STHand HIV infection were significantly associated with anemia. Antenatal care should promote de-worming, education on dietary practice and personal hygiene Therefor, there is a need to design strategies that help to diagnosis early and management of HIV and STHinfection during their antenatal care (ANC) visit instead of testing for only haemoglobin (Hgb) levels and bloodgroup. Key Words: Prevalence, Anemia, ANC, Pregnant, Western Ethiopia

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan

Background Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an important indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A binary logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. Results A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR = 3.47; 95% confidence interval, CI) = 1.54-7.81; P = 0.003), smear-positive pulmonary TB (AOR) = 3.58; 95% CI = 1.89-6.78; P = < 0.001), treatment category (AOR = 4.71; 95% CI = 1.17-18.97; P = 0.029), and year of enrollment 2012 (AOR = 6.26; 95% CI = 2.52-15.59; P = < 0.001) were significantly associated with successful treatment outcome. Conclusions The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomesThis study was supported by Chinese National Natural Fund (81573258), Jiangsu Provincial Six Talent Peak (WSN-002)

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

Global, regional, and national burden of Alzheimer's disease and other dementias, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: The number of individuals living with dementia is increasing, negatively affecting families, communities, and health-care systems around the world. A successful response to these challenges requires an accurate understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence, mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016, and highlight the most important messages for clinicians and neurologists. METHODS: GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from 195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-sweetened beverages). FINDINGS: In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval [UI] 37·8-51·0), increased from 20.2 million (17·4-23·5) in 1990. This increase of 117% (95% UI 114-121) contrasted with a minor increase in age-standardised prevalence of 1·7% (1·0-2·4), from 701 cases (95% UI 602-815) per 100 000 population in 1990 to 712 cases (614-828) per 100 000 population in 2016. More women than men had dementia in 2016 (27·0 million, 95% UI 23·3-31·4, vs 16.8 million, 14.4-19.6), and dementia was the fifth leading cause of death globally, accounting for 2·4 million (95% UI 2·1-2·8) deaths. Overall, 28·8 million (95% UI 24·5-34·0) DALYs were attributed to dementia; 6·4 million (95% UI 3·4-10·5) of these could be attributed to the modifiable GBD risk factors of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages. INTERPRETATION: The global number of people living with dementia more than doubled from 1990 to 2016, mainly due to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide

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. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.Peer reviewe

Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017 : a systematic analysis for the Global Burden of Disease Study 2017

Background Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings In 2017, 544.9 million people (95% uncertainty interval [UI] 506.9- 584.8) worldwide had a chronic respiratory disease, representing an increase of 39.8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex- specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7.0% [95% UI 6.8-7 .2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578-4 044 819) in 2017, an increase of 18.0% since 1990, while total DALYs increased by 13.3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14.3% decrease), agestandardised death rates (42.6%), and age-standardised DALY rates (38.2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis