Melake Demena

The health problems of adults have been neglected in many developing countries, yet many studies in these countries show high rates of premature mortality in adults. Measuring adult mortality and its cause through verbal autopsy (VA) methods is becoming an important process for mortality estimates and is a good indicator of the overall mortality rates in resource-limited settings. The objective of this analysis is to describe the levels, distribution, and trends of adult mortality over time (2008-2013) and causes of adult deaths using VA in Kersa Health and Demographic Surveillance System (Kersa HDSS). Kersa HDSS is a demographic and health surveillance and research center established in 2007 in the eastern part of Ethiopia. This is a community-based longitudinal study where VA methods were used to assign probable cause of death. Two or three physicians independently assigned cause of death based on the completed VA forms in accordance with the World Health Organization’s International Classification of Diseases. In this analysis, the VA data considered were of all deaths of adults age 15 years and above, over a period of six years (2008–2013). The mortality fractions were determined and the causes of death analyzed. Analysis was done using STATA and graphs were designed using Microsoft Excel. A total of 1535 adult deaths occurred in the surveillance site during the study period and VA was completed for all these deaths. In general, the adult mortality rate over the six-year period was 8.5 per 1000 adult population, higher for males (9.6) and rural residents (8.6) than females (7.5) and urban residents (8.2). There is a general decrease in the mortality rates over the study period from 9.4 in 2008–2009 to 8.1 in 2012–2013. Out of the total deaths, about one-third (32.4%) occurred due to infectious and parasitic causes, and the second leading cause of death was diseases of circulatory system (11.4%), followed by gastrointestinal disorders (9.2%). Tuberculosis (TB) showed an increasing trend over the years and has been the leading cause of death in 2012 and 2013 for all adult age categories (15–49, 50–64, and 65 years and over). Chronic liver disease (CLD) was indicated as leading cause of death among adults in the age group 15–49 years. The increasing TB-related mortality in the study years as well as the relative high mortality due to CLD among adults of age 15–49 years should be further investigated and triangulated with health service data to understand the root cause of death.

In the world, Neonatal mortality accounts for 40 % of death of children under the age of 5 years. Majority of neonatal deaths occur in developing countries outside of formal health system, among which death in the first hour of first day of their life constitute the huge bulk. This analysis is intended to estimate neonatal mortality rates and identify the leading causes of death based on the surveillance data over 6 years period in Kersa health and demographic surveillance system (Kersa HDSS) site, Eastern Ethiopia. Kersa HDSS is an open dynamic cohort of population established in 2007. The surveillance started after conducting a baseline census followed by population update and events registration on house-to-house visits every 6 months. Data were collected using verbal autopsy (VA) questionnaire from close relatives (usually mothers in this case) and causes of deaths were assigned by 2 to 3 physicians. This analysis was done based on 301 neonatal deaths and 10,934 live births occurred during 2008 to 2013. The overall neonatal death rate during the study period was 27.5 per 1000 live births. Nearly all neonatal deaths (94 %) occurred at home. More than four-fifth (82.4 %) of the deaths was occurred in the first week of life. More than 80 % of the deaths were due to perinatal causes. Bacterial sepsis of the newborn accounted for 31.2 % followed by birth asphyxia and perinatal respiratory disorder (28.2 %), and prematurity (17.3 %). Higher number of death was observed in Tolla and Bereka sub-districts located at the southern parts of the study site which are away from the main road network. The overall neonatal mortality over 6 years is the same to the national average (27 per 1000 live births). The leading causes of neonatal death were bacterial sepsis of newborn and birth asphyxia. Community-based skilled health care delivery during birth should be emphasized.

The harmful infant feeding practices of prelacteal feeding is widely practiced in Ethiopia. Hence, it is vital to appreciate the cultural basis and potential factors on infant feeding practices in different parts of Ethiopia. This study aimed to investigate prelacteal feeding practices and associated factors among mothers of children aged less than 24 months in Raya Kobo district, North Eastern Ethiopia. A quantitative community-based cross-sectional study supplemented by qualitative methods was employed. Sixty hundred thirty (630) mothers of children aged less than 24 months were selected by systematic random sampling technique. Descriptive statistics, bivariate and multivariable logistic regression analysis were employed to identify the factors associated with prelacteal feeding practices. Variables with a p-value < 0.05 were identified as statistically significant factors. Qualitative data was collected by focus group discussion and in-depth interview and analyzed using thematic frameworks. The prevalence of prelacteal feeding was 38.8% (95% CI: 35.00%, 43.00%). Home delivery was a risk factor for practicing prelacteal feeding. Those mothers who gave birth at home were seven times more likely to practice prelacteal feeding as compared to mothers who delivered at health institutions (Adjusted Odd Ratio (AOR):7.10; 95% CI: 3.91, 12.98). Mothers who were not aware of the risks associated with prelacteal feeding were nearly four times more likely to practice prelacteal feeding as compared to knowledgeable mothers (AOR: 3.70; 95% CI: 2.44, 5.53). Late initiation of breastfeeding (after one hour of delivery) was also associated with prelacteal feeding practice (AOR: 2.70; 95% CI: 1.78, 3.99). The major reasons stated for providing prelacteal feeding were to prevent “evil eye” and illness and to “clean infant’s stomach”. Prelacteal feeding was commonly practiced in Raya Kobo district. Home delivery, delayed commencement of breastfeeding after birth and lack of awareness about the risks associated with prelacteal feeding were predictors of prelacteal feeding. Therefore, strengthening infant feeding counseling about the risks associated with prelacteal feeding, promoting institutional delivery and timely initiation of breastfeeding are important measures for preventing prelacteal feeding in Raya Kobo district.