Mortality Decreases among Young Adults in Southern Central Ethiopia

Background: Despite the anticipated high impact of HIV and AIDS among young people; AIDS related mortality is not well documented because of the lack of death registration systems in Ethiopia. The objective of this analysis was to investigate the trends in mortality among young adults (aged 10-24 years) in the era of the AIDS epidemic. Methods: We analyzed data for young adults aged between 10-24 years using the Butajira Rural Health Programme (BRHP) open cohort database. The study covers 1 urban and 9 rural communities; which were initially randomly selected from the Butajira district. The BHRP database covers the period 1987-2004; recording vital events and migration at the household level after an initial baseline census in 1987; using village-based data collectors. The data included 34;150 young people who contributed a total of 248;154 person years. Results: In the 18-year follow-up period; 1;030 young adults died; giving an age-specific crude mortality rate of 4.2 per 1;000 person-years. The trends of mortality in this population declined from 6 per 1;000 person-years in 1987- 1989 to less than 2 per 1;000 person-years in 2002-2004. Deaths due to HIV were recorded at a rate of only 0.02 per1;000 person-years; according to causes of death reported by family care givers. A multivariate regression model showed that young adults from the rural highlands and lowlands had a higher risk of death (adjusted rate ratios 1.99 [1.40-2.83] and 2.58 [1.82-3.66] respectively) than young urban adults; even after adjusting for water source; literacy and housing type. The earlier cohorts (1987-1989 and 1990-1994) had higher risks of mortality than the latest cohort (1999-2004) - (adjusted rate ratios 1.91 [1.59-2.29] and 2.03 [1.75-2.35] respectively). Conclusion: A remarkable decline in mortality was observed in this population with little sign of excessive HIV/AIDS-related mortality appearing during this 18-year period. However; the occurrence of AIDS-related deaths in the latter part of the study period suggests appropriate interventions to counter the developing HIV epidemic are justified

Mortality Decreases among Young Adults in Southern Central Ethiopia

Background: Despite the anticipated high impact of HIV and AIDS among young people; AIDS related mortality is not well documented because of the lack of death registration systems in Ethiopia. The objective of this analysis was to investigate the trends in mortality among young adults (aged 10-24 years) in the era of the AIDS epidemic. Methods: We analyzed data for young adults aged between 10-24 years using the Butajira Rural Health Programme (BRHP) open cohort database. The study covers 1 urban and 9 rural communities; which were initially randomly selected from the Butajira district. The BHRP database covers the period 1987-2004; recording vital events and migration at the household level after an initial baseline census in 1987; using village-based data collectors. The data included 34;150 young people who contributed a total of 248;154 person years. Results: In the 18-year follow-up period; 1;030 young adults died; giving an age-specific crude mortality rate of 4.2 per 1;000 person-years. The trends of mortality in this population declined from 6 per 1;000 person-years in 1987- 1989 to less than 2 per 1;000 person-years in 2002-2004. Deaths due to HIV were recorded at a rate of only 0.02 per 1;000 person-years; according to causes of death reported by family care givers. A multivariate regression model showed that young adults from the rural highlands and lowlands had a higher risk of death (adjusted rate ratios 1.99 [1.40-2.83] and 2.58 [1.82-3.66] respectively) than young urban adults; even after adjusting for water source; literacy and housing type. The earlier cohorts (1987-1989 and 1990-1994) had higher risks of mortality than the latest cohort (1999-2004) - (adjusted rate ratios 1.91 [1.59-2.29] 2.03 [1.75-2.35] respectively). Conclusion: A remarkable decline in mortality was observed in this population with little sign of excessive HIV/AIDS-related mortality appearing during this 18-year period. However; the occurrence of AIDS-related deaths in the latter part of the study period suggests appropriate interventions to counter the developing HIV epidemic are justified

Health Facility-Based Maternal Death Audit in Tigray; Ethiopia

Background: Maternal deaths are often unrecognized and improperly documented in the health system. Objective: To identify causes of maternal death occurring in hospitals and determine avoidability of maternal death. Methods: The study assessed each death for the cause and surrounding circumstances as well as avoidable factors; by reviewing two years patient and facility records and interviewing individuals who were involved in caring for the deceased. Data were collected between December 2005 and May 2006. Result: A total of 34 maternal deaths were identified in five public hospitals in Tigray over a period of two years; ofwhich 12 (35.2) were reported to have been avoidable. The leading causes of death were infection; haemorrhage and hypertensive disorders. Avoidable factors were mainly related to hospital service or medical factors such as lack of blood for transfusion; delay in transfusion; and inappropriate treatment. Lack of transportation and delayed careseeking also contributed to avoidable maternal deaths. The quality of medical records was very poor. Nearly 73.5of maternal deaths were of rural residents and 20.5of those who died were under the age of 18; which shows that young girls and rural residents carry significant maternal Conclusions: Maternal deaths are not properly documented in health facilities. Improper care led to avoidable maternal death. Improving care and information systems is crucial to making pregnancy safer and reducing maternal death

The role of changing diet and altitude on goitre prevalence in five regional states in Ethiopia

Objective: Iodine Deficiency Disorders (IDD) as one of the leading nutritional problems has been increasing through time due to iodine deficiency; aggravating factors and IDD knowledge in many parts of Ethiopia. The effect of changing diet and altitude on goitre prevalence is assessed. Methodology: Randomly selected five regional states (Amhara; Oromiya; Tigray; SNNP and Benshangul-Gumuz) were used to conduct cross-sectional study on IDD. In each region cluster sampling method was applied to select study subjects. Low land and adjacent high land were independently sampled to investigate the role of altitude on goiter prevalence. Totally 6960 children and the same number of biological mothers of the children were included in the clinical examination for goiter and household interview. Urine samples were collected from children for urinary iodine examination/analysis (UIE). Besides; in all clusters qualitative data were collected on IDD knowledge and cassava introduction; cultivation and consumption. Results: Cassava consumption and living in high altitude were found to be risk factors for IDD. In the two regions (SNNP and Benshangul-Gumuz) among three where cassava is cultivated; those who consume cassava frequently were significantly (p0.001) affected by goitre than those consuming rarely or not. In the last thirty years cassava consumption has been increasing with the concomitant increase in goitre rate and other associated health problems. Acute cyanide intoxication in children from cassava meal was reported. In Amhara region; goitre rate was significantly (p0.05) higher in high altitudes than in low both for children and mothers. This was due to significantly (p0.01) low level of iodine intake in high lands than in low as indicated by UIE. Due to stigma; parents do not send goitrous children to schools and goitrous girls are not wanted for marriage. Conclusion: Besides low level of iodine intake; cassava consumption and living in high altitude were responsible for the observed variation and severity in goitre rates. IDD affects several dimensions of human life including school enrolment and marriage. Addressing IDD in-terms of salt iodization and training communities on cassava processing techniques to remove cyanide; awareness creation on IDD and soil conservation are highly recommended