Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
The maternal continuum of care (CoC) is comprehensive healthcare provided for women during pregnancy, childbirth, and postpartum. Equitable maternal CoC can reduce the risk of maternal and neonatal mortality. We examined inequalities in the completion of maternal continuum of care, and factors associated with CoC among reproductive age women in Ethiopian using the 2019 mini-Ethiopian Demographic and Health Survey (mini-EDHS). The concentration curve and concentration curve index were used to examine socioeconomic inequalities in maternal CoC. Odds ratios were used to assess associations, with significance at p < 0.05. Overall, 23.97% (95% CI 21.63-26.48) of women completed maternal continuum of care. There was pro-rich inequality in the completion of maternal CoC in Ethiopia (Concentration index: 0.244 (95% CI 0.177-0.311, p ≤ 0.001)), rural resident (Concentration index: 0.146 (95% CI 0.087-0.205, p ≤ 0.001)), and urban resident (Concentration index: 0.154 (95% CI 0.045-0.263, p ≤ 0.01)). Being urban resident (adjust odds ratio (AOR) = 1.59, 95% CI 1.09-2.33), attaining secondary (AOR = 1.67, 95% CI 1.19-2.33), or higher education (AOR = 1.93, 95% CI 1.30-2.87), and early initiation of antenatal care (AOR = 1.97, 95% CI 1.61-2.41) were positively associated with the completion of maternal CoC. However, belonging to pastoral region (Afar or Somali) (AOR = 0.46, 95% CI 0.28-0.77), belonging to poorest (AOR = 0.58, 95% CI 0.37-0.92) or middle (AOR = 0.62, 95% CI 0.40-0.96) wealth quintile, not being informed about obstetric danger signs (AOR = 0.54, 95% CI 0.43-0.66), and blood pressure not being measured (AOR = 0.53, 95% CI 0.32-0.85) were negatively associated with maternal CoC. The results of this study revealed that completion of the maternal continuum of care was low in Ethiopia and there was a significant inequality in the completion of maternal CoC across wealth status, place of residence, and educational status. Targeted strategies are needed to improve maternal healthcare utilization among disadvantaged women, particularly those in rural areas, with low education, and from poor households. Interventions should focus on improving access, promoting early and high-quality ANC, and providing culturally tailored services.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Skilled birth attendance is among the crucial maternal health interventions for maternal and neonatal mortality reduction. The availability of core components of services at healthcare facilities and the quality-of-service provision are essential for the effective utilization of skilled birth attendance. Effective coverage measures the availability of essential components at health facilities and the quality of care delivered. This study aimed to measure effective coverage of skilled birth attendance in Ethiopia. We applied the cascade approach to measure effective coverage, focusing on four steps up to quality-adjusted coverage as a proxy for effective coverage of skilled birth attendance. To assess the structural quality of facilities, we used the PMA service delivery assessment data in 2019. Effective coverage was defined as the product of skilled birth attendance, facility readiness score, intervention coverage (proportion who received uterotonic injection), and a process quality score. The crude coverage for skilled delivery attendance was 54% (95%CI; 52, 56). The average level of facility readiness to provide skilled delivery service was 72%, ranging from 17% for private and non-governmental facilities to 88% for hospitals. The uterotonic injection coverage was 42% and the mean process quality for skilled delivery service was 46%. Based on the effective coverage cascade, the input-adjusted coverage was 38%, and the intervention-adjusted coverage was 16%, and the quality-adjusted coverage was 7%. Low level of facility readiness and low quality of service explain the low effective coverage of skilled delivery attendance. Apart from the overall low level of readiness, there was variability between different levels of facilities. Though the skilled delivery attendance coverage is improving, the low level of readiness, intervention provision, and poor process quality resulted in low effective coverage. The minimum level of readiness needs to be ensured at all levels of facilities to provide skilled delivery services. The minimum level of service readiness and quality of care need to be ensured at all facilities to provide skilled birth attendance.
Neglected Tropical Diseases (NTDs) are a group of 20 diverse communicable diseases of significant public health concern. Adequately trained personnel play a vital role in implementing effective NTD control programs, as their expertise directly influences patient outcomes and the overall success of intervention strategies. This study assessed the awareness, knowledge, and perceptions of NTDs among staff in a tertiary healthcare facility in Benue State, Nigeria. A cross-sectional descriptive design was employed to study 310 randomly selected respondents using an interviewer-administered, semi-structured questionnaire. Data collected were analyzed using descriptive and inferential statistical techniques. The majority of respondents were aged 31-50 years (75.4%), predominantly female (54.8%), married (72.9%), and had tertiary education (97.4%). Most were health-related professionals (59.7%). Overall, 72.6% of respondents were aware of NTDs, but only 42.6% demonstrated good knowledge. The main source of information was schools/seminars (85.8%). However, only 18.5% could name at least one NTD. Health-related disciplines significantly influenced knowledge, including recognition of NTDs as public health issues (P = 0.030) and awareness of vaccine-preventable NTDs (P = 0.001). Preventive measures such as health education and improved sanitation were widely endorsed. While awareness of NTDs was relatively high, good knowledge remained suboptimal, particularly among non-health-related professionals. Health-related disciplines significantly influenced both awareness and knowledge, underscoring the need for targeted educational interventions in non-health sectors. Strengthening public health education, integrating NTD-related content into broader curricula, and prioritizing funding for NTD control measures are recommended to bridge knowledge gaps and promote effective prevention strategies.
Malaria is a life-threatening disease that is transmitted by the bites of infected female Anopheles mosquitoes. Women of reproductive age (WRA) are a more vulnerable group to malaria, which increases the risk of severe anemia, maternal death, and unfavorable birth outcomes. However, only limited comprehensive studies are available in the Eastern Sub-Saharan African (ESSA) region. The Global Burden of Diseases (GBD) 2023 estimates were to assess the fatal and non-fatal health outcomes of malaria among WRA in ESSA region from 1990 to 2023. The Cause of Death Ensemble Model (CODEm) modeling platform was used to estimate mortality and Years of Life Lost (YLLs) in the GBD 2023 study. Years Lived with Disability (YLDs), prevalence, and incidence of malaria disease was estimated by using Bayesian meta-regression for Disease modeling. The net change from 1990 to 2023 was evaluated by percentage change. All estimates were presented together with the 95% uncertainty intervals (95% UIs). In 2023, the highest prevalence rate of malaria among WRA was recorded in Mozambique [19627 cases per 100,000 WRA (95% UI: 12,347, 27,601)]. However, the lowest prevalence rate was estimated in Eritrea [842 (95% UI: 450, 1430)] and Rwanda [1603 (95% UI: 587, 3180)]. Mozambique had the highest incidence rate [16076 new cases per 100,000 WRA (95% UI: 11,890, 21,714)], whereas Eritrea had the lowest rate [2267 new cases per 100,000 WRA (95% UI: 962, 4539)]. The highest rates of mortality, YLLs and Disability-Adjusted Life Years (DALYs) were estimated in Mozambique, whereas the lowest rates were recorded in Ethiopia. There were substantial reductions in the rates throughout the region in 2023 compared to 1990, except in Djibouti and Ethiopia. This study has revealed that there was substantial reduction in the rates of non-fatal and fatal health outcomes of malaria among WRA in the ESSA region in 2023 compared to 1990. However, the rates remain high and heterogeneous across the region. Therefore, strengthening the health service system and sustaining strong malaria control programs across the countries are crucial to end malaria epidemics by 2030.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023. Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population. In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths. The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action. Gates Foundation, St Jude Children's Research Hospital.
Work-Related Quality of Life (WRQoL) reflects healthcare professionals' (HCPs) well-being and satisfaction in their work environment. It is a key determinant of retention, productivity, and organizational effectiveness. Despite its importance, evidence on WRQoL in Ethiopia remains limited. To assess the level of WRQoL and its associated factors among HCPs in public hospitals of Northwest Ethiopia. A facility‑based cross‑sectional study was conducted from May 15 to June 15, 2024, among 408 HCPs selected through simple random sampling. Of these, 385 participated, yielding a response rate of 94.4%. Data were collected using a self‑administered questionnaire, entered into EpiData version 4.7, and analyzed with SPSS version 27.0. WRQoL mean scores were calculated and treated as continuous variables in regression analyses, while descriptive presentation used standard cut‑off classifications. Linear regression analyses were performed. Simple linear regression was initially used to screen candidate variables, and those with p < .25 were entered into a multiple linear regression model. Final results are presented from the multiple regression analysis as coefficients (B, β) with 95% confidence intervals (CI). Statistical significance was set at p < .05. The overall WRQoL mean score was 2.45 ± 0.61 (95% CI: 2.39-2.51) on a five-point Likert scale. Domain analysis showed the highest score in control at work (2.84 ± 0.83), while working conditions (2.26 ± 0.82) and general well-being (2.34 ± 0.73) were lowest. Tertile classification revealed that 36.1% of participants had low WRQoL, 33.2% moderate and 30.6% high WRQoL. In multiple regression, monthly income (β = 0.193, p =.003) was positively associated with WRQoL, whereas psychological distress (β = -0.166, p =.003), longer work experience (β = -0.195, p =.016), and professional category (midwives: β = -0.215, p <.001; medical doctors: β = -0.137, p =.010) were negatively associated. More than one third of HCPs experience low WRQoL, with deficits in working conditions and well-being. Addressing workload, inequities across professional categories, and psychosocial stressors, while strengthening resources such as fair income and supportive environments, is essential to improve WRQoL and ensure better patient care outcomes.
High-quality primary healthcare is essential for improving health outcomes and patient satisfaction. Facility endorsement-patients' willingness to recommend a health facility-reflects trust and perceived service quality and can provide actionable feedback for quality improvement. This study assessed perceived quality of care and its association with facility endorsement among primary care patients in Addis Ababa. A mobile-based interactive voice response (IVR) survey was administered to 1,584 patients receiving primary care services from public and private health facilities in Addis Ababa. Perceived quality of care was assessed across three dimensions: structural quality, provider competence, and patient-centered care. Linear and ordered logit regression models were used to examine associations between quality dimensions and endorsement, and a Chow test assessed structural differences across facility types. Overall perceptions of care quality were moderate, corresponding to average scores of around 50-60% across all quality dimensions, indicating room for improvement. Average scores across facility types were 55.9% for structural quality, 58.0% for provider competence, and 51.2% for patient-centered care. Private facilities-particularly clinics-consistently outperformed public hospitals and health centers, with 60-70% of patients in private facilities rating quality indicators as "good" or "very good," compared with 40-50% in public facilities. The Chow test confirmed significant differences in patient responses by facility type (χ² = 96.7, p < 0.001). Provider competence was a strong and consistent predictor of facility endorsement across all settings; for example, in private hospitals, a one-unit increase in perceived competence more than doubled the odds of endorsement (OR = 2.37, 95% CI: 1.42-3.95). Patient-centered care was also positively associated with endorsement across all facility types. Structural quality influenced endorsement only in public hospitals. Perceived quality of primary care in Addis Ababa remains moderate, with clear disparities between public and private facilities. Provider competence and patient-centered care are the strongest drivers of patient endorsement, highlighting the importance of clinical skills, communication, and respectful care as key factors associated with patient endorsement. In public hospitals, addressing structural gaps through targeted investments in infrastructure, medicines, and diagnostics remains important for improving patient experience and may contribute to broader system performance.
This study aimed to assess the utilization and associated factors of second-dose measles vaccine among mothers with children less than two years old in Enderta district, South Eastern Tigray. A mixed community-based cross-sectional study was conducted in Enderta district, South Eastern Tigray from January- to March 2020. The sample size of this study was 410 mothers, 10 in-depth interviews, and 2 focus group discussions. Multistage sampling technique for the quantitative data and purposive sampling for the qualitative data was used. Quantitative data were collected by the interviewer-administered questionnaires and entered and analyzed using Epi-data-3.1 and SPSS-20, respectively. Binary logistic regression analysis was done and adjusted odds ratios measured the strength of statistical association at 95% confidence interval. Variables with a P-value < 0.2 in the bivariate analysis were entered into multivariable analysis statistical significance was declared at P-value < 0.05. Thematic analysis was employed for the qualitative data. After the qualitative data was coded, themes were developed. The result of the qualitative data was presented and discussed by triangulating. Utilization of second dose measles-containing vaccine was 32.4%. Top reasons for not vaccinating second dose measles-containing vaccines to their children were: lack of awareness about the necessity of the vaccine, missing the appointment date, mother being too busy and absence of vaccine supply. In the multivariable analysis; children aged 18-23 months (AOR 0.5; CI (0.3-0.8)), number of children greater than five per family (AOR 2.3; CI (1.3-4.3)), type of health facility (AOR 1.7; CI (1.05-2.9)), children with a history of completed basic vaccines at 12 months (AOR 2.6; CI (1.5-4.3)) and knowledgeable mothers (AOR 1.67; CI (1.04-2.7)) were significantly associated with the taking of second dose measles vaccine of their last child. Despite the slight improvement from the regional and national Ethiopian Demographic Health Survey reports, utilization of second dose measles vaccine in this study was low.
Post-tuberculosis lung disease (PTLD) is a major public health challenge in sub-Saharan Africa (SSA), where the burden of tuberculosis (TB) remains high. Only a few studies have reported the global burden of PTLD, and the associated factors of PTLD have been understudied. This systematic review and meta-analysis aimed to estimate the pooled prevalence and associated factors of PTLD in SSA. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for systematic review and meta-analysis. We included studies reporting the prevalence and associated factors of PTLD among individuals with a history of pulmonary TB in SSA. A comprehensive literature search was conducted via PubMed, Embase, Google Scholar, and African Journal Online databases from February 25, 2025, to March 20, 2025. The pooled prevalence of PTLD was estimated using a random-effects model. Due to the lack of reports on adjusted odds ratios (aORs), the associated factors were analyzed using crude odds ratios (ORs). A total of 21 studies, consisting of 4,463 participants, were included. The overall pooled prevalence of PTLD in SSA was 43.26% (95% CI: 34.17%-52.34%). The key Factors significantly associated with PTLD included: female sex (OR: 1.57, 95% CI: 1.16, 2.11), smoking (OR: 1.64, 95% CI: 1.09, 2.46), Presence of cough (OR: 1.73, 95% CI: 1.03, 2.9) and fibrotic pattern (OR:3.94 (95% CI: 1.96, 7.92). Nearly half of prior TB patients in SSA develop PTLD. Being female, smoking, fibrosis, and post-treatment cough were key factors associated with PTLD. To effectively manage PTLD in SSA, it is important to implement targeted interventions for high-risk groups, strengthen screening and chronic care services, enhance healthcare system capacity, ensure equity in health resources and integrate PTLD management into national TB control programs.
Chronic conditions are a significant global health challenge that adversely affects the quality of care for patients with type 2 diabetes (T2D). To evaluate and improve the quality of care, the Patient Assessment Chronic Illness Care (PACIC-5As) tool has been developed. It is the most widely used tool designed to assess the perceived quality of care among individuals with chronic conditions, including diabetes. Nevertheless, it has not yet been culturally adapted and validated in the Ethiopian context. Therefore, this study aimed to translate, culturally adapt, and evaluate the psychometric properties of the PACIC-5As tool in Ethiopia. A multicenter cross-sectional study was conducted among individuals with type 2 diabetes from March 24, 2025, to May 5, 2025, in the Amhara region's comprehensive specialized referral hospitals. A systematic random sampling technique was used to select the study participants. Data were collected through face-to-face interviews. The tool consists of 26 items and 5 domains. Content validity was assessed at both the individual and scale levels. Internal consistency was evaluated using Cronbach's alpha (α) and composite reliability (CR), with a value ≥ 0.70 considered acceptable. Confirmatory factor analysis (CFA) was conducted to evaluate model fit and factor structure. Model fit was assessed using the absolute and incremental fit indices and interpreted based on the recommended thresholds. Convergent validity was computed using average variance extracted (AVE), with a value ≥ 0.4 considered adequate, while discriminant validity was evaluated using AVE and inter-construct correlations. A total of 520 study participants were enrolled, and 517 (99.4%) were included in the study. The overall mean summary score of PACIC-5As-ET was 2.68 (±0.62). The content validity index at the item and scale levels ranged from 80% to 100%, with an inter-rater agreement of 95%. The Cronbach's alpha and composite reliability (CR) of the PACIC-5As-ET were 0.93. The Cronbach's alpha values for the subscales ranged from 0.71 (Assist) to 0.82 (Arrange). The test-retest reliability of PACIC-5As-ET was 0.94. The model fit indices were χ²/df (2.79), RMSEA (0.06), SRMR (0.08), GFI (0.89), and CFI (0.40). The AVE value of the overall PACIC-5As-ET was 0.93, and the subscales ranged from 0.47 (Advise) to 0.59 (Arrange). The Amharic version of the PACIC-5As-ET tool demonstrated excellent internal consistency and acceptable validity for assessing the perceptions of patients with T2D. The absolute fit indices were generally within the recommended range, whereas the incremental fit indices were low. Therefore, support for the hypothesized five-factor structure is limited and should be interpreted with caution.
Self-care during pregnancy is a crucial factor influencing the health of pregnant women. Maternal complications are often associated with low self-care behavior during pregnancy. The ability and awareness of pregnant women play a significant role in fostering good self-care, which is closely linked to health literacy. Unfortunately, in Indonesia-a low-income country-health literacy among pregnant women remains relatively low, and limited research has addressed this issue. This study aimed to determine the relationship between health literacy and self-care among pregnant women. A quantitative study with a cross-sectional design was conducted, involving a population of 80 postpartum mothers. A total of 66 participants were selected using a non-probability purposive sampling technique. Data were collected through two questionnaires: the Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLPAQ) to measure maternal health literacy, and a self-care questionnaire developed by researchers to assess self-care practices. The Spearman test was employed for data analysis. The study was carried out at the Kassi-Kassi Public Health Center from May 10 to June 7, 2024. The findings revealed a significant relationship between health literacy and self-care (r = 0.849; p-value < 0.001), indicating a very strong positive correlation. This demonstrates that health literacy is closely associated with self-care among pregnant women at the Kassi-Kassi Public Health Center, Indonesia. Higher health literacy is associated with better self-care behavior among pregnant women. Therefore, enhancing health literacy is essential for improving maternal self-care practices in Indonesia.
Children with epilepsy (CWE) face multiple challenges that impact their emotional, behavioral, social, and academic lives. Despite the importance of health-related quality of life (HRQOL), few studies have explored this in low-resource settings. This study assesses HRQOL among Ethiopian CWE using the parent-reported Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-16). A hospital-based cross-sectional study was conducted at Yekatit 12 Hospital Medical College's Pediatric Neurology Clinic from May to July 2022. The QOLCE-16, which measures cognitive, emotional, social, and physical functioning, was administered to parents of 108 CWE. Sociodemographic and clinical data were collected via structured interviews. Data were analyzed using SPSS (version 27). Independent t-tests, analysis of variance, and multiple linear regression were employed. The mean total QOLCE-16 score was 67.5 ± 30.4. Higher HRQOL scores were associated with school attendance, monotherapy, absence of comorbidities, and good seizure control. Children living with both parents and those with married or privately employed parents also had significantly better HRQOL. Multiple linear regression showed that comorbidities (β = 0.615, P < 0.001), school attendance (β = -0.225, P = 0.001), ongoing seizures (β = -0.187, P = 0.034), and child living arrangements (β = 0.173, P = 0.010) significantly predicted HRQOL scores. HRQOL in CWE is significantly influenced by clinical and family factors. Improving seizure management, encouraging school attendance, and strengthening family support are critical. Context-sensitive and multidisciplinary interventions are essential to improve outcomes.
Globally, the consumption of vitamin A-rich foods remains a significant public health challenge, particularly in sub-Saharan Africa, where access to these foods is limited. Preschool-aged children in rural areas are especially vulnerable to vitamin A deficiency due to poor dietary diversity and limited access to healthcare services. In Ethiopia, there is a scarcity of research on vitamin A intake among rural preschoolers, particularly in the Gambella Region. The objective of this study was to assess the consumption patterns and primary dietary sources of vitamin A-rich foods among rural preschool children in the Gambella Region of Ethiopia. A community-based cross-sectional study was conducted among 381 preschool children in the Gambella Region. Data were collected using the Helen Keller International (HKI) food frequency questionnaire and a 24-hour dietary recall. Statistical analysis was performed using SPSS version 26.0, with findings presented through frequency tables and graphs to illustrate dietary trends. Of the 381 participants, 380 (99.7%) completed the study. The majority of children (74.3%) ate two meals per day, predominantly cereals and legumes. Only 32.4% consumed vitamin A-rich foods, with particularly low intake reported for milk (2.9%), dark green leafy vegetables (6.1%), fish (5%), and fortified margarine (0.5%). Over 75% of children had inadequate vitamin A intake (P < 0.01), and 78.4% of caregivers lacked awareness of vitamin A-rich food sources. Nearly half of households (48.1%) relied on personal production for these foods, and 54.9% indicated that availability was seasonal. The study highlights critically low consumption of vitamin A-rich foods among rural preschool children in the Gambella Region, placing them at increased risk of vitamin A deficiency and related health complications such as impaired vision and weakened immunity. To address this issue, targeted nutrition education and community awareness programs are essential, alongside policy interventions to improve food access and dietary diversity.
Malaria is a major public health problem in Ethiopia, including Enor-Ener Woreda. This study aimed to determine the prevalence and associated factors of malaria among febrile children under five years of age attending Ener Amanuel Health Center, Southern Ethiopia. A cross-sectional study was conducted at Ener Amanuel Health Center, located in Enor-Ener Woreda, from December 2022 to April 2023. A total of 218 febrile children under five years were enrolled. Blood samples were collected, and malaria was diagnosed using microscopy. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with Plasmodium infection. The prevalence of malaria was 21.1% in Enor-Ener Woreda, with P. falciparum being the predominant species (60.9%). Factors significantly associated with Plasmodium infection included proximity to mosquito breeding sites (P=0.025), not sleeping under insecticide-treated nets (ITNs) (P=0.021), and having beds unsuitable for ITN hanging (0.002). Malaria remains a significant public health concern in the study area. Key factors associated with infection include the presence of mosquito breeding sites and improper ITN use. Strengthening ITN utilization and eliminating mosquito breeding sites are essential to reduce the malaria burden among under-five children in the area.
Accurate cost and pricing information is essential for optimal budget allocation and sound strategic decision-making. Establishing an appropriate costing system is critical for understanding educational expenses, improving services, and managing budgets more efficiently. This study aimed to estimate the cost of educating students at the dental school during the 2022-23 academic year. This cross-sectional study estimated the cost of educating dental students at Iran University of Medical Sciences in 2023 using the Activity-Based Costing (ABC) method. Data were collected through interviews with financial and administrative officials, as well as relevant units such as accounting and administration, utilizing a structured checklist. After estimating the costs of activity centers, overhead and intermediate center expenses were allocated to final activity centers based on suitable allocation bases. Ultimately, the costs associated with the final activity centers which is, the educational departments, were determined, and the total cost per student was calculated. The average cost of educating a general dentistry student in the 2022-23 academic year was approximately 132,438 Purchasing Power Parity (PPP) adjusted US Dollars. In the dental school, total overhead costs amounted to 802,953, while total direct costs were 1,133,853 in PPP-adjusted dollars. The largest portion of total costs (61%) was attributed to human resources, followed by consumables (20%) and equipment depreciation (14%). The majority of costs are allocated to human resources, indicating the need to enhance productivity. Reducing consumable costs and equipment depreciation could further improve financial efficiency. It is recommended that managers and policymakers implement strategies to optimize resources and enhance educational quality.
Meningitis remains the leading infectious cause of neurological disabilities globally, disproportionately affecting children younger than 5 years and populations in the African meningitis belt. Whereas previous global estimates focused on ten pathogen categories, this study presents the most comprehensive analysis to date, assessing the meningitis burden attributable to 17 causative pathogens based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework. GBD is a systematic, scientific effort aimed at quantifying the comparative magnitude of health loss caused by diseases, injuries, and risk factors across age groups, sexes, and geographical locations over time. We estimated meningitis mortality using the Cause of Death Ensemble model (CODEm) and morbidity using DisMod-MR 2.1, incorporating data from vital registration, verbal autopsy, surveillance, hospital data, and systematic reviews. Aetiology-specific estimates were generated with pathogen-linked case-fatality ratios and splined binomial regression models. Risk factor attribution was based on established risk-outcome pairs and population attributable fractions. In 2023, there were 259 000 (95% uncertainty interval 202 000-335 000) global deaths and 2·54 million (2·20-2·93) incident cases of meningitis. Children younger than 5 years accounted for more than a third of deaths (86 600 [53 300-149 000]). Streptococcus pneumoniae, Neisseria meningitidis, non-polio enteroviruses, and other viruses were the leading causes of death, while non-polio enteroviruses caused the most cases. The four WHO-defined preventable meningitis pathogens of interest (S pneumoniae, N meningitidis, Haemophilus influenzae, and Group B streptococcus) contributed to 98 700 deaths (77 000-127 000) and 594 000 cases (514 000-686 000). Low birthweight, short gestation, and household air pollution were the top risk factors for meningitis-related mortality. Although mortality and incidence have declined significantly since 1990, progress is insufficient to meet WHO 2030 targets. Despite marked progress in reducing bacterial meningitis via global vaccination campaigns, a substantial meningitis burden persists, attributable both to common pathogens such as S pneumoniae and N meningitidis and to emerging non-bacterial pathogens such as Candida spp and drug-resistant fungi. Achieving WHO goals will require sustained investment in surveillance, vaccination, maternal screening, and health-system strengthening, especially in high-burden settings. Gates Foundation, Wellcome Trust, and UK Department of Health and Social Care.
Pneumonia remains the leading cause of mortality and morbidity among pediatric age groups worldwide. Several risk factors contribute to the progression of pneumonia into severe and complicated forms. Parapneumonic effusion is one of the most common complications to consider when severe pneumonia advances to a more critical stage. This study evaluates the prevalence, risk factors, and disease progression of severe pneumonia in children, providing valuable insights for resource-limited settings. A hospital-based prospective cohort study was conducted at a tertiary center from July 2022 to December 2023 among children aged 2 months to 14 years with severe pneumonia. Data were collected on socio-demographic characteristics, clinical status, disease progression, microbiological findings, and patient outcomes, and were analyzed using Stata Version 14. A total of 74.13% of severe pneumonia cases occurred in children under 5 years of age. Fever, cough, tachypnea, dyspnea, and chest indrawing were the most frequently observed clinical presentations. Overall, 31.46% of patients progressed to parapneumonic effusion. Absence of prior pneumonia (AOR = 0.25; 95% CI: 0.11-0.57), no prior hospitalization for the current diagnosis (AOR = 0.49; 95% CI: 0.28-0.86), no exposure to secondhand cigarette smoke (AOR 0.24; 95% CI: 0.07-0.84), and no contact with a coughing patient (AOR = 0.53; 95% CI: 0.29-0.96) were each associated with lower odds of progression to parapneumonic effusion. In contrast, malnutrition was associated with higher odds of progression (AOR = 2.00; 95% CI: 1.18-3.54). A higher prevalence of severe pneumonia was observed in children under 5 years of age. Disease progression to parapneumonic effusion occurred in 31.46% of cases, and the mortality rate was 4.54%.