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1. Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review

Author: Gesesew, HA, Koye, DN, Fetene, DM, Woldegiorgis, M, Kinfu, Y, Geleto, AB, Melaku, YA, Mohammed, H, Alene, KA, Awoke, MA, Birhanu, MM, Gebremedhin, AT, Gelaw, YA, Shifti, DM, Muluneh, MD, Tegegne, TK, Abrha, S, Aregay, AF, Ayalew, MB, Gebre, AK, Gebremariam, KT, Gebremedhin, T, Gebremichael, L, Leshargie, CT, Kibret, GD, Meazaw, MW, Mekonnen, AB, Tekle, DY, Tesema, AG, Tesfay, FH, Tesfaye, W, Wubishet, BL, Dachew, BA, Adane, AA, Gesesew, HA, Koye, DN, Fetene, DM, Woldegiorgis, M, Kinfu, Y, Geleto, AB, Melaku, YA, Mohammed, H, Alene, KA, Awoke, MA, Birhanu, MM, Gebremedhin, AT, Gelaw, YA, Shifti, DM, Muluneh, MD, Tegegne, TK, Abrha, S, Aregay, AF, Ayalew, MB, Gebre, AK, Gebremariam, KT, Gebremedhin, T, Gebremichael, L, Leshargie, CT, Kibret, GD, Meazaw, MW, Mekonnen, AB, Tekle, DY, Tesema, AG, Tesfay, FH, Tesfaye, W, Wubishet, BL, Dachew, BA, and Adane, AA
Abstract: Objective The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. Design A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa. Data sources Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv. Eligibility criteria Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020. Data extraction and synthesis We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form. Results Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths. Conclusions Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategi
Published: 2021

2. COVID-19 in Ethiopia: A geospatial analysis of vulnerability to infection, case severity and death

Author: Alene, KA, Gelaw, YA, Fetene, DM, Koye, DN, Melaku, YA, Gesesew, H, Birhanu, MM, Adane, AA, Muluneh, MD, Dachew, BA, Abrha, S, Aregay, A, Ayele, AA, Bezabhe, WM, Gebremariam, KT, Gebremedhin, T, Gebremedhin, AT, Gebremichael, L, Geleto, AB, Kassahun, HT, Kibret, GD, Leshargie, CT, Mekonnen, A, Mirkuzie, AH, Mohammed, H, Tegegn, HG, Tesema, AG, Tesfay, FH, Wubishet, BL, Kinfu, Y, Alene, KA, Gelaw, YA, Fetene, DM, Koye, DN, Melaku, YA, Gesesew, H, Birhanu, MM, Adane, AA, Muluneh, MD, Dachew, BA, Abrha, S, Aregay, A, Ayele, AA, Bezabhe, WM, Gebremariam, KT, Gebremedhin, T, Gebremedhin, AT, Gebremichael, L, Geleto, AB, Kassahun, HT, Kibret, GD, Leshargie, CT, Mekonnen, A, Mirkuzie, AH, Mohammed, H, Tegegn, HG, Tesema, AG, Tesfay, FH, Wubishet, BL, and Kinfu, Y
Abstract: Background COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. Methods Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km. Results This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples' Region. The risk of COVID-19-related death is high in the country's border regions, where public health preparedness for responding to COVID-19 is limited. Conclusion This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.
Published: 2021

3. Multidrug‐resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta‐analysis

Author: Alene, KA, primary, Jegnie, A, additional, and Adane, AA, additional
Published: 2020
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4. Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (The Lancet (2018) 392(10159) (1923–1994), (S0140673618322256), (10.1016/S0140-6736(18)32225-6))

Author: Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, and Azzopardi, PS
Abstract: Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes du
Published: 2019

5. Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of

Author: Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, Stokes, Mark, Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, and Stokes, Mark
Published: 2019

6. Disparities between Aboriginal and non-Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015

Author: Adane, AA, Bailey, HD, Marriott, R, Farrant, BM, White, SW, Stanley, FJ, Shepherd, CCJ, Adane, AA, Bailey, HD, Marriott, R, Farrant, BM, White, SW, Stanley, FJ, and Shepherd, CCJ
Abstract: BACKGROUND: Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia. OBJECTIVES: This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings. METHODS: All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories. RESULTS: From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period. CONCLUSIONS: Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations.
Published: 2019

7. Department of Error.

Author: Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NME, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, and Azzopardi, PS
Published: 2019

8. Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study

Author: Alene, KA, Adane, AA, Yifiru, S, Bitew, BD, Adane, A, Koye, DN, Alene, KA, Adane, AA, Yifiru, S, Bitew, BD, Adane, A, and Koye, DN
Abstract: OBJECTIVE: The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control. STUDY DESIGN AND SETTINGS: A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital. PARTICIPANTS: Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants. OUTCOME MEASURES: The main outcomes were knowledge and self-reported practice of health workers about MDR-TB. RESULTS: A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26-30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00). CONCLUSIONS: This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for heal
Published: 2019

9. Multidrug‐resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta‐analysis.

Author: Alene, KA, Jegnie, A, and Adane, AA
Subjects: MULTIDRUG-resistant tuberculosis, RANDOM effects model, SCIENCE databases, PREGNANCY, PREMATURE labor
Abstract: Background: Multidrug‐resistant tuberculosis (MDR‐TB) is a major global public health concern. However, there is a dearth of literature on whether MDR‐TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. Objectives: This systematic review and meta‐analysis aimed to examine the impact of MDR‐TB and its medications during pregnancy on maternal and perinatal outcomes. Search strategy: PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. Selection criteria: Records were screened based on pre‐defined selection criteria and assessed for quality by two independent reviewers. Data collection and analysis: A meta‐analysis was performed using the random effects model to calculate pooled prevalence for each outcome. Main results: Of the 72 records identified, 12 were included in the systematic review and meta‐analysis, consisting of 174 pregnant women with MDR‐TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2–12.8) for maternal death, 10.6% (95% CI 6.0–16.3) for pregnancy loss, 12.9% (95% CI 0.0–38.0) for preterm birth and 23.7% (95% CI 17.0–31.0) for low birthweight. Conclusions: The findings suggest that MDR‐TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. Multidrug‐resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes. Multidrug‐resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]
Published: 2021
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10. 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

Author: Fullman, N, Yearwood, J, Abay, SM, Abbafati, C, Abd-Allah, F, Abdela, J, Abdelalim, A, Abebe, Z, Abebo, TA, Aboyans, V, Abraha, HN, Abreu, DMX, Abu-Raddad, LJ, Adane, AA, Adedoyin, RA, Adetokunboh, O, Adhikari, TB, Afarideh, M, Afshin, A, Agarwal, G, Agius, D, Agrawal, A, Agrawal, S, Ahmad Kiadaliri, A, Aichour, MTE, Akibu, M, Akinyemi, RO, Akinyemiju, TF, Akseer, N, Al Lami, FH, Alahdab, F, Al-Aly, Z, Alam, K, Alam, T, Alasfoor, D, Albittar, MI, Alene, KA, Al-Eyadhy, A, Ali, SD, Alijanzadeh, M, Aljunid, SM, Alkerwi, A, Alla, F, Allebeck, P, Allen, C, Alomari, MA, Al-Raddadi, R, Alsharif, U, Altirkawi, KA, Alvis-Guzman, N, Amare, AT, Amenu, K, Ammar, W, Amoako, YA, Anber, N, Andrei, CL, Androudi, S, Antonio, CAT, Araújo, VEM, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Asfaw, ET, Asgedom, SW, Asghar, RJ, Ashebir, MM, Asseffa, NA, Atey, TM, Atre, SR, Atteraya, MS, Avila-Burgos, L, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayalew, AA, Ayele, HT, Ayer, R, Ayuk, TB, Azzopardi, P, Azzopardi-Muscat, N, Babalola, TK, Badali, H, Badawi, A, Banach, M, Banerjee, A, Banstola, A, Barber, RM, Barboza, MA, Barker-Collo, SL, Bärnighausen, T, Barquera, S, Barrero, LH, Bassat, Q, Basu, S, Baune, BT, Bazargan-Hejazi, S, Bedi, N, and Beghi, E
Subjects: General & Internal Medicine, Humans, Wounds and Injuries, Noncommunicable Diseases, Communicable Diseases, Health Services Accessibility, Quality of Health Care, Global Burden of Disease
Abstract: Copyright © 2018 The Author(s). Published by Elsevier Ltd. 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.
Published: 2018

11. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease S

Author: Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NM, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, Stokes, Mark A, Stanaway, JD, Afshin, A, Gakidou, E, Lim, SS, Abate, D, Abate, KH, Abbafati, C, Abbasi, N, Abbastabar, H, Abd-Allah, F, Abdela, J, Abdelalim, A, Abdollahpour, I, Abdulkader, RS, Abebe, M, Abebe, Z, Abera, SF, Abil, OZ, Abraha, HN, Abrham, AR, Abu-Raddad, LJ, Abu-Rmeileh, NM, Accrombessi, MMK, Acharya, D, Acharya, P, Adamu, AA, Adane, AA, Adebayo, OM, Adedoyin, RA, Adekanmbi, V, Ademi, Z, Adetokunboh, OO, Adib, MG, Admasie, A, Adsuar, JC, Afanvi, KA, Afarideh, M, Agarwal, G, Aggarwal, A, Aghayan, SA, Agrawal, A, Agrawal, S, Ahmadi, A, Ahmadi, M, Ahmadieh, H, Ahmed, MB, Aichour, AN, Aichour, I, Aichour, MTE, Akbari, ME, Akinyemiju, T, Akseer, N, Al-Aly, Z, Al-Eyadhy, A, Al-Mekhlafi, HM, Alahdab, F, Alam, K, Alam, S, Alam, T, Alashi, A, Alavian, SM, Alene, KA, Ali, K, Ali, SM, Alijanzadeh, M, Alizadeh-Navaei, R, Aljunid, SM, Alkerwi, A, Alla, F, Alsharif, U, Altirkawi, K, Alvis-Guzman, N, Amare, AT, Ammar, W, Anber, NH, Anderson, JA, Andrei, CL, Androudi, S, Animut, MD, Anjomshoa, M, Ansha, MG, Antó, JM, Antonio, CAT, Anwari, P, Appiah, LT, Appiah, SCY, Arabloo, J, Aremu, O, Ärnlöv, J, Artaman, A, Aryal, KK, Asayesh, H, Ataro, Z, Ausloos, M, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayer, R, Ayuk, TB, Azzopardi, PS, and Stokes, Mark A
Published: 2018

12. 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

Author: Fullman, Nancy, Yearwood, Jamal, Abay, SM, Abbafati, C, Abd-Allah, F, Abdela, J, Abdelalim, A, Abebe, Z, Abebo, TA, Aboyans, V, Abraha, HN, Abreu, DMX, Abu-Raddad, LJ, Adane, AA, Adedoyin, RA, Barbo, Islam, Shariful, Rahman, Muhammad, Stokes, Mark, Fullman, Nancy, Yearwood, Jamal, Abay, SM, Abbafati, C, Abd-Allah, F, Abdela, J, Abdelalim, A, Abebe, Z, Abebo, TA, Aboyans, V, Abraha, HN, Abreu, DMX, Abu-Raddad, LJ, Adane, AA, Adedoyin, RA, Barbo, Islam, Shariful, Rahman, Muhammad, and Stokes, Mark
Abstract: 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 summ
Published: 2018

13. Non-Adherence to Anti-Tuberculosis Treatment and Determinant Factors among Patients with Tuberculosis in Northwest Ethiopia

Author: Wilkinson, RJ, Adane, AA, Alene, KA, Koye, DN, Zeleke, BM, Wilkinson, RJ, Adane, AA, Alene, KA, Koye, DN, and Zeleke, BM
Abstract: BACKGROUND: Non-adherence to anti tuberculosis treatment is one of the crucial challenges in improving tuberculosis cure-rates and reducing further healthcare costs. The poor adherence to anti-tuberculosis treatment among patients with tuberculosis is a major problem in Ethiopia. Hence, this study assessed level of non-adherence to anti-tuberculosis therapy and associated factors among patients with tuberculosis in northwest Ethiopia. METHODS: An institution based cross-sectional survey was conducted among tuberculosis patients who were following anti-tuberculosis treatment in North Gondar zone from February 20--March 30, 2013. Data were collected by trained data collectors using a structured and pre-tested questionnaire. Data were entered to EPI INFO version 3.5.3 and analyzed using statistical package for social sciences (SPSS) version 20. Multiple logistic regressions were fitted to identify associations and to control potential confounding variables. Odds ratio (OR) with 95% confidence interval was calculated and p-values<0.05 were considered statistically significant. RESULTS: A total of 280 tuberculosis patients were interviewed; 55.7% were males and nearly three quarters (72.5%) were urban dwellers. The overall non-adherence for the last one month and the last four days before the survey were 10% and 13.6% respectively. Non-adherence was high if the patients had forgetfulness (AOR 7.04, 95% CI 1.40-35.13), is on the continuation phase of chemotherapy (AOR: 6.95, 95% CI 1.81-26.73), had symptoms of tuberculosis during the interview (AOR: 4.29, 95% CI 1.53-12.03), and had co-infection with HIV (AOR: 4.06, 95% CI 1.70-9.70). CONCLUSIONS: Non-adherence to anti-tuberculosis treatment was high. Forgetfulness, being in the continuation phases of chemotherapy, having symptoms of tuberculosis during the interview, and co-infected with HIV were significantly associated with non-adherence to anti-tuberculosis therapy. Special attention on adherence counseling should be
Published: 2013

14. Knowing your audience: investigating stillbirth knowledge and perceptions in the general population to inform future public health campaigns

Author: Jane Warland, Danielle Pollock, Carrington C. J. Shepherd, Claire Foord, Brad M. Farrant, Akilew Awoke Adane, Pollock, D, Shepherd, CCJ, Adane, AA, Foord, C, Farrant, BM, and Warland, J
Subjects: Male, medicine.medical_specialty, media_common.quotation_subject, Population, Select committee, Health Promotion, myths, Pregnancy, Surveys and Questionnaires, Maternity and Midwifery, medicine, Humans, General knowledge, awareness, education, reproductive and urinary physiology, media_common, education.field_of_study, Government, Public health, Incidence (epidemiology), public health, Australia, Obstetrics and Gynecology, Stillbirth, medicine.disease, female genital diseases and pregnancy complications, Cross-Sectional Studies, Family medicine, Female, stillbirth, Worry, Psychology
Abstract: Background: The prevalence of stillbirth in many high income countries like Australia has remained unchanged for over 30 years. The 2018 Australian government Senate Select Committee on Stillbirth Research and Education highlighted the need for a public health campaign to encourage public conversations and increase awareness. However, there is little evidence about the community's knowledge and perceptions towards pregnancy and stillbirth, nor their aspirations for a public health campaign. Aims: To assess the general knowledge, perceptions, myths and attitudes towards stillbirth to inform future public health campaigns. Methods: Australian participants (n = 344; predominately women n = 294 (85.5%)) were recruited via Facebook.com. They completed a cross-sectional online survey designed to assess their knowledge of pregnancy and stillbirth, with additional questions on socio-demographic characteristics. Results: Stillbirth knowledge and awareness of incidence was low in this sample. Prominent myths, such as baby runs out of room in the uterus (n = 112, 33%) and baby slows down when preparing for labour (n = 24, 27%) were endorsed. Only 25% (n = 85) knew the prevalence of stillbirth in Australia (six per day). Almost two-thirds (n = 205; 62%) agreed that there needs to be a public health campaign, however one in five (n = 65; 20%) were concerned that talking about stillbirth with pregnant women may cause them to worry. Discussion and conclusion: Our findings reinforce the need for a targeted campaign, which educates the general population about the definition and prevalence of stillbirth, stillbirth risks and modifiable health behaviours. Appropriate messaging should target pregnant women during antenatal care as well as their support and care systems (family, friends, and care providers).53 Refereed/Peer-reviewed
Published: 2022

15. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Author: Stanaway, Jeffrey D., Afshin, Ashkan, Gakidou, Emmanuela, Lim, Stephen S., Abate, Degu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Molla, Abebe, Zegeye, Abera, Semaw F., Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Adamu, Abdu A., Adane, Akilew Awoke, Adebayo, Oladimeji M., Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Ademi, Zanfina, Adetokunboh, Olatunji O., Adib, Mina G., Admasie, Amha, Adsuar, Jose C., Afanvi, Kossivi Agbelenko, Afarideh, Mohsen, Agarwal, Gina, Aggarwal, Anju, Aghayan, Sargis Aghasi, Agrawal, Anurag, Agrawal, Sutapa, Ahmadi, Alireza, Ahmadi, Mehdi, Ahmadieh, Hamid, Ahmed, Muktar Beshir, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akbari, Mohammad Esmaeil, Akinyemiju, Tomi, Akseer, Nadia, Al-Aly, Ziyad, Al-Eyadhy, Ayman, Al-Mekhlafi, Hesham M., Alahdab, Fares, Alam, Khurshid, Alam, Samiah, Alam, Tahiya, Alashi, Alaa, Alavian, Seyed Moayed, Alene, Kefyalew Addis, Ali, Komal, Ali, Syed Mustafa, Alijanzadeh, Mehran, Alizadeh-Navaei, Reza, Aljunid, Syed Mohamed, Alkerwi, Ala'a, Alla, François, Alsharif, Ubai, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amare, Azmeraw T., Ammar, Walid, Anber, Nahla Hamed, Anderson, Jason A., Andrei, Catalina Liliana, Androudi, Sofia, Animut, Megbaru Debalkie, Anjomshoa, Mina, Ansha, Mustafa Geleto, Antó, Josep M., Antonio, Carl Abelardo T., Anwari, Palwasha, Appiah, Lambert Tetteh, Appiah, Seth Christopher Yaw, Arabloo, Jalal, Aremu, Olatunde, Ärnlöv, Johan, Artaman, Al, Aryal, Krishna K., Asayesh, Hamid, Ataro, Zerihun, Ausloos, Marcel, Avokpaho, Euripide F.G.A., Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Ayer, Rakesh, Ayuk, Tambe B., Azzopardi, Peter S., Babazadeh, Arefeh, Badali, Hamid, Badawi, Alaa, Balakrishnan, Kalpana, Bali, Ayele Geleto, Ball, Kylie, Ballew, Shoshana H., Banach, Maciej, Banoub, Joseph Adel Mattar, Barac, Aleksandra, Barker-Collo, Suzanne Lyn, Bärnighausen, Till Winfried, Barrero, Lope H., Basu, Sanjay, Baune, Bernhard T., Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Béjot, Yannick, Bekele, Bayu Begashaw, Bekru, Eyasu Tamru, Belay, Ezra, Belay, Yihalem Abebe, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bensenor, Isabela M., Bergeron, Gilles, Berhane, Adugnaw, Bernabe, Eduardo, Bernstein, Robert S., Beuran, Mircea, Beyranvand, Tina, Bhala, Neeraj, Bhalla, Ashish, Bhattarai, Suraj, Bhutta, Zulfiqar A., Biadgo, Belete, Bijani, Ali, Bikbov, Boris, Bilano, Ver, Bililign, Nigus, Bin Sayeed, Muhammad Shahdaat, Bisanzio, Donal, Biswas, Tuhin, Bjørge, Tone, Blacker, Brigette F., Bleyer, Archie, Borschmann, Rohan, Bou-Orm, Ibrahim R., Boufous, Soufiane, Bourne, Rupert, Brady, Oliver J., Brauer, Michael, Brazinova, Alexandra, Breitborde, Nicholas J.K., Brenner, Hermann, Briko, Andrey Nikolaevich, Britton, Gabrielle, Brugha, Traolach, Buchbinder, Rachelle, Burnett, Richard T., Busse, Reinhard, Butt, Zahid A., Cahill, Leah E., Cahuana-Hurtado, Lucero, Campos-Nonato, Ismael R., Cárdenas, Rosario, Carreras, Giulia, Carrero, Juan J., Carvalho, Félix, Castañeda-Orjuela, Carlos A., Castillo Rivas, Jacqueline, Castro, Franz, Catalá-López, Ferrán, Causey, Kate, Cercy, Kelly M., Cerin, Ester, Chaiah, Yazan, Chang, Hsing Yi, Chang, Jung Chen, Chang, Kai Lan, Charlson, Fiona J., Chattopadhyay, Aparajita, Chattu, Vijay Kumar, Chee, Miao Li, Cheng, Ching Yu, Chew, Adrienne, Chiang, Peggy Pei Chia, Chimed-Ochir, Odgerel, Chin, Ken Lee, Chitheer, Abdulaal, Choi, Jee Young J., Chowdhury, Rajiv, Christensen, Hanne, Christopher, Devasahayam J., Chung, Sheng Chia, Cicuttini, Flavia M., Cirillo, Massimo, Cohen, Aaron J., Collado-Mateo, Daniel, Cooper, Cyrus, Cooper, Owen R., Coresh, Josef, Cornaby, Leslie, Cortesi, Paolo Angelo, Cortinovis, Monica, Costa, Megan, Cousin, Ewerton, Criqui, Michael H., Cromwell, Elizabeth A., Cundiff, David K., Daba, Alemneh Kabeta, Dachew, Berihun Assefa, Dadi, Abel Fekadu, Damasceno, Albertino Antonio Moura, Dandona, Lalit, Dandona, Rakhi, Darby, Sarah C., Dargan, Paul I., Daryani, Ahmad, Das Gupta, Rajat, Das Neves, José, Dasa, Tamirat Tesfaye, Dash, Aditya Prasad, Davitoiu, Dragos Virgil, Davletov, Kairat, De la Cruz-Góngora, Vanessa, De La Hoz, Fernando Pio, De Leo, Diego, De Neve, Jan Walter, Degenhardt, Louisa, Deiparine, Selina, Dellavalle, Robert P., Demoz, Gebre Teklemariam, Denova-Gutiérrez, Edgar, Deribe, Kebede, Dervenis, Nikolaos, Deshpande, Aniruddha, Des Jarlais, Don C., Dessie, Getenet Ayalew, Deveber, Gabrielle Aline, Dey, Subhojit, Dharmaratne, Samath Dhamminda, Dhimal, Meghnath, Dinberu, Mesfin Tadese, Ding, Eric L., Diro, Helen Derara, Djalalinia, Shirin, Do, Huyen Phuc, Dokova, Klara, Doku, David Teye, Doyle, Kerrie E., Driscoll, Tim R., Dubey, Manisha, Dubljanin, Eleonora, Duken, Eyasu Ejeta, Duncan, Bruce B., Duraes, Andre R., Ebert, Natalie, Ebrahimi, Hedyeh, Ebrahimpour, Soheil, Edvardsson, David, Effiong, Andem, Eggen, Anne Elise, El Bcheraoui, Charbel, El-Khatib, Ziad, Elyazar, Iqbal Rf, Enayati, Ahmadali, Endries, Aman Yesuf, Er, Benjamin, Erskine, Holly E., Eskandarieh, Sharareh, Esteghamati, Alireza, Estep, Kara, Fakhim, Hamed, Faramarzi, Mahbobeh, Fareed, Mohammad, Farid, Talha A., Farinha, Carla Sofia E.sá, Farioli, Andrea, Faro, Andre, Farvid, Maryam S., Farzaei, Mohammad Hosein, Fatima, Batool, Fay, Kairsten A., Fazaeli, Ali Akbar, Feigin, Valery L., Feigl, Andrea B., Fereshtehnejad, Seyed Mohammad, Fernandes, Eduarda, Fernandes, Joao C., Ferrara, Giannina, Ferrari, Alize J., Ferreira, Manuela L., Filip, Irina, Finger, Jonas David, Fischer, Florian, Foigt, Nataliya A., Foreman, Kyle J., Fukumoto, Takeshi, Fullman, Nancy, Fürst, Thomas, Furtado, João M., Futran, Neal D., Gall, Seana, Gallus, Silvano, Gamkrelidze, Amiran, Ganji, Morsaleh, Garcia-Basteiro, Alberto L., Gardner, William M., Gebre, Abadi Kahsu, Gebremedhin, Amanuel Tesfay, Gebremichael, Teklu Gebrehiwo, Gelano, Tilayie Feto, Geleijnse, Johanna M., Geramo, Yilma Chisha Dea, Gething, Peter W., Gezae, Kebede Embaye, Ghadimi, Reza, Ghadiri, Keyghobad, Ghasemi Falavarjani, Khalil, Ghasemi-Kasman, Maryam, Ghimire, Mamata, Ghosh, Rakesh, Ghoshal, Aloke Gopal, Giampaoli, Simona, Gill, Paramjit Singh, Gill, Tiffany K., Gillum, Richard F., Ginawi, Ibrahim Abdelmageed, Giussani, Giorgia, Gnedovskaya, Elena V., Godwin, William W., Goli, Srinivas, Gómez-Dantés, Hector, Gona, Philimon N., Gopalani, Sameer Vali, Goulart, Alessandra C., Grada, Ayman, Grams, Morgan E., Grosso, Giuseppe, Gugnani, Harish Chander, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Tanush, Gutiérrez, Reyna Alma, Gutiérrez-Torres, Daniela S., Haagsma, Juanita A., Habtewold, Tesfa Dejenie, Hachinski, Vladimir, Hafezi-Nejad, Nima, Hagos, Tekleberhan B., Hailegiyorgis, Tewodros Tesfa, Hailu, Gessessew Bugssa, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hamadeh, Randah R., Hamidi, Samer, Handal, Alexis J., Hankey, Graeme J., Hao, Yuantao, Harb, Hilda L., Harikrishnan, Sivadasanpillai, Haro, Josep Maria, Hassankhani, Hadi, Hassen, Hamid Yimam, Havmoeller, Rasmus, Hawley, Caitlin N., Hay, Simon I., Hedayatizadeh-Omran, Akbar, Heibati, Behzad, Heidari, Behnam, Heidari, Mohsen, Hendrie, Delia, Henok, Andualem, Heredia-Pi, Ileana, Herteliu, Claudiu, Heydarpour, Fatemeh, Heydarpour, Sousan, Hibstu, Desalegn T., Higazi, Tarig B., Hilawe, Esayas Haregot, Hoek, Hans W., Hoffman, Howard J., Hole, Michael K., Homaie Rad, Enayatollah, Hoogar, Praveen, Hosgood, H. 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Roth, Ga, Sahraian, Ma, Salomon, Ja, Salvi, Dd, Samy, Am, Sanchez-Niño, Md, Sánchez-Pimienta, Tg, Santomauro, Df, Santos, Jv, Santric Milicevic, Mm, Sao Jose, Bp, Sarker, Ar, Sawant, Ar, Schmidt, Mi, Schneider, Ijc, Schutte, Ae, Schwebel, Dc, Scott, Jg, Sepanlou, Sg, Serre, Ml, Shaheen, Aa, Shaikh, Ma, Shin, Mj, Shrime, Mg, Sibai, Am, Siddiqi, Tj, Sigfusdottir, Id, Silva, Da, Silva, Jp, Silveira, Dga, Singh, Ja, Singh, Np, Sinha, Dn, Smith, Dl, Sobaih, Bh, Sorensen, Rjd, Soriano, Jb, Soyiri, In, Sposato, La, Sreeramareddy, Ct, Starodubov, Vi, Stein, Dj, Stein, Mb, Stokes, Ma, Subart, Ml, Sufiyan, Mb, Sunguya, Bf, Sur, Pj, Sykes, Bl, Szoeke, Cei, Tadakamadla, Sk, Tassew, Sg, Tekalign, Tg, Tekelemedhin, Sw, Tekle, Mg, Temsah, Mh, Thankappan, Kr, Thomas, Hj, Thomas, Ml, Thurston, Gd, To, Qg, Torre, Ae, Tovani-Palone, Mr, Towbin, Ja, Tran, Bx, Tran, Kb, Truelsen, Tc, Truong, Nt, Tsadik, Ag, Tuzcu, Em, Tymeson, Hd, Ukwaja, Kn, Updike, Rl, Uthman, Oa, Valdez, Pr, Vasankari, Tj, Vladimirov, Sk, Vollset, Se, Vu, Gt, Waller, Sg, Walson, Jl, Wang, Yp, Weintraub, Rg, Werkneh, Aa, West, Jj, Whiteford, Ha, Wiyeh, Ab, Wolfe, Cda, Wong, Ty, Yahyazadeh Jabbari, Sh, Yan, Ll, Yasin, Yj, Yimer, Em, Yoon, Sj, Younis, Mz, Zaman, Sb, Zhang, Al, Zimsen, Srm, Murray, Cjl., Stanaway, Jeffrey D, Afshin, Ashkan, Gakidou, Emmanuela, Lim, Stephen S, Abate, Degu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbasi, Nooshin, Abbastabar, Hedayat, Abd-Allah, Foad, Abdela, Jemal, Abdelalim, Ahmed, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Molla, Abebe, Zegeye, Abera, Semaw F, Abil, Olifan Zewdie, Abraha, Haftom Niguse, Abrham, Aklilu Roba, Abu-Raddad, Laith Jamal, Abu-Rmeileh, Niveen ME, Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Acharya, Pawan, Adamu, Abdu A, Adane, Akilew Awoke, Adebayo, Oladimeji M, Adedoyin, Rufus Adesoji, Adekanmbi, Victor, Ademi, Zanfina, Adetokunboh, Olatunji O, Adib, Mina G, Admasie, Amha, Adsuar, Jose C, Afanvi, Kossivi Agbelenko, Afarideh, 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Artaman, Al, Aryal, Krishna K, Asayesh, Hamid, Ataro, Zerihun, Ausloos, Marcel, Avokpaho, Euripide F G A, Awasthi, Ashish, Ayala Quintanilla, Beatriz Paulina, Ayer, Rakesh, Ayuk, Tambe B, Azzopardi, Peter S, Babazadeh, Arefeh, Badali, Hamid, Badawi, Alaa, Balakrishnan, Kalpana, Bali, Ayele Geleto, Ball, Kylie, Ballew, Shoshana H, Banach, Maciej, Banoub, Joseph Adel Mattar, Barac, Aleksandra, Barker-Collo, Suzanne Lyn, Bärnighausen, Till Winfried, Barrero, Lope H, Basu, Sanjay, Baune, Bernhard T, Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Béjot, Yannick, Bekele, Bayu Begashaw, Bekru, Eyasu Tamru, Belay, Ezra, Belay, Yihalem Abebe, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Bergeron, Gille, Berhane, Adugnaw, Bernabe, Eduardo, Bernstein, Robert S, Beuran, Mircea, Beyranvand, Tina, Bhala, Neeraj, Bhalla, Ashish, Bhattarai, Suraj, Bhutta, Zulfiqar A, Biadgo, Belete, Bijani, Ali, Bikbov, Bori, Bilano, Ver, 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Shokraneh, Farhad, Shoman, Haitham, Shrime, Mark G, Shupler, Matthew S, Si, Si, Siabani, Soraya, Sibai, Abla Mehio, Siddiqi, Tariq J, Sigfusdottir, Inga Dora, Sigurvinsdottir, Rannveig, Silva, Diego Augusto Santo, Silva, João Pedro, Silveira, Dayane Gabriele Alve, Singh, Jasvinder A, Singh, Narinder Pal, Singh, Virendra, Sinha, Dhirendra Narain, Skiadaresi, Eirini, Skirbekk, Vegard, Smith, David L, Smith, Mari, Sobaih, Badr Hasan, Sobhani, Soheila, Somayaji, Ranjani, Soofi, Moslem, Sorensen, Reed J D, Soriano, Joan B, Soyiri, Ireneous N, Spinelli, Angela, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Srinivasan, Vinay, Starodubov, Vladimir I, Steckling, Nadine, Stein, Dan J, Stein, Murray B, Stevanovic, Goran, Stockfelt, Leo, Stokes, Mark A, Sturua, Lela, Subart, Michelle L, Sudaryanto, Agu, Sufiyan, Mu'awiyyah Babale, Sulo, Gerhard, Sunguya, Bruno F, Sur, Patrick John, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadakamadla, Santosh 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Muthiah, Vaezi, Afsane, Valdez, Pascual R, Van Donkelaar, Aaron, Varavikova, Elena, Varughese, Santosh, Vasankari, Tommi Juhani, Venkateswaran, Vidhya, Venketasubramanian, Narayanaswamy, Villafaina, Santo, Violante, Francesco S, Vladimirov, Sergey Konstantinovitch, Vlassov, Vasily, Vollset, Stein Emil, Vos, Theo, Vosoughi, Kia, Vu, Giang Thu, Vujcic, Isidora S, Wagnew, Fasil Shiferaw, Waheed, Yasir, Waller, Stephen G, Walson, Judd L, Wang, Yafeng, Wang, Yanping, Wang, Yuan-Pang, Weiderpass, Elisabete, Weintraub, Robert G, Weldegebreal, Fitsum, Werdecker, Andrea, Werkneh, Adhena Ayaliew, West, J Jason, Westerman, Ronny, Whiteford, Harvey A, Widecka, Justyna, Wijeratne, Tissa, Winkler, Andrea Sylvia, Wiyeh, Alison B, Wiysonge, Charles Shey, Wolfe, Charles D A, Wong, Tien Yin, Wu, Shouling, Xavier, Deni, Xu, Gelin, Yadgir, Simon, Yadollahpour, Ali, Yahyazadeh Jabbari, Seyed Hossein, Yamada, Tomohide, Yan, Lijing L, Yano, Yuichiro, Yaseri, Mehdi, Yasin, Yasin Jemal, Yeshaneh, Alex, Yimer, Ebrahim M, Yip, Paul, Yisma, Engida, Yonemoto, Naohiro, Yoon, Seok-Jun, Yotebieng, Marcel, Younis, Mustafa Z, Yousefifard, Mahmoud, Yu, Chuanhua, Zaidi, Zoubida, Zaman, Sojib Bin, Zamani, Mohammad, Zavala-Arciniega, Lui, Zhang, Anthony Lin, Zhang, Hao, Zhang, Kai, Zhou, Maigeng, Zimsen, Stephanie R M, Zodpey, Sanjay, and Murray, Christopher J L
Subjects: Science & Technology, GBD, risks, risk factors, comparative risk assesment, Dalys, Medicine (all), CHOLESTEROL, BLOOD-PRESSURE, 11 Medical And Health Sciences, ILLNESS, TRENDS, humanities, Medicine, General & Internal, TOBACCO CONTROL, General & Internal Medicine, parasitic diseases, Medicine and Health Sciences, CARDIOVASCULAR-DISEASES, TRIAL, Human medicine, Life Sciences & Biomedicine, METAANALYSIS
Abstract: Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk– outcome associations. Methods We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017. Findings In 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3–6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low. Lancet 2018; 392: 1923–94 *Collaborators listed at the end of the paper Correspondence to: Prof Christopher J L Murray, Institute for Health Metrics and Evalution, Seattle, WA 98121, USA cjlm@uw.edu Global Health Metrics 1924 www.thelancet.com Vol 392 November 10, 2018 Interpretation By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.
Published: 2018

16. 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

Author: Nancy, Fullman, Jamal, Yearwood, Solomon, M, Abay, Cristiana, Abbafati, Foad, Abd-Allah, Jemal, Abdela, Ahmed, Abdelalim, Zegeye, Abebe, Teshome, Abuka, Abebo, Victor, Aboyans, Haftom, Niguse, Abraha, Daisy, M, X, Abreu, Laith, Abu-Raddad, J, Akilew, Awoke, Adane, Rufus, Adesoji, Adedoyin, Olatunji, Adetokunboh, Tara, Ballav, Adhikari, Mohsen, Afarideh, Ashkan, Afshin, Gina, Agarwal, Dominic, Agius, Anurag, Agrawal, Sutapa, Agrawal, Aliasghar, Ahmad, Kiadaliri, Miloud, Taki, Eddine, Aichour, Mohammed, Akibu, Rufus, Olusola, Akinyemi, Tomi, Akinyemiju, F, Nadia, Akseer, Faris, Hasan, Lami, Al, Fares, Alahdab, Ziyad, Al-Aly, Khurshid, Alam, Tahiya, Alam, Deena, Alasfoor, Mohammed, I, Albittar, Kefyalew, Addis, Alene, Ayman, Al-Eyadhy, Syed, Danish, Ali, Mehran, Alijanzadeh, Syed, M, Aljunid, Ala’A, Alkerwi, François, Alla, Peter, Allebeck, Christine, Allen, Mahmoud, A, Alomari, Rajaa, Al-Raddadi, Ubai, Alsharif, Khalid, A, Altirkawi, Nelson, Alvis-Guzman, Azmeraw, T, Amare, Kebede, Amenu, Walid, Ammar, Yaw, Ampem, Amoako, Nahla, Anber, Catalina, Liliana, Andrei, Sofia, Androudi, Carl, Abelardo, Antonio, T, Valdelaine, E, Araújo, M, Olatunde, Aremu, Johan, Ärnlöv, Artaman, Al, Krishna, Kumar, Aryal, Hamid, Asayesh, Ephrem, Tsegay, Asfaw, Solomon, Weldegebreal, Asgedom, Rana, Jawad, Asghar, Mengistu, Mitiku, Ashebir, Netsanet, Abera, Asseffa, Tesfay, Mehari, Atey, Sachin, R, Atre, Madhu, Atteraya, S, Leticia, Avila-Burgos, Euripide, Frinel, Arthur, G, Avokpaho, Ashish, Awasthi, Beatriz, Paulina, Ayala, Quintanilla, Animut, Alebel, Ayalew, Henok, Tadesse, Ayele, Rakesh, Ayer, Tambe, Betrand, Ayuk, Peter, Azzopardi, Natasha, Azzopardi-Muscat, Tesleem, Kayode, Babalola, Hamid, Badali, Alaa, Badawi, Maciej, Banach, Amitava, Banerjee, Amrit, Banstola, Ryan, M, Barber, Miguel, Barboza, A, Suzanne, L, Barker-Collo, Till, Bärnighausen, Simon, Barquera, Lope, H, Barrero, Quique, Bassat, Sanjay, Basu, Bernhard, T, Baune, Shahrzad, Bazargan-Hejazi, Neeraj, Bedi, Ettore, Beghi, Masoud, Behzadifar, Meysam, Behzadifar, Bayu, Begashaw, Bekele, Abate, Bekele, Belachew, Saba, Abraham, Belay, Yihalem, Abebe, Belay, Michelle, L, Bell, Aminu, Bello, K, Derrick, A, Bennett, James, Bennett, R, Isabela, M, Bensenor, Derbew, Fikadu, Berhe, Eduardo, Bernabé, Robert, Steven, Bernstein, Mircea, Beuran, Ashish, Bhalla, Paurvi, Bhatt, Soumyadeep, Bhaumik, Zulfiqar, A, Bhutta, Belete, Biadgo, Ali, Bijani, Boris, Bikbov, Charles, Birungi, Stan, Biryukov, Hailemichael, Bizuneh, Ian, W, Bolliger, Kaylin, Bolt, Ibrahim, R, Bou-Orm, Kayvan, Bozorgmehr, Oliver, Jerome, Brady, Alexandra, Brazinova, Nicholas, J, Breitborde, K, Hermann, Brenner, Gabrielle, Britton, Traolach, S, Brugha, Zahid, Butt, A, Lucero, Cahuana-Hurtado, Ismael, Ricardo, Campos-Nonato, Julio, Cesar, Campuzano, Josip, Car, Mate, Car, Rosario, Cárdenas, Juan, Jesus, Carrero, Felix, Carvalho, Carlos, A, Castañeda-Orjuela, Jacqueline, Castillo, Rivas, Ferrán, Catalá-López, Kelly, Cercy, Julian, Chalek, Hsing-Yi, Chang, Jung-Chen, Chang, Aparajita, Chattopadhyay, Pankaj, Chaturvedi, Peggy, Pei-Chia, Chiang, Vesper, Hichilombwe, Chisumpa, Jee-Young, J, Choi, Hanne, Christensen, Devasahayam, Jesudas, Christopher, Sheng-Chia, Chung, Liliana, G, Ciobanu, Cirillo, Massimo, Danny, Colombara, Sara, Conti, Cyrus, Cooper, Leslie, Cornaby, Paolo, Angelo, Cortesi, Monica, Cortinovis, Alexandre, Costa, Pereira, Ewerton, Cousin, Michael, H, Criqui, Elizabeth, Cromwell, A, Christopher, Stephen, Crowe, John, Crump, A, Alemneh, Kabeta, Daba, Berihun, Assefa, Dachew, Abel, Fekadu, Dadi, Lalit, Dandona, Rakhi, Dandona, Paul, I, Dargan, Ahmad, Daryani, Maryam, Daryani, Jai, Das, Siddharth, Kumar, Das, José, Das, Neves, Nicole, Davis, Weaver, Kairat, Davletov, Barbora, De, Courten, Diego, Leo, De, Jan-Walter, De, Neve, Robert, Dellavalle, P, Gebre, Demoz, Kebede, Deribe, Don, C, Des, Jarlais, Subhojit, Dey, Samath, D, Dharmaratne, Meghnath, Dhimal, Shirin, Djalalinia, David, Teye, Doku, Kate, Dolan, Ray, E, Dorsey, Kadine, Priscila, Bender, Dos, Santos, Kerrie, E, Doyle, Tim, Driscoll, R, Manisha, Dubey, Eleonora, Dubljanin, Bruce, Bartholow, Duncan, Michelle, Echko, Dumessa, Edessa, David, Edvardsson, Joshua, R, Ehrlich, Erika, Eldrenkamp, Ziad, El-Khatib, Matthias, Endres, Aman, Yesuf, Endries, Babak, Eshrati, Sharareh, Eskandarieh, Alireza, Esteghamati, Mahdi, Fakhar, Tamer, Farag, Mahbobeh, Faramarzi, Emerito, Jose, Aquino, Faraon, André, Faro, Farshad, Farzadfar, Adesegun, Fatusi, Mir, Sohail, Fazeli, Valery, Feigin, L, Andrea, B, Feigl, Netsanet, Fentahun, Seyed-Mohammad, Fereshtehnejad, Eduarda, Fernandes, João, C, Fernandes, Daniel, Obadare, Fijabi, Irina, Filip, Florian, Fischer, Christina, Fitzmaurice, Abraham, D, Flaxman, Luisa, Sorio, Flor, Nataliya, Foigt, Kyle, J, Foreman, Joseph, Frostad, J, Thomas, Fürst, Neal, D, Futran, Emmanuela, Gakidou, Silvano, Gallus, Ketevan, Gambashidze, Amiran, Gamkrelidze, Morsaleh, Ganji, Abadi, Kahsu, Gebre, Tsegaye, Tewelde, Gebrehiwot, 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Sd, Aljunid, Sm, Alomari, Ma, Altirkawi, Ka, Amare, At, Amoako, Ya, Andrei, Cl, Antonio, Cat, Araújo, Vem, Aryal, Kk, Asfaw, Et, Asgedom, Sw, Asghar, Rj, Ashebir, Mm, Asseffa, Na, Atey, Tm, Atre, Sr, Avokpaho, Efga, Ayala Quintanilla, Bp, Ayalew, Aa, Ayele, Ht, Ayuk, Tb, Babalola, Tk, Barber, Rm, Barboza, Ma, Barker-Collo, Sl, Barrero, Lh, Baune, Bt, Bekele, Bb, Belachew, Ab, Belay, Sa, Belay, Ya, Bell, Ml, Bello, Ak, Bennett, Da, Bennett, Jr, Bensenor, Im, Berhe, Df, Bhutta, Za, Bolliger, Iw, Bou-Orm, Ir, Brady, Oj, Breitborde, Njk, Butt, Za, Campos-Nonato, Ir, Campuzano, Jc, Carrero, Jj, Castañeda-Orjuela, Ca, Chang, Hy, Chang, Jc, Chiang, Pp, Chisumpa, Vh, Choi, Jj, Christopher, Dj, Chung, Sc, Ciobanu, Lg, Cortesi, Pa, Criqui, Mh, Cromwell, Ea, Crump, Ja, Daba, Ak, Dachew, Ba, Dadi, Af, Dargan, Pi, Das, Sk, De Neve, Jw, Dellavalle, Rp, Des Jarlais, Dc, Dharmaratne, Sd, Doku, Dt, Dorsey, Er, Dos Santos, Kpb, Doyle, Ke, Driscoll, Tr, Duncan, Bb, Ehrlich, Jr, El-Khatib, Zz, Endries, Ay, Faraon, Eja, Feigin, Vl, Feigl, Ab, Fereshtehnejad, Sm, Fernandes, Jc, Fijabi, Do, Flaxman, Ad, Foreman, Kj, Frostad, Jj, Futran, Nd, Gebre, Ak, Gebrehiwot, Tt, Gebremedhin, At, Gelaw, Ya, Geleijnse, Jm, Gething, Pw, Giref, Az, Gishu, Md, Godwin, Ww, Gona, Pn, Gopalani, Sv, Goulart, Ac, Gugnani, Hc, Haagsma, Ja, Hailu, Gb, Hamadeh, Rr, Hankey, Gj, Harb, Hl, Harewood, Hc, Haro, Jm, Hassen, Hy, Hay, Si, Hearps, Sjc, Hegazy, Mi, Henry, Nj, Herrera Ballesteros, Vh, Hibstu, Dt, Hiluf, Mk, Hoek, Hw, Hosgood, Hd, Hosseini, Sr, Hoy, Dg, Huang, Jj, Iburg, Km, Igumbor, Eu, Ileanu, Bv, Irvani, Ssn, Irvine, Cm, Jacobs, Ta, Jacobsen, Kh, Jain, Sk, Jakovljevic, Mb, Jalu, Mt, Jamal, Aa, Jayatilleke, Au, Jha, Rp, Johnson, Sc, Jonas, Jb, Karema, Ck, Karimi, Sm, Kassa, Dh, Kassa, Gm, Kassa, Td, Kassebaum, Nj, Katikireddi, Sv, Keiyoro, Pn, Kemp, Gr, Kengne, Ap, Ketema, Eb, Khafaie, Ma, Khalil, Ia, Khan, Ea, Khan, Mn, Khan, Ma, Khanal, Mn, Khang, Yh, Khater, Mm, Khoja, Ata, Kibret, Gd, Kiirithio, Dn, Kim, Yj, Kimokoti, Rw, Kopec, Ja, Koul, Pa, Krohn, Kj, Kumar, Ga, Kyu, Hh, Lad, Dp, Lal, Dk, Lang, Jj, Lansingh, Vc, Lazarus, Jv, Leasher, Jl, Lee, Ph, Leshargie, Ct, Liben, Ml, Lim, Ll, Lopez, Ad, Lorch, Sa, Lotufo, Pa, Lucas, Tcd, Lyons, Ra, Macarayan, Erk, Mackay, Mt, Maddison, Er, Malta, Dc, Mamun, Aa, Mansournia, Ma, Mantovani, Lg, Mapoma, Cc, Martins, Sco, Martins-Melo, Fr, Massenburg, Bb, Mathur, Mr, Maulik, Pk, Mcgrath, Jj, Mehta, Km, Meles, Kg, Memish, Za, Mengiste, Da, Mengistu, Dt, Menota, Bg, Mensah, Ga, Meretoja, Tj, Mezgebe, Hb, Miller, Tr, Mini, Gk, Mirrakhimov, Em, Mitchell, Pb, Mlashu, Fw, Mohammad, Ka, Mohammed, Ma, Mokdad, Ah, Mola, Gl, Montañez Hernandez, Jc, Morrison, Sd, Mousavi, Sm, Mueller, Uo, Murthy, Gv, Musa, Ki, Naik, Ga, Nansseu, Jrn, Narayan, Kv, Nascimento, Br, Negoi, Ri, Newton, Cr, Ngunjiri, Jw, Nguyen, Th, Ningrum, Dna, Nong, Vm, Norheim, Of, Noubiap, Jjn, Obermeyer, Cm, Ogbo, Fa, Oh, Ih, Olagunju, At, Olagunju, To, Olivares, Pr, Oliveira, Ppv, Olsen, He, Olusanya, Bo, Olusanya, Jo, Opio, Jn, Ortega-Altamirano, Dv, Pain, Aw, Palone, Mrt, Pandian, Jd, Park, Ek, Patil, St, Patton, Gc, Paturi, Vr, Pedroso, Mm, Pedroza, Sp, Pereira, Dm, Phillips, Mr, Piel, Fb, Pigott, Dm, Pillay, Jd, Piradov, Ma, Pond, Cd, Postma, Mj, Prasad, Nm, Quintana, Hk, Rahman, Ma, Rahman, Su, Rai, Rk, Raju, Sb, Rana, Sm, Rawaf, Dl, Ray, Se, Razo-García, Ca, Reiner, Rc, Reitsma, Mb, Renzaho, Amn, Ribeiro, Al, Rios Blancas, Mj, Rivera, Ja, Roth, Ga, Ruhago, Gm, Sabde, Yd, Sahraian, Ma, Saldanha, Rf, Salomon, Ja, Samy, Am, Sanabria, Jr, Sancheti, Pk, Sanchez-Niño, Md, Santric Milicevic, Mm, Sarker, Ar, Saylan, Mi, Schmidt, Mi, Schneider, Ijc, Schumacher, Ae, Schutte, Ae, Schwebel, Dc, Sepanlou, Sg, Servan-Mori, Ee, Shaikh, Ma, Shariful Islam, Sm, Shfare, Mt, Shrime, Mg, Shukla, Sr, Sigfusdottir, Id, Silberberg, Dh, Silva, Da, Silva, Jp, Silveira, Dga, Singh, Ja, Singh, Np, Sinha, Dn, Sinke, Ah, Soares Filho, Am, Sobaih, Bha, Sorensen, Rjd, Soriano, Jb, Soyiri, In, Sposato, La, Sreeramareddy, Ct, Stanaway, Jd, Stein, Dj, Stokes, Ma, Sufiyan, Mb, Suliankatchi, Ra, Sunguya, Bf, Sur, Pj, Sykes, Bl, Sylaja, Pn, Tadakamadla, Sk, Tadesse, Ah, Taffere, Gr, Tariku, At, Temsah, Mh, Tesema, Ag, Tesfaye, Dj, Thompson, Mj, To, Qg, Tran, Bx, Tran, Kb, Tripathy, Sp, Tuem, Kb, Ukwaja, Kn, Uthman, Oa, Uzochukwu, Bsc, Valdez, Pr, van Boven, Jfm, Vladimirov, Sk, Vlassov, Vv, Vollset, Se, Wallin, Mt, Walson, Jl, Wang, Yp, Wassie, Mm, Weaver, Mr, Weintraub, Rg, Weldegwergs, Kg, West, Te, White, Rg, Whiteford, Ha, Wolfe, Cd, Wondimkun, Ya, Wyper, Gma, Yan, Ll, Yimer, Nb, Yirsaw, Bd, Yoon, Sj, Younis, Mz, Zaki, Me, Zaman, Sb, Zenebe, Zm, Zimsen, Srm, Zuhlke, Lj, Murray, Cjl, and Lozano, R.
Subjects: Peformance, Coverage, Dánartíðni, Lífslíkur, Life expectancy, GBD, 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), universal health coverage, Article, access quality health care, health care access and quality index, Nations, Healthcare Acce, Cause-specific mortality, Psychology, Healthcare Access and Quality Index, Mælitæki, States, Medicine (all), Health care, Þjóðir, Public Health, Global Health, Social Medicine and Epidemiology, Quality, Heilbrigðisþjónusta, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Sálfræði, Indicator, Amenable mortality, Transition, 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, Trends, Inequalities
Abstract: 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 (89.1-936) 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 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., Bill & Melinda Gates Foundation. Barbora de Courten is supported by a National Heart Foundation Future Leader Fellowship (100864). Ai Koyanagi’s work is supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII —General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER). Alberto Ortiz was supported by Spanish Government (Instituto de Salud Carlos III RETIC REDINREN RD16/0019 FEDER funds). Ashish Awasthi acknowledges funding support from Department of Science and Technology, Government of India through INSPIRE Faculty scheme Boris Bikbov has received funding from the European Union’s Horizon 2020 research and innovation programme under Marie Sklodowska-Curie grant agreement No. 703226. Boris Bikbov acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Panniyammakal Jeemon acknowledges support from the clinical and public health intermediate fellowship from the Wellcome Trust and Department of Biotechnology, India Alliance (2015–20). Job F M van Boven was supported by the Department of Clinical Pharmacy & Pharmacology of the University Medical Center Groningen, University of Groningen, Netherlands. Olanrewaju Oladimeji is an African Research Fellow hosted by Human Sciences Research Council (HSRC), South Africa and he also has honorary affiliations with Walter Sisulu University (WSU), Eastern Cape, South Africa and School of Public Health, University of Namibia (UNAM), Namibia. He is indeed grateful for support from HSRC, WSU and UNAM. EUI is supported in part by the South African National Research Foundation (NRF UID: 86003). Ulrich Mueller acknowledges funding by the German National Cohort Study grant No 01ER1511/D, Gabrielle B Britton is supported by Secretaría Nacional de Ciencia, Tecnología e Innovación and Sistema Nacional de Investigación de Panamá. Giuseppe Remuzzi acknowledges that the work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Behzad Heibati would like to acknowledge Air pollution Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran. Syed Aljunid acknowledges the National University of Malaysia for providing the approval to participate in this GBD Project. Azeem Majeed and Imperial College London are grateful for support from the Northwest London National Insititute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care. Tambe Ayuk acknowledges the Institute of Medical Research and Medicinal Plant Studies for office space provided. José das Neves was supported in his contribution to this work by a Fellowship from Fundação para a Ciência e a Tecnologia, Portugal (SFRH/BPD/92934/2013). João Fernandes gratefully acknowledges funding from FCT–Fundação para a Ciência e a Tecnologia (grant number UID/Multi/50016/2013). Jan-Walter De Neve was supported by the Alexander von Humboldt Foundation. Kebede Deribe is funded by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (201900). Kazem Rahimi was supported by grants from the Oxford Martin School, the NIHR Oxford BRC and the RCUK Global Challenges Research Fund. Laith J Abu-Raddad acknowledges the support of Qatar National Research Fund (NPRP 9-040-3-008) who provided the main funding for generating the data provided to the GBD-IHME effort. Liesl Zuhlke is funded by the national research foundation of South Africa and the Medical Research Council of South Africa. Monica Cortinovis acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group. Chuanhua Yu acknowleges support from the National Natural Science Foundation of China (grant number 81773552 and grant number 81273179) Norberto Perico acknowledges that work related to this paper has been done on behalf of the GBD Genitourinary Disease Expert Group. Charles Shey Wiysonge’s work is supported by the South African Medical Research Council and the National Research Foundation of South Africa (grant numbers 106035 and 108571). John J McGrath is supported by grant APP1056929 from the John Cade Fellowship from the National Health and Medical Research Council and the Danish National Research Foundation (Niels Bohr Professorship). Quique Bassat is an ICREA (Catalan Institution for Research and Advanced Studies) research professor at ISGlobal. Richard G White is funded by the UK MRC and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement that is also part of the EDCTP2 programme supported by the European Union (MR/P002404/1), the Bill & Melinda Gates Foundation (TB Modelling and Analysis Consortium: OPP1084276/OPP1135288, CORTIS: OPP1137034/OPP1151915, Vaccines: OPP1160830), and UNITAID (4214-LSHTM-Sept15; PO 8477-0-600). Rafael Tabarés-Seisdedos was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI17/00719 from ISCIII-FEDER. Mihajlo Jakovljevic acknowleges contribution from the Serbian Ministry of Education Science and Technological Development of the Republic of Serbia (grant OI 175 014). Shariful Islam is funded by a Senior Fellowship from Institute for Physical Activity and Nutrition, Deakin University and received career transition grants from High Blood Pressure Research Council of Australia. Sonia Saxena is funded by various grants from the NIHR. Stefanos Tyrovolas was supported by the Foundation for Education and European Culture, the Sara Borrell postdoctoral program (reference number CD15/00019 from the Instituto de Salud Carlos III (ISCIII–Spain) and the Fondos Europeo de Desarrollo Regional. Stefanos was awarded with a 6 months visiting fellowship funding at IHME from M-AES (reference no. MV16/00035 from the Instituto de Salud Carlos III). S Vittal Katikreddi was funded by a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the MRC (MC_UU_12017/13 & MC_ UU_12017/15) and the Scottish Government Chief Scientist Office (SPHSU13 & SPHSU15). Traolach S Brugha has received funding from NHS Digital UK to collect data used in this study. The work of Hamid Badali was financially supported by Mazandaran University of Medical Sciences, Sari, Iran. The work of Stefan Lorkowski is funded by the German Federal Ministry of Education and Research (nutriCARD, Grant agreement number 01EA1411A). Mariam Molokhia’s research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We also thank the countless individuals who have contributed to GBD 2016 in various capacities.
Published: 2018

17. Maternal Pregnancy and Pre-Pregnancy Weight and Behavioural Outcomes in Children.

Author: Dachew BA, Adane AA, and Alati R
Abstract: Reported associations of pre-pregnancy weight and/or gestational weight gain with offspring behavioural outcomes are inconsistent. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), this study aimed to examine these associations at five developmental stages between the ages of 3 and 16. Over 6800 mother-offspring pairs at age 3 and 3925 pairs at age 16 were included. Pre-pregnancy underweight was associated with a 22% increased risk of total behavioural difficulties (OR = 1.22, 95% CI 1.02-1.45). In separate analyses using the SDQ subscales, pre-pregnancy underweight was linked to a 37% (OR = 1.37, 95% CI 1.14-1.65) and 33% (OR = 1.33, 95% CI 1.01-1.76) increased risk of emotional symptoms and prosocial behaviour problems over time, respectively. While pre-pregnancy overweight was associated with an 11% (OR = 1.11, 95% CI 1.03-1.20) and 18% (OR = 1.18, 95% CI 1.03-1.36) increased risk of conduct and peer relationship problems, respectively, pregnancy obesity was associated with a 43% increased risk of emotional problems (OR = 1.43, 95% CI 1.16-1.77). We found no evidence of associations between gestational weight gain and child behaviour except for a reduced risk in prosocial behaviour problems (OR = 0.82, 95% CI 0.70-0.96). Our findings provide insights into the link between preconception BMI and child behaviour, underscoring the necessity for further research to validate these associations and elucidate underlying mechanisms.
Published: 2024
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18. Perinatal outcomes of Aboriginal women with mental health disorders.

Author: Adane AA, Shepherd CC, Walker R, Bailey HD, Galbally M, and Marriott R
Subjects: Pregnancy, Infant, Newborn, Female, Humans, Birth Weight, Retrospective Studies, Fetal Distress, Mental Health, Australia epidemiology, Premature Birth epidemiology, Pregnancy Complications epidemiology, Substance-Related Disorders
Abstract: Objective: Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births., Methods: We used whole population-based linked data to conduct a retrospective cohort study ( N = 38,592) using all Western Australia singleton Aboriginal births (1990-2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals., Results: After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder., Conclusions: This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
Published: 2023
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19. Severe maternal morbidity following stillbirth in Western Australia 2000-2015: a population-based study.

Author: Bailey HD, Adane AA, White SW, Farrant BM, and Shepherd CCJ
Subjects: Pregnancy, Female, Humans, Retrospective Studies, Western Australia epidemiology, Australia, Risk Factors, Stillbirth epidemiology, Pregnancy Complications epidemiology, Pregnancy Complications etiology
Abstract: Purpose: There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities., Methods: In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks' gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately., Results: This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value < 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively., Conclusion: In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted., (© 2022. The Author(s).)
Published: 2023
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20. The perinatal and childhood outcomes of children born to Indigenous women with mental health problems: A scoping review.

Author: Adane AA, Shepherd CC, Reibel T, Ayano G, and Marriott R
Subjects: Child, Female, Humans, Pregnancy, Australia, Family, Parturition, Mental Health, Substance-Related Disorders
Abstract: Objective: Maternal mental health problems are common during the perinatal period and have been associated with several negative outcomes in children. However, few studies have examined the associations between maternal mental health problems and offspring outcomes among Indigenous people, and the findings across these studies have been inconsistent. This scoping review examined the birth and childhood (≤12 years) health and development outcomes of the children of Indigenous women with mental health problems., Methods: A scoping review was conducted following the methodological framework developed by Arksey and O'Malley and based on the PRISMA-ScR guidelines. Eight databases were searched electronically for studies examining the associations between any perinatal maternal mental health problems and birth and childhood outcomes among the Indigenous populations of Australia, Canada, New Zealand, and the USA. Two authors reviewed studies for inclusion. A narrative synthesis approach was adopted., Results: Of 2,836 records identified, 10 were eligible. One of three studies evaluating maternal depression and anxiety problems found a negative (adverse) association with birth and childhood behavioural outcomes. Six of seven studies that examined the associations between maternal substance use disorder (mainly alcohol use disorder) and several birth and childhood outcomes found at least one negative association., Conclusions and Implications for Practice: Maternal substance use disorder appears to be associated with adverse birth and childhood outcomes among some Indigenous populations. However, there is preliminary evidence for the other common maternal mental health problems. Further research is critically required to draw definitive conclusions regarding the impact of maternal mental health problems on the birth and childhood outcomes., Competing Interests: Declaration of Competing Interest The authors reported no potential conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
Published: 2023
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21. Early mortality among aboriginal and non-aboriginal women who had a preterm birth in Western Australia: A population-based cohort study.

Author: Bailey HD, Gray C, Adane AA, Strobel NA, White SW, Marriott R, Tessema GA, Shepherd CCJ, and Sharp M
Subjects: Female, Humans, Infant, Newborn, Pregnancy, Cohort Studies, Retrospective Studies, Western Australia epidemiology, Australian Aboriginal and Torres Strait Islander Peoples, Premature Birth epidemiology, Maternal Mortality
Abstract: Background: Having a preterm (<37 weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women., Objectives: We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status., Methods: This retrospective cohort study used population-based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all-cause and cause-specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all-cause and cause-specific mortality., Results: There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non-Aboriginal mothers (7646 deaths) with 8.6 million person-years of follow-up. The all-cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person-years respectively. Among non-Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person-years. The HR for all-cause mortality for Aboriginal and non-Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes., Conclusions: Both Aboriginal and non-Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening., (© 2022 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)
Published: 2023
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22. Mapping national, regional and local prevalence of hypertension and diabetes in Ethiopia using geospatial analysis.

Author: Koye DN, Melaku YA, Gelaw YA, Zeleke BM, Adane AA, Tegegn HG, Gebreyohannes EA, Erku DA, Tesfay FH, Gesesew HA, Mekonnen A, Dadi AF, and Alene KA
Subjects: Humans, Adolescent, Young Adult, Adult, Middle Aged, Aged, Ethiopia epidemiology, Prevalence, Bayes Theorem, Cross-Sectional Studies, Risk Factors, Hypertension epidemiology, Hypertension complications, Diabetes Mellitus epidemiology
Abstract: Objectives: This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia., Design and Setting: Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources., Participants: 9801 participants aged between 15 and 69 years., Primary Outcome Measures: Prevalence of hypertension and diabetes were collected using the WHO's STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km 2 ) with corresponding 95% credible intervals (95% CrIs)., Results: The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People's region and Addis Ababa. Population density (number of people/km 2 ) was positively associated with the prevalence of hypertension (β: 0.015; 95% CrI: 0.003-0.027) and diabetes (β: 0.046; 95% CrI: 0.020-0.069); whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: -0.374; 95% CrI: -0.711 to -0.044)., Conclusions: Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2022
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23. Patterns of recurrent preterm birth in Western Australia: A 36-year state-wide population-based study.

Author: Adane AA, Shepherd CCJ, Farrant BM, White SW, and Bailey HD
Subjects: Australia, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Term Birth, Western Australia epidemiology, Premature Birth epidemiology
Abstract: Background: It is known that a previous preterm birth increases the risk of a subsequent preterm birth, but a limited number of studies have examined this beyond two consecutive pregnancies., Aims: This study aimed to assess the risk and patterns of (recurrent) preterm birth up to the fourth pregnancy., Materials and Methods: We used Western Australian routinely linked population health datasets to identify women who had two or more consecutive singleton births (≥20 weeks gestation) from 1980 to 2015. A log-binomial model was used to calculate risk ratios (RRs) and 95% confidence interval (CIs) for preterm birth risk in the third and fourth deliveries by the combined outcomes of previous pregnancies., Results: We analysed 255 435 women with 651 726 births. About 7% of women had a preterm birth in the first delivery, and the rate of continuous preterm birth recurrence was 22.9% (second), 44.9% (third) and 58.5% (fourth) deliveries. The risk of preterm birth at the third delivery was highest for women with two prior indicated preterm births (RR 12.5, 95% CI: 11.3, 13.9) and for those whose first pregnancy was 32-36 weeks gestation, and second pregnancy was less than 32 weeks gestation (RR 11.8, 95% CI: 10.3, 13.5). There were similar findings for the second and fourth deliveries., Conclusions: Our findings demonstrate that women with any prior preterm birth were at greater risk of preterm birth in subsequent pregnancies compared with women with only term births, and the risk increased with shorter gestational length, and the number of previous preterm deliveries, especially sequential ones., (© 2022 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
Published: 2022
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24. Caesarean section following antepartum stillbirth in Western Australia 2010-2015: A population-based study.

Author: Bailey HD, Adane AA, White SW, Farrant BM, and Shepherd CCJ
Subjects: Female, Humans, Placenta, Pregnancy, Retrospective Studies, Western Australia epidemiology, Cesarean Section, Stillbirth epidemiology
Abstract: Background: There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However, little is known about caesarean section rates following antepartum stillbirth in Australia., Aims: We aimed to describe the onset of labour, mode of birth, and use of analgesia and anaesthesia following antepartum stillbirth and to identify factors associated with caesarean section., Material and Methods: In this retrospective cohort study, we used a population-based dataset of all singleton antepartum stillbirths ≥20 weeks gestation in Western Australia between 2010-2015. The overall, primary and repeat caesarean section rates for antepartum stillbirths were calculated and multivariable Poisson regression analyses were performed to identify associated factors, and to calculate relative risks (RRs) and 95% confidence intervals (CIs)., Results: This study included 634 antepartum stillbirths. Labour was spontaneous for 134 (21.1%), induced for 457 (72.1%), and 43 (6.8%) had a prelabour caesarean section. The overall, primary and repeat caesarean section rates were 8.5%, 4.6% and 23.0% respectively and increased with gestation (P trends all <0.01). Other factors associated with an increased caesarean section risk included: any placenta praevia or placental abruption, birth at a metropolitan private hospital, large-for-gestational-age birthweight, and any maternal chronic condition. During labour, the most frequently used types of analgesia were systemic narcotics (46.0%) and regional blocks (34.7%) while among those who had a caesarean section, 40.7% had a general anaesthetic., Conclusions: In Western Australia between 2010-2015, the caesarean section rates among women with antepartum stillbirths were low, in line with current guidelines., (© 2022 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
Published: 2022
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25. Knowing your audience: Investigating stillbirth knowledge and perceptions in the general population to inform future public health campaigns.

Author: Pollock D, Shepherd CCJ, Adane AA, Foord C, Farrant BM, and Warland J
Subjects: Australia epidemiology, Cross-Sectional Studies, Female, Humans, Male, Pregnancy, Surveys and Questionnaires, Health Promotion, Stillbirth epidemiology
Abstract: Background: The prevalence of stillbirth in many high income countries like Australia has remained unchanged for over 30 years. The 2018 Australian government Senate Select Committee on Stillbirth Research and Education highlighted the need for a public health campaign to encourage public conversations and increase awareness. However, there is little evidence about the community's knowledge and perceptions towards pregnancy and stillbirth, nor their aspirations for a public health campaign., Aims: To assess the general knowledge, perceptions, myths and attitudes towards stillbirth to inform future public health campaigns., Methods: Australian participants (n = 344; predominately women n = 294 (85.5%)) were recruited via Facebook.com. They completed a cross-sectional online survey designed to assess their knowledge of pregnancy and stillbirth, with additional questions on socio-demographic characteristics., Results: Stillbirth knowledge and awareness of incidence was low in this sample. Prominent myths, such as baby runs out of room in the uterus (n = 112, 33%) and baby slows down when preparing for labour (n = 24, 27%) were endorsed. Only 25% (n = 85) knew the prevalence of stillbirth in Australia (six per day). Almost two-thirds (n = 205; 62%) agreed that there needs to be a public health campaign, however one in five (n = 65; 20%) were concerned that talking about stillbirth with pregnant women may cause them to worry., Discussion and Conclusion: Our findings reinforce the need for a targeted campaign, which educates the general population about the definition and prevalence of stillbirth, stillbirth risks and modifiable health behaviours. Appropriate messaging should target pregnant women during antenatal care as well as their support and care systems (family, friends, and care providers)., (Copyright © 2021 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)
Published: 2022
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26. Authors' reply re: Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis: Practice-embedded research to address knowledge gaps in multidrug-resistant tuberculosis in pregnancy.

Author: Alene KA, Jegnie A, and Adane AA
Subjects: Female, Humans, Parturition, Pregnancy, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant epidemiology
Published: 2021
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27. Disparities in severe neonatal morbidity and mortality between Aboriginal and non-Aboriginal births in Western Australia: a decomposition analysis.

Author: Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, and Shepherd CCJ
Subjects: Australia, Female, Humans, Infant, Infant, Newborn, Morbidity, Pregnancy, Retrospective Studies, Western Australia epidemiology, Native Hawaiian or Other Pacific Islander, Sociodemographic Factors
Abstract: Background: The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors., Method: A retrospective cohort study with singleton live births (≥32 weeks' gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers' self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality., Results: Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%)., Conclusions: There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2021
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28. The impact of maternal prenatal mental health disorders on stillbirth and infant mortality: a systematic review and meta-analysis.

Author: Adane AA, Bailey HD, Morgan VA, Galbally M, Farrant BM, Marriott R, White SW, and Shepherd CC
Subjects: Female, Humans, Infant, Infant Mortality, Infant, Newborn, Mental Health, Pregnancy, Prenatal Care, Mental Disorders diagnosis, Mental Disorders epidemiology, Stillbirth epidemiology
Abstract: Evidence about the association between maternal mental health disorders and stillbirth and infant mortality is limited and conflicting. We aimed to examine whether maternal prenatal mental health disorders are associated with stillbirth and/or infant mortality. MEDLINE, Embase, PsycINFO, and Scopus were searched for studies examining the association of any maternal prenatal (occurring before or during pregnancy) mental health disorder(s) and stillbirth or infant mortality. A random-effects meta-analysis was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). The between-study heterogeneity was quantified using the I 2 statistic. Subgroup analyses were performed to identify the source of heterogeneity. Of 4487 records identified, 28 met our inclusion criteria with 27 contributing to the meta-analyses. Over 60% of studies examined stillbirth and 54% of them evaluated neonatal or infant mortality. Thirteen studies investigated the association between maternal depression and anxiety and stillbirth/infant mortality, pooled OR, 1.42 (95% CI, 1.16-1.73; I 2 , 76.7%). Another 13 studies evaluated the association between severe maternal mental illness and stillbirth/infant mortality, pooled OR, 1.47 (95% CI, 1.28-1.68; I 2 , 62.3%). We found similar results for the association of any maternal mental health disorders and stillbirth/infant mortality (OR, 1.59; 95% CI, 1.43-1.77) and in subgroup analyses according to types of fetal/infant mortality. We found no significant evidence of publication bias. Maternal prenatal mental health disorders appear to be associated with a moderate increase in the risk of stillbirth and infant mortality, although the mechanisms are unclear. Efforts to prevent and treat these disorders may reduce the scale of stillbirth/infant deaths.
Published: 2021
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29. Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis.

Author: Alene KA, Jegnie A, and Adane AA
Subjects: Abortion, Spontaneous, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Maternal Mortality, Pregnancy, Premature Birth, Pregnancy Complications, Infectious, Tuberculosis, Multidrug-Resistant complications
Abstract: Background: Multidrug-resistant tuberculosis (MDR-TB) is a major global public health concern. However, there is a dearth of literature on whether MDR-TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting., Objectives: This systematic review and meta-analysis aimed to examine the impact of MDR-TB and its medications during pregnancy on maternal and perinatal outcomes., Search Strategy: PubMed, Scopus and Web of Science databases were searched from earliest to February 2020., Selection Criteria: Records were screened based on pre-defined selection criteria and assessed for quality by two independent reviewers., Data Collection and Analysis: A meta-analysis was performed using the random effects model to calculate pooled prevalence for each outcome., Main Results: Of the 72 records identified, 12 were included in the systematic review and meta-analysis, consisting of 174 pregnant women with MDR-TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2-12.8) for maternal death, 10.6% (95% CI 6.0-16.3) for pregnancy loss, 12.9% (95% CI 0.0-38.0) for preterm birth and 23.7% (95% CI 17.0-31.0) for low birthweight., Conclusions: The findings suggest that MDR-TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings., Tweetable Abstract: Multidrug-resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes., (© 2020 John Wiley & Sons Ltd.)
Published: 2021
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30. Comparison of stillbirth trends over two decades in Wales, United Kingdom and Western Australia: An international retrospective cohort study.

Author: Bailey HD, Kotecha SJ, Watkins WJ, Adane AA, Shepherd CCJ, and Kotecha S
Subjects: Cohort Studies, Female, Gestational Age, Humans, Pregnancy, Retrospective Studies, United Kingdom, Wales epidemiology, Western Australia epidemiology, Stillbirth epidemiology
Abstract: Background: Stillbirth is a critical public health issue worldwide. While the rates in high-income countries are relatively low, there are persistent between-country disparities., Objectives: To compare stillbirth rates and trends in Wales and the State of Western Australia (WA), Australia, and provide insights into any differences., Methods: In this international retrospective cohort study, we pooled population-based data collections of all births ≥24 weeks' gestation (excluding terminations for congenital anomalies) between 1993 and 2015, divided into six time periods. The stillbirth rate per 1000 births was estimated for each cohort in each time period. Multivariable Poisson regression analyses, adjusted for appropriateness of growth, socio-economic status, maternal age, and multiple birth, were performed to evaluate the interaction between cohort and time period. Relative risk (RR) and 95% confidence interval (CI) for each time period and cohort were calculated., Results: There were 767 731 births (3725 stillbirths) in Wales and 648 373 (2431 stillbirths) in WA. The overall stillbirth rate declined by 15.9% over the study period in Wales (from 5.3 in 1993-96 to 4.5 per 1000 births in 2013-15; P trend < .01) but by 40.4% in WA (from 4.9 to 2.9 per 1000 births in WA; P trend < .01). Using 1993-96 in WA as the reference group, the adjusted RRs for stillbirths at 37-38 weeks' gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64, 1.13) in Wales and 0.51 (95% CI 0.36, 0.73) in WA., Conclusions: The stillbirth rates between Wales and WA have widened in the last two decades (especially among late-term births), although the absolute rates for both are distinctly higher than the best-performing nations. While the differences may be partly explained by timing of birth and maternal life style behaviours such as smoking, it is important to identify and ameliorate the associated risk factors to support a reduction in preventable stillbirths., (© 2020 John Wiley & Sons Ltd.)
Published: 2021
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31. Risk factors for COVID-19 infection, disease severity and related deaths in Africa: a systematic review.

Author: Gesesew HA, Koye DN, Fetene DM, Woldegiorgis M, Kinfu Y, Geleto AB, Melaku YA, Mohammed H, Alene KA, Awoke MA, Birhanu MM, Gebremedhin AT, Gelaw YA, Shifti DM, Muluneh MD, Tegegne TK, Abrha S, Aregay AF, Ayalew MB, Gebre AK, Gebremariam KT, Gebremedhin T, Gebremichael L, Leshargie CT, Kibret GD, Meazaw MW, Mekonnen AB, Tekle DY, Tesema AG, Tesfay FH, Tesfaye W, Wubishet BL, Dachew BA, and Adane AA
Subjects: Africa epidemiology, COVID-19 mortality, Humans, Risk Factors, Severity of Illness Index, COVID-19 epidemiology
Abstract: Objective: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa., Design: A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa., Data Sources: Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv., Eligibility Criteria: Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020., Data Extraction and Synthesis: We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form., Results: Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and individuals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths., Conclusions: Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2021
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32. COVID-19 in Ethiopia: a geospatial analysis of vulnerability to infection, case severity and death.

Author: Alene KA, Gelaw YA, Fetene DM, Koye DN, Melaku YA, Gesesew H, Birhanu MM, Adane AA, Muluneh MD, Dachew BA, Abrha S, Aregay A, Ayele AA, Bezabhe WM, Gebremariam KT, Gebremedhin T, Gebremedhin AT, Gebremichael L, Geleto AB, Kassahun HT, Kibret GD, Leshargie CT, Mekonnen A, Mirkuzie AH, Mohammed H, Tegegn HG, Tesema AG, Tesfay FH, Wubishet BL, and Kinfu Y
Subjects: COVID-19 mortality, Ethiopia epidemiology, Female, Humans, Male, Pandemics, Risk Factors, COVID-19 epidemiology, Geography, Medical
Abstract: Background: COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia., Methods: Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km., Results: This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples' Region. The risk of COVID-19-related death is high in the country's border regions, where public health preparedness for responding to COVID-19 is limited., Conclusion: This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2021
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33. Socioethnic disparities in severe maternal morbidity in Western Australia: a statewide retrospective cohort study.

Author: Adane AA, Farrant BM, Marriott R, White SW, Bailey HD, and Shepherd CCJ
Subjects: Adolescent, Adult, Female, Humans, Pregnancy, Retrospective Studies, Western Australia epidemiology, White People, Young Adult, Mothers
Abstract: Objectives: To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities., Design: Retrospective cohort study., Setting: Whole-of-population linked administrative data from 2002 to 2015 in Western Australia., Participants: Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks' or more gestation, including terminations for congenital anomalies., Primary and Secondary Outcome Measures: Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into 'explained' and 'unexplained' components., Results: During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and 'other' ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women., Conclusions: There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2020
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34. Correction to: Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia.

Author: Bailey HD, Adane AA, Farrant BM, White SW, Hardelid P, and Shepherd CCJ
Abstract: Unfortunately, after publication, we found errors in the extraction of data on gestational diabetes and threatened miscarriage.
Published: 2020
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35. Modern Contraceptive Utilization and Associated Factors among Married Gumuz Women in Metekel Zone North West Ethiopia.

Author: Adane AA, Bekele YA, Melese E, Worku GT, and Netsere HB
Subjects: Adolescent, Adult, Cross-Sectional Studies, Ethiopia, Female, Humans, Contraception Behavior, Educational Status, Health Knowledge, Attitudes, Practice, Marriage, Surveys and Questionnaires
Abstract: Background . Modern contraceptives are a key intervention to improve the health of both the mother and children by preventing unintended pregnancy. However, significant numbers of women were facing abortion-related morbidity and mortality globally including Ethiopia due to the nonuse or failure of contraceptive uses. Therefore, the aim of this study was to assess the utilization of modern contraceptive methods and associated factors among married Gumuz women in Metekel Zone North West Ethiopia. A community-based cross-sectional study was conducted among 580 women from March 1 to 30/2019. Pretested structured interview administer questionnaires was used to collect the data. Data were cleaned, coded, and entered into Epi-info version 7.1 and export to SPSS for farther analysis. Both bivariate and multivariate analyses were used. On bivariate analysis P value, less than 0.2 were used to select the candidate variable for multivariate analysis. P value and 95% confidence interval were used to measure the level of significance on multivariate analysis and those variables whose P value < 0.05 were considered as statically significant. The prevalence of modern contraceptive method was 18.6% [95% CI: 15.00-22.00]. Age ≥ 35 year AOR 4.67; 95% CI (1.34 -16.18), able to read and write AOR 6.45 95% CI(2.98-13.97), primary school AOR 6.56; 95% CI (2.22-19.38), secondary school AOR 7.27; 95% CI (3.00 -17.61), counseled on contraceptive methods AOR 3.72 95% CI (2.11-6.56), moderate knowledge on modern contraceptive method AOR 2.31; 95% CI (1.15-4.64), and good knowledge on modern contraceptive method AOR 4.37; 95% CI (2.38-8.02) were identified as statistically significant with modern contraceptive methods utilization. The prevalence of contraceptive utilization was low when compared to the national and the regional figure. Maternal age, maternal educational status, counseling about modern contraceptive methods, and knowledge on modern contraceptive methods were found as statistically significant with modern contraceptive utilization., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Alemnew Ashagrie Adane et al.)
Published: 2020
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36. Profile of severely growth-restricted births undelivered at 40 weeks in Western Australia.

Author: Bailey HD, Adane AA, Farrant BM, White SW, Hardelid P, and Shepherd CCJ
Abstract: Purpose: To investigate the proportion of severely growth-restricted singleton births < 3rd percentile (proxy for severe fetal growth restriction; FGR) undelivered at 40 weeks (FGR_40), and compare maternal characteristics and outcomes of FGR_40 births and FGR births at 37-39 weeks' (FGR_37-39) to those not born small-for-gestational-age at term (Not SGA_37+)., Methods: The annual rates of singleton FGR_40 births from 2006 to 2015 were calculated using data from linked Western Australian population health datasets. Using 2013-2015 data, maternal factors associated with FGR births were investigated using multinomial logistic regression to estimate odds ratios (OR) with 95% confidence intervals (CI) while relative risks (RR) of birth outcomes between each group were calculated using Poisson regression. Neonatal adverse outcomes were identified using a published composite indicator (diagnoses, procedures and other factors)., Results: The rate of singleton FGR_40 births decreased by 23.0% between 2006 and 2015. Factors strongly associated with FGR_40 and FGR_37-39 births compared to Not SGA_37+ births included the mother being primiparous (ORs 3.13: 95% CI 2.59-3.79; 1.69, 95% CI 1.47, 1.94, respectively) and ante-natal smoking (ORs 2.55, 95% CI 1.97, 3.32; 4.48, 95% CI 3.74, 5.36, respectively). FGR_40 and FGR_37-39 infants were more likely to have a neonatal adverse outcome (RRs 1.70, 95% CI 1.41, 2.06 and 2.46 95% CI 2.18, 2.46, respectively) compared to Not SGA 37+ infants., Conclusions: Higher levels of poor perinatal outcomes among FGR births highlight the importance of appropriate management including fetal growth monitoring. Regular population-level monitoring of FGR_40 rates may lead to reduced numbers of poor outcomes.
Published: 2020
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37. Stroke Characteristics and Outcomes of Adult Patients in Northwest Ethiopia.

Author: Baye M, Hintze A, Gordon-Murer C, Mariscal T, Belay GJ, Gebremariam AA, and Hughes CML
Abstract: Stroke is becoming one of the leading causes of adult disability and death in sub-Saharan African countries. The aim of the present study is to provide an up-to-date account of the clinical and demographic characteristics of patients with stroke admitted to the University of Gondar College of Medicine and Health Science Comprehensive Specialized Hospital (CMHS). A hospital based retrospective study design was used to analyze the medical records of all patients with stroke admitted to CMHS from June 20th 2012 and April 30th 2018. Data were cleaned and entered into SPSS for analysis. Among the 448 patients with stroke admitted to CMHS, 58.0% ( n = 260) of patients were female, and 42.0% ( n = 188) were male. In the present sample, 141 (31.5%) had an ischemic stroke confirmed by neuroimaging, 82 (18.3%) had a hemorrhagic stroke confirmed by neuroimaging, and 252 (50.2%) had a stroke with undetermined type. The mean age of stroke was 63.9 years (range = 18-100, SD : 15.1 years), with no differences observed between stroke subtypes. The most common symptoms that led to patients seeking medical intervention were hemiparesis (67.4%), communication difficulties (56.0%), facial deviation (37.3%), and globalized headache (36.4%). Hypertension was the most commonly reported risk factor (37.1%), which was more prevalent in hemorrhagic ( n = 37, 45.1%) than ischemic stroke patients ( n = 53, 37.6%), stroke with undetermined type ( n = 76, 33.8%). Stroke places a significant burden on sub-Saharan African countries. Results of the current study highlight the need to develop programs that educate the Ethiopian populace about the risk factors and symptoms of stroke, the importance of seeking medical care within the golden window, and the benefits of neuroimaging to accurately diagnose stroke subtype. In addition, the current study provides hospital administrators with empirical data that they can use to form an interdisciplinary stroke rehabilitation team capable of improving outcomes of Ethiopian patients with stroke., (Copyright © 2020 Baye, Hintze, Gordon-Murer, Mariscal, Belay, Gebremariam and Hughes.)
Published: 2020
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38. Role of maternal mental health disorders on stillbirth and infant mortality risk: a protocol for a systematic review and meta-analysis.

Author: Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Morgan VA, and Shepherd CC
Subjects: Female, Humans, Infant, Meta-Analysis as Topic, Pregnancy, Research Design, Risk Factors, Systematic Reviews as Topic, Infant Mortality, Maternal Health, Mental Health, Stillbirth
Abstract: Introduction: Maternal mental health disorders such as anxiety and depression are major public health concerns. Evidence shows a link between maternal mental health disorders and preterm birth and low birth weight. However, the impacts of maternal mental health disorders on stillbirth and infant mortality have been less investigated and inconsistent findings have been reported. Thus, using the available literature, we plan to examine whether prenatal maternal mental health disorders impact the risk of stillbirth and infant mortality., Methods and Analysis: This systematic review and meta-analysis will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews. Systematic searches will be conducted (from database inception to December 2019) in Medline, Embase, PsycINFO and Scopus for studies examining the association of prenatal mental health disorders and stillbirth and infant mortality. The search will be limited to studies published in English language and in humans only, with no restriction on the year of publication. Two independent reviewers will evaluate records and assess the quality of individual studies. The Newcastle-Ottawa scales and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to assess the methodological quality and bias of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I 2 statistics will be used to assess between-study heterogeneity in the estimated effect size., Ethics and Dissemination: As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences., Prospero Registration Number: 159834., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2020
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39. Impact of multidrug-resistant tuberculosis and its medications on adverse maternal and perinatal outcomes: protocol for a systematic review and meta-analysis.

Author: Alene KA, Adane AA, and Jegnie A
Subjects: Female, Humans, Infant, Newborn, Pregnancy, Meta-Analysis as Topic, Pregnancy Complications, Infectious drug therapy, Pregnancy Outcome, Research Design, Systematic Reviews as Topic, Tuberculosis, Multidrug-Resistant drug therapy
Abstract: Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes., Methods and Analysis: This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I 2 statistics will be used to assess the heterogeneity between studies., Ethics and Dissemination: As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2019
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40. Disparities between Aboriginal and non-Aboriginal perinatal mortality rates in Western Australia from 1980 to 2015.

Author: Adane AA, Bailey HD, Marriott R, Farrant BM, White SW, Stanley FJ, and Shepherd CCJ
Subjects: Adult, Female, Humans, Infant, Newborn, Male, Perinatal Mortality trends, Pregnancy, Western Australia epidemiology, Health Status Disparities, Native Hawaiian or Other Pacific Islander statistics & numerical data, Perinatal Mortality ethnology, Stillbirth ethnology
Abstract: Background: Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia., Objectives: This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings., Methods: All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories., Results: From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period., Conclusions: Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations., (© 2019 John Wiley & Sons Ltd.)
Published: 2019
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41. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis.

Author: Adane AA, Shepherd CCJ, Lim FJ, White SW, Farrant BM, and Bailey HD
Subjects: Body Mass Index, Female, Humans, Obesity complications, Overweight complications, Pregnancy, Pregnancy Complications etiology, Weight Gain, Abruptio Placentae epidemiology, Gestational Weight Gain, Thinness complications
Abstract: Purpose: The aim of this systematic review was to evaluate the associations between pre-pregnancy body mass index and gestational weight gain and placental abruption., Methods: Relevant studies were identified from PubMed, EMBASE, Scopus and CINAHL. Unpublished findings from analyses of linked population-based data sets from Western Australia (2012-2015, n = 114,792) were also included. Studies evaluating pre-pregnancy body mass index and/or gestational weight gain and placental abruption were included. Two independent reviewers evaluated studies for inclusion and quality. Data including odds ratios (ORs) and 95% confidence intervals (CIs) were extracted and analysed by random effects meta-analysis., Results: 21 studies were included, of which 15 were eligible for meta-analyses. The summary ORs for the association of being underweight, overweight and obese, and placental abruption, compared to normal weight women, were 1.4 (95% CI 1.1, 1.7), 0.8 (95% CI 0.8, 0.9) and 0.8 (95% CI 0.7, 0.9), respectively. These findings remained unchanged when each study was eliminated from the analysis and in subgroup analyses. Although data were scarce, women with gestational weight gain below the Institute of Medicine recommendations appeared to be at greater risk of abruption compared with women who had optimal weight gain., Conclusions: Mothers that are underweight prior to or in early pregnancy are at a moderately increased risk of placental abruption.
Published: 2019
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42. The role of offspring's birthweight on the association between pre-pregnancy obesity and offspring's childhood anthropometrics: a mediation analysis.

Author: Adane AA, Tooth LR, and Mishra GD
Subjects: Adolescent, Adult, Anthropometry, Australia epidemiology, Body Weight, Child, Female, Growth Disorders etiology, Humans, Incidence, Life Style, Longitudinal Studies, Male, Mothers, Pregnancy, Prenatal Exposure Delayed Effects etiology, Young Adult, Birth Weight, Body Mass Index, Child Development, Growth Disorders epidemiology, Obesity complications, Overweight complications, Prenatal Exposure Delayed Effects epidemiology
Abstract: While birthweight of offspring is associated with pre-pregnancy body mass index (BMI) and later risk of obesity, its mediating effect between the association of maternal pre-pregnancy BMI and offspring's childhood anthropometrics has rarely been investigated. This study aimed to examine whether offspring birthweight is a mediator in the association between pre-pregnancy BMI and offspring's childhood anthropometrics. The study included 1,618 mother-child pairs from the Australian Longitudinal Study on Women's Health and Mothers and their Children's Health Study. Children's anthropometrics [mean age 8.6 (s.d. =3.0) years] were calculated from the mothers' self-reported child weight and height measures. G-computation was used to estimate the natural direct and indirect (via birthweight) effects of pre-pregnancy BMI. In the fully adjusted model for maternal sociodemographic and lifestyle factors, the natural direct effects of pre-pregnancy obesity on child BMI-for-age, height-for-age, weight-for-age and weight-for-height outcomes were, β (95% confidence interval, CI), 0.75 (0.55, 0.95), 0.13 (-0.07, 0.32), 0.62 (0.44, 0.80) and 0.57 (0.24, 0.90), respectively. The corresponding natural indirect effects were 0.04 (-0.04, 0.12), -0.01 (-0.09, 0.07), -0.01 (-0.08, 0.07) and 0.09 (-0.05, 0.23). Similar results were observed for pre-pregnancy overweight and pre-pregnancy BMI as a continuous scale. Most of the effect of pre-pregnancy obesity on childhood weight-related anthropometric outcomes appears to be via a direct effect, not mediated through offspring's birthweight.
Published: 2019
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43. Seroprevalence of Hepatitis B Virus and Associated Factors among Health Professionals in University of Gondar Hospital, Northwest Ethiopia.

Author: Gebremariam AA, Tsegaye AT, Shiferaw YF, Reta MM, and Getaneh A
Abstract: Introduction: Hepatitis B virus infection is one of the commonest occupational risks in healthcare workers. However; there is limited evidence regarding the prevalence of hepatitis in health professionals in Ethiopia., Objective: This study was aimed at assessing the prevalence of hepatitis B and associated factors in health professionals., Methods: Institution based cross-sectional study was conducted among health professionals at University of Gondar Hospital from January to February, 2015. Self-administered questionnaire was used to collect sociodemographic variables and blood sample was also taken to determine hepatitis B virus sero-status. Chi square test with 95% confidence interval (CI) was computed to assess the associations of different factors with hepatitis B infection., Result: A total of 332 health professionals (with a response rate of 92.2%) participated in the study. Most (98.5%) of health professionals were not vaccinated for hepatitis B. The prevalence of hepatitis B in health professionals at UOG hospital was found to be 4.52% (95% CI: 2.4, 6.5). Hepatitis B infection was more common among males (P value = 0.0299). Conclusion . The prevalence of hepatitis B in health professionals in this study was comparable with other studies done in Ethiopia among health professionals. Males were more affected than females for hepatitis B infection. Hepatitis B virus vaccine, treatment for the infected, and training on infection prevention should be more available for healthcare workers.
Published: 2019
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44. Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study.

Author: Alene KA, Adane AA, Yifiru S, Bitew BD, Adane A, and Koye DN
Subjects: Adult, Cross-Sectional Studies, Ethiopia, Female, Humans, Logistic Models, Male, Multivariate Analysis, Referral and Consultation, Self Report, Young Adult, Antitubercular Agents pharmacology, Health Knowledge, Attitudes, Practice, Health Personnel, Tuberculosis, Multidrug-Resistant drug therapy, Tuberculosis, Multidrug-Resistant prevention & control
Abstract: Objective: The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control., Study Design and Settings: A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital., Participants: Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants., Outcome Measures: The main outcomes were knowledge and self-reported practice of health workers about MDR-TB., Results: A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26-30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00)., Conclusions: This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2019
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45. Maternal preconception weight trajectories, pregnancy complications and offspring's childhood physical and cognitive development.

Author: Adane AA, Mishra GD, and Tooth LR
Subjects: Adult, Australia, Body Mass Index, Child, Preschool, Cross-Sectional Studies, Female, Humans, Infant, Infant, Newborn, Longitudinal Studies, Maternal Exposure adverse effects, Maternal Health statistics & numerical data, Motor Skills Disorders physiopathology, Motor Skills Disorders prevention & control, Pregnancy, Risk Factors, Surveys and Questionnaires statistics & numerical data, Body-Weight Trajectory, Child Development physiology, Cognition physiology, Motor Skills Disorders diagnosis, Pregnancy Complications physiopathology
Abstract: There is limited evidence on the association between maternal preconception body mass index (BMI) trajectories and pregnancy complications and child development. This study examined the relationships of maternal BMI trajectories, diabetes and hypertensive disorders during pregnancy and offspring's childhood physical and cognitive development. Data were from the Australian Longitudinal Study on Women's Health and the Mothers and their Children's Health study (n=771). Women's preconception BMI trajectories were identified using group-based trajectory modelling. Children's physical and cognitive development (up to the average age of 5 years) were obtained from the Ages and Stages Questionnaire (suspected gross motor delay) and the Australian Early Development Census (AEDC). Generalized estimating equation models, adjusted for maternal sociodemographic and lifestyle factors, were used for analyses. Three distinct BMI trajectories were identified (normative, chronically overweight and chronically obese). Children born to chronically obese women were more likely to be classified as developmentally vulnerable/at-risk on AEDC domains; gross and fine motor skills [risk ratio (RR)=1.64, 95% confidence interval (CI): 1.04, 2.61] and communication skills and general knowledge (RR=1.71, 95% CI: 1.09, 2.68). They also had an elevated risk of suspected gross motor delay (RR=2.62, 95% CI: 1.26, 5.44) compared with children born to women with a normative BMI trajectory. Maternal diabetes or hypertensive disorders during pregnancy were not associated with child outcomes. Maternal preconception BMI trajectories were associated with poorer childhood development. This study finding underscores the importance of excessive weight gain prevention throughout the reproductive stage of life.
Published: 2018
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46. Maternal preconception weight trajectories are associated with offsprings' childhood obesity.

Author: Adane AA, Dobson A, Tooth L, and Mishra GD
Subjects: Adult, Australia epidemiology, Body Mass Index, Child, Female, Humans, Ideal Body Weight, Logistic Models, Longitudinal Studies, Male, Middle Aged, Pregnancy, Prospective Studies, Body-Weight Trajectory, Mothers, Overweight epidemiology, Thinness epidemiology
Abstract: Objectives: This study aimed to examine the associations between (1) mothers' preconception body mass index (BMI) trajectories over 6-7 years and offspring childhood BMI, and (2) mothers' BMI changes between first and second pregnancy and the second-born child's BMI., Methods: We used data (1606 mothers with 2733 children with mean age 7.7 years, SD 2.9) from the Australian Longitudinal Study on Women's Health and the Mothers and their Children's Health study. Preconception BMI trajectories were identified using latent class growth modeling. Children were categorized as underweight, normal, overweight or obese based on age and sex-specific BMI cut-off points for children. Multinomial and binary logistic regression were used for analyses., Results: We identified three preconception BMI trajectories, named as 'normative' (61.2%), 'chronically overweight' (30.7%), and 'chronically obese' (8.1%). Children born to 'chronically overweight' and 'chronically obese' mothers were more likely to be overweight than normal weight relative to children born to women with a 'normative' BMI trajectory. The corresponding adjusted relative risk ratios (RRRs) (95% confidence interval [CI]) of childhood overweight were 1.75 (1.33, 2.31) for chronically overweight mothers and 2.48 (1.65, 3.73) for chronically obese mothers. Similarly, we found a much stronger association between 'chronically overweight' and 'chronically obese' BMI trajectories and childhood risk of obesity; RRR (95% CI), 2.49 (1.41, 4.40) and 6.65 (3.40, 13.01), respectively. Second-born children of mothers with high interpregnancy weight gain (≥4 BMI units) were also at higher risk of being overweight or obese (OR = 2.20, 95% CI: 1.02, 4.75) compared with children of mothers with stable interpregnancy weight (gain or loss of 1 BMI unit or less)., Conclusions: In this population-based prospective cohort study, we found strong dose-response associations between preconception BMI trajectories and offsprings' childhood BMI.
Published: 2018
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47. Correction to: Mental health training for primary health care workers and implication for success of integration of mental health into primary care: evaluation of effect on knowledge, attitude and practices (KAP).

Author: Ayano G, Assefa D, Haile K, Chaka A, Haile K, Solomon M, Yohannis K, Adane AA, and Jemal K
Abstract: [This corrects the article DOI: 10.1186/s13033-017-0169-8.].
Published: 2017
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48. Prevalence and determinants of active trachoma among preschool-aged children in Dembia District, Northwest Ethiopia.

Author: Ferede AT, Dadi AF, Tariku A, and Adane AA
Subjects: Child, Preschool, Cross-Sectional Studies, Ethiopia epidemiology, Female, Humans, Male, Prevalence, Risk Factors, Trachoma microbiology, Chlamydia trachomatis physiology, Trachoma epidemiology
Abstract: Background: Trachoma is an infectious eye disease caused by Chlamydia trachomatis, which is the leading infectious cause of blindness worldwide. In areas where trachoma is endemic, active trachoma is common among preschool-aged children, with varying magnitude. This study aimed to estimate the prevalence of active trachoma and associated risk factors among preschool-aged children in Dembia District, northwest Ethiopia., Methods: A community-based cross-sectional survey was conducted among preschool-aged children of northwest Ethiopia. Multistage systematic random sampling was used to select 695 subjects. Trained clinical optometrists subjected each child to an ocular examination and assessed the presence of active trachoma. Face to face interview using pretested and structured questionnaire were conducted to collect data on possible risk factors. Trachoma cases were graded following a World Health Organization simplified grading scheme. All statistical analysis was carried out using the SPSS software version 20. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to identify factors associated with active trachoma., Results: Of the 681 preschool-aged children studied, 18% (95% CI: 15.4% - 21.1%) had a prevalence of active trachoma. Children who had clean faces (absence of nasal and ocular discharges) had a lower chance of having active trachoma [aOR = 0.55, 95% CI: 0.37 - 0.82]. The odds of having active trachoma decreased with an increase in the distance to a water point [aOR = 0.51, 95% CI: 0.33 - 0.78]. Similarly, no or poor utilization of liquid waste disposal in the child's household was associated with an increased chance of having active trachoma [aOR = 3.83, 95% CI: 1.26 - 11.61]., Conclusion: The prevalence of active trachoma in these preschool-aged children was found to be high and needs special interventions that focus on educating families about proper face washing, liquid waste disposal, and improving safe water supply near the households.
Published: 2017
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49. Adult Pre-pregnancy Weight Change and Risk of Developing Hypertensive Disorders in Pregnancy.

Author: Adane AA, Mishra GD, and Tooth LR
Subjects: Adult, Australia epidemiology, Blood Pressure, Body Mass Index, Female, Follow-Up Studies, Humans, Hypertension, Pregnancy-Induced physiopathology, Incidence, Longitudinal Studies, Overweight physiopathology, Pregnancy, Risk Factors, Young Adult, Hypertension, Pregnancy-Induced epidemiology, Overweight epidemiology, Pregnant Women, Weight Gain, Women's Health
Abstract: Background: While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders in pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change and HDP. We examined the impact of adult pre-pregnancy weight change on the development of HDP., Methods: We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalised estimating equations were used to assess the effect of baseline BMI (mean age 20 years) and pre-pregnancy weight change on the incidence of HDP., Results: Over 9 years of follow up, 301 incident HDP cases (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 (95% CI 1.3, 2.2) and 2.15 (95% CI 1.4, 3.3) times more likely to develop HDP than normal weight women, respectively. Compared with stable weight women, women with small (>1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR 1.67 95% CI 1.3, 2.2; RR 2.31, 95% CI 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24 years were 46% (95% CI 0.4, 0.8) less likely to develop HDP., Conclusions: Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP., (© 2017 John Wiley & Sons Ltd.)
Published: 2017
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50. Pre-pregnancy weight change and incidence of gestational diabetes mellitus: A finding from a prospective cohort study.

Author: Adane AA, Tooth LR, and Mishra GD
Subjects: Adolescent, Adult, Aged, Australia epidemiology, Body Mass Index, Female, Humans, Incidence, Longitudinal Studies, Middle Aged, Obesity complications, Parity, Pregnancy, Risk Factors, Young Adult, Diabetes, Gestational epidemiology, Obesity epidemiology, Weight Gain physiology
Abstract: Aims: In a population-based cohort study we examined the associations between early adult pre-pregnancy weight change and the risk of gestational diabetes mellitus (GDM)., Methods: The study included 3111 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. These women have been surveyed regularly since 1996. Women without diabetes and GDM were followed-up between 2003 and 2012. Generalized estimating equations were used to assess the effect of baseline (1996, mean age 20years) and pre-pregnancy body mass index (BMI) and the pre-pregnancy weight changes on the incidence of GDM. The full models were adjusted for sociodemographic and lifestyle factors., Results: From 2003 to 2012, 229GDM cases (4.4%) were reported in 5242 pregnancies. Relative to normal BMI women, obese women at baseline (RR: 1.8, 95% CI: 1.1, 2.8) and prior to pregnancy (RR: 2.7, 95% CI: 2.0, 3.6) were at greater risk of GDM. Weight gains prior to each study pregnancy were strongly associated with increased GDM risk with an adjusted RR ranging from 2.0 to 2.9. Within under/normal range of BMI, women with a moderate/high (>2.5%/year) weight gain had 2.7 (95% CI: 1.3, 5.5) times the risk of GDM compared with women with stable weight., Conclusions: Early adult weight gain, even within normal BMI range, is an important risk factor for the development of GDM. Weight gain prevention from early adulthood to prior to pregnancy appears to be the main strategy to prevent the incidence of GDM., (Copyright © 2017 Elsevier B.V. All rights reserved.)
Published: 2017
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