Wondu Feyisa Balcha

BACKGROUND: The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. METHODS: We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. FINDINGS: In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. INTERPRETATION: The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. FUNDING: Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

Introduction: Anemia is characterized by a decline in the number or size of red blood cells and Hb concentration, which results in impairment capacity to transport oxygen. It is a major cause of indirect maternal mortality. Anemia is largely preventable and easily treatable, if detected in time; however, it remains one of the leading causes of maternal morbidity and mortality, especially in developing countries. This study aimed to assess factors associated with anemia among pregnant women who attended antenatal care. Methods: A health facility-based cross-sectional study was conducted from 1 February 2020 to 2 March 2020 among 420 pregnant women. The data were collected by systematic random sampling technique, entered into a computer using EpiData 3.5, and analyzed using the Statistical Package of Social Sciences 23.0 version. Bivariate and multivariable logistic regression analyses were done to estimate the crude and adjusted odds ratio with a CI of 95% and a P -value of less than 0.05 considered statistically significant. Frequency tables, figures, and descriptive summaries were used to describe the study variables. Results: The overall prevalence of anemia was 32.9% (95% CI: 28.6–37.4), and it was higher in rural than urban pregnant women (45 vs. 23%), respectively. In multivariable analysis women who are found in the age group of greater than or equal to 30 years (AOR=3.45, 95% CI=1.22–9.78), rural residency (AOR=3.51, 95% CI=1.92–6.42), low family income (AOR=3.10, 95% CI=1.19–8.08), multiparty (AOR=2.91, 95% CI=1.33–6.38), a short interpregnancy gap (AOR 3.32, 95% CI=1.69–6.53), not taking iron and folate (AOR=4.83, 95% CI=2.62–9.90), third trimester of pregnancy (AOR=3.21, 95% CI=1.25–8.25), poor minimum dietary diversity score (AOR=3.54, 95% CI=1.58–7.95), undernourished (AOR=4.9, 95% CI=2.19–7.64), poor knowledge of anemia (AOR=3.19, 95% CI=1.72–5.93), consumption of coffee always after meal per day (AOR=3.24, 95% CI=1.42–7.42), having a history of irregular menstruation, and antepartum hemorrhage were significantly associated with anemia in pregnant women. Conclusion: This study showed that the prevalence of anemia in pregnant women in this study area was a moderate public health problem. The author suggest emphasizing the education and counseling of women on the advantage of taking the supplemented iron and folic acid. Health care providers should have to advise women to stay for at least 2 years before the next pregnancy to reduce the risk of adverse maternal and infant outcomes. Awareness creation in the community on the utilization of insecticide-treated bed nets is also needed.

Anemia is a largely preventable and curable medical disease if detected intime. This study aimed to assess maternal knowledge of anemia and its prevention strategies in the public health facilities of Pawi district, Northwest, Ethiopia. A health facility-based cross-sectional study was conducted from February 1/2020 to March 2/2020, among 410 antenatal care attendees in the public health facilities of the Pawi district. The data was collected by systematic random sampling technique and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a CI of 95% and a P-value of less than .05 considered statistically significant. Less than half, 184 (44.9%) [95% CI = 40.0-49.8] and almost half, 216 (52.7%) [95% CI = 47.8-57.5] of the pregnant women had good knowledge of anemia and good adherence to its prevention strategies respectively. Women who are found in the age group of 15 to 19, 20 to 24, and 25 to 29 years, rural residency, secondary, and above educational level, vaginal bleeding, third trimester of pregnancy, and medium and high minimum dietary diversification score were significantly associated with knowledge of anemia. On the other hand: women who are found in the age group of 15 to 19 years, secondary above educational level, primigravida women, having ≤2 and 3 to 4 family sizes, second and third trimester of pregnancy, high minimum dietary diversification score, and good knowledge of anemia were significantly associated with adherence to anemia prevention strategies. Maternal knowledge of anemia and adherence to its prevention strategies were low. Nutritional counseling on the consumption of iron-rich foods and awareness creation on the effects of anemia in pregnant women must be strengthened to increase the knowledge of anemia and adherence to its prevention strategies.

Background . Obstetric fistula is abnormal passageway between the vagina and bladder or rectum, and it has the most devastating effects on physical, social, and economic levels and represents a major public health issue of thousands of women, which failed to provide accessible and appropriate intrapartum care for women within a developing country, particularly in Ethiopia. Therefore, we tried to assess the awareness and its associated factors of obstetrics fistula among pregnant mothers attending antenatal care clinics. Methods . A health institutional-based cross-sectional study was employed from March 4 to 29/2019 among 413 pregnant women. Data was collected by a systematic random sampling technique and entered into a computer using Epi data 3.5, edited and analyzed using Statistical Package of Social Sciences 23.0 version. Bivariate and multivariate logistic regression analyses were employed to estimate the crude and adjusted odds ratio with a confidence interval of 95% and <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mi>p</mml:mi></mml:math> value of less than 0.05 considered statically significant. Result. This study identified that 39.5% with 95% confidence interval (34.6-44.6%) of pregnant women had good awareness about obstetrics fistula. Multivariate logistic regression analysis showed that living in urban [<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>A</mml:mi><mml:mi>O</mml:mi><mml:mi>R</mml:mi><mml:mo>=</mml:mo><mml:mn>1.98</mml:mn></mml:math>, 95% <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>C</mml:mi><mml:mi>I</mml:mi><mml:mo>=</mml:mo><mml:mn>1.07</mml:mn><mml:mo>−</mml:mo><mml:mn>3.69</mml:mn></mml:math>], attending formal education [<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>A</mml:mi><mml:mi>O</mml:mi><mml:mi>R</mml:mi><mml:mo>=</mml:mo><mml:mn>2.11</mml:mn></mml:math>, 95% <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>C</mml:mi><mml:mi>I</mml:mi><mml:mo>=</mml:mo><mml:mn>1.06</mml:mn><mml:mo>−</mml:mo><mml:mn>4.12</mml:mn></mml:math>], having history antenatal care [<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mi>A</mml:mi><mml:mi>O</mml:mi><mml:mi>R</mml:mi><mml:mo>=</mml:mo><mml:mn>3.87</mml:mn></mml:math>, 95% <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>C</mml:mi><mml:mi>I</mml:mi><mml:mo>=</mml:mo><mml:mn>1.60</mml:mn><mml:mo>−</mml:mo><mml:mn>9.68</mml:mn></mml:math>], and childbirth at health institution [<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mi>A</mml:mi><mml:mi>O</mml:mi><mml:mi>R</mml:mi><mml:mo>=</mml:mo><mml:mn>7.10</mml:mn></mml:math>, 95% <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mi>C</mml:mi><mml:mi>I</mml:mi><mml:mo>=</mml:mo><mml:mn>2.52</mml:mn><mml:mo>−</mml:mo><mml:mn>2.02</mml:mn></mml:math>] were significantly associated with awareness of obstetrics fistula. Conclusion and recommendation. This study showed that awareness of obstetrics fistula was low. Residency, education, and occupation of the women, having history of antenatal care and childbirth at health institution was significantly associated with awareness of obstetrics fistula. Still, there is a gap on awareness of obstetrics fistula; therefore, it is good to emphasize on providing information on maternal health care issues, particularly about obstetrics fistula.

A Trial of labor after cesarean section is an attempt to deliver vaginally by a woman who had a previous cesarean delivery and when achieved by a vaginal delivery it is called successful vaginal birth after cesarean section. Vaginal birth after a caesarian section is a preferred method to decrease complications associated with repeated caesarian section delivery for both mother and fetus. It has a higher success rate when the right women are selected for a trial of labor. This study aimed to assess factors associated with successful vaginal birth after one lower uterine transverse cesarean section and to validate the Flamm and Geiger score at the public hospitals of Bahir Dar City, Northwest, Ethiopia, 2021. A health facility-based retrospective cross-sectional study was conducted from March 1 to 15/2021. A medical record review of 408 women charts with a trial of labor after one lower uterine transverse cesarean section from January 1/2020 to December 31/2020 was done and 345 women charts with complete maternal and fetal information were included in the study with a response rate of 84.6%. The data were collected using a structured checklist, entered into Epi data 3.1, and analyzed using SPSS 25.0 version. Logistic regression analyses were done to estimate the crude and adjusted odds ratio with a confidence interval of 95% and a P-value of less than 0.05 considered statistically significant. This study identified that the trial of labor after cesarean section rate was 69.5%, and the success rate of vaginal birth after one lower uterine transverse cesarean section was 35.07%. Of the failed trial of labor, fetal distress (38.9%) and failed progress of labor (32.1%) were the main indications for an emergency cesarean section. The maternal age group of 21-30 years, prior vaginal birth after or before cesarean section, non-recurring indication (fetal distress and malpresentation), ruptured membrane, cervical dilatation ≥ 4 cm, cervical effacement ≥ 50%, and low station (≥ 0) at admission were associated with successful vaginal birth after one lower uterine transverse cesarean section. For the Flamm and Geiger score at a cut point of 5, the sensitivity and specificity were 73.6% and 86.6% respectively. In this study area, the trial of labor after cesarean section rate is encouraging, however, the success rate of vaginal birth after one lower uterine transverse caesarian section was lower. The maternal socio-demographic and obstetric-related factors were significantly associated with successful vaginal birth after one lower transverse caesarian section delivery. This study indicated that when the Flamm and Geiger score increases, the chance of successful vaginal birth after one lower uterine transverse caesarian section also increases. We suggest emphasizing counselling and encouraging the women, as their chance of successful vaginal delivery will be high in the subsequent pregnancy, especially if the indications of primary caesarian section delivery were non-recurring.