Publications by authors named "Hirbo Shore Roba"

8 Publications

  • Page 1 of 1

Self-care practice and associated factors among hypertensive patients in public health facilities in Harar Town, Eastern Ethiopia: A cross-sectional study.

SAGE Open Med 2020 3;8:2050312120974145. Epub 2020 Dec 3.

School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.

Background: Self-care practice is the activity that a hypertensive patient undertakes intending to improve their health. Poor self-care practice leads to uncontrolled hypertension. Therefore, strategies designed to prevent and control hypertension-related death, disability, and morbidity should consider the level of the patient's self-care practice and risk factors. This study assessed self-care practice and associated factors among hypertensive patients in public health facilities of Harar Town in eastern Ethiopia.

Method: An institution-based cross-sectional study was conducted among 398 randomly selected hypertensive patients from 25 March 2019 to 16 April 2019. Pretested structured questionnaires adapted from validated tools were used to collect data from participants using electronic Open Data Kit software through face-to-face exit interview. Data were analyzed by SPSS version 24. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with self-care practice. Adjusted odds ratio with 95% confidence interval was used to report association and the significance was declared at value < 0.05.

Results: Level of good self-care practice was 29.9% (95% confidence interval: 25.3% and 34.7%). Age ⩾ 60 years (adjusted odds ratio = 3.4, 95% confidence interval: 1.2 and 9.3), formal education (adjusted odds ratio = 2.3, 95% confidence interval: 1.3 and 4.2), absence of comorbidities (adjusted odds ratio = 1.8, 95% confidence interval: 1.1 and 3.1), adequate knowledge about hypertension (adjusted odds ratio = 4.7, 95% confidence interval: 2.5 and 8.8), good social support (adjusted odds ratio = 2.7, 95% confidence interval: 1.6 and 4.7), and being khat abstainer (adjusted odds ratio = 1.9, 95% confidence interval: 1.1 and 3.5) were significantly associated with good self-care practice.

Conclusion: The prevalence of good self-care practice was low. In this study, good self-care practice was significantly associated with age, formal education, comorbidities, knowledge about hypertension, social support, and current khat chewing condition. Regular check-up and follow-up of patients' compliance with self-management protocol, and more emphasis should be given to identify factors that potentially impeding patients' adherence to hypertension self-management protocol.
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December 2020

Prevalent, uncontrolled, and undiagnosed diabetes mellitus among urban adults in Dire Dawa, Eastern Ethiopia: A population-based cross-sectional study.

SAGE Open Med 2020 20;8:2050312120975235. Epub 2020 Nov 20.

Department of Epidemiology and Biostatistics Unit, College of Health and Medical Sciences, School of Public Health, Haramaya University, Harar, Ethiopia.

Objective: Globally, 8.8% of adults were estimated to have diabetes mellitus, with the low-and middle-income countries sharing the largest burden. However, the research evidence for targeted interventions is lacking in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of diabetes mellitus, disaggregated by the epidemiology of diabetes mellitus morbidity and associated factors among adults in Dire Dawa town, Eastern Ethiopia.

Methods: Data from a total of 872 randomly sampled adults aged 25-64 years were obtained for analysis using the World Health Organization STEPwise approach to non-communicable disease risk factors surveillance instruments. We estimated the prevalence of diabetes mellitus disaggregated by the previous diabetes mellitus diagnosis status and by the current blood sugar level control status. The bivariable and multivariable binary logistic regression model was used to identify correlates of diabetes mellitus, along with STATA version 14.2 for data management and analysis. All statistical tests were declared significant at p-value < 0.05.

Results: 14.9% (95% confidence interval: 12.1, 17.4) of adults aged 25-64 years had diabetes mellitus in the study sample with 58.5% (95% confidence interval: 49.7, 66.7) on diabetes mellitus medication. Among adults currently taking diabetes mellitus medications, 30.3% (95% confidence interval: 19.8, 45.6) had uncontrolled diabetes mellitus. The magnitude of previously undiagnosed diabetes mellitus was 6.2% (95% confidence interval: 4.8, 8.0) in the study sample and 41.5% (95% confidence interval: 33.3, 50.3) among the diabetics. The odds of diabetes mellitus were higher among adults over the age of 55 years (adjusted odds ratio = 2.1, 95% confidence interval: 1.2, 3.6), currently married adults (adjusted odds ratio = 2.3, 95% confidence interval: 1.2, 4.4), and overweight adults (adjusted odds ratio = 1.6, 95% confidence interval: 1.1, 2.1). Adults with primary education (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) and no formal education (adjusted odds ratio = 0.5, 95% confidence interval: 0.2, 0.9) had lower odds of diabetes mellitus.

Conclusion: The prevalence of diabetes mellitus among adults was high in Dire Dawa, with a third of the diabetics having poor control of their blood sugar levels and, nearly four in ten were previously undiagnosed. Adults who were overweight, currently married, and those over 55 years need to be targeted for regular diabetes health checkups and community-based screening. Also, a mechanism should be instituted to track a patient's adherence to medications and promote diabetes self-care management.
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November 2020

Clustering of Elevated Blood Pressure, Elevated Blood Glucose, and Abdominal Obesity Among Adults in Dire Dawa: A Community-Based Cross-Sectional Study.

Diabetes Metab Syndr Obes 2020 16;13:2013-2024. Epub 2020 Jun 16.

Haramaya University, College of Health and Medical Sciences, School of Public Health, Department of Epidemiology and Biostatistics, Harar, Ethiopia.

Background: Evidence shows that the presence of a single component of the metabolic syndrome (MetS) increases the risk of developing the MetS later in life. This study estimated the prevalence and associated factors of abdominal obesity, elevated blood pressure, elevated blood glucose, and the 3-factor MetS components among urban adults in Dire Dawa, East Ethiopia.

Methods: Community-based cross-sectional data were collected from 872 adults aged 25-64 years. The joint interim statement (JIS) was used to define the MetS components. The dependent outcome variables were both the individual and the 3-factor MetS components. A robust variance Poisson regression model was used to directly estimate the prevalence ratio (PR) of risk factors.

Results: The prevalence of the 3-factor MetS components (abdominal obesity, elevated blood pressure, and elevated blood glucose) was 9.5% (95% CI: 7.7, 11.7). Women had two times higher prevalence of the 3-factor MetS components compared with men, 11.6% (95% CI: 9.2, 14.5) vs 5.2% (95% CI: 3.2, 8.5). A higher prevalence of abdominal obesity, 46.4% (95% CI: 43.1, 49.8), followed by a raised blood pressure, 42.7% (95% CI: 39.4, 46.0), was observed among study subjects. The presence of a single MetS component had an associated cluster of other components: 33.7% of subjects with elevated blood glucose, 22.3% with elevated blood pressure, and 20.5% with abdominal obesity had also the 3-factor MetS components. Age, sex, body mass index, waist circumference, and physical activity were significantly associated with the individual components or the 3-factor MetS components.

Conclusion: A higher prevalence of the individual components and the presence of clustering with a single factor identified call for the need of community screening. Interventions targeting both abdominal and general obesity through physical activity and lifestyle modification can contribute towards reducing cardiometabolic risk factors with due attention given to women and older adults.
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June 2020

Prevalence of lifetime substances use among students in Ethiopia: a systematic review and meta-analysis.

Syst Rev 2019 12 14;8(1):326. Epub 2019 Dec 14.

School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.

Background: The use of substances is a growing concern in Ethiopia, and their impacts on younger generation have been a concern of different professionals. Even though students are at high-risk of substance abuse, there is lack of comprehensive evidence for policy decision on substance use among students. Therefore, the aim of this systematic review and meta-analysis was to estimate the prevalence of common substances among students in Ethiopia.

Method: A comprehensive literature searches were done from biomedical databases: PubMed/Medline, African Journal Online, HINARI, Science Direct, and Google Scholar for article published until Dcember 31, 2017, and Addis Ababa Uiversity's electronic library search of unpublished thesis and dissertations. Two authors autonomously selected studies, extracted data, and evaluated quality of studies. The prevalence of lifetime substances use was estimated using the random effects model. Q and I statistics were computed to measure the extents of heterogeneity.

Results: A total 676 study articles were identified from electronic databases, and 28 of them were included in meta-analysis. The analysis revealed that the lifetime prevalence of any substance use was 52.5% (95% CI 42.4-62.4%), khat 24.7% (95% CI 21.8-27.7%), alcohol 46.2% (95% CI 40.3-52.2%), and smoking cigarette 14.7% (95% CI 11.3-18.5%). Significant heterogeneity was observed but there was no significant publication bias. The lifetime prevalence of khat, alcohol, and cigarette smoking among high school vs university students was 22.5% (95% CI 15.2-30.7%) vs 25.1% (95% CI 21.9-28.5%), 41.4% (95% CI 22.1-62.1%) vs 47.8% (95% CI 39.9-55.7%), and 21.5% (95% CI 12.6-32.1%) vs 12.9% (95% CI 10.1-16.0%), respectively.

Conclusion: This meta-analysis highlighted the extent of lifetime prevalence of any substance, khat, alcohol, and cigarettes smoking among students in Ethiopia. Significant percent of high school students have exposed to substances. Policy makers should devise and implement strictly binding regulation to curb widespread of substances around educational institution premises at national level. Priority should be given to intervention strategies that help delay first use of substance to prevent problems later in life. Besides, the problem warrants regular national-level educational institutions based studies focusing on the magnitude, trajectory, and consequences of substance use among students. Systematic review registration: PROSPERO CRD42018082635.
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December 2019

Level of physical activity among urban adults and the socio-demographic correlates: a population-based cross-sectional study using the global physical activity questionnaire.

BMC Public Health 2019 Aug 22;19(1):1160. Epub 2019 Aug 22.

Department of Environmental Health Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.

Background: Globally, in 2016, 23.3% of adult populations were physically inactive, and it accounts for 9% of the global premature mortality. However, evidence on the level of physical activity was limited in resource-poor settings. This study, therefore, assessed the adult's level of physical activity and its correlates among the urban population in Dire Dawa, eastern Ethiopia.

Methods: A total of 872 randomly selected adults of age 25-64 years in Dire Dawa city, eastern Ethiopia, are included in this analysis. The Global Physical Activity Questionnaire (GPAQ) is used to measure physical activity. Individuals are considered physically active when they achieved metabolic equivalent tasks (MET) minutes of 600 or more per week, and otherwise inactive. A binary logistic regression is used to identify the correlates of physical activity.

Results: 54.9% (95% confidence interval (CI) 51.6 to 58.2) of adults were physically active, with a higher proportion of men being physically active than women, 63.9% (95% CI 58.1 to 69.3) versus 50.6% (95% CI 46.5 to 54.6). Among the adults who reported doing physical activity, the highest domain-specific contribution to the total physical activity was from activities at workplaces, and leisure-time activities contributed the least. The proportion of adults who engaged in a high-level physical activity was 37.0% (95% CI 33.9 to 40.3). Male adults were 1.45 times (aOR (adjusted odds ratio) =1.45; 95% CI 1.05 to 1.99) more likely to achieve the recommended level of physical activity. In contrary, unemployed adults (aOR = 0.51; 95% CI 0.35 to 0.75) were less likely to perform the recommended level of physical activity to accrue health benefits.

Conclusion: Interventions aimed at promoting physical activity should target unemployed and female adults. We recommend further study to explore the contextual factors that hinder physical activity in the study setting.
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August 2019

Prevalence of Hypertension and Associated Factors in Dire Dawa City, Eastern Ethiopia: A Community-Based Cross-Sectional Study.

Int J Hypertens 2019 15;2019:9878437. Epub 2019 May 15.

Haramaya University, College of Health and Medical Science, School of Public Health, Harar, Ethiopia.

Background: Hypertension is a major cardiovascular risk factor that is linked with fatal complications and is an overwhelming global challenge. Primary prevention is a key to control hypertension with identification of major risk factors. This study was aimed at assessing the prevalence and factors associated with hypertension.

Methods: Community-based cross-sectional study was conducted among 903 adults aged 25 to 64 years in Dire Dawa City, East Ethiopia. Data were collected using World Health Organization (WHO) STEPwise approach to Surveillance (STEPS) for non-communicable disease (NCD) standard survey tool. Multivariate logistic regression models were used to identify relative effects of distal, proximal, and immediate risk factors of hypertension, and all statistical tests were declared significantly at -value<0.05.

Results: The average SBP and DBP were 124.98±17.18 mmHg and 78.92±10.13 mmHg, respectively. The prevalence of hypertension was 24.43% (95% CI: 21.57, 27.28). Majority (51.64%) of adults were not aware of their elevated blood pressure status. hypertension was significantly associated with the age group 30-44 (aOR 3.61, 95% CI: 2.0, 6.55), 45-54 (aOR 5.36, 95% CI: 2.62, 10.91), and 55-64 (aOR 9.38, 95% CI: 4.73, 18.59), being unemployed (aOR 1.68, 95%CI: 1.03, 2.77), ever smoking (aOR 1.89, 95% CI: 1.04, 2.23), having abdominal obesity (aOR 1.72, 95% CI: 1.13, 2.64), and BMI≥25 kg/m (aOR 1.48, 95%CI: 1.01, 2.15).

Conclusion: Moderately high prevalence of hypertension was observed among adults in study setting demonstrating a major public health problem. Majority of adults with hypertension in study setting were not aware of their elevated BP status highlighting the burden of the hidden morbidity and subsequent complications. Community level intervention and routine assessment of sociodemographic, behavioral, and biophysiological risk factors, screening, and diagnosis of NCDs should be institutionalized to address the occult burden.
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May 2019

Gender-based violence among female youths in educational institutions of Sub-Saharan Africa: a systematic review and meta-analysis.

Syst Rev 2019 02 25;8(1):59. Epub 2019 Feb 25.

Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.

Background: Gender-based violence is a public health issue. The prevalence of gender-based violence is high in Sub-Saharan Africa. Therefore, this study aims to produce an overall summary estimate on the prevalence of gender-based violence according to different types and its risk factors among female youths in educational institutions of Sub-Saharan Africa.

Methods: Studies published in English between 2000 and 2017 were identified by searching electronic databases such as MEDLINE, CINAHL, EMBASE, PsychINFO, and other relevant data bases. Three reviewers independently extracted the data and assessed the quality of studies using the Loney guidelines. The pooled prevalence of gender-based violence and type of GBV was computed using STATA software version 14, and between studies heterogeneity was tested using Cochran's Q test and I statistics. Meta-regression analyses were done to identify factors associated with GBV estimates.

Results: A total of 1377 articles were produced from different databases, and a final 24 articles were included in the review. The overall prevalence of gender-based violence ranged from 42.3% in Nigeria to 67.7% in Ethiopia. The lifetime prevalence of sexual violence ranged from 4.3 to 76.4%, physical violence ranged from 7.4 to 66.1%, and emotional violence prevalence ranged from 26.1 to 50.8%. The overall pooled prevalence of lifetime GBV (n = 7 studies) was 52.83% [95% CI 39.54-65.90%, I = 99.1, P < 0.00]. The pooled estimate of sexual violence (n = 23), 26.22% [95% CI 19.48-33.57%, I = 99.39, P < 0.00], physical violence (n = 9), 18.86% [95% CI 10.96-28.3%, I = 98.98, P < 0.00], and emotional violence (n = 5), 27.06% [95% CI19.57-35.28%], I = 97.1, P < 0.00]. The review showed that gender-based violence was significantly associated with place of residence, witnessing parental violence, substance abuse, marital status, and educational status.

Conclusions: The overall prevalence of overall gender-based violence, sexual, physical, and emotional violence was high in Sub-Saharan Africa. The lowest prevalence of GBV was observed in Nigeria, and it was highest in Ethiopia. However, the results should be interpreted with caution because of high between studies heterogeneity. Evidence from the review part revealed GBV was significantly associated with place of residence, witnessing parental violence, substance abuse, marital status, and educational status. The Sub-Saharan African countries should develop a comprehensive educational institution-based prevention strategy and effective interventions to mitigate gender-based violence and to specifically achieve the SDG.

Systematic Review Registration: PROSPERO CRD4201073260.
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February 2019

Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.

Nicholas Kassebaum Hmwe Hmwe Kyu Leo Zoeckler Helen Elizabeth Olsen Katie Thomas Christine Pinho Zulfiqar A Bhutta Lalit Dandona Alize Ferrari Tsegaye Tewelde Ghiwot Simon I Hay Yohannes Kinfu Xiaofeng Liang Alan Lopez Deborah Carvalho Malta Ali H Mokdad Mohsen Naghavi George C Patton Joshua Salomon Benn Sartorius Roman Topor-Madry Stein Emil Vollset Andrea Werdecker Harvey A Whiteford Kalkidan Hasen Abate Kaja Abbas Solomon Abrha Damtew Muktar Beshir Ahmed Nadia Akseer Rajaa Al-Raddadi Mulubirhan Assefa Alemayohu Khalid Altirkawi Amanuel Alemu Abajobir Azmeraw T Amare Carl A T Antonio Johan Arnlov Al Artaman Hamid Asayesh Euripide Frinel G Arthur Avokpaho Ashish Awasthi Beatriz Paulina Ayala Quintanilla Umar Bacha Balem Demtsu Betsu Aleksandra Barac Till Winfried Bärnighausen Estifanos Baye Neeraj Bedi Isabela M Bensenor Adugnaw Berhane Eduardo Bernabe Oscar Alberto Bernal Addisu Shunu Beyene Sibhatu Biadgilign Boris Bikbov Cheryl Anne Boyce Alexandra Brazinova Gessessew Bugssa Hailu Austin Carter Carlos A Castañeda-Orjuela Ferrán Catalá-López Fiona J Charlson Abdulaal A Chitheer Jee-Young Jasmine Choi Liliana G Ciobanu John Crump Rakhi Dandona Robert P Dellavalle Amare Deribew Gabrielle deVeber Daniel Dicker Eric L Ding Manisha Dubey Amanuel Yesuf Endries Holly E Erskine Emerito Jose Aquino Faraon Andre Faro Farshad Farzadfar Joao C Fernandes Daniel Obadare Fijabi Christina Fitzmaurice Thomas D Fleming Luisa Sorio Flor Kyle J Foreman Richard C Franklin Maya S Fraser Joseph J Frostad Nancy Fullman Gebremedhin Berhe Gebregergs Alemseged Aregay Gebru Johanna M Geleijnse Katherine B Gibney Mahari Gidey Yihdego Ibrahim Abdelmageem Mohamed Ginawi Melkamu Dedefo Gishu Tessema Assefa Gizachew Elizabeth Glaser Audra L Gold Ellen Goldberg Philimon Gona Atsushi Goto Harish Chander Gugnani Guohong Jiang Rajeev Gupta Fisaha Haile Tesfay Graeme J Hankey Rasmus Havmoeller Martha Hijar Masako Horino H Dean Hosgood Guoqing Hu Kathryn H Jacobsen Mihajlo B Jakovljevic Sudha P Jayaraman Vivekanand Jha Tariku Jibat Catherine O Johnson Jost Jonas Amir Kasaeian Norito Kawakami Peter N Keiyoro Ibrahim Khalil Young-Ho Khang Jagdish Khubchandani Aliasghar A Ahmad Kiadaliri Christian Kieling Daniel Kim Niranjan Kissoon Luke D Knibbs Ai Koyanagi Kristopher J Krohn Barthelemy Kuate Defo Burcu Kucuk Bicer Rachel Kulikoff G Anil Kumar Dharmesh Kumar Lal Hilton Y Lam Heidi J Larson Anders Larsson Dennis Odai Laryea Janni Leung Stephen S Lim Loon-Tzian Lo Warren D Lo Katharine J Looker Paulo A Lotufo Hassan Magdy Abd El Razek Reza Malekzadeh Desalegn Markos Shifti Mohsen Mazidi Peter A Meaney Kidanu Gebremariam Meles Peter Memiah Walter Mendoza Mubarek Abera Mengistie Gebremichael Welday Mengistu George A Mensah Ted R Miller Charles Mock Alireza Mohammadi Shafiu Mohammed Lorenzo Monasta Ulrich Mueller Chie Nagata Aliya Naheed Grant Nguyen Quyen Le Nguyen Elaine Nsoesie In-Hwan Oh Anselm Okoro Jacob Olusegun Olusanya Bolajoko O Olusanya Alberto Ortiz Deepak Paudel David M Pereira Norberto Perico Max Petzold Michael Robert Phillips Guilherme V Polanczyk Farshad Pourmalek Mostafa Qorbani Anwar Rafay Vafa Rahimi-Movaghar Mahfuzar Rahman Rajesh Kumar Rai Usha Ram Zane Rankin Giuseppe Remuzzi Andre M N Renzaho Hirbo Shore Roba David Rojas-Rueda Luca Ronfani Rajesh Sagar Juan Ramon Sanabria Muktar Sano Kedir Mohammed Itamar S Santos Maheswar Satpathy Monika Sawhney Ben Schöttker David C Schwebel James G Scott Sadaf G Sepanlou Amira Shaheen Masood Ali Shaikh June She Rahman Shiri Ivy Shiue Inga Dora Sigfusdottir Jasvinder Singh Naris Silpakit Alison Smith Chandrashekhar Sreeramareddy Jeffrey D Stanaway Dan J Stein Caitlyn Steiner Muawiyyah Babale Sufiyan Soumya Swaminathan Rafael Tabarés-Seisdedos Karen M Tabb Fentaw Tadese Mohammad Tavakkoli Bineyam Taye Stephanie Teeple Teketo Kassaw Tegegne Girma Temam Shifa Abdullah Sulieman Terkawi Bernadette Thomas Alan J Thomson Ruoyan Tobe-Gai Marcello Tonelli Bach Xuan Tran Christopher Troeger Kingsley N Ukwaja Olalekan Uthman Tommi Vasankari Narayanaswamy Venketasubramanian Vasiliy Victorovich Vlassov Elisabete Weiderpass Robert Weintraub Solomon Weldemariam Gebrehiwot Ronny Westerman Hywel C Williams Charles D A Wolfe Rachel Woodbrook Yuichiro Yano Naohiro Yonemoto Seok-Jun Yoon Mustafa Z Younis Chuanhua Yu Maysaa El Sayed Zaki Elias Asfaw Zegeye Liesl Joanna Zuhlke Christopher J L Murray Theo Vos

JAMA Pediatr 2017 06;171(6):573-592

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions And Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.
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June 2017