The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3•5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

Background. Maternal tetanus is defined as tetanus acquired during pregnancy or within 6 weeks after the end of conception. As tetanus is a vaccine-preventable disease, immunization of pregnant mothers with a TT (tetanus toxoid) dose is one of the most effective ways to protect against the disease. Some studies showed that 94% of neonatal mortality reduction could be achieved through immunization of pregnant and childbearing-age mothers with at least two doses of TT vaccination. Objective. To assess the uptake of tetanus toxoid vaccine and associated factors among mothers who gave birth in the last 12 months in Errer district, Somali Regional State, Eastern Ethiopia, 2017. Methods and Materials. A community-based cross-sectional study design was implemented to study 440 mothers who gave birth in the last 12 months. Participants were selected using the strata and systematic sampling technique after conducting a preliminary survey. Data were collected through a face-to-face interviewer-administered questionnaire. The collected data was entered into EpiData version 3.02 and then exported to Statistical Package for the Social Sciences (SPSS) version 20. Bivariate and multivariate logistic regressions were carried out to see the association between variables at p<0.05 and 95% confidence interval. Finally, the information was presented by using frequencies, summary measures, and tables. Result. The overall tetanus vaccination uptake (≥TT2) doses was found to be 51.8%, 95% CI (47.7%, 56.4%). The total number of mothers who complete the five TT doses was 31 (14.8%). Urban residence [AOR=6.1, 95% CI: (2.33, 10.43)], multiparity [AOR=2.3, 95% CI: (1.7, 6.4)], and traveling less than 30 minutes from the home to a health facility [AOR=4.6, 95% CI: (1.34, 6.72)] were some the factors that were significantly associated with tetanus toxoid vaccination uptake. Conclusion and Recommendation. Although TT immunization is a scientifically proven mechanism to protect against maternal and neonatal tetanus, only half of the district mothers received ≥TT2 doses. Besides, our study revealed that the low vaccine uptake is attributed to long distance travel to reach a health facility, maternal illiteracy, and pastoralist lifestyle of mothers in the district. Thus, the regional stakeholders are required to scale up efforts on mother’s awareness creation towards the importance of the vaccine through health education and to arrange outreach TT vaccination campaigns in distant pastoralist communities within the region.

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Background: Neonatal thermal care is a vital intervention as newborns are susceptible to hypothermia than adults for certain reasons such as having a large body surface area, thin skin, little insulating fat, and overwhelmed thermoregulation mechanisms. Many newborn complications develop because of hypothermia due to thermal care malpractices. The leading thermal practice by women of developing countries is early bathing which predisposes newborns for life-threatening situations, such as low blood sugar levels, respiratory distress, abnormal clotting, jaundice, pulmonary hemorrhage and increased risk of developing infections. Hence, this research is aimed to provide substantial evidence regarding the women’s practices of newborn bath and the factors that determine early (<24hr) bathing. Objective: The study aimed to assess the early newborn bath and its associated factors among parturient women who gave birth in the last month in the Harar region, Eastern Ethiopia, 2017. Methods: The study applied an institutional-based cross-sectional study design by recruiting 433 women. The data collectors interviewed study participants face to face at the baby immunization ward from two hospitals and four health centers. The author calculated the sample size using a double population proportion formula. A systematic sampling technique from the women’s medical registration frame was used to select the final study participants. The data collectors gathered the data using a structured questionnaire adapted from different literature, checking its consistency, reliability and validity by a pretest. Results: The response rate of this study was 99.8%. The early newborn bathing practice was found in 153 (35.4% with 95% (CI): (30.3%, 40.3%) women. Uneducated (AOR=3.12 95% CI: (2.12-5.3), no knowledge of hypothermia (AOR=4.95 95% CI: (3.10-12.2), being Primi para (AOR=3.5 95% CI: (2.5-5.6) and no utilization of newborn bed net (AOR=6.2 95% CI: (3.3-45) were statistically significant factors determining early newborn bathing practice. Conclusion: The study revealed that although the ministry implemented a good deal of awareness promotion activities, women still practice early newborn bathing. Maternal illiteracy, giving birth for the first time, knowledge deficiency related to hypothermia and newborn bed net application were among the factors which demand improvement to solve the problem.

Objective The purpose of this study was to assess knowledge about neonatal danger signs and associated factors among mothers who gave birth in the last 4 months attending immunization services. Result The study recruited 432 mothers to participate. A knowledge score of neonatal danger signs was found [32.9% (95% CI 28.9%, 37%)]. Mothers educated to secondary level were 4.9 times more likely to know about neonatal danger signs [(AOR = 4.9, 95% CI (1.15, 21). Similarly, mothers whose husband educated to college and above [AOR = 4.95, 95% CI (1.15, 21)], and being multipara mother [(AOR = 2.59, 95% CI (1.05, 6.6)], were factors significantly associated with good knowledge of mothers about neonatal danger signs.

Background. The right to prefer mode of delivery is a crucial component of compassionate and respectful care that fosters both maternal and neonatal well-being as the failure to respect the mother’s interest increases to the risk of maternal depression and posttraumatic stress. Thus, the aim of the study was to assess delivery mode preference and associated factors among pregnant women. Methods and Materials. The study was conducted in two hospitals and two health centers. We used a cross-sectional study design incorporating 398 pregnant mothers attending an antenatal care follow-up from February to May 2018. The study excluded pregnant mothers with any previous uterine surgery including caesarean delivery from participation due to their restricted chance to prefer their mode of delivery. Data were collected by using a pretested questionnaire. Data were entered to EpiData Manager version 3.1 and exported to Statistical Package for the Social Sciences version 22 for analysis. Besides, the analysis included both the bivariate and multivariable analyses to check the association between dependent and independent variables. Finally, level of statistical significance was declared at P value < 0.05. Result. The participant’s level of response was 100% (398). The age of the mothers ranges from 15 to 45 years old. The delivery mode preference of the caesarean section (C/S) and spontaneous vertex delivery (SVD) was 115 (28.9%) and 283 (71.1%), respectively. The study revealed that planned 47 pregnancy [AOR, 1.76; CI: 0.89-3.47], young age [AOR, 12.9; CI: 0.23-7.1], and primigravida [AOR, 1.24; CI: 0.29-5.2] were among the variables associated with maternal preference of caesarean section. Conclusion and Recommendation. Nearly one-third of the mothers preferred caesarean delivery as their mode of delivery due to fear of labor pain and repeated vaginal examination by the care providers. This is particularly seen in women who had received higher education level, claim their pregnancy as planned, their choice of delivery at hospital, young aged, pregnant for the first time, and those who had visited antenatal care repeatedly. This implies that policy makers and stakeholders should exert due emphasis to ongoing desire of caesarean delivery as the procedure is not without risk, if it is done without indication. For researchers, we recommend to investigate the preference of mode of delivery in a much broader aspect.

Objectives: The aim of this study was to determine the unfavorable outcomes and to assess factors contribute for the unfavorable management outcomes after caesarean deliveries in Ayder Specialized Comprehensive Hospital, Mekelle, Tigray, Ethiopia, 2017. Results: The unfavorable maternal management outcomes were Adhesion 28(8.3%), excessive blood loss and blood transfusion 19(5.6%), caesarean hysterectomy 10(3%), relaparotomy 5(1.5%), wound infection and wound dehiscence 23(6.8%).Unfavorable fetal outcomes were were still birth 9(2.6%), early neonatal death 8(2.4%), low birth weight 58(17.2%). Women’s who did not booked for Antenatal Care and having history of previous Caesarean delivery were found to be associated with unfavorable maternal outcomes and indications of Caesarean delivery as obstructed labor was associated with unfavorable fetal outcomes. Key words: caesarean delivery, fetal outcomes, maternal outcomes.

Objective. The objective of this study was to assess the determinants of cesarean section deliveries in public hospitals of Addis Ababa, Ethiopia, 2019. Method. A hospital-based unmatched case-control study was conducted to study 780 (260 cases and 520 controls) women who delivered in public hospitals of Addis Ababa from August 22 to September 20, 2019. The cases were all mothers who delivered through caesarean section, and controls were all mothers who delivered vaginally in the same time in the study area. Data were collected from the randomly selected women and looking into their cards. Data were entered on EpiData 3.1 and exported to SPSS version 20 for cleaning and analyzing. Binary logistic regression and AOR with 95% CI were used to assess the determinants of caesarean section. Results. Majority of the study participants were in the age category 20–34 years. Nearly more than 1/3rd of the participants (32.7% cases and 34.6% controls) have attended primary school. Most of the cases 217 (83.5%) and few of the controls 21 (4%) possess previous caesarean section. One hundred three (52.3%) of the cases and 329 (63.6%) controls were multi-parous. Previous caesarean delivery (AOR = 6.93, 95% CI; (3.39, 14.16)), singleton pregnancy (AOR = 0.34, 95% CI; (0.12, 0.83)), birth weight less than 2500 gm (AOR = 0.29, 95% CI; (0.18, 0.92)), birth weight greater than 4000 gm (AOR = 16.15 (8.22, 31.74)), completely documented partograph (AOR = 0.13, 95% CI; (0.078, 0.23)), and pregnancy-induced hypertension (AOR = 2.44, 95% CI; (1.46, 4.08)) were significant determinants of caesarean delivery in this study. Conclusion. Previous caesarean section, number of delivery, birth weight, partograph documentation, and pregnancy-induced hypertension had significant association with caesarean section delivery in this study.