Burden of lower respiratory infections and associated risk factors across regions in Ethiopia: a subnational analysis of the Global Burden of Diseases 2019 study.

OBJECTIVE: This analysis is to present the burden and trends of morbidity and mortality due to lower respiratory infections (LRIs), their contributing risk factors, and the disparity across administrative regions and cities from 1990 to 2019. DESIGN: This analysis used Global Burden of Disease 2019 framework to estimate morbidity and mortality outcomes of LRI and its contributing risk factors. The Global Burden of Disease study uses all available data sources and Cause of Death Ensemble model to estimate deaths from LRI and a meta-regression disease modelling technique to estimate LRI non-fatal outcomes with 95% uncertainty intervals (UI). STUDY SETTING: The study includes nine region states and two chartered cities of Ethiopia. OUTCOME MEASURES: We calculated incidence, death and years of life lost (YLLs) due to LRIs and contributing risk factors using all accessible data sources. We calculated 95% UIs for the point estimates. RESULTS: In 2019, LRIs incidence, death and YLLs among all age groups were 8313.7 (95% UI 7757.6-8918), 59.4 (95% UI 49.8-71.4) and 2404.5 (95% UI 2059.4-2833.3) per 100 000 people, respectively. From 1990, the corresponding decline rates were 39%, 61% and 76%, respectively. Children under the age of 5 years account for 20% of episodes, 42% of mortalities and 70% of the YLL of the total burden of LRIs in 2019. The mortality rate was significantly higher in predominantly pastoralist regions-Benishangul-Gumuz 101.8 (95% UI 84.0-121.7) and Afar 103.7 (95% UI 86.6-122.6). The Somali region showed the least decline in mortality rates. More than three-fourths of under-5 child deaths due to LRIs were attributed to malnutrition. Household air pollution from solid fuel attributed to nearly half of the risk factors for all age mortalities due to LRIs in the country. CONCLUSION: In Ethiopia, LRIs have reduced significantly across the regions over the years (except in elders), however, are still the third-leading cause of mortality, disproportionately affecting children younger than 5 years old and predominantly pastoralist regions. Interventions need to consider leading risk factors, targeted age groups and pastoralist and cross-border communities.

Placental and Umbilical Cord Indices and Their Association with Fetal Distress in Hadiya Zone Public Hospitals, Southern Ethiopia: A Cross-Sectional Study.

BACKGROUND: The placenta and umbilical cord have been considered as significant contributors to the perinatal outcome and have contributed to some degree to neonatal mortality. The placenta has a very crucial role in normal fetal development. After about four weeks of gestation, the only link of the fetus to the placenta is the umbilical cord. Very little is known about placental and umbilical indices in Ethiopia. This study was aimed to determine placental and umbilical cord indices and their association with fetal distress in Hadiya zone public hospitals, southern Ethiopia. METHODS: This study included 249 placentae with the attached umbilical cord from normal singleton live birth with known gestational age. Bivariable and multivariable logistic regression was used, and variables with p < 0.25 in the bivariable analysis were entered into a multivariable logistic regression to identify the independent factors for the outcome variable. Odds ratios with 95% confidence were computed, and statistical significance was declared at p-value <0.05. RESULTS: Three-fourth (75.9%) of diameter of studied placenta was in normal range and 18.1%, 6.0% below and above normal range, respectively. About one-third (32.9%) of umbilical cords were short, 61.8% normal, and 5.2% long. Newborns with thin placenta [AOR = 3.43; 95% CI: 1.25, 9.40], short cord length [AOR = 3.43; 95% CI: 1.66, 7.09] and long cord length [AOR = 7.55; 95% CI: 2.07, 27.53] were significantly associated with fetal distress. CONCLUSION: In this study, deviation of umbilical cord length from the normal range and placental thickness were significantly associated with fetal distress. In addition, fetal distress was also associated with gestation age and sex of the newborn.