Medical and psychological consequences of rape among survivors during armed conflicts in northeast Ethiopia

BACKGROUND

Rape is the most common act of violence against women during wartime which is considered interpersonal, social and political violence because survivors usually suffer from stigma and discrimination in the community. Sexual violence is a serious threat to women's health. The psychological and medical consequences of rape during the conflict period are not well documented. Therefore, this study investigated the psychological and medical consequences of rape among survivor in the northern Ethiopia conflict, which occurred since 2020-2022.

METHODS

A retrospective cross-sectional survey supplemented with a qualitative data was conducted among survivors of rape recorded until June 2022. Health institutions that provide maternal and child health services in the study area were included. All rape victims who received medical care following the incident were included. Victims who were found in active war areas or rape care recorded before wartime were excluded. To understand the experience of raped women's psychological consequences related to sexual assault we conducted 23 in-depth interviews. Thematic analysis was used to conduct qualitative interpretation.

RESULTS

The mean age of the participants was 31.66 (SD ± 20.95) years. One-third of 92(33.9%) of the survivors were diagnosed positive for sexually transmitted infections. Chlamydia 54(58.4%) and HIV 32(34.8%) were the most frequently diagnosed infections. Among the rape survivors, one-tenth 29(10.7%) of them were positive for pregnancy, and induced abortion was done for 13 (44.8%) women who got pregnant due to sexual assault. The armed groups not only have sexual interests but inhumane individuals and consider rape as their way of expressing abjection to civilians. Survivors of raped women are confronted with social rejection and exclusion in the community that aggravates the traumatic process. Because of shame and fear, rape survivors often do not seek help but have to be offered support proactively. The victims claimed that they didn't able to return to their previous life and considered their future in peril.

CONCLUSION

Conflict has a multidimensional devastating life effect, especially on women's health. The victims experienced many physical and psychological consequences. Hence, resolving conflicts with peaceful discussion has numerous benefits for civilians.

Nearly one-in-five mothers avoid colostrum in North Wollo Zone, Ethiopia: an institution-based cross-sectional study

Colostrum contains antibodies that protect the newborn against disease. Despite this fact, many Ethiopian mothers see colostrum feeding as a cause of neonatal morbidity and mortality. These mothers believe that colostrum must discard to alleviate this effect. However, the cause of this misconception about colostrum was not well researched, particularly in this study area. The main aim of the present study was to assess colostrum avoidance and associated factors among mothers having children aged 6-59 months in North Wollo Zone, Northeastern Ethiopia. An institution-based cross-sectional study design was used. Descriptive statistics, binary and multivariable logistic regression analyses were used for the statistical analysis. The prevalence of colostrum avoidance was 19 % (95 % CI 15⋅03, 22⋅89 %) among mother-child pair aged 6-59 months. In multivariable logistic regression analysis, the most important predictors were breast-feeding initiation Adjusted Odds Ratio (AOR) 6⋅369; 95 %, Confidence Interval (CI) (3⋅067, 13⋅224), pre-lacteal feeding AOR 3⋅464; 95 % CI (1⋅721, 6⋅973), shared household decision about child feeding AOR 3⋅585; 95 % CI (1⋅563, 7⋅226), Index child sex AOR 2⋅103; 95 % CI (1⋅015, 4⋅358) and health facility delivery AOR 3⋅033; 95 % CI (1⋅293, 7⋅117). The colostrum avoidance in the present study was 19 %. The study recommends the promotion of institutional delivery, timely initiation of breast-feeding, the shared household decisions about child feeding, avoiding sex preferences and stopping pre-lacteal feeding were critically important.

Is preterm birth associated with intimate partner violence and maternal malnutrition during pregnancy in Ethiopia? A systematic review and meta analysis

BACKGROUND

Despite remarkable progress in the reduction of under-five mortality, preterm birth associated mortality and morbidity remains a major public health problem in Sub-saharan Africa. In Ethiopia, study findings on the association of preterm birth with intimate partner violence and maternal malnutrition have been inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled effect of intimate partner violence and maternal malnutrition on preterm birth.

METHODS

International databases including PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library, were systematically searched. All identified observational studies and/or predictors were included. I2 statistics and Egger's test were used to assess the heterogeneity and publication biases of the studies. A random-effects model was computed to estimate the prevalence and its determinants of preterm birth.

RESULTS

The random effects meta-analysis showed that a pooled national prevalence of preterm birth was 13% (95% CI: 10.0%, 16.0%). The highest prevalence of preterm birth was 25% (95% CI: 21.0%, 30.0%) in Harar, and the lowest prevalence was 8% in Southern Nations Nationalities People of Representatives. The meta-analysis suggested a decrease in preterm birth of up to 61% among women receiving antenatal care [POR = 0.39 (95% CI: 0.21, 0.72)]. Women who experienced intimate partner violence [POR = 2.52 (95% CI: 1.68, 3.78)], malnutrition during pregnancy [POR = 2.00 (95% CI: 1.16, 3.46)], and previous preterm birth [POR = 3.73 (95% CI: 2.37, 5.88)] had significantly higher odds of preterm birth.

CONCLUSION

One in every eight live births in Ethiopia were preterm. Women who experienced intimate partner violence, malnutrition, and had previous preterm exposure were significantly associated with preterm birth. Thus, improving antenatal care visits and screening women who experience previous preterm birth are key interventions. The Federal Ministry of Health could be instrumental in preventing intimate partner violence and improving the nutritional status of pregnant women through proper and widespread implementation of programs to reduce preterm birth.

Exclusive breastfeeding lowers the odds of childhood diarrhea and other medical conditions: evidence from the 2016 Ethiopian demographic and health survey

BACKGROUND

Lack of exclusive breastfeeding during the first 6 months of infant life contributes to childhood morbidity and mortality. This study aimed to investigate the association of exclusive breastfeeding and childhood illnesses in Ethiopia.

METHODS

A secondary data analysis was conducted using data from the 2016 Ethiopian Demographic and Health Survey (EDHS). Descriptive and multivariable logistic regression analyses were carried out.

RESULTS

A total of 1034 mother-infant pairs were included in the analysis. The overall magnitude of exclusive breastfeeding among infants aged under 6 months was 87.6% (95% CI: 84.3-90.3%). Compared to infants who were non-exclusively breastfed, the odds of having an illness with fever in the last 2 weeks among infants who were exclusively breastfed decreased by 66% (AOR: 0.34; 95% CI: 0.16, 0.75). Similarly, exclusively breastfed infants had lower odds of having an illness with a cough (AOR: 0.38; CI: 0.20, 0.72) and having diarrhea (AOR: 0.33; CI: 0.13, 0.83) compared to non-exclusively breastfed infants.

CONCLUSION

Exclusive breastfeeding lowers the odds of an illness with fever, illness with cough and diarrhea. The findings of this study implicate the need for promotion of exclusive breastfeeding in the country.

Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis

OBJECTIVES

The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I² test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias.

RESULTS

We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I² = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations.

CONCLUSIONS

Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.

Knowledge on Intrapartum Danger Sign Influences Place of Delivery: The Case of Raya Kobo District, Northeastern Ethiopia

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.

The effect of antenatal care on colostrum avoidance in pastoralists: The case of Afar, Northeast Ethiopia

Breastfeeding is sufficient for infants in the first 6 months of life and is important to maintain maternal health. Evidences revealed that neonatal mortality is higher among children who received colostrum as compared to those who are deprived of colostrum. Therefore, this study aimed to assess the factors associated with colostrum avoidance practice among pastoralists in Afar Regional State, Northeast Ethiopia. A community-based cross-sectional study was conducted on 1188 mother-child pairs in Afar Regional State in June 2016. Univariable and multivariable logistic regression analyses were carried out to identify the predictors of colostrum avoidance. Statistical significance was declared at P-value <.05. About 40% of children deprived of colostrum. Mothers aged 20 to 34 years (AOR: 1.79; 95% CI: 1.18, 2.73), not attending antenatal checkup (AOR: 1.82; 95% CI: 1.64, 2.85), receiving prelacteal feeding (AOR: 2.21; CI: 1.88, 3.93) and late initiation of breastfeeding (AOR: 2.71; 95% CI: 2.02, 3.65) were positively associated with colostrum avoidance. Nearly 4 in 10 children deprived of colostrum. Therefore, promoting antenatal care and strengthening service-based counseling on proper newborn feeding practices will be important to improve colostrum feeding.

Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis

Background

Uterine rupture has a significant public health importance, contributing to 13% of maternal mortality and 74%-92% of perinatal mortality in Sub-Saharan Africa, and 36% of maternal mortality in Ethiopia. The prevalence and predictors of uterine rupture were highly variable and inconclusive across studies in the country. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence and predictor of uterine rupture in Ethiopia.

Methods

This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 checklist. PubMed, Cochrane Library, Google Scholar, and African Journals Online databases were searched. The Newcastle- Ottawa quality assessment tool was used for critical appraisal. I² statistic and Egger’s tests were used to assess the heterogeneity and publication bias, respectively. The random-effects model was used to estimate the pooled prevalence and odds ratios with a 95% confidence interval.

Results

Sixteen studies were included, with a total of 91,784 women in the meta-analysis. The pooled prevalence of uterine rupture was 2% (95% CI: 1.99, 3.01). The highest prevalence was observed in the Amhara regional state (5%) and the lowest was in Tigray region (1%). Previous cesarean delivery (OR = 9.95, 95% CI: 3.09, 32.0), lack of antenatal care visit (OR = 8.40, 95% CI: 4.5, 15.7), rural residence (OR = 4.75, 95% CI: 1.17, 19.3), grand multiparity (OR = 4.49, 95% CI: 2.83, 7.11) and obstructed labor (OR = 6.75, 95%CI: 1.92, 23.8) were predictors of uterine rupture.

Conclusion

Uterine rupture is still high in Ethiopia. Therefore, proper auditing on the appropriateness of cesarean section and proper labor monitoring, improving antenatal care visit, and birth preparedness and complication readiness plan are needed. Moreover, early referral and family planning utilization are the recommended interventions to reduce the burden of uterine rupture among Ethiopia women.

Adverse obstetric outcomes in public hospitals of southern Ethiopia: the role of parity

Purpose: Direct obstetric causes have a significant contribution for severe maternal morbidities and mortalities, although the effect of grand multiparity on adverse obstetric outcomes remains controversial across studies. This study aimed to compare obstetric outcomes in grand multiparous and low multiparous women in two hospitals of southern Ethiopia.Materials and methods: A comparative cross-sectional study was conducted in one general and one comprehensive specialized hospitals in 2018. Four hundred and sixty-one mothers were included in the study. Data were collected by structured questionnaire and extraction sheets from clinical documents, and were analyzed using STATA version 14 (StataCorp, College Station, TX, USA).Results: About 39% of the included mothers had at least one adverse obstetric outcome. Hypertensive disorders of pregnancy, antepartum hemorrhage, and premature rupture of membrane and were higher in the grand multiparous mothers. However, obstructed labor and risk of cesarean delivery were higher in low multiparous women. History of medical illnesses, previous cesarean delivery, and high birth weight were independent predictors of adverse maternal outcomes regardless of parity. However, parity did not show statistically significant difference in obstetric outcomes.Conclusion: Parity did not show statistically significant difference in experiencing adverse obstetric outcomes in women. Early identification and treatment of high-risk mothers is recommended regardless of parity.

Knowledge on Intrapartum Danger Sign Influences Place of Delivery: The Case of Raya Kobo District, Northeastern Ethiopia

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.

Burden, risk factors and outcomes of hyperemesis gravidarum in low-income and middle-income countries (LMICs): systematic review and meta-analysis protocol

INTRODUCTION

Hyperemesis gravidarum (HG) is a pregnancy condition characterised by excessive nausea and vomiting resulting in dehydration, weight loss and serious adverse pregnancy outcomes including termination of pregnancies. Even though evidence in low-income and middle-income countries (LMICs) is limited, the prevalence of HG in pregnancy ranges from 0.3% to 10.8%. With this systematic review and meta-analysis, we aim to determine the prevalence/burden, risk factors, and maternal and perinatal outcomes of HG in LMICs.

METHODS

PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS databases will be searched. Reference lists of selected articles will be assessed in order to identify other potential studies of interest. Observational studies and (non) randomised controlled trials conducted from January 2000 to September 2018 in LMIC will be included. A weighted inverse-variance meta-analysis using fixed-effects and random-effects model will be done to generate a pooled estimate. Funnel plot and Egger's regression statistical test will be applied to check publication bias. Heterogeneity among studies will be checked using Τ² to determine dispersion. Moreover, meta-regression analysis will be performed to investigate the source of heterogeneity. STATA V.14 will be used to analyse the data.

ETHICS AND DISSEMINATION

Formal ethical approval and patient consent are not required; as primary data collection will not be employed. The result will be published in a peer-reviewed scientific journal and will be presented at scientific conferences and public press.

PROSPERO REGISTRATION NUMBER

CRD42018096284.

Risk factors for low birth weight in hospitals of North Wello zone, Ethiopia: A case-control study

BACKGROUND

Low birth weight at birth is an important underlying contributor for neonatal and infant mortality. It accounts for nearly half of all perinatal deaths. Identifying predictors of low birth weight is the first essential step in designing appropriate management strategies. Hence, this study aimed to identify risk factors for low birth weight in hospitals of northeastern Ethiopia.

METHODS

An institution based case-control study design was conducted from 10th April to 15th December 2016. Three hundred sixty mother-infant pairs (120 low birth weight babies as cases and 240 normal birth weights as controls) were included in the study. Data were collected by face-to-face interview. Univariable and multivariable logistic regression models were computed to examine the effect of independent variables on outcome variable using SPSS 20.0. Variables with p-value <0.05 were considered statistically significant.

RESULTS

The mean (±SD) gestational age and birth weight (±SD) were 39.2 (±1.38) weeks and 2800 (±612), grams respectively. Partner's education/being illiterate (AOR: 4.09; 95% CI 1.45, 11.50), antenatal care visit at private health institutions (AOR: 0.13; 95% CI 0.02, 0.66), having history of obstetric complications (AOR: 5.70; 95% CI 2.38, 13.63), maternal weight during pregnancy (AOR: 4.04; 95% CI 1.50, 10.84) and gravidity (AOR: 0.36; 95% CI 0.18, 0.73) were significantly associated with low birth weight. Additionally, a site for water storage and water treatment were significant environmental factors.

CONCLUSION

Maternal weight during pregnancy, paternal education, previous obstetric complication and place of antenatal follow-up were associated with low birth weight. The risk factors identified in this study are preventable. Thus, nutritional counseling, health education on improvement of lifestyle and early recognition and treatment of complications are the recommended interventions.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study

IMPORTANCE

The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.

OBJECTIVE

To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.

EVIDENCE REVIEW

Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.

FINDINGS

In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories.

CONCLUSIONS AND RELEVANCE

Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

BACKGROUND

A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.

METHODS

Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0-100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0-100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.

FINDINGS

In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8-98·1) in Iceland, followed by 96·6 (94·9-97·9) in Norway and 96·1 (94·5-97·3) in the Netherlands, to values as low as 18·6 (13·1-24·4) in the Central African Republic, 19·0 (14·3-23·7) in Somalia, and 23·4 (20·2-26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1-93·6) in Beijing to 48·0 (43·4-53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6-68·8) in Goa to 34·0 (30·3-38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

INTERPRETATION

GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view-and subsequent provision-of quality health care for all populations.

FUNDING

Bill & Melinda Gates Foundation.

Effects of home delivery on colostrum avoidance practices in North Wollo zone, an urban setting, Ethiopia: a cross sectional study

BACKGROUND

Colostrum is the first liquid that is produced in the first few days after delivery. It is the perfect first food for newborns which is considered as an infant's first immunization. Despite of this fact colostrum is discarded as unclean and bad for the infant's health. This study aimed to investigate the prevalence and the factors associated with colostrum avoidance in Woldia, Kobo and Lalibela town administrations of North Wollo zone.

METHODS

A quantitative community based cross sectional study was employed in March 2015 on 810 mothers of children aged less than 24 months. Descriptive statistics, binary and multivariable logistic regression analysis were employed to identify the factors associated with colostrum avoidance. Variables with a p-value < 0.05 in the multivariable model were identified as predictors of colostrum avoidance practices.

RESULTS

Colostrum was discarded by 12.0% (95%CI: 10.0-14.0%) of mothers of children aged less than 24 months. In multivariable logistic regression analysis late initiation of breastfeeding [AOR (95% CI) =2.03 (1.18, 3.49)], prelacteal feeding [AOR (95% CI) =3.38 (1.83, 6.24)], mothers not living with their husband [AOR (95% CI) = 2.24 (1.22, 4.12)] and delivering the index child at home [AOR (95% CI) =2.92 (1.521, 5.59)] were independent positive predictors of colostrum avoidance practices.

CONCLUSION

The foundation of any nutrition package for the prevention of childhood malnutrition is the promotion of an optimal breastfeeding practices, including colostrum feeding, in the community. Therefore, promoting institutional delivery, early initiation of breastfeeding and creating awareness on the dangers of prelacteal feeding and the advantages of colostrum feeding are recommended interventions to reduce colostrum avoidance practices in the study area.

Determinants of psychoactive substances use among Woldia University students in Northeastern Ethiopia

BACKGROUND

Psychoactive substance use has become a major public health problem among students in Ethiopian universities. Hence, this study aimed to investigate the magnitude and determinants of psychoactive substances use (khat chewing, alcohol drinking and cigarette smoking) among undergraduate students of Woldia University, Ethiopia.

METHODS

Institution based quantitative cross-sectional study was employed on Woldia University students in April 2015. 730 students were included in the study. Data were collected using self-administered questionnaires. EpiData version 3.02 was used to enter data. Then, data were exported to SPSS version 20 for analysis.

RESULTS

The lifetime prevalence of alcohol drinking, khat chewing and cigarette smoking among the study students were 33.1, 13 and 7.9%, respectively. Likewise, the current prevalence of alcohol drinking, khat chewing and cigarette smoking was 27.9, 10.4 and 6.4%, respectively. More than half of the surveyed students (59.1%) were introduced to psychoactive substance use by peer pressure. About 66% of the study participants believed that psychoactive substances are important for relaxation, and 19% to relief from stress. Students who were Muslims [adjusted odds ratio (AOR) 3.74, 95% CI (1.57, 8.91)], Oromo ethnic group [AOR 2.63, 95% CI (1.19, 5.81)], ever drunk alcohol [AOR 6.32, 95% CI (2.96, 13.48)] and ever smoked cigarette [AOR: 9.16, 95% CI (4.33, 19.38)] were positively associated with khat chewing. Furthermore, pocket money and ever khat chewing were associated with alcohol drinking and cigarette smoking.

CONCLUSION

This study showed that psychoactive substances use is somewhat prevalent among students in Woldia University. Hence, support of religious institutions in providing education aimed at preventing substance use, establishing and strengthening peer educators in the university are important interventions to tackle psychoactive substances use.