1
|
Matheson AI, Colombara DV, Pennucci A, Chan A, Shannon T, Suter M, Laurent AA. A Good Farewell? Positive Exits from Federal Housing Assistance and Lower Acute Healthcare Utilization. J Urban Health 2023; 100:1202-1211. [PMID: 38012503 PMCID: PMC10728032 DOI: 10.1007/s11524-023-00789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
Little is known regarding the health outcomes of people who exit from housing assistance and if that experience varies by the circumstances under which a person exits. We asked two questions: (1) does the type of exit from housing assistance matter for healthcare utilization? And (2) how does each exit type compare to remaining in housing assistance in terms of healthcare utilization? This retrospective cohort study of 5550 exits between 2012 and 2018 used data from two large, urban public housing authorities in King County, Washington. Exposures were exiting from housing assistance and type of exit (positive, neutral, negative). Outcomes were emergency department visits, hospitalizations, and well-child checks (among those aged < 6) in the year following exit from housing assistance. After adjustment for demographics and baseline healthcare utilization, people with positive exits had 26% (95% confident interval: 6-39%) lower odds of having 1 + ED visits in the year following exit than people with negative exits and 20% (95% CI: 6-31%) lower odds than those who continued receiving housing assistance. Neutral and negative exits did not differ substantially from each other, and both exit types appear to be detrimental to health, with higher levels of ED visits and hospitalizations and lower levels of well-child checks. Why people exit from housing assistance matters. Those with negative exits experience poorer outcomes and efforts should be made to both prevent this kind of exit and mitigate its impact.
Collapse
Affiliation(s)
- Alastair I Matheson
- Public Health - Seattle & King County, Seattle, WA, USA.
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Danny V Colombara
- Public Health - Seattle & King County, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Andy Chan
- Seattle Housing Authority, Seattle, WA, USA
| | | | - Megan Suter
- Public Health - Seattle & King County, Seattle, WA, USA
| | - Amy A Laurent
- Public Health - Seattle & King County, Seattle, WA, USA
| |
Collapse
|
2
|
Wong EY, Schachter A, Collins HN, Song L, Ta ML, Dawadi S, Neal S, Pajimula FF, Colombara DV, Johnson K, Laurent AA. Cross-Sector Monitoring and Evaluation Framework: Social, Economic, and Health Conditions Impacted During the COVID-19 Pandemic. Am J Public Health 2021; 111:S215-S223. [PMID: 34709876 DOI: 10.2105/ajph.2021.306422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Public Health 3.0 approaches are critical for monitoring disparities in economic, social, and overall health impacts following the COVID-19 pandemic and its associated policy changes to slow community spread. Timely, cross-sector data as identified using this approach help decisionmakers identify changes, track racial disparities, and address unintended consequences during a pandemic. We applied a monitoring and evaluation framework that combined policy changes with timely, relevant cross-sector data and community review. Indicators covered unemployment, basic needs, family violence, education, childcare, access to health care, and mental, physical, and behavioral health. In response to increasing COVID-19 cases, nonpharmaceutical intervention strategies were implemented in March 2020 in King County, Washington. By December 2020, 554 000 unemployment claims were filed. Social service calls increased 100%, behavioral health crisis calls increased 25%, and domestic violence calls increased 25%, with disproportionate impact on communities of color. This framework can be replicated by local jurisdictions to inform and address racial inequities in ongoing COVID-19 mitigation and recovery. Cross-sector collaboration between public health and sectors addressing the social determinants of health are an essential first step to have an impact on long-standing racial inequities. (Am J Public Health. 2021;111(S3):S215-S223. https://doi.org/10.2105/AJPH.2021.306422).
Collapse
Affiliation(s)
- Eva Y Wong
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Abigail Schachter
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Hannah N Collins
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Lin Song
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Myduc L Ta
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Shuva Dawadi
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Scott Neal
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Fel F Pajimula
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Danny V Colombara
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Kristen Johnson
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Amy A Laurent
- All authors are with Public Health‒Seattle and King County, Seattle, WA. Eva Y. Wong is also with the Department of Epidemiology, School of Public Health, University of Washington, Seattle. Hannah N. Collins is an applied epidemiology fellow, Council of State and Territorial Epidemiologists, Atlanta, GA
| |
Collapse
|
3
|
Bartlett ES, Flor LS, Medeiros DS, Colombara DV, Johanns CK, Camargo Vaz FA, Wilson S, Duber HC. Public knowledge of cardiovascular disease and response to acute cardiac events in three municipalities in Brazil. Open Heart 2020; 7:openhrt-2020-001322. [PMID: 32847995 PMCID: PMC7451281 DOI: 10.1136/openhrt-2020-001322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil. Methods A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations. Results 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use. Conclusions In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.
Collapse
Affiliation(s)
- Emily S Bartlett
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Luisa S Flor
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | | | - Casey K Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Herbert C Duber
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA .,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Flor LS, Wilson S, Bhatt P, Bryant M, Burnett A, Camarda JN, Chakravarthy V, Chandrashekhar C, Chaudhury N, Cimini C, Colombara DV, Narayanan HC, Cortes ML, Cowling K, Daly J, Duber H, Ellath Kavinkare V, Endlich P, Fullman N, Gabert R, Glucksman T, Harris KP, Loguercio Bouskela MA, Maia J, Mandile C, Marcolino MS, Marshall S, McNellan CR, Medeiros DSD, Mistro S, Mulakaluri V, Murphree J, Ng M, Oliveira JAQ, Oliveira MG, Phillips B, Pinto V, Polzer Ngwato T, Radant T, Reitsma MB, Ribeiro AL, Roth G, Rumel D, Sethi G, Soares DA, Tamene T, Thomson B, Tomar H, Ugliara Barone MT, Valsangkar S, Wollum A, Gakidou E. Community-based interventions for detection and management of diabetes and hypertension in underserved communities: a mixed-methods evaluation in Brazil, India, South Africa and the USA. BMJ Glob Health 2020; 5:e001959. [PMID: 32503887 PMCID: PMC7279660 DOI: 10.1136/bmjgh-2019-001959] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/25/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION As non-communicable disease (NCD) burden rises worldwide, community-based programmes are a promising strategy to bridge gaps in NCD care. The HealthRise programme sought to improve hypertension and diabetes management for underserved communities in nine sites across Brazil, India, South Africa and the USA between 2016 and 2018. This study presents findings from the programme's endline evaluation. METHODS The evaluation utilises a mixed-methods quasi-experimental design. Process indicators assess programme implementation; quantitative data examine patients' biometric measures and qualitative data characterise programme successes and challenges. Programme impact was assessed using the percentage of patients meeting blood pressure and A1c treatment targets and tracking changes in these measures over time. RESULTS Almost 60 000 screenings, most of them in India, resulted in 1464 new hypertension and 295 new diabetes cases across sites. In Brazil, patients exhibited statistically significant reductions in blood pressure and A1c. In Shimla, India, and in South Africa, country with the shortest implementation period, there were no differences between patients served by facilities in HealthRise areas relative to comparison areas. Among participating patients with diabetes in Hennepin and Ramsey counties and hypertension patients in Hennepin County, the percentage of HealthRise patients meeting treatment targets at endline was significantly higher relative to comparison group patients. Qualitative analysis identified linking different providers, services, communities and information systems as positive HealthRise attributes. Gaps in health system capacities and sociodemographic factors, including poverty, low levels of health education and limited access to nutritious food, are remaining challenges. CONCLUSIONS Findings from Brazil and the USA indicate that the HealthRise model has the potential to improve patient outcomes. Short implementation periods and strong emphasis on screening may have contributed to the lack of detectable differences in other sites. Community-based care cannot deliver its full potential if sociodemographic and health system barriers are not addressed in tandem.
Collapse
Affiliation(s)
- Luisa S Flor
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Shelley Wilson
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, USA
| | - Miranda Bryant
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Aaron Burnett
- Department of Emergency Medicine, University of Minnesota, Minneapolis, Minnesota, USA
- Regions Hospital, Saint Paul, Minnesota, USA
| | - Joseph N Camarda
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | | | - Christiane Cimini
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | | | | | - Matheus Lopes Cortes
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Krycia Cowling
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Jessica Daly
- Medtronic Foundation, Minneapolis, Minnesota, USA
| | - Herbert Duber
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | | | - Patrick Endlich
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | - Nancy Fullman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Rose Gabert
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Thomas Glucksman
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Katie Panhorst Harris
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Junia Maia
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Milena S Marcolino
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Claire R McNellan
- National CASA/GAL Association for Children, Seattle, Washington, USA
| | - Danielle Souto de Medeiros
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Sóstenes Mistro
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Vasudha Mulakaluri
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | - Marie Ng
- IBM Watson Health, San Jose, California, USA
| | - J A Q Oliveira
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Márcio Galvão Oliveira
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Bryan Phillips
- Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
| | - Vânia Pinto
- School of Medicine, Federal University of Jequitinhonha and Mucuri Valleys, Teofilo Otoni, MG, Brazil
| | | | - Tia Radant
- Regions Hospital, Saint Paul, Minnesota, USA
| | - Marissa B Reitsma
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Antonio Luiz Ribeiro
- Telehealth Department, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gregory Roth
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Davi Rumel
- Research and Teaching Institute, Hospital Sirio-Libanes, Sao Paulo, São Paulo, Brazil
- School of Medicine, Municipal University Sao Caetano do Sul, Sao Caetano do Sul, Sao Paulo, Brazil
| | - Gaurav Sethi
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Daniela Arruda Soares
- Anisio Teixeira Campus, Federal University of Bahia Multidisciplinary Institute in Health, Vitoria da Conquista, Bahia, Brazil
| | - Tsega Tamene
- Pillsbury United Communities, Minneapolis, Minnesota, USA
| | - Blake Thomson
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Harsha Tomar
- MAMTA Health Institute for Mother and Child, New Delhi, Delhi, India
| | - Mark Thomaz Ugliara Barone
- Medtronic Foundation, Minneapolis, Minnesota, USA
- Global Health Leaders, Public Health Institute, Sao Paulo, Sao Paulo, Brazil
| | - Sameer Valsangkar
- Research and Monitoring Systems, The Catholic Health Association of India, Hyderabad, Telangana, India
| | | | - Emmanuela Gakidou
- Department of Health Metrics Sciences, University of Washington, Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| |
Collapse
|
5
|
Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H, Tsoi D, Colombara DV, Abdoli A, Adedoyin RA, Afarideh M, Agrawal S, Ahmad S, Ahmadian E, Ahmadpour E, Akinyemiju T, Akunna CJ, Alipour V, Almasi-Hashiani A, Almulhim AM, Al-Raddadi RM, Alvis-Guzman N, Anber NH, Angus C, Anoushiravani A, Arabloo J, Araya EM, Asmelash D, Ataeinia B, Ataro Z, Atout MMW, Ausloos F, Awasthi A, Badawi A, Banach M, Bejarano Ramirez DF, Bhagavathula AS, Bhala N, Bhattacharyya K, Biondi A, Bolla SR, Boloor A, Borzì AM, Butt ZA, Cámera LLAA, Campos-Nonato IR, Carvalho F, Chu DT, Chung SC, Cortesi PA, Costa VM, Cowie BC, Daryani A, de Courten B, Demoz GT, Desai R, Dharmaratne SD, Djalalinia S, Do HT, Dorostkar F, Drake TM, Dubey M, Duncan BB, Effiong A, Eftekhari A, Elsharkawy A, Etemadi A, Farahmand M, Farzadfar F, Fernandes E, Filip I, Fischer F, Gebremedhin KBB, Geta B, Gilani SA, Gill PS, Gutirrez RA, Haile MT, Haj-Mirzaian A, Hamid SS, Hasankhani M, Hasanzadeh A, Hashemian M, Hassen HY, Hay SI, Hayat K, Heidari B, Henok A, Hoang CL, Hostiuc M, Hostiuc S, Hsieh VCR, Igumbor EU, Ilesanmi OS, Irvani SSN, Jafari Balalami N, James SL, Jeemon P, Jha RP, Jonas JB, Jozwiak JJ, Kabir A, Kasaeian A, Kassaye HG, Kefale AT, Khalilov R, Khan MA, Khan EA, Khater A, Kim YJ, Koyanagi A, La Vecchia C, Lim LL, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Magdy Abd El Razek M, Mai HT, Manafi N, Manafi A, Mansournia MA, Mantovani LG, Mazzaglia G, Mehta D, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Mestrovic T, Miazgowski B, Miller TR, Mirrakhimov EM, Mithra P, Moazen B, Moghadaszadeh M, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Montero-Zamora PA, Moradi G, Naimzada MD, Nayak V, Negoi I, Nguyen TH, Ofori-Asenso R, Oh IH, Olagunju TO, Padubidri JR, Pakshir K, Pana A, Pathak M, Pourshams A, Rabiee N, Radfar A, Rafiei A, Ramezanzadeh K, Rana SMM, Rawaf S, Rawaf DL, Reiner RC, Roever L, Room R, Roshandel G, Safari S, Samy AM, Sanabria J, Sartorius B, Schmidt MI, Senthilkumaran S, Shaikh MA, Sharif M, Sharifi A, Shigematsu M, Singh JA, Soheili A, Suleria HAR, Teklehaimanot BF, Tesfay BE, Vacante M, Vahedian-Azimi A, Valdez PR, Vasankari TJ, Vu GT, Waheed Y, Weldegwergs KG, Werdecker A, Westerman R, Wondafrash DZ, Wondmieneh AB, Yeshitila YG, Yonemoto N, Yu C, Zaidi Z, Zarghi A, Zelber-Sagi S, Zewdie KA, Zhang ZJ, Zhao XJ, Naghavi M, Malekzadeh R. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5:245-266. [PMID: 31981519 PMCID: PMC7026710 DOI: 10.1016/s2468-1253(19)30349-8] [Citation(s) in RCA: 711] [Impact Index Per Article: 177.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. METHODS We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. FINDINGS In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8-38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8-10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3-4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4-133·4] per 100 000 in 2017). There were 10·6 million (10·3-10·9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. INTERPRETATION Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
6
|
Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, Colombara DV, Ikuta KS, Kissoon N, Finfer S, Fleischmann-Struzek C, Machado FR, Reinhart KK, Rowan K, Seymour CW, Watson RS, West TE, Marinho F, Hay SI, Lozano R, Lopez AD, Angus DC, Murray CJL, Naghavi M. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet 2020; 395:200-211. [PMID: 31954465 PMCID: PMC6970225 DOI: 10.1016/s0140-6736(19)32989-7] [Citation(s) in RCA: 2647] [Impact Index Per Article: 661.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/11/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. METHODS We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990-2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. FINDINGS In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9-62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1-12·0) sepsis-related deaths were reported, representing 19·7% (18·2-21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8-54·5) and mortality decreased by 52·8% (47·7-57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. INTERPRETATION Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. FUNDING The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.
Collapse
Affiliation(s)
- Kristina E Rudd
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kareha M Agesa
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Derrick Tsoi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kevin S Ikuta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Newtown, NSW, Australia
| | | | - Flavia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, São Paulo, Brazil
| | - Konrad K Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Anästhesiologie mit Sp operative Intensivmeidzin, Charité University Medical Center Berlin, Berlin, Germany
| | - Kathryn Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, UK; Faculty of Public Health & Policy linked to the Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - R Scott Watson
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - T Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Fatima Marinho
- Institute of Advanced Studies, University of São Paulo, São Paulo, Brazil
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; University of Melbourne, Melbourne, QLD, Australia
| | - Derek C Angus
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
| |
Collapse
|
7
|
Khalil IA, Troeger C, Rao PC, Blacker BF, Brown A, Brewer TG, Colombara DV, De Hostos EL, Engmann C, Guerrant RL, Haque R, Houpt ER, Kang G, Korpe PS, Kotloff KL, Lima AAM, Petri WA, Platts-Mills JA, Shoultz DA, Forouzanfar MH, Hay SI, Reiner RC, Mokdad AH. Morbidity, mortality, and long-term consequences associated with diarrhoea from Cryptosporidium infection in children younger than 5 years: a meta-analyses study. Lancet Glob Health 2019; 6:e758-e768. [PMID: 29903377 PMCID: PMC6005120 DOI: 10.1016/s2214-109x(18)30283-3] [Citation(s) in RCA: 228] [Impact Index Per Article: 45.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/08/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022]
Abstract
Background The protozoan Cryptosporidium is a leading cause of diarrhoea morbidity and mortality in children younger than 5 years. However, the true global burden of Cryptosporidium infection in children younger than 5 years might have been underestimated in previous quantifications because it only took account of the acute effects of diarrhoea. We aimed to demonstrate whether there is a causal relation between Cryptosporidium and childhood growth and, if so, to quantify the associated additional burden. Methods The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2016 was a systematic and scientific effort to quantify the morbidity and mortality associated with more than 300 causes of death and disability, including diarrhoea caused by Cryptosporidium infection. We supplemented estimates on the burden of Cryptosporidium in GBD 2016 with findings from a systematic review of published and unpublished cohort studies and a meta-analysis of the effect of childhood diarrhoea caused by Cryptosporidium infection on physical growth. Findings In 2016, Cryptosporidium infection was the fifth leading diarrhoeal aetiology in children younger than 5 years, and acute infection caused more than 48 000 deaths (95% uncertainty interval [UI] 24 600–81 900) and more than 4·2 million disability-adjusted life-years lost (95% UI 2·2 million–7·2 million). We identified seven data sources from the scientific literature and six individual-level data sources describing the relation between Cryptosporidium and childhood growth. Each episode of diarrhoea caused by Cryptosporidium infection was associated with a decrease in height-for-age Z score (0·049, 95% CI 0·014–0·080), weight-for-age Z score (0·095, 0·055–0·134), and weight-for-height Z score (0·126, 0·057–0·194). We estimated that diarrhoea from Cryptosporidium infection caused an additional 7·85 million disability-adjusted life-years (95% UI 5·42 million–10·11 million) after we accounted for its effect on growth faltering—153% more than that estimated from acute effects alone. Interpretation Our findings show that the substantial short-term burden of diarrhoea from Cryptosporidium infection on childhood growth and wellbeing is an underestimate of the true burden. Interventions designed to prevent and effectively treat infection in children younger than 5 years will have enormous public health and social development impacts. Funding The Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Ibrahim A Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Brigette F Blacker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alexandria Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Thomas G Brewer
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Cyril Engmann
- PATH, Seattle, WA, USA; School of Public Health, University of Washington, Seattle, WA, USA
| | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | - Eric R Houpt
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Gagandeep Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - Poonum S Korpe
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen L Kotloff
- Departments of Pediatrics and Medicine, Center for Vaccine Development, Institute for Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Aldo A M Lima
- Center for Global Health, Federal University of Ceara, Fortaleza, Ceara, Brazil
| | - William A Petri
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James A Platts-Mills
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | | | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| |
Collapse
|
8
|
McNellan CR, Dansereau E, Wallace MCG, Colombara DV, Palmisano EB, Johanns CK, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries. BMC Pregnancy Childbirth 2019; 19:66. [PMID: 30755183 PMCID: PMC6371485 DOI: 10.1186/s12884-019-2207-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). Methods We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Results Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62–7.69]; Mexico OR = 5.00 [95% CI: 3.41–7.32]; Honduras OR = 2.60 [95% CI: 1.42–4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21–7.23]; Mexico OR = 4.02 [95% CI: 2.77–5.82]; Honduras OR = 2.14 [95% CI: 1.26–3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. Conclusions Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services.
Collapse
Affiliation(s)
- Claire R McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Marielle C G Wallace
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.,University of Washington Department of Health Metrics Sciences and Department of Global Health, 1510 San Juan Rd, Seattle, WA, 98195, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| |
Collapse
|
9
|
Troeger C, Khalil IA, Rao PC, Cao S, Blacker BF, Ahmed T, Armah G, Bines JE, Brewer TG, Colombara DV, Kang G, Kirkpatrick BD, Kirkwood CD, Mwenda JM, Parashar UD, Petri WA, Riddle MS, Steele AD, Thompson RL, Walson JL, Sanders JW, Mokdad AH, Murray CJL, Hay SI, Reiner RC. Rotavirus Vaccination and the Global Burden of Rotavirus Diarrhea Among Children Younger Than 5 Years. JAMA Pediatr 2018; 172:958-965. [PMID: 30105384 PMCID: PMC6233802 DOI: 10.1001/jamapediatrics.2018.1960] [Citation(s) in RCA: 475] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Rotavirus infection is the global leading cause of diarrhea-associated morbidity and mortality among children younger than 5 years. OBJECTIVES To examine the extent of rotavirus infection among children younger than 5 years by country and the number of deaths averted because of the rotavirus vaccine. DESIGN, SETTING, AND PARTICIPANTS This report builds on findings from the Global Burden of Disease Study 2016, a cross-sectional study that measured diarrheal diseases and their etiologic agents. Models were used to estimate burden in data-sparse locations. EXPOSURE Diarrhea due to rotavirus infection. MAIN OUTCOMES AND MEASURES Rotavirus-associated mortality and morbidity by country and year and averted deaths attributable to the rotavirus vaccine by country. RESULTS Rotavirus infection was responsible for an estimated 128 500 deaths (95% uncertainty interval [UI], 104 500-155 600) among children younger than 5 years throughout the world in 2016, with 104 733 deaths occurring in sub-Saharan Africa (95% UI, 83 406-128 842). Rotavirus infection was responsible for more than 258 million episodes of diarrhea among children younger than 5 years in 2016 (95% UI, 193 million to 341 million), an incidence of 0.42 cases per child-year (95% UI, 0.30-0.53). Vaccine use is estimated to have averted more than 28 000 deaths (95% UI, 14 600-46 700) among children younger than 5 years, and expanded use of the rotavirus vaccine, particularly in sub-Saharan Africa, could have prevented approximately 20% of all deaths attributable to diarrhea among children younger than 5 years. CONCLUSIONS AND RELEVANCE Rotavirus-associated mortality has decreased markedly over time in part because of the introduction of the rotavirus vaccine. This study suggests that prioritizing vaccine introduction and interventions to reduce diarrhea-associated morbidity and mortality is necessary in the continued global reduction of rotavirus infection.
Collapse
Affiliation(s)
| | | | - Puja C. Rao
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | - Shujin Cao
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - George Armah
- Noguchi Memorial Institute for Medical Research, Accra, Ghana
| | - Julie E. Bines
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia,Murdoch Children’s Research Institute, Department of Gastroenterology, Clinical Nutrition Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
| | | | | | - Gagandeep Kang
- Translational Health Science and Technology Institute, Faridabad, India
| | - Beth D. Kirkpatrick
- Department of Medicine, University of Vermont College of Medicine, Burlington
| | | | - Jason M. Mwenda
- World Health Organization Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - William A. Petri
- Division of Infectious Diseases and International Health, Department of Internal Medicine, University of Virginia, Charlottesville
| | | | | | | | - Judd L. Walson
- Department of Global Health, University of Washington, Seattle,Department of Medicine, University of Washington, Seattle,Department of Pediatrics, University of Washington, Seattle,Department of Epidemiology, University of Washington, Seattle
| | - John W. Sanders
- Wake Forest University School of Medicine, Salem, North Carolina
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, Seattle, Washington
| | | | - Simon I. Hay
- Institute for Health Metrics and Evaluation, Seattle, Washington,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Robert C. Reiner
- Institute for Health Metrics and Evaluation, Seattle, Washington
| |
Collapse
|
10
|
Dwyer-Lindgren L, Squires ER, Teeple S, Ikilezi G, Allen Roberts D, Colombara DV, Allen SK, Kamande SM, Graetz N, Flaxman AD, El Bcheraoui C, Asbjornsdottir K, Asiimwe G, Augusto Â, Augusto O, Chilundo B, De Schacht C, Gimbel S, Kamya C, Namugaya F, Masiye F, Mauieia C, Miangotar Y, Mimche H, Sabonete A, Sarma H, Sherr K, Simuyemba M, Sinyangwe AC, Uddin J, Wagenaar BH, Lim SS. Small area estimation of under-5 mortality in Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia using spatially misaligned data. Popul Health Metr 2018; 16:13. [PMID: 30103791 PMCID: PMC6090708 DOI: 10.1186/s12963-018-0171-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 08/03/2018] [Indexed: 01/10/2023] Open
Abstract
Background The under-5 mortality rate (U5MR) is an important metric of child health and survival. Country-level estimates of U5MR are readily available, but efforts to estimate U5MR subnationally have been limited, in part, due to spatial misalignment of available data sources (e.g., use of different administrative levels, or as a result of historical boundary changes). Methods We analyzed all available complete and summary birth history data in surveys and censuses in six countries (Bangladesh, Cameroon, Chad, Mozambique, Uganda, and Zambia) at the finest geographic level available in each data source. We then developed small area estimation models capable of incorporating spatially misaligned data. These small area estimation models were applied to the birth history data in order to estimate trends in U5MR from 1980 to 2015 at the second administrative level in Cameroon, Chad, Mozambique, Uganda, and Zambia and at the third administrative level in Bangladesh. Results We found substantial variation in U5MR in all six countries: there was more than a two-fold difference in U5MR between the area with the highest rate and the area with the lowest rate in every country. All areas in all countries experienced declines in U5MR between 1980 and 2015, but the degree varied both within and between countries. In Cameroon, Chad, Mozambique, and Zambia we found areas with U5MRs in 2015 that were higher than in other parts of the same country in 1980. Comparing subnational U5MR to country-level targets for the Millennium Development Goals (MDG), we find that 12.8% of areas in Bangladesh did not meet the country-level target, although the country as whole did. A minority of areas in Chad, Mozambique, Uganda, and Zambia met the country-level MDG targets while these countries as a whole did not. Conclusions Subnational estimates of U5MR reveal significant within-country variation. These estimates could be used for identifying high-need areas and positive deviants, tracking trends in geographic inequalities, and evaluating progress towards international development targets such as the Sustainable Development Goals. Electronic supplementary material The online version of this article (10.1186/s12963-018-0171-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA.
| | - Ellen R Squires
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Stephanie Teeple
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Gloria Ikilezi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - D Allen Roberts
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Sarah Katherine Allen
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Stanley M Kamande
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Abraham D Flaxman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| | | | | | | | - Orvalho Augusto
- Department of Community Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Baltazar Chilundo
- Department of Community Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Sarah Gimbel
- Department of Family & Child Nursing, University of Washington, Seattle, WA, USA
| | - Carol Kamya
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Faith Namugaya
- Infectious Disease Research Collaboration, Kampala, Uganda
| | - Felix Masiye
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA.,University of Zambia, Lusaka, Zambia
| | | | | | - Honoré Mimche
- Institut de Formation et de Recherche Démographiques, University of Yaoundé II, Yaoundé, Cameroon
| | | | - Haribondhu Sarma
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | | | - Jasim Uddin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98103, USA
| |
Collapse
|
11
|
Troeger C, Colombara DV, Rao PC, Khalil IA, Brown A, Brewer TG, Guerrant RL, Houpt ER, Kotloff KL, Misra K, Petri WA, Platts-Mills J, Riddle MS, Swartz SJ, Forouzanfar MH, Reiner RC, Hay SI, Mokdad AH. Global disability-adjusted life-year estimates of long-term health burden and undernutrition attributable to diarrhoeal diseases in children younger than 5 years. Lancet Glob Health 2018; 6:e255-e269. [PMID: 29433665 PMCID: PMC5861379 DOI: 10.1016/s2214-109x(18)30045-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/30/2017] [Accepted: 01/26/2018] [Indexed: 12/12/2022]
Abstract
Background Diarrhoea is a leading cause of death and illness globally among children younger than 5 years. Mortality and short-term morbidity cause substantial burden of disease but probably underestimate the true effect of diarrhoea on population health. This underestimation is because diarrhoeal diseases can negatively affect early childhood growth, probably through enteric dysfunction and impaired uptake of macronutrients and micronutrients. We attempt to quantify the long-term sequelae associated with childhood growth impairment due to diarrhoea. Methods We used the Global Burden of Diseases, Injuries, and Risk Factors Study framework and leveraged existing estimates of diarrhoea incidence, childhood undernutrition, and infectious disease burden to estimate the effect of diarrhoeal diseases on physical growth, including weight and height, and subsequent disease among children younger than 5 years. The burden of diarrhoea was measured in disability-adjusted life-years (DALYs), a composite metric of mortality and morbidity. We hypothesised that diarrhoea is negatively associated with three common markers of growth: weight-for-age, weight-for-height, and height-for-age Z-scores. On the basis of these undernutrition exposures, we applied a counterfactual approach to quantify the relative risk of infectious disease (subsequent diarrhoea, lower respiratory infection, and measles) and protein energy malnutrition morbidity and mortality per day of diarrhoea and quantified the burden of diarrhoeal disease due to these outcomes caused by undernutrition. Findings Diarrhoea episodes are significantly associated with childhood growth faltering. We found that each day of diarrhoea was associated with height-for-age Z-score (–0·0033 [95% CI −0·0024 to −0·0041]; p=4·43 × 10−14), weight-for-age Z-score (–0·0077 [–0·0058 to −0·0097]; p=3·19 × 10−15), and weight-for-height Z-score (–0·0096 [–0·0067 to −0·0125]; p=7·78 × 10−11). After addition of the DALYs due to the long-term sequelae as a consequence of undernutrition, the burden of diarrhoeal diseases increased by 39·0% (95% uncertainty interval [UI] 33·0–46·6) and was responsible for 55 778 000 DALYs (95% UI 49 125 400–62 396 200) among children younger than 5 years in 2016. Among the 15 652 300 DALYs (95% UI 12 951 300–18 806 100) associated with undernutrition due to diarrhoeal episodes, more than 84·7% are due to increased risk of infectious disease, whereas the remaining 15·3% of long-term DALYs are due to increased prevalence of protein energy malnutrition. The burden of diarrhoea has decreased substantially since 1990, but progress has been greater in long-term (78·7% reduction [95% UI 69·3–85·5]) than in acute (70·4% reduction [95% UI 61·7–76·5]) DALYs. Interpretation Diarrhoea represents an even larger burden of disease than was estimated in the Global Burden of Disease Study. In order to adequately address the burden of its long-term sequelae, a renewed emphasis on controlling the risk of diarrhoea incidence may be required. This renewed effort can help further prevent the potential lifelong cost on child health, growth, and overall potential. Funding Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ibrahim A Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alexandria Brown
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Richard L Guerrant
- Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Karen L Kotloff
- Departments of Pediatrics and Medicine, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kavita Misra
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - James Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Mark S Riddle
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Scott J Swartz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| |
Collapse
|
12
|
Duber HC, Hartford EA, Schaefer AM, Johanns CK, Colombara DV, Iriarte E, Palmisano EB, Rios-Zertuche D, Zuniga-Brenes P, Hernández-Prado B, Mokdad AH. Appropriate and timely antibiotic administration for neonatal sepsis in Mesoamérica. BMJ Glob Health 2018; 3:e000650. [PMID: 29862053 PMCID: PMC5969725 DOI: 10.1136/bmjgh-2017-000650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 01/09/2023] Open
Abstract
Neonatal sepsis is a leading cause of mortality among children under-5 in Latin America. The Salud Mesoamérica Initiative (SMI), a multicountry results-based aid programme, was designed to improve maternal, newborn and child health in impoverished communities in Mesoamérica. This study examines the delivery of timely and appropriate antibiotics for neonatal sepsis among facilities participating in the SMI project. A multifaceted health facility survey was implemented at SMI inception and approximately 18 months later as a follow-up. A random sample of medical records from neonates diagnosed with sepsis was reviewed, and data regarding antibiotic administration were extracted. In this paper, we present the percentage of patients who received timely (within 2 hours) and appropriate antibiotics. Multilevel logistic regression was used to assess for potential facility-level determinants of timely and appropriate antibiotic treatment. Among 821 neonates diagnosed with sepsis in 63 facilities, 61.8% received an appropriate antibiotic regimen, most commonly ampicillin plus an aminoglycoside. Within 2 hours of presentation, 32.3% received any antibiotic and only 26.6% received an appropriate regimen within that time. Antibiotic availability improved over the course of the SMI project, increasing from 27.5% at baseline to 64.0% at follow-up, and it was highly correlated with timely and appropriate antibiotic administration (adjusted OR=5.36, 95% CI 2.85 to 10.08). However, we also found a decline in the percentage of neonates documented to have received appropriate antibiotics (74.4% vs 51.1%). Our study demonstrated early success of the SMI project through improvements in the availability of appropriate antibiotic regimens for neonatal sepsis. At the same time, overall rates of timely and appropriate antibiotic administration remain low, and the next phase of the initiative will need to address other barriers to the provision of life-saving antibiotic treatment for neonatal sepsis.
Collapse
Affiliation(s)
- Herbert C Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.,Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Emily A Hartford
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington, USA
| | - Alexandra M Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
| | - Paola Zuniga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Panama City, Panama
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| |
Collapse
|
13
|
Wollum A, Gabert R, McNellan CR, Daly JM, Reddy P, Bhatt P, Bryant M, Colombara DV, Naidoo P, Ngongo B, Nyembezi A, Petersen Z, Phillips B, Wilson S, Gakidou E, Duber HC. Identifying gaps in the continuum of care for cardiovascular disease and diabetes in two communities in South Africa: Baseline findings from the HealthRise project. PLoS One 2018; 13:e0192603. [PMID: 29538420 PMCID: PMC5851537 DOI: 10.1371/journal.pone.0192603] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/28/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The HealthRise initiative seeks to implement and evaluate innovative community-based strategies for diabetes, hypertension and hypercholesterolemia along the entire continuum of care (CoC)-from awareness and diagnosis, through treatment and control. In this study, we present baseline findings from HealthRise South Africa, identifying gaps in the CoC, as well as key barriers to care for non-communicable diseases (NCDs). METHODS This mixed-methods needs assessment utilized national household data, health facility surveys, focus group discussions, and key informant interviews in Umgungundlovu and Pixley ka Seme districts. Risk factor and disease prevalence were estimated from the South Africa National Health and Nutrition Examination Survey. Health facility surveys were conducted at 86 facilities, focusing on essential intervention, medications and standard treatment guidelines. Quantitative results are presented descriptively, and qualitative data was analyzed using a framework approach. RESULTS 46.8% of the population in Umgungundlovu and 51.0% in Pixley ka Seme were hypertensive. Diabetes was present in 11.0% and 9.7% of the population in Umgungundlovu and Pixley ka Seme. Hypercholesterolemia was more common in Pixley ka Seme (17.3% vs. 11.1%). Women and those of Indian descent were more likely to have diabetes. More than half of the population was found to be overweight, and binge drinking, inactivity and smoking were all common. More than half of patients with hypertension were unaware of their disease status (51.6% in Pixley ka Seme and 51.3% in Umgungundlovu), while the largest gap in the diabetes CoC occurred between initiation of treatment and achieving disease control. Demand-side barriers included lack of transportation, concerns about confidentiality, perceived discrimination and long wait times. Supply-side barriers included limited availability of testing equipment, inadequate staffing, and pharmaceutical stock outs. CONCLUSION In this baseline assessment of two South African health districts we found high rates of undiagnosed hypercholesterolemia and hypertension, and poor control of hypercholesterolemia, hypertension, and diabetes. The HealthRise Initiative will need to address key supply- and demand-side barriers in an effort to improve important NCD outcomes.
Collapse
Affiliation(s)
- Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Rose Gabert
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Jessica M. Daly
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | | | - Paurvi Bhatt
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
| | - Miranda Bryant
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Danny V. Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Pamela Naidoo
- Human Sciences Reseach Council, Cape Town, South Africa
| | - Belinda Ngongo
- Medtronic Foundation, Minneapolis, Minnesota, United States of America
- Public Health Institute, Global Health Fellows Program, Washington, DC, United States of America
| | - Anam Nyembezi
- Human Sciences Reseach Council, Cape Town, South Africa
| | | | - Bryan Phillips
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Shelley Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Herbert C. Duber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
14
|
Hernandez B, Colombara DV, Gagnier MC, Desai SS, Haakenstad A, Johanns C, McNellan CR, Nelson J, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Barriers and facilitators for institutional delivery among poor Mesoamerican women: a cross-sectional study. Health Policy Plan 2017; 32:769-780. [PMID: 28335004 DOI: 10.1093/heapol/czx010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2017] [Indexed: 11/13/2022] Open
Abstract
Professional skilled care has shown to be one of the most promising strategies to reduce maternal mortality, and in-facility deliveries are a cost-effective way to ensure safe births. Countries in Mesoamerica have emphasized in-facility delivery care by professionally skilled attendants, but access to good-quality delivery care is still lacking for many women. We examined the characteristics of women who had a delivery in a health facility and determinants of the decision to bypass a closer facility and travel to a distant one. We used baseline information from the Salud Mesoamerica Initiative (SMI). Data were collected from a large household and facilities sample in the poorest quintile of the population in Guatemala, Honduras and Nicaragua. The analysis included 1592 deliveries. After controlling for characteristics of women and health facilities, being primiparous (RR = 1.15, 95% CI 1.10, 1.21), being literate (RR = 1.24, 95% CI 1.04, 1.48), having antenatal care (RR = 1.68, 95% CI 1.24, 2.27), being informed of the need for having a C-section (RR = 1.07, 95% CI 1.02, 1.11) and travel time to the closest facility totaling 1-2 h vs under 30 min (RR = 0.88, 95% CI 0.77, 0.99) were associated with in-health facility deliveries. In Guatemala, increased availability of medications and equipment at a distant facility was strongly associated with bypassing the closest facility in favor of a distant one for delivery (RR = 2.10, 95% CI 1.08, 4.07). Our study showed a strong correlation between well-equipped facilities and delivery attendance in poor areas of Mesoamerica. Indeed, women were more likely to travel to more distant facilities if the facilities were of higher level, which scored higher on our capacity score. Our findings call for improving the capacity of health facilities, quality of care and addressing cultural and accessibility barriers to increase institutional delivery among the poor population in Mesoamerica.
Collapse
Affiliation(s)
- Bernardo Hernandez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Annie Haakenstad
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA and
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jennifer Nelson
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Paola Zúñiga-Brenes
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Emma Iriarte
- Salud Mesoamerica Initiative/Inter-American Development Bank, Panama, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| |
Collapse
|
15
|
Karimkhani C, Colombara DV, Drucker AM, Norton SA, Hay R, Engelman D, Steer A, Whitfeld M, Naghavi M, Dellavalle RP. The global burden of scabies: a cross-sectional analysis from the Global Burden of Disease Study 2015. Lancet Infect Dis 2017; 17:1247-1254. [PMID: 28941561 PMCID: PMC5700804 DOI: 10.1016/s1473-3099(17)30483-8] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Numerous population-based studies have documented high prevalence of scabies in overcrowded settings, particularly among children and in tropical regions. We provide an estimate of the global burden of scabies using data from the Global Burden of Disease (GBD) Study 2015. METHODS We identified scabies epidemiological data sources from an extensive literature search and hospital insurance data and analysed data sources with a Bayesian meta-regression modelling tool, DisMod-MR 2·1, to yield prevalence estimates. We combined prevalence estimates with a disability weight, measuring disfigurement, itch, and pain caused by scabies, to produce years lived with disability (YLDs). With an assumed zero mortality from scabies, YLDs were equivalent to disability-adjusted life-years (DALYs). We estimated DALYs for 195 countries divided into 21 world regions, in both sexes and 20 age groups, between 1990 and 2015. FINDINGS Scabies was responsible for 0·21% of DALYs from all conditions studied by GBD 2015 worldwide. The world regions of east Asia (age-standardised DALYs 136·32), southeast Asia (134·57), Oceania (120·34), tropical Latin America (99·94), and south Asia (69·41) had the greatest burden of DALYs from scabies. Mean percent change of DALY rate from 1990 to 2015 was less than 8% in all world regions, except North America, which had a 23·9% increase. The five individual countries with greatest scabies burden were Indonesia (age-standardised DALYs 153·86), China (138·25), Timor-Leste (136·67), Vanuatu (131·59), and Fiji (130·91). The largest standard deviations of age-standardised DALYs between the 20 age groups were observed in southeast Asia (60·1), Oceania (58·3), and east Asia (56·5), with the greatest DALY burdens in children, adolescents, and the elderly. INTERPRETATION The burden of scabies is greater in tropical regions, especially in children, adolescents, and elderly people. As a worldwide epidemiological assessment, GBD 2015 provides broad and frequently updated measures of scabies burden in terms of skin effects. These global data might help guide research protocols and prioritisation efforts and focus scabies treatment and control measures. FUNDING Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Chante Karimkhani
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Aaron M Drucker
- Department of Dermatology, Brown University, Providence, RI, USA
| | - Scott A Norton
- Department of Dermatology, Children's National Medical Center, NW Washington DC, USA
| | - Roderick Hay
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK
| | - Daniel Engelman
- Centre for International Child Health and Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Andrew Steer
- Centre for International Child Health and Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Margot Whitfeld
- Department of Dermatology, St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health System, Denver, CO, USA
| |
Collapse
|
16
|
Rios-Zertuche D, Blanco LC, Zúñiga-Brenes P, Palmisano EB, Colombara DV, Mokdad AH, Iriarte E. Contraceptive knowledge and use among women living in the poorest areas of five Mesoamerican countries. Contraception 2017; 95:549-557. [PMID: 28126542 PMCID: PMC5493184 DOI: 10.1016/j.contraception.2017.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 11/18/2022]
Abstract
Objective To identify factors associated with contraceptive use among women in need living in the poorest areas in five Mesoamerican countries: Guatemala, Honduras, Nicaragua, Panama and State of Chiapas (Mexico). Study design We analyzed baseline data of 7049 women of childbearing age (15–49 years old) collected for the Salud Mesoamérica Initiative. Data collection took place in the 20% poorest municipalities of each country (July, 2012-August, 2013). Results Women in the poorest areas were very poorly informed about family planning methods. Concern about side effects was the main reason for nonuse. Contraceptive use was lower among the extremely poor (<$1.25 USD PPP per day) [odds ratio (OR): 0.75; confidence interval (CI): 0.59–0.96], those living more than 30 min away from a health facility (OR 0.71, CI: 0.58–0.86), and those of indigenous ethnicity (OR 0.50, CI: 0.39–0.64). Women who were insured and visited a health facility also had higher odds of using contraceptives than insured women who did not visit a health facility (OR 1.64, CI: 1.13–2.36). Conclusions Our study showed low use of contraceptives in poor areas in Mesoamerica. We found the urgent need to improve services for people of indigenous ethnicity, low education, extreme poverty, the uninsured, and adolescents. It is necessary to address missed opportunities and offer contraceptives to all women who visit health facilities. Governments should aim to increase the public's knowledge of long-acting reversible contraception and offer a wider range of methods to increase contraceptive use. Implications We show that unmet need for contraception is higher among the poorest and describe factors associated with low use. Our results call for increased investments in programs and policies targeting the poor to decrease their unmet need.
Collapse
Affiliation(s)
- Diego Rios-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA, USA.
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panama, Panama.
| |
Collapse
|
17
|
Khalil I, Colombara DV, Forouzanfar MH, Troeger C, Daoud F, Moradi-Lakeh M, Bcheraoui CE, Rao PC, Afshin A, Charara R, Abate KH, Razek MMAE, Abd-Allah F, Abu-Elyazeed R, Kiadaliri AA, Akanda AS, Akseer N, Alam K, Alasfoor D, Ali R, AlMazroa MA, Alomari MA, Al-Raddadi RMS, Alsharif U, Alsowaidi S, Altirkawi KA, Alvis-Guzman N, Ammar W, Antonio CAT, Asayesh H, Asghar RJ, Atique S, Awasthi A, Bacha U, Badawi A, Barac A, Bedi N, Bekele T, Bensenor IM, Betsu BD, Bhutta Z, Abdulhak AAB, Butt ZA, Danawi H, Dubey M, Endries AY, Faghmous IDA, Farid T, Farvid MS, Farzadfar F, Fereshtehnejad SM, Fischer F, Fitchett JRA, Gibney KB, Ginawi IAM, Gishu MD, Gugnani HC, Gupta R, Hailu GB, Hamadeh RR, Hamidi S, Harb HL, Hedayati MT, Hsairi M, Husseini A, Jahanmehr N, Javanbakht M, Jibat T, Jonas JB, Kasaeian A, Khader YS, Khan AR, Khan EA, Khan G, Khoja TAM, Kinfu Y, Kissoon N, Koyanagi A, Lal A, Latif AAA, Lunevicius R, Razek HMAE, Majeed A, Malekzadeh R, Mehari A, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Misganaw A, Mohamed LAI, Nachega JB, Nguyen QL, Nisar MI, Peprah EK, Platts-Mills JA, Pourmalek F, Qorbani M, Rafay A, Rahimi-Movaghar V, Rahman SU, Rai RK, Rana SM, Ranabhat CL, Rao SR, Refaat AH, Riddle M, Roshandel G, Ruhago GM, Saleh MM, Sanabria JR, Sawhney M, Sepanlou SG, Setegn T, Sliwa K, Sreeramareddy CT, Sykes BL, Tavakkoli M, Tedla BA, Terkawi AS, Ukwaja K, Uthman OA, Westerman R, Wubshet M, Yenesew MA, Yonemoto N, Younis MZ, Zaidi Z, Zaki MES, Rabeeah AAA, Wang H, Naghavi M, Vos T, Lopez AD, Murray CJL, Mokdad AH. Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013. Am J Trop Med Hyg 2016; 95:1319-1329. [PMID: 27928080 PMCID: PMC5154365 DOI: 10.4269/ajtmh.16-0339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/03/2016] [Indexed: 12/22/2022] Open
Abstract
Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
Collapse
Affiliation(s)
- Ibrahim Khalil
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Christopher Troeger
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Maziar Moradi-Lakeh
- Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Puja C Rao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Raghid Charara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | | | | | | | - Aliasghar Ahmad Kiadaliri
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | | | - Nadia Akseer
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
| | - Khurshid Alam
- University of Sydney, Sydney, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Raghib Ali
- University of Oxford, Oxford, United Kingdom
| | | | - Mahmoud A Alomari
- Division of Physical Therapy, Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Shirina Alsowaidi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | | | | | | | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, College of Public Health, University of the Philippines, Manila, Philippines
| | - Hamid Asayesh
- Department of Medical Emergency, School of Paramedic, Qom University of Medical Sciences, Qom, Iran
| | | | - Suleman Atique
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan
| | - Ashish Awasthi
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, Canada
| | | | - Neeraj Bedi
- College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
| | | | | | | | - Zulfiqar Bhutta
- Medical Center, Aga Khan University, Karachi, Pakistan.,The Hospital for Sick Children, Toronto, Canada
| | | | - Zahid A Butt
- Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Manisha Dubey
- International Institute for Population Sciences, Mumbai, India
| | | | - Imad D A Faghmous
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Talha Farid
- University of Louisville, Louisville, Kentucky
| | - Maryam S Farvid
- Institute for Health Policy, Boston, Massachusetts.,University of Louisville, Louisville, Kentucky
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Katherine B Gibney
- Melbourne Health, Parkville, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Melkamu Dedefo Gishu
- Kersa Health and Demographic Surveillance System, Harar, Ethiopia.,Haramaya University, Dire Dawa, Ethiopia
| | - Harish Chander Gugnani
- Department of Epidemiology and Biostatistics, Saint James School of Medicine, Anguilla, British West Indies.,Department of Microbiology, Saint James School of Medicine, Anguilla, British West Indies
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston, West Virginia
| | - Gessessew Bugssa Hailu
- Kilte Awlaelo Health and Demographic Surveillance System, Ethiopia.,Mekelle University, Mekelle, Ethiopia
| | | | - Samer Hamidi
- Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Mohammad T Hedayati
- Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohamed Hsairi
- Department of Epidemiology, Salah Azaiz Institute, Tunis, Tunisia
| | | | - Nader Jahanmehr
- Department of Public Health, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Tariku Jibat
- Wageningen University, Wageningen, Netherlands.,Addis Ababa University, Debre Zeit, Ethiopia
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | - Yohannes Kinfu
- Centre for Research and Action in Public Health, Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu (CIBERSAM), Barcelona, Spain
| | - Aparna Lal
- Australian National University, Canberra, Australia
| | | | - Raimundas Lunevicius
- School of Medicine, University of Liverpool, Liverpool, United Kingdom.,Aintree University Hospital, National Health Service Foundation Trust, Liverpool, United Kingdom
| | | | | | - Reza Malekzadeh
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alem Mehari
- Howard University College of Medicine, Washington, District of Columbia
| | | | - Yohannes Adama Melaku
- School of Medicine, University of Adelaide, Adelaide, Australia.,School of Public Health, Mekelle University, Mekelle, Ethiopia
| | - Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Saudi Ministry of Health, Riyadh, Saudi Arabia
| | | | - Awoke Misganaw
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | | | - Jean B Nachega
- Stellenbosch University, Cape Town, Western Cape, South Africa.,University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Quyen Le Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | | | | | | | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Anwar Rafay
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Saleem M Rana
- Contech School of Public Health, Lahore, Pakistan.,Contech International Health Consultants, Lahore, Pakistan
| | - Chhabi L Ranabhat
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea.,Wonju College of Medicine, Yonsei University, Wonju, South Korea
| | - Sowmya R Rao
- Department of Surgery, School of Medicine, Boston University, Boston, Massachusetts
| | - Amany H Refaat
- Suez Canal University, Ismailia, Egypt.,Walden University, Minneapolis, Minnesota
| | - Mark Riddle
- Naval Medical Research Center, Silver Spring, Maryland
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran.,Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Juan R Sanabria
- Case Western Reserve University, Cleveland, Ohio.,Department of Surgery and Comprehensive Cancer Center, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | | | - Sadaf G Sepanlou
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Karen Sliwa
- Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | | | - Bryan L Sykes
- Departments of Criminology, Law and Society, Sociology, and Public Health, University of California-Irvine, Irvine, California
| | | | - Bemnet Amare Tedla
- James Cook University, Cairns, Australia.,University of Gondar, Gondar, Ethiopia
| | - Abdullah S Terkawi
- Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.,Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio.,Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Kingsley Ukwaja
- Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
| | - Olalekan A Uthman
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Ronny Westerman
- German National Cohort Consortium, Heidelberg, Germany.,Federal Institute for Population Research, Wiesbaden, Germany
| | - Mamo Wubshet
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,University of Gondar, Gondar, Ethiopia
| | | | - Naohiro Yonemoto
- Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | | | | | | | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| |
Collapse
|
18
|
Colombara DV, Manhart LE, Carter JJ, Hawes SE, Weiss NS, Hughes JP, Qiao YL, Taylor PR, Smith JS, Galloway DA. Absence of an association of human polyomavirus and papillomavirus infection with lung cancer in China: a nested case-control study. BMC Cancer 2016; 16:342. [PMID: 27246610 PMCID: PMC4888628 DOI: 10.1186/s12885-016-2381-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/24/2016] [Indexed: 12/18/2022] Open
Abstract
Background Studies of human polyomavirus (HPyV) infection and lung cancer are limited and those regarding the association of human papillomavirus (HPV) infection and lung cancer have produced inconsistent results. Methods We conducted a nested case–control study to assess the association between incident lung cancer of various histologies and evidence of prior infection with HPyVs and HPVs. We selected serum from 183 cases and 217 frequency matched controls from the Yunnan Tin Miner’s Cohort study, which was designed to identify biomarkers for early detection of lung cancer. Using multiplex liquid bead microarray (LBMA) antibody assays, we tested for antibodies to the VP1 structural protein and small T antigen (ST-Ag) of Merkel cell, KI, and WU HPyVs. We also tested for antibodies against HPV L1 structural proteins (high-risk types 16, 18, 31, 33, 52, and 58 and low-risk types 6 and 11) and E6 and E7 oncoproteins (high risk types 16 and 18). Measures of antibody reactivity were log transformed and analyzed using logistic regression. Results We found no association between KIV, WUV, and MCV antibody levels and incident lung cancer (P-corrected for multiple comparisons >0.10 for all trend tests). We also found no association with HPV-16, 18, 31, 33, 52, and 58 seropositivity (P-corrected for multiple comparisons >0.05 for all). Conclusions Future studies of infectious etiologies of lung cancer should look beyond HPyVs and HPVs as candidate infectious agents. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2381-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA. .,Fred Hutchinson Cancer Research Center, Seattle, WA, USA. .,Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA.
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Noel S Weiss
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James P Hughes
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
| | - Philip R Taylor
- Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
19
|
Colombara DV, Hernández B, Schaefer A, Zyznieuski N, Bryant MF, Desai SS, Gagnier MC, Johanns CK, McNellan CR, Palmisano EB, Ríos-Zertuche D, Zúñiga-Brenes P, Iriarte E, Mokdad AH. Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama. PLoS One 2016; 11:e0154388. [PMID: 27120070 PMCID: PMC4847770 DOI: 10.1371/journal.pone.0154388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/12/2016] [Indexed: 11/23/2022] Open
Abstract
Indigenous women in Mesoamerica experience disproportionately high maternal mortality rates and are less likely to have institutional deliveries. Identifying correlates of institutional delivery, and satisfaction with institutional deliveries, may help improve facility utilization and health outcomes in this population. We used baseline surveys from the Salud Mesoamérica Initiative to analyze data from 10,895 indigenous and non-indigenous women in Guatemala and Mexico (Chiapas State) and indigenous women in Panama. We created multivariable Poisson regression models for indigenous (Guatemala, Mexico, Panama) and non-indigenous (Guatemala, Mexico) women to identify correlates of institutional delivery and satisfaction. Compared to their non-indigenous peers, indigenous women were substantially less likely to have an institutional delivery (15.2% vs. 41.5% in Guatemala (P<0.001), 29.1% vs. 73.9% in Mexico (P<0.001), and 70.3% among indigenous Panamanian women). Indigenous women who had at least one antenatal care visit were more than 90% more likely to have an institutional delivery (adjusted risk ratio (aRR) = 1.94, 95% confidence interval (CI): 1.44-2.61), compared to those who had no visits. Indigenous women who were advised to give birth in a health facility (aRR = 1.46, 95% CI: 1.18-1.81), primiparous (aRR = 1.44, 95% CI: 1.24-1.68), informed that she should have a Caesarean section (aRR = 1.41, 95% CI: 1.21-1.63), and had a secondary or higher level of education (aRR = 1.36, 95% CI: 1.04-1.79) also had substantially higher likelihoods of institutional delivery. Satisfaction among indigenous women was associated with being able to be accompanied by a community health worker (aRR = 1.15, 95% CI: 1.05-1.26) and facility staff speaking an indigenous language (aRR = 1.10, 95% CI: 1.02-1.19). Additional effort should be exerted to increase utilization of birthing facilities by indigenous and poor women in the region. Improving access to antenatal care and opportunities for higher-level education may increase institutional delivery rates, and providing culturally adapted services may improve satisfaction.
Collapse
Affiliation(s)
- Danny V. Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Nicholas Zyznieuski
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Miranda F. Bryant
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Sima S. Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Casey K. Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Erin B. Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Emma Iriarte
- Salud Mesoamérica Initiative, Inter-American Development Bank, Calle 50 con Calle Elvira Méndez, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá City, Panamá
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, Washington, United States of America
| |
Collapse
|
20
|
Colombara DV, Hernández B, McNellan CR, Desai SS, Gagnier MC, Haakenstad A, Johanns C, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Diarrhea Prevalence, Care, and Risk Factors Among Poor Children Under 5 Years of Age in Mesoamerica. Am J Trop Med Hyg 2016; 94:544-52. [PMID: 26787152 DOI: 10.4269/ajtmh.15-0750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022] Open
Abstract
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ(2) tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.
Collapse
Affiliation(s)
- Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Bernardo Hernández
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Claire R McNellan
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Marielle C Gagnier
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Annie Haakenstad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Casey Johanns
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Diego Ríos-Zertuche
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Paola Zúñiga-Brenes
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Nicholas Zyznieuski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Emma Iriarte
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
| |
Collapse
|
21
|
Colombara DV, Manhart LE, Carter JJ, Hawes SE, Weiss NS, Hughes JP, Barnett MJ, Goodman GE, Smith JS, Qiao YL, Galloway DA. Prior human polyomavirus and papillomavirus infection and incident lung cancer: a nested case-control study. Cancer Causes Control 2015; 26:1835-44. [PMID: 26415892 DOI: 10.1007/s10552-015-0676-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/22/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To test whether infection with select human polyomaviruses (HPyV) and human papillomaviruses (HPV) is associated with incident lung cancer. METHODS We performed a nested case-control study, testing serum from the carotene and retinol efficacy trial, conducted 1985-2005, for antibodies to Merkel cell (MCV), KI (KIV), and WU (WUV) HPyVs as well as to six high-risk and two low-risk HPV types. Incident lung cancer cases (n = 200) were frequency-matched with controls (n = 200) on age, enrollment and blood draw dates, intervention arm assignment, and the number of serum freeze/thaw cycles. Sera were tested using multiplex liquid bead microarray antibody assays. We used logistic regression to assess the association between HPyV and HPV antibodies and lung cancer. RESULTS There was no evidence of a positive association between levels of MCV, KIV, or WUV antibodies and incident lung cancer (p corrected >0.10 for all trend tests; odds ratio (OR) range 0.72-1.09, p corrected >0.10 for all). There was also no evidence for a positive association between HPV 16 or 18 infection and incident lung cancer (p corrected ≥0.10 for all trend tests; OR range 0.25-2.54, p > 0.05 for all OR > 1), but the number of persons with serologic evidence of these infections was small. CONCLUSIONS Prior infection with any of several types of HPyV or HPV was not associated with subsequent diagnosis of lung cancer. Infection with these viruses likely does not influence a person's risk of lung cancer in Western smoking populations.
Collapse
Affiliation(s)
- Danny V Colombara
- Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA, 98121, USA. .,Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA. .,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA.
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA
| | - Joseph J Carter
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA
| | - Noel S Weiss
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA, 98195-7236, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, F-600, Health Sciences Building, Box 357232, Seattle, WA, 98195-7232, USA
| | - Matt J Barnett
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Gary E Goodman
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - You-Lin Qiao
- Department of Cancer Epidemiology, Cancer Institute, Chinese Academy of Medical Sciences, 17 South Pan Jia Yuan Lane, Chaoyang Dist., P. O. Box 2258, Beijing, 100021, People's Republic of China
| | - Denise A Galloway
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA, 98109-1024, USA
| |
Collapse
|
22
|
Colombara DV, Hernández B, Gagnier MC, Johanns C, Desai SS, Haakenstad A, McNellan CR, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Zyznieuski N, Iriarte E, Mokdad AH. Breastfeeding Practices among Poor Women in Mesoamerica. J Nutr 2015; 145:1958-65. [PMID: 26136592 DOI: 10.3945/jn.115.213736] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breastfeeding is an effective intervention to reduce pediatric morbidity and mortality. The prevalence of practices and predictors of breastfeeding among the poor in Mesoamerica has not been well described. OBJECTIVES We estimated the prevalence of ever breastfeeding, early initiation of breastfeeding, exclusive breastfeeding, and breastfeeding between 6 mo and 2 y of age using household survey data for the poorest quintile of families living in 6 Mesoamerican countries. We also assessed the predictors of breastfeeding behaviors to identify factors amenable to policy interventions. METHODS We analyzed data from 12,529 children in Guatemala, Honduras, Mexico (Chiapas State), Nicaragua, Panama, and El Salvador using baseline survey data from the Salud Mesoamérica 2015 Initiative. We created multivariable Poisson regression models with robust variance estimates to calculate adjusted risk ratios (aRRs) and 95% CIs for breastfeeding outcomes and to control for sociodemographic and healthcare-related factors. RESULTS Approximately 97% of women in all countries breastfed their child at least once, and 65.1% (Nicaragua) to 79.0% (Panama) continued to do so between 6 mo and 2 y of age. Breastfeeding in the first hour of life varied by country (P < 0.001), with the highest proportion reported in Panama (89.8%) and the lowest in El Salvador (65.6%). Exclusive breastfeeding also varied by country (P = 0.037), ranging from 44.5% in Panama to 76.8% in Guatemala. For every 20% increase in the proportion of peers who exclusively breastfed, there was an 11% (aRR: 1.11, 95% CI: 1.04, 1.18) increase in the likelihood of exclusive breastfeeding. CONCLUSION Our study revealed significant variation in the prevalence of breastfeeding practices by poor women across countries surveyed by the Salud Mesoamérica 2015 initiative. Future interventions to promote exclusive breastfeeding should consider ways to leverage the role of the community in supporting individual women.
Collapse
Affiliation(s)
| | | | | | - Casey Johanns
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | - Sima S Desai
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| | | | | | | | - Diego Ríos-Zertuche
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Paola Zúñiga-Brenes
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | | | - Emma Iriarte
- Salud Mesoamérica 2015, Inter-American Development Bank, Panama City, Panama
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA; and
| |
Collapse
|
23
|
Colombara DV, Hughes JP, Burnett-Hartman AN, Hawes SE, Galloway DA, Schwartz SM, Bostick RM, Potter JD, Manhart LE. Analysis of liquid bead microarray antibody assay data for epidemiologic studies of pathogen-cancer associations. J Immunol Methods 2015; 425:45-50. [PMID: 26071614 DOI: 10.1016/j.jim.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/03/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Liquid bead microarray antibody (LBMA) assays are used to assess pathogen-cancer associations. However, studies analyze LBMA data differently, limiting comparability. METHODS We generated 10,000 Monte Carlo-type simulations of log-normal antibody distributions (exposure) with 200 cases and 200 controls (outcome). We estimated type I error rates, statistical power, and bias associated with t-tests, logistic regression with a linear exposure and with the exposure dichotomized at 200 units, 400 units, the mean among controls plus two standard deviations, and the value corresponding to the optimal sensitivity and specificity. We also applied these models, and data visualizations (kernel density plots, receiver operating characteristic (ROC) curves, predicted probability plots, and Q-Q plots), to two empirical datasets to assess the consistency of the exposure-outcome relationship. RESULTS All strategies had acceptable type I error rates (0.03 ≤ P ≤ 0.048), except for the dichotomization according to optimal sensitivity and specificity, which had a type I error rate of 0.27. Among the remaining methods, logistic regression with a linear predictor (Power=1.00) and t-tests (Power=1.00) had the highest power to detect a mean difference of 1.0 MFI (median fluorescence intensity) on the log scale and were unbiased. Dichotomization methods upwardly biased the risk estimates. CONCLUSION These results indicate that logistic regression with linear predictors and unpaired t-tests are superior to logistic regression with dichotomized predictors for assessing disease associations with LBMA data. Logistic regression with continuous linear predictors and t-tests are preferable to commonly used LBMA dichotomization methods.
Collapse
Affiliation(s)
- Danny V Colombara
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA.
| | - James P Hughes
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Biostatistics, School of Public Health, University of Washington, F-600 Health Sciences Building, Box 357232, Seattle, WA 98195-7232, USA
| | - Andrea N Burnett-Hartman
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Denise A Galloway
- Human Biology Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Microbiology, School of Medicine, University of Washington, Box 357735, Seattle, WA 98195-7735, USA
| | - Stephen M Schwartz
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; Winship Cancer Institute, Emory University, 1365-C Clifton Road NE, Atlanta, GA 30322, USA
| | - John D Potter
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., P.O. Box 19024, Seattle, WA 98109-1024, USA; Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA; Centre for Public Health Research, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Lisa E Manhart
- Department of Epidemiology, School of Public Health, University of Washington, F-263 Health Sciences Building, Box 357236, Seattle, WA 98195-7236, USA; University of Washington Center for AIDS and STD, 325 9th Ave, Campus Box 359931, Seattle, WA 98104, USA
| |
Collapse
|
24
|
Colombara DV, Faruque ASG, Cowgill KD, Mayer JD. Risk factors for diarrhea hospitalization in Bangladesh, 2000-2008: a case-case study of cholera and shigellosis. BMC Infect Dis 2014; 14:440. [PMID: 25127553 PMCID: PMC4141120 DOI: 10.1186/1471-2334-14-440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 08/12/2014] [Indexed: 02/05/2023] Open
Abstract
Background Cholera and shigellosis are endemic on the Indian subcontinent. Our objective was to identify cholera-specific risk factors distinct from shigellosis risk factors. Methods We conducted a case-case study among hospitalized diarrheal patients, comparing those with cholera and shigellosis in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospitals in Matlab (rural) and Dhaka (urban) between January 1, 2000 and December 31, 2008. Results Multivariable Poisson regression models revealed that having more than nine years of education, compared to no education, was associated with a 39% (adjusted Risk Ratio [aRR] = 0.61, 95% confidence interval [CI]: 0.40-0.93) decreased risk for cholera hospitalization in Matlab and a 16% (aRR = 0.84, 95% CI: 0.75-0.94) decreased risk in Dhaka. Having a family member with diarrhea in the past seven days increased cholera hospitalization risk by 17% (aRR = 1.17, 95% CI: 1.09-1.26) in Matlab. Conclusions Further studies are needed to elucidate the pathway through which education impacts cholera risk in order to create targeted interventions in cholera-endemic areas. Interventions seeking to reduce transmission and facilitate hygienic practices among family members of index cases with diarrhea should be considered, especially in rural cholera endemic settings.
Collapse
Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | | | | | | |
Collapse
|
25
|
Khosropour CM, Manhart LE, Colombara DV, Gillespie CW, Lowens MS, Totten PA, Golden MR, Simoni J. Suboptimal adherence to doxycycline and treatment outcomes among men with non-gonococcal urethritis: a prospective cohort study. Sex Transm Infect 2013; 90:3-7. [PMID: 24106340 DOI: 10.1136/sextrans-2013-051174] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Doxycycline, one of two recommended therapies for non-gonococcal urethritis (NGU), consists of a 7-day course of therapy (100 mg BID). Since suboptimal adherence may contribute to poor treatment outcomes, we examined the association between self-reported imperfect adherence to doxycycline and clinical and microbiologic failure among men with NGU. METHODS Men aged ≥16 years with NGU attending a Seattle, WA, sexually transmitted diseases clinic were enrolled in a double-blind, parallel-group superiority trial from January 2007 to July 2011. Men were randomised to active doxycycline/placebo azithromycin or placebo doxycycline/active azithromycin. Imperfect adherence was defined as missing ≥1 dose in 7 days. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), and Ureaplasma urealyticum-biovar 2 (UU-2) using nucleic acid amplification tests. Clinical failure (symptoms and ≥5 PMNs/HPF or discharge) and microbiologic failure (positive tests for CT, MG, and/or UU-2) were determined after 3 weeks. RESULTS 184 men with NGU were randomised to active doxycycline and provided data on adherence. Baseline prevalence of CT, MG and UU-2 was 26%, 13% and 27%, respectively. 28% of men reported imperfect adherence, and this was associated with microbiologic failure among men with CT (aRR=9.33; 95% CI 1.00 to 89.2) and UU-2 (aRR=3.08; 95% CI 1.31 to 7.26) but not MG. Imperfect adherence was not significantly associated with clinical failure overall or for any specific pathogens, but it was more common among imperfectly adherent men with CT (aRR=2.63; 0.93-7.41, p=0.07). CONCLUSIONS Adherence may be important for microbiologic cure of select pathogens. Factors other than adherence should be considered for CT-negative men with persistent NGU.
Collapse
|
26
|
Colombara DV, Wang SM. The impact of HPV vaccination delays in China: lessons from HBV control programs. Vaccine 2013; 31:4057-9. [PMID: 23777955 DOI: 10.1016/j.vaccine.2013.06.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 02/06/2023]
Affiliation(s)
- Danny V Colombara
- Cancer Institute/Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China
| | | |
Collapse
|
27
|
Colombara DV, Cowgill KD, Faruque ASG. Risk factors for severe cholera among children under five in rural and urban Bangladesh, 2000-2008: a hospital-based surveillance study. PLoS One 2013; 8:e54395. [PMID: 23349875 PMCID: PMC3548801 DOI: 10.1371/journal.pone.0054395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 12/11/2012] [Indexed: 11/19/2022] Open
Abstract
Background Children under five bear the largest cholera burden. We therefore sought to identify modifiable risk factors among Bangladeshi children. Methodology/Principal Findings We used multivariate Poisson regression to assess risk factors for severe cholera among diarrheal patients presenting at hospitals in Matlab (rural) and Dhaka (urban), Bangladesh. Risk increased with age. Compared to those under one, rural and urban four-year-olds had adjusted risk ratios (aRR) of 4.17 (95% confidence interval (CI) 2.43–7.15) and 6.32 (95% CI: 4.63–8.63), respectively. Breastfeeding halved the risk in both rural (aRR = 0.49, 95% CI: 0.35–0.67) and urban (aRR = 0.51, 95% CI: 0.41–0.62) settings. Rural children’s risk decreased with maternal education (P-trend: <0.001) and increased among those with a family member with diarrhea in the past week (aRR = 1.61, 95% CI: 1.22–2.14) and those with prior vitamin A supplementation (aRR = 1.65, 95% CI: 1.12–2.43). Urban children whose mothers daily (aRR = 0.41, 95% CI: 0.21–0.79) or occasionally (aRR = 0.55, 95% CI: 0.36–0.84) read a newspaper experienced reduced risk. Urban children from households with incomes between 34–84 USD/month had a 30% increased risk compared to those from households with incomes >84 USD/month. Conclusion/Significance Increasing age, lower socioeconomic status, and lack of breastfeeding are key correlates of increased risk for cholera hospitalization among those under five in rural and urban Bangladesh. In addition, having a family member with diarrhea in the past week was associated with increased risk among rural children. Continued attention should be directed to the promotion of breastfeeding. Further research is needed to elucidate the relationship between maternal education and cholera risk. Renewed research regarding the use of chemoprophylaxis among family members of cholera cases may be warranted in rural endemic settings.
Collapse
Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.
| | | | | |
Collapse
|
28
|
Manhart LE, Gillespie CW, Lowens MS, Khosropour CM, Colombara DV, Golden MR, Hakhu NR, Thomas KK, Hughes JP, Jensen NL, Totten PA. Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. Clin Infect Dis 2012; 56:934-42. [PMID: 23223595 DOI: 10.1093/cid/cis1022] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Azithromycin or doxycycline is recommended for nongonococcal urethritis (NGU); recent evidence suggests their efficacy has declined. We compared azithromycin and doxycycline in men with NGU, hypothesizing that azithromycin was more effective than doxycycline. METHODS From January 2007 to July 2011, English-speaking males ≥16 years, attending a sexually transmitted diseases clinic in Seattle, Washington, with NGU (visible urethral discharge or ≥5 polymorphonuclear leukocytes per high-power field [PMNs/HPF]) were eligible for this double-blind, parallel-group superiority trial. Participants received active azithromycin (1 g) + placebo doxycycline or active doxycycline (100 mg twice daily for 7 days) + placebo azithromycin. Urine was tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Ureaplasma urealyticum biovar 2 (UU-2), and Trichomonas vaginalis (TV) using nucleic acid amplification tests. Clinical cure (<5 PMNs/HPF with or without urethral symptoms and absence of discharge) and microbiologic cure (negative tests for CT, MG, and/or UU-2) were determined after 3 weeks. RESULTS Of 606 men, 304 were randomized to azithromycin and 302 to doxycycline; CT, MG, TV, and UU-2 were detected in 24%, 13%, 2%, and 23%, respectively. In modified intent-to-treat analyses, 172 of 216 (80%; 95% confidence interval [CI], 74%-85%) receiving azithromycin and 157 of 206 (76%; 95% CI, 70%-82%) receiving doxycycline experienced clinical cure (P = .40). In pathogen-specific analyses, clinical cure did not differ by arm, nor did microbiologic cure differ for CT (86% vs 90%, P = .56), MG (40% vs 30%, P = .41), or UU-2 (75% vs 70%, P = .50). No unexpected adverse events occurred. CONCLUSIONS Clinical and microbiologic cure rates for NGU were somewhat low and there was no significant difference between azithromycin and doxycycline. Mycoplasma genitalium treatment failure was extremely common. Clinical Trials Registration.NCT00358462.
Collapse
Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Colombara DV, Soh JD, Menacho LA, Schiff MA, Reed SD. Birth injury in a subsequent vaginal delivery among women with a history of shoulder dystocia. J Perinat Med 2011; 39:709-15. [PMID: 21812753 DOI: 10.1515/jpm.2011.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM To examine risk factors for birth injury in a subsequent vaginal delivery among women with a prior delivery complicated by shoulder dystocia. METHODS Population-based retrospective cohort study, Washington State (1987-2007). Logistic regression was used to assess risk factors associated with subsequent birth injury. RESULTS Of 9232 women who met inclusion criteria, 223 (2.4%) had a subsequent vaginal delivery with birth injury. Birth injury in an index delivery, adjusted odds ratio (aOR) 2.6 [95% confidence interval (CI) 1.7-4.1] and factors in subsequent delivery: birth weight ≥4000 g, aOR 4.4 (95% CI: 3.0-6.3), gestational diabetes, aOR 1.9 (95% CI: 1.2-3.2), Hispanic ethnicity aOR 1.9 (95% CI: 1.2-2.9), and maternal obesity, aOR 1.8 (95% CI: 1.3-2.6) were associated with birth injury. CONCLUSION Among women with prior delivery complicated by shoulder dystocia, the risk factors identified in this study should be carefully considered prior to deciding upon route of delivery - cesarean vs. vaginal delivery.
Collapse
Affiliation(s)
- Danny V Colombara
- Department of Epidemiology, University of Washington, School of Public Health, Seattle, WA 98195, USA.
| | | | | | | | | |
Collapse
|