Browsing by Subject "AFRICA"

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  • Teppo, Annika (2013)
  • Khattab, Ayman; Jylha, Kaisa; Hakala, Tomi; Aalto, Mikko; Malima, Robert; Kisinza, William; Honkala, Markku; Nousiainen, Pertti; Meri, Seppo (2017)
    Background: Mosquitoes are vectors for many diseases such as malaria. Insecticide-treated bed nets and indoor residual spraying of insecticides are the principal malaria vector control tools used to prevent malaria in the tropics. Other interventions aim at reducing man-vector contact. For example, house screening provides additive or synergistic effects to other implemented measures. We used commercial screen materials made of polyester, polyethylene or polypropylene to design novel mosquito screens that provide remarkable additional benefits to those commonly used in house screening. The novel design is based on a double screen setup made of a screen with 3D geometric structures parallel to a commercial mosquito screen creating a trap between the two screens. Owing to the design of the 3D screen, mosquitoes can penetrate the 3D screen from one side but cannot return through the other side, making it a unidirectional mosquito screen. Therefore, the mosquitoes are trapped inside the double screen system. The permissiveness of both sides of the 3D screens for mosquitoes to pass through was tested in a wind tunnel using the insectary strain of Anopheles stephensi. Results: Among twenty- five tested 3D screen designs, three designs from the cone, prism, or cylinder design groups were the most efficient in acting as unidirectional mosquito screens. The three cone-,prism-, and cylinder-based screens allowed, on average, 92, 75 and 64% of Anopheles stephensi mosquitoes released into the wind tunnel to penetrate the permissive side and 0, 0 and 6% of mosquitoes to escape through the non-permissive side, respectively. Conclusions: A cone- based 3D screen fulfilled the study objective. It allowed capturing 92% of mosquitoes within the double screen setup inside the wind tunnel and blocked 100% from escaping. Thus, the cone- based screen effectively acted as a unidirectional mosquito screen. This 3D screen-based trap design could therefore be used in house screening as a means of avoiding infective bites and reducing mosquito population size.
  • Kort, Remco; Westerik, Nieke; Serrano, L. Mariela; Douillard, Francois P.; Gottstein, Willi; Mukisa, Ivan M.; Tuijn, Coosje J.; Basten, Lisa; Hafkamp, Bert; Meijer, Wilco C.; Teusink, Bas; de Vos, Willem M.; Reid, Gregor; Sybesma, Wilbert (2015)
    Background: The lactic acid bacterium Lactobacillus rhamnosus GG is the most studied probiotic bacterium with proven health benefits upon oral intake, including the alleviation of diarrhea. The mission of the Yoba for Life foundation is to provide impoverished communities in Africa increased access to Lactobacillus rhamnosus GG under the name Lactobacillus rhamnosus yoba 2012, world's first generic probiotic strain. We have been able to overcome the strain's limitations to grow in food matrices like milk, by formulating a dried starter consortium with Streptococcus thermophilus that enables the propagation of both strains in milk and other food matrices. The affordable seed culture is used by people in resource-poor communities. Results: We used S. thermophilus C106 as an adjuvant culture for the propagation of L. rhamnosus yoba 2012 in a variety of fermented foods up to concentrations, because of its endogenous proteolytic activity, ability to degrade lactose and other synergistic effects. Subsequently, L. rhamnosus could reach final titers of 1E+09 CFU ml(-1), which is sufficient to comply with the recommended daily dose for probiotics. The specific metabolic interactions between the two strains were derived from the full genome sequences of L. rhamnosus GG and S. thermophilus C106. The piliation of the L. rhamnosus yoba 2012, required for epithelial adhesion and inflammatory signaling in the human host, was stable during growth in milk for two rounds of fermentation. Sachets prepared with the two strains, yoba 2012 and C106, retained viability for at least 2 years. Conclusions: A stable dried seed culture has been developed which facilitates local and low-cost production of a wide range of fermented foods that subsequently act as delivery vehicles for beneficial bacteria to communities in east Africa.
  • Ahlberg, Sara; Grace, Delia; Kiarie, Gideon; Kirino, Yumi; Lindahl, Johanna (2018)
    Aflatoxin M1 (AFM1), a human carcinogen, is found in milk products and may have potentially severe health impacts on milk consumers. We assessed the risk of cancer and stunting as a result of AFM1 consumption in Nairobi, Kenya, using worst case assumptions of toxicity and data from previous studies. Almost all (99.5%) milk was contaminated with AFM1. Cancer risk caused by AFM1 was lower among consumers purchasing from formal markets (0.003 cases per 100,000) than for low-income consumers (0.006 cases per 100,000) purchasing from informal markets. Overall cancer risk (0.004 cases per 100,000) from AFM1 alone was low. Stunting is multifactorial, but assuming only AFM1 consumption was the determinant, consumption of milk contaminated with AFM1 levels found in this study could contribute to 2.1% of children below three years in middle-income families, and 2.4% in low-income families, being stunted. Overall, 2.7% of children could hypothetically be stunted due to AFM1 exposure from milk. Based on our results AFM1 levels found in milk could contribute to an average of −0.340 height for age z-score reduction in growth. The exposure to AFM1 from milk is 46 ng/day on average, but children bear higher exposure of 3.5 ng/kg bodyweight (bw)/day compared to adults, at 0.8 ng/kg bw/day. Our paper shows that concern over aflatoxins in milk in Nairobi is disproportionate if only risk of cancer is considered, but that the effect on stunting children might be much more significant from a public health perspective; however, there is still insufficient data on the health effects of AFM1.
  • Strganac, Christopher; Salminen, Johanna; Jacobs, Louis L.; Polcyn, Michael J.; Ferguson, Kurt M.; Mateus, Octavio; Schulp, Anne S.; Morais, Maria Luisa; Tavares, Tatiana da Silva; Goncalves, Antonio Olimpio (2014)
  • Craig, Christie; Thomson, Robert; Santangeli, Andrea (2018)
    Ecosystem services are cited as one of the many reasons for conserving declining vulture populations in Africa. We aimed to explore how communal farmers in Namibia perceive vultures and the ecosystem services they provide, with special focus on cultural and regulating ecosystem services. We surveyed 361 households across Namibia’s communal farmlands and found that over two-thirds of households liked vultures and found them useful, stating that they were harmless and useful for locating dead livestock. The minority of households who disliked vultures believed that they were killing their livestock. Poisoning was the main cause of vulture mortalities reported by farmers. While poisoning appears to be a concern for vultures in the communal farmlands, it appears that cultural use of vulture body parts is a minimal threat. We found that few farmers knew of cultural beliefs about vultures or uses for body parts; most farmers believed these beliefs and practices to be outdated. It is further promising that communal farmers have an overall positive perception of vultures. This highlights the potential for communal conservancies to bring attention to vulture conservation in their constituencies.
  • Gagliardone, Iginio; Diepeveen, Stephanie; Findlay, Kyle; Olaniran, Samuel; Pohjonen, Matti; Tallam, Edwin (2021)
    This article presents new empirical insights into what people do with conspiracy theories during crises. By suppressing the impulse to distinguish between truth and falsehood, which has characterized most scholarship on the COVID-19 "infodemic," and engaging with claims surrounding two popular COVID-19 conspiracies-on 5G and on Bill Gates-in South Africa and Nigeria, we illustrate how conspiracies morph as they interact with different socio-political contexts. Drawing on a mixed-method analysis of more than 6 million tweets, we examine how, in each country, conspiracies have uniquely intersected with longer-term discourses and political projects. In Nigeria, the two conspiracies were both seized as opportunities to extend criticism to the ruling party. In South Africa, they produced distinctive responses: while the 5G conspiracy had limited buy-in, the Gates conspiracy resonated with deep-rooted resentment toward the West, corporate interests, and what is seen as a paternalistic attitude of some external actors toward Africa. These findings stress the importance of taking conspiracy theories seriously, rather than dismissing them simply as negative externalities of digital ecosystems. Situating conspiracies in specific dynamics of trust and mistrust can make an important difference when designing responses that are not limited to broadcasting truthful information, but can also enable interventions that account for deeply rooted sentiments of suspicion toward specific issues and actors, which can vary significantly across communities.
  • Scott, Ashley; Reinhold, Sabine; Hermes, Taylor; Kalmykov, Alexey A.; Belinskiy, Andrey; Buzhilova, Alexandra; Berezina, Natalia; Kantorovich, Anatoliy R.; Maslov, Vladimir E.; Guliyev, Farhad; Lyonnet, Bertille; Gasimov, Parviz; Jalilov, Bakhtiyar; Eminli, Jeyhun; Iskandarov, Emil; Hammer, Emily; Nugent, Selin E.; Hagan, Richard; Majander, Kerttu; Onkamo, Päivi; Nordqvist, Kerkko; Shishlina, Natalia; Kaverzneva, Elena; Korolev, Arkadiy I.; Khokhlov, Aleksandr A.; Smolyaninov, Roman V.; Sharapova, Svetlana V.; Krause, Rudiger; Karapetian, Marina; Stolarczyk, Eliza; Krause, Johannes; Hansen, Svend; Haak, Wolfgang; Warinner, Christina (2022)
    Archaeological and archaeogenetic evidence points to the Pontic-Caspian steppe zone between the Caucasus and the Black Sea as the crucible from which the earliest steppe pastoralist societies arose and spread, ultimately influencing populations from Europe to Inner Asia. However, little is known about their economic foundations and the factors that may have contributed to their extensive mobility. Here, we investigate dietary proteins within the dental calculus proteomes of 45 individuals spanning the Neolithic to Greco-Roman periods in the Pontic-Caspian Steppe and neighbouring South Caucasus, Oka-Volga-Don and East Urals regions. We find that sheep dairying accompanies the earliest forms of Eneolithic pastoralism in the North Caucasus. During the fourth millennium Bc, Maykop and early Yamnaya populations also focused dairying exclusively on sheep while reserving cattle for traction and other purposes. We observe a breakdown in livestock specialization and an economic diversification of dairy herds coinciding with aridification during the subsequent late Yamnaya and North Caucasus Culture phases, followed by severe climate deterioration during the Catacomb and Lola periods. The need for additional pastures to support these herds may have driven the heightened mobility of the Middle and Late Bronze Age periods. Following a hiatus of more than 500 years, the North Caucasian steppe was repopulated by Early Iron Age societies with a broad mobile dairy economy, including a new focus on horse milking.
  • Rimhanen, Karoliina; Ketoja, Elise; Yli-Halla, Markku; Kahiluoto, Helena (2016)
    More than half of the cultivation-induced carbon loss from agricultural soils could be restored through improved management. To incentivise carbon sequestration, the potential of improved practices needs to be verified. To date, there is sparse empirical evidence of carbon sequestration through improved practices in East-Africa. Here, we show that agroforestry and restrained grazing had a greater stock of soil carbon than their bordering pair-matched controls, but the difference was less obvious with terracing. The controls were treeless cultivated fields for agroforestry, on slopes not terraced for terracing, and permanent pasture for restrained grazing, representing traditionally managed agricultural practices dominant in the case regions. The gain by the improved management depended on the carbon stocks in the control plots. Agroforestry for 6-20 years led to 11.4 Mg ha(-1) and restrained grazing for 6-17 years to 9.6 Mg ha(-1) greater median soil carbon stock compared with the traditional management. The empirical estimates are higher than previous process-model-based estimates and indicate that Ethiopian agriculture has greater potential to sequester carbon in soil than previously estimated.
  • Dieleman, Joseph; Campbell, Madeline; Chapin, Abigail; Eldrenkamp, Erika; Fan, Victoria Y.; Haakenstad, Annie; Kates, Jennifer; Liu, Yingying; Matyasz, Taylor; Micah, Angela; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Sorensen, Reed; Evans, Tim; Evans, David; Kurowski, Christoph; Tandon, Ajay; Abbas, Kaja M.; Abera, Semaw Ferede; Kiadaliri, Aliasghar Ahmad; Ahmed, Kedir Yimam; Ahmed, Muktar Beshir; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, Ala'a; Amini, Erfan; Ammar, Walid; Amrock, Stephen Marc; Antonio, Carl Abelardo T.; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Barac, Aleksandra; Alberto Bernal, Oscar; Beyene, Addisu Shunu; Beyene, Tariku Jibat; Birungi, Charles; Bizuayehu, Habtamu Mellie; Breitborde, Nicholas J. K.; Cahuana-Hurtado, Lucero; Estanislao Castro, Ruben; Catalia-Lopez, Ferran; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; de Jager, Pieter; Dharmaratne, Samath D.; Dubey, Manisha; Meretoja, Atte; Global Burden Dis Hlth Financing (2017)
    Background An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.
  • Mattlin, Mikael; Wigell, Mikael (2016)
    Geoeconomic power and its use appear to be a crucial, albeit understudied aspect of today's international relations. Traditionally, international power has been thought of in geopolitical rather than geoeconomic terms. Indeed, ever since the famous debate about sea power and land power between Alfred Thayer Mahan and Halford MacKinder at the cusp of the twentieth century, scholars have linked geography with the pursuit of political and military power. However, the term "geoeconomics" is of a more recent origin, and also more vexing than geopolitics. The term is commonly associated with Edward Luttwak's writings in the early 1990s Luttwak (Natl Interes 20:17-24, 1990, Int Econ 7/5:18-67, 1993), although it did not spin a major scholarly discussion at the time. For Luttwak, geoeconomics denoted the successor system of interstate rivalry that emerged in the aftermath of Cold War geopolitics. As a consequence of the rise of major new economic powers, such as China, India and Brazil, there is renewed interest in the concept. Yet, an overview of the literature indicates that there seems to be no agreement on what exactly the term means. This special issue tackles the different ways in which the term geoeconomics is used, in the context of the policies pursued by major regional powers (e.g. China, Russia and Germany). How are we to understand the actions of these regional powers in contexts where economic interests, political power and geography intersect? In the introductory article, we overview the literature and summarise the main arguments of the individual papers.
  • Naghavi, Mohsen; Abajobir, Amanuel Alemu; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Aboyans, Victor; Adetokunboh, Olatunji; Arnlov, Johan; Afshin, Ashkan; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ahmadi, Alireza; Ahmed, Muktar Beshir; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Aiyar, Sneha; Al-Eyadhy, Ayman; Alahdab, Fares; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore; Alam, Tahiya; Alene, Kefyalew Addis; Ali, Syed Danish; Alizadeh-Navaei, Reza; Alkaabi, Juma M.; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Allen, Christine; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Amini, Erfan; Ammar, Walid; Amoako, Yaw Ampem; Anber, Nahla; Andersen, Hjalte H.; Andrei, Catalina Liliana; Androudi, Sofia; Ansari, Hossein; Kivimaki, Mika; Lallukka, Tea; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete; GBD 2016 Causes Death Collaborato (2017)
    Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72.3% (95% uncertainty interval [UI] 71.2-73.2) of deaths in 2016 with 19.3% (18.5-20.4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8.43% (8.00-8.67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1.80 million deaths (95% UI 1.59 million to 1.89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2.89%); the median annualised rate of change for all other causes was lower (a decrease of 1.59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  • Hay, Simon I.; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abdulle, Abdishakur M.; Abebo, Teshome Abuka; Abera, Semaw Ferede; Aboyans, Victor; Abu-Raddad, Laith J.; Ackerman, Ilana N.; Adedeji, Isaac A.; Adetokunboh, Olatunji; Afshin, Ashkan; Aggarwal, Rakesh; Agrawal, Sutapa; Agrawal, Anurag; Kiadaliri, Aliasghar Ahmad; Ahmed, Muktar Beshir; Aichour, Amani Nidhal; Aichour, Ibtihel; Aichour, Miloud Taki Eddine; Aiyar, Sneha; Akinyemiju, Tomi F.; Akseer, Nadia; Al Lami, Faris Hasan; Alahdab, Fares; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore; Alam, Tahiya; Alasfoor, Deena; Alene, Kefyalew Addis; Ali, Raghib; Alizadeh-Navaei, Reza; Alkaabi, Juma M.; Alkerwi, Ala'a; Alla, Francois; Allebeck, Peter; Allen, Christine; Al-Maskari, Fatma; AlMazroa, Mohammad AbdulAziz; Al-Raddadi, Rajaa; Alsharif, Ubai; Kivimaki, Mika; Lallukka, Tea; Meretoja, Atte; Meretoja, Tuomo J.; Weiderpass, Elisabete; GBD 2016 DALYs HALE Collaborators (2017)
    Background Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). Methods We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. Findings The highest globally observed HALE at birth for both women and men was in Singapore, at 75.2 years (95% uncertainty interval 71.9-78.6) for females and 72.0 years (68.8-75.1) for males. The lowest for females was in the Central African Republic (45.6 years [42.0-49.5]) and for males was in Lesotho (41.5 years [39.0-44.0]). From 1990 to 2016, global HALE increased by an average of 6.24 years (5.97-6.48) for both sexes combined. Global HALE increased by 6.04 years (5.74-6.27) for males and 6.49 years (6.08-6.77) for females, whereas HALE at age 65 years increased by 1.78 years (1.61-1.93) for males and 1.96 years (1.69-2.13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2.3% [-5.9 to 0.9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16.1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. Interpretation At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
  • Junqueira, André Braga; Fernandez-Llamazares Onrubia, Alvaro; Torrents-Ticó, Miquel; Haira, Paul Lokono; Nasak, Job Guol; Burgas, Daniel; Fraixedas, Sara; Cabeza, Mar; Reyes-García, Victoria (2021)
    The fast and widespread environmental changes that have intensified in the last decades are bringing disproportionate impacts to Indigenous Peoples and Local Communities. Changes that affect water resources are particularly relevant for subsistence-based peoples, many of whom already suffer from constraints regarding reliable access to safe water. Particularly in areas where water is scarce, climate change is expected to amplify existing stresses in water availability, which are also exacerbated by multiple socioeconomic drivers. In this paper, we look into the local perceptions of environmental change expressed by the Daasanach people of northern Kenya, where the impacts of climate change overlap with those brought by large infrastructure projects recently established in the Omo River. We show that the Daasanach have rich and detailed understanding of changes in their environment, especially in relation to water resources. Daasanach understand observations of change in different elements of the social-ecological system as an outcome of complex interactions between climatic and non-climatic drivers of change. Our findings highlight the perceived synergistic effects of climate change and infrastructure projects in water resources, driving multiple and cascading impacts on biophysical elements and local livelihoods. Our results also demonstrate the potential of Local Ecological Knowledge in enhancing the understanding of complex social-ecological issues, such as the impacts of environmental change in local communities. To minimize and mitigate the social-ecological impacts of development projects, it is essential to consider potential synergies between climatic and socioeconomic factors and to ensure inclusive governance rooted in local understandings of environmental change.
  • Lokki, A. Inkeri; Jarvela, Irma; Israelsson, Elisabeth; Maiga, Bakary; Troye-Blomberg, Marita; Dolo, Amagana; Doumbo, Ogobara K.; Meri, Seppo; Holmberg, Ville (2011)
    Background: Fulani are a widely spread African ethnic group characterized by lower susceptibility to Plasmodium falciparum, clinical malaria morbidity and higher rate of lactase persistence compared to sympatric tribes. Lactase non-persistence, often called lactose intolerance, is the normal condition where lactase activity in the intestinal wall declines after weaning. Lactase persistence, common in Europe, and in certain African people with traditions of raising cattle, is caused by polymorphisms in the enhancer region approximately 14 kb upstream of the lactase gene. Methods: To evaluate the relationship between malaria and lactase persistence genotypes, a 400 bp region surrounding the main European C/T(-13910) polymorphism upstream of the lactase gene was sequenced. DNA samples used in the study originated from 162 Fulani and 79 Dogon individuals from Mali. Results: Among 79 Dogon only one heterozygote of the lactase enhancer polymorphism was detected, whereas all others were homozygous for the ancestral C allele. Among the Fulani, the main European polymorphism at locus C/T(-13910) was by far the most common polymorphism, with an allele frequency of 37%. Three other single-nucleotide polymorphisms were found with allele frequencies of 3.7%, 1.9% and 0.6% each. The novel DNA polymorphism T/C(-13906) was seen in six heterozygous Fulani. Among the Fulani with lactase non-persistence CC genotypes at the C/T(-13910) locus, 24% had malaria parasites detectable by microscopy compared to 18% for lactase persistent genotypes (P = 0.29). Pooling the lactase enhancer polymorphisms to a common presumptive genotype gave 28% microscopy positives for non-persistent and 17% for others (P = 0.11). Conclusions: Plasmodium falciparum parasitaemia in asymptomatic Fulani is more common in individuals with lactase non-persistence genotypes, but this difference is not statistically significant. The potential immunoprotective properties of dietary cow milk as a reason for the partial malaria resistance of Fulani warrant further investigation.
  • Burstein, Roy; Henry, Nathaniel J.; Collison, Michael L.; Marczak, Laurie B.; Sligar, Amber; Watson, Stefanie; Marquez, Neal; Abbasalizad-Farhangi, Mahdieh; Abbasi, Masoumeh; Abd-Allah, Foad; Abdoli, Amir; Abdollahi, Mohammad; Abdollahpour, Ibrahim; Abdulkader, Rizwan Suliankatchi; Abrigo, Michael R. M.; Acharya, Dilaram; Adebayo, Oladimeji M.; Adekanmbi, Victor; Adham, Davoud; Afshari, Mahdi; Aghaali, Mohammad; Ahmadi, Keivan; Ahmadi, Mehdi; Ahmadpour, Ehsan; Ahmed, Rushdia; Akal, Chalachew Genet; Akinyemi, Joshua O.; Alahdab, Fares; Alam, Noore; Alamene, Genet Melak; Alene, Kefyalew Addis; Alijanzadeh, Mehran; Alinia, Cyrus; Alipour, Vahid; Aljunid, Syed Mohamed; Almalki, Mohammed J.; Al-Mekhlafi, Hesham M.; Altirkawi, Khalid; Alvis-Guzman, Nelson; Amegah, Adeladza Kofi; Amini, Saeed; Amit, Arianna Maever Loreche; Anbari, Zohreh; Androudi, Sofia; Anjomshoa, Mina; Ansari, Fereshteh; Antonio, Carl Abelardo T.; Arabloo, Jalal; Arefi, Zohreh; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Artaman, Al; Asadi, Anvar; Asadi-Aliabadi, Mehran; Ashraf-Ganjouei, Amir; Assadi, Reza; Ataeinia, Bahar; Atre, Sachin R.; Quintanilla, Beatriz Paulina Ayala; Ayanore, Martin Amogre; Azari, Samad; Babaee, Ebrahim; Babazadeh, Arefeh; Badawi, Alaa; Bagheri, Soghra; Bagherzadeh, Mojtaba; Baheiraei, Nafiseh; Balouchi, Abbas; Barac, Aleksandra; Bassat, Quique; Baune, Bernhard T.; Bayati, Mohsen; Bedi, Neeraj; Beghi, Ettore; Behzadifar, Masoud; Behzadifar, Meysam; Belay, Yared Belete; Bell, Brent; Bell, Michelle L.; Berbada, Dessalegn Ajema; Bernstein, Robert S.; Bhattacharjee, Natalia V.; Bhattarai, Suraj; Bhutta, Zulfiqar A.; Bijani, Ali; Bohlouli, Somayeh; Breitborde, Nicholas J. K.; Britton, Gabrielle; Browne, Annie J.; Nagaraja, Sharath Burugina; Busse, Reinhard; Butt, Zahid A.; Car, Josip; Cardenas, Rosario; Castaneda-Orjuela, Carlos A.; Cerin, Ester; Chanie, Wagaye Fentahun; Chatterjee, Pranab; Chu, Dinh-Toi; Cooper, Cyrus; Costa, Vera M.; Dalal, Koustuv; Dandona, Lalit; Dandona, Rakhi; Daoud, Farah; Daryani, Ahmad; Das Gupta, Rajat; Davis, Ian; Weaver, Nicole Davis; Davitoiu, Dragos Virgil; De Neve, Jan-Walter; Demeke, Feleke Mekonnen; Demoz, Gebre Teklemariam; Deribe, Kebede; Desai, Rupak; Deshpande, Aniruddha; Desyibelew, Hanna Demelash; Dey, Sagnik; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Diaz, Daniel; Doshmangir, Leila; Duraes, Andre R.; Dwyer-Lindgren, Laura; Earl, Lucas; Ebrahimi, Roya; Ebrahimpour, Soheil; Effiong, Andem; Eftekhari, Aziz; Ehsani-Chimeh, Elham; El Sayed, Iman; Zaki, Maysaa El Sayed; El Tantawi, Maha; El-Khatib, Ziad; Emamian, Mohammad Hassan; Enany, Shymaa; Eskandarieh, Sharareh; Eyawo, Oghenowede; Ezalarab, Maha; Faramarzi, Mahbobeh; Fareed, Mohammad; Faridnia, Roghiyeh; Faro, Andre; Fazaeli, Ali Akbar; Fazlzadeh, Mehdi; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Joao C.; Filip, Irina; Fischer, Florian; Foigt, Nataliya A.; Foroutan, Masoud; Francis, Joel Msafiri; Fukumoto, Takeshi; Fullman, Nancy; Gallus, Silvano; Gebre, Destallem Gebremedhin; Gebrehiwot, Tsegaye Tewelde; Gebremeskel, Gebreamlak Gebremedhn; Gessner, Bradford D.; Geta, Birhanu; Gething, Peter W.; Ghadimi, Reza; Ghadiri, Keyghobad; Ghajarzadeh, Mahsa; Ghashghaee, Ahmad; Gill, Paramjit Singh; Gill, Tiffany K.; Golding, Nick; Gomes, Nelson G. M.; Gona, Philimon N.; Gopalani, Sameer Vali; Gorini, Giuseppe; Goulart, Barbara Niegia Garcia; Graetz, Nicholas; Greaves, Felix; Green, Manfred S.; Guo, Yuming; Haj-Mirzaian, Arvin; Haj-Mirzaian, Arya; Hall, Brian James; Hamidi, Samer; Haririan, Hamidreza; Haro, Josep Maria; Hasankhani, Milad; Hasanpoor, Edris; Hasanzadeh, Amir; Hassankhani, Hadi; Hassen, Hamid Yimam; Hegazy, Mohamed I.; Hendrie, Delia; Heydarpour, Fatemeh; Hird, Thomas R.; Hoang, Chi Linh; Hollerich, Gillian; Rad, Enayatollah Homaie; Hoseini-Ghahfarokhi, Mojtaba; Hossain, Naznin; Hosseini, Mostafa; Hosseinzadeh, Mehdi; Hostiuc, Mihaela; Hostiuc, Sorin; Househ, Mowafa; Hsairi, Mohamed; Ilesanmi, Olayinka Stephen; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Nazrul; Islam, Sheikh Mohammed Shariful; Jurisson, Mikk; Balalami, Nader Jafari; Jalali, Amir; Javidnia, Javad; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Ji, John S.; Jobanputra, Yash B.; Johnson, Kimberly; Jonas, Jost B.; Shushtari, Zahra Jorjoran; Jozwiak, Jacek Jerzy; Kabir, Ali; Kahsay, Amaha; Kalani, Hamed; Kalhor, Rohollah; Karami, Manoochehr; Karki, Surendra; Kasaeian, Amir; Kassebaum, Nicholas J.; Keiyoro, Peter Njenga; Kemp, Grant Rodgers; Khabiri, Roghayeh; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Muhammad Shahzeb; Khang, Young-Ho; Khatab, Khaled; Khater, Amir; Khater, Mona M.; Khatony, Alireza; Khazaei, Mohammad; Khazaei, Salman; Khazaei-Pool, Maryam; Khubchandani, Jagdish; Kianipour, Neda; Kim, Yun Jin; Kimokoti, Ruth W.; Kinyoki, Damaris K.; Kisa, Adnan; Kisa, Sezer; Kolola, Tufa; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Kraemer, Moritz U. G.; Krishan, Kewal; Krohn, Kris J.; Kugbey, Nuworza; Kumar, G. Anil; Kumar, Manasi; Kumar, Pushpendra; Kuupiel, Desmond; Lacey, Ben; Lad, Sheetal D.; Lami, Faris Hasan; Larsson, Anders O.; Lee, Paul H.; Leili, Mostafa; Levine, Aubrey J.; Li, Shanshan; Lim, Lee-Ling; Listl, Stefan; Longbottom, Joshua; Lopez, Jaifred Christian F.; Lorkowski, Stefan; Magdeldin, Sameh; Abd El Razek, Hassan Magdy; Abd El Razek, Muhammed Magdy; Majeed, Azeem; Maleki, Afshin; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A.; Manafi, Navid; Manda, Ana-Laura; Mansourian, Morteza; Martins-Melo, Francisco Rogerlandio; Masaka, Anthony; Massenburg, Benjamin Ballard; Maulik, Pallab K.; Mayala, Benjamin K.; Mazidi, Mohsen; Mckee, Martin; Mehrotra, Ravi; Mehta, Kala M.; Meles, Gebrekiros Gebremichael; Mendoza, Walter; Menezes, Ritesh G.; Meretoja, Atte; Meretoja, Tuomo J.; Mestrovic, Tomislav; Miller, Ted R.; Miller-Petrie, Molly K.; Mills, Edward J.; Milne, George J.; Mini, G. K.; Mir, Seyed Mostafa; Mirjalali, Hamed; Mirrakhimov, Erkin M.; Mohamadi, Efat; Mohammad, Dara K.; Darwesh, Aso Mohammad; Mezerji, Naser Mohammad Gholi; Mohammed, Ammas Siraj; Mohammed, Shafiu; Mokdad, Ali H.; Molokhia, Mariam; Monasta, Lorenzo; Moodley, Yoshan; Moosazadeh, Mahmood; Moradi, Ghobad; Moradi, Masoud; Moradi, Yousef; Moradi-Lakeh, Maziar; Moradinazar, Mehdi; Moraga, Paula; Morawska, Lidia; Mosapour, Abbas; Mousavi, Seyyed Meysam; Mueller, Ulrich Otto; Muluneh, Atalay Goshu; Mustafa, Ghulam; Nabavizadeh, Behnam; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Nahvijou, Azin; Najafi, Farid; Nangia, Vinay; Ndwandwe, Duduzile Edith; Neamati, Nahid; Negoi, Ionut; Negoi, Ruxandra Irina; Ngunjiri, Josephine W.; Huong Lan Thi Nguyen; Long Hoang Nguyen; Son Hoang Nguyen; Nielsen, Katie R.; Ningrum, Dina Nur Anggraini; Nirayo, Yirga Legesse; Nixon, Molly R.; Nnaji, Chukwudi A.; Nojomi, Marzieh; Noroozi, Mehdi; Nosratnejad, Shirin; Noubiap, Jean Jacques; Motlagh, Soraya Nouraei; Ofori-Asenso, Richard; Ogbo, Felix Akpojene; Oladimeji, Kelechi E.; Olagunju, Andrew T.; Olfatifar, Meysam; Olum, Solomon; Olusanya, Bolajoko Olubukunola; Oluwasanu, Mojisola Morenike; Onwujekwe, Obinna E.; Oren, Eyal; Ortega-Altamirano, Doris D. V.; Ortiz, Alberto; Osarenotor, Osayomwanbo; Osei, Frank B.; Osgood-Zimmerman, Aaron E.; Otstavnov, Stanislav S.; Owolabi, Mayowa Ojo; Mahesh, P. A.; Pagheh, Abdol Sattar; Pakhale, Smita; Panda-Jonas, Songhomitra; Pandey, Animika; Park, Eun-Kee; Parsian, Hadi; Pashaei, Tahereh; Patel, Sangram Kishor; Pepito, Veincent Christian Filipino; Pereira, Alexandre; Perkins, Samantha; Pickering, Brandon V.; Pilgrim, Thomas; Pirestani, Majid; Piroozi, Bakhtiar; Pirsaheb, Meghdad; Plana-Ripoll, Oleguer; Pourjafar, Hadi; Puri, Parul; Qorbani, Mostafa; Quintana, Hedley; Rabiee, Mohammad; Rabiee, Navid; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Zohreh; Rahimi-Movaghar, Vafa; Rahimzadeh, Shadi; Rajati, Fatemeh; Raju, Sree Bhushan; Ramezankhani, Azra; Ranabhat, Chhabi Lal; Rasella, Davide; Rashedi, Vahid; Rawal, Lal; Reiner, Robert C.; Renzaho, Andre M. N.; Rezaei, Satar; Rezapour, Aziz; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Roever, Leonardo; Roro, Elias Merdassa; Roser, Max; Roshandel, Gholamreza; Roshani, Daem; Rostami, Ali; Rubagotti, Enrico; Rubino, Salvatore; Sabour, Siamak; Sadat, Nafis; Sadeghi, Ehsan; Saeedi, Reza; Safari, Yahya; Safari-Faramani, Roya; Safdarian, Mahdi; Sahebkar, Amirhossein; Salahshoor, Mohammad Reza; Salam, Nasir; Salamati, Payman; Salehi, Farkhonde; Zahabi, Saleh Salehi; Salimi, Yahya; Salimzadeh, Hamideh; Salomon, Joshua A.; Sambala, Evanson Zondani; Samy, Abdallah M.; Milicevic, Milena M. Santric; Sao Jose, Bruno Piassi; Saraswathy, Sivan Yegnanarayana Iyer; Sarmiento-Suarez, Rodrigo; Sartorius, Benn; Sathian, Brijesh; Saxena, Sonia; Sbarra, Alyssa N.; Schaeffer, Lauren E.; Schwebel, David C.; Sepanlou, Sadaf G.; Seyedmousavi, Seyedmojtaba; Shaahmadi, Faramarz; Shaikh, Masood Ali; Shams-Beyranvand, Mehran; Shamshirian, Amir; Shamsizadeh, Morteza; Sharafi, Kiomars; Sharif, Mehdi; Sharif-Alhoseini, Mahdi; Sharifi, Hamid; Sharma, Jayendra; Sharma, Rajesh; Sheikh, Aziz; Shields, Chloe; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Shuval, Kerem; Siddiqi, Tariq J.; Silva, Joao Pedro; Singh, Jasvinder A.; Sinha, Dhirendra Narain; Sisay, Malede Mequanent; Sisay, Solomon; Sliwa, Karen; Smith, David L.; Somayaji, Ranjani; Soofi, Moslem; Soriano, Joan B.; Sreeramareddy, Chandrashekhar T.; Sudaryanto, Agus; Sufiyan, Mu'awiyyah Babale; Sykes, Bryan L.; Sylaja, P. N.; Tabares-Seisdedos, Rafael; Tabb, Karen M.; Tabuchi, Takahiro; Taveira, Nuno; Temsah, Mohamad-Hani; Terkawi, Abdullah Sulieman; Tessema, Zemenu Tadesse; Thankappan, Kavumpurathu Raman; Thirunavukkarasu, Sathish; To, Quyen G.; Tovani-Palone, Marcos Roberto; Bach Xuan Tran, [No Value]; Khanh Bao Tran; Ullah, Irfan; Usman, Muhammad Shariq; Uthman, Olalekan A.; Vahedian-Azimi, Amir; Valdez, Pascual R.; van Boven, Job F. M.; Vasankari, Tommi Juhani; Vasseghian, Yasser; Veisani, Yousef; Venketasubramanian, Narayanaswamy; Violante, Francesco S.; Vladimirov, Sergey Konstantinovitch; Vlassov, Vasily; Vos, Theo; Giang Thu Vu; Vujcic, Isidora S.; Waheed, Yasir; Wakefield, Jon; Wang, Haidong; Wang, Yafeng; Wang, Yuan-Pang; Ward, Joseph L.; Weintraub, Robert G.; Weldegwergs, Kidu Gidey; Weldesamuel, Girmay Teklay; Westerman, Ronny; Wiysonge, Charles Shey; Wondafrash, Dawit Zewdu; Woyczynski, Lauren; Wu, Ai-Min; Xu, Gelin; Yadegar, Abbas; Yamada, Tomohide; Yazdi-Feyzabadi, Vahid; Yilgwan, Christopher Sabo; Yip, Paul; Yonemoto, Naohiro; Lebni, Javad Yoosefi; Younis, Mustafa Z.; Yousefifard, Mahmoud; Yousof, Hebat-Allah Salah A.; Yu, Chuanhua; Yusefzadeh, Hasan; Zabeh, Erfan; Moghadam, Telma Zahirian; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zangeneh, Alireza; Zerfu, Taddese Alemu; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Murray, Christopher J. L.; Hay, Simon I. (2019)
    Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
  • Local Burden Dis Educ Attainment C; Graetz, Nicholas; Woyczynski, Lauren; Wilson, Katherine F.; Meretoja, Tuomo J. (2020)
    Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations. Educational attainment is an important social determinant of maternal, newborn, and child health(1-3). As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting(4-6). The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness(7,8); however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health(9-11). Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries(12-14). By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.
  • Deshpande, Aniruddha; Miller-Petrie, Molly K.; Lindstedt, Paulina A.; Baumann, Mathew M.; Johnson, Kimberly B.; Blacker, Brigette F.; Abbastabar, Hedayat; Abd-Allah, Foad; Abdelalim, Ahmed; Abdollahpour, Ibrahim; Abegaz, Kedir Hussein; Abejie, Ayenew Negesse; Abreu, Lucas Guimaraes; Abrigo, Michael R. M.; Abualhasan, Ahmed; Accrombessi, Manfred Mario Kokou; Adamu, Abdu A.; Adebayo, Oladimeji M.; Adedeji, Isaac Akinkunmi; Adedoyin, Rufus Adesoji; Adekanmbi, Victor; Adetokunboh, Olatunji O.; Adhikari, Tara Ballav; Afarideh, Mohsen; Agudelo-Botero, Marcela; Ahmadi, Mehdi; Ahmadi, Keivan; Ahmed, Muktar Beshir; Ahmed, Anwar E.; Akalu, Temesgen Yihunie; Akanda, Ali S.; Alahdab, Fares; Al-Aly, Ziyad; Alam, Samiah; Alam, Noore; Alamene, Genet Melak; Alanzi, Turki M.; Albright, James; Albujeer, Ammar; Alcalde-Rabanal, Jacqueline Elizabeth; Alebel, Animut; Alemu, Zewdie Aderaw; Ali, Muhammad; Alijanzadeh, Mehran; Alipour, Vahid; Aljunid, Syed Mohamed; Almasi, Ali; Almasi-Hashiani, Amir; Al-Mekhlafi, Hesham M.; Altirkawi, Khalid A.; Alvis-Guzman, Nelson; Alvis-Zakzuk, Nelson J.; Amini, Saeed; Amit, Arianna Maever L.; Amul, Gianna Gayle Herrera; Andrei, Catalina Liliana; Anjomshoa, Mina; Ansariadi, Ansariadi; Antonio, Carl Abelardo T.; Antony, Benny; Antriyandarti, Ernoiz; Arabloo, Jalal; Aref, Hany Mohamed Amin; Aremu, Olatunde; Armoon, Bahram; Arora, Amit; Aryal, Krishna K.; Arzani, Afsaneh; Asadi-Aliabadi, Mehran; Asmelash, Daniel; Atalay, Hagos Tasew; Athari, Seyyede Masoume; Athari, Seyyed Shamsadin; Atre, Sachin R.; Ausloos, Marcel; Awasthi, Shally; Awoke, Nefsu; Quintanilla, Beatriz Paulina Ayala; Ayano, Getinet; Ayanore, Martin Amogre; Aynalem, Yared Asmare; Azari, Samad; Azman, Andrew S.; Babaee, Ebrahim; Badawi, Alaa; Bagherzadeh, Mojtaba; Bakkannavar, Shankar M.; Balakrishnan, Senthilkumar; Banach, Maciej; Banoub, Joseph Adel Mattar; Barac, Aleksandra; Barboza, Miguel A.; Barnighausen, Till Winfried; Basu, Sanjay; Vo Dinh Bay; Bayati, Mohsen; Bedi, Neeraj; Beheshti, Mahya; Behzadifar, Meysam; Behzadifar, Masoud; Ramirez, Diana Fernanda Bejarano; Bell, Michelle L.; Bennett, Derrick A.; Benzian, Habib; Berbada, Dessalegn Ajema; Bernstein, Robert S.; Bhat, Anusha Ganapati; Bhattacharyya, Krittika; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bijani, Ali; Bikbov, Boris; Bin Sayeed, Muhammad Shahdaat; Biswas, Raaj Kishore; Bohlouli, Somayeh; Boufous, Soufiane; Brady, Oliver J.; Briko, Andrey Nikolaevich; Briko, Nikolay Ivanovich; Britton, Gabrielle B.; Brown, Alexandria; Nagaraja, Sharath Burugina; Butt, Zahid A.; Camera, Luis Alberto; Campos-Nonato, Ismael R.; Rincon, Julio Cesar Campuzano; Cano, Jorge; Car, Josip; Cardenas, Rosario; Carvalho, Felix; Castaneda-Orjuela, Carlos A.; Castro, Franz; Cerin, Ester; Chalise, Binaya; Chattu, Vijay Kumar; Chin, Ken Lee; Christopher, Devasahayam J.; Chu, Dinh-Toi; Cormier, Natalie Maria; Costa, Vera Marisa; Cromwell, Elizabeth A.; Dadi, Abel Fekadu Fekadu; Dahiru, Tukur; Dahlawi, Saad M. A.; Dandona, Rakhi; Dandona, Lalit; Dang, Anh Kim; Daoud, Farah; Darwesh, Aso Mohammad; Darwish, Amira Hamed; Daryani, Ahmad; Das, Jai K.; Das Gupta, Rajat; Dash, Aditya Prasad; Davila-Cervantes, Claudio Alberto; Weaver, Nicole Davis; De la Hoz, Fernando Pio; De Neve, Jan-Walter; Demissie, Dereje Bayissa; Demoz, Gebre Teklemariam; Denova-Gutierrez, Edgar; Deribe, Kebede; Desalew, Assefa; Dharmaratne, Samath Dhamminda; Dhillon, Preeti; Dhimal, Meghnath; Dhungana, Govinda Prasad; Diaz, Daniel; Dipeolu, Isaac Oluwafemi; Hoa Thi; Dolecek, Christiane; Doyle, Kerrie E.; Dubljanin, Eleonora; Duraes, Andre Rodrigues; Edinur, Hisham Atan; Effiong, Andem; Eftekhari, Aziz; El Nahas, Nevine; Zaki, Maysaa El Sayed; El Tantawi, Maha; Elhabashy, Hala Rashad; El-Jaafary, Shaimaa; El-Khatib, Ziad; Elkout, Hajer; Elsharkawy, Aisha; Enany, Shymaa; Endalew, Daniel Adane; Eshrati, Babak; Eskandarieh, Sharareh; Etemadi, Arash; Ezekannagha, Oluchi; Faraon, Emerito Jose A.; Fareed, Mohammad; Faro, Andre; Farzadfar, Farshad; Fasil, Alebachew Fasil; Fazlzadeh, Mehdi; Feigin, Valery L.; Fekadu, Wubalem; Fentahun, Netsanet; Fereshtehnejad, Seyed-Mohammad; Fernandes, Eduarda; Filip, Irina; Fischer, Florian; Flohr, Carsten; Foigt, Nataliya A.; Folayan, Morenike Oluwatoyin; Foroutan, Masoud; Franklin, Richard Charles; Frostad, Joseph Jon; Fukumoto, Takeshi; Gad, Mohamed M.; Garcia, Gregory M.; Gatotoh, Augustine Mwangi; Gayesa, Reta Tsegaye; Gebremedhin, Ketema Bizuwork; Geramo, Yilma Chisha Dea; Gesesew, Hailay Abrha; Gezae, Kebede Embaye; Ghashghaee, Ahmad; Sherbaf, Farzaneh Ghazi; Gill, Tiffany K.; Gill, Paramjit Singh; Ginindza, Themba G.; Girmay, Alem; Gizaw, Zemichael; Goodridge, Amador; Gopalani, Sameer Vali; Goulart, Barbara Niegia Garcia; Goulart, Alessandra C.; Grada, Ayman; Green, Manfred S.; Gubari, Mohammed Ibrahim Mohialdeen; Gugnani, Harish Chander; Guido, Davide; Guimaraes, Rafael Alves; Guo, Yuming; Gupta, Rajeev; Gupta, Rahul; Ha, Giang Hai; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haile, Dessalegn H.; Haile, Michael Tamene; Hall, Brian J.; Hamidi, Samer; Handiso, Demelash Woldeyohannes; Haririan, Hamidreza; Hariyani, Ninuk; Hasaballah, Ahmed; Hasan, Mehedi; Hasanzadeh, Amir; Hassen, Hamid Yimam; Hayelom, Desta Haftu; Hegazy, Mohamed; Heibati, Behzad; Heidari, Behnam; Hendrie, Delia; Henok, Andualem; Herteliu, Claudiu; Heydarpour, Fatemeh; de Hidru, Hagos Degefa; Hird, Thomas R.; Chi Linh Hoang; Hollerich, Gillian; Hoogar, Praveen; Hossain, Naznin; Hosseinzadeh, Mehdi; Househ, Mowafa; Hu, Guoqing; Humayun, Ayesha; Hussain, Syed Ather; Hussen, Mamusha Aman A.; Ibitoye, Segun Emmanuel; Ilesanmi, Olayinka Stephen; Ilic, Milena D.; Imani-Nasab, Mohammad Hasan; Iqbal, Usman; Irvani, Seyed Sina Naghibi; Islam, Sheikh Mohammed Shariful; Ivers, Rebecca Q.; Iwu, Chinwe Juliana; Jahanmehr, Nader; Jakovljevic, Mihajlo; Jalali, Amir; Jayatilleke, Achala Upendra; Jenabi, Ensiyeh; Jha, Ravi Prakash; Jha, Vivekanand; Ji, John S.; Jonas, Jost B.; Jozwiak, Jacek Jerzy; Kabir, Ali; Kabir, Zubair; Kanchan, Tanuj; Karch, Andre; Karki, Surendra; Kasaeian, Amir; Kasahun, Gebremicheal Gebreslassie; Kasaye, Habtamu Kebebe; Kassa, Gebrehiwot G.; Kassa, Getachew Mullu; Kayode, Gbenga A.; Kebede, Mihiretu M.; Keiyoro, Peter Njenga; Ketema, Daniel Bekele; Khader, Yousef Saleh; Khafaie, Morteza Abdullatif; Khalid, Nauman; Khalilov, Rovshan; Khan, Ejaz Ahmad; Khan, Junaid; Khan, Nuruzzaman; Khatab, Khaled; Khater, Mona M.; Khater, Amir M.; Khayamzadeh, Maryam; Khazaei, Mohammad; Khosravi, Mohammad Hossein; Khubchandani, Jagdish; Kiadaliri, Ali; Kim, Yun Jin; Kimokoti, Ruth W.; Kisa, Sezer; Kisa, Adnan; Kochhar, Sonali; Kolola, Tufa; Komaki, Hamidreza; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Krishan, Kewal; Defo, Barthelemy Kuate; Kugbey, Nuworza; Kumar, Pushpendra; Kumar, G. Anil; Kumar, Manasi; Kusuma, Dian; La Vecchia, Carlo; Lacey, Ben; Lal, Aparna; Lal, Dharmesh Kumar; Lam, Hilton; Lami, Faris Hasan; Lansingh, Van Charles; Lasrado, Savita; Lebedev, Georgy; Lee, Paul H.; LeGrand, Kate E.; Leili, Mostafa; Lenjebo, Tsegaye Lolaso; Leshargie, Cheru Tesema; Levine, Aubrey J.; Lewycka, Sonia; Li, Shanshan; Linn, Shai; Liu, Shiwei; Lopez, Jaifred Christian F.; Lopukhov, Platon D.; Abd El Razek, Muhammed Magdy; Prasad, D. R. Mahadeshwara; Mahasha, Phetole Walter; Mahotra, Narayan B.; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Mamun, Abdullah A.; Manafi, Navid; Mansournia, Mohammad Ali; Mapoma, Chabila Christopher; Martinez, Gabriel; Martini, Santi; Martins-Melo, Francisco Rogerlandio; Mathur, Manu Raj; Mayala, Benjamin K.; Mazidi, Mohsen; McAlinden, Colm; Meharie, Birhanu Geta; Mehndiratta, Man Mohan; Nasab, Entezar Mehrabi; Mehta, Kala M.; Mekonnen, Teferi; Mekonnen, Tefera Chane; Meles, Gebrekiros Gebremichael; Meles, Hagazi Gebre; Memiah, Peter T. N.; Memish, Ziad A.; Mendoza, Walter; Menezes, Ritesh G.; Mereta, Seid Tiku; Meretoja, Tuomo J.; Mestrovic, Tomislav; Metekiya, Workua Mekonnen; Miazgowski, Bartosz; Miller, Ted R.; Mini, G. K.; Mirrakhimov, Erkin M.; Moazen, Babak; Mohajer, Bahram; Mohammad, Yousef; Mohammad, Dara K.; Mezerji, Naser Mohammad Gholi; Mohammadibakhsh, Roghayeh; Mohammed, Shafiu; Mohammed, Jemal Abdu; Mohammed, Hassen; Mohebi, Farnam; Mokdad, Ali H.; Moodley, Yoshan; Moradi, Masoud; Moradi, Ghobad; Moradi-Joo, Mohammad; Moraga, Paula; Morales, Linda; Mosapour, Abbas; Mosser, Jonathan F.; Mouodi, Simin; Mousavi, Seyyed Meysam; Mozaffor, Miliva; Munro, Sandra B.; Muriithi, Moses K.; Murray, Christopher J. L.; Musa, Kamarul Imran; Mustafa, Ghulam; Muthupandian, Saravanan; Naderi, Mehdi; Nagarajan, Ahamarshan Jayaraman; Naghavi, Mohsen; Naik, Gurudatta; Nangia, Vinay; Nascimento, Bruno Ramos; Nazari, Javad; Ndwandwe, Duduzile Edith; Negoi, Ionut; Netsere, Henok Biresaw; Ngunjiri, Josephine W.; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Nguyen, QuynhAnh P.; Nigatu, Solomon Gedlu; Ningrum, Dina Nur Anggraini; Nnaji, Chukwudi A.; Nojomi, Marzieh; Norheim, Ole F.; Noubiap, Jean Jacques; Oancea, Bogdan; Ogbo, Felix Akpojene; Oh, In-Hwan; Olagunju, Andrew T.; Olusanya, Jacob Olusegun; Olusanya, Bolajoko Olubukunola; Onwujekwe, Obinna E.; Ortega-Altamirano, Doris; Osarenotor, Osayomwanbo; Osei, Frank B.; Owolabi, Mayowa O.; Mahesh, P. A.; Padubidri, Jagadish Rao; Pakhale, Smita; Pana, Adrian; Park, Eun-Kee; Patel, Sangram Kishor; Pathak, Ashish; Patle, Ajay; Paulos, Kebreab; Pepito, Veincent Christian Filipino; Perico, Norberto; Pervaiz, Aslam; Pescarini, Julia Moreira; Pesudovs, Konrad; Pham, Hai Quang; Pigott, David M.; Pilgrim, Thomas; Pirsaheb, Meghdad; Poljak, Mario; Pollock, Ian; Postma, Maarten J.; Pourmalek, Farshad; Pourshams, Akram; Prada, Sergio; Preotescu, Liliana; Quintana, Hedley; Rabiee, Navid; Rabiee, Mohammad; Radfar, Amir; Rafiei, Alireza; Rahim, Fakher; Rahimi, Siavash; Rahimi-Movaghar, Vafa; Rahman, Muhammad Aziz; Rahman, Mohammad Hifz Ur; Rajati, Fatemeh; Ranabhat, Chhabi Lal; Rao, Puja C.; Rasella, Davide; Rath, Goura Kishor; Rawaf, Salman; Rawal, Lal; Rawasia, Wasiq Faraz; Remuzzi, Giuseppe; Renjith, Vishnu; Renzaho, Andre M. N.; Resnikoff, Serge; Riahi, Seyed Mohammad; Ribeiro, Ana Isabel; Rickard, Jennifer; Roever, Leonardo; Ronfani, Luca; Rubagotti, Enrico; Rubino, Salvatore; Saad, Anas M.; Sabour, Siamak; Sadeghi, Ehsan; Moghaddam, Sahar Saeedi; Safari, Yahya; Sagar, Rajesh; Sahraian, Mohammad Ali; Sajadi, S. Mohammad; Salahshoor, Mohammad Reza; Salam, Nasir; Saleem, Ahsan; Salem, Hosni; Salem, Marwa Rashad; Salimi, Yahya; Salimzadeh, Hamideh; Samy, Abdallah M.; Sanabria, Juan; Santos, Itamar S.; Santric-Milicevic, Milena M.; Sao Jose, Bruno Piassi; Saraswathy, Sivan Yegnanarayana Iyer; Sarrafzadegan, Nizal; Sartorius, Benn; Sathian, Brijesh; Sathish, Thirunavukkarasu; Satpathy, Maheswar; Sawhney, Monika; Sayyah, Mehdi; Sbarra, Alyssa N.; Schaeffer, Lauren E.; Schwebel, David C.; Senbeta, Anbissa Muleta; Senthilkumaran, Subramanian; Sepanlou, Sadaf G.; Servan-Mori, Edson; Shafieesabet, Azadeh; Shaheen, Amira A.; Shahid, Izza; Shaikh, Masood Ali; Shalash, Ali S.; Shams-Beyranvand, Mehran; Shamsi, MohammadBagher; Shamsizadeh, Morteza; Shannawaz, Mohammed; Sharafi, Kiomars; Sharma, Rajesh; Sheikh, Aziz; Shetty, B. Suresh Kumar; Shiferaw, Wondimeneh Shibabaw; Shigematsu, Mika; Shin, Jae Il; Shiri, Rahman; Shirkoohi, Reza; Shivakumar, K. 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Chudi; Valdez, Pascual R.; Varughese, Santosh; Veisani, Yousef; Violante, Francesco S.; Vollmer, Sebastian; Whawariat, Feleke Gebremeskel; Waheed, Yasir; Wallin, Mitchell Taylor; Wang, Yuan-Pang; Wang, Yafeng; Wangdi, Kinley; Weiss, Daniel J.; Weldesamuel, Girmay Teklay; Werkneh, Adhena Ayaliew; Westerman, Ronny; Wiangkham, Taweewat; Wiens, Kirsten E.; Wijeratne, Tissa; Wiysonge, Charles Shey; Wolde, Haileab Fekadu; Wondafrash, Dawit Zewdu; Wonde, Tewodros Eshete; Worku, Getasew Taddesse; Yadollahpour, Ali; Jabbari, Seyed Hossein Yahyazadeh; Yamada, Tomohide; Yaseri, Mehdi; Yatsuya, Hiroshi; Yeshaneh, Alex; Yilma, Mekdes Tigistu; Yip, Paul; Yisma, Engida; Yonemoto, Naohiro; Younis, Mustafa Z.; Yousof, Hebat-Allah Salah A.; Yu, Chuanhua; Yusefzadeh, Hasan; Zadey, Siddhesh; Moghadam, Telma Zahirian; Zaidi, Zoubida; Bin Zaman, Sojib; Zamani, Mohammad; Zandian, Hamed; Zar, Heather J.; Zerfu, Taddese Alemu; Zhang, Yunquan; Ziapour, Arash; Zodpey, Sanjay; Zuniga, Yves Miel H.; Hay, Simon; Reiner, Robert C. (2020)
    Background Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40.0% (95% uncertainty interval [UI] 39.4-40.7) to 50.3% (50.0-50.5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46.3% (95% UI 46.1-46.5) in 2017, compared with 28.7% (28.5-29.0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88.6% (95% UI 87.2-89.7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664-711) of the 1830 (1797-1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76.1% (95% UI 71.6-80.7) of countries from 2000 to 2017, and in 53.9% (50.6-59.6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
  • Local Burden Dis Diarrhoea; Reiner, Robert C.; Wiens, Kirsten E.; Deshpande, Aniruddha; Meretoja, Tuomo J.; Shiri, Rahman (2020)
    Background Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. Methods We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. Findings The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54.0% (95% uncertainty interval [UI] 38.1-65.8), 17.4% (7.7-28.4), and 59.5% (34.2-86.9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. Interpretation By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.
  • Local Burden Dis Diarrhoea; Wiens, Kirsten E.; Lindstedt, Paulina A.; Blacker, Brigette F.; Meretoja, Tuomo J.; Shiri, Rahman (2020)
    Background Oral rehydration solution (ORS) is a form of oral rehydration therapy (ORT) for diarrhoea that has the potential to drastically reduce child mortality; yet, according to UNICEF estimates, less than half of children younger than 5 years with diarrhoea in low-income and middle-income countries (LMICs) received ORS in 2016. A variety of recommended home fluids (RHF) exist as alternative forms of ORT; however, it is unclear whether RHF prevent child mortality. Previous studies have shown considerable variation between countries in ORS and RHF use, but subnational variation is unknown. This study aims to produce high-resolution geospatial estimates of relative and absolute coverage of ORS, RHF, and ORT (use of either ORS or RHF) in LMICs. Methods We used a Bayesian geostatistical model including 15 spatial covariates and data from 385 household surveys across 94 LMICs to estimate annual proportions of children younger than 5 years of age with diarrhoea who received ORS or RHF (or both) on continuous continent-wide surfaces in 2000-17, and aggregated results to policy-relevant administrative units. Additionally, we analysed geographical inequality in coverage across administrative units and estimated the number of diarrhoeal deaths averted by increased coverage over the study period. Uncertainty in the mean coverage estimates was calculated by taking 250 draws from the posterior joint distribution of the model and creating uncertainty intervals (UIs) with the 2 center dot 5th and 97 center dot 5th percentiles of those 250 draws. Findings While ORS use among children with diarrhoea increased in some countries from 2000 to 2017, coverage remained below 50% in the majority (62 center dot 6%; 12 417 of 19 823) of second administrative-level units and an estimated 6 519 000 children (95% UI 5 254 000-7 733 000) with diarrhoea were not treated with any form of ORT in 2017. Increases in ORS use corresponded with declines in RHF in many locations, resulting in relatively constant overall ORT coverage from 2000 to 2017. Although ORS was uniformly distributed subnationally in some countries, within-country geographical inequalities persisted in others; 11 countries had at least a 50% difference in one of their units compared with the country mean. Increases in ORS use over time were correlated with declines in RHF use and in diarrhoeal mortality in many locations, and an estimated 52 230 diarrhoeal deaths (36 910-68 860) were averted by scaling up of ORS coverage between 2000 and 2017. Finally, we identified key subnational areas in Colombia, Nigeria, and Sudan as examples of where diarrhoeal mortality remains higher than average, while ORS coverage remains lower than average. Interpretation To our knowledge, this study is the first to produce and map subnational estimates of ORS, RHF, and ORT coverage and attributable child diarrhoeal deaths across LMICs from 2000 to 2017, allowing for tracking progress over time. Our novel results, combined with detailed subnational estimates of diarrhoeal morbidity and mortality, can support subnational needs assessments aimed at furthering policy makers' understanding of within-country disparities. Over 50 years after the discovery that led to this simple, cheap, and life-saving therapy, large gains in reducing mortality could still be made by reducing geographical inequalities in ORS coverage. Copyright (c) 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.