Development and validation of a nomogram for predicting low birth weight among pregnant women who had antenatal care visits at Debre Markos Comprehensive and Specialized Hospital, Ethiopia

BackgroundBirth weight is a crucial factor linked to a newborn’s survival and can also affect their future health, growth, and development. Earlier, researchers focused on exploring maternal and fetal factors contributing to low birth weight. However, in recent years, there has been a shift toward effectively predicting low birth weight by utilizing a combination of variables. This study aims to develop and validate a nomogram for predicting low birth weight in Ethiopia.MethodsA retrospective follow-up study was conducted, and a total of 1,120 pregnant women were included. Client charts were selected using a simple random sampling technique. Data were extracted using a structured checklist prepared on the KoboToolbox (Cambridge, Massachusetts in the United States) and exported to STATA version 14 (Computing Resource Center in California) and R version 4.2.2 (University of Auckland, New Zealand) for data management and analysis. A nomogram was developed based on a binary logistic model, and its performance was assessed by discrimination power and calibration. Internal validation was performed using bootstrapping. To evaluate the clinical impact, decision curve analysis was applied.ResultsThe nomogram included gestational age, hemoglobin, primigravida, unplanned pregnancy, and preeclampsia. The AUROC of the predicted nomogram was 84.3%, and internal validation was 80.1%. The calibration plot indicated that the nomogram was well calibrated. The model was found to have clinical benefit.ConclusionThe nomogram demonstrates strong discrimination performance and can predict low birth weight clinically. As a result, it can be used in clinical practice, which will help clinicians in making quick and personalized predictions simply and rapidly, enabling the early identification and medical intervention. For broader applicability, the nomogram must be externally validated

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Determinants of births protected against neonatal tetanus in Ethiopia: A multilevel analysis using EDHS 2016 data.

BackgroundEven though there is low coverage of maternal health services such as antenatal care and skilled birth attendant delivery as well as poor sanitary practice during delivery in Ethiopia, the proportion of births protected by the tetanus vaccine is low. Thus, this study aimed to investigate the determinants of births protected against neonatal tetanus in Ethiopia.ObjectiveTo assess the determinants of births protected against neonatal tetanus in Ethiopia.MethodThe study was based on secondary data analysis of the Ethiopian Demographic and Health Survey 2016 data. A weighted sample of 7590 women who gave birth within five years preceding the survey was used for analysis. We conducted a multilevel analysis, due to the hierarchical nature of the data. Variables with p-value ResultIn this study, mothers with primary education [adjusted odds ratio (AOR) = 1.23; 95%CI: 1.04, 1.44] and secondary and above education [AOR = 1.36; 95%CI: 1.06, 1.73], media exposure [AOR = 1.35; 95%CI: 1.15, 1.58], not perceiving distance from the health facility as a big problem [AOR = 1.24; 95%CI: 1.08,1.42], one antenatal care (ANC) visit [AOR = 1.56; 95%CI: 2.71, 4.68], two to three ANC visit [AOR = 11.82; 95%CI: 9.94,14.06], and four and more ANC visit [AOR = 15.25; 95%CI: 12.74, 18.26], being in Amhara [AOR = 0.59; 95%CI: 0.38,0.92], Afar [AO = 0.41; 95%CI: 0.25,0.66], and Harari [AOR = 1.88; 95%CI: 1.15,3.07] regions, being in communities with higher level of women education [AOR = 1.25; 95%CI: 1.03,1.52], and higher level of media exposure [AOR = 1.22; 95%CI: 1.01,1.48] were significant predictors of having a protected birth against neonatal tetanus.ConclusionIn this study, both individual level and community level factors were associated with having protected birth against neonatal tetanus. Therefore, strengthening maternal health services such as ANC visits and interventions related to increasing media campaigns regarding tetanus could increase the immunization against tetanus among reproductive-age women. In addition, it is also better to give attention to those reproductive age group women from remote areas and also better to distribute maternal services fairly and equally between regions

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Spatial distribution and determinants of the change in pre-lacteal feeding practice over time in Ethiopia: A spatial and multivariate decomposition analysis.

BackgroundPre-lacteal feeding persists in low and middle-income countries as deep-rooted nutritional malpractice. It imposes significant negative consequences on neonatal health, including increased risk of illness and mortality. Different studies revealed that pre-lacteal feeding practice is decreased over time. Even though different studies are done on the prevalence and determinants of pre-lacteal feeding practice, up to our knowledge, the spatial distribution and the determinants of the change in pre-lacteal feeding practice over time are not researched.ObjectiveTo assess the spatial distribution and determinants of the change in pre-lacteal feeding practice over time in Ethiopia.MethodsWe used the Ethiopian demographic and health surveys (EDHSs) data. For this study, a total weighted sample of 14672 (5789 from EDHS 2005, 4510 from EDHS 2011, and 4373 from EDHS 2016) reproductive-age women who gave birth within two years preceding the respective surveys and whoever breastfeed were used. The logit-based multivariate decomposition analysis was used to identify factors that contributed to the decrease in pre-lacteal feeding practice over the last 10 years (from 2005 to 2016). Using the 2016 EDHS data, we also conducted a spatial analysis by using ArcGIS version 10.3 and SaTScan version 9.6 software to explore the spatial distribution and hotspot clusters of pre-lacteal feeding practice.ResultPre-lacteal feeding practice was decreased from 29% [95% Confidence interval (CI): 27.63-29.96%] in 2005 to 8% [95% CI: 7.72-8.83%] in 2016 with annual rate of reduction of 7.2%. The overall decomposition analysis showed that about 20.31% of the overall decrease in pre-lacteal feeding practice over the last 10 years was attributable to the difference in composition of women (endowment) across the surveys, while, the remaining 79.39% of the overall decrease was explained by the difference in the effect of characteristics (coefficient) across the surveys. In the endowment component, the difference in composition of residence, perception of distance from the health facility, maternal educational level, wealth status, occupation, ANC visit, place of delivery, the timing of breastfeeding initiation, and wanted last-child/pregnancy were found to be significant contributing factors for the decrease in pre-lacteal feeding practice. After controlling for the role of compositional changes, the difference in the effect of distance from the health facility, wealth status, occupation, antenatal care (ANC) visit, and wanted last-child/pregnancy across the surveys were significantly contributed to the observed decrease in pre-lacteal feeding practice. Regarding the spatial distribution, pre-lacteal feeding practice was non-random in Ethiopia in which the primary and secondary clusters' of pre-lacteal feeding identified in Somalia and the Afar region respectively.ConclusionPre-lacteal feeding practice has shown a significant decline over the 10-year period. Program interventions considering women with poor maternal health service utilization such as ANC visits, women with poor socioeconomic status, women with an unintended pregnancy, and women from remote areas especially at border areas such as Somali and Afar could decrease pre-lacteal feeding practice in Ethiopia

Prevalence and associated factors of adolescent fatherhood in Ethiopia: A multilevel analysis using the 2016 Ethiopian demographic health survey data.

BackgroundThough the consequences of teenage pregnancy and early motherhood has been studied very well, little is known about the magnitude as well as the determinants of adolescent fatherhood. Unlike adolescent motherhood, limited public health programs are working on adolescent fatherhood. Currently, in developed countries, there is an increased work to acknowledge teen fathers in clinical practice and in the research forum, but still, there are more issues that need to be addressed in developing countries including Ethiopia. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent fatherhood in Ethiopia based on the nationally representative survey.MethodsThis study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 4455 adolescent men was included for the final analysis. For the associated factors, multilevel logistic regression analysis was conducted to consider the hierarchical nature of the EDHS data. Intra-class Correlation Coefficient (ICC), and deviance (-2LLR) were used for model comparison and for assessing model fitness. The model with the largest adjusted R2, lowest Bayesian Information Criteria (BIC) and the smallest cross-validation prediction error were considered as the best-fitted model. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the presence of statistically significant factors associated with adolescent fatherhood, and variables with p-value ResultsThe prevalence of adolescent fatherhood in Ethiopia was 6.79% [95%CI; 6.08%, 7.56%]. Adolescent men with contraceptive knowledge [AOR = 4.25; 95%CI = 1.23, 14.69], age in 20 to 24 years [AOR = 7.93; 95%CI = 3.66, 17.27] and being Muslim [AOR = 1.84; 95%CI = 1.02, 3.39] were significantly associated with Higher odds of adolescent fatherhood. Individuals who initiate sex lately [AOR = 0.35; 95%CI = 0.22, 0.54], being in female-headed family [AOR = 0.46; 95%CI; 0.26, 0.82] and being from Amhara region [AOR = 0.35; 95%CI = 0.14, 0.84] were significantly associated with lower odds of adolescent fatherhood.ConclusionIn this study, adolescent fatherhood was a common public health problem in Ethiopia as it is closely linked with poor quality of life and premature death (year of potential life lost). Age of respondent, knowledge of respondent about contraceptive methods, early initiation of sex, religion, sex of household head, and region were significantly associated with adolescent fatherhood. Therefore, program planners and decision-makers should give special attention to adolescent men through enhancing reproductive health services utilization and their knowledge towards it to decrease the incidence of adolescent fatherhood

Spatial distribution and determinants of abortion among reproductive age women in Ethiopia, evidence from Ethiopian Demographic and Health Survey 2016 data: Spatial and mixed-effect analysis.

BackgroundUnsafe abortion remains a global public health concern and it is the leading cause of maternal mortality and morbidity. Despite the efforts made to improve maternal health care service utilization, unsafe abortion yet constitutes the highest maternal mortality in Sub-Saharan Africa (SSA) including Ethiopia. Although abortion among reproductive-age women is a common problem in Ethiopia, there is limited evidence about the spatial distribution and determinants of abortion. Therefore, this study aimed to investigate the spatial distribution and determinants of abortion among reproductive-age women in Ethiopia.MethodsA secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 12378 reproductive-age women were included in this study. The Bernoulli model was fitted using SaTScan version 9.6 statistical software to identify significant hotspot areas of abortion and ArcGIS version 10.6 statistical software was used to explore the spatial distributions of abortion. For the determinant factors, a mixed effect logistic regression model was fitted to take into account the hierarchical nature of the EDHS data. Deviance (-2LL), AIC, BIC, and ICC were used for model comparison. The AOR with a 95% CI was estimated for the potential determinants of abortion.ResultsThe overall prevalence of abortion in Ethiopia was 8.9% ranging from 4.5% in Benishangul to 11.3% in Tigray regions. The spatial analysis revealed that abortion was significantly varied across the country. The SaTScan analysis identified a total of 60 significant clusters, of these 19 clusters were primary clusters. The primary clusters were located in the northern part of the Tigray region (LLR = 26.6, pConclusionsThe prevalence of abortion remains unacceptably high in Ethiopia. The spatial distribution of abortion has been significantly varied across regions in Ethiopia. Having primary education, being rural, having media exposure, and being from the richest household were significantly associated with higher odds of abortion whereas being protestant religious followers were associated with lower odds of abortion. Therefore, the government should design public health programs targeting the identified hotspot areas of abortion and should scale up maternal health programs in rural areas, to reduce maternal morbidity and mortality

COVID-19-related disruptions to routine vaccination services in India: a survey of paediatric providers

The COVID-19 pandemic has led to disruptions in essential health services globally. We surveyed Indian paediatric providers on their perceptions of the impact of the pandemic on routine vaccination. Among 424 (survey 1) and 141 (survey 2) respondents representing 26 of 36 Indian states and union territories, complete suspension of vaccination services was reported by 33.4% and 7.8%, respectively. In April–June 2020, 83.1% perceived that vaccination services dropped by half, followed by 32.6% in September 2020, indicating slow resumption of services. Concerns that vaccine coverage gaps can lead to mortality were expressed by 76.6%. Concerted multipronged efforts are needed to sustain gains in vaccination coverage

Exploring spatiotemporal distribution of under-five mortality in Ethiopia: further analysis of Ethiopian Demographic and Health Surveys 2000, 2005, 2011 and 2016

Objective The aim of this study was to explore spatiotemporal distribution of under-five mortality in Ethiopia using data from four (2000, 2005, 2011 and 2016) consecutive demographic and health surveys.Methods A total of 41 498 children were included from four consecutive Ethiopian Demographic and Health Surveys. The geospatial analysis was conducted by using ArcGIS V.10.7 and saTScan V.9.6. Thus, spatial autocorrelation, hotspot analysis, spatial interpolation and spatial scan statistics were carried out for each survey separately to show the temporal pattern of geographically risk areas of under-five mortality in Ethiopia. Finally, the most under-five mortality rate (U5MR) risk areas in each survey period were mapped.Results Under-five mortality was spatially clustered in Ethiopia (Moran’s Index: 0.046–0.096, p<0.01). The Benishangul-Gumuz region was consistently at a higher risk in the last two decades. Additional hotspot areas were detected at Afar and Amhara (in 2000, 2005, 2016), at Gambala (in 2011) and the South Nation Nationality and People’s (SNNP) Region (in 2016). Moreover, 160 primary clusters were identified. Of these, 85 clusters (log-likelihood ratio (LLR)=13.10, p<0.01) were from Benishangul-Gumuz and Amhara regions (in 2000); 67 clusters (LLR=12.93, p<0.01) were from Afar and Amhara regions (in 2005); 4 clusters (LLR=10.54, p<0.01) were from Benishangul-Gumuz region (in 2011); and another 4 clusters (LLR=11.85, p<0.01) were from Afar region (in 2016).Conclusion High-risk areas were detected mainly in the Benishangul-Gumuz and Afar regions. As a result, designing under-five population targeted intervention programmes in those high-risk geographical regions was vital to reduce under-five mortality in Ethiopia

Spatial variations and associated factors of knowledge of ORS packet or pre-packaged liquids for the management of diarrhea among women of reproductive age in Ethiopia: A spatial and multilevel analysis.

BackgroundEven though diarrhea is not lethal by itself, the lack of knowledge about its management results in devastating complications such as dehydration and lastly death. Using an oral rehydration solution (ORS) is an easy, inexpensive, and most reliable way of treating dehydration and reducing diarrhea-related mortalities. The literature revealed that Knowledge of ORS packet or pre-packaged liquids is a very important and critical factor for the utilization of ORS during the management of diarrhea.MethodsWe used the 2016 Ethiopian Demographic and Health Survey data, which is the fourth survey conducted by the Central Statistical Agency. A total weighted sample of 7590 reproductive-age women who gave birth within five years preceding the survey was used. Multilevel logistic regression analysis was done to assess factors associated with knowledge of ORS packet or pre-packaged liquids. Arc GIS version 10.3 and Kuldorff's SaTScan version 9.6 software were used for the spatial analysis.ResultsIn the multilevel analysis maternal education, media exposure, residence, community illiteracy level, and region were significantly associated with knowledge of ORS packet or pre-packaged liquids. Besides, knowledge of ORS packet or pre-packaged liquids for the management of diarrhea was not random in Ethiopia (with Moran's Index = 0.46 and p-value ConclusionIn this study knowledge of ORS packet or pre-packaged liquids was not random across the country. Lack of formal education, lack of media exposure, being from a rural area, and being from communities with a higher illiteracy level was associated with lower odds of knowledge of ORS packet or pre-packaged liquids. Therefore, special emphasis should be given to these high-risk groups and the hot spot regions (SNNPR, most parts of the Oromia region, and eastern parts of the Gambela region). Moreover, distributing information through different media regarding ORS packet or pre-packaged liquids is necessary