Background Bone fractures are a global public health issue; however, to date, no comprehensive study of their incidence and burden has been done. We aimed to measure the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of fractures from 1990 to 2019.Methods Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we compared numbers and age-standardised rates of global incidence, prevalence, and YLDs of fractures across the 21 GBD regions and 204 countries and territories, by age, sex, and year, from 1990 to 2019. We report estimates with 95% uncertainty intervals (UIs). FindingsGlobally, in 2019, there were 178 million (95% UI 162-196) new fractures (an increase of 33•4% [30•1-37•0] since 1990), 455 million (428-484) prevalent cases of acute or long-term symptoms of a fracture (an increase of 70•1% [67•5-72•5] since 1990), and 25•8 million (17•8-35•8) YLDs (an increase of 65•3% [62•4-68•0] since 1990). The agestandardised rates of fractures in 2019 were 2296•2 incident cases (2091•1-2529•5) per 100 000 population (a decrease of 9•6% [8•1-11•1] since 1990), 5614•3 prevalent cases (5286•1-5977•5) per 100 000 population (a decrease of 6•7% [5•7-7•6] since 1990), and 319•0 YLDs (220•1-442•5) per 100 000 population (a decrease of 8•4% [7•2-9•5] since 1990). Lower leg fractures of the patella, tibia or fibula, or ankle were the most common and burdensome fracture in 2019, with an age-standardised incidence rate of 419•9 cases (345•8-512•0) per 100 000 population and an age-standardised rate of YLDs of 190•4 (125•0-276•9) per 100 000 population. In 2019, age-specific rates of fracture incidence were highest in the oldest age groups, with, for instance, 15 381•5 incident cases (11 245•3-20 651•9) per 100 000 population in those aged 95 years and older.Interpretation The global age-standardised rates of incidence, prevalence, and YLDs for fractures decreased slightly from 1990 to 2019, but the absolute counts increased substantially. Older people have a particularly high risk of fractures, and more widespread injury-prevention efforts and access to screening and treatment of osteoporosis for older individuals should help to reduce the overall burden.Funding Bill & Melinda Gates Foundation.

ObjectiveThe aim of this study was to determine the prevalence and associated factors of postpartum depression among mothers who gave birth within the last 12 months among hospitals of Southwest Ethiopia, 2017.ResultThe study revealed that 138 (33.82%) of mothers had postpartum depression. Unplanned pregnancy adjusted odds ratio (AOR) = 4.49, 95% CI (2.31, 8.71), age from 15 to 24 years AOR = 0.420, 95% CI (0.18, 0.98), having a chronic physical illness AOR = 7.71, 95% CI (2.34, 25.44), experiencing death of infant AOR = 4.12, (1.78, 9.51) and unstable marital condition AOR = 6.02, (2.79, 12.99) were significantly associated with postpartum depression. The prevalence of post-partum depression was found to be high. Therefore urgent attention must be given to this problem, in particular towards its early detection, so that morbidity could be reduced in this group of women.

Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and RiskFactors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. FindingsIn 2019, 273•9 million (95% uncertainty interval 258•5 to 290•9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4•72% (4•46 to 5•01). 228•2 million (213•6 to 244•7; 83•29% [82•15 to 84•42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1•21% [-1•26 to -1•16]), similar progress was not observed for chewing tobacco (0•46% [0•13 to 0•79]). Among the 12 highest prevalence countries

Summary Background High-resolution estimates of HIV burden across space and time provide an important tool for tracking and monitoring the progress of prevention and control efforts and assist with improving the precision and efficiency of targeting efforts. We aimed to assess HIV incidence and HIV mortality for all second-level administrative units across sub-Saharan Africa. Methods In this modelling study, we developed a framework that used the geographically specific HIV prevalence data collected in seroprevalence surveys and antenatal care clinics to train a model that estimates HIV incidence and mortality among individuals aged 15–49 years. We used a model-based geostatistical framework to estimate HIV prevalence at the second administrative level in 44 countries in sub-Saharan Africa for 2000–18 and sought data on the number of individuals on antiretroviral therapy (ART) by second-level administrative unit. We then modified the Estimation and Projection Package (EPP) to use these HIV prevalence and treatment estimates to estimate HIV incidence and mortality by second-level administrative unit. Findings The estimates suggest substantial variation in HIV incidence and mortality rates both between and within countries in sub-Saharan Africa, with 15 countries having a ten-times or greater difference in estimated HIV incidence between the second-level administrative units with the lowest and highest estimated incidence levels. Across all 44 countries in 2018, HIV incidence ranged from 2·8 (95% uncertainty interval 2·1–3·8) in Mauritania to 1585·9 (1369·4–1824·8) cases per 100 000 people in Lesotho and HIV mortality ranged from 0·8 (0·7–0·9) in Mauritania to 676·5 (513·6–888·0) deaths per 100 000 people in Lesotho. Variation in both incidence and mortality was substantially greater at the subnational level than at the national level and the highest estimated rates were accordingly higher. Among second-level administrative units, Guijá District, Gaza Province, Mozambique, had the highest estimated HIV incidence (4661·7 [2544·8–8120·3]) cases per 100 000 people in 2018 and Inhassunge District, Zambezia Province, Mozambique, had the highest estimated HIV mortality rate (1163·0 [679·0–1866·8]) deaths per 100 000 people. Further, the rate of reduction in HIV incidence and mortality from 2000 to 2018, as well as the ratio of new infections to the number of people living with HIV was highly variable. Although most second-level administrative units had declines in the number of new cases (3316 [81·1%] of 4087 units) and number of deaths (3325 [81·4%]), nearly all appeared well short of the targeted 75% reduction in new cases and deaths between 2010 and 2020. Interpretation Our estimates suggest that most second-level administrative units in sub-Saharan Africa are falling short of the targeted 75% reduction in new cases and deaths by 2020, which is further compounded by substantial within-country variability...

Background. Road traffic accidents (RTAs) remain an important public health issue worldwide. Psychoactive substance use is one of the main contributors to the occurrence of traffic accidents, and its use by truck drivers is a global problem. Also, psychoactive substance use is a commonly observed behavior among truck drivers. To the best of our knowledge, no evidence shows the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia. Therefore, this study was aimed at assessing the prevalence and factors associated with psychoactive substance use among truck drivers in Ethiopia. Methods. A cross-sectional study was conducted among 400 systematically selected truck drivers at Modjo dry port in Ethiopia, from February 1 to March 1, 2018. The data were collected through face-to-face individual interviews using a structured questionnaire. The collected data were entered into EpiData version 4.2.0.0 and analyzed using SPSS version 20. Binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. The level of significance was declared at p value < 0.05 in the multivariable binary logistic regression analysis. Results. Of the 400 truck drivers interviewed, the overall one-month self-reported prevalence of psychoactive substance use was 70% ( n = 280 ). In the multivariable binary logistic regression analysis, aged 38 years and above ( AOR = 0.40 , 95% CI [0.23-0.69]), Christianity religion ( AOR = 0.52 , 95% CI [0.28-0.97]), college and university education ( AOR = 3.47 , 95% CI [1.27-9.47]), having a family size of 3 or more ( AOR = 0.34 , 95% CI [0.20-0.60]), having 6 or more hours spent sleeping at night ( AOR = 0.46 , 95% CI [0.28-0.75]), and rest breaks between driving ( AOR = 2.13 , 95% CI [1.14-3.97]) were significantly associated with psychoactive substance use. Conclusion. The one-month prevalence of psychoactive substance use among truck drivers was remarkably high. We can conclude that psychoactive substance use is a public health problem among truck drivers, which is a major threat to themselves and others on the road. The sociodemographic and occupational factors are the factors associated with drivers’ psychoactive substance use. Therefore, devising health education and counseling program for drivers to tackle the problem plays paramount importance.

Background The cases of coronavirus disease 2019 (COVID-19) and related deaths are increasing exponentially in Ethiopia. Prevention is currently available effective management, and its implementation has not been assessed adequately. This study aimed to identify the factors associated with COVID-19 prevention practices in three zones of southwest Ethiopia. Methods A community-based cross-sectional study was conducted in the Bench Sheko, Kafa, and West Omo zones. A multistage sampling technique was employed to select 845 study participants. The data collection tool was adapted from the WHO resources and related literature. Independent factors were identified using binary logistic regression and a p-value less than 0.05 was used to declare the level of statistical significance. Results In this study, 803 participants participated. About two-thirds (64.7%) of the respondents had a history of going to crowded places, while only 30.3% of the participants had a history of wearing a mask when leaving home. Two-thirds of the respondents had a history of maintaining their distance at 2 meters (64.4%) and washing their hands with soap and water or using alcohol-based hand sanitizers (64.8%). Generally, less than two-thirds (59.4%) of study participants had a good prevention practices of COVID-19. Urban residence (AOR [adjusted odds ratio] =2.34; 95% CI=1.39, 3.94), highest family size (AOR=2.95; 95% CI=1.56, 5.57), good knowledge (AOR=1.74; 95% CI=1.10, 2.77), positive attitude (AOR=1.86; 95% CI=1.27, 2.73), intention to seek care (AOR=1.73; 95% CI=1.13, 2.63), and perceived mortality (AOR=2.20; 95% CI=1.50, 3.08) were positively associated with good prevention practices. Conclusion The proportion of individuals who had good COVID-19 prevention practices was inadequate. For such highly infectious diseases, prevention should be the priority intervention, and improving its implementation needs further effort. Community-based interventions such as risk communication and mass education should center on scaling up community knowledge and practice by prioritizing vulnerable groups such as rural residents.

Background Regarding the protection of community and health professionals suffering from a COVID-19 outbreak, currently different alcohol-based hand sanitizers have been distributed. Even though for effective protection effective alcohol-based hand sanitizers are mandatory. Their efficacy was not evaluated. This is the reason why this research was designed to assess the antimicrobial efficacy of hand sanitizers that have been sold in southern parts of Ethiopia. Methods Six test organisms ( Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Salmonella typhimurium and Shigella boydii ) were selected from different clinical specimens. Then seven locally made products of alcohol-based hand sanitizers (MTU, Folium Fine, Epharm, Harego, Taflen and Sheba) were purchased and the disc diffusion, minimum inhibition concentration and minimum bactericidal concentration test were done against selected test organisms. Quality control measures throughout the whole process of the laboratory work were implemented and descriptive parameters were analyzed. Results The zones of inhibition of the hand sanitizers at their claim concentration were ranged from noninhibition zone (Folium) to 27mm (Sheba). The minimum inhibitory concentration against all selected test organisms was observed at 45%, 55%, 65% and Taflen on undiluted form. The growth of test organisms was decreased across increasing the concentration gradient of different hand sanitizers. MTU except against E. coli, Fine, Hargo, Ephra and Sheba hand sanitizers were showed growth below 60% concentrations for all test micro-organisms. But a Folium product against all selected test micro-organisms and MTU product against E. coli were not bactericidal. Conclusion Fine, Hargo, Ephra, Sheba and Taflen sanitizers were the products that were effective in inhibiting the growth of all the selected test organisms, and they were having effective bactericidal activity in vitro at their claim concentration. But MTU product against E. coli and Folium product against all test microorganisms were not having an effective bactericidal activity. So, regulatory authorities and manufacturers should implement strict quality control measures and regular observations throughout the production to ensure the efficacy of hand sanitizers.

Introduction: Globally 41.8% of pregnant women are anemic with the highest proportion affected in developing countries. Nationally, only 0.4% of the pregnant women take Iron supplements more than 90 days of the recommended 180 days. In Oromiya region 75.3% of pregnant women do not take any iron tablets or syrup during their last pregnancy, while 10.8% take for less than 60 days, 0.4% took for 60-89 days and only 0.3% took for 90 days or more.Objective: To assess the adherence rate to iron and folic acid supplements among pregnant women attending antenatal clinics in Asella Town, south east Ethiopia Method and materials: Institution based cross-sectional quantitative study design was conducted in Asella town from September 2015 to June 2016. A purposive sampling technique used to select the health institution. There are six health institutions selected for this study. The sample size 317 was selected with systematic random sampling method. Ten percent of pre-test was conducted in one institution which is not included in data collection. Data were collected using structured pre-tested questionnaire. Before data collection verbal consent was obtained.The collected data were analyzed using Epi-data and SPSS version 22.00 packages. Result:The study revealed that Out of 317 pregnant women 296 (93%) responded to the questioner. The study revealed that 177 (59.8%) of pregnant mothers in the town adhered to the iron/folic acid supplement. Conclusion and recommendation:Adherence of iron/folic acid supplementation found in this study is very low. Consequently, maternal education, adequate supplement supply to the health facility, early starting antenatal visit, and health education on duration of supplementation