Burden of disease attributable to suboptimal diet, metabolic risks and low physical activity in Ethiopia and comparison with Eastern sub-Saharan African countries, 1990-2015: findings from the Global Burden of Disease Study 2015.

BACKGROUND: Twelve of the 17 Sustainable Development Goals (SDGs) are related to malnutrition (both under- and overnutrition), other behavioral, and metabolic risk factors. However, comparative evidence on the impact of behavioral and metabolic risk factors on disease burden is limited in sub-Saharan Africa (SSA), including Ethiopia. Using data from the Global Burden of Disease (GBD) Study, we assessed mortality and disability-adjusted life years (DALYs) attributable to child and maternal undernutrition (CMU), dietary risks, metabolic risks and low physical activity for Ethiopia. The results were compared with 14 other Eastern SSA countries. METHODS: Databases from GBD 2015, that consist of data from 1990 to 2015, were used. A comparative risk assessment approach was utilized to estimate the burden of disease attributable to CMU, dietary risks, metabolic risks and low physical activity. Exposure levels of the risk factors were estimated using spatiotemporal Gaussian process regression (ST-GPR) and Bayesian meta-regression models. RESULTS: In 2015, there were 58,783 [95% uncertainty interval (UI): 43,653-76,020] or 8.9% [95% UI: 6.1-12.5] estimated all-cause deaths attributable to CMU, 66,269 [95% UI: 39,367-106,512] or 9.7% [95% UI: 7.4-12.3] to dietary risks, 105,057 [95% UI: 66,167-157,071] or 15.4% [95% UI: 12.8-17.6] to metabolic risks and 5808 [95% UI: 3449-9359] or 0.9% [95% UI: 0.6-1.1] to low physical activity in Ethiopia. While the age-adjusted proportion of all-cause mortality attributable to CMU decreased significantly between 1990 and 2015, it increased from 10.8% [95% UI: 8.8-13.3] to 14.5% [95% UI: 11.7-18.0] for dietary risks and from 17.0% [95% UI: 15.4-18.7] to 24.2% [95% UI: 22.2-26.1] for metabolic risks. In 2015, Ethiopia ranked among the top four countries (of 15 Eastern SSA countries) in terms of mortality and DALYs based on the age-standardized proportion of disease attributable to dietary and metabolic risks. CONCLUSIONS: In Ethiopia, while there was a decline in mortality and DALYs attributable to CMU over the last two and half decades, the burden attributable to dietary and metabolic risks have increased during the same period. Lifestyle and metabolic risks of NCDs require more attention by the primary health care system of the country.

The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013.

BACKGROUND: The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013. METHOD: We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors. RESULTS: In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable. CONCLUSIONS: Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed.

Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013.

BACKGROUND: Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013. METHODS: We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used. RESULTS: Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap. CONCLUSIONS: LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.

DETERMINANT FACTORS OF VISUAL INSPECTION WITH ACETIC ACID (VIA) POSITIVE LESIONS AMONG HIV POSITIVE WOMEN IN MEKELLE HOSPITAL, NORTHERN ETHIOPIA: A CASE CONTROL STUDY.

BACKGROUND: Cervical cancer is the second commonest type and third cause of cancer death among women in low-income countries. Women living with HIV/AIDS are at greater risk of developing cervical cancer. The study aimed to identify the determinant factors forsuspected precancerous cervical lesions among HIV- positive women in Mekelle hospital, Ethiopia. METHODS: Anunmatched case-control study was conducted among randomly selected HIV positive women in Mekelle hospital in 2014. In Mekelle Hospital, routine screening for lesions of the cervix uteri by visual inspection with acetic acid (VIA) is done in HIV positive women by trained nurses. Suspicious findings are treated by cryotherapy or referred to the Gynaecologist. A number of 116 cases, who had suspicious findings on VIA, and 232 HIV-positive controls without suspicious findings on VIA were randomly selected and enrolled into the study The determinant factors for precancerous cervical lesion were analyzed using multiple logistic regression and described as adjusted odds ratio (AOR). RESULTS: HIV positive women who had CD4 cells less than 350/mm3 were two times more likely to have precancerous cervical lesion compared to those with CD4 cells above 350/mm3. Women with two (AOR = 3.6; 95% CI: 1.7, 7.7) and three (AOR = 2.5; 95% CI: 1.2, 5.4) sexual partners were four and three times more likely to have precancerous cervical lesion, respectively, as compared to those who had one sexual partner. Age, History of STI and duration of ART had no influence on presence of VIA positive lesions in HIV positive women. CONCLUSION: CD4 count cells and number of sexual partners were predictors of VIA positive cervical lesion among HIV positive women.

ASSESSMENT OF THE MAGNITUDE OF TEENAGE PREGNANCY AND ITS ASSOCIATED FACTORS AMONG TEENAGE FEMALES VISITING ASSOSA GENERAL HOSPITAL.

BACKGROUND: Teenage pregnancy is directly related to high incidence of pregnancy related complications contributing to maternal morbidity and mortality and social problems. There are no enough data on teenage pregnancy and related complications in Ethiopia and in Benishangul Gumuz region in particular. OBJECTIVE: To investigate the magnitude and factors associated with teenage pregnancy among teenage females visiting Assosa general hospital for health care services. METHODS: Facility-based quantitative cross-sectional study was carried out among 783 randomly selected teenage females using structured and pre-tested questionnaire from January to April 2014. RESULTS: Teenage pregnancy is estimated at 20.4% in this study. The median age of subjects at first sexual intercourse and at first marriage being 16 and 17 years respectively. High proportion of (46.8%) teenagers had engaged in premarital sex. Among sexually active teenage females, 46.7% experienced their first sexual encounter by coercion. Being young [AOR = 0.21, 95% CI = 0.06-0.67], single [AOR = 0.06, 95% CI = 0.03-0.12], housemaid [AOR = 3.93, 95% CI = 1.71-9.04] and use of family planning [AOR = 2.39, 95% CI = 1.20-4.75] have statistically significant association with teenage pregnancy. CONCLUSIONS AND RECOMMENDATIONS: A range offactors including age, marital status, level of education, occupational status, average family income and use of family planning have influence on teenage pregnancy in the study area. Behavioral change communication, strengthening school health program, empowering young women specifically the rural women, and promoting parent-children discussion on sexuality is recommended.

MAGNITUDE OF DISABILITY AND ASSOCIATED FACTORS AMONG PATIENTS IN BORU MEDA HOSPITAL, SOUTH WOLLO ZONE, AMHARA REGION, ETHIOPIA.

BACKGROUND: Leprosy is a chronic infectious disease affecting the skin and peripheral nerves. Early diagnosis and full course treatment are critical for preventing lifelong neuropathy and disability to minimize the occurrence of disability. OBJECTIVE: The objective of this study is to assess the magnitude of disability and associated factors among leprosy patients after treatment in Boru Meda Hospital. METHODS: Facility based cross sectional study was conducted among 128 leprosy patients registered at Boru Meda Hospital from January 1, 2010 to December 31, 2012. Data was collected from charts, entered into a computer, cleaned, edited using EPI Info Version 3.53 for windows and analyzed by SPSS. RESULTS: Five patients (4%) had Grade 2 disability at discharge; the remaining 123 (96%) were discharged with either disability grading 0 or disability grading 1, which are considered to be normal disability grading. Males and rural people were more affected by the diseases: 72% and 92% respectively. Sixty percent of disability occurred due to type one reaction. The mean age of patients and treatment duration were 39.3 years and 60 days respectively. Among the factors type of reaction was significantly associated with disability grading (P = 0.02). CONCLUSION AND RECOMMENDATION: Rural people and males are more affected by leprosy and the prevalence of disability is decreasing. This findings suggest that we need to work on awareness creation on rural people and patients with leprosy to see healthcare providers as early as possible.

PATTERNS OF HYPERTENSIVE DISORDERS OF PREGNANCY AND ASSOCIATED FACTORS AT DEBRE BERHAN REFERRAL HOSPITAL, NORTH SHOA, AMHARA REGION.

BACKGROUND: Hypertensive Disorders of Pregnancy (HDP) represent the most common medical complication in pregnancy associated with significant maternal and perinatal morbidity and mortality worldwide. Identification of common maternal and perinatal morbidities associated with hypertensive disorders of pregnancy is important for policy makers to plan to alleviate the problem. OBJECTIVE: To assess the patterns of hypertensive disorders of pregnancy and associated factors in Debre Berhan Referral Hospital. METHOD: Institution-based retrospective cross sectional study was conducted by reviewing logbooks and patients charts. RESULT: Among 8626 women who got services in the hospital 340 (3.9%)had hypertensive disorders. The proportion of HDP shows an increasing trend from 1.8% in 2011 to 5.7% in 2014. Preeclampsia accounts for 67.4% of all case followed by eclampsia which account for 27.8%. In this study, HDP was associated with 35.4% preterm delivery, 30.8% fetal death, 39.4% low birth weight, 38.4% low APGAR score and 8.5% IUGR. About 15.8% of newborns born from mothers with HDP mothers needed resuscitation and 40.1% ICU admission. Maternal death occurs in 2.5% mothers who had HDP with the case fatality rate for eclampsia being 6.67%. HDP contributed for 35% of all maternal deaths. Of all mothers with HDP, 58% were primi-gravida ladies. CONCLUSION: The prevalence of HDP shows an increasing pattern over the last years. Preeclampsia and eclampsia together take the lion-share of HDP. Primi-gravida women are affected more frequently than multi-gravida women with hypertensive disorders of pregnancy. HDP was associated with major adverse perinatal and maternal outcome.

REDUCING PMTCT ATTRITION: PERSPECTIVES OF HIV+ WOMEN ON THE PREVENTION OF MOTHER-TO-CHILD HIV SERVICES IN ADDIS ABABA, ETHIOPIA.

BACKGROUND: Only 41% of eligible Ethiopian women completed (PMTCT) therapy in 2012, with MTCT rate of 20%. OBJECTIVE: This study elicited the perspectives of HIV positive mothers on the situation and the unique beliefs, attitudes, cultural norms and individuals who have influence over them during their pregnancy. METHODS: The mixed-methods parent study included community level surveys, focus groups and in-depth individual interviews of HIV positive women with a child at least one year of age in Addis Ababa, Ethiopia: only focus group and interview data are presented here. All tools were completed in Amharic with English translation. RESULTS: 23 women completed in-depth interviews; 27 participated within 4 focus groups. The greatest barriers to PMTCT completion were: feelings of hopelessness and carelessness, lack of understanding of the efficacy of ARV, and negative religious influences. The advice to improve PMTCT adherence most frequently offered included increasing PLWHIV peer support and improving and extending current HIV educational efforts. Participants recommended that PLWHIV mothers be utilized in all PMTCT planning and interventions in the future. CONCLUSION: Maintaining the motivation to adhere to the entire PMTCT cascade requires that a PLWHIV mother understands the validity of the steps she is taking and receives support for the many challenges she faces. Engaging PLWHIV peers as active members of the health care workforce and expanding their use as educators and counselors is important. Health officials can consider these findings to develop innovative and effective PMTCT interventions.

TOWARDS A 'GLOBAL' STRATEGY FOR TACKLING THE GLOBAL BURDEN OF COMMUNICABLE AND NON-COMMUNICABLE DISEASES IN RESOURSE LIMITED SETTINGS.

The global burden of communicable diseases (CD) and non-communicable diseases (NCD) in low and middle-income countries (LMICs) likely stems from a common substratum of societal and system inadequacies. In order to appropriately control these conditions and to manage the determinants and deterrents of both CDs and NCDs related deaths and disabilities, joint strategies aimed at both systemic and population levels are warranted. Although deficiencies exist within the health systems of LMICs, assets which could be leveraged efficiently to produce desirable outcomes also abound. Significant changes are already taking place through health initiatives within LMICs, opening up opportunities for further success through the involvement of international agencies. The role of these agencies, including donor countries and LMICs' Diaspora, is to strengthen and support the opportunities offered by on-going changes at the country level. There is a need to better understand and support the drivers and processes of positive change within LMICs in order to harness them for more widespread benefit through scale-up efforts. Strategies for addressing CDs and NCDs should be devised and implemented as complementary rather than competing 'sides of the same coin'.