Wubegzier Mekonnen

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

Background The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. Methods Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. Results In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. Conclusions Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

A rural Ethiopian population undergoing epidemiological transition over a generation: Butajira from 1987 to 2004:

Aims: To describe the epidemiological development of a rural Ethiopian population from 1987 to 2004 in terms of mortality and associated sociodemographic factors. Methods: A rural population comprising 10 communities was defined in 1987 and has since been followed by means of regular household visits. After an initial census, births, deaths and migration events were recorded, together with key background factors, on an open cohort basis. Over 97,000 individuals were observed during a total of over 700,000 person years. Results: The initial population of 28,614 increased by an average of 3.64% annually to 54,426 from 1987 to 2004, and also grew older on average. Birth and mortality rates fell, but were still subject to short-term variation due to external factors. Overall mortality was 13.5 per 1000 person years. Increasing mortality in some adult age groups was consistent with increasing AIDS-related deaths, but a new local hospital in 2002 may have contributed to later falls in overall mortality. Sex, age group, time period, literacy, water source, house ownership and distance to town were all significantly associated with mortality differentials. Conclusions: This population has undergone a complex epidemiological transition during a generation. Detailed long-term surveillance of this kind is essential for describing such processes. Many factors that significantly affect mortality cannot be directly controlled by the health sector and will only improve with general development.

From birth to adulthood in rural Ethiopia: the Butajira Birth Cohort of 1987.

Long-term birth cohorts from developing countries are uncommon. Here a unique birth to 18-years cohort based on all births during 1987 in a rural area of Ethiopia is presented. This was the first year of the ongoing Butajira Rural Health Programme, since when the sampled population has been followed up in regular household visits. A total of 1884 livebirths in 1987 formed the cohort, corresponding to a birth rate of 0.31 per woman per year; the male : female ratio was 1.10. Perinatal mortality was 22 per 1000 livebirths, and infant mortality 65 per 1000 livebirths. Survival from birth to 18 years was 760 per 1000. Living in Butajira town had a considerable survival advantage compared with the surrounding villages. Most deaths were due to infections. Four per cent of the cohort experienced the death of their mothers before the age of 18 years, and 15 of the girls delivered their own children, suggesting that 1 in 25 women may bear a child before their eighteenth birthday in this community. The children in the cohort received no consequent special care or attention, and so they probably accurately represent the harsh realities of growing up in rural Ethiopia at the turn of the Millennium. The huge gaps between their experience and that of their contemporaries in more affluent settings are a scandal of the 21st century.

Physician distribution and attrition in the public health sector of Ethiopia.

Background Shortages and imbalances in physician workforce distribution between urban and rural and among the different regions in Ethiopia are enormous. However, with the recent rapid expansion in medical education training, it is expected that the country can make progress in physician workforce supply. Therefore, the aim of this study was to examine the distribution of physician workforce in Ethiopia and assess the role of retention mechanisms in the reduction of physician migration from the public health sector of Ethiopia. Methods This organizational survey examined physician workforce data from 119 hospitals from 5 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples Region [SNNPR], Tigray, and Harari) and 2 city administrations (Addis Ababa and Dire Dawa City). Training opportunity, distribution, and turnover between September 2009 and July 2015 were analyzed descriptively. Poisson regression model was used to find the association of different covariates with physician turnover. Results There were 2,300 medical doctors in 5 regions and 2 city administrations in ~6 years of observations. Of these, 553 (24.04%) medical doctors moved out of their duty stations and the remaining 1,747 (75.96%) were working actively. Of the actively working, the majority of the medical doctors, 1,407 (80.5%), were males, in which 889 (50.9%) were born after the year 1985, 997 (57%) had work experience of <3 years, and most, 1,471 (84.2%), were general practitioners. Within the observation period, physician turnover among specialists ranged from 21.4% in Dire Dawa to 43.3% in Amhara region. The capital, Addis Ababa, was the place of destination for 32 (82%) of the physicians who moved out to other regions from elsewhere in the country. The Poisson regression model revealed a decreased incidence of turnover among physicians born between the years 1975 and 1985 (incident rate ratio [IRR]: 0.63; 95% confidence interval [CI]: 0.51, 0.79) and among those who were born prior to 1975 (IRR: 0.24; 95% CI: 0.17, 0.34) compared to those who were born after 1985. Female physicians were 1.4 times (IRR: 1.44; 95% CI: 1.14, 1.81) more likely to move out from their duty stations compared to males. In addition, physicians working in district hospitals were 2 times (IRR: 2.14; 95% CI: 1.59, 2.89) more likely to move out and those working in general hospitals had 1.39 times (IRR: 1.39; 95% CI: 1.08, 1.78) increased rate of turnover in comparison with those who were working in referral hospitals. Physicians working in the Amhara region had 2 times (IRR: 2.01; 95% CI: 1.49, 2.73) increased risk of turnover in comparison with those who were working in the capital, Addis Ababa. The probability of migration did not show a statistically significant difference in all other regions (P>0.05). Conclusion The public health sector physician workforce largely constituted of male physicians, young and less experienced. High turnover rate among females, the young and less experienced physicians, and those working in distant places (district hospitals) indicate the need for special attention in devising human resources management and retention strategies.

Medical students’ career choices, preference for placement, and attitudes towards the role of medical instruction in Ethiopia

BackgroundIn Ethiopia, the health care delivery and the system of medical education have been expanding rapidly. However, in spite of the expansion, no studies have been carried out among medical students to identify their career choices and attitudes towards the medical instruction. Therefore, this study aimed to fill the gap in evidence in these specific areas.MethodsPretested questionnaire was self-administered among fifth and sixth year medical students in six government owned medical schools in Ethiopia. A total of 959 students were involved in the study with a response rate of 82.2%. Career choices, intention where to work just after graduation, and attitudes towards medical instruction were descriptively presented. Binary logistic regression model was fitted to identify factors associated with the intention of medical students to work in rural and remote areas.ResultsMajority, (70.1%) of the medical students wanted to practice in clinical care settings. However, only a small proportion of them showed interest to work in rural and remote areas (21% in zonal and 8.7% in district/small towns). For most, internal medicine was the first specialty of choice followed by surgery. However, students showed little interest in obstetrics and gynecology, as well as in pediatrics and child health as their first specialty of choice.Medical students’ attitudes towards their school in preparing them to work in rural and remote areas, to pursue their career within the country and to specialize in medical disciplines in which there are shortages in the country were low. The binary logistic regression model revealed that a significantly increased odds of preference to work in rural and remote areas was observed among males, those who were born in rural areas, the medical students of Addis Ababa University and those who had the desire to serve within the country.ConclusionThis study showed that Ethiopian medical schools are training medical workforce with preferences not to work in rural and remote places, and not to specialize in disciplines where there are shortages in the country. Thus, attention should be given to influence medical students’ attitude to work in rural and remote locations and to specialize in diverse clinical specialties.

Interrelationships among key Reproductive Health indicators in Sub-Saharan Africa

Introduction Indicators of reproductive health (RH) services, outputs, outcomes and impacts are expected to be related with each other and with key social determinants. As the provision of RH services is usually integrated, the effort expended to improve one component is also expected to affect the other components. There is a lack of evidence-based models demonstrating the interrelationships among these indicators and between RH indicators and social determinants. Objective To examine interrelationships among key RH indicators and their relationship with key social determinants in Sub-Saharan Africa (SSA). Method This study used data from the most recent demographic and health survey conducted during the period from 2010 to 2016 in 391 provinces of 29 SSA countries. We focused on seven RH indicator — antenatal care, skilled birth attendance, postnatal care, contraceptive prevalence rate (CPR), ideal number of children, birth interval and total fertility rate (TFR), along with selected socio-demographic indicators. The unit of analysis was sub-national, at provincial level. Structural equation modelling was used to examine the strength of interrelationships among the indicators based on the total standardized effect sizes. Significance tests and 95% confidence intervals for the total effects were presented using a bias-corrected bootstrap method. Results Women’s literacy rate, at the centre of the model, has direct connections with all the RH indicators included in the final model. The strongest relationship was observed between women’s literacy rate and CPR with a total standardized (std.) effect size of 0.79 (95% CI: 0.74, 0.83). RH indicators are interrelated directly and/or indirectly. A strong direct effect was also observed in the relationship between CPR and birth interval (β=0.63, 95%: 0.50, 0.77) and the model suggests that the reported ideal number of children is a key predictor of birth interval (Std. effect size=-0.58, 95% CI: -0.69, -0.48) and TFR (Std. effect size=0.52, 95% CI: 0.38, 0.62). Conclusion RH indicators are strongly interrelated and are all associated with women’s literacy. The model of interrelationships developed in this study may guide the design, implementation and evaluation of RH policies and programs.