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Global, regional and national burden of maternal haemorrhage (2000-2021) and projections to 2050 in 204 countries and territories

Por: Ayele · M. · Duko · B. · Tiruye · T. · Ward · P. R. · Mwanri · L. · Pereira · G. · Kitaw · T. A. · Abate · B. B. · Lake · E. S. · Alamrew · A. · Yetwale · A. · Yilak · G. · Tilahun · B. D. · Mulugeta · C. · Emagneneh · T. · Gebremedhin · A. T.
Objective

To estimate the global, regional and national burden of maternal haemorrhage (2000–2021) and its 2050 projections in 204 countries and territories.

Design

This study systematic analysis of the burden of maternal haemorrhage sourced data from the Global Burden of Disease (GBD) 2021 study. We estimated the incidence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) due to maternal haemorrhage. Changes in the burden from 2000 to 2021 were computed using AAPC. To detect statistically notable changes in the trends of maternal haemorrhage metrics between 2000 and 2021, Joinpoint regression analysis using the Joinpoint Regression Programme was conducted. We also projected mortality rates, YLDs and YLLs through to 2050 using maps and trends generated by the GBD Foresight visualisation tool.

Results

Globally, the incidence of maternal haemorrhage among women aged 15–49 years declined from 881.98 per 100 000 reproductive aged women (95% uncertainty interval (UI) 687.01 to –1150.23) in 2000 to 714.00 (95% UI 556.97 o t908.54) in 2021, with an average annual percentage change (AAPC) of –0.91 (–1.37 to –0.49). Similar downward trends were observed for maternal deaths, DALYs, YLDs and YLLs attributable to maternal haemorrhage, with AAPCs of –3.78 (–4.39 to –3.18), –4.68 (–4.83 to –4.55), –1.21 (–1.54 to –0.89) and –4.80 (–5.10 to –4.52), respectively. Sub-Saharan Africa, particularly Western Sub-Saharan Africa, recorded the highest burden in 2021, which is almost 300 times higher than in Western Europe. Elevated rates of mortality, DALYs and YLDs were also evident in Sierra Leone, Chad, Niger, Mali, Nigeria, Burkina Faso, Central African Republic, Somalia and South Sudan in 2021 and projections for 2050. However, the high-income Asia Pacific region had the lowest incidence, DALYs and YLDs at 151.32 (109.63–203.68), 2.21 (1.72–2.86) and 0.87 (0.46–1.38) per 1 00 000 women, respectively. Australasia recorded the lowest maternal death count and YLLs attributed to maternal haemorrhage at 0.69 (0.50–0.90) and 0.56 (0.41–0.74) per 1 00 000 women, respectively.

Conclusion

While the global burden of maternal haemorrhage has declined over time, significant regional and national inequities persist. Even though the 2050 projections show improvement in the burden of maternal haemorrhage, there is also regional and national variation in the rate of decrease in maternal haemorrhage burden. Targeted, context-specific interventions are urgently needed to reduce maternal haemorrhage-related mortality and morbidity.

Time to first optimal glycaemic control and associated factors among adult patients with diabetes at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia: a retrospective cohort study

Por: Getahun · A. D. · Ayele · E. M. · Tsega · T. D. · Anberbr · S. S. · Geremew · G. W. · Biyazin · A. A. · Taye · B. M. · Mekonnen · G. A.
Objective

To assess the time to first optimal glycaemic control and its predictors among adult patients with type 1 and type 2 diabetes at the University of Gondar Comprehensive Specialized Hospital in Ethiopia.

Design

A retrospective cohort study.

Setting

University of Gondar Comprehensive Specialized Hospital, northwest, Ethiopia.

Participants

We recruited 423 adult diabetic patients who were diagnosed between 1 January 2018 and 30 December 2022 at the University of Gondar Comprehensive Specialized Hospital.

Outcome measures

The primary outcome was the time from diagnosis to the achievement of the first optimal glycaemic control, measured in months. A Cox proportional hazards regression model was fitted to identify predictors of time to first optimal glycaemic control. Data were collected with KoboToolbox from patient medical charts and exported to Stata V.17. The log-rank test was used to determine the survival difference between subgroups of participants.

Results

Median time to first optimal glycaemic control was 10.6 months. Among 423 adult diabetic patients, 301 (71.16%) achieved the first optimal glycaemic control during the study period. Age category (middle age (adjusted HR (AHR)=0.56, 95% CI 0.41 to 0.76), older age (AHR=0.52, 95% CI 0.33 to 0.82)), comorbidity (AHR=0.52, 95% CI 0.35 to 0.76), therapeutic inertia (AHR=0.20, 95% CI 0.13 to 0.30) and medication non-compliance (AHR=0.49, 95% CI 0.27 to 0.89) were significant predictors of time to optimal glycaemic control.

Conclusion

The median time to first optimal glycaemic control was prolonged. Diabetic care should focus on controlling the identified predictors to achieve optimal glycaemic control early after diagnosis.

Opportunities, challenges and perceived strategies for the uptake of the OraQuick HIV self-test among female sex workers in Ethiopia: a qualitative study

Por: Ayele · M. · Alamrew · A. · Lake · E. S. · Yilak · G. · Tilahun · B. D. · Tenaw · L. A. · Tunta · A. · Erega · B. B. · Gashaw · A. · Kumie · G.
Objective

To explore the opportunities, challenges and perceived strategies for the uptake of OraQuick HIV self-testing (HIVST) among female sex workers in Ethiopia.

Design

A phenomenological study design, with the Integrated Behavioural Model used as a framework for analysis and interpretation.

Setting

Woldia, North Wollo, Ethiopia, 13–30 February 2024.

Participants

Twenty female sex workers and 18 key informants in Woldia participated in in-depth interviews, key informant interviews and focus group discussions.

Results

The advantages related to OraQuick HIVST include its privacy, ease of use, reduced waiting time, lowered transportation costs, usability for immobile individuals, application in screening for index case testing programmes, providing confidence and reliability and the elimination of the need for healthcare providers during testing. Perceived possible challenges for the uptake of OraQuick HIVST included kit shortage, absence of policies or guidelines for HIVST, lack of post-test counselling and immediate treatment for positive individuals, potential psychological trauma such as suicidal ideation or attempts, lack of linkage to care for those with reactive results, inaccurate reporting of positive results or result concealment and doubts about reliability before education. Strategies perceived for enhancing the uptake of OraQuick HIVST included making the HIVST kit accessible to higher education communities, addressing HIVST-related doubts by including phone or email contact information, advocating and creating awareness about OraQuick HIVST and ensuring the availability of kits in easily accessible locations.

Conclusion

The study findings highlight many positive opportunities related to the uptake of OraQuick HIVST. Policymakers should prioritise addressing the challenges identified and implementing the proposed strategies to enhance the uptake of OraQuick HIVST, potentially leading to improved HIV testing rates and outcomes.

Cancellation of elective surgery and its associated factors among scheduled patients at Debre Markos Comprehensive Specialized Hospital, Amhara Region, North West Ethiopia: a cross-sectional explanatory mixed-methods approach

Por: Getie · A. · Ayele · B. · Getie · G. A.
Objective

To assess the magnitude of elective surgery cancellation and associated factors among scheduled patients at Debre Markos Comprehensive Specialized Hospital, Amhara region, North West Ethiopia, 2023.

Design

A cross-sectional explanatory mixed-methods approach was used.

Setting

The study was carried out at Debre Markos Comprehensive Specialized Hospital between 1 March and 30 April 2023.

Participants

A total of 340 participants were included in the study, comprising 194 males and 146 females from various ethnic backgrounds. All participants scheduled for elective surgical procedures were selected using a simple random sampling method. Those with missing key information, such as operation or cancellation dates, were excluded from the study.

Primary and secondary outcome measures

The primary outcome was the status of elective surgery, whether it was cancelled or conducted. The secondary outcomes focused on identifying the factors associated with elective surgery cancellations.

Result

Elective surgery cancellations accounted for 24.40% of the scheduled procedures. Significant factors associated with cancellation included residing in a rural area (rural area (AOR)=2.47; 95% CI: 1.19 to 5.11), overscheduling (AOR=6.85; 95% CI: 2.27 to 20.63), lack of health insurance (AOR=8.68; 95% CI: 2.18 to 34.61), unstable medical conditions (AOR=9.99; 95% CI: 2.57 to 38.92), absence of a recovery bed (AOR=14.91; 95% CI: 5.10 to 43.59) and missing preoperative laboratory orders (AOR=18.16; 95% CI: 5.22 to 63.11).

Conclusion

A substantial number of elective surgeries were cancelled on the day they were scheduled. Key contributing factors included patients’ medical conditions, health insurance status, place of residence, availability of preoperative laboratory tests, overscheduling and lack of recovery beds. To reduce cancellations, healthcare stakeholders should enhance preoperative assessments, schedule procedures based on estimated surgical duration and ensure the availability of essential operating room resources.

Cardiovascular disease risk and its determinants among hypertensive patients in Eastern Ethiopia: an institution-based cross-sectional study

Por: Ali · S. Y. · Shegere · M. M. · Abdulahi · A. · Hussein · A. A. · Abdinur · A. H. · Muhumed · A. A. · Ayele · Z. A. · Abebe · D. · Abdu · S. M. · Gemechu · W. D.
Objectives

This study aims to assess the level of cardiovascular disease (CVD) risk and its associated determinants among hypertensive patients in Jigjiga, Somali Region, Ethiopia using the WHO 10-year CVD risk score.

Design

An institution-based cross-sectional study design was employed.

Setting

Hypertensive patients aged 40–74 years in two public hospitals in Jigjiga, Somali Region, Ethiopia, from 20 December 2023 to 20 February 2024.

Participants

Randomly selected 344 hypertensive patients aged 40–74 years with a duration of 1 year or more from the time of diagnosis and at least having 6-month follow-up.

Primary outcome measures

10-year CVD risk level was assessed by using WHO 10-year CVD risk score. Risk levels were categorised as low (

Secondary outcome measures

Associated factors influencing CVD risk.

Results

The study included 341 hypertensive individuals, with a 99.1% response rate. Of the respondents, 58.9% were men. The overall prevalence of CVD risk within the coming 10 years was 134 (39.3%; 95% CI: 34.1% to 44.5%). Multivariable logistic regression analysis identified age, khat chewing, smoking and comorbid conditions as significant independent predictors of CVD risk. Specifically, individuals aged 60–69 years had an adjusted OR (AOR) of 3.97 (95% CI: 1.94 to 8.16) and those aged 70–74 years had an AOR of 2.99 (95% CI: 1.57 to 5.71). Khat chewers had an AOR of 2.58 (95% CI: 1.22 to 5.46), smokers an AOR of 3.44 (95% CI: 1.59 to 7.48) and individuals with comorbidities an AOR of 2.42 (95% CI: 1.47 to 3.99).

Conclusion

There is a significant increase in 10-year CVD risk among hypertensive patients in the study area. Age, khat chewing, smoking and comorbidities were independent predictors. Regular CVD risk screening for older patients, focused health education to reduce khat and tobacco use and integrated management of comorbidities are essential to lower future cardiovascular risk.

Forecasting birth trends in Ethiopia using time-series and machine-learning models: a secondary data analysis of EDHS surveys (2000-2019)

Por: Alemayehu · M. A. · Ejigu · A. G. · Mekonen · H. · Teym · A. · Temesegen · A. · Bayeh · G. M. · Yeshiwas · A. G. · Anteneh · R. M. · Atikilit · G. · Shimels · T. · Yenew · C. · Ayele · W. M. · Ahmed · A. F. · Kassa · A. A. · Tsega · T. D. · Tsega · S. S. · Mekonnen · B. A. · Malkamu · B.
Objective

Ethiopia, the second most populous country in Africa, faces significant demographic transitions, with fertility rates playing a central role in shaping economic and healthcare policies. Family planning programmes face challenges due to funding limitations. The recent suspension of the US Agency for International Development funding exacerbates these issues, highlighting the need for accurate birth forecasting to guide policy and resource allocation. This study applied time-series and advanced machine-learning models to forecast future birth trends in Ethiopia.

Design

Secondary data from the Ethiopian Demographic and Health Survey from 2000 to 2019 were used. After data preprocessing steps, including data conversion, filtering, aggregation and transformation, stationarity was checked using the Augmented Dickey-Fuller (ADF) test. Time-series decomposition was then performed, followed by time-series splitting. Seven forecasting models, including Autoregressive Integrated Moving Average, Prophet, Generalised Linear Models with Elastic Net Regularisation (GLMNET), Random Forest and Prophet-XGBoost, were built and compared. The models’ performance was evaluated using key metrics such as root mean square error (RMSE), mean absolute error (MAE) and R-squared value.

Results

GLMNET emerged as the best model, explaining 77% of the variance with an RMSE of 119.01. Prophet-XGBoost performed reasonably well but struggled to capture the full complexity of the data, with a lower R-squared value of 0.32 and an RMSE of 146.87. Forecasts were made for both average monthly births and average births per woman over a 10-year horizon (2025–2034). The forecast for average monthly births indicated a gradual decline over the projection period. Meanwhile, the average births per woman showed an increasing trend but fluctuated over time, influenced by demographic shifts such as changes in fertility preferences, age structure and migration patterns.

Conclusions

This study demonstrates the effectiveness of combining time-series models and machine learning, with GLMNET and Prophet XGBoost emerging as the most effective. While average monthly births are expected to decline due to demographic transitions and migration, the average births per woman will remain high, reflecting persistent fertility preferences within certain subpopulations. These findings underscore the need for policies addressing both population trends and sociocultural factors.

Incidence of maternal near miss among women in labour admitted to hospitals in Ethiopia

To assess the incidence of maternal near miss and contributing factors among hospitals in Ethiopia. The study also assessed the ability of hospitals to provide signal functions of emergency obstetric care and its regional distribution.
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