Patterns of mortality in public and private hospitals of Addis Ababa, Ethiopia

Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015

BACKGROUND

Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015.

METHODS

This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates.

RESULTS

Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015.

CONCLUSIONS

There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.

Patterns of Medical Admissions and Predictors of Mortality in Ayder Comprehensive Specialized Hospital, Northern Ethiopia: A Prospective Observational Study

Background

Previous works show that noncommunicable diseases (NCDs) are on the rise in developing nations, including Ethiopia, in the background of preexisting communicable diseases (CDs). Data on hospital admission in sub-Saharan Africa are scarce, particularly prospectively collected, and hence this study was done to close the gap in acquiring accurate diagnosis usually faced with retrospective data. We aimed to describe medical admission patterns, their outcomes and determinants at Ayder Comprehensive Specialized Hospital (ACSH) in Tigray, Ethiopia.

Methods

Data were collected prospectively from November 1, 2017 to October 31, 2018 for all medical admissions. Sociodemographic profiles, final diagnosis, outcome of hospitalization, and complications were recorded using a data-abstraction checklist. Data were analyzed using SPSS 26.

Results

There were 2084 medical admissions over 1 year. Median age was 45 years (IQR 31). A majority (1107, 53.1%) were male. The age-group 25-34 years had the most admissions (19.0%). NCDs constituted 68.2% of admissions. According to the International Classification of Diseases, patients were admitted most frequently due to disease of the circulatory system (36.7%) followed by infectious or parasitic diseases (24.1%). Of NCDs, cardiovascular diseases contributed to 53.9%, followed by cancers (8.6%). Of CDs, HIV/AIDS contributed to 31.3%, followed by tuberculosis (22.8%). A total of 1375 (66%) were discharged improved, while 311 (14.9%) died. On multivariate analysis, the in-hospital mortality was significantly higher (18.7%) for CDs than NCDs (13.2%, AOR 1.8, 95% CI 1.4-2.3; P<0.001). Bed occupancy of ACSH medical wards and ICU was 54%.

Conclusion

NCDs were leading causes of medical admissions in ACSH. The presence of CDs and the development of complications were associated with higher risk of death. Attention should be given by policy-makers to curb the higher morbidity from NCDs and mortality from CDs.

All-cause and cause-specific mortality rates for Kisumu County: a comparison with Kenya, low-and middle-income countries

Background

Understanding the magnitude and causes of mortality at national and sub-national levels for countries is critical in facilitating evidence-based prioritization of public health response. We provide comparable cause of death data from Kisumu County, a high HIV and malaria-endemic county in Kenya, and compared them with Kenya and low-and-middle income countries (LMICs).

Methods

We analyzed data from a mortuary-based study at two of the largest hospital mortuaries in Kisumu. Mortality data through 2019 for Kenya and all LMICs were downloaded from the Global Health Data Exchange. We provided age-standardized rates for comparisons of all-cause and cause-specific mortality rates, and distribution of deaths by demographics and Global Burden of Disease (GBD) classifications.

Results

The all-cause age-standardized mortality rate (SMR) was significantly higher in Kisumu compared to Kenya and LMICs (1118 vs. 659 vs. 547 per 100,000 population, respectively). Among women, the all-cause SMR in Kisumu was almost twice that of Kenya and double the LMICs rate (1150 vs. 606 vs. 518 per 100,000 population respectively). Among men, the all-cause SMR in Kisumu was approximately one and a half times higher than in Kenya and nearly double that of LMICs (1089 vs. 713 vs. 574 per 100,000 population). In Kisumu and LMICs non-communicable diseases accounted for most (48.0 and 58.1% respectively) deaths, while in Kenya infectious diseases accounted for the majority (49.9%) of deaths. From age 10, mortality rates increased with age across all geographies. The age-specific mortality rate among those under 1 in Kisumu was nearly twice that of Kenya and LMICs (6058 vs. 3157 and 3485 per 100,000 population, respectively). Mortality from injuries among men was at least one and half times that of women in all geographies.

Conclusion

There is a notable difference in the patterns of mortality rates across the three geographical areas. The double burden of mortality from GBD Group I and Group II diseases with high infant mortality in Kisumu can guide prioritization of public health interventions in the county. This study demonstrates the importance of establishing reliable vital registry systems at sub-national levels as the mortality dynamics and trends are not homogeneous.

Magnitude of central obesity and associated factors among adults working in government offices in Bedele town, Buno Bedele zone, Southwest Ethiopia

Objective:

Central obesity is an emerging public health problem globally and an independent risk factor for heart, blood vessels, and metabolic disorder. This study aimed to assess the central obesity and associated factors among adults working in government offices in Bedele town, Southwest Ethiopia, 2021.

Methods:

An institutional survey was conducted among randomly selected government offices. Anthropometric measurements were carried out. Face-to-face interview using standard questionnaires were also used to collect data. A total of 403 respondents were selected from the list of public office workers employed in Bedele Town. Data were entered into Epi data 3.1 then exported to SPSS version 20 for analysis. Each variable with a p value less than 0.25 in the bivariate analysis was entered into logistic regression and p value 0.05 was considered as statistically significant.

Results:

The response rate was 373 respondents (92.6%). The overall prevalence of central obesity among public office workers of Bedele town was 54.7%. Sitting for more than 5 h at workplace adjusted odds ratio = 2.911 (95% confidence interval = 1.644, 5.156), being a female adjusted odds ratio = 3.258 (95% confidence interval = 1.744, 6.047), age range of 40–49 (adjusted odds ratio = 4.520, 95% confidence interval = 1.798, 11.363), age ⩾ 50 years (adjusted odds ratio = 5.907, 95% confidence interval = 1.808, 19.297), being physically inactive (adjusted odds ratio = 4.594, 95% confidence interval = 2.313, 9.125), consumption of snack (adjusted odds ratio = 4.521, 95% confidence interval = 2.583, 7.913), and alcohol consumption (adjusted odds ratio = 2.324 95% confidence interval = 1.210, 4.463) were factors significantly associated with central obesity among office workers in Bedele town.

Conclusion:

The magnitude of central obesity was high among office workers in Bedele town and being female gender, older age, physical inactivity, consumption of snacks, and alcohol were associated with it. Physical exercise and a healthy lifestyle should be promoted to minimize the problem.

Quality of life and its predictors among clients visiting antiretroviral therapy clinics in Addis Ababa, Ethiopia

This study assessed the quality of life (QoL) and associated factors among a group of clients visiting ART clinics in Addis Ababa, Ethiopia. A multi-site cross-sectional study was conducted from 1 to 30 August 2020. Adults with HIV and who fulfilled the inclusion criteria were considered. A systematic random sampling technique with proportional size allocation was employed. Data were collected using a modified EQ-5D and EQ-VAS tool. The analysis was done using SPSS version 26. Non-parametric statistical analyses were done using Mann-Whitney U, Kruskal-Wallis and Spearman's correlation tests. A p-value ≤ 0.05 and 95% confidence level were considered for analysis. The majority of the clients were from health centres (58%), were 43 years old or less (54%), and were males (63%). Pain/discomfort and depression/anxiety were the most prominent dimensions in the age group above 43 years. The mean score of EQ-5D index values was 0.87 (SD 0.05; 95% CI 0.86-0.87) and that of EQ-VAS was 81 (SD 15; 95% CI 80-83). About 38% and 43% of the clients showed an altered health state of some degree in functional and current overall status respectively. Comorbidity, history of current substance use, facility type, social support and sleep disturbance showed a statistically significant association with both outcomes. A considerable proportion of clients have altered functional and overall health status, with pain/discomfort and depression/anxiety most affected. Inclusion of multidisciplinary treatments for HIV and the highlighting of psychosocial issues that are likely among this group are warranted.

Patterns, Outcomes and Predictors of Pediatric Medical Admissions at Gadarif Hospital in Eastern Sudan

BACKGROUND

The reduction of childhood mortality is a reliable indicator of a national health system's progress and improvement. Sudan's population is still suffering from communicable diseases, with a considerably higher mortality rate among children. Efforts are therefore needed to reduce mortality and achieve the Millennium Development Goals and Sustainable Development Goals. This study was conducted to determine the morbidity, mortality and outcomes of children admitted to Gadarif Hospital in eastern Sudan.

METHOD

A retrospective study was conducted by reviewing the medical files of pediatric patients who were admitted to Gadarif Hospital between March 1, 2019 and March 31, 2020.

RESULT

A total of 740 medical files were reviewed. Most, 453 (61.2%) of the admissions were males. The median (interquartile range) age was 3.0 (8.0) years and 433 (58.8%) of the admissions were under 5 years of age. The median (interquartile range) of the length of hospital stay was 9.0 (12.0) days. Visceral leishmaniasis, malnutrition, severe malaria, sickle cell disease, acute watery diarrhea, severe anemia (regardless of its cause), septicemia and acute respiratory infection were the most common causes of admission. The mortality rate was 5.7%, and it was significantly higher in females than males [24/287 (8.4%) vs. 18/453 (4.0%), P = 0.01] and in children under 5 years [36/433 (8.3%) vs. 6/307 (2.0%), P < 0.001]. Malnutrition, visceral leishmaniasis, septicemia and meningitis/encephalitis were the main diseases causing death in the study population. The case fatality rate was not significantly different in malnutrition than in visceral leishmaniasis [9/93 (9.7%) vs. 7/178 (3.9%), P = 0.05].

CONCLUSION

The main causes of morbidity and mortality for children admitted to Gadarif Pediatric Hospital were communicable diseases. The mortality rate was 5.7%. Females and children under 5 years were the most vulnerable groups for fatality.

Magnitude of central obesity and associated factors among adults working in government offices in Bedele town, Buno Bedele zone, Southwest Ethiopia

Objective:

Central obesity is an emerging public health problem globally and an independent risk factor for heart, blood vessels, and metabolic disorder. This study aimed to assess the central obesity and associated factors among adults working in government offices in Bedele town, Southwest Ethiopia, 2021.

Methods:

An institutional survey was conducted among randomly selected government offices. Anthropometric measurements were carried out. Face-to-face interview using standard questionnaires were also used to collect data. A total of 403 respondents were selected from the list of public office workers employed in Bedele Town. Data were entered into Epi data 3.1 then exported to SPSS version 20 for analysis. Each variable with a p value less than 0.25 in the bivariate analysis was entered into logistic regression and p value 0.05 was considered as statistically significant.

Results:

The response rate was 373 respondents (92.6%). The overall prevalence of central obesity among public office workers of Bedele town was 54.7%. Sitting for more than 5 h at workplace adjusted odds ratio = 2.911 (95% confidence interval = 1.644, 5.156), being a female adjusted odds ratio = 3.258 (95% confidence interval = 1.744, 6.047), age range of 40–49 (adjusted odds ratio = 4.520, 95% confidence interval = 1.798, 11.363), age ⩾ 50 years (adjusted odds ratio = 5.907, 95% confidence interval = 1.808, 19.297), being physically inactive (adjusted odds ratio = 4.594, 95% confidence interval = 2.313, 9.125), consumption of snack (adjusted odds ratio = 4.521, 95% confidence interval = 2.583, 7.913), and alcohol consumption (adjusted odds ratio = 2.324 95% confidence interval = 1.210, 4.463) were factors significantly associated with central obesity among office workers in Bedele town.

Conclusion:

The magnitude of central obesity was high among office workers in Bedele town and being female gender, older age, physical inactivity, consumption of snacks, and alcohol were associated with it. Physical exercise and a healthy lifestyle should be promoted to minimize the problem.

Trends and causes of adult mortality from 2007 to 2017 using verbal autopsy method, Addis Ababa, Ethiopia

OBJECTIVES

We aim to analyse the trends and causes of mortality among adults in Addis Ababa.

SETTING

This analysis was conducted using verbal autopsy data from the Addis Ababa Mortality Surveillance in Addis Ababa, Ethiopia.

PARTICIPANTS

All deceased adults aged 15 years and above between 2007-2012 and 2015-2017 were included in the analysis.

OUTCOME MEASURES

We collected verbal autopsy and conducted physician review to ascertain cause of death.

RESULT

A total of 7911 data were included in this analysis. Non-communicable disease (NCD) accounted for 62.8% of adult mortality. Mortality from communicable diseases, maternal conditions and nutritional deficiencies followed this by accounting for 30.3% of total mortality. Injury accounted for 6.8% of total mortality. We have observed a significant decline in mortality attributed to group one cause of death (43.25% in 2007 to 12.34% in 2017, p<0.001). However, we observed a significant increase in mortality attributed to group II cause of death (from 49.95% in 2007 to 81.17% in 2017, p<0.001). The top five leading cause of death in 2017 were cerebrovascular disease (12.8%), diabetes mellitus (8.1%), chronic liver disease (6.3%), hypertension (5.7%), ischaemic heart disease (5.7%) and other specified neoplasm (5.2%).

CONCLUSION

We documented an epidemiological shift in cause of mortality from communicable diseases to NCD over 10 years. There is a great progress in reducing mortality due to communicable diseases over the past years. However, the burden of NCDs call for actions for improving access to quality health service, improved case detection and community education to increase awareness. Integrating NCD intervention in to a well-established and successful programme targeting communicable diseases in the country might be beneficial for improving provision of comprehensive healthcare.

The Trend of Health Service Utilization and Challenges Faced During the COVID-19 Pandemic at Primary Units in Addis Ababa: A Mixed-Methods Study

Introduction

The COVID-19 pandemic has imposed an extraordinary challenge to the health and socio-economic facet of nations globally. Health facilities have encountered tremendous challenges to contain service delivery at all levels. This study aims to assess the trend of health service utilization and challenges faced during the COVID-19 pandemic at primary units in Addis Ababa, Ethiopia.

Method

A multi-facility-based cross-sectional study was conducted in Addis Ababa between 1 and 30 of August 2020. A mixed-methods design was employed, and both quantitative and qualitative data were collected at 5 health centers. Facilities were selected randomly from 5 sub-cities while interviewees were recruited purposively. A structured questionnaire was used to collect quantitative data from the HMIS units of each facility. Qualitative data was collected using a semi-structured key-informant interview guide. Quantitative data were analyzed using Microsoft Excel, and a 10-month time-series trend was generated. For the qualitative data, qualitative data analysis (QDA-minor) software was used.

Results

Time-series comparison of the pre-COVID-19 era loads with the COVID-19 period showed that there was an extensive disparity in the service delivery capacity of the health facilities. A huge drop in inpatient flow of some units such as PICT, VCT, FP services, and most sub-units of the OPDs has been recorded following the COVID-19 outbreak. The key-informant interview also revealed that such challenges, as fear of infection and stigma, poor infrastructure, challenges related to human resources, and challenges related to the supply of prevention and treatment inputs were prominently encountered at the health centers.

Conclusion

The COVID-19 wave has negatively impacted many service delivery points in the study settings. The presence of weak infrastructure, lack of PPEs, fear of the infection and stigma, and staff workload have been mentioned as the predominant challenges faced during the outbreak. Health authorities should arrange multifaceted supports to ensure uninterrupted service delivery at primary healthcare units.

Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic

Objective

This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic.

Methods

A multi-site cross-sectional design was conducted from 1^st through 30^th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence.

Results

A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36–0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02–2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13–3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52–88.05) predicted high odds of poor adherence.

Conclusion

Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.

A two-year review of adult emergency department mortality at Tikur Anbesa specialized tertiary hospital, Addis Ababa, Ethiopia

BACKGROUND

Adult emergency department mortality remains high in resource-limited lower-income countries. The majority of deaths occur within the first 24 h of presentation to the emergency department. Many of these mortality's can be alleviated with appropriate interventions. This study was aimed to assess the magnitude, cause, and factors related to very early mortality in patients presented to the emergency department of Tikur Anbesa Specialized Tertiary Hospital, Ethiopia from March 2018 to 2020.

METHODS

This is a cross-sectional retrospective chart review. Retrospective data were collected from the records of all patients who died within 72 h of emergency department presentation from March 2018 to 2020. Data entered using Epi data 4.2.1 and analyzed using SPSS Version 23. Using the Chi-square test, binary and multiple logistic regression analysis were carried out to measure the association of variables of interest and very early emergency mortality. P-value < 0.05, odds ratio with 95% CI were used to identify the significant factors.

RESULTS

Between March 2018 to 2020, 30,086 patients visited the ED and 604 patients died within 72 h of presentation (274 died within 24 h and 232 within > 24-72 h). Shock (36.7%) and road traffic accidents (3.16%) were the major causes of death. Triage category red AOR 0.23 95% CI 0.1-0.55 and duration of illness 4-24 h AOR 0.47 95% CI 0.26-0.87 were significantly associated with decreased very early emergency department mortality. Meanwhile, co-morbid disease HIV AIDS AOR 2.72 95% CI 1.01-7.30 and residence Addis Ababa AOR 2.78 95% CI 1.36-5.68 and Oromia AOR 3.23 95% CI 1.58-6.54 were found significantly associated with increased very early emergency department mortality.

CONCLUSIONS AND RECOMMENDATIONS

The mortality burden of a road traffic accident and shock in the TASTH is significant and the magnitude of ED mortality differs between these groups. Residence Addis Ababa and Oromia, triage category red, co-morbid disease HIV AIDS, and duration of symptom 4-24 h were significantly associated with early emergency department mortality. Early detection and intervention are required to minimize emergency mortality.

Magnitude and Associated Factors of Metabolic Syndrome Among Adult Urban Dwellers of Northern Ethiopia

BACKGROUND

Metabolic Syndrome (MetS) is becoming a big public health problem in developing countries like Ethiopia. Developing countries have an almost two-fold higher risk of death due to non-communicable diseases (NCDs) compared to high-income countries. This study aimed to assess the magnitude and factors associated with MetS among adult residents of Mekelle city.

METHODS

A population-based cross-sectional study was carried out among 266 randomly selected adults from July to September 2019. Data were collected on socio-demographic, clinical, anthropometric, and lifestyle characteristics using a structured questionnaire adapted from the WHO STEPs survey tool. Fasting Blood Glucose (FBG) and lipid profiles were tested using a blood sample. Bivariate and multivariable logistic regression analyses were used to identify factors associated with MetS and variables were considered statistically significant at p ≤0.05.

RESULTS

The findings of this study showed the magnitude of MetS was 21.8%. The proportion of MetS was relatively higher among women (24.6%) than men (18.5%). Raised blood pressure was the most prominent (42.5%) component of MetS followed by central obesity (41.7%). The magnitude of the other components of MetS was 38.0%, 21.4%, and 14.3% for elevated triglyceride, raised FBG, and low HDL-C, respectively. Advanced age, medium and high monthly income, walking less than 10 minutes per day, raised Body Mass Index (BMI), higher waist to hip ratio, and elevated total cholesterol were significantly associated with a higher risk of metabolic syndrome.

CONCLUSION

In this study, we found a high prevalence of metabolic syndrome and its components, which highlights an urgent need for a public health strategy for its prevention, early diagnosis, and management.

Injury related adult deaths in Addis Ababa, Ethiopia: analysis of data from verbal autopsy

Background

Injury related deaths are causing huge impact on families and communities throughout the world. Reports show that developing countries are highly affected by injury deaths. Ethiopia is among the countries that are highly affected by injury deaths especially road traffic accident. Previous studies in Ethiopia concerning injury deaths were mostly based on hospital records. However, in the context of Ethiopia, where majority of the deaths are happening outside health facilities, hospital-based studies cannot give the exact proportion of injury deaths. This study aimed to assess the proportion and types of injury deaths in Addis Ababa and the distribution with different socio-demographic characteristics using data from verbal autopsy.

Methods

We used verbal autopsy data of Addis Ababa Mortality Surveillance Program. The basic source of data for Addis Ababa Mortality Surveillance is burial surveillance from all cemeteries of Addis Ababa. We analyzed causes of injury mortality by different characteristics and tried to show the trends.

Results

Over the 8 years period of time injury has contributed about 7 % of the total deaths. Majority of injury related deaths were among males. Traffic accidents were the major injury related deaths for both sexes; intentional self-harm was highly observed among males compared with females. The findings of this study showed that the proportion of injury related deaths decreased with increasing age.

Conclusions

This study witnessed that deaths resulting from injuries are substantial health challenges in Addis Ababa. Road traffic accident is the most common cause of injury related deaths in the study area. The findings also indicated that males and the productive age groups are highly affected by injury deaths.

Impact of food insecurity and malnutrition on the burden of Non-communicable diseases and death in Ethiopia: A situational analysis

BACKGROUND

Currently, Ethiopia is undergoing an epidemiological transition. Consequently, NCDs are becoming an increasingly important public health problem in the country. Furthermore, the country has faced a high level of food insecurity.

METHODS

We conducted a comprehensive review based on published articles from 2010 to 2018 and WHO reports on food insecurity, malnutrition and their impacts on the burden of NCDs death in order to obtain a deeper understanding of the seriousness of the NCDs cause of deaths in relation to food insecurity and malnutrition. In addition, policy for protecting vulnerability and the implementation of SDGs on food insecurity, malnutrition, and NCDs were also discussed. The results of this review highlight the progress that was made in the overall condition of food insecurity, nutrition, and diseases in the country.

RESULTS

The finding shows that there has been large burden of recurrent food insecurity, which could be due to malnutrition that might be associated to inconsistent rainfall distribution and also the experience of violent conflict in recent periods. However, the prevalence of undernourishment was declined from 75% in 1990s to 32% in 2015 though the numbers indicate a marginal reduction. But unexpectedly still the child mortality rate of under-five that results from malnutrition accounts about 57% of all children deaths. As the result of malnutrition, obesity is recognized as the determinants for a number of NCDs such as diabetes, cancer, and cardiovascular diseases. Communicable diseases seems the only identified health problem in the country, however; the burden of NCDs is facing major aspects. Hence, NCDs like cardiovascular diseases and diabetes, currently, are among the leading causes of death among adults, which is responsible for 39% of deaths in the country in 2015 while the risk of premature NCDs mortality was reached about 15.2%. Of these deaths, 4% was due to cancer and 9% was related to other NCDs such as obesity and nutrition-related cases. Therefore, food insecurity has a high-flying impact in early death from chronic health conditions and the cause of undernutrition that leads to an augmented susceptibility and decreased flexibility to NCDs as a result of compromised nutrition.

CONCLUSION

In order to sustain the economic growth, reduce poverty and achieving food security, the Ethiopian government has started discourse at high level of agenda hoping to avoid recurrent violent conflict, food insecurity and famine by targeting urban low-income households and empowering youth and women.

Associated factors from loss productivity among people involved in road traffic accident: a prospective study

OBJECTIVE

To study associated factors with loss productivity in people involved road traffic accidents (RTA).

METHODS

The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis.

RESULTS

The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85).

CONCLUSION

Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.

Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Antiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia.

METHODS

Relevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I 2 tests were used to assess the heterogeneity of the studies.

RESULTS

From 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I 2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure.

CONCLUSION

In this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.

[Non-communicable diseases in Southern Tunisia: morbidity, mortality profile and chronological trends]

OBJECTIVES

Non-communicable diseases (NCDs) represent a major public health problem worldwide. Giving their impact on the morbidity and mortality burden, understanding their chronological trends over time is a priority for epidemiological surveillance. We aimed to determine the epidemiological specificities of NCDs and to study their chronological trends over the period&#160;2010-2015.

METHODS

We retrospectively collected data of hospitalized&#160;patients from the regional registry of morbidity and mortality in the Southern University Hospital of Tunisia during the period 2010-2015.

RESULTS

We included 18,081 patients with NCDs aged ≥ 25 years. The distribution of NCDs was characterized by the predominance of cardiovascular disease (CVD) (10,346 cases, 57.2%). Chronological trends analysis of NCDs showed that NCDs remained globally stable between 2010 and 2015. The same result applied to the group of cancers, chronic respiratory diseases and diabetes mellitus. However, CVD increased significantly between 2010 and 2015 (ρ = 0.84; p = 0.036). The proportion of CVD increased significantly among men (ρ = 0.87; p = 0.019) and elderly (ρ = 0.88; p = 0.019). The hospital mortality rate of NCDs increased significantly (ρ = 0.85; p = 0.031), notably for CVDs (ρ = 0.94; p = 0.005).

CONCLUSION

Chronological trends analysis revealed a significant rise in the morbidity and mortality burden of CVDs during the period 2010-2015. It is imperative, therefore, to strengthen health care for these&#160;patients and to introduce the concept of integrated NCDs prevention as an essential component of the health system.

Drug therapy problems among patients with cardiovascular disease admitted to the medical ward and had a follow-up at the ambulatory clinic of Hiwot Fana Specialized University Hospital: The case of a tertiary hospital in eastern Ethiopia

Background:

Pharmacotherapy is important in reducing morbidity and mortality related to cardiovascular diseases. However, these advantages are limited by drug therapy problems that can impact on a patient’s quality of life, prolong hospital stays, and increase the overall burden of healthcare expenditures. Therefore, this study was aimed to assess drug therapy problems among patients with cardiovascular diseases who were hospitalized and received follow-up at the ambulatory clinic of Hiwot Fana Specialized University Hospital.

Methods:

An institution-based cross-sectional study design was used to collect data from patients with cardiovascular diseases who were admitted to the medical ward and those who had received follow-up at the ambulatory clinic of Hiwot Fana Specialized University Hospital. The collected data were coded, entered, and analyzed using SPSS version 16. The associations of selected categorical variables were done using binary logistic and multivariate logistic regression analyses.

Results:

Out of 216 study participants, females accounted for 123 (57%), whereas 93 (43%) of them were males. Among cardiovascular diseases identified in the medical ward and ambulatory clinics of Hiwot Fana Specialized University Hospital, congestive heart failure 96 (44.4%) and hypertension 93 (43.1%) were the two most commonly diagnosed disorders. Of the total participants involved in the study, 131 (60.65%) had drug therapy problems. Among the seven classes of drug therapy problems assessed, the most commonly observed was the need for additional drug therapy 76 (58%); followed by cases related to unnecessary drug therapy and noncompliance both of which were estimated to be 16 (12.2%). In addition, of independent variables, only the use of more than three drugs was significantly associated in both binary logistic (crude odds ratio = 0.41, 95% confidence interval = 0.234–0.719, p = 0.002) and multivariate logistic regressions (adjusted odds ratio = 4.86, 95% confidence interval = 1.625–14.536, p = 0.005) as compared with those patients who were using less than three drugs.

Conclusion:

The findings of the study indicated that more than half of the study participants experienced drug therapy problems, for which 58% required additional drug therapy. The risk of drug therapy problem is found to increase with the use of more than three drugs. Since these problems are adversely affecting the treatment outcome of patients, this is an area which requires special attention and the cooperation of healthcare professionals to tackle it.

Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia

Background

Well organized and appropriately utilized pre-hospital emergency services play a critical role in augmenting emergency care systems. The primary objective of this study was to understand the demographic and clinical profile of patients who used ambulances in Addis Ababa. The secondary objectives were to assess ambulance response time, transport time and reasons for referral amongst inter-facility transported patients in Addis Ababa.

Methods

The study was designed as a cross-sectional retrospective chart review of ambulance transported patients using ambulance station records from Addis Ababa Fire and Emergency Prevention and Control Authority. With IRB approval, simple random sampling and manual review of six months of clinical records was performed. Data were collected by trained data collectors and descriptive analysis was done using SPSS version 20.

Results

Female patients used ambulance services more often than males (female to male ratio of 3:1) and the mean age of the patients was 26 years. The most commonly transported age group was 16–30 years, followed by 31–50 years and neonatal patients (i.e. < 1 month). The majority of the patients had pregnancy related illnesses (n = 492, 61.4%), followed by general medical issues (n = 210, 26.2%) and injury secondary to trauma (n = 99, 12.3%). Most patients (n = 702, 87.6%) were transported for inter-facility transfers, while only 12.4% (n = 99) were primary responses (i.e. from the scene). Prolonged labor was the most common reason (n = 103, 23.4%) for inter-facility transfer of pregnant patients, followed by premature rupture of the amniotic membrane (n = 60, 13.6%). The mean dispatch to scene time interval was 10.1 min, and mean scene to facility time interval was 17.2 min.

Conclusion

Inter-facility transfers accounted for the largest proportion of ambulance utilization and dispatch in Addis Ababa. Ambulance transport time was twice as long compared to international recommendations of less than eight minutes for emergent transports. The most common reasons for ambulance dispatch were Obstetric. We recommend urgent action to decrease the transport times and to dedicate further pre-hospital resources to address the high burden of inter-facility transfers.

Mortality in Hospitalised HIV/AIDS Patients in a Tertiary Centre in Sub-Saharan Africa: Trends Between 2007 and 2015, Causes and Associated Factors

Background:

With easy accessibility to combination Antiretroviral Therapy (cART), mortality amongst hospitalized HIV/AIDS patients needs to be described.

Objective:

We aimed at determining the trends, causes and factors associated with in-hospital mortality amongst HIV/AIDS patients in the Douala General Hospital.

Methods:

We retrospectively reviewed hospitalisation records of HIV/AIDS patients hospitalized in the medical wards of the DGH from 2007 to 2015. Four cause-of-death categories were defined: 1. Communicable conditions and AIDS-defining malignancies, 2. Chronic non-communicable conditions and non-AIDS defining malignancies’, 3. Other non-communicable conditions and 4. Unknown conditions. Logistic regression was used to determine factors associated mortality.

Results:

We analyzed 891 eligible files. The mean age was 43 (standard deviation (SD): 10) years and median length of hospital stay was 9 (interquatile range (IQR)4 - 15) days. The overall all-cause mortality was 23.5% (95% CI: 20.8% - 26.4%). The category - communicable conditions and AIDS defining malignancies represented 79.9%, of deaths and this remained constant for each year during the study period. Tuberculosis was the most common specific cause of death (23.9%). Patients who had two (OR=2.35, 95%CI: 1.35 - 4.06) and more than two (OR=4.23, 95%CI: 1.62 – 11.12) opportunistic infections, a haemoglobin level less than 10g/l (OR=2.38, 95%CI: 1.58 - 3.59) had increased odds of dying.

Conclusion:

In-hospital mortality is high amongst HIV/AIDS patients at the Douala general hospital. The category - communicable conditions and AIDS defining malignancies - is still the main underlying cause of death. We hope that our findings will help to develop interventions aimed at reducing in-hospital mortality.

Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015

Background

Understanding the causes of inpatient mortality in hospitals is important for monitoring the population health and evidence-based planning for curative and public health care. Dearth of information on causes and trends of hospital mortality in most countries of Sub-Saharan Africa has resulted to wide use of model-based estimation methods which are characterized by estimation errors. This retrospective analysis used primary data to determine the cause-specific mortality patterns among inpatient hospital deaths in Tanzania from 2006–2015.

Materials and methods

The analysis was carried out from July to December 2016 and involved 39 hospitals in Tanzania. A review of hospital in-patient death registers and report forms was done to cover a period of 10 years. Information collected included demographic characteristics of the deceased and immediate underlying cause of death. Causes of death were coded using international classification of diseases (ICD)-10. Data were analysed to provide information on cause-specific, trends and distribution of death by demographic and geographical characteristics.

Principal findings

A total of 247,976 deaths were captured over a 10-year period. The median age at death was 30 years, interquartile range (IQR) 1, 50. The five leading causes of death were malaria (12.75%), respiratory diseases (10.08%), HIV/AIDS (8.04%), anaemia (7.78%) and cardio-circulatory diseases (6.31%). From 2006 to 2015, there was a noted decline in the number of deaths due to malaria (by 47%), HIV/AIDS (28%) and tuberculosis (26%). However, there was an increase in number of deaths due to neonatal disorders by 128%. Malaria and anaemia killed more infants and children under 5 years while HIV/AIDS and Tuberculosis accounted for most of the deaths among adults.

Conclusion

The leading causes of inpatient hospital death were malaria, respiratory diseases, HIV/AIDS, anaemia and cardio-circulatory diseases. Death among children under 5 years has shown an increasing trend. The observed trends in mortality indicates that the country is lagging behind towards attaining the global and national goals for sustainable development. The increasing pattern of respiratory diseases, cancers and septicaemia requires immediate attention of the health system.

Decomposition of Ethiopian life expectancy by age and cause of mortality; 1990-2015

Ethiopia's average life expectancy has improved by more than 18 years from 1990 to 2015. This initiated interest to study the gain in life expectancy with respect to age structure and cause of death. Applying a life expectancy decomposition technique on secondary data obtained from the Institute of Health Metrics and Evaluation, the study found that the burden of disease in Ethiopia has declined from 626.18 in 1990 to 225.69 in 2015 per 1000 population measured in age-standardized rate of life years lost. The major causes of burden in 1990; namely lower respiratory tract infections, neonatal disorders, diarrheal diseases and neglected tropical diseases at rates of 89.2, 63.2, 61.2, and 42.2 age-standardized years of life lost per 1000 population respectively; have shown a fast decline in 2015. Deaths from neglected tropical disease showed 94.95% reduction, contributing to 5.71(27.30%) years gain in life expectancy followed by lower respiratory tract infection and diarrheal disease contributing about 4.65 years (22.23%) and 1.48 years (7.10%) respectively. On the other hand, about 3.3 (15.73%) years and 6.4 (30.71%) years of increase in life expectancy are achieved through improved longevity in infants and children aged 1-4 years respectively. In conclusion, the study found that reductions in under-five child mortality and decline in burden of major communicable diseases could explain the major gain in life expectancy. However, findings also revealed that the prevalence of non-communicable diseases and injuries are on the rise calling for the need to be addressed by the public health system.

Mortality from adverse drug reaction-related hospitalizations in south-west Ethiopia: A cross-sectional study

WHAT IS KNOWN AND OBJECTIVE

Adverse drug reactions (ADRs) are an important cause of mortality during medical care. To our knowledge, no Ethiopian studies have reported on mortality due to ADRs in patients presenting to hospital from the community setting. The aim of this study was to determine the mortality rate attributable to ADRs in patients presenting to hospital, identify drugs implicated in the ADR-related deaths and identify factors contributing to ADR-related mortality at Jimma University Specialised Hospital (JUSH), south-west Ethiopia METHODS: This cross-sectional study included 1001 patients aged ≥18 years consecutively admitted to medical wards from May 2015 to August 2016. ADR-related mortality was determined through detailed review of medical records, laboratory tests and patient interviews followed by causality assessment by the Naranjo algorithm and expert consensus.

RESULTS

Of 1001 patients, 15, 1.5% (95% confidence interval [CI]: 0.80%-2.30%) died with an ADR. The primary suspected causes of death were drug-induced hepatotoxicity (7, 43.8%) followed by acute kidney injury (4, 25.0%). Isoniazid (6, 33.3%), pyrazinamide (3, 16.7%), efavirenz (2, 11.1%) and tenofovir (2, 11.1%) were commonly implicated drugs. The majority of ADRs (14, 93.8%) were preventable. Unadjusted bivariate comparisons suggested patients who died with ADRs were more likely to have pre-existing liver disease (40.0% vs 7.0%; 95% confidence interval [CI]: 8.1%-57.8%), a history of ADRs (40% vs 1.4%; 95% CI: 13.8%-63.4%), a lower mean (±SD) body mass index (BMI, 17.6 ± 2.1 vs 20.0 ± 2.9 kg/m² ; 95% CI = 0.9-3.9), exposure to antitubercular (46.7% vs 18.9%; 95% CI: 2.3%-53.1%) and antiretroviral (40.0% vs 7.7%; 95% CI: 7.5%-57.2%) therapies, and a higher mean number of medications (7.1 ± 3.3 vs 3.8 ± 2.1; 95% CI: 2.2-4.4) and Charlson Comorbidity Index (3.9 ± 2.9 vs 1.6 ± 1.8; 95% CI: 1.4-3.2) than surviving patients without ADRs.

WHAT IS NEW AND CONCLUSION

Fatal ADRs were common in patients presenting to hospital. The drugs implicated were mostly antitubercular and antiretroviral therapies, reflecting the high burden of HIV and tuberculosis in the study population. ADR-related deaths were significantly associated with poor nutritional status. The majority of ADR-related deaths were preventable, highlighting the need to develop a multidisciplinary approach to closely monitor patients who are prescribed antitubercular and antiretroviral therapies, particularly in patients with hepatic disease, a history of ADRs, who are malnourished and who are exposed to multiple medications.

Etiology of Chronic Liver Disease in Ethiopia: A Case Control Study with Special Reference to Viral Hepatitis and Alcohol

INTRODUCTION

Chronic diseases of the liver are a global health problem with high morbidity and mortality. Viral hepatitis is the predominant cause for liver disease in low and middle-income countries. Viral hepatitis is also frequent in high-income countries but mainly as a complication to drug abuse or iatrogenic to treatment. In high-income countries non-fatty-liver-disease and complications to alcohol consumption are the most frequent etiology of liver disease. Viral hepatitis B and C is prevalent in Ethiopia but there are only few studies done in relation to chronic liver disease and a relationship between the increasing alcohol consumption and chronic liver disease.

OBJECTIVE

A The aim of the study was to assess the association between chronic liver disease in Ethiopia and infection with viral hepatitis and possible relation to alcohol consumption.

METHODS AND MATERIAL

An unmatched case control study was conducted in Addis Ababa. Cases were chronic liver disease patients (n = 812) and controls were patients without liver disease (n = 798). Data were collected from the records of patients treated at a specialized clinic of Gastrsoenterology and Hepatology in Addis Ababa from 1^st January 2013 - 31^st, December 2013.

RESULTS

The odds of having hepatitis infection among chronic liver disease was AOR = 100.96, (95%CI: 62.15 - 164.02) for HBV and AOR = 59.2, (95%CI: 27.23 - 130.9) for HCV. Consumption of alcohol was associated with chronic liver disease (OR: 8.23 95%CI: 3.76 - 12.70). Liver enzymes were elevated significantly in patients with hepatitis and alcohol consumption compared to patients without alcohol consumption.

CONCLUSION

Viral hepatitis infections are strongly associated with chronic liver disease. Prevention of viral hepatitis infections and control of alcohol consumption need to be strengthened in order to reduce the burden of chronic liver disease in Ethiopia.

Social determinants of adult mortality from non-communicable diseases in northern Ethiopia, 2009-2015: Evidence from health and demographic surveillance site

INTRODUCTION

In developing countries, mortality and disability from non-communicable diseases (NCDs) is rising considerably. The effect of social determinants of NCDs-attributed mortality, from the context of developing countries, is poorly understood. This study examines the burden and socio-economic determinants of adult mortality attributed to NCDs in eastern Tigray, Ethiopia.

METHODS

We followed 45,982 adults implementing a community based dynamic cohort design recording mortality events from September 2009 to April 2015. A physician review based Verbal autopsy was used to identify the most probable causes of death. Multivariable Cox proportional hazards regression was performed to identify social determinants of NCD mortality.

RESULTS

Across the 193,758.7 person-years, we recorded 1,091 adult deaths. Compared to communicable diseases, NCDs accounted for a slightly higher proportion of adult deaths; 33% vs 34.5% respectively. The incidence density rate (IDR) of NCD attributed mortality was 194.1 deaths (IDR = 194.1; 95% CI = 175.4, 214.7) per 100,000 person-years. One hundred fifty-seven (41.8%), 68 (18.1%) and 34 (9%) of the 376 NCD deaths were due to cardiovascular disease, cancer and renal failure, respectively. In the multivariable analysis, age per 5-year increase (HR = 1.35; 95% CI: 1.30, 1.41), and extended family and non-family household members (HR = 2.86; 95% CI: 2.05, 3.98) compared to household heads were associated with a significantly increased hazard of NCD mortality. Although the difference was not statistically significant, compared to poor adults, those who were wealthy had a 15% (HR = 0.85; 95% CI: 0.65, 1.11) lower hazard of mortality from NCDs. On the other hand, literate adults (HR = 0.35; 95% CI: 0.13, 0.9) had a significantly decreased hazard of NCD attributed mortality compared to those adults who were unable to read and write. The effect of literacy was modified by age and its effect reduced by 18% for every 5-year increase of age among literate adults.

CONCLUSION

In summary, the study indicates that double mortality burden from both NCDs and communicable diseases was evident in northern rural Ethiopia. Public health intervention measures that prioritise disadvantaged NCD patients such as those who are unable to read and write, the elders, the extended family and non-family household co-residents could significantly reduce NCD mortality among the adult population.

High burden of hypertension across the age groups among residents of Gondar city in Ethiopia: a population based cross sectional study

Background

According to a report on the worldwide trends in blood pressure from 1975 to 2015, mean blood pressure is increasing in low and middle income countries while it is either decreasing or stabilizing in high income countries. Few studies have been published on the prevalence of hypertension in Ethiopia demonstrating an increased trend; however, these studies had small sample size and were limited to participants older than 35 years; which left the burden among adolescents and young adults unaddressed. The aim of this study was to assess prevalence of hypertension (HTN) and associated factors in Gondar city.

Method

A population based cross-sectional study was conducted among 3227 individuals in Gondar city. A multistage cluster random sampling was used. The Kish method from World Health Organization (WHO) STEPS instrument of random sampling method was used for selecting one individual older than or equal to 18 years from each household. WHO and International Diabetic Association (IDA) criterion was used to classify HTN.

Result

The overall prevalence of HTN was 27. 4% [95% CI: (25. 8–28.9)]. The prevalence for participants in the age group of ≥35 years was 36. 1%. It consistently increased from 9.5% in the age group of 18–25 years to 46.3% in the age group of ≥65 years (P-value < 0. 001). Only 47% of the participants had ever had any kind of blood pressure measurement. Being elderly (AOR = 5. 56; 95% CI: 3. 71–8. 35), obese (AOR =2. 62; 95%CI: 1. 70–4. 03), widowed (AOR = 1. 87; 95%CI: 1. 27–2. 75), separated (AOR = 1. 87; 95%CI: 1. 27–2. 75), daily alcohol user (AOR = 1. 51; 95%CI: 1. 02–2. 23), male gender (AOR = 1. 42; 95%CI: 1. 18–1. 72) and born in urban area (AOR = 1. 31; 95%CI: 1. 10–1. 56) were found to be independently associated with HTN.

Conclusion

There is a high prevalence of hypertension in Gondar city and is showing increasing trend compared to previous reports. Interventions to raise awareness and to improve both capacity and accessibility of facilities for screening hypertension are highly recommended.

Tuberculosis and HIV are the leading causes of adult death in northwest Ethiopia: evidence from verbal autopsy data of Dabat health and demographic surveillance system, 2007-2013

BACKGROUND

Reliable data on causes of death form the basis for building evidence on health policy, planning, monitoring, and evaluation. In Ethiopia, the majority of deaths occur at home and civil registration systems are not yet functional. The main objective of verbal autopsy (VA) is to describe the causes of death at the community or population level where civil registration and death certification systems are weak and where most people die at home without having had contact with the health system.

METHODS

Causes of death were classified and prepared based on the International Classification of Diseases (ICD-10). The cause of a death was ascertained based on an interview with next of kin or other caregivers using a standardized questionnaire that draws information on signs, symptoms, medical history, and circumstances preceding death. The cause of death, or the sequence of causes that led to death, is assigned based on the data collected by the questionnaire. The complete VA questionnaires were given to two blinded physicians and reviewed independently. A third physician was assigned to review the case when disagreements in diagnosis arose.

RESULTS

Communicable diseases (519 deaths [48.0%]), non-communicable diseases (377 deaths [34.8%]), and external causes (113 deaths [10.4%]) were the main causes of death between 2007 and 2013. Of communicable diseases, tuberculosis (207 deaths [19.7%]), HIV/AIDS (96 deaths [8.9%]) and meningitis (76 deaths [7.0%]) were the most common causes of death.

CONCLUSION

Tuberculosis, HIV/AIDS, and meningitis were the most common causes of deaths among adults. Death due to non-communicable diseases showed an increasing trend. Increasing community awareness of infections and their interrelationships, tuberculosis case finding, effective local TB programs, successful treatment, and interventions for HIV are supremely important.

Mortality among 5-17 year old children in Kenya

Introduction

Global mortality trends have changed over time and are expected to continue changing with a reduction in communicable diseases and an increase of non-communicable disease. Increased survival of children beyond five years may change mortality patterns for these children. There are few studies in Africa that explore the causes of mortality in children over five years. The objective of this study was to determine the mortality rate and clinical profiles of children aged 5-17 years who died in six Kenyan hospitals in 2013.

Methods

Retrospective review of patients’ medical records to abstract data on diagnosis for those who died in year 2013. Data was analysed to provide descriptive statistics and explored differences in mortality rates between age groups and gender.

Results

We retrieved 4,520 patient records. The in-hospital mortality rate was 3.5% (95%CI 3.0-4.1) with variations in deaths between the ages and gender. Among the deaths, 60% suffered from communicable diseases, maternal and nutritional causes; 41.3% suffered from non-communicable diseases. A further 11.9% succumbed to traumatic injuries. The predominant clinical diagnoses among patients who died were HIV/AIDS, respiratory tract infections and malaria.

Conclusion

Infectious causes had the highest proportion of diagnoses among children aged 5-17 years who died.

Out-of-pocket expenditures for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa, Ethiopia: a cross-sectional cohort study

BACKGROUND

Cardiovascular disease poses a great financial risk on households in countries without universal health coverage like Ethiopia. This paper aims to estimate the magnitude and intensity of catastrophic health expenditure and factors associated with catastrophic health expenditure for prevention and treatment of cardiovascular disease in general and specialised cardiac hospitals in Addis Ababa.

METHODS AND FINDINGS

We conducted a cross-sectional cohort study among individuals who sought cardiovascular disease care in selected hospitals in Addis Ababa during February to March 2015 (n=589, response rate 94%). Out-of-pocket payments on direct medical costs and direct non-medical costs were accounted for. Descriptive statistics was used to estimate the magnitude and intensity of catastrophic health expenditure within households, while logistic regression models were used to assess the factors associated with it.About 27% (26 .7;95% CI 23.1 to 30.6) of the households experienced catastrophic health expenditure, defined as annual out-of-pocket payments above 10% of a household's annual income. Family support was the the most common coping mechanism. Low income, residence outside Addis Ababa and hospitalisation increased the likelihood of experiencing catastrophic health expenditure. The bottom income quintile was about 60 times more likely to suffer catastrophic health expenditure compared with the top quintile (adjusted OR=58.6 (16.5-208.0), p value=0.00). Of those that experienced catastrophic health expenditure, the poorest and richest quintiles spent on average 34% and 15% of households' annual income, respectively. Drug costs constitute about 50% of the outpatient care cost.

CONCLUSIONS

Seeking prevention and treatment services for cardiovascular disease in Addis Ababa poses substantial financial burden on households, affecting the poorest and those who reside outside Addis Ababa more. Economic and geographical inequalities should also be considered when setting priorities for expanding coverage of these services. Expanded coverage has to go hand-in-hand with implementation of sound prepayment and risk pooling arrangements to ensure financial risk protection to the most needy.

Chronic illness needing palliative care in Kinshasa hospitals, Democratic Republic of the Congo (DRC)

BACKGROUND

Chronic illnesses are a major public health problem in low-income countries. In the Democratic Republic of the Congo (DRC), few data are available, especially in palliative care. In this context, the present study aimed at describing the patterns of diseases in Kinshasa hospitals as well as risk factors associated with patients' evolving status and length of hospital stay.

METHODS

A prospective study was conducted in ten hospitals of Kinshasa, over a 1-year period. A total of 2699 patients with a chronic condition (non-communicable diseases (NCD) and/or AIDS) were consecutively enrolled in the study between January and December, 2013.

RESULTS

Out of 2699 patients studied, 36.9% were suffering from cardiovascular diseases, 29.7% from comorbidity and 17.5% from AIDS. 27.5% of patients died while hospitalized, and 67.4% were lost to follow-up. The risk factors independently associated with death in hospitals were AIDS (adjusted OR = 2.2) and age over 65 years old (adjusted OR = 1.7). Peri-urban and rural areas were significantly associated with a mean adjusted hospital stay longer than 3 days. The length of stay (LOS) was shorter for women and patients living in urban areas. Patients survived for a median of 10 days (range 7-20 days).

CONCLUSIONS

This study reveals the high proportion of patients suffering from advanced chronic diseases, including cardiovascular diseases, AIDS and comorbidity. It demonstrates the need for palliative care (PC) in medical practices in Kinshasa, the capital of the Democratic Republic of the Congo.

Demographic and mortality analysis of hospitalized children at a referral hospital in Addis Ababa, Ethiopia

BACKGROUND

Global childhood mortality rates remain high. Millennium Development Goal 4 focused efforts on reducing rates by two-thirds between 1990 and 2015. In Ethiopia, child mortality rates dropped 71 % from 1990 to 2015, however it is estimated that 184,000 Ethiopian children die each year. There is limited information about pediatric hospital admissions in Ethiopia. Our aims were to examine the temporal relationship of mortality to admission, describe the demographics, and identify cause mortality of children admitted to the Zewditu Memorial Hospital (ZMH).

METHODS

A four-year retrospective review of pediatric admissions was conducted at the pediatric emergency room and pediatric hospital ward at ZMH in Addis Ababa, Ethiopia. Admission entries from 2011-2014 of children age 29 days-14 years were reviewed. Age, gender, admission date, disease classification, discharge status and date were obtained. Patient gender was compared using Chi-square analysis. A descriptive analysis was used for age and cause mortality.

RESULTS

A total of 6866 patient entries were reviewed. The proportion of admissions younger than age 5 was 0.747 (95 % CI 0.736-0.757). Overall mortality was 0.042 (95 % CI, 0.037-0.047). The proportion of recorded deaths occurring within 2 days of admission was 0.437 (95 % CI 0.380-0.494). The proportion of male admissions was significantly higher than female admissions in all age groups (male 0.575, p < 0.0001, 95 % CI 0.562-0.586). The main causes of mortality were pneumonia (0.253, 95 % CI, 0.203-0.303), severe acute malnutrition (0.222, 95 % CI 0.174-0.27), HIV/AIDS-related complications (0.056, 95 % CI 0.029-0.083), spina bifida (0.049, 95 % CI 0.024-0.074), and hydrocephalus (0.045, 95 % CI 0.021-0.069).

CONCLUSIONS

Our study revealed a lower mortality rate than previously reported in Ethiopia. Despite this, 44 % of pediatric hospital mortality occurred early during hospitalization, higher than reported at other Ethiopian hospitals. This adds further evidence that systematic efforts should be dedicated to improve pediatric emergency care. Admissions included 58 % male patients, similar to other reports in Ethiopia implying that this may be a nation-wide phenomenon. The observed disparity may be due to societal factors regarding care-seeking behaviors or male predilection for respiratory illness warranting further investigation. Cause mortality patterns were similar to reports in analogous settings.

Explanatory models of adult patients with type 2 diabetes mellitus from urban centers of central Ethiopia

BACKGROUND

Type 2 diabetes, which is increasing as a public health problem in the low resource settings of Africa has been associated with the high prevalence of micro-vascular complications and increasing levels of macro-vascular complications. There is evidence from the developed world that understanding patient perceptions of chronic illness is important to design effective strategies for helping patients manage these conditions. This study utilized Kleinman's model to explore the illness perceptions of type 2 diabetes patients attending treatment in Addis Ababa and Butajira (Ethiopia) and better understand how they manage their illness.

DESIGN

Qualitative interviews were conducted to elicit the explanatory models of purposively sampled type 2 diabetes patients attending treatment in three hospitals in central Ethiopia until saturation of key emerging themes was achieved. Analysis of interview transcripts was guided by Kleinman's model.

RESULTS

A total of 39 participants, 24 from Addis Ababa and the rest from Butajira took part in the study. This study revealed that patients' explanatory models were informed by both the traditional and biomedical models with emotional distress evident in some of the participants. The traditional model seemed to reflect the strong religious and cultural influences for the majority of study participants. The findings also revealed that symptoms played significant roles in how patients viewed their illness including assessment of its severity. Most were uncertain about the cause of their illness, with those expressing certainty citing factors over which they believed they had little or no control. This may have contributed to the perceptions about the use of religious healing and traditional medicines in a complementary or alternative manner to the biomedical regimen which could affect their adherence to recommended regimens and their health outcomes.

CONCLUSION

This study suggests the need for a strong diabetes care program that is sensitive to patients' experiences of their illness including emotional distress. Individuals providing the diabetes care should consider local and individual contexts and strive to make their approach patient-centered and engage active participation of patients. There appears to be a need for better training of health providers in different areas including health communications and the fundamentals of mental healthcare.

Prevention and treatment of cardiovascular disease in Ethiopia: a cost-effectiveness analysis

BACKGROUND

The coverage of prevention and treatment strategies for ischemic heart disease and stroke is very low in Ethiopia. In view of Ethiopia's meager healthcare budget, it is important to identify the most cost-effective interventions for further scale-up. This paper's objective is to assess cost-effectiveness of prevention and treatment of ischemic heart disease (IHD) and stroke in an Ethiopian setting.

METHODS

Fifteen single interventions and sixteen intervention packages were assessed from a healthcare provider perspective. The World Health Organization's Choosing Interventions that are Cost-Effective model for cardiovascular disease was updated with available country-specific inputs, including demography, mortality and price of traded and non-traded goods. Costs and health benefits were discounted at 3 % per year. Incremental cost-effectiveness ratios are reported in US$ per disability adjusted life year (DALY) averted. Sensitivity analysis was undertaken to assess robustness of our results.

RESULTS

Combination drug treatment for individuals having >35 % absolute risk of a CVD event in the next 10 years is the most cost-effective intervention. This intervention costs US$67 per DALY averted and about US$7 million annually. Treatment of acute myocardial infarction (AMI) (costing US$1000-US$7530 per DALY averted) and secondary prevention of IHD and stroke (costing US$1060-US$10,340 per DALY averted) become more efficient when delivered in integrated packages. At an annual willingness-to-pay (WTP) level of about US$3 million, a package consisting of aspirin, streptokinase, ACE-inhibitor and beta-blocker for AMI has the highest probability of being most cost-effective, whereas as WTP increases to > US$7 million, combination drug treatment to individuals having >35 % absolute risk stands out as the most cost-effective strategy. Cost-effectiveness ratios were relatively more sensitive to halving the effectiveness estimates as compared with doubling the price of drugs and laboratory tests.

CONCLUSIONS

In Ethiopia, the escalating burden of CVD and its risk factors warrants timely action. We have demonstrated that selected CVD intervention packages could be scaled up at a modest budget increase. The level of willingness-to-pay has important implications for interventions' probability of being cost-effective. The study provides valuable evidence for setting priorities in an essential healthcare package for CVD in Ethiopia.

Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia

Background

The global burden of mortality among children is still very huge though its trend has started declining following the improvements in the living standard. It presents serious challenges to the well-being of children in many African countries. Today, Sub-Saharan Africa alone accounts for about 50% of global child mortality. The overall objective of this study was to determine the magnitude and distribution of causes of death among children aged 5 to 14 year olds in the population of Kersa HDSS using verbal autopsy method for the period 2008 to 2013.

Methods

Kersa Health and Demographic Surveillance System(Kersa HDSS) was established in September 2007. The center consists of 10 rural and 2 urban kebeles which were selected randomly from 38 kebeles in the district. Thus this study was conducted in Kersa HDSS and data was taken from Kersa HDSS database. The study population included all children aged 5 to 14 years registered during the period of 2008 to 2013 in Kersa HDSS using age specific VA questionnaires. Data were extracted from SPSS database and analyzed using STATA.

Results

A total of 229 deaths were recorded over the period of six years with a crude death rate of 219.6 per 100,000 population of this age group over the study period. This death rate was 217.5 and 221.5 per 100,000 populations for females and males, respectively. 75% of deaths took place at home. The study identified severe malnutrition(33.9%), intestinal infectious diseases(13.8%) and acute lower respiratory infections(9.2%) to be the three most leading causes of death. In broad causes of death classification, injuries have been found to be the second most cause of death next to communicable diseases(56.3%) attributing to 13.1% of the total deaths.

Conclusion and Recommendation

In specific causes of death classification severe malnutrition, intestinal infectious diseases and acute lower respiratory infections were the three leading causes of death where, in broad causes of death communicable diseases and injuries were among the leading causes of death. Hence, concerned bodies should take measures to avert the situation of mortality from these causes of death and further inferential analysis into the prevention and management of infectious diseases should also be taken.

Indoor and Outdoor Air Pollution- related Health Problem in Ethiopia: Review of Related Literature

BACKGROUND

The health effects of air pollution are generally global problems, but they have, since recently become issues of particular concern for developing countries. This review assessed the situation of air pollution and related health effects in the context of Ethiopia.

METHODS

The materials reviewed in this publication are published scientific papers from online search engines, unpublished government reports and academic theses/dissertations. In addition, interview data obtained from authorities and experts involved in the management of air quality were analyzed, interpreted and reported in the article.

RESULTS

Review of the few studies conducted in Ethiopia showed that average concentrations of PM2.5 reached as high as 280 µg/m3 for 24-hour measurements (range: 2,417-12,739 µg/m3). Indoor carbon monoxide (CO) levels were universally higher than regulatory limits for the United States and were found to be much higher among households using traditional stoves and solid biomass fuels. The use of traditional stoves and solid biomass fuels was reported in >95% of the households considered. High average levels of NO2 (97 ppb) were reported in a large longitudinal study. The ambient PM10 level was below the WHO guideline values in the majority of the samples. About 50% of the on-road CO samples taken from traffic roads in Addis Ababa were found to be less than the guideline values while the number of motor vehicles in Ethiopia is reported to be increasing by more than 9% per annum. There is a very limited air quality monitoring capacity in the country. The co-ordination between stakeholders in this regard is also inadequate. The limited evidence available on health effects of air pollution indicates that the prevalence of acute respiratory illness among children living in households using crude biomass fuels is significantly higher than the national average figures.

CONCLUSION

The limited evidence reviewed and reported in this article indicates high levels of indoor air pollution and trends of worsening outdoor air pollution. This tentative conclusion carries with it the urgent need for more evidence-based research and capacity building in the areas of indoor and outdoor air pollution.

Patterns and predictors of early mortality among emergency department patients in Addis Ababa, Ethiopia

Background

Ethiopian emergency department (ED) patients have a considerable burden of illness and injury for which all-cause mortality rates have not previously been published. This study sought to characterize the burden of and to identify predictors for early all-cause mortality among patients presenting to the Tikur Anbessa Specialized Hospital ED (TASH-ED) in Ethiopia.

Methods

Data was prospectively collected from the records of all patients who died within 72 h of ED presentation. Pearson’s Chi square and Fisher’s exact tests were used to investigate associations between two outcome variables: (a) time to death and (b) immediate cause of death in relation to specific demographic and clinical factors. Time from ED presentation to death was dichotomized as ‘very early’ mortality within ≤6 h and death >6–72 h and logistic regression was used to assess the adjusted impact of these demographic and clinical variables on the probability of dying within 6 h of ED presentation.

Results

Between October 2012 and May 2013, 9956 patients visited the ED and 220 patients died within 72 h of admission. After excluding patients dead on arrival (n = 34), the average age of death was 43.1 years and the overall mortality rate was 1.9 %. Head injury (21.5 %) and sepsis (18.8 %) were the most common causes of death. Relative to medical patients, trauma patients were more likely to be male (p < 0.01), less likely to have had prior recent ED visits (p < 0.01) and more likely to be triaged as higher acuity (p = 0.04). The sole statistically significant predictor of death within 6 h from our multivariable logistic regression model was symptom duration less than 4 h (4–48 h vs. <4 h: OR = 0.20, 95 % CI 0.07, 0.53, p < 0.01; >48 h vs. <4 h: OR = 0.27, 95 % CI 0.09, 0.81, p = 0.02).

Conclusions

The mortality burden of trauma and sepsis in the TASH-ED is substantial, and mortality patterns differ between these groups. As emergency medicine develops as a specialty in the Ethiopian health system, the potential impact of context-specific clinical care protocol development, trauma prevention advocacy and ED care re-organization initiatives to reduce mortality among these young, previously well patients warrants exploration.

How much do the physician review and InterVA model agree in determining causes of death? A comparative analysis of deaths in rural Ethiopia

Background

Despite it is costly, slow and non-reproducible process, physician review (PR) is a commonly used method to interpret verbal autopsy data. However, there is a growing interest to adapt a new automated and internally consistent method called InterVA. This study evaluated the level of agreement in determining causes of death between PR and the InterVA model.

Methods

Verbal autopsy data for 434 cases collected between September 2009 and November 2012, were interpreted using both PR and the InterVA model. Cohen’s kappa statistic (κ) was used to compare the level of chance corrected case-by-case agreement in the diagnosis reached by the PR and InterVA model.

Results

Both methods gave comparable cause specific mortality fractions of communicable diseases (36.6 % by PR and 36.2 % by the model), non-communicable diseases (31.1 % by PR and 38.2 % by the model) and accidents/injuries (12.9 % by PR and 10.1 % by the model). The level of case-by-case chance corrected concordance between the two methods was 0.33 (95 % CI for κ = 0.29–0.34). The highest and lowest agreements were seen for accidents/injuries and non-communicable diseases; with κ = 0.75 and κ = 0.37, respectively.

Conclusion

If the InterVA were used in place of the existing PR process, the overall diagnosis would be fairly similar. The methods had better agreement in important public health diseases like; TB, perinatal causes, and pneumonia/sepsis; and lower in cardiovascular diseases and neoplasms. Therefore, both methods need to be validated against a gold-standard diagnosis of death.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2032-7) contains supplementary material, which is available to authorized users.

Magnitude and Predictors of Anti-Retroviral Treatment (ART) Failure in Private Health Facilities in Addis Ababa, Ethiopia

BACKGROUND

The public health approach to antiretroviral treatment management encourages the public private partnership in resource limited countries like Ethiopia. As a result, some private health facilities are accredited to provide antiretroviral treatment free services. Evidence on magnitude and predictors of treatment failure are crucial for timely actions. However, there are few studies in this regard.

OBJECTIVE

To assess the magnitude and predictors of ART failure in private health facilities in Addis Ababa, Ethiopia.

METHODS

The study followed retrospective cohort design, with 525 adult antiretroviral treatment clients who started the treatment since October 2009 and have at least six months follow up until December 31, 2013. Kaplan Meier survival analysis and Cox proportional hazard model were used for analysis.

RESULTS

Treatment failure, using the three WHO antiretroviral treatment failure criteria, was 19.8%. The immunologic, clinical, and virologic failures were 15%, 6.3% and 1.3% respectively. The mean and median survival times in months were 41.17 with 95% Confidence Interval (CI) [39.69, 42.64] and 49.00, 95% CI [47.71, 50.29] respectively. The multivariate cox regression analysis showed years since HIV diagnosis (Adjusted Hazard Ratio (AHR)=13.87 with 95% CI [6.65, 28.92]), disclosure (AHR=0.59, 95% CI [0.36, 0.96]), WHO stage at start (AHR=1.84, 95% CI [1.16, 2.93]), weight at baseline (AHR=0.58, 95% CI [0.38, 0.89]), and functionality status at last visit (AHR=2.57, 95% CI [1.59, 4.15]) were independent predictors of treatment failure.

CONCLUSION

The study showed that the treatment failure is high among the study subjects. The predictors for antiretroviral treatment failure were years since HIV diagnosis, weight at start, WHO stage at start, status at last visit and disclosure.

RECOMMENDATIONS

Facilities need to monitor antiretroviral treatment clients to avoid disease progression and drug resistance.

Novel genomic signals of recent selection in an Ethiopian population

The recent feasibility of genome-wide studies of adaptation in human populations has provided novel insights into biological pathways that have been affected by adaptive pressures. However, only a few African populations have been investigated using these genome-wide approaches. Here, we performed a genome-wide analysis for evidence of recent positive selection in a sample of 120 individuals of Wolaita ethnicity belonging to Omotic-speaking people who have inhabited the mid- and high-land areas of southern Ethiopia for millennia. Using the 11 HapMap populations as the comparison group, we found Wolaita-specific signals of recent positive selection in several human leukocyte antigen (HLA) loci. Notably, the selected loci overlapped with HLA regions that we previously reported to be associated with podoconiosis-a geochemical lymphedema of the lower legs common in the Wolaita area. We found selection signals in PPARA, a gene involved in energy metabolism during prolonged food deficiency. This finding is consistent with the dietary use of enset, a crop with high-carbohydrate and low-fat and -protein contents domesticated in Ethiopia subsequent to food deprivation 10 000 years ago, and with metabolic adaptation to high-altitude hypoxia. We observed novel selection signals in CDKAL1 and NEGR1, well-known diabetes and obesity susceptibility genes. Finally, the SLC24A5 gene locus known to be associated with skin pigmentation was in the top selection signals in the Wolaita, and the alleles of single-nucleotide polymorphisms rs1426654 and rs1834640 (SLC24A5) associated with light skin pigmentation in Eurasian populations were of high frequency (47.9%) in this Omotic-speaking indigenous Ethiopian population.

The burden of underweight and overweight among women in Addis Ababa, Ethiopia

BACKGROUND

Obesity and overweight are rising worldwide while underweight rates persist in low-income countries. The aim of this study was to examine changes in the prevalence of underweight and overweight/obesity among non-pregnant women aged 15-49 years, and its socio-demographic correlates in Addis Ababa, Ethiopia.

METHODS

The data are from 2000, 2005 and 2011 nationally representative Ethiopian Demographic and Health Surveys in Addis Ababa. The dependent variable was women's nutritional status measured in terms of body mass index coded in binary outcomes to examine risk of being underweight (<18.5 kg/m2 vs. ≥18.5 kg/m2) or overweight/obese (>25 kg/m2 vs. ≤25 kg/m2). Logistic regression models were used to estimate the strength of associations.

RESULTS

The prevalence of overweight/obesity increased significantly by 28%; while underweight decreased by 21% between 2000 and 2011. Specifically, the prevalence of urban obesity increased by 43.3% i.e., from 3.0% to 4.3% in about 15 years. Overall, more than one-third (34.7%) of women in Addis Ababa were either under or overweight. Women's age and proxies for high socio-economic status (i.e. household wealth quintile, educational attainment, access to improved source of drinking water, and television watching) were positively associated with being overweight. The correlates of underweight were young age and proxies for low socio-economic status (i.e. low wealth quintile, limited access to improved source of water or toilet facility).

CONCLUSIONS

There is a need for policies to recognize the simultaneous public health problems of under and overnutrition, and for programs to target the distinct populations that suffer from these nutrition problems in this urban area.

Applying the InterVA-4 model to determine causes of death in rural Ethiopia

BACKGROUND

In Ethiopia, most deaths take place at home and routine certification of cause of death by physicians is lacking. As a result, reliable cause of death (CoD) data are often not available. Recently, a computerized method for interpretation of verbal autopsy (VA) data, called InterVA, has been developed and used. It calculates the probability of a set of CoD given the presence of circumstances, signs, and symptoms reported during VA interviews. We applied the InterVA model to describe CoD in a rural population of Ethiopia.

OBJECTIVE

VA data for 436/599 (72.7%) deaths that occurred during 2010-2011 were included. InterVA-4 was used to interpret the VA data into probable cause of death. Cause-specific mortality fraction was used to describe frequency of occurrence of death from specific causes.

RESULTS

InterVA-4 was able to give likely cause(s) of death for 401/436 of the cases (92.0%). Overall, 35.0% of the total deaths were attributed to communicable diseases, and 30.7% to chronic non-communicable diseases. Tuberculosis (12.5%) and acute respiratory tract infections (10.4%) were the most frequent causes followed by neoplasms (9.6%) and diseases of circulatory system (7.2%).

CONCLUSION

InterVA-4 can produce plausible estimates of the major public health problems that can guide public health interventions. We encourage further validation studies, in local settings, so that InterVA can be integrated into national health surveys.

Causes of death among females-investigating beyond maternal causes: a community-based longitudinal study

Background

In developing countries, investigating mortality levels and causes of death among all age female population despite the childhood and maternal related deaths is important to design appropriate and tailored interventions and to improve survival of female residents.

Methods

Under Kilite-Awlealo Health and Demographic Surveillance System, we investigated mortality rates and causes of death in a cohort of female population from 1st of January 2010 to 31st of December 2012. At the baseline, 33,688 females were involved for the prospective follow-up study. Households under the study were updated every six months by fulltime surveillance data collectors to identify vital events, including deaths. Verbal Autopsy (VA) data were collected by separate trained data collectors for all identified deaths in the surveillance site. Trained physicians assigned underlining causes of death using the 10th edition of International Classification of Diseases (ICD). We assessed overall, age- and cause-specific mortality rates per 1000 person-years. Causes of death among all deceased females and by age groups were ranked based on cause specific mortality rates. Analysis was performed using Stata Version 11.1.

Results

During the follow-up period, 105,793.9 person-years of observation were generated, and 398 female deaths were recorded. This gave an overall mortality rate of 3.76 (95% confidence interval (CI): 3.41, 4.15) per 1,000 person-years. The top three broad causes of death were infectious and parasitic diseases (1.40 deaths per 1000 person-years), non-communicable diseases (0.98 deaths per 1000 person-years) and external causes (0.36 per 1000 person-years). Most deaths among reproductive age female were caused by Human Deficiency Virus/Acquired Immune Deficiency Virus (HIV/AIDS) and tuberculosis (0.14 per 1000 person-years for each cause). Pregnancy and childbirth related causes were responsible for few deaths among women of reproductive age—3 out of 73 deaths (4.1%) or 5.34 deaths per 1,000 person-years.

Conclusions

Communicable diseases are continued to be the leading causes of death among all age females. HIV/AIDS and tuberculosis were major causes of death among women of reproductive age. Together with existing efforts to prevent pregnancy and childbirth related deaths, public health and curative interventions on other causes, particularly on HIV/AIDS and tuberculosis, should be strengthened.

Causes of death among adults in northern Ethiopia: evidence from verbal autopsy data in health and demographic surveillance system

BACKGROUND

In countries where registration of vital events is lacking and the proportion of people who die at home without medical care is high, verbal autopsy is used to determine and estimate causes of death.

METHODS

We conducted 723 verbal autopsy interviews of adult (15 years of age and above) deaths from September 2009 to January 2013. Trained physicians interpreted the collected verbal autopsy data, and assigned causes of death according to the international classification of diseases (ICD-10). We did analysis of specific as well as broad causes of death (i.e. non-communicable diseases, communicable diseases and external causes of death) by sex and age using Stata version 11.1. We performed logistic regression to identify socio-demographic predictors using odds ratio with 95% confidence interval and a p-value of 0.05.

FINDINGS

Tuberculosis, cerebrovascular diseases and accidental falls were leading specific causes of death accounting for 15.9%, 7.3% and 3.9% of all deaths. Two hundred sixty three (36.4% [95% CI: 32.9, 39.9]), 252 (34.9% [95% CI: 31.4, 38.4]) and 89 (12.3% [95% CI: 10.1, 14.9]) deaths were due to non-communicable, communicable diseases, and external causes, respectively. Females had 1.5 times (AOR = 1.53 [95% CI: 1.10, 2.15]) higher odds of dying due to communicable diseases than males. The odds of dying due to external causes were 4 times higher among 15-49 years of age (AOR  = 4.02 [95% CI: 2.25, 7.18]) compared to older ages. Males also had 1.7 times (AOR = 1.70 [95% CI: 1.01, 2.85]) higher odds of dying due to external causes than females.

CONCLUSION

Tuberculosis, cerebrovascular diseases and accidental falls were the top three causes of death among adults. Efforts to prevent tuberculosis and cerebrovascular diseases related deaths should be improved and safety efforts to reduce accidents should also receive attention.

Attitudes toward neurosurgery in a low-income country: a qualitative study

OBJECTIVE

To adapt a study exploring the needs of neurosurgery patients in a tertiary care hospital in Canada to examine, for the first time, the perspectives of neurosurgery patients in a low-income country with limited health care resources.

METHODS

Semistructured interviews were conducted with 25 neurosurgery patients at Tikur Anbessa Specialized Teaching Hospital in Addis Ababa, Ethiopia. Interviews were conducted in Amharic or Oromo, translated into English, and subjected to modified thematic analysis.

RESULTS

The following 5 themes emerged: 1) With limited resources, many patients did not seek information outside of that obtained during the clinical encounter. 2) Patients valued direct verbal communication and deferred to the surgeon's authority. 3) Religion played an instrumental role in patient attitudes toward surgery. 4) Most patients did not feel anxious about surgery. 5) A few patients did not inform family members about their medical condition.

CONCLUSIONS

Qualitative research methodology in neurosurgery can be successfully adapted from resource-abundant to resource-poor contexts. In low-income countries, patients are faced with limited options for self-education and self-empowerment, and fatalistic and paternalistic attitudes may be prevalent. Local cultural values and expectations can influence practice differently than they do in resource-rich countries.

Retrospective analysis of mortalities in a tertiary care hospital in Northeast Ethiopia

Background

Mortalities in the health care set up are prevalent, and causes are multifactorial with variations from area to area and also from ward to ward in the same health care set up. Analysis of mortalities and its causes in Ethiopian hospitals including Dessie Referral Hospital is not adequately known. Thus, the aim of this study is to determine the prevalence of mortalities and its causes in the Dessie Referral Hospital, Northeast Ethiopia.

Methods

A retrospective analysis of mortalities during a three year period (September 2010–2012) was conducted in the Dessie Referral Hospital from August-September, 2012. All in hospital mortalities in the hospital during the last three years were included in the study. Data were collected from patient discharge recording books. Finally, data were entered into SPSS windows version 16.0 and descriptive statistics were generated to meet the study objective.

Results

During the last 3 years there were 1,481 (4.8%) mortalities in the hospital. Around 60.0% of the mortalities were among male patients, and two third of the mortalities were among patients aged 15 years or older. The majority of the mortalities (38.9%) were in the medical ward followed by pediatric (34.6%) and surgical (18.2%) wards. Most of the mortalities (34.8%) occurred during 2011 while least was in 2012 (31.8%). HIV/AIDS (14.8%), pneumonia (9.9%), and sepsis/shock (7.6%) were the three most common causes of mortality in the hospital during the three year period. On average, patients stayed for 2.86 (±2. 99) days in the wards before mortality.

Conclusion

Mortalities in the wards of the Dessie Referral Hospital were high and the causes were mainly of infectious origin, HIV/AIDS and its complications being the most common causes. This calls for an integrated effort to reduce in hospital mortalities by equipping the hospital and its health care providers with the skills and medical supplies required for proper management of the most common causes of in hospital mortality reported in this study.

Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa

The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a major cause of disability and premature death. Third, the burden of risk factors for atherosclerosis is increasing rapidly in most urban and some rural regions. A concerted effort to understand the primary drivers of this increase in cardiac risk factors is required to prevent a future epidemic of atherosclerosis and its sequelae.