Summary Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast,...

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths.

Background: Neonatal mortality is a concern for global population especially in developing countries. The majority of neonatal mortality occurs at home where only few families recognize key danger signs of neonatal illness. Thus, we assessed the knowledge on neonatal danger signs of illness and associated factors among mothers who gave birth in the last one year prior to this study in Debre Markos town, East Gojjam, northwest Ethiopia. Methods: A community-based, cross-sectional study was conducted among 521 mothers. Cluster sampling technique was used to select the study participants and interviewed using structured and pre-tested questionnaire. Data were entered to Epi Info and exported to SPSS for analysis. Variables in binary logistic regression with a P value <0.2 were fitted to multivariable logistic regression. Significant variables were declared at 95% CI and a P value <0.05. Results: A total 473 participants were interviewed by making a response of 91.0%. The proportion of knowledgeable mothers was found to be 26.2% (95% CI 22.2, 30.4). Mother’s secondary and tertiary education(AOR=3.64, 95% CI 1.14, 11.61 and AOR=3.80, 95% CI 1.25, 11.56), husband’s secondary and tertiary education(AOR=4.22, 95% CI 1.53, 11.60 and AOR=4.34, 95% CI 1.52, 12.37) respectively, antenatal care attendance(AOR = 3.54, 95% CI 1.62, 7.75), postnatal care attendance(AOR = 2.41, 95% CI 1.13, 5.14), getting prepared for birth(AOR =2.43, 95% CI 1.20, 4.89) and access for television(AOR = 2.06, 95% CI 1.01, 4.21) were found to be positively associated with being knowledgeable on neonatal danger signs. Conclusion: Mothers’ knowledge on neonatal danger signs was low. The finding showed that, intervention modalities to increase parental education, both antenatal and postnatal care attendance, mothers’ preparedness for birth and advocating the use of television might be helpful to improve mothers’ knowledge on neonatal danger signs. Key words: Neonatal Danger Signs, Mothers’ Knowledge, East Gojjam, Ethiopia

Background Maternal deaths due to unsafe abortion have increased steadily in sub- Saharan Africa. In Ethiopia, 25% of the pregnancy is unintended pregnancy. This contributes from 6–9% maternal deaths from unsafe abortion .Previously, many fragmented cross-sectional studies were conducted but there is no cumulative evidence on health care providers’ attitude and associated factors to safe abortion in Ethiopia. This study aimed to measure pooled health care Providers’ attitude and determinants of safe abortion in EthiopiaMethods In this review the databases used were Google Scholar, Medline/PubMed, EMBASE, Science Direct, HINARI and African Journals Online. The quality of articles that met the inclusion criteria was assessed. The studies were critically appraised by using the Joanna Briggs Critical Appraisal tools and the preferred reporting item for systematic review was used for quality assessment. Data were extracted in an excel spreadsheet and imported to STATA version 17 software for meta-analysis. The random- effect model was used to pooled the health care Providers’ attitude to safe abortion. The I2 statistics were used to test heterogeneity and Egger’s tests were used to assess publication bias. Forest plot were used to present the odds ratio (OR) with a 95% confidence interval (CI).Results A total of eight studies with a total sample size of 2,826 were included for this review and meta-analysis. The overall pooled health care providers’ favorable attitude towards safe abortion in Ethiopia was 65.49% (95%CI; 49.64, 81.34; I2 = 99.20%, P = 0.000). Familiarize with abortion law, OR = 2.25 (95% CI: 1.06, 3.43), being male provider, OR = 1.89 (95% CI: 1.23, 2.54), taking training on abortion, OR = 2.91 (95% CI: 1.17, 4.65), being midwives profession, OR = 3.029 (95% CI: 1.605, 4.453) and practicing abortion procedure, OR = 2.55 (95% CI: 1.32, 3.78) were positively associated with providers’ favorable attitude to safe abortion.Conclusion Health care provider who trained on abortion service and who were familiarized with abortion law were more likely to have favorable attitude to safe abortion services in Ethiopia. Therefore, all health institutions and other stakeholders should facilitate training on safe abortion services and enable providers familiarize with abortion law in Ethiopia.