Deribew A, Kebede B, Tessema G A, Adama Y A, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Desalegn B, Abajobir A A, Shafi O, Abera S F, Negussu N, Mengistu B, Amare A T, Mulugeta A, Kebede Z, Mengistu B, Tadesse Z, Sileshi M, Tamiru M, Chromwel E A, Glenn S D, Stanaway J D, Deribe K
St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
Dilla University, Dilla, Ethiopia.
Ethiop Med J. 2017;55(Suppl 1):3-14.
Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years.
We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD).
All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years.
Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.
被忽视的热带病（NTDs）是埃塞俄比亚重要的公共卫生问题。2013年，联邦卫生部（FMOH）启动了一项国家NTD总体计划，目标是到2020年消除具有公共卫生重要性的主要NTDs。对该国NTDs的当前状况进行基准评估，对于监测和评估干预措施的实施进展及其影响至关重要。因此，本研究旨在评估过去25年中优先NTDs的死亡率和伤残调整生命年（DALY）趋势。
本研究使用了《2015年全球疾病负担（GBD）》的估计数据。用于死因和DALY估计的《2015年全球疾病负担》数据源包括口头尸检（VA）、人口与健康调查（DHS）以及其他特定疾病调查、提交给联合国（UN）机构的卫生部报告和已发表的科学文章。使用死因汇总建模（CODEm）和/或自然史模型来估计NTDs死亡率。DALY被估计为过早死亡导致的生命年损失（YLL）和残疾生存年（YLD）之和。
1990年，所有NTDs估计导致6293例死亡（95%不确定区间（UI）：3699 - 10080），2015年为3593例死亡（95% UI：2051 - 6178），25年间下降了43%。1990年至2015年期间，血吸虫病、土壤传播的蠕虫感染（STH）和利什曼病的年龄标准化死亡率分别下降了91.3%、73.5%和21.6%。所有NTDs导致的DALY数量从1990年的81.44万（95% UI：54.8万 - 120万）下降到2015年的57.95万（95% UI：30.94万 - 130万）。所有NTDs的年龄标准化DALY率下降了30.7%，从1990年的每1000人17.6例（95% UI：12.5 - 26.5）降至2015年的每1000人12.2例（95% UI：6.5 - 27.4）。沙眼的年龄标准化DALY率从1990年的每10万人92.7例（95% UI：63.2 - 128.4）降至2015年的每10万人41.2例（95% UI：27.4 - 59.2），1990年至2015年期间下降了55.6%。1990年至2015年期间，盘尾丝虫病、血吸虫病和淋巴丝虫病的年龄标准化DALY率分别下降了66.2%、29.4%和12.5%。蛔虫病的DALY率在过去25年中下降了56.8%。
在过去25年中，埃塞俄比亚在降低大多数NTDs的DALY率方面取得了显著进展。快速扩大的干预措施规模和更广泛的系统加强可能对实现2020年消除大多数NTDs的目标产生持久影响。埃塞俄比亚应通过与其他卫生项目和部门以及社区参与进行适当协调，加强NTD综合干预措施的覆盖范围，以在2020年消除NTDs。
