31 research outputs found
Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria.
No full textIntroductionNeonatal infections contribute substantially to infant mortality in Nigeria and globally. Management requires hospitalization, which is not accessible to many in low resource settings. World Health Organization developed a guideline to manage possible serious bacterial infection (PSBI) in young infants up to two months of age when a referral is not feasible. We evaluated the feasibility of implementing this guideline to achieve high coverage of treatment.MethodsThis implementation research was conducted in out-patient settings of eight primary health care centres (PHC) in Lagelu Local Government Area (LGA) of Ibadan, Oyo State, Nigeria. We conducted policy dialogue with the Federal and State officials to adopt the WHO guideline within the existing programme setting and held orientation and sensitization meetings with communities. We established a Technical Support Unit (TSU), built the capacity of health care providers, supervised and mentored them, monitored the quality of services and collected data for management and outcomes of sick young infants with PSBI signs. The Primary Health Care Directorate of the state ministry and the local government led the implementation and provided technical support. The enablers and barriers to implementation were documented.ResultsFrom 1 April 2016 to 31 July 2017 we identified 5278 live births and of these, 1214 had a sign of PSBI. Assuming 30% of births were missed due to temporary migration to maternal homes for delivery care and approximately 45% cases came from outside the catchment area due to free availability of medicines, the treatment coverage was 97.3% (668 cases/6861 expected births) with an expected 10% PSBI prevalence within the first 2 months of life. Of 1214 infants with PSBI, 392 (32%) infants 7-59 days had only fast breathing (pneumonia), 338 (27.8%) infants 0-6 days had only fast breathing (severe pneumonia), 462 (38%) presented with signs of clinical severe infection (CSI) and 22 (1.8%) with signs of critical illness. All but two, 7-59 days old infants with pneumonia were treated with oral amoxicillin without a referral; 80% (312/390) adhered to full treatment; 97.7% (381/390) were cured, and no deaths were reported. Referral to the hospital was not accepted by 87.7% (721/822) families of infants presenting with signs of PSBI needing hospitalization (critical illness 5/22; clinical severe infection; 399/462 and severe pneumonia 317/338). They were treated on an outpatient basis with two days of injectable gentamicin and seven days of oral amoxicillin. Among these 81% (584/721) completed treatment; 97% (700/721) were cured, and three deaths were reported (two with critical illness and one with clinical severe infection). We identified health system gaps including lack of staff motivation and work strikes, medicines stockouts, sub-optimal home visits that affected implementation.ConclusionsWhen a referral is not feasible, outpatient treatment for young infants with signs of PSBI is possible within existing programme structures in Nigeria with high coverage and low case fatality. To scale up this intervention successfully, government commitment is needed to strengthen the health system, motivate and train health workers, provide necessary commodities, establish technical support for implementation and strengthen linkages with communities.RegistrationTrial is registered on Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617001373369
Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam
No full textPurpose To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam.Methods This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one–to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed.Results Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders’ mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores.Conclusion Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one–to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance<br/
Global estimates on the number of people blind or visually impaired by glaucoma: A meta-analysis from 2000 to 2020
No full textConsortia:- Vision Loss Expert Group of the Global Burden of Disease Study: Rupert R. A. Bourne, Jost B. Jonas, David Friedman, Vinay Nangia, Alain Bron, Ian Tapply, Arthur G. Fernandes, Maria Vittoria Cicinelli, Alessandro Arrigo, Nicolas Leveziel, Serge Resnikoff, Hugh R. Taylor, Tabassom Sedighi, Mukkharram M. Bikbov, Tasanee Braithwaite, Ching-Yu Cheng, Nathan Congdon, Monte A. Del Monte, Joshua R. Ehrlich, Tim Fricke, João M. Furtado, Gus Gazzard, Ronnie George, M. Elizabeth Hartnett, Rim Kahloun, John H. Kempen, Moncef Khairallah, Rohit C. Khanna, Judy E. Kim, Van Charles Lansingh, Janet Leasher, Kovin S. Naidoo, Michal Nowak, Konrad Pesudovs, Tunde Peto, Pradeep Ramulu, Fotis Topouzis, Mitiadis Tsilimbaris, Ya Xing Wang, Ningli Wang & Seth Flaxman- the GBD 2019 Blindness and Vision Impairment Collaborators: Rupert R. A. Bourne, Jost B. Jonas, Robert James Casson, David S. Friedman, Vinay Nangia, Alain M. Bron, Ian Tapply, Arthur G. Fernandes, Maria Vittoria Cicinelli, Alessandro Arrigo, Nicolas Leveziel, Paul Svitil Briant, Theo Vos, Serge Resnikoff, Hugh R. Taylor, Tabassom Sedighi, Yohannes Habtegiorgis Abate, Melsew Dagne Abate, Zahra Abbasi Dolatabadi, Mozhan Abdollahi, Richard Gyan Aboagye, Eman Abu-Gharbieh, Salahdein Aburuz, Qorinah Estiningtyas Sakilah Adnani, Shahin Aghamiri, Bright Opoku Ahinkorah, Danish Ahmad, Hamid Ahmadieh, Hooman Ahmadzadeh, Ayman Ahmed, Ahmad Samir Alfaar, Cyrus Alinia, Louay Almidani, Hubert Amu, Sofia Androudi, Abhishek Anil, Jalal Arabloo, Damelash Areda, Tahira Ashraf, Sara Bagherieh, Ovidiu Constantin Baltatu, Mehmet Firat Baran, Amadou Barrow, Azadeh Bashiri, Nebiyou Simegnew Bayileyegn, Fatemeh Bazvand, Alemshet Yirga Berhie, Jasvinder Singh Bhatti, Mukharram Bikbov, Marina G. Birck, Veera R. Bitra, Marija M. Bozic, Tasanee Braithwaite, Katrin Burkart, Yasser Bustanji, Zahid A. Butt, Muthia Cenderadewi, Vijay Kumar Chattu, Kaleb Coberly, Omid Dadras, Xiaochen Dai, Ana Maria Dascalu, Anna Dastiridou, Vinoth Gnana Chellaiyan Devanbu, Meghnath Dhimal, Daniel Diaz, Thao Huynh Phuong Do, Thanh Chi Do, Arkadiusz Marian Dziedzic, Joshua R. Ehrlich, Michael Ekholuenetale, Muhammed Elhadi, Mohammad Hassan Emamian, Mehdi Emamverdi, Hossein Farrokhpour, Getahun Fetensa, Florian Fischer, Ali Forouhari, Kayode Raphael Fowobaje, João M. Furtado, Aravind P. Gandhi, Miglas W. W. Gebregergis, Bárbara Niegia Garcia Goulart, Mesay Dechasa Gudeta, Sapna Gupta, Vivek Kumar Gupta, Veer Bala Gupta, Golnaz Heidari, Sung Hwi Hong, Hong-Han Huynh, Segun Emmanuel Ibitoye, Irena M. Ilic, Mustapha Immurana, Sathish Kumar Jayapal, Nitin Joseph, Charity Ehimwenma Joshua, Rim Kahloun, Himal Kandel, Ibraheem M. Karaye, Hengameh Kasraei, Getu Mosisa Kebebew, John H. Kempen, Mahmoud Tawfik KhalafAlla, Sudarshan Khanal, Mahalaqua Nazli Khatib, Kewal Krishan, Chandrakant Lahariya, Janet L. Leasher, Stephen S. Lim, Roy Rillera Marzo, Andrea Maugeri, Yang Meng, Tomislav Mestrovic, Manish Mishra, Nouh Saad Mohamed, Hoda Mojiri-forushani, Ali H. Mokdad, Hamed Momeni-Moghaddam, Fateme Montazeri, Admir Mulita, Christopher J. L. Murray, Mahdi Nabi Foodani, Ganesh R. Naik, Zuhair S. Natto, Biswa Prakash Nayak, Mohammad Negaresh, Hadush Negash, Dang H. Nguyen, Bogdan Oancea, Andrew T. Olagunju, Matthew Idowu Olatubi, Wael M. S. Osman, Uchechukwu Levi Osuagwu, Jagadish Rao Padubidri, Songhomitra Panda-Jonas, Shahina Pardhan, Seoyeon Park, Jay Patel, Arokiasamy Perianayagam, Konrad Pesudovs, Hoang Tran Pham, Elton Junio Sady Prates, Ibrahim Qattea, Fakher Rahim, Mosiur Rahman, Deepthi Rapaka, Salman Rawaf, Nazila Rezaei, Priyanka Roy, Basema Saddik, Umar Saeed, Sher Zaman Safi, Sare Safi, Joseph W. Sakshaug, Mohamed A. Saleh, Vijaya Paul Samuel, Abdallah M. Samy, Aswini Saravanan, Allen Seylani, Masood Ali Shaikh, Muhammad Aaqib Shamim, Mohammed Shannawaz, Bereket Beyene Shashamo, Maryam Shayan, Aminu Shittu, Emmanuel Edwar Siddig, Jasvinder A. Singh, Yonatan Solomon, Raúl A. R. C. Sousa, Seyyed Mohammad Tabatabaei, Mohammad Tabish, Jansje Henny Vera Ticoalu, Temesgen Mohammed Toma, Aristidis Tsatsakis, Guesh Mebrahtom Tsegay, Rohollah Valizadeh, Maria Viskadourou, Gizachew Tadesse Wassie, Nuwan Darshana Wickramasinghe, Dong Keon Yon, Yuyi You, Seth Flaxman & Jaimie D. SteinmetzInternational audienceObjectives To estimate global and regional trends from 2000 to 2020 of the number of persons visually impaired by glaucoma and their proportion of the total number of vision-impaired individuals. Methods A systematic review and meta-analysis of published population studies and grey literature from 2000 to 2020 was carried out to estimate global and regional trends in number of people with vision loss due to glaucoma. Moderate or severe vision loss (MSVI) was defined as visual acuity of 6/60 or better but <6/18 (moderate) and visual acuity of 3/60 or better but <6/60 (severe vision loss). Blindness was defined as presenting visual acuity <3/60. Results Globally, in 2020, 3.61 million people were blind and nearly 4.14 million were visually impaired by glaucoma. Glaucoma accounted for 8.39% (95% uncertainty intervals [UIs]: 6.54, 10.29) of all blindness and 1.41% (95% UI: 1.10, 1.75) of all MSVI. Regionally, the highest proportion of blindness relating to glaucoma was found in high-income countries (26.12% [95% UI: 20.72, 32.09]), while the region with the highest age-standardized prevalence of glaucoma-related blindness and MSVI was Sub-Saharan Africa. Between 2000 and 2020, global age-standardized prevalence of glaucoma-related blindness among adults >= 50 years decreased by 26.06% among males (95% UI: 25.87, 26.24), and by 21.75% among females (95% UI: 21.54, 21.96), while MSVI due to glaucoma increased by 3.7% among males (95% UI: 3.42, 3.98), and by 7.3% in females (95% UI: 7.01, 7.59). Conclusions Within the last two decades, glaucoma has remained a major cause of blindness globally and regionally
Global Investments in Pandemic Preparedness and Covid-19: Development Assistance and Domestic Spending on Health Between 1990 and 2026
No full textAmeyaw, Edward Kwabena/0000-0002-6617-237X; Gunawardane, Damitha Asanga/0000-0001-8844-296X; Khajuria, Himanshu/0000-0002-2438-0007; Senthilkumaran, Subramanian/0000-0001-5262-8367; Fattahi, Hamed/0000-0001-7011-3797; KAAMBWA, BILLINGSLEY/0000-0002-2128-3404; Zaman, Burhan/0000-0002-6480-7693; Al-Hanawi, Mohammed/0000-0002-8419-2219; Krishan, Kewal/0000-0001-5321-0958; Ranabhat, Chhabi L/0000-0002-4460-2121; Berezvai, Zombor/0000-0001-7807-2977; Iradukunda, Arnaud/0000-0002-0995-800X; Mostafavi, Ebrahim/0000-0003-3958-5002; Aruleba, Raphael/0000-0003-0879-344X; Okonji, Osaretin Christabel/0000-0002-1511-2094; Vervoort, Dominique/0000-0002-3142-0388; Catala-Lopez, Ferran/0000-0002-3833-9312; Chattu, Vijay Kumar/0000-0001-9840-8335; Naimzada, Mukhammad David/0000-0002-7894-6029; Rahim, Fakher/0000-0002-2857-4562; Joo, Tamas/0000-0002-3551-6125; Mesregah, Mohamed/0000-0002-8047-9159; Abbas, Jaffar/0000-0002-8830-1435; Goshu, Yitayal Ayalew/0000-0002-3760-4903; Alhassan, Robert Kaba/0000-0003-4227-4854; Guha, Avirup/0000-0003-0253-1174; Batiha, Prof.Dr. Abdul-Monim/0009-0003-8933-7637; Dandona, Rakhi/0000-0003-0926-788X; Hezam, Kamal/0000-0001-8551-8383; Palladino, Raffaele/0000-0002-3437-812X; Hussien, Mohammed/0000-0002-5747-8967; Majeed, Azeem/0000-0002-2357-9858; El Tantawi, Maha/0000-0003-4989-6584; Freitas, Alberto/0000-0003-2113-9653; Kadel, Rajendra/0000-0002-2547-6342; Satpathy, Maheswar/0000-0003-3521-4781; Wassie, Gizachew Tadesse/0000-0001-6213-0191; Lee, Wei Chen/0000-0003-4333-5444; Yunusa, Ismaeel/0000-0002-9107-8561; Tufa, Derara Girma/0000-0002-4905-1189; Barrow, Amadou/0000-0002-6006-9355; Khafaie, Morteza Abdullatif/0000-0002-1651-3017; Mathews, Elezebeth/0000-0002-0663-9644; /0000-0002-4876-6043; Lorenzovici, Laszlo/0000-0002-1817-2674; Shenoy M, Suchitra/0000-0003-1425-0097; Desye, Belay/0000-0001-5265-0994; Mirza, Moonis/0000-0002-8844-7311; Murthy, Shruti/0000-0002-1523-8244; Isola, Gaetano/0000-0003-4267-6992; Damtew, Mesfin Gebrehiwot/0000-0002-8124-5151; ALVIS-ZAKZUK, NELSON J./0000-0001-9382-214X; Ratan, Dr. Zubair Ahmed/0000-0001-7309-9599; LENZI, JACOPO/0000-0003-2882-4223; Meretoja, Atte/0000-0001-6433-1931; Gerema, Urge/0000-0001-5286-5100; Otstavnov, Stanislav/0000-0003-2043-495X; Zare Dehnavi, Ali/0000-0002-8584-6579; Akelew, Yibeltal/0000-0002-8843-3913; Prada Rios, Sergio Ivan/0000-0001-7986-0959; Kumar, G Anil/0000-0002-7986-0905; Debela, Sisay Abebe/0000-0001-7824-7562; Shanawaz, Mohd/0000-0001-6306-8633; Lee, Yo Han/0000-0002-9631-9969; Ayanore, Martin/0000-0002-4095-3047; KM, Shivakumar/0000-0002-8062-9209; Stefan, Simona Catalina/0000-0003-4731-6785; Hoque, Mohammad Enamul/0000-0002-5188-0736; Fatehizadeh, Ali/0000-0001-6067-0637; Wickramasinghe, Nuwan Darshana/0000-0001-6025-6022; Dadras, Omid/0000-0001-9385-2170; Perna, Simone/0000-0002-2720-1473; Dodangeh, Milad/0000-0001-6974-7346; Santos, Joao Vasco/0000-0003-4696-1002; Maude, Richard/0000-0002-5355-0562; Santric Milicevic, Milena/0000-0002-0684-359X; Mossialos, Elias/0000-0001-8664-9297; Tichopad, Ales/0000-0002-1308-0877; Alanzi, Turki/0000-0001-6598-1274; Nayak, Biswa Prakash/0000-0002-5680-269X; Suleman, Muhammad/0000-0003-2914-1862; Getnet Kassa, Bekalu/0000-0003-2837-922X; Bhaskar, Sonu/0000-0002-9783-3628; Machado, Vanessa/0000-0003-2503-260X; Saad, Aly/0000-0002-0764-1068; NZOPUTAM, CHIMEZIE/0000-0002-7552-9545; Jurisson, Mikk/0000-0002-4487-7045; , Pawar/0000-0002-6157-2462; Kandel, Himal/0000-0002-6745-6411; Martorell, Miquel/0000-0003-3183-7623; Fowobaje, Kayode/0000-0002-3995-160X; Lee, Shaun/0000-0001-7361-6576; Sathian, Brijesh/0000-0003-0851-4762; Abrigo, Michael R.M./0000-0002-8187-4302; Hay, Simon/0000-0002-0611-7272; Karanth, Shama/0000-0001-5371-6908; Meretoja, Tuomo/0000-0002-2691-0710; Keskin, Cumali/0000-0003-3758-0654; Servan-Mori, Edson/0000-0001-9820-8325; khader, yousef/0000-0002-7830-6857; solomon, yonatan/0000-0002-7798-7267; Buendia, Jefferson Antonio/0000-0003-2404-6612; Sharew, Nigussie Tadesse/0000-0002-6443-6992; Petermann Rocha, Fanny/0000-0002-4384-4962; Fischer, Florian/0000-0002-4388-1245; mohammadi, mokhtar/0000-0002-1393-5062; BALTAZAR MENDES, JOSE JOAO/0000-0003-0167-4077; Zuhlke, Liesl Joanna/0000-0003-3961-2760; Ghafourifard, Mansour/0000-0002-3771-5152; Skhvitaridze, Natia/0000-0002-0312-4151; Nzoputam, Ogochukwu/0000-0002-4043-6605; Alvis-Guzman, Nelson/0000-0001-9458-864X; Alam, Khurshid/0000-0002-7402-7519; Immurana, Mustapha/0000-0001-5711-7566; Golinelli, Davide/0000-0001-7331-9520; Fekadu, Ginenus/0000-0002-4926-0685; akbarialiabad, Hossein/0000-0003-2018-6378; NZOPUTAM, OGOCHUKWU/0000-0002-4508-4928; Rahman, Md. Mosiur/0000-0002-0612-8369; Kompani, Farzad/0000-0001-6090-4595; Rashedi, Sina/0000-0003-0146-5611; Dube, John/0000-0002-5326-8188; Keshri, MD, PhD, Vikash R./0000-0001-6668-0107; Samy, Abdallah/0000-0003-3978-1134; Rashid, Tarik A/0000-0002-8661-258X; Ismail, Nahlah Elkudssiah/0000-0002-4274-8581; Saeed, Umar/0000-0002-9740-0371; Mohammadian-Hafshejani, Abdollah/0000-0002-2961-2719; Redwan, Elrashdy M./0000-0001-8246-0075; Botelho, Joao/0000-0002-1019-8263; Mantovani, Lorenzo Giovanni/0000-0003-3866-8199; Mpundu-Kaambwa, Christine/0000-0002-8152-6068; Cahuana-Hurtado, Lucero/0000-0002-9438-1443; Ghanbari, Reza/0000-0001-9296-4293; Abolhassani, Hassan/0000-0002-4838-0407; Mohammed, Shafiu/0000-0001-5715-966X; /0000-0002-9160-6846; Rashidi, Mohammad-Mahdi/0000-0002-7460-6000; Saki, Morteza/0000-0001-7419-0116; Rezaei, Nazila/0000-0003-4241-1783; Oancea, Bogdan/0000-0001-6987-5137; Mirrakhimov, Erkin/0000-0003-2982-6108; Ancuceanu, Robert/0000-0002-9369-3314; Petcu, Ionela-Roxana/0000-0001-7262-4371; YIGIT, Vahit/0000-0002-9805-8504; Monasta, Lorenzo/0000-0001-7774-548X; Vasic, Milena/0000-0001-6340-9338Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US7 center dot 3 trillion (95% UI 7 center dot 2-7 center dot 4) in 2019; 293 center dot 7 times the 43 center dot 1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, 37 center dot 8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12 center dot 2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health -related COVID-19 response is 252 center dot 2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11-21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained.Bill & Melinda Gates Foundation; Grants-in-Aid for Scientific Research [19K19432, 21KK0293] Funding Source: KAKENBill & Melinda Gates Foundation
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textRegular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.Research reported in this publication was supported by the Bill & Melinda Gates Foundation; Queensland Department of Health, Australia; UK Department of Health and Social Care; the Norwegian Institute of Public Health; St Jude Children’s Research Hospital; and the New Zealand Ministry of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. The Palestinian Central Bureau of Statistics granted the researchers access to relevant data in accordance with license number SLN2014-3-170, after subjecting data to processing aiming to preserve the confidentiality of individual data in accordance with the General Statistics Law–2000. The researchers are solely responsible for the conclusions and inferences drawn upon available data. Collection of these data was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00.Peer ReviewedArticle signat per 2000 autors/es: Mohsen Naghavi , Kanyin Liane Ong , Amirali Aali , Hazim S Ababneh , Yohannes Habtegiorgis Abate , Cristiana Abbafati , Rouzbeh Abbasgholizadeh , Mohammadreza Abbasian , Mohsen Abbasi-Kangevari , Hedayat Abbastabar , Samar Abd ElHafeez , Michael Abdelmasseh , Sherief Abd-Elsalam , Ahmed Abdelwahab , Mohammad Abdollahi , Mohammad-Amin Abdollahifar , Meriem Abdoun , Deldar Morad Abdulah , Auwal Abdullahi , Mesfin Abebe , Samrawit Shawel Abebe , Aidin Abedi , Kedir Hussein Abegaz , E S Abhilash , Hassan Abidi , Olumide Abiodun , Richard Gyan Aboagye , Hassan Abolhassani , Meysam Abolmaali , Mohamed Abouzid , Girma Beressa Aboye , Lucas Guimarães Abreu , Woldu Aberhe Abrha , Dariush Abtahi , Samir Abu Rumeileh , Hasan Abualruz , Bilyaminu Abubakar , Eman Abu-Gharbieh , Niveen ME Abu-Rmeileh , Salahdein Aburuz , Ahmed Abu-Zaid , Manfred Mario Kokou Accrombessi , Tadele Girum Adal , Abdu A Adamu , Isaac Yeboah Addo , Giovanni Addolorato , Akindele Olupelumi Adebiyi , Victor Adekanmbi , Abiola Victor Adepoju , Charles Oluwaseun Adetunji , Juliana Bunmi Adetunji , Temitayo Esther Adeyeoluwa , Daniel Adedayo Adeyinka , Olorunsola Israel Adeyomoye , Biruk Adie Adie Admass , Qorinah Estiningtyas Sakilah Adnani , Saryia Adra , Aanuoluwapo Adeyimika Afolabi , Muhammad Sohail Afzal , Saira Afzal , Suneth Buddhika Agampodi , Pradyumna Agasthi , Manik Aggarwal , Shahin Aghamiri , Feleke Doyore Agide , Antonella Agodi , Anurag Agrawal , Williams Agyemang-Duah , Bright Opoku Ahinkorah , Aqeel Ahmad , Danish Ahmad , Firdos Ahmad , Muayyad M Ahmad , Sajjad Ahmad , Shahzaib Ahmad , Tauseef Ahmad , Keivan Ahmadi , Amir Mahmoud Ahmadzade , Ali Ahmed , Ayman Ahmed , Haroon Ahmed , Luai A Ahmed , Mehrunnisha Sharif Ahmed , Meqdad Saleh Ahmed , Muktar Beshir Ahmed , Syed Anees Ahmed , Marjan Ajami , Budi Aji , Essona Matatom Akara , Hossein Akbarialiabad , Karolina Akinosoglou , Tomi Akinyemiju , Mohammed Ahmed Akkaif , Samuel Akyirem , Hanadi Al Hamad , Syed Mahfuz Al Hasan , Fares Alahdab , Samer O Alalalmeh , Tariq A Alalwan , Ziyad Al-Aly , Khurshid Alam , Manjurul Alam , Noore Alam , Rasmieh Mustafa Al-amer , Fahad Mashhour Alanezi , Turki M Alanzi , Sayer Al-Azzam , Almaza Albakri , Mohammed Albashtawy , Mohammad T AlBataineh , Jacqueline Elizabeth Alcalde-Rabanal , Khalifah A Aldawsari , Wafa A Aldhaleei , Robert W Aldridge , Haileselasie Berhane Alema , Mulubirhan Assefa Alemayohu , Sharifullah Alemi , Yihun Mulugeta Alemu , Adel Ali Saeed Al-Gheethi , Khalid F Alhabib , Fadwa Alhalaiqa Naji Alhalaiqa , Mohammed Khaled Al-Hanawi , Abid Ali , Amjad Ali , Liaqat Ali , Mohammed Usman Ali , Rafat Ali , Shahid Ali , Syed Shujait Shujait Ali , Gianfranco Alicandro , Sheikh Mohammad Alif , Reyhaneh Alikhani , Yousef Alimohamadi , Ahmednur Adem Aliyi , Mohammad A M Aljasir , Syed Mohamed Aljunid , François Alla , Peter Allebeck , Sabah Al-Marwani , Sadeq Ali Ali Al-Maweri , Joseph Uy Almazan , Hesham M Al-Mekhlafi , Louay Almidani , Omar Almidani , Mahmoud A Alomari , Basem Al-Omari , Jordi Alonso , Jaber S Alqahtani , Shehabaldin Alqalyoobi , Ahmed Yaseen Alqutaibi , Salman Khalifah Al-Sabah , Zaid Altaany , Awais Altaf , Jaffar A Al-Tawfiq , Khalid A Altirkawi , Deborah Oyine Aluh , Nelson Alvis-Guzman , Hassan Alwafi , Yaser Mohammed Al-Worafi , Hany Aly , Safwat Aly , Karem H Alzoubi , Reza Amani , Azmeraw T Amare , Prince M Amegbor , Edward Kwabena Ameyaw , Tarek Tawfik Amin , Alireza Amindarolzarbi , Sohrab Amiri , Mohammad Hosein Amirzade-Iranaq , Hubert Amu , Dickson A Amugsi , Ganiyu Adeniyi Amusa , Robert Ancuceanu , Deanna Anderlini , David B Anderson , Pedro Prata Andrade , Catalina Liliana Andrei , Tudorel Andrei , Colin Angus , Abhishek Anil , Sneha Anil , Amir Anoushiravani , Hossein Ansari , Ansariadi Ansariadi , Alireza Ansari-Moghaddam , Catherine M Antony , Ernoiz Antriyandarti , Davood Anvari , Saeid Anvari , Saleha Anwar , Sumadi Lukman Anwar , Razique Anwer , Anayochukwu Edward Anyasodor , Muhammad Aqeel , Juan Pablo Arab , Jalal Arabloo , Mosab Arafat , Aleksandr Y Aravkin , Demelash Areda , Abdulfatai Aremu , Olatunde Aremu , Hany Ariffin , Mesay Arkew , Benedetta Armocida , Michael Benjamin Arndt , Johan Ärnlöv , Mahwish Arooj , Anton A Artamonov , Judie Arulappan , Raphael Taiwo Aruleba , Ashokan Arumugam , Malke Asaad , Mohsen Asadi-Lari , Akeza Awealom Asgedom , Mona Asghariahmadabad , Mohammad Asghari-Jafarabadi , Muhammad Ashraf , Armin Aslani , Thomas Astell-Burt , Mohammad Athar , Seyyed Shamsadin Athari , Bantalem Tilaye Tilaye Atinafu , Habtamu Wondmagegn Atlaw , Prince Atorkey , Maha Moh'd Wahbi Atout , Alok Atreya , Avinash Aujayeb , Marcel Ausloos , Abolfazl Avan , Atalel Fentahun Awedew , Amlaku Mulat Aweke , Beatriz Paulina Ayala Quintanilla , Haleh Ayatollahi , Jose L Ayuso-Mateos , Seyed Mohammad Ayyoubzadeh , Sina Azadnajafabad , Rui M S Azevedo , Ahmed Y Azzam , Darshan B B , Abraham Samuel Babu , Muhammad Badar , Ashish D Badiye , Soroush Baghdadi , Nasser Bagheri , Sara Bagherieh , Sulaiman Bah , Saeed Bahadorikhalili , Najmeh Bahmanziari , Ruhai Bai , Atif Amin Baig , Jennifer L Baker , Abdulaziz T Bako , Ravleen Kaur Bakshi , Senthilkumar Balakrishnan , Madhan Balasubramanian , Ovidiu Constantin Baltatu , Kiran Bam , Maciej Banach , Soham Bandyopadhyay , Palash Chandra Banik , Hansi Bansal , Kannu Bansal , Franca Barbic , Martina Barchitta , Mainak Bardhan , Erfan Bardideh , Suzanne Lyn Barker-Collo , Till Winfried Bärnighausen , Francesco Barone-Adesi , Hiba Jawdat Barqawi , Lope H Barrero , Amadou Barrow , Sandra Barteit , Lingkan Barua , Zarrin Basharat , Azadeh Bashiri , Afisu Basiru , Pritish Baskaran , Buddha Basnyat , Quique Bassat , João Diogo Basso , Ann V L Basting , Sanjay Basu , Kavita Batra , Bernhard T Baune , Mohsen Bayati , Nebiyou Simegnew Bayileyegn , Thomas Beaney , Neeraj Bedi , Massimiliano Beghi , Emad Behboudi , Priyamadhaba Behera , Amir Hossein Behnoush , Masoud Behzadifar , Maryam Beiranvand , Diana Fernanda Bejarano Ramirez , Yannick Béjot , Sefealem Assefa Belay , Chalie Mulu Belete , Michelle L Bell , Muhammad Bashir Bello , Olorunjuwon Omolaja Bello , Luis Belo , Apostolos Beloukas , Rose Grace Bender , Isabela M Bensenor , Azizullah Beran , Zombor Berezvai , Alemshet Yirga Berhie , Betyna N Berice , Robert S Bernstein , Gregory J Bertolacci , Paulo J G Bettencourt , Kebede A Beyene , Devidas S Bhagat , Akshaya Srikanth Bhagavathula , Neeraj Bhala , Ashish Bhalla , Dinesh Bhandari , Kayleigh Bhangdia , Nikha Bhardwaj , Pankaj Bhardwaj , Prarthna V Bhardwaj , Ashish Bhargava , Sonu Bhaskar , Vivek Bhat , Gurjit Kaur Bhatti , Jasvinder Singh Bhatti , Manpreet S Bhatti , Rajbir Bhatti , Zulfiqar A Bhutta , Boris Bikbov , Jessica Devin Bishai , Catherine Bisignano , Francesca Bisulli , Atanu Biswas , Bijit Biswas , Saeid Bitaraf , Bikes Destaw Bitew , Veera R Bitra , Tone Bjørge , Micheal Kofi Boachie , Mary Sefa Boampong , Anca Vasilica Bobirca , Virginia Bodolica , Aadam Olalekan Bodunrin , Eyob Ketema Bogale , Kassawmar Angaw Bogale , Somayeh Bohlouli , Obasanjo Afolabi Bolarinwa , Archith Boloor , Milad Bonakdar Hashemi , Aime Bonny , Kaustubh Bora , Berrak Bora Basara , Hamed Borhany , Arturo Borzutzky , Souad Bouaoud , Antoine Boustany , Christopher Boxe , Edward J Boyko , Oliver J Brady , Dejana Braithwaite , Luisa C Brant , Michael Brauer , Alexandra Brazinova , Javier Brazo-Sayavera , Nicholas J K Breitborde , Susanne Breitner , Hermann Brenner , Andrey Nikolaevich Briko , Nikolay Ivanovich Briko , Gabrielle Britton , Julie Brown , Traolach Brugha , Norma B Bulamu , Lemma N Bulto , Danilo Buonsenso , Richard A Burns , Reinhard Busse , Yasser Bustanji , Nadeem Shafique Butt , Zahid A Butt , Florentino Luciano Caetano dos Santos , Daniela Calina , Luis Alberto Cámera , Luciana Aparecida Campos , Ismael R Campos-Nonato , Chao Cao , Yin Cao , Angelo Capodici , Rosario Cárdenas , Sinclair Carr , Giulia Carreras , Juan J Carrero , Andrea Carugno , Cristina G Carvalheiro , Felix Carvalho , Márcia Carvalho , Joao Mauricio Castaldelli-Maia , Carlos A Castañeda-Orjuela , Giulio Castelpietra , Ferrán Catalá-López , Alberico L Catapano , Maria Sofia Cattaruzza , Christopher R Cederroth , Luca Cegolon , Francieli Cembranel , Muthia Cenderadewi , Kelly M Cercy , Ester Cerin , Muge Cevik , Joshua Chadwick , Yaacoub Chahine , Chiranjib Chakraborty , Promit Ananyo Chakraborty , Jeffrey Shi Kai Chan , Raymond N C Chan , Rama Mohan Chandika , Eeshwar K Chandrasekar , Chin-Kuo Chang , Jung-Chen Chang , Gashaw Sisay Chanie , Periklis Charalampous , Vijay Kumar Chattu , Pankaj Chaturvedi , Victoria Chatzimavridou-Grigoriadou , Akhilanand Chaurasia , Angela W Chen , An-Tian Chen , Catherine S Chen , Haowei Chen , Meng Xuan Chen , Simiao Chen , Ching-Yu Cheng , Esther T W Cheng , Nicolas Cherbuin , Wondimye Ashenafi Cheru , Ju-Huei Chien , Odgerel Chimed-Ochir , Ritesh Chimoriya , Patrick R Ching , Jesus Lorenzo Chirinos-Caceres , Abdulaal Chitheer , William C S Cho , Bryan Chong , Hitesh Chopra , Sonali Gajanan Choudhari , Rajiv Chowdhury , Devasahayam J Christopher , Isaac Sunday Chukwu , Eric Chung , Erin Chung , Eunice Chung , Sheng-Chia Chung , Muhammad Chutiyami , Zinhle Cindi , Iolanda Cioffi , Mareli M Claassens , Rafael M Claro , Kaleb Coberly , Rebecca M Cogen , Alyssa Columbus , Haley Comfort , Joao Conde , Samuele Cortese , Paolo Angelo Cortesi , Vera Marisa Costa , Simona Costanzo , Ewerton Cousin , Rosa A S Couto , Richard G Cowden , Kenneth Michael Cramer , Michael H Criqui , Natália Cruz-Martins , Silvia Magali Cuadra-Hernández , Garland T Culbreth , Patricia Cullen , Matthew Cunningham , Maria paula Curado , Sriharsha Dadana , Omid Dadras , Siyu Dai , Xiaochen Dai , Zhaoli Dai , Lachlan L Dalli , Giovanni Damiani , Jiregna Darega Gela , Jai K Das , Saswati Das , Subasish Das , Ana Maria Dascalu , Nihar Ranjan Dash , Mohsen Dashti , Anna Dastiridou , Gail Davey , Claudio Alberto Dávila-Cervantes , Nicole Davis Weaver , Kairat Davletov , Diego De Leo , Katie de Luca , Aklilu Tamire Debele , Shayom Debopadhaya , Louisa Degenhardt , Azizallah Dehghan , Lee Deitesfeld , Cristian Del Bo' , Ivan Delgado-Enciso , Berecha Hundessa Demessa , Andreas K Demetriades , Ke Deng , Xinlei Deng , Edgar Denova-Gutiérrez , Niloofar Deravi , Nebiyu Dereje , Nikolaos Dervenis , Emina Dervišević , Don C Des Jarlais , Hardik Dineshbhai Desai , Rupak Desai , Vinoth Gnana Chellaiyan Devanbu , Syed Masudur Rahman Dewan , Arkadeep Dhali , Kuldeep Dhama , Meghnath Dhimal , Sameer Dhingra , Vishal R Dhulipala , Diana Dias da Silva , Daniel Diaz , Michael J Diaz , Adriana Dima , Delaney D Ding , Huanghe Ding , Ricardo Jorge Dinis-Oliveira , M Ashworth Dirac , Shirin Djalalinia , Thao Huynh Phuong Do , Camila Bruneli do Prado , Saeid Doaei , Masoud Dodangeh , Milad Dodangeh , Sushil Dohare , Klara Georgieva Dokova , Christiane Dolecek , Regina-Mae Villanueva Dominguez , Wanyue Dong , Deepa Dongarwar , Mario D'Oria , Fariba Dorostkar , E Ray Dorsey , Wendel Mombaque dos Santos , Rajkumar Doshi , Leila Doshmangir , Robert Kokou Dowou , Tim Robert Driscoll , Haneil Larson Dsouza , Viola Dsouza , Mi Du , John Dube , Bruce B Duncan , Andre Rodrigues Duraes , Senbagam Duraisamy , Oyewole Christopher Durojaiye , Laura Dwyer-Lindgren , Paulina Agnieszka Dzianach , Arkadiusz Marian Dziedzic , Abdel Rahman E'mar , Ejemai Eboreime , Alireza Ebrahimi , Chidiebere Peter Echieh , Hisham Atan Edinur , David Edvardsson , Kristina Edvardsson , Defi Efendi , Ferry Efendi , Diyan Ermawan Effendi , Terje Andreas Eikemo , Ebrahim Eini , Michael Ekholuenetale , Temitope Cyrus Ekundayo , Iman El Sayed , Iffat Elbarazi , Teshome Bekele Elema , Noha Mousaad Elemam , Frank J Elgar , Islam Y Elgendy , Ghada Metwally Tawfik ElGohary , Hala Rashad Elhabashy , Muhammed Elhadi , Waseem El-Huneidi , Legesse Tesfaye Elilo , Omar Abdelsadek Abdou Elmeligy , Mohamed A Elmonem , Mohammed Elshaer , Ibrahim Elsohaby , Theophilus I Emeto , Luchuo Engelbert Bain , Ryenchindorj Erkhembayar , Christopher Imokhuede Esezobor , Babak Eshrati , Sharareh Eskandarieh , Juan Espinosa-Montero , Habtamu Esubalew , Farshid Etaee , Natalia Fabin , Adewale Oluwaseun Fadaka , Adeniyi Francis Fagbamigbe , Ayesha Fahim , Saman Fahimi , Aliasghar Fakhri-Demeshghieh , Luca Falzone , Mohammad Fareed , Carla Sofia e Sá Farinha , MoezAlIslam Ezzat Mahmoud Faris , Pawan Sirwan Faris , Andre Faro , Abidemi Omolara Fasanmi , Ali Fatehizadeh , Hamed Fattahi , Nelsensius Klau Fauk , Pooria Fazeli , Valery L Feigin , Alireza Feizkhah , Ginenus Fekadu , Xiaoru Feng , Seyed-Mohammad Fereshtehnejad , Abdullah Hamid Feroze , Daniela Ferrante , Alize J Ferrari , Nuno Ferreira , Getahun Fetensa , Bikila Regassa Feyisa , Irina Filip , Florian Fischer , Joanne Flavel , David Flood , Bobirca Teodor Florin , Nataliya A Foigt , Morenike Oluwatoyin Folayan , Artem Alekseevich Fomenkov , Behzad Foroutan , Masoud Foroutan , Ingeborg Forthun , Daniela Fortuna , Matteo Foschi , Kayode Raphael Fowobaje , Kate Louise Francis , Richard Charles Franklin , Alberto Freitas , Joseph Friedman , Sara D Friedman , Takeshi Fukumoto , John E Fuller , Blima Fux , Peter Andras Gaal , Muktar A Gadanya , Abhay Motiramji Gaidhane , Santosh Gaihre , Emmanuela Gakidou , Yaseen Galali , Natalie C Galles , Silvano Gallus , Mandukhai Ganbat , Aravind P Gandhi , Balasankar Ganesan , Mohammad Arfat Ganiyani , MA Garcia-Gordillo , William M Gardner , Jalaj Garg , Naval Garg , Rupesh K Gautam , Semiu Olatunde Gbadamosi , Tilaye Gebru Gebi , Miglas W Gebregergis , Mesfin Gebrehiwot , Teferi Gebru Gebremeskel , Simona Roxana Georgescu , Tamirat Getachew , Peter W Gething , Molla Getie , Keyghobad Ghadiri , Sulmaz Ghahramani , Khalid Yaser Ghailan , Mohammad-Reza Ghasemi , Ghazal Ghasempour Dabaghi , Afsaneh Ghasemzadeh , Ahmad Ghashghaee , Fariba Ghassemi , Ramy Mohamed Ghazy , Ajnish Ghimire , Sama Ghoba , Maryam Gholamalizadeh , Asadollah Gholamian , Ali Gholamrezanezhad , Nasim Gholizadeh , Mahsa Ghorbani , Pooyan Ghorbani Vajargah , Aloke Gopal Ghoshal , Paramjit Singh Gill , Tiffany K Gill , Richard F Gillum , Themba G Ginindza , Alem Girmay , James C Glasbey , Elena V Gnedovskaya , Laszlo Göbölös , Myron Anthony Godinho , Amit Goel , Ali Golchin , Mohamad Goldust , Mahaveer Golechha , Pouya Goleij , Nelson G M Gomes , Philimon N Gona , Sameer Vali Gopalani , Giuseppe Gorini , Houman Goudarzi , Alessandra C Goulart , Bárbara Niegia Garcia Goulart , Anmol Goyal , Ayman Grada , Simon Matthew Graham , Michal Grivna , Giuseppe Grosso , Shi-Yang Guan , Giovanni Guarducci , Mohammed Ibrahim Mohialdeen Gubari , Mesay Dechasa Gudeta , Avirup Guha , Stefano Guicciardi , Rafael Alves Guimarães , Snigdha Gulati , Damitha Asanga Gunawardane , Sasidhar Gunturu , Cui Guo , Anish Kumar Gupta , Bhawna Gupta , Manoj Kumar Gupta , Mohak Gupta , Rajat Das Gupta , Rajeev Gupta , Sapna Gupta , Veer Bala Gupta , Vijai Kumar Gupta , Vivek Kumar Gupta , Lami Gurmessa , Reyna Alma Gutiérrez , Farrokh Habibzadeh , Parham Habibzadeh , Rasool Haddadi , Mostafa Hadei , Najah R Hadi , Nils Haep , Nima Hafezi-Nejad , Alemayehu Hailu , Arvin Haj-Mirzaian , Esam S Halboub , Brian J Hall , Sebastian Haller , Rabih Halwani , Randah R Hamadeh , Sajid Hameed , Samer Hamidi , Erin B Hamilton , Chieh Han , Qiuxia Han , Asif Hanif , Nasrin Hanifi , Graeme J Hankey , Fahad Hanna , Md Abdul Hannan , Md Nuruzzaman Haque , Harapan Harapan , Arief Hargono , Josep Maria Haro , Ahmed I Hasaballah , Ikramul Hasan , M Tasdik Hasan , Hamidreza Hasani , Mohammad Hasanian , Abdiwahab Hashi , Md Saquib Hasnain , Ikrama Hassan , Soheil Hassanipour , Hadi Hassankhani , Johannes Haubold , Rasmus J Havmoeller , Simon I Hay , Jiawei He , Jeffrey J Hebert , Omar E Hegazi , Golnaz Heidari , Mohammad Heidari , Mahsa Heidari-Foroozan , Bartosz Helfer , Delia Hendrie , Brenda Yuliana Herrera-Serna , Claudiu Herteliu , Hamed Hesami , Kamal Hezam , Catherine L Hill , Yuta Hiraike , Ramesh Holla , Nobuyuki Horita , Md Mahbub Hossain , Sahadat Hossain , Mohammad-Salar Hosseini , Hassan Hosseinzadeh , Mehdi Hosseinzadeh , Ahmad Hosseinzadeh Adli , Mihaela Hostiuc , Sorin Hostiuc , Mohamed Hsairi , Vivian Chia-rong Hsieh , Rebecca L Hsu , Chengxi Hu , Junjie Huang , Michael Hultström , Ayesha Humayun , Tsegaye Gebreyes Hundie , Javid Hussain , M Azhar Hussain , Nawfal R Hussein , Foziya Mohammed Hussien , Hong-Han Huynh , Bing-Fang Hwang , Segun Emmanuel Ibitoye , Khalid S Ibrahim , Pulwasha Maria Iftikhar , Desta Ijo , Adalia I Ikiroma , Kevin S Ikuta , Paul Chukwudi Ikwegbue , Olayinka Stephen Ilesanmi , Irena M Ilic , Milena D Ilic , Mohammad Tarique Imam , Mustapha Immurana , Sumant Inamdar , Endang Indriasih , Muhammad Iqhrammullah , Arnaud Iradukunda , Kenneth Chukwuemeka Iregbu , Md Rabiul Islam , Sheikh Mohammed Shariful Islam , Farhad Islami , Faisal Ismail , Nahlah Elkudssiah Ismail , Hiroyasu Iso , Gaetano Isola , Masao Iwagami , Chidozie C D Iwu , Ihoghosa Osamuyi Iyamu , Mahalaxmi Iyer , Linda Merin J , Jalil Jaafari , Louis Jacob , Kathryn H Jacobsen , Farhad Jadidi-Niaragh , Morteza Jafarinia , Abdollah Jafarzadeh , Khushleen Jaggi , Kasra Jahankhani , Nader Jahanmehr , Haitham Jahrami , Nityanand Jain , Ammar Abdulrahman Jairoun , Abhishek Jaiswal , Elham Jamshidi , Mark M Janko , Abubakar Ibrahim Jatau , Sabzali Javadov , Tahereh Javaheri , Sathish Kumar Jayapal , Shubha Jayaram , Rime Jebai , Sun Ha Jee , Jayakumar Jeganathan , Anil K Jha , Ravi Prakash Jha , Heng Jiang , Yingzhao Jin , Olatunji Johnson , Mohammad Jokar , Jost B Jonas , Tamas Joo , Abel Joseph , Nitin Joseph , Charity Ehimwenma Joshua , Grace Joshy , Jacek Jerzy Jozwiak , Mikk Jürisson , Vaishali K , Billingsley Kaambwa , Ali Kabir , Zubair Kabir , Vidya Kadashetti , Dler Hussein Kadir , Rizwan Kalani , Laleh R Kalankesh , Leila R Kalankesh , Feroze Kaliyadan , Sanjay Kalra , Vineet Kumar Kamal , Sivesh Kathir Kamarajah , Rajesh Kamath , Zahra Kamiab , Naser Kamyari , Thanigaivelan Kanagasabai , Tanuj Kanchan , Himal Kandel , Arun R Kanmanthareddy , Edmund Wedam Kanmiki , Kehinde Kazeem Kanmodi , Suthanthira Kannan S , Sushil Kumar Kansal , Rami S Kantar , Neeti Kapoor , Mehrdad Karajizadeh , Shama D Karanth , Reema A Karasneh , Ibraheem M Karaye , André Karch , Asima Karim , Salah Eddin Karimi , Arman Karimi Behnagh , Faizan Zaffar Kashoo , Qalandar Hussein Abdulkarim Kasnazani , Hengameh Kasraei , Nicholas J Kassebaum , Molly B Kassel , Joonas H Kauppila , Navjot Kaur , Norito Kawakami , Gbenga A Kayode , Foad Kazemi , Sina Kazemian , Tahseen Haider Kazmi , Getu Mosisa Kebebew , Adera Debella Kebede , Fassikaw Kebede , Tibebeselassie S Keflie , Peter Njenga Keiyoro , Cathleen Keller , Jaimon Terence Kelly , John H Kempen , Jessica A Kerr , Emmanuelle Kesse-Guyot , Himanshu Khajuria , Amirmohammad Khalaji , Nauman Khalid , Anees Ahmed Khalil , Alireza Khalilian , Faham Khamesipour , Ajmal Khan , Asaduzzaman Khan , Gulfaraz Khan , Ikramullah Khan , Imteyaz A Khan , M Nuruzzaman Khan , Maseer Khan , Mohammad Jobair Khan , Moien AB Khan , Zeeshan Ali Khan , Mahammed Ziauddin Khan suheb , Shaghayegh Khanmohammadi , Khaled Khatab , Fatemeh Khatami , Haitham Khatatbeh , Moawiah Mohammad Khatatbeh , Armin Khavandegar , Hamid Reza Khayat Kashani , Feriha Fatima Khidri , Elaheh Khodadoust , Mohammad Khorgamphar , Moein Khormali , Zahra Khorrami , Ahmad Khosravi , Mohammad Ali Khosravi , Zemene Demelash Kifle , Grace Kim , Jihee Kim , Kwanghyun Kim , Min Seo Kim , Yun Jin Kim , Ruth W Kimokoti , Kasey E Kinzel , Adnan Kisa , Sezer Kisa , Desmond Klu , Ann Kristin Skrindo Knudsen , Jonathan M Kocarnik , Sonali Kochhar , Timea Kocsis , David S Q Koh , Ali-Asghar Kolahi , Kairi Kolves , Farzad Kompani , Gerbrand Koren , Soewarta Kosen , Karel Kostev , Parvaiz A Koul , Sindhura Lakshmi Koulmane Laxminarayana , Kewal Krishan , Hare Krishna , Varun Krishna , Vijay Krishnamoorthy , Yuvaraj Krishnamoorthy , Kris J Krohn , Barthelemy Kuate Defo , Burcu Kucuk Bicer , Md Abdul Kuddus , Mohammed Kuddus , Ilari Kuitunen , Mukhtar Kulimbet , Vishnutheertha Kulkarni , Akshay Kumar , Ashish Kumar , Harish Kumar , Manasi Kumar , Rakesh Kumar , Madhulata Kumari , Fantahun Tarekegn Kumie , Satyajit Kundu , Om P Kurmi , Asep Kusnali , Dian
Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019
No full textChronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.
© 2025. The Author(s)
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100 : a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textNatalia V Bhattacharjee, Austin E Schumacher, Amirali Aali, Yohannes Habtegiorgis Abate, Rouzbeh Abbasgholizadeh, Mohammadreza Abbasian, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Samar Abd ElHafeez, Sherief Abd-Elsalam, Mohammad Abdollahi, Mohammad-Amin Abdollahifar, Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe, Samrawit Shawel Abebe, Olumide Abiodun, Hassan Abolhassani, Meysam Abolmaali, Mohamed Abouzid, Girma Beressa Aboye, Lucas Guimarães Abreu, Woldu Aberhe Abrha, Michael R M Abrigo, Dariush Abtahi, Hasan Abualruz, Bilyaminu Abubakar, Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh, Tadele Girum Girum Adal, Mesafint Molla Adane, Oluwafemi Atanda Adeagbo Adeagbo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Bashir Aden, Abiola Victor Adepoju, Olatunji O Adetokunboh, Juliana Bunmi Adetunji, Daniel Adedayo Adeyinka, Olorunsola Israel Adeyomoye, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Rotimi Felix Afolabi, Shadi Afyouni, Muhammad Sohail Afzal, Saira Afzal, Shahin Aghamiri, Antonella Agodi, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Austin J Ahlstrom, Aqeel Ahmad, Danish Ahmad, Firdos Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Luai A Ahmed, Meqdad Saleh Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Gizachew Taddesse Akalu, Hossein Akbarialiabad, Rufus Olusola Akinyemi, Mohammed Ahmed Akkaif, Sreelatha Akkala, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Mohammad Al Qadire, Tareq Mohammed Ali AL-Ahdal, Samer O Alalalmeh, Tariq A Alalwan, Ziyad Al-Aly, Khurshid Alam, Rasmieh Mustafa Al-amer, Fahad Mashhour Alanezi, Turki M Alanzi, Almaza Albakri, Mohammed Albashtawy, Mohammad T AlBataineh, Hediyeh Alemi, Sharifullah Alemi, Yihun Mulugeta Alemu, Ayman Al-Eyadhy, Adel Ali Saeed Al-Gheethi, Khalid F Alhabib, Noora Alhajri, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Abid Ali, Beriwan Abdulqadir Ali, Liaqat Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Shujait Ali, Sheikh Mohammad Alif, Mohammad Aligol, Mehran Alijanzadeh, Mohammad A M Aljasir, Syed Mohamed Aljunid, Sabah Al-Marwani, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Omar Almidani, Mahmoud A Alomari, Basem Al-Omari, Jaber S Alqahtani, Ahmed Yaseen Alqutaibi, Rajaa M Al-Raddadi, Salman Khalifah Al-Sabah, Awais Altaf, Jaffar A Al-Tawfiq, Khalid A Altirkawi, Deborah Oyine Aluh, Farrukh Jawad Alvi, Nelson Alvis-Guzman, Hassan Alwafi, Yaser Mohammed Al-Worafi, Hany Aly, Safwat Aly, Karem H Alzoubi, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Alireza Amindarolzarbi, Mostafa Amini-Rarani, Sohrab Amiri, Irene Gyamfuah Ampomah, Dickson A Amugsi, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Deanna Anderlini, Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei, Abhishek Anil, Sneha Anil, Adnan Ansar, Alireza Ansari-Moghaddam, Catherine M Antony, Ernoiz Antriyandarti, Saeid Anvari, SALEHA ANWAR, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Razman Arabzadeh Bahri, Elshaimaa A Arafa, Mosab Arafat, Ana Margarida Araújo, Aleksandr Y Aravkin, Abdulfatai Aremu, Timur Aripov, Mesay Arkew, Benedetta Armocida, Johan Ärnlöv, Mahwish Arooj, Anton A Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Ashokan Arumugam, Mohsen Asadi-Lari, Zatollah Asemi, Saeed Asgary, Mona Asghariahmadabad, Mohammad Asghari-Jafarabadi, Mubarek Yesse Ashemo, Muhammad Ashraf, Tahira Ashraf, Marvellous O Asika, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Alok Atreya, Avinash Aujayeb, Marcel Ausloos, Abolfazl Avan, Amlaku Mulat Aweke, Getnet Melaku Ayele, Seyed Mohammad Ayyoubzadeh, Sina Azadnajafabad, Rui M S Azevedo, Ahmed Y Azzam, Muhammad Badar, Ashish D Badiye, Soroush Baghdadi, Nasser Bagheri, Sara Bagherieh, Najmeh Bahmanziari, Ruhai Bai, Atif Amin Baig, Jennifer L Baker, Abdulaziz T Bako, Ravleen Kaur Bakshi, Madhan Balasubramanian, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Palash Chandra Banik, Hansi Bansal, Mehmet Firat Baran, Martina Barchitta, Mainak Bardhan, Erfan Bardideh, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Sandra Barteit, Zarrin Basharat, Asma'u I J Bashir, Hameed Akande Bashiru, Afisu Basiru, João Diogo Basso, Sanjay Basu, Abdul-Monim Mohammad Batiha, Kavita Batra, Bernhard T Baune, Mohsen Bayati, Tahmina Begum, Emad Behboudi, Amir Hossein Behnoush, Maryam Beiranvand, Diana Fernanda Bejarano Ramirez, Alehegn Bekele, Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Michelle L Bell, Olorunjuwon Omolaja Bello, Apostolos Beloukas, Isabela M Bensenor, Zombor Berezvai, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Paulo J G Bettencourt, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Prarthna V Bhardwaj, Sonu Bhaskar, Vivek Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti, Rajbir Bhatti, Antonio Biondi, Catherine Bisignano, Atanu Biswas, Raaj Kishore Biswas, Veera R Bitra, Tone Bjørge, Elye Bliss, Micheal Kofi Boachie, Anca Vasilica Bobirca, Virginia Bodolica, Aadam Olalekan Bodunrin, Eyob Ketema Bogale, Kassawmar Angaw Bogale, Milad Bonakdar Hashemi, Berrak Bora Basara, Souad Bouaoud, Dejana Braithwaite, Michael Brauer, Nicholas J K Breitborde, Dana Bryazka, Norma B Bulamu, Danilo Buonsenso, Katrin Burkart, Richard A Burns, Yasser Bustanji, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Daniela Calina, Ismael R Campos-Nonato, Fan Cao, Shujin Cao, Angelo Capodici, Giulia Carreras, Andrea Carugno, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Maria Sofia Cattaruzza, Arthur Caye, Luca Cegolon, Francieli Cembranel, Ester Cerin, Joshua Chadwick, Yaacoub Chahine, Chiranjib Chakraborty, Julian Chalek, Jeffrey Shi Kai Chan, Periklis Charalampous, Vijay Kumar Chattu, Sarika Chaturvedi, Malizgani Paul Chavula, An-Tian Chen, Haowei Chen, Simiao Chen, Gerald Chi, Fatemeh Chichagi, Ju-Huei Chien, Patrick R Ching, William C S Cho, Sungchul Choi, Bryan Chong, Hitesh Chopra, Sonali Gajanan Choudhari, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Eric Chung, Sheng-Chia Chung, Zinhle Cindi, Iolanda Cioffi, Raffaela Ciuffreda, Rafael M Claro, Kaleb Coberly, Alyssa Columbus, Haley Comfort, Joao Conde, Michael H Criqui, Natália Cruz-Martins, Silvia Magali Cuadra-Hernández, Sriharsha Dadana, Omid Dadras, Tukur Dahiru, Zhaoli Dai, Bronte Dalton, Giovanni Damiani, Aso Mohammad Darwesh, Jai K Das, Saswati Das, Mohsen Dashti, Anna Dastiridou, Claudio Alberto Dávila-Cervantes, Kairat Davletov, Aklilu Tamire Debele, Shayom Debopadhaya, Somayeh Delavari, Ivan Delgado-Enciso, Dessalegn Demeke, Berecha Hundessa Demessa, Xinlei Deng, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Hardik Dineshbhai Desai, Rupak Desai, Vinoth Gnana Chellaiyan Devanbu, Arkadeep Dhali, Kuldeep Dhama, Meghnath Dhimal, Vishal R Dhulipala, Diana Dias da Silva, Daniel Diaz, Michael J Diaz, Adriana Dima, Delaney D Ding, M Ashworth Dirac, Thanh Chi Do, Thao Huynh Phuong Do, Camila Bruneli do Prado, Sushil Dohare, Wanyue Dong, Mario D'Oria, Wendel Mombaque dos Santos, Leila Doshmangir, Robert Kokou Dowou, Ashel Chelsea Dsouza, Haneil Larson Dsouza, Viola Dsouza, John Dube, Joe Duprey, Andre Rodrigues Duraes, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Sulagna Dutta, Laura Dwyer-Lindgren, Paulina Agnieszka Dzianach, Arkadiusz Marian Dziedzic, Alireza Ebrahimi, Hisham Atan Edinur, Kristina Edvardsson, Ferry Efendi, Terje Andreas Eikemo, Michael Ekholuenetale, Maha El Tantawi, Noha Mousaad Elemam, Ghada Metwally Tawfik ElGohary, Muhammed Elhadi, Legesse Tesfaye Elilo, Omar Abdelsadek Abdou Elmeligy, Mohamed A Elmonem, Mohammed Elshaer, Ibrahim Elsohaby, Amir Emami Zeydi, Luchuo Engelbert Bain, Sharareh Eskandarieh, Francesco Esposito, Kara Estep, Farshid Etaee, Natalia Fabin, Adeniyi Francis Fagbamigbe, Saman Fahimi, Aliasghar Fakhri-Demeshghieh, Luca Falzone, Ali Faramarzi, MoezAlIslam Ezzat Mahmoud Faris, Sam Farmer, Andre Faro, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Nelsensius Klau Fauk, Pooria Fazeli, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Abdullah Hamid Feroze, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Irina Filip, Florian Fischer, Joanne Flavel, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Artem Alekseevich Fomenkov, Behzad Foroutan, Matteo Foschi, Kayode Raphael Fowobaje, Kate Louise Francis, Alberto Freitas, Takeshi Fukumoto, John E Fuller, Blima Fux, Peter Andras Gaal, Muktar A Gadanya, Abhay Motiramji Gaidhane, Yaseen Galali, Silvano Gallus, Aravind P Gandhi, Balasankar Ganesan, Mohammad Arfat Ganiyani, M.A. Garcia-Gordillo, Naval Garg, Rupesh K Gautam, Federica Gazzelloni, Semiu Olatunde Gbadamosi, Miglas W Gebregergis, Mesfin Gebrehiwot, Tesfay Brhane Gebremariam, Tesfay B B Gebremariam, Teferi Gebru Gebremeskel, Yohannes Fikadu Geda, Simona Roxana Georgescu, Urge Gerema, Habtamu Geremew, Motuma Erena Getachew, Peter W Gething, MohammadReza Ghasemi, Ghazal Ghasempour Dabaghi, Afsaneh Ghasemzadeh, Fariba Ghassemi, Ramy Mohamed Ghazy, Sailaja Ghimire, Asadollah Gholamian, Ali Gholamrezanezhad, Mahsa Ghorbani, Aloke Gopal Ghoshal, Arun Digambarrao Ghuge, Artyom Urievich Gil, Tiffany K Gill, Matteo Giorgi, Alem Girmay, James C Glasbey, Laszlo Göbölös, Amit Goel, Ali Golchin, Mahaveer Golechha, Pouya Goleij, Sameer Vali Gopalani, Houman Goudarzi, Alessandra C Goulart, Anmol Goyal, Simon Matthew Graham, Michal Grivna, Shi-Yang Guan, Giovanni Guarducci, Mohammed Ibrahim Mohialdeen Gubari, Mesay Dechasa Gudeta, Stefano Guicciardi, Snigdha Gulati, David Gulisashvili, Damitha Asanga Gunawardane, Cui Guo, Anish Kumar Gupta, Bhawna Gupta, Manoj Kumar Gupta, Mohak Gupta, Sapna Gupta, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Kumar Gupta, Annie Haakenstad, Farrokh Habibzadeh, Najah R Hadi, Nils Haep, Ramtin Hajibeygi, Sebastian Haller, Rabih Halwani, Randah R Hamadeh, Nadia M Hamdy, Sajid Hameed, Samer Hamidi, Qiuxia Han, Alexis J Handal, Graeme J Hankey, Md Nuruzzaman Haque, Josep Maria Haro, Ahmed I Hasaballah, Ikramul Hasan, Mohammad Jahid Hasan, S.M. Mahmudul Hasan, Hamidreza Hasani, Md Saquib Hasnain, Amr Hassan, Ikrama Hassan, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Jeffrey J Hebert, Omar E Hegazi, Mohammad Heidari, Bartosz Helfer, Mehdi Hemmati, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamran Hessami, Kamal Hezam, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Hassan Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mohamed Hsairi, Vivian Chia-rong Hsieh, Chengxi Hu, Junjie Huang, M Mamun Huda, Ayesha Humayun, Javid Hussain, Nawfal R Hussein, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Afrin Iqbal, Md. Rabiul Islam, Nahlah Elkudssiah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Mahalaxmi Iyer, Linda Merin J, Jalil Jaafari, Louis Jacob, Farhad Jadidi-Niaragh, Khushleen Jaggi, Kasra Jahankhani, Nader Jahanmehr, Haitham Jahrami, Akhil Jain, Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Elham Jamshidi, Sabzali Javadov, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Anil K Jha, Ravi Prakash Jha, Heng Jiang, Mohammad Jokar, Jost B Jonas, Tamas Joo, Nitin Joseph, Charity Ehimwenma Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Vaishali K, Billingsley Kaambwa, Abdulkareem Kabir, Ali Kabir, Hannaneh Kabir, Zubair Kabir, Rizwan Kalani, Leila R Kalankesh, Feroze Kaliyadan, Sanjay Kalra, Rajesh Kamath, Sagarika Kamath, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Sushil Kumar Kansal, Rami S Kantar, Neeti Kapoor, Mehrdad Karajizadeh, Manoochehr Karami, Ibraheem M Karaye, Faizan Zaffar Kashoo, Hengameh Kasraei, Nicholas J Kassebaum, Molly B Kassel, Joonas H Kauppila, Foad Kazemi, sara Kazeminia, John H Kempen, Evie Shoshannah Kendal, Kamyab Keshtkar, Mohammad Keykhaei, Himanshu Khajuria, Amirmohammad Khalaji, Nauman Khalid, Anees Ahmed Khalil, Alireza Khalilian, Faham Khamesipour, Ajmal Khan, Asaduzzaman Khan, Ikramullah Khan, M Nuruzzaman Khan, Maseer Khan, Mohammad Jobair Khan, Moien AB Khan, Young-Ho Khang, Shaghayegh Khanmohammadi, Khaled Khatab, Armin Khavandegar, Hamid Reza Khayat Kashani, Feriha Fatima Khidri, Moein Khormali, Mohammad Ali Khosravi, Mahmood Khosrowjerdi, Wondwosen Teklesilasie Kidane, Zemene Demelash Kifle, Julie Sojin Kim, Min Seo Kim, Ruth W Kimokoti, Kasey E Kinzel, Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Connor M Kubeisy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Mukhtar Kulimbet, Harish Kumar, Satyajit Kundu, Kunle Rotimi Kunle, Om P Kurmi, Asep Kusnali, Dian Kusuma, Evans F Kyei, Ilias Kyriopoulos, Carlo La Vecchia, Ben Lacey, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Daphne Teck Ching Lai, Dharmesh Kumar Lal, Ratilal Lalloo, Judit Lám, Demetris Lamnisos, Iván Landires, Francesco Lanfranchi, Berthold Langguth, Ariane Laplante-Lévesque, Heidi Jane Larson, Anders O Larsson, Savita Lasrado, Kamaluddin Latief, Kaveh Latifinaibin, Long Khanh Dao Le, Nhi Huu Hanh Le, Trang Diep Thanh Le, Caterina Ledda, Munjae Lee, Paul H Lee, Seung Won Lee, Yo Han Lee, Gebretsadik Kiros Lema, Elvynna Leong, Temesgen L Lerango, An Li, Ming-Chieh Li, Shanshan Li, Wei Li, Xiaopan Li, Virendra S Ligade, Stephen S Lim, Ro-Ting Lin, Paulina A Lindstedt, Stefan Listl, Gang Liu, Jue Liu, Xiaofeng Liu, Xuefeng Liu, Yuewei Liu, Erand Llanaj, Rubén López-Bueno, Platon D Lopukhov, László Lorenzovici, Paulo A Lotufo, Jailos Lubinda, Giancarlo Lucchetti, Alessandra Lugo, Raimundas Lunevicius, Hengliang Lv, Zheng Feei Ma, Kelsey Lynn Maass, Monika Machoy, Áurea M Madureira-Carvalho, Mohammed Magdy Abd El Razek, Azzam A Maghazachi, Soleiman Mahjoub, Mansour Adam Mahmoud, Azeem Majeed, Jeadran N Malagón-Rojas, Elaheh Malakan Rad, Kashish Malhotra, Ahmad Azam Malik, Iram Malik, Deborah Carvalho Malta, Abdullah A Mamun, Yosef Manla, Yasaman Mansoori, Ali Mansour, Borhan Mansouri, Zeinab Mansouri, Mohammad Ali Mansournia, Joemer C Maravilla, Mirko Marino, Abdoljalal Marjani, Gabriel Martinez, Ramon Martinez-Piedra, Francisco Rogerlândio Martins-Melo, Miquel Martorell, Sharmeen Maryam, Roy Rillera Marzo, Alireza Masoudi, Jishanth Mattumpuram, Richard James Maude, Andrea Maugeri, Erin A May, Mahsa Mayeli, Maryam Mazaheri, John J McGrath, Martin McKee, Anna Laura Wensel McKowen, Susan A McLaughlin, Steven M McPhail, Rahul Mehra, Kamran Mehrabani-Zeinabad, Entezar Mehrabi Nasab, Tesfahun Mekene Meto, Max Alberto Mendez Mendez-Lopez, Walter Mendoza, Ritesh G Menezes, George A Mensah, Alexios-Fotios A Mentis, Sultan Ayoub Meo, Mohsen Merati, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Pouya Metanat, Kukulege Chamila Dinushi Mettananda, Sachith Mettananda, Adquate Mhlanga, Laurette Mhlanga, Tianyue Mi, Tomasz Miazgowski, Georgia Micha, Irmina Maria Michalek, Ted R Miller, Le Huu Nhat Minh, Mojgan Mirghafourvand, Erkin M Mirrakhimov, Mizan Kiros Mirutse, Moonis Mirza, Roya Mirzaei, Ashim Mishra, Sanjeev Misra, Philip B Mitchell, Chaitanya Mittal, Babak Moazen, Abdalla Z Mohamed, Ahmed Ismail Mohamed, Jama Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Sakineh Mohammad-Alizadeh-Charandabi, Soheil Mohammadi, Abdollah Mohammadian-Hafshejani, Mustapha Mohammed, Salahuddin Mohammed, Shafiu Mohammed, Ali H Mokdad, Peyman Mokhtarzadehazar, Hossein Molavi Vardanjani, Sabrina Molinaro, Lorenzo Monasta, Mohammad Ali Moni, Maryam Moradi, Yousef Moradi, Paula Moraga, Rafael Silveira Moreira, Negar Morovatdar, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Elias Mossialos, Rohith Motappa, Parsa Mousavi, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Lorenzo Muccioli, Francesk Mulita, Kavita Munjal, Efrén Murillo-Zamora, Jonah Musa, Fungai Musaigwa, Ana-Maria Musina, Sathish Muthu, Saravanan Muthupandian, Muhammad Muzaffar, Woojae Myung, Ahamarshan Jayaraman Nagarajan, Gabriele Nagel, Pirouz Naghavi, Ganesh R Naik, Gurudatta Naik, Mukhammad David Naimzada, Firzan Nainu, Vinay Nangia, Sreenivas Narasimha Swamy, Bruno Ramos Nascimento, Gustavo G Nascimento, Abdallah Y Naser, Mohammad Javad Nasiri, Zuhair S Natto, Javaid Nauman, Muhammad Naveed, Biswa Prakash Nayak, Vinod C Nayak, Rawlance Ndejjo, Sabina Onyinye Nduaguba, Hadush Negash, Chernet Tafere Negesse, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Chakib Nejjari, Samata Nepal, Henok Biresaw Netsere, Georges Nguefack-Tsague, Josephine W. Ngunjiri, Dang H Nguyen, Hau Thi Hien Nguyen, Phuong The Nguyen, QuynhAnh P Nguyen, Van Thanh Nguyen, Robina Khan Niazi, Yeshambel T Nigatu, Taxiarchis Konstantinos Nikolouzakis, Ali Nikoobar, Amin Reza Nikpoor, Chukwudi A Nnaji, Lawrence Achilles Nnyanzi, Efaq Ali Noman, Shuhei Nomura, Mamoona Noreen, Nafise Noroozi, Chisom Adaobi Nri-Ezedi, Mengistu H Nunemo, Virginia Nuñez-Samudio, Dieta Nurrika, Jerry John Nutor, Bogdan Oancea, Kehinde O Obamiro, Ismail A Odetokun, Nkechi Martina Odogwu, Martin James O'Donnell, Oluwakemi Ololade Odukoya, Ayodipupo Sikiru Oguntade, James Odhiambo Oguta, In-Hwan Oh, Sylvester Reuben Okeke, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Patrick Godwin Okwute, Andrew T Olagunju, Omotola O Olasupo, Matthew Idowu Olatubi, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Gideon Olamilekan Oluwatunase, Hany A Omar, Goran Latif Omer, Obinna E Onwujekwe, Michal Ordak, Orish Ebere Orisakwe, Verner N Orish, Doris V Ortega-Altamirano, Alberto Ortiz, Esteban Ortiz-Prado, Wael M S Osman, Uchechukwu Levi Osuagwu, Olayinka Osuolale, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia, Guoqing Ouyang, Mayowa O Owolabi, Yaz Ozten, Mahesh Padukudru P A, Mohammad Taha Pahlevan Fallahy, Feng Pan, Hai-Feng Pan, Adrian Pana, Paramjot Panda, Songhomitra Panda-Jonas, Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh, Seoyeon Park, Ashwaghosha Parthasarathi, Ava Pashaei, Roberto Passera, Hemal M Patel, Jay Patel, Shankargouda Patil, Dimitrios Patoulias, Venkata Suresh Patthipati, Uttam Paudel, Mihaela Paun, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Minjin Peng, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Gavin Pereira, Mario F P Peres, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Richard G Pestell, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Daniela Pierannunzio, Manon Pigeolet, David M Pigott, Evgenii Plotnikov, Dimitri Poddighe, Peter Pollner, Ramesh Poluru, Maarten J Postma, Ghazaleh Pourali, Akram Pourshams, Naeimeh Pourtaheri, Disha Prabhu, Sergio I Prada, Pranil Man Singh Pradhan, Manya Prasad, Akila Prashant, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Deepthi R, Mehrdad Rabiee Rad, Amir Radfar, Venkatraman Radhakrishnan, Pourya Raee, Hadi Raeisi Shahraki, Alireza Rafiei, Seyedeh Niloufar Rafiei Alavi, Cat Raggi, Pankaja Raghav Raghav, Fakher Rahim, Md Jillur Rahim, Md. Mosfequr Rahman, Mohammad Hifz Ur Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Vahid Rahmanian, Masoud Rahmati, Niloufar Rahnavard, Pramila Rai, Diego Raimondo, Ali Rajabpour-Sanati, Prashant Rajput, Prasanna Ram, Shakthi Kumaran Ramasamy, Juwel Rana, Kritika Rana, Shailendra Singh Rana, Chhabi Lal Ranabhat, Nemanja Rancic, Amey Rane, Shubham Ranjan, Chythra R Rao, Indu Ramachandra Rao, Deepthi Rapaka, Davide Rasella, Sina Rashedi, Vahid Rashedi, Mohammad-Mahdi Rashidi, Azad Rasul, Zubair Ahmed Ratan, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Nakul Ravikumar, David Laith Rawaf, Salman Rawaf, Reza Rawassizadeh, Bharat Rawlley, Murali Mohan Rama Krishna Reddy, Elrashdy Moustafa Mohamed Redwan, Giuseppe Remuzzi, Bhageerathy Reshmi, Nazila Rezaei, Aida Rezaei Nejad, Mohsen Rezaeian, Abanoub Riad, Mavra A Riaz, Jennifer Rickard, Reza Rikhtegar, Hannah Elizabeth Robinson-Oden, Célia Fortuna Rodrigues, Jefferson Antonio Buendia Rodriguez, Ravi Rohilla, Debby Syahru Romadlon, Luca Ronfani, Himanshu Sekhar Rout, Bedanta Roy, Nitai Roy, Priyanka Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Manjula S, Chandan S N, Aly M A Saad, Zahra Saadatian, Maha Mohamed Saber-Ayad, Morteza SaberiKamarposhti, Siamak Sabour, Fatos Sada, Basema Saddik, Bashdar Abuzed Sadee, Ehsan Sadeghi, Erfan Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Dominic Sagoe, Manika Saha, Amirhossein Sahebkar, Soumya Swaroop Sahoo, Monalisha Sahu, Zahra Saif, Joseph W Sakshaug, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Marwa Rashad Salem, Mohammed Z Y Salem, Sohrab Salimi, Sara Samadzadeh, Yoseph Leonardo Samodra, Vijaya Paul Samuel, Abdallah M Samy, Juan Sanabria, Nima Sanadgol, Francesca Sanna, Milena M Santric-Milicevic, Haaris Saqib, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Babak Saravi, Yaser Sarikhani, Tanmay Sarkar, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Anudeep Sathyanarayan, Abu Sayeed, Md Abu Sayeed, Nikolaos Scarmeas, Winfried Schlee, Art Schuermans, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Pallav Sengupta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Dragos Serban, Edson Serván-Mori, Yashendra Sethi, SeyedAhmad SeyedAlinaghi, Seyed Arsalan Seyedi, Allen Seylani, Mahan Shafie, Jaffer Shah, Pritik A Shah, Ataollah Shahbandi, Samiah Shahid, Moyad Jamal Shahwan, Ahme
Global estimates on the number of people blind or visually impaired by age-related macular degeneration: a meta-analysis from 2000 to 2020
No full textBackground: We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). Methods: We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness ( < 3/60) caused by AMD, stratified by age, region, and year. Results: In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%. Conclusions: The estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services
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Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026
No full textBackground
The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness.
Methods
In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need.
Findings
In 2019, at the onset of the COVID-19 pandemic, US7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the 43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, 37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP.
Interpretation
There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
