Girma Temam Shifa

Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115 mm Hg, 1990-2015

Importance Elevated systolic blood (SBP) pressure is a leading global health risk. Quantifying the levels of SBP is important to guide prevention policies and interventions. Objective To estimate the association between SBP of at least 110 to 115 mm Hg and SBP of 140 mm Hg or higher and the burden of different causes of death and disability by age and sex for 195 countries and territories, 1990-2015. Design A comparative risk assessment of health loss related to SBP. Estimated distribution of SBP was based on 844 studies from 154 countries (published 1980-2015) of 8.69 million participants. Spatiotemporal Gaussian process regression was used to generate estimates of mean SBP and adjusted variance for each age, sex, country, and year. Diseases with sufficient evidence for a causal relationship with high SBP (eg, ischemic heart disease, ischemic stroke, and hemorrhagic stroke) were included in the primary analysis. Main Outcomes and Measures Mean SBP level, cause-specific deaths, and health burden related to SBP (≥110-115 mm Hg and also ≥140 mm Hg) by age, sex, country, and year. Results Between 1990-2015, the rate of SBP of at least 110 to 115 mm Hg increased from 73 119 (95% uncertainty interval [UI], 67 949-78 241) to 81 373 (95% UI, 76 814-85 770) per 100 000, and SBP of 140 mm Hg or higher increased from 17 307 (95% UI, 17 117-17 492) to 20 526 (95% UI, 20 283-20 746) per 100 000. The estimated annual death rate per 100 000 associated with SBP of at least 110 to 115 mm Hg increased from 135.6 (95% UI, 122.4-148.1) to 145.2 (95% UI 130.3-159.9) and the rate for SBP of 140 mm Hg or higher increased from 97.9 (95% UI, 87.5-108.1) to 106.3 (95% UI, 94.6-118.1). Loss of disability-adjusted life-years (DALYs) associated with SBP of at least 110 to 115 mm Hg increased from 148 million (95% UI, 134-162 million) to 211 million (95% UI, 193-231 million), and for SBP of 140 mm Hg or higher, the loss increased from 5.2 million (95% UI, 4.6-5.7 million) to 7.8 million (95% UI, 7.0-8.7 million). The largest numbers of SBP-related deaths were caused by ischemic heart disease (4.9 million [95% UI, 4.0-5.7 million]; 54.5%), hemorrhagic stroke (2.0 million [95% UI, 1.6-2.3 million]; 58.3%), and ischemic stroke (1.5 million [95% UI, 1.2-1.8 million]; 50.0%). In 2015, China, India, Russia, Indonesia, and the United States accounted for more than half of the global DALYs related to SBP of at least 110 to 115 mm Hg. Conclusions and Relevance In international surveys, although there is uncertainty in some estimates, the rate of elevated SBP (≥110-115 and ≥140 mm Hg) increased substantially between 1990 and 2015, and DALYs and deaths associated with elevated SBP also increased. Projections based on this sample suggest that in 2015, an estimated 3.5 billion adults had SBP of at least 110 to 115 mm Hg and 874 million adults had SBP of 140 mm Hg or higher.

Maternal and child characteristics and health practices affecting under-five mortality: A matched case control study in Gamo Gofa Zone, Southern Ethiopia

Background Though Ethiopia has shown a considerable improvement in reducing under-five mortality rate since 1990, many children still continue to die prematurely. Mixed results have been reported about determinants of under-five mortality. Besides, there is paucity of mortality studies in the current study site. Therefore, this study was conducted to assess maternal and child health related predictors of under-five mortality in Southern Ethiopia. Methods A matched case control study was conducted in 2014 in Arba Minch Town and Arba Minch Zuria District of Gamo Gofa Zone, Southern Ethiopia. Conditional logistic regression was employed to identify the predictors of under-five mortality. Sampling weight was applied to account for the non-proportional allocation of sample to different clusters. Based on the Mosley & Chens analytical framework for under-five and infant mortalities, the predictors were organized in to three groups: 1) personal illness control, 2) child feeding and newborn care and 3) other maternal and child related factors. Results Among personal illness control related factors: lack of post-natal care, immunization status of the child and lack of Vitamin A supplementation were significantly associated with higher rate of under-five mortality. Not breastfeeding and delaying first bath at least for 24 hours were child feeding and newborn care related factors which were found to be significantly associated with under-five mortality. Among other maternal and child related factors, shorter previous birth interval, history of death of index child’s older sibling, being multiple birth and live birth after the index child were significantly associated with under-five mortality. Conclusions In order to maintain reduction of under-five mortality during the Sustainable Development Goals era, strengthening of maternal and child health interventions, such as post-natal care, family planning, immunization, supplementation of Vitamin A for children older than six months, breastfeeding and delaying of first bath after delivery at least for 24 hours are recommended.