Ethiopian Journal of Health Development

Understanding subnational burden of diseases for better health policy decision making in Ethiopia

Messay Hailu — 2023-10-20

Ethiopia has been progressing on key health indicators, but the conflicts and war coupled with drought and emergency conditions, and the COVID-19 pandemic could negatively affect progress (1). This special issue has highlighted substantial health gains from specific diseases and conditions over the past three decades, as well as the disparities between regions and chartered cities, and the opportunity to reduce this burden of premature mortality and disability by addressing specific diseases, risk factors, and social determinants of health. We have identified and ranked potential priorities for action that would reduce the total burden of diseases and provide relevant support for specific regions and chartered cities.

Burden of and Health Loss Due to the Effect of Maternal Hypertensive disorders in Ethiopia: A systematic analysis of Global burden of diseases, 2019

Bedilu Abebe — 2023-10-20

Abstract

Background: Worldwide, maternal hypertensive disorders complicate one in ten pregnancies. As a result of changes in the life styles of society, currently, it is becoming a common public life encounter. However, Ethiopia lacks comprehensive and comparable maternal hypertensive disorders, causing burden and health loss to inform policy and practice.

Objective: To describe the incidence and prevalence of maternal hypertensive disorders and deaths, Disability Adjusted Life Years, and Years Life Lost attributable to maternal hypertensive disorders in Ethiopia and its regional distributions from 1990 to 2019 as part of a collaborative Global Burden of Diseases, (2019) Study.

Methods: The data for this study were collected from surveys, demographic surveillances, medical record reviews, health facility observations and interviews socio-demographic, health care service utilization, and other data sources such as case notifications, scientific literature, and unpublished data as per the Global Burden of Disease protocol and analysis techniques to produce national and regional estimates of maternal hypertensive disorders in Ethiopia. Cause of death ensemble modeling and Bayesian meta-regression disease modeling was employed to ascertain cause of death and morbidity. Each metric was estimated per 100,000 populations with a 95% uncertainty interval (UI).

Results: In the last thirty years, in Ethiopia, , the incidence of maternal hypertensive disorders among young women was raised by 52,596 cases per 100,000 population [199,707 (95% UI 150,261-267,221) to 252,303 (95% UI 191,335-332,524)], while decreased among adolescent women from 67,206 (95% UI 46,887-90,883) to 64, 622 (95% UI; 47,587-84,664) per 100,000 population. The prevalence among women of reproductive age had increased from 94, 818 (95% UI 59,434-135,332) in 1990 to 138, 263 (95% UI 88,447-196,029) in 2019. Between 1990 and 2019, deaths attributable to maternal hypertensive disorders among adolescents and young women had increased by 1.5 and 1.17 times, respectively. In 2019, disability adjusted life years among adolescent, young women and women of reproductive age due to maternal hypertensive disorders was 8,493 (UI 95% 5,370-12,849), 21,812 (UI 95% 14,682-32,139) and 57,867 (UI 95% 41,751-79,165) respectively. The highest daily adjusted life years due to maternal hypertensive disorders had occurred among young women, 13,319 (UI 95% 8,592-19,931) which was higher than 1990 whereas the young women years of life lost had increased.

Conclusions: Based on the finding, increasingly high new cases, prevalence and burden of maternal hypertensive disorders and significant health loss were observed in the last three decades in Ethiopia. Hence, prevention of cases, disabilities, deaths and health losses caused by maternal hypertensive disorders can be prevented by properly advocating lifestyle modifications with specifically designed age-specific interventions. On the top of continuing prevention efforts with newly devised magnesium sulphate administration in the new ANC initiative of the ministry, contextualized, need based, localized, and targeted interventions could be reconstituted. [Ethiop. J. Health Dev. 2023;37 (SI-2)]

Keywords: Maternal hypertensive disorders, Incidence, Prevalence, Deaths, Disability Adjusted Life Years, Years Lived with Disability, Years Life Lost, Ethiopia.

Burden and Trend of Nutritional deficiency across regions in Ethiopia: A systematic subnational analysis in Global Burden of Disease 2019 study

Wendwosen Teklemariam — 2023-10-20

Abstract
Background: In Ethiopia, nutritional deficiency has contributed to high child and maternal morbidity and mortality. Understanding the burden and trends of nutrition deficiency across the region helps policymakers and programmers to devise context-specific interventions. Therefore, this study estimated bthe burden and trends of nutritional deficiency at national and regional levels from 1990 to 2019.
Methods: This analysis is part of Global Burden of Diseases 2019 Study that estimated deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD), and Disability Adjusted Life Years (DALYs) attributable to protein energy malnutrition and common micro-nutrient deficiencies, and incidence and prevalence for Ethiopia at national and sub-national levels by sex, years and all age groups. The study used causes of death ensemble model (CODEm) and a Bayesian meta-regression disease modeling (DisMod-MR 2.1) techniques to aanalyzeall accessible protein energy malnutrition and common micro-nutrient deficiencies related data sources. We calculated 95% uncertainty intervals (UI) for the point estimates.
Result: In 2019, the age-standardized death rate due to protein energy malnutrition was 12.9 per 100,000 population. Age-standardizedized DALYs rate due to protein energy malnutrition was estimated to be 492 per 100,000 populations [95%UI: 381.4-654.7] in Ethiopia. The highest DALYs rate attributed to protein energy malnutrition was reported in Somali 1214 per 100,000 populations [95% UI: 804.6-1747.3], Benishangul-Gumuz 1088.5[95% UI: 771.0-1474.7], and Afar 998.0 [95% UI: 759.7-1281.0] regions. The prevalence of Iodine deficiency per 100, 000 populations was 9,671 [95%UI: 7,799- 12,099], 221 [95%UI:132-338], and 15451 [95%UI: 12,272-19,615] among all age groups, children under five years of age and reproductive age women, respectively. The prevalence rate of Vitamin A deficiency declined by 56% from 1990 to 2019. In 2019, the prevalence of dietary iron deficiency was highest in under-five children.
Conclusion: Reproductive-age women, children under five, and elderly people are disproportionately affected by protein-energy malnutrition. The prevalence of dietary iron, and Iodine deficiency was higher in all regions of Ethiopia and needs targeted intervention. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Disability-adjusted life years, Nutritional deficiency disorders, Years of life lost, Years lived with disability, prevalence, Death, Ethiopia

Diarrheal Disease Incidence and Associated Mortality in Ethiopia: A Systematic Subnational Analysis in Global Burden of Disease Study, 1990-2019

Getachew T. Gessese — 2023-10-20

Abstract
Background: A diarrheal disease prevalent in low and middle-income countries, it majorly affects children and elders. In Ethiopia, where there is a disparity in health service access, sanitation, and safe water across regions, there is a lack of evidence on diarrheal disease incidence and mortality rate and trends at national and regional levels for Ethiopia. This study aims to provide national and regional diarrheal disease incidence and associated mortality trends from 1990-2019 to inform policy and practice in Ethiopia.
Methods: The stated analysis is a component of the GBD-2019 study, a collaborative effort between the Ethiopian Public Health Institute (EPHI) and the Institute for Health Metrics and Evaluation (IHME). It aims to evaluate the extent of diarrheal disease burden in Ethiopia, along with its regional states and chartered cities, by examining specific locations and age groups. This study provides comprehensive data on the incidence and mortality trends of diarrheal diseases at national and regional levels, standardized for age, from 1990 to 2019. The results are presented along with 95% uncertainty intervals (UI) to account for the inherent uncertainty in the findings.
Results: The national age-standardized diarrheal disease incidence rate was 122,781.8 [95% Uncertainly Interval (UI): 113,245.4-132,880.6] per 100,000 populations in 2019. It declined by an annual rate of 16.43% [95% UI;12.26%-20.58%] from 1990 to 2019. It was higher among under-5 children (186,732.2 [95% UI: 153,251.4–226,075.6]) and older than 70-year adults 244.2 [95% UI: 289,749.3 –324,673.4]). The national age-standardized diarrheal disease-associated mortality was 76.4 [95% UI:45.1-112.2] per 100,000 populations in 2019. Nationally, it was declined by an annual rate of 74.99% between 1990 and 2019. The findings indicate that the national age-standardized life years lost due to diarrheal disease declined by 76.30 % [95% UI: 53.90%, 85.29%] between 1990 and 2019.
Conclusion: Diarrheal disease has remained a public health problem by affecting a large number of the population in Ethiopia. The youngest and elder populations were disproportionately affected by diarrheal disease incidence and associated mortality. This result may call the attention of Primary Public Health Services to revisit universal health coverage in Ethiopia. Moreover, prevention and management modalities need the community's and other stakeholders' engagement and participation. Equal attention needs to be given to older adults as of under-five children. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: diarrheal disease, incidence, morbidity, mortality, Ethiopia

Forecasting Health outcomes to Envision Health strategies in Ethiopia

Awoke Misganaw — 2023-10-20

Abstract
Background: Universal health coverage is the main goal of the health sector in the coming decade for Ethiopia in the country’s transition to a middle-income state. We used the Global Burden of Disease 2017-2040 forecasting study to support Ethiopia’s envisioning strategies with baseline and targets.
Methods:The research utilized 2017 forecasts from the Global Burden of Disease, focusing on Ethiopia. The forecasts included 250 causes and causes of death, spanning from 2017 to 2040. The study examined various parameters, including life expectancy, death rates, and premature mortality rates. It employed broader and detailed categories from the Global Burden of Disease, accompanied by 95% uncertainty intervals.
Results: In Ethiopians, life expectancy is expected to increase from 66 years (64-68.5) in 2017 to 73.8 years (70.3-77.3) in 2040. In 2040, the all-cause age-standardized death rate will be 854 per 100,000. Projected age-standardized death rates from 2017 to 2040 due to non-communicable diseases and injuries showed a smaller reduction of 26% and 23%, respectively, while communicable, maternal, neonatal, and nutritional disorders decreased by 53%. In 2040, cardiovascular and neoplasms are projected to cause age-standardized death rates of 224.7 and 137.8 per 100,000, respectively. The age-standardized premature mortality percentage contribution of communicable, maternal, neonatal, and nutritional disorders altogether declined from 62.4% in 1990, 45% in 2018, and 34% in 2040, whereas non-communicable diseases contribution increased from 25.2% in 1990, 46% in 2019 and 54% in 2040.
Conclusions:This major life expectancy gain is expected to be attributed to further reductions in major communicable, maternal, neonatal, and nutritional causes of death. Ethiopia is more likely to achieve the success of lower middle-income countries in terms of life expectancy. However less likely to achieve the success of upper middle-income countries by 2040. Non-communicable disease and injuries are expected to be leading causes from 2017 through 2040 that need more emphasis on the country's envisioning plans and strategies. This finding could help to strengthen the health care system, devise prevention and control strategies, and implement Best Buy interventions for NCDs and Injuries while addressing the unfinished agenda of communicable diseases and others. Providing subnational forecasting results could also be helpful in understanding projected progress and disparities between regional states to devise relevant strategies and interventions. There is also a need to improve quality data availability and accessibility to produce reliable decision-making results. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Forecasting, health outcomes, envisioning strategy, Ethiopia

Household air pollution impacts on mortality and disease burden in East Africa and Nile Basin African countries

Awoke Misganaw — 2023-10-20

Abstract
Background: Clean household energy access is a major public health challenge across East Africa and the Nile Basin African countries.
Objectives: This is to quantify exposure and health impacts of household air pollution from using solid fuels for cooking from 1990 to 2019 to inform policy and practice.
Methods: In all 18 countries across East Africa and the Nile Basin Africa region, we estimated exposure to household air pollution from solid fuels (defined as the percentage of households using solid cooking fuels and the corresponding exposure to particulate matter 2.5 (PM2.5). We applied the methods of the Global Burden of Diseases, Injuries, and Risk Factor Study 2019 to estimate deaths, premature mortality, and disability-adjusted life years attributable to household air pollution from solid fuels with 95% Uncertainty Intervals (UI).
Results: There was a high prevalence of household air pollution from using solid fuels for cooking, ranging from 78% in Somalia to 0.02% in Egypt in 2019. In total, there were 346,600 deaths attributable to household air pollution from using solid fuels for cooking in ENB countries in 2019. The highest number of all-cause household air pollution-attributable deaths was in Ethiopia, 67,830 (95% UI: 52,710-82,420), DR. Congo, 58,040 (95% UI: 41,170-77,460), Tanzania 39,170 (95% UI: 29,180-49,860) and Somalia 27,550 (95%% UI: 19,570-38,960), and the lowest deaths were in Comoros 550 (95% UI: 410-710), Djibouti 20 (95% UI: 90-360) and Egypt 70 (95% UI: 30-170). Almost all deaths were due to respiratory infection, neonatal diseases and conditions, cardiovascular diseases, chronic respiratory disease, and diabetes across all countries. Premature mortality and disability attributable to household air pollution from solid fuels were highly prevalent in Somalia, DR. Congo, Ethiopia, Tanzania, and Uganda compared to Egypt. Though the trend of death rate per 100,000 populations attributable to household air pollution showed a decline in Ethiopia and all countries between 1990 and 2019, it was unacceptably high in Somalia (272 deaths), Burundi (186 deaths), DR. Congo (157 deaths), Eritrea (140 deaths), South Sudan (133 deaths) and Ethiopia (130 deaths) compared to Egypt (0 deaths).
Conclusion: Household air pollution is highly prevalent and a major public health concern across East Africa and the Nile Basin Africa countries except Egypt. The prevalence and impact vary between countries. Governments need to address Household air pollution in their disease prevention and control strategies for lower respiratory infection, neonatal, diabetes, chronic respiratory diseases, and cardiovascular diseases. To provide affordable and clean energy for their population and achieve Sustainable Development Goal 7, partnership on different energy sources, including building dams for electrification, such as the Grand Ethiopian Renaissance Dam, could be important. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords. Household air pollution, Solid Fuels, risk factors, burden of diseases, Ethiopia, East Africa countries, Nile Basin Countries.

The Burden of Mental Disorders in Ethiopia, from 1990 to 2019: A Systematic Analysis of the Global Burden of Diseases Study 2019

Ababi Zergaw — 2023-10-20

Abstract
Background: Currently, non-communicable diseases are prevailing in Ethiopia, with mental disorders being a significant contributor. However, there is a lack of substantial evidence regarding the impact and distribution of these illnesses across the country.
Objective: This study aims to evaluate the occurrence, prevalence, and disability-adjusted life years associated with mental disorders in all regional states and chartered cities of Ethiopia between 1990 and 2019.
Methods: In this study, the 2019 Global Burden of Diseases data, tools, processing, and estimation techniques were used to estimate incidence, prevalence, and disability-adjusted life years due to mental disorders in all regional states and chartered cities in Ethiopia from 1990-2019. The Bayesian meta-regression disease modeling (DisMR.2) and causes of death ensemble modeling (CODEm) methods were used to calculate fatal and non-fatal health metrics values over time. The spatiotemporal Gaussian process regression was employed to transfer strength between points and over time for each relevant metric. All available data sources including population census, household surveys, demographic surveillance, disease registry, health service use, disease notifications, and other data, were used for this analysis. Each metric was estimated per 100,000 populations with a 95% uncertainty interval.
Results: The most common forms of mental disorders in Ethiopia were depressive disorders [4,650 cases (4,166-5,200)], anxiety disorders [3,466 cases (2,967-4,084)], bipolar disorders [614 cases (520-720)], and schizophrenia [213 cases (182-247)]. Mental disorders accounted for about 4.0% (4.5% female vs. 3.5% male) of the total burden of diseases from all causes in Ethiopia, with 1,393 disability-adjusted life years (1,019-1,845). Addis Ababa city administration had the highest disability-adjusted life years due to mental disorders, whereas the Somali region had the lowest.
Conclusion: This study has indicated that depressive disorders, anxiety disorders, bipolar disorders, and schizophrenia were the most common mental disorders in Ethiopia from 1990 to 2019, indicating that there were unparalleled prevention and treatment efforts to halt the burdens due to these disorders. Moreover, there were variations in the distribution of the burden of mental disorders at the sub-national level. Therefore, mental health interventions should include addressing common disorders and inter-regional disparities. [Ethiop. J. Health Dev. 2023; 37 (SI-2)]
Keywords: anxiety disorders, bipolar disorders, depressive disorders, disability-adjusted life years, global burden of diseases, incidence, mental disorders, prevalence, schizophrenia

The Burden of Non-Communicable Diseases and Its Implications for Sustainable Development Goals Across Regions in Ethiopia.

Atalel Fentahun Awedew — 2023-10-20

Abstract
Background: Non- Non-communicable diseases (NCDs) are major global public health concerns that cause nearly three-quarters of the burden of mortality worldwide. Cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes alone account for over eight out of ten NCD deaths. To alleviate this huge burden, the Sustainable Development Goals (SDG) aimed to reduce premature mortality from non-communicable diseases by one-third. However, the magnitude of NCDs at national and subnation levels is poorly documented in resource-constrained settings such as Ethiopia, making it difficult to track progress. We analyzed the burden of non-communicable diseases across regions to show the disparity, progress, and implications towards achieving SDG targets in Ethiopia.
Methods: This analysis is a component of the GBD 2019 study, which is a collaborative effort between the Ethiopian Public Health Institute and the Institute for Health Metrics and Evaluation for Ethiopia. The primary sources of data utilized for estimating the GBD included census data, demographic surveillance, cancer registration, household surveys, health service utilization, disease reporting, and verbal autopsy. Our assessment, conducted in accordance with the GBD protocol, focuses on reporting the incidence, mortality, disability-adjusted life years (DALYs) along with a 95% Uncertainty Interval (UI), and the progress of non-communicable diseases in Ethiopia..
Results: In 2019, 202 million new cases of NCDs (95% Uncertainty Interval (UI), 189 million-215 million), 219,000(197,000-241,000) deaths, 13 million (11-15) DALY of NCDs were exhibited in Ethiopia. In the same period, Incident rate, death rates, DALY rates of NCDs were 190,000 (180,000-200,000), 550 (500-600), and 12,200 (10,400-14,200) per 100,000 population, respectively. Overall, NCD prevalence accounted for 63.2% of total cases in Addis Ababa, 59.8% in Harari, and 55% in Somali regional states. Overall, NCD deaths accounted for 55% of total deaths in Addis Ababa, 51% in Tigray, 45% in Harari, 43% in Amhara, and 42% in Dire Dawa, while it was 29% to 33% of total deaths in Somali, Benishngul Gumuz and Afar regional states. From 2010-2019, the percentage change in death count was 21% (8-35%), incidence cases 25% (24-26%), and DALYs count was 17% (6-29%). In 2019, skin and subcutaneous diseases, neurological disorders, mental disorders, digestive diseases, musculoskeletal disorders, and neoplasms were the five leading causes of incidence rates in Ethiopia. In contrast, cardiovascular diseases, neoplasms, digestive diseases, chronic respiratory diseases, and diabetes mellitus were Ethiopia's leading causes of death rates. In 2019, modifiable risk factors accounted for 52% (48-56%) of all NCD-caused mortality.
Conclusion: This study showed a high burden and relatively stable trend of NCD-caused mortality and disability in Ethiopia. The epidemiological transition was not uniform across the regions. Current NCD strategies fail to address high-incidence NCDs that overburden the health care system while designed to address killer NCD types and their risk factors. Strategies and interventions could target modifiable risk factors such as high systolic blood pressure, dietary risks, air pollution, and high fasting plasma glucose, which contribute almost half of NCD mortality and disability. This study suggests the need to develop proclamations and strategies on risk factors, such as reducing sodium, fat, and sugar use to prevent and control non-communicable diseases in Ethiopia. This result may also call for tailored and innovative public health interventions across highly NCD-prevalent regions to progress on reducing NCD deaths by one-third at the end of 2030. . [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Sustainable Development Goals, Non-communicable diseases, Global Burden of Diseases, Ethiopia

The Burden of Tuberculosis across Regions in Ethiopia: A Systematic Subnational Analysis for the Global Burden of Disease Study 2019

Asrat Arja — 2023-10-20

Abstract
Background: Tuberculosis remains a major global public health problem, with insufficient evidence at national and subnational levels.
Objective: The objective of this study was to assess the impact of tuberculosis on individuals who are HIV-negative in Ethiopia and regional states. It focused on comparing the progress made during the Millennium Development Goals (MDG) era with that achieved after the MDG era with regard to gender, age group, and drug resistance status.
Methods: We used the Global Burden of Disease 2019 collaborative study for computing age-standardized and age-specific Tuberculosis incidence, mortality, and disability-adjusted life years. Results are reported in absolute number and age-standardized rates (per 100,000 populations) with 95% uncertainty intervals.
Results: In 2019, 212,220 new TB cases and 29,874 TB-related deaths occurred among HIV-negative individuals in the country. TB affected more men than women in most age groups. The Annualized Rate of Change (ARC) in age-standardized TB incidence decreased by 2.2% from 1990 to 2015, but a 0.05% decrement was observed from 2016 to 2019. The ARC in age-standardized TB mortality dropped by 5.5% from 1990 to 2015 and 4.2% from 2016 to 2019. Multidrug-resistant Tuberculosis (MDR-TB) increased by only 1.3% from 2016 to 2019 nationally, but the ARC in mortality of MDR-TB declined by 3.1% from 2016-2019, a significant improvement from its initial increase of 9.2% between 1990-2015. ARC in the age-standardized incidence of extensively drug-resistant Tuberculosis (XDR-TB) increased by 4.2% from 2016 to 2019 and 22% from 1990 to 2015. In 2019, Dire Dawa had the lowest age-standardized TB incidence rate of 192 per 100,000, while Afar Region had the highest rate of 425 per 100,000. All regions except Somali, Gambella, and SNNPR showed a slow decline in ARC mortality between 1990-2015. Drug-susceptible TB was the most common variant, followed by MDR-TB in 2019. The age-standardized DALY rate due to TB has declined by 80% from 10,326 per 100,000 in 1990 to 1,853 per 100,000 in 2019.
Conclusion: The study reveals a decreasing TB burden among HIV-negative individuals in Ethiopia from 1990 to 2019. It emphasizes the need for Ethiopia's TB control strategies to enhance access to prevention, early diagnosis, and treatment, focusing on high-risk groups and vulnerable individuals. Targeted interventions, including social protections, are needed to engage more men in TB care and emphasize the importance of early diagnosis. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Tuberculosis, Burden, Subnational, Global burden of disease, Ethiopia

Trends in Mortality and Years of Life Lost across regions in Ethiopia: A Systematic Subnational Analysis in Global Burden of Disease Study 1990-2019

Yihunie Lakew — 2023-10-20

Abstract
Background: Evidence on premature mortality from any cause is vital to understanding disparities in the availability and accessibility of health care and health resource allocation across regions and city administrations, yet this evidence is often lacking. This analysis investigates the levels and trends of mortality and age-standardized Years of Life Lost (YLL) rates and explores the cause-specific burden of disease variations across nine regions and two cities in Ethiopia from 1990 to 2019.
Methods: The Global Burden of Disease (GBD) 2019 utilized various data sources such as national census, demographic surveillance, household surveys, health service utilization, and other relevant data. The aim of GBD 2019 was to provide comprehensive information on the number of deaths, death rates, and years of life lost (YLLs). To determine the causes of death based on age, sex, year, and location, GBD 2019 applied a Cause of Death Ensemble Modelling (CODEm) approach, which involved using mixed-effects linear models and spatiotemporal Gaussian process regression (ST-GPR) models. This report specifically focuses on the trends and levels of deaths from all causes and age-standardized YLL rates for the top 25 causes of death in Ethiopia. The point estimates were accompanied by 95% uncertainty intervals (UI) to provide a measure of uncertainty.
Results: Overall, 559,997 (95% UI: 506,117-621,976) deaths occurred in Ethiopia in 2019 from all causes, with 317,818 (95% UI: 278,395-361,016) male deaths. In 2019 the age-standardized all-cause mortality rate was 993.5 per 100,000 population (95% UI: 915.0-1070.6). Males had a higher rate than females, 1,101.5 (963.4-1,246.0) per 100,000 population among males. A 38.2% decline in the number of deaths, a 58.4% decline in the age-standardized death rate, and a 68.3% decline in the age-standardized YLL rate were observed from 1990 to 2019 in Ethiopia. Age-standardized death rates due to communicable, maternal, neonatal, and nutritional diseases and disorders (CMNND), non-communicable diseases (NCDs), and injuries were 368.6 (95% UI: 329.7-413.5), 553.4 (95% UI: 501.9-604.9), and 71.6 (95% UI: 61.1-82.7) per 100,000 populations respectively in 2019. Neonatal disorders, diarrheal diseases, lower respiratory infections, tuberculosis, and stroke featured among the five leading specific causes of age-standardized YLL rates in all regions with different ranking orders. HIV/AIDS was the leading cause of age-standardized YLL rates in Addis Ababa and Gambella, causing respectively 4,381.9 (95% UI: 3,213.4-5,800.0) and 4,584.1 (95% UI: 2,776.2-7,087.1) YLL per 100,000 population in 2019. Tuberculosis was the leading cause of YLL in the Afar region, with YLL rates of 4,224.4 (95% UI: 3,303.1-5,286.2) per 100,000 populations in 2019.
Conclusion: There was a significant decline in age-standardized YLL rates between 1990 and 2019 across all regions, with some disparities. Neonatal disorders, diarrheal disease, lower respiratory infections, tuberculosis, HIV/AIDS, ischemic heart disease, and stroke were the leading causes of age-standardized YLL rates 2019 across the nation and regions. Federal, regional, and city administrative policymakers should focus on designing strategies, resources, and interventions on disease burden and avoiding leading causes of YLL. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Cause of death, trends in mortality, Years of Life Lost, Ethiopia

Trends in Burden of Diseases among Adolescents in Ethiopia, from 1990 to 2019: A Subnational Analysis in Global Burden of Diseases 2019 Study

Ababi Zergaw — 2023-10-20

Abstract
Background: Adolescence is a time of major physical, social, and emotional changes and can present significant health risks. Nearly 35% of the global disease burden is believed to be rooted in adolescence. However, the burden of diseases among adolescents is poorly studied in Ethiopia despite having a large adolescent population.
Objective: The objective of this research is to analyze the patterns of premature mortality, disability, and overall disease burden among adolescents in Ethiopia from 1990 to 2019, considering age, gender, and regional variation.
Methods: Using the 2019 Global Burden of Disease data and estimation techniques, disability-adjusted life years, years lived with disabilities, years of life lost, and maternal mortality rates were calculated. The causes of death ensemble model (CODEm) and Bayesian meta-regression disease modeling (DisMR 2) methods were used to calculate fatal and non-fatal health metrics values over time. All available data sources were used for this analysis, including e population census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data. The 95% uncertainty intervals were computed to check for the presence of statistical significance in the trend. Rates were estimated per 100,000 populations.
Results: From 1990 to 2019, there was a significant decreasing trend in mortality rate from 237 deaths (226–248) to 56 deaths (50–69), years of life lost from 18,093 years lost (17,264–19,008) to 4,264 years lost (3,788–5,276), and disability-adjusted life years from 24,615 years (22,598–27,127) to 9,803 years (8,153–11,815) among early adolescents, whereas mortality rate from 402 deaths (384–423) to 98 deaths (83–117), years of life lost from 28,769 years lost (27,439–30,266) to 7,015 years lost (5,949–8,372), and disability-adjusted life years from 36,494 years (33,987–39,428) in 1990 to 13,591 years (11,433–16,068) among late adolescents. Moreover, there were slight variations in the burden of diseases by sex and region. The leading causes of the total burden of diseases were mental disorders, HIV/AIDS and sexually transmitted infections, skin diseases, enteric infections, malaria and neglected tropical diseases, nutritional deficiencies, unintended injuries, tuberculosis and respiratory infections, and maternal and neonatal disorders. Additionally, those causes on the bottom list in 1990 shifted to the top in 2019.
Conclusion: According to the study, there has been a decline in the burden of diseases among adolescents from 1990 to 2019, although with slight variations across regions. Adolescents experienced a triple burden of diseases, including communicable, maternal, neonatal, and nutritional conditions, non-communicable diseases, and injuries. As a result, interventions aimed at addressing the health issues of adolescents should prioritize increased access to healthcare services, enhanced health education programs, better distribution of disease prevention resources across regions, and higher investment in public health infrastructure. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: adolescent health, burden of diseases, disability, HIV/AIDS, injuries, maternal disorders