69832 research outputs found
Sort by
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021
Get PDFBACKGROUND: Despite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.
METHODS: Using established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5-14 years, typically in school and cared for by child health services) and older adolescents (aged 15-24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990-2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.
FINDINGS: Between 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6-96·6) individuals aged 5-14 years and 80·6 million (78·2-83·3) aged 15-24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15-24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5-14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7-17·2) of those aged 5-14 years are forecasted to have obesity by 2050 (186 million [141-221]), compared with 14·2% (11·4-15·7) of those aged 15-24 years (175 million [136-203]). We forecasted that by 2050, there will be more young males (aged 5-14 years) living with obesity (16·5% [13·3-18·3]) than overweight (12·9% [12·2-13·6]); while for females (aged 5-24 years) and older males (aged 15-24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041-50: children and adolescents (males and females aged 5-24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5-14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5-14 years in Australasia; females aged 15-24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15-24 years in high-income North America.
INTERPRETATION: Both overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis. FUNDING: Bill & Melinda Gates Foundation and Australian National Health and Medical Research Council
Evaluation of statistical models of carriage to predict the impact of the 10-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in Nigeria
Get PDFBackground: A substantial fraction of the population-level impact of Pneumococcal Conjugate Vaccines (PCVs) on Invasive Pneumococcal Disease (IPD) is mediated through indirect effects, i.e., their capacity to protect against carriage acquisition of vaccine serotypes (VTs) among vaccinees, thereby proportionately reducing transmission and indirectly averting invasive disease in the whole population. Therefore, by relying on the consequent near elimination of VT carriage, early carriage-based models successfully captured the impact of seven-valent PCV (PCV7) in high-income settings. We sought to determine the applicability of three published statistical carriage-based models for the evaluation of PCV10 impact in Nigeria, where carriage prevalence data are available from urban and rural sites. Methods: We applied external data, with assumptions, to empirical carriage prevalence data to predict IPD incidence rate ratios (IRRs). The models assume PCV has no effect on serotype invasiveness among carriers because VT carriage is eliminated. Model 1 uses estimates of relative proportions of pre-PCV VT-IPD to predict IRRs. Model 2 uses pre-PCV serotype IPD incidence, while Model 3 uses measures of serotype invasiveness, the case-carrier ratio (CCR). Results: Model 1 estimates the largest PCV10 impact on overall IPD (IRR:0.38 and 0.50) in the urban and rural sites, respectively. Whereas estimates from Model 2 (IRR:0.69 and 0.78) and Model 3 (IRR:0.63 and 0.70) were more conservative. Conclusions: VT carriage was not eliminated in our setting, so Model 1 estimates the hypothetical maximum impact. Relying entirely on indirect effects, Models 2 and 3 represent the minimum impact of PCV. Predictions would be more accurate if they accounted for direct effects among vaccinated VT carriers. This study illustrates the importance of capturing vaccination data on individuals sampled in carriage prevalence surveys designed to estimate IPD burden at population level
Characterisation of between-cluster heterogeneity in malaria cluster randomised trials to inform future sample size calculations.
Get PDFCluster randomised trials (CRTs) are important tools for evaluating the community-wide effect of malaria interventions. During the design stage, CRT sample sizes need to be inflated to account for the cluster heterogeneity in measured outcomes. The coefficient of variation (k), a measure of such heterogeneity, is typically used in malaria CRTs yet is often predicted without prior data. Underestimation of k decreases study power, thus increases the probability of generating null results. In this meta-analysis of cluster-summary data from 24 malaria CRTs, we calculate true prevalence and incidence k values using methods-of-moments and regression modelling approaches. Using random effects regression modelling, we investigate the impact of empirical k values on original trial power and explore factors associated with elevated k. Results show empirical estimates of k often exceed those used in sample size calculations, which reduces study power and effect size precision. Elevated k values are associated with incidence outcomes (compared to prevalence), lower endemicity settings, and uneven intervention coverage across clusters. Study findings can enhance the robustness of future malaria CRT sample size calculations by providing informed k estimates based on expected prevalence or incidence, in the absence of cluster-level data
Antitrypanosomal quinazolines targeting lysyl-tRNA synthetase show partial efficacy in a mouse model of acute Chagas disease.
Get PDFThe protozoan parasite Trypanosoma cruzi causes Chagas disease, which is among the deadliest parasitic infections in Latin America. Current therapies are toxic and lack efficacy against the chronic stage of infection; thus, new drugs are urgently needed. Here, we describe a previously unidentified series of quinazoline compounds with potential against Trypanosoma cruzi and the related trypanosomatid parasites Trypanosoma brucei and Leishmania donovani. We demonstrated partial efficacy of a lead quinazoline compound in a mouse model of acute Chagas disease. Mechanism of action studies using several orthogonal approaches showed that this quinazoline compound series targeted the ATP-binding pocket of T. cruzi lysyl-tRNA synthetase 1 (KRS1). A high-resolution crystal structure of KRS1 bound to the drug indicated binding interactions that led to KRS1 inhibition. Our study identified KRS1 as a druggable target for treating T. cruzi infection in a mouse model. This quinazoline series shows potential for treating Chagas disease but will require further development to become a future treatment for this neglected disease
Do long-lasting insecticidal nets retain their efficacy after three years of usage in Afghanistan? Findings from a study on survivorship, physical integrity, insecticidal activity and wash resistance.
Get PDFBACKGROUND: Long-Lasting Insecticidal Nets (LLINs) are effective malaria prevention tools. However, information is limited about their durability and wash resistance in field circumstances, especially in seasonal transmission areas in South Asia. This study comprised a systematic examination of usage, physical integrity and insecticidal activity of LLINs in households in Afghanistan, three years after distribution. METHODS: In 2014, 500 households in 5 malaria endemic Afghan provinces (Balkh, Herat, Khost, Kunduz and Nangarhar) that had received LLINs (PermaNet 2.0) three years earlier were randomly selected through cluster sampling. All household heads were interviewed about LLIN survivorship, usage and maintenance. One randomly selected LLIN from each household was rigorously inspected to calculate the proportionate Hole Index (pHI). Four location-specific pieces from 200 randomly selected LLINs (40 per province) underwent cone bioassay testing in the Jalalabad entomology laboratory, to measure mosquito knock-down after 60 min and 24-h mortality. The number and percentage of nets with ≥ 80% mosquito mortality was assessed. Five location-specific pieces from 34 randomly selected LLINs (5-8 per province) were tested for insecticidal content by High-Performance Liquid Chromatography (HPLC). RESULTS: Of the 1190 distributed LLINs, 1045 were still in the household at the time of the survey (survivorship 87.8%) and 1006 of those (96.3%) had been used every night in the past week. 9.1% of the LLINs were used by more than three people.. Physical integrity measurements indicated that 97.0% of the LLINs were in a serviceable condition (pHI 0-642), while 3.0% were 'too torn' (pHI > 642). Functional Net survival was 93.4% (95%CI 91.7-94.8%). However, only 28% of the LLINs met the WHOPES ≥ 80% mortality criterion. Washing of LLINs was associated with a significant reduction in mosquito mortality. Median deltamethrin concentration was 0.12 g/kg netting material (6.7% of the original concentration at production). CONCLUSIONS: LLIN survivorship and functional net survival in this setting was excellent, while only a minority of LLINs retained sufficient insecticidal activity after three years of usage. This study underlines the need for evaluation of real-life LLIN durability in field circumstances. LLIN washing should be avoided, as it lowers insecticide content and LLIN efficacy
City School Meals Case Study: Milan
No full textThis city school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice in collaboration with Cities Feeding the Future Initiative. The City School Meals Case Study of Milan serves to document how the municipal school meals programme is organized, funded, and monitored throughout the city. The objectives of this case study include presenting an introduction to the city profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
Potential Contributions of Edible Oil and Wheat Flour Fortification on Reducing Inadequate Micronutrient Intake in Ethiopia.
No full textIn 2022, Ethiopia enacted the mandatory fortification of wheat flour and edible oil to counter inadequate micronutrient intake as a risk factor for micronutrient deficiencies. This study aimed to model the potential contributions of fortifying wheat flour and edible oil to reducing the risk of micronutrient inadequacy. The 2015/16 Ethiopian Household Consumption-Expenditure Survey was used to estimate apparent micronutrient intakes of nine micronutrients and triangulated to existing food consumption and micronutrient surveys. Population risk for inadequate micronutrient intake was assessed overall using a mean adequacy ratio and for individual micronutrients included in the fortification standards. Potential contributions of fortification were assessed by comparing two scenarios across subpopulations: assuming no fortification and full compliance with the fortification policy. The reach of fortifiable wheat flour (39%) and edible oil (70%) suggests that fortifying these vehicles could reduce the risk of inadequate micronutrient intake by 44%, with variation between micronutrients, geographies, urban/rural residence, and socioeconomic status. Even under optimistic fortification scenarios, however, micronutrient gaps would remain for the rural poor. Sustained efforts are needed to drive the implementation of Ethiopia's fortification policy and to coordinate fortification with other interventions targeting populations beyond the reach of fortified foods
Another potential etiology for cardiac manifestation after snakebite.
Get PDFThis letter discusses the possibility of Takotsubo cardiomyopathy (TTC) as an alternative diagnosis in a recently reported case of acute myocardial infarction following a hump-nosed viper bite. The patient's presentation, including delayed chest tightness, elevated troponin, ECG changes, and normal coronary arteries, coupled with complete recovery within 3 months, strongly suggests TTC. Multiple case reports have documented the association between snakebites and TTC, with proposed pathophysiological mechanisms including sympathetic surge from pain and stress, direct cardiotoxic effects of venom, and inflammatory mediators during envenomation. The excessive catecholamine response may trigger transient cardiac dysfunction characteristic of TTC. Recognizing TTC as a potential complication of snakebites has important clinical implications, as its management and prognosis differ from acute coronary syndrome. Understanding this association may enhance diagnostic approaches and treatment strategies in similar cases, particularly when normal coronary arteries and complete cardiac recovery are observed
Induction and augmentation of labor in India: A systematic review.
Get PDFBACKGROUND: A recent publication regarding intrapartum care in low- and middle-income countries (LMICs) found that India has the one of the highest proportions of women receiving pharmacological augmentation of labor (51%-78%). National guidelines on the use of uterotonics during labor are available in India, requiring appropriate indication and monitoring for optimal maternal and fetal outcomes. OBJECTIVES: The aim of this research was to quantify induction and augmentation of labor in India and describe the characteristics of these practices and related outcomes for women and newborns. SEARCH STRATEGY: The following electronic databases of published studies and gray literature were searched: PubMed, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Global Health, African Journals Online, Global Health Library, Global Index Medicus, ProQuest Dissertations & Theses, Cochrane Central Register of Controlled Trials, EMCare, Google Scholar, JSTOR, and Snowglobe (snowball search). We also consulted gray literature in Clinicaltrials.gov, WHO Trials, Cochrane Trials, OpenGrey, and the International Clinical Trials Registry Platform. All searches were completed on October 6, 2022. Search terms relevant to the research aims were applied, with initial searches for research conducted in any LMIC. SELECTION CRITERIA: The review included primary research articles in English on induction and augmentation of labor in any setting in India, between January 1, 2011 and October 6, 2022. Two reviewers worked independently screening titles and abstracts for relevance to the research aims using Covidence® software. Non-concordant selection was resolved by a third team member. The full texts of included references were then retrieved for review and data extraction. Studies with low quality of evidence were excluded. DATA COLLECTION AND ANALYSIS: The data extraction grid was piloted on five full-text reports. One reviewer manually extracted data from each full text. Three categories of variables were included in that grid: study characteristics, exposure variables, and outcome variables. The quality of the evidence was assessed by one reviewer using the National Institute for Health and Care Excellence preferred tools for the corresponding study design. To synthesize and present results, we used percentages for prevalence studies, survey studies, and for descriptive sections of comparative studies. For comparative studies, associations between variables were presented using odds ratios, risk ratios, and risk differences with their 95% confidence interval (CIs) and P-values (where the latter was the only measure used to assess difference). For each quantitative outcome of the review, we compiled and interpreted results extracted from individual studies. Qualitative findings were grouped by domains of interest (settings, category of providers, induction and augmentation procedures). Meta-analysis was not possible due to the marked heterogeneity between studies. MAIN RESULTS: This review included 59 studies and provided evidence of moderate quality that high proportions of laboring women receive induction and augmentation of labor for facility-based childbirth across Indian geographies. Included studies reported that from 2.6% to 84.3% of laboring women received induction of labor; and from 9.6% to 86.9% received augmentation of labor. The review indicated that induction and augmentation are used in home-based childbirths as well, although these account for less than 10% of deliveries in India. The review identified several practices related to induction and augmentation of labor that are non-compliant with WHO guidelines, driven by synergistic promoting factors pertaining to both health systems and communities. Studies documented relatively high rates of complications, and reported descriptions suggest that these were related to type and regimens of induction and augmentation drugs, settings, and qualifications of providers. However, statistical associations between induction and augmentation and complications were not assessed. Included studies also revealed varied and inappropriate oxytocin storage conditions across settings. Finally, this review indicated that women were generally satisfied with the care provided to them during induction and augmentation of labor. CONCLUSIONS: This review documented high use of pharmaceuticals for the induction and augmentation of labor, including practices that are not compliant with global and Indian recommendations for safety and quality. The review also identified both provider- and community-side drivers of these practices. These findings suggest multiple interventions that can be taken at the policy, facility, and community levels to monitor and improve induction and augmentation practices at health facilities in India. This review was funded by USAID and its protocol was registered in PROSPERO (2022 CRD42022298949)
Gametocyte production and transmission fitness of African and Asian Plasmodium falciparum isolates with differential susceptibility to artemisinins.
Get PDFThe emergence of Plasmodium falciparum parasites partially resistant to artemisinins (ART-R) poses a significant threat to recent gains in malaria control. ART-R has been associated with PfKelch13 (K13) mutations, which differ in fitness costs. This study investigates the gametocyte production and transmission fitness of African and Asian P. falciparum isolates with different K13 genotypes across multiple mosquito species. We tested three ART-sensitive (ART-S) isolates (NF54, NF135, and NF180) and three ART-R isolates (ARN1G, 3815, and PAT-023) for sexual conversion and transmission to Anopheles stephensi, An. gambiae, and An. coluzzii. ART-R levels were quantified in vitro using the Ring-stage Survival Assay (RSA), and the transmission-reducing effects of dihydroartemisinin (DHA) on mature gametocytes were assessed. Results showed that ART-S parasite lines consistently produced gametocytes and transmitted effectively in all three mosquito species. ART-R isolates showed variability: ARN1G maintained high transmission levels, whereas 3815 showed limited transmission potential despite higher sporozoite loads in An. coluzzii. The African ART-R isolate PAT-023 demonstrated low gametocyte commitment but was transmitted efficiently in both An. gambiae and An. coluzzii. DHA exposure reduced mosquito infectivity for all isolates, regardless of K13 genotype. These findings, based on a limited number of field isolates, suggest that ART-R parasites remain transmissible across different Anopheles species. However, ART-R does not appear to confer a direct transmission advantage. This study highlights the complexity of ART-R dynamics and underscores the need for further research to inform malaria control strategies in regions where ART-R parasites are circulating