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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, 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K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert 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Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, 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A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2100-2132. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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Kyei EF, Kyriopoulos I, La Vecchia C, Lacey B, Ladan MA, Laflamme L, Lahariya C, Lai DTC, Lal DK, Lalloo R, Lám J, Lamnisos D, Landires I, Lanfranchi F, Langguth B, Laplante-Lévesque A, Larson HJ, Larsson AO, Lasrado S, Latief K, Latifinaibin K, Le LKD, Le NHH, Le TDT, Ledda C, Lee M, Lee PH, Lee SW, Lee YH, Lema GK, Leong E, Lerango TL, Li A, Li MC, Li S, Li W, Li X, Ligade VS, Lim SS, Lin RT, Lindstedt PA, Listl S, Liu G, Liu J, Liu X, Liu X, Liu Y, Llanaj E, López-Bueno R, Lopukhov PD, Lorenzovici L, Lotufo PA, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Lv H, Ma ZF, Maass KL, Machoy M, Madureira-Carvalho ÁM, Magdy Abd El Razek M, Maghazachi AA, Mahjoub S, Mahmoud MA, Majeed A, Malagón-Rojas JN, Malakan Rad E, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Manla Y, Mansoori Y, Mansour A, Mansouri B, Mansouri Z, Mansournia MA, Maravilla JC, Marino M, Marjani A, Martinez G, Martinez-Piedra R, Martins-Melo FR, Martorell M, Maryam S, Marzo RR, Masoudi A, Mattumpuram J, Maude RJ, Maugeri A, May EA, Mayeli M, Mazaheri M, McGrath JJ, McKee M, McKowen ALW, McLaughlin SA, McPhail SM, Mehra R, Mehrabani-Zeinabad K, Mehrabi Nasab E, Mekene Meto T, Mendez-Lopez MAM, Mendoza W, Menezes RG, Mensah GA, Mentis AFA, Meo SA, Merati M, Meretoja A, Meretoja TJ, Mersha AM, Mestrovic T, Metanat P, Mettananda KCD, Mettananda S, Mhlanga A, Mhlanga L, Mi T, Miazgowski T, Micha G, Michalek IM, Miller TR, Minh LHN, Mirghafourvand M, Mirrakhimov EM, Mirutse MK, Mirza M, Mirzaei R, Mishra A, Misra S, Mitchell PB, Mittal C, Moazen B, Mohamed AZ, Mohamed AI, Mohamed J, Mohamed MFH, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadi S, Mohammadian-Hafshejani A, Mohammed M, Mohammed S, Mohammed S, Mokdad AH, Mokhtarzadehazar P, Molavi Vardanjani H, Molinaro S, Monasta L, Moni MA, Moradi M, Moradi Y, Moraga P, Moreira RS, Morovatdar N, Morrison SD, Morze J, Mosapour A, Mossialos E, Motappa R, Mousavi P, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mubarik S, Muccioli L, Mulita F, Munjal K, Murillo-Zamora E, Musa J, Musaigwa F, Musina AM, Muthu S, Muthupandian S, Muzaffar M, Myung W, Nagarajan AJ, Nagel G, Naghavi P, Naik GR, Naik G, Naimzada MD, Nainu F, Nangia V, Narasimha Swamy S, Nascimento BR, Nascimento GG, Naser AY, Nasiri MJ, Natto ZS, Nauman J, Naveed M, Nayak BP, Nayak VC, Ndejjo R, Nduaguba SO, Negash H, Negesse CT, Negoi I, Negoi RI, Nejadghaderi SA, Nejjari C, Nepal S, Netsere HB, Nguefack-Tsague G, Ngunjiri JW, Nguyen DH, Nguyen HTH, Nguyen PT, Nguyen QP, Nguyen VT, Niazi RK, Nigatu YT, Nikolouzakis TK, Nikoobar A, Nikpoor AR, Nnaji CA, Nnyanzi LA, Noman EA, Nomura S, Noreen M, Noroozi N, Nri-Ezedi CA, Nunemo MH, Nuñez-Samudio V, Nurrika D, Nutor JJ, Oancea B, Obamiro KO, Odetokun IA, Odogwu NM, O'Donnell MJ, Odukoya OO, Oguntade AS, Oguta JO, Oh IH, Okeke SR, Okekunle AP, Okonji OC, Okwute PG, Olagunju AT, Olasupo OO, Olatubi MI, Oliveira GMM, Olusanya BO, Olusanya JO, Oluwatunase GO, Omar HA, Omer GL, Onwujekwe OE, Ordak M, Orisakwe OE, Orish VN, Ortega-Altamirano DV, Ortiz A, Ortiz-Prado E, Osman WMS, Osuagwu UL, Osuolale O, Otoiu A, Otstavnov SS, Ouyahia A, Ouyang G, Owolabi MO, Ozten Y, P A MP, Pahlevan Fallahy MT, Pan F, Pan HF, Pana A, Panda P, Panda-Jonas S, Pangaribuan HU, Panos GD, Panos LD, Pantazopoulos I, Pantea Stoian AM, Parikh RR, Park S, Parthasarathi A, Pashaei A, Passera R, Patel HM, Patel J, Patil S, Patoulias D, Patthipati VS, Paudel U, Paun M, Pazoki Toroudi H, Pease SA, Peden AE, Pedersini P, Peng M, Pensato U, Pepito VCF, Peprah P, Pereira G, Peres MFP, Perianayagam A, Perico N, Perna S, Pestell RG, Petermann-Rocha FE, Pham HT, Philip AK, Pierannunzio D, Pigeolet M, Pigott DM, Plotnikov E, Poddighe D, Pollner P, Poluru R, Postma MJ, Pourali G, Pourshams A, Pourtaheri N, Prabhu D, Prada SI, Pradhan PMS, Prasad M, Prashant A, Purohit BM, Puvvula J, Qasim NH, Qattea I, R D, Rabiee Rad M, Radfar A, Radhakrishnan V, Raee P, Raeisi Shahraki H, Rafiei A, Rafiei Alavi SN, Raggi C, Raghav PR, Rahim F, Rahim MJ, Rahman MM, Rahman MHU, Rahman M, Rahman MA, Rahmanian V, Rahmati M, Rahnavard N, Rai P, Raimondo D, Rajabpour-Sanati A, Rajput P, Ram P, Ramasamy SK, Rana J, Rana K, Rana SS, Ranabhat CL, Rancic N, Rane A, Ranjan S, Rao CR, Rao IR, Rapaka D, Rasella D, Rashedi S, Rashedi V, Rashidi MM, Rasul A, Ratan ZA, Rathnaiah Babu G, Rauniyar SK, Ravikumar N, Rawaf DL, Rawaf S, Rawassizadeh R, Rawlley B, Reddy MMRK, Redwan EMM, Remuzzi G, Reshmi B, Rezaei N, Rezaei Nejad A, Rezaeian M, Riad A, Riaz MA, Rickard J, Rikhtegar R, Robinson-Oden HE, Rodrigues CF, Rodriguez JAB, Rohilla R, Romadlon DS, Ronfani L, Rout HS, Roy B, Roy N, Roy P, Rubagotti E, Ruela GDA, Rumisha SF, Runghien T, S M, S N C, Saad AMA, Saadatian Z, Saber-Ayad MM, SaberiKamarposhti M, Sabour S, Sada F, Saddik B, Sadee BA, Sadeghi E, Sadeghi E, Saeb MR, Saeed U, Safi SZ, Sagoe D, Saha M, Sahebkar A, Sahoo SS, Sahu M, Saif Z, Sakshaug JW, Salamati P, Salami AA, Saleh MA, Salem MR, Salem MZY, Salimi S, Samadzadeh S, Samodra YL, Samuel VP, Samy AM, Sanabria J, Sanadgol N, Sanna F, Santric-Milicevic MM, Saqib H, Saraswathy SYI, Saravanan A, Saravi B, Sarikhani Y, Sarkar T, Sarmiento-Suárez R, Sarode GS, Sarode SC, Sarveazad A, Sathian B, Sathish T, Sathyanarayan A, Sayeed A, Sayeed MA, Scarmeas N, Schlee W, Schuermans A, Schwebel DC, Schwendicke F, Selvaraj S, Sengupta P, Senthilkumaran S, Sepanlou SG, Serban D, Serván-Mori E, Sethi Y, SeyedAlinaghi S, Seyedi SA, Seylani A, Shafie M, Shah J, Shah PA, Shahbandi A, Shahid S, Shahwan MJ, Shaikh A, Shaikh MA, Shamim MA, Shams-Beyranvand M, Shamsi MA, Shanawaz M, Shankar A, Shannawaz M, Sharath M, Sharfaei S, Sharifan A, Sharifi-Rad J, Sharma M, Sharma R, Sharma U, Sharma V, Shastry RP, Shavandi A, Shaw DH, Shayan AM, Shayan M, Shehabeldine AME, Sheikh A, Sheikhi RA, Shenoy MM, Shetty PH, Shi P, Shiferaw D, Shigematsu M, Shiri R, Shirkoohi R, Shittu A, Shivarov V, Shokraneh F, Shool S, Shorofi SA, Shuja KH, Shuval K, Siddig EE, Silva JP, Silva LMLR, Silva S, Simonetti B, Singal A, Singh A, Singh BB, Singh JA, Siraj MS, Smith G, Socea B, Sokhan A, Solanki R, Solanki S, Soleimani H, Soliman SSM, Solomon Y, Song Y, Sorensen RJD, Spartalis M, Sreeramareddy CT, Srivastava VK, Stanikzai MH, Starodubov VI, Starodubova AV, Stefan SC, Steiropoulos P, Stokes MA, Subramaniyan V, Suleman M, Suliankatchi Abdulkader R, Sultana A, Sun J, Swain CK, Sykes BL, Szarpak L, Szeto MD, Szócska M, Tabaee Damavandi P, Tabarés-Seisdedos R, Tabatabaei Malazy O, Tabatabaeizadeh SA, Tabatabai S, Tabb KM, Tabish M, Taheri Soodejani M, Taiba J, Tajbakhsh A, Talaat IM, Talukder A, Tampa M, Tamuzi JL, Tan KK, Tang H, Tareke DADA, Tariku MK, Tat VY, Tavangar SM, Teimoori M, Temsah MH, Temsah RMH, Teramoto M, Terefa DR, Tesler R, Teye-Kwadjo E, Thakur R, Thangaraju P, Thankappan KR, Thapar R, Tharwat S, Thayakaran R, Thomas N, Tichopad A, Ticoalu JHV, Tiruye TY, Titova MV, Tonelli M, Tovani-Palone MR, Traini E, Tran JT, Tran NM, Trihandini I, Tromans SJ, Truyen TTTT, Tsatsakis A, Tsermpini EE, Tumurkhuu M, Tyrovolas S, Uddin SMN, Udoakang AJ, Udoh A, Ullah A, Ullah S, Ullah S, Umakanthan S, Umeokonkwo CD, Unim B, Unnikrishnan B, Upadhyay E, Usman JS, Vacante M, Vahabi SM, Vaithinathan AG, Valizadeh R, Van den Eynde J, Varavikova E, Varga O, Vart P, Varthya SB, Vasankari TJ, Vellingiri B, Venugopal D, Verghese NA, Verma M, Veroux M, Verras GI, Vervoort D, Villafañe JH, Vinayak M, Violante FS, Vishwakarma M, Vladimirov SK, Vlassov V, Vo B, Volovat SR, Vos T, Vujcic IS, Wafa HA, Waheed Y, Wakwoya EB, Wang C, Wang D, Wang F, Wang S, Wang Y, Wang YP, Ward P, Wassie EG, Watson S, Weaver MR, Weerakoon KG, Weiss DJ, Wells KM, Wen YF, Westerman R, Wiangkham T, Wickramasinghe DP, Wickramasinghe ND, Willeit P, Wondimagegene YA, Wu F, Xia J, Xiao H, Xu G, Xu S, Xu X, Yadollahpour A, Yaghoobpoor S, Yaghoobpour T, Yaghoubi S, Yahaya ZS, Yang D, Yang L, Yano Y, Yaribeygi H, Ye P, Yesodharan R, Yesuf SA, Yezli S, Yigezu A, Yip P, Yon DK, Yonemoto N, You Y, Younis MZ, Yousefi Z, Yu C, Yu Y, Yuan CW, Zafari N, Zakham F, Zaki N, Zamagni G, Zandi M, Zandieh GGZ, Zangiabadian M, Zastrozhin MS, Zhang H, Zhang M, Zhang Y, Zhong C, Zhou J, Zhu B, Zhu L, Zielińska M, Zou Z, Zyoud SH, Murray CJL, Smith AE, Vollset SE. Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024; 403:2057-2099. [PMID: 38521087 DOI: 10.1016/s0140-6736(24)00550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. METHODS To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. FINDINGS During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. INTERPRETATION Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. FUNDING Bill & Melinda Gates Foundation.
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Terefe B, Belachew TB, Asmamaw DB, Wassie GT, Azene AG, Eshetu HB, Muchie KF, Bantie GM, Bogale KA, Negash WD. Determinants of early initiation of breastfeeding following birth in West Africa: A multilevel analysis using data from multi-country national health surveys. PLoS One 2024; 19:e0302143. [PMID: 38753614 PMCID: PMC11098389 DOI: 10.1371/journal.pone.0302143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Early initiation of breastfeeding (EIBF), within the first hour of birth, is crucial for promoting exclusive breastfeeding and establishing optimal nursing practices. However, global EIBF rates remain low, with even lower rates observed in Africa. Despite existing research gaps, this study aims to determine the prevalence of EIBF and identify maternal and child-related factors associated with its practice in West Africa. METHODS This study utilized West African Demographic and Health Survey (DHS) data from 13 countries, including 146,964 children's records. To assess model fit, likelihood test and deviance were used. Similarly, intraclass correlation coefficient, median odds ratio, and proportional change in variance were employed for random effect. A multilevel logistic regression model was used to identify individual- and community-level factors influencing EIBF due to the hierarchical nature of the data. Variables with p-values ≤0.2 in the binary model and <0.05 in the final analysis were considered significantly associated with EIBF. RESULTS The pooled prevalence of EIBF in West African nations was 50.60% (95% CI; 50.34-50.85%). The highest prevalence rate was observed in Serra Leone (75.33%) and the lowest prevalence was found in Senegal (33.94%). In the multilevel multiple logistic regression model, maternal education (AOR = 1.10, 95% CI, 1.03,1.16), marital status AOR = 1.07, 95% CI, 1.01,1.13), birth weight (AOR = 0.91, CI 0.86,0.96), birth orders (AOR = 1.09, CI 1.03,1.16), and (AOR = 1.11, CI 1.03,1.19), place of residence (AOR = 1.14, CI 1.07,1.21), and mode of delivery type (AOR = 0.26, CI 0.24,0.29) were significantly correlated with EIBF in West Africa. CONCLUSIONS The incidence of EIBF in West Africa was found to be low. The study emphasizes the need for targeted behavioral change communication programs to address timely breastfeeding initiation, specifically targeting mothers and child characteristics. Factors such as education, delivery mode, marital status, birth weight, birth order, and place of residence were significantly associated with EIBF. Special attention should be given to improving EIBF rates among women undergoing caesarean sections, infants with low birth weight, and primiparous mothers, along with structural improvements in the healthcare sector in West Africa.
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Affiliation(s)
- Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Negash WD, Asmamaw DB, Wassie GT, Azene AG, Eshetu HB, Terefe B, Muchie KF, Bantie GM, Bogale KA, Belachew TB. Less than one in four mothers get quality intrapartum health care services in Ethiopia. Sci Rep 2024; 14:4194. [PMID: 38378838 PMCID: PMC10879093 DOI: 10.1038/s41598-024-54506-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
Intrapartum care is a platform of comprehensive healthcare for pregnant women that is designed to improve birth outcomes for mother and child. However, complications during the intrapartum period continued to be the leading cause of death for women of reproductive age and newborns. Therefore, the aim of this study was to assess the prevalence of quality of intrapartum care and its associated factors among mothers in Ethiopia. A community based cross sectional study was conducted among 4469 mothers who gave birth in the last 2 years. Quality of intrapartum care was analyzed based on the assessment of health facility delivery, skilled birth attendants and early initiations of breast-feeding. Stata version 14 software was used for data cleaning and analysis. A mixed effect multilevel logistic regression was conducted to determine factors associated with quality of intrapartum care. An adjusted odds ratio with 95% confidence interval and a P value of less than or equal to 0.05 was used for the identification of both individual and community level factors. Overall, the prevalence of quality intrapartum care in Ethiopia was 23.8% (95% CI 22.6, 25.13). Primary education (AOR = 1.46, 95% CI = 1.14, 1.88), rich household class (AOR = 1.48, 95% CI = 1.10, 1.98), history of ANC (AOR = 2.91, 95% CI = 2.18, 3.86), perceived distance to the health facility as not a big issue (AOR = 1.63, 95% CI = 1.30, 2.05), urban residence (AOR = 2.97, 95% CI = 1.93, 5.09), Tigray region (AOR = 5.01, 95% CI = 1.25, 20.59), community level poverty (AOR = 0.63, 95% CI = 0.41, 0.97), and having 2-4 children (AOR = 0.74, 95% CI = 0.56, 0.97) were significantly associated with quality of intrapartum care. The finding conclude that less than one in four mothers received good quality intrapartum care. In order to optimize the quality of intrapartum care, the government should empower women through extensive education. It is also recommended for the Ministry of Health to evaluate the health facilities and community health workers to increase coverage of ANC and provide financial assistance to rural residents and the poor household class.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia.
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Biresaw Belachew
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO Box 196, Gondar, Ethiopia
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Tefera T, Bogale KA, Tegegn Y, Azene AG, Mulatu K, Wassie GT. Determinants of podoconiosis among residents of Machakle District East Gojjam Zone Amhara Region Ethiopia. PLoS Negl Trop Dis 2023; 17:e0011686. [PMID: 37797041 PMCID: PMC10581460 DOI: 10.1371/journal.pntd.0011686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 10/17/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Podoconiosis (endemic non-filarial elephantiasis) is a chronic disease characterized by the development of persistent swelling of plantar foot initially; which progresses to the dorsal foot and lower leg slowly or in a number of acute episodes to reach the knee. About 4 million people are said to be affected by the disease worldwide and it is deemed a serious public health problem in at least 10 African countries including Ethiopia. Therefore this study aimed to identify the determinants of podoconiosis among residence in Machakel district. METHOD Unmatched case control study design was conducted at Machakel district from August 30 to September 30, 2022. The sample size calculated using Epi-info software yielded 211 controls and 106 cases (317 study participants). Simple random sampling technique was used to select the cases using registration books of the district. Data were entered to Epi info version 7 and exported to SPSS version 22 for statistical analysis. Binary logistic regression was used to identify explanatory variables. RESULT A total of 312 study participants (104 cases and 208 controls) were included giving a response rate of 98.42%. Bare foot (AOR, 5.83 [95% CI: 2.34-14.50]), female sex (AOR, 4.25 [95% CI: 2.22-8.14]), family history of podoconiosis (AOR: 3.01(95% CI: 1.41-6.42) and age group 41-60 (AOR: 5.05(95% CI: 2.35-10.83), and 61-80 AOR 15.74 95% CI: (5.56-44.55) were determinants of Podoconiosis. CONCLUSION AND RECOMMENDATION Barefoot, sex, family history of podoconiosis and age were determinants of Podoconiosis. District health office should encourage at risk populations especially older people and individuals with family history of podoconiosis about shoe wearing practice all the time and not to expose their skin and feet.
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Affiliation(s)
- Teshome Tefera
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yiteka Tegegn
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kebadnew Mulatu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Bogale KA, Zeru T, Tarkegn M, Balew M, Worku M, Asrat A, Adamu A, Mulu Y, Getachew A, Ambaw F. Awareness and care seeking for long COVID symptoms among Coronavirus disease survivors in Bahir Dar City, Northwest Ethiopia: phenomenological study. BMC Public Health 2023; 23:941. [PMID: 37226170 DOI: 10.1186/s12889-023-15889-0] [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: 03/27/2023] [Accepted: 05/13/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Corona Virus Disease (COVID-19) has long-term sequels that persisted for months to years and manifested with a spectrum of signs and symptoms. Presentations of long COVID-19 symptoms are heterogeneous, vary from person to person, and can reach up to over 200 symptoms. Limited studies are conducted on the awareness of long COVID-19. So, this study aimed to explore the awareness about and care seeking for long COVID-19 symptoms among COVID survivors in Bahir Dar City in 2022. METHODS A qualitative study with a phenomenological design was used. Participants of the study were individuals who survived five months or longer after they tested positive for COVID-19 in Bahir Dar city. Individuals were selected purposively. An in-depth interview guide was prepared and used to collect the data. Open Cod 4.03 software was used for coding and synthesizing. Thematic analysis was used to analyze the transcripts. RESULTS The themes emerged from the data were awareness, experience of symptoms and their effects, and care practices of long COVID-19. Although only one participant mentioned the common symptoms of long COVID-19 the survivors experienced general, respiratory, cardiac, digestive, neurological, and other symptoms. These symptoms include rash, fatigue fever, cough, palpitations, shortness of breath, chest pain, and abdominal pain, loss of concentration, loss of smell, sleep disorder, depression, joint and muscle pain. These symptoms brought various physical and psychosocial effects. The majority of the respondents described that long COVID-19 symptoms will go off by themselves. To alleviate the problems some of the participants had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification. CONCLUSIONS The result of this study revealed that participants have a significant deficit of awareness about the common symptoms, risk groups, and communicability of Long COVID. However, they experienced the majority of the common symptoms of Long COVID. To alleviate the problems, they had taken different measures including medical care, homemade remedies, spiritual solutions, and lifestyle modification.
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Affiliation(s)
- Kassawmar Angaw Bogale
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Taye Zeru
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Molalign Tarkegn
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Melashu Balew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Masetewal Worku
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Anemaw Asrat
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Ayinengida Adamu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yared Mulu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Rennes University, Rennes, France
| | - Atalay Getachew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Endeshaw BA, Belay W, Gete A, Bogale KA, Wubeshet B, Azene AG, Wassie GT, Aderaw W, Teshome B, Muluneh AG, Demissie BA. Traditional bone setting service users and associated factors among people with trauma in Mecha district, Ethiopia. BMC Complement Med Ther 2023; 23:142. [PMID: 37138250 PMCID: PMC10158158 DOI: 10.1186/s12906-023-03951-8] [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: 12/15/2022] [Accepted: 04/09/2023] [Indexed: 05/05/2023] Open
Abstract
World Health Organization stated that traditional medicine is an important part of health care and countries need to consider integrating it into their primary health care system. Traditional bone setting has a long history in Ethiopia and it enjoys enormous acceptance in the community. However, these methods are raw, there is no standardized training and at the same time, complications are common. Therefore, this research aimed to assess the prevalence of traditional bone setting service utilization and associated factors among people with trauma in Mecha district. Methods A Community- based cross-sectional study design was employed from January 15 to February 15, 2021. A total of 836 participants were selected using a simple random sampling technique. Binary and multiple logistic regressions were employed to assess the association between the independent variables with traditional bone setting service utilization. Results The prevalence of traditional bone setting service utilization was 46.05%. Factors significantly associated with TBS utilization were: Age ≥ 60 years (AOR = 0.13, 95% CI: 0.03- 0.43), rural residence (AOR = 3.63, 95% CI: 1.76 -7.50), occupation (merchant (AOR = 0.21, 95% CI: 0.07 -0.61), and housewife (AOR = 4.12, 95% CI: 1.33 -12.70), type of trauma: dislocation (AOR = 6.40, 95% CI: 3.69-11.10), and strain (AOR = 2.09, 95% CI: 1.05- 4.14)), site of trauma: extremity (AOR = 0.20, 95% CI: 0.11, 0.37), trunk (AOR = 0.08, 95% CI: 0.03-0.22), and shoulder (AOR = 0.20, 95% CI: 0.11-0.37), cause of trauma: fall down and natural deformity (AOR = 9.87, 95% CI: 5.93-16.42) and household annual income greater than > 36,500 (AOR = 2.33, 95% CI: 1.29-4.22). Conclusion The prevalence of traditional bone setting practice is high in the study area, despite recent advancements in the practice of orthopedics and trauma in Ethiopia. Since TBS services are more accepted in society, the integration of TBS into the health care delivery system is recommended.
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Affiliation(s)
- Belaynew Adugna Endeshaw
- Department of Physiotherapy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Worku Belay
- Department of Orthopedics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aderaw Gete
- Department of Orthopedics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Bekalu Wubeshet
- Department of Orthopedics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abebaw Gedef Azene
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Tadesse Wassie
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Wubshet Aderaw
- Department of Physiotherapy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Birlew Teshome
- Department of Orthopedics, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Assefa Gebeyehu Muluneh
- Department of Physiotherapy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Berihun Assefa Demissie
- Department of Physiotherapy, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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Amera TG, Bogale KA, Tefera YM. Time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital: a retrospective cohort study. AIDS Res Ther 2021; 18:93. [PMID: 34863200 PMCID: PMC8645131 DOI: 10.1186/s12981-021-00418-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anti-retroviral therapy regimen discontinuations become a big challenge and cause diminishing the clinical and immunological benefit of treatment in Ethiopia. It reduces both the duration and the chance of viral control due to cross-resistance between different alternative drugs and overlapping toxicity between and within a class of antiretroviral drugs in Ethiopia. However, information’s on the time of initial regimen discontinuation and its predictors are not well studied. Objective This study aimed to assess the time to initial highly active antiretroviral therapy discontinuation and its predictors among HIV patients in Felege Hiwot comprehensive specialized hospital, North West Ethiopia. Method Institution-based retrospective cohort study was conducted among 418 HIV patients who started HAART from January 1, 2014, to December 31, 2019. Data were collected from the patient chart using a data extraction tool. The Kaplan–Meier curve was employed to compare survival rates. Multivariable Cox proportional hazard regression was applied to identify independent predictors of time to initial regimen discontinuation. Result A total of 418 patients on anti-retroviral therapy were followed. Incidence of initial HAART discontinuation was 16.7/100 person year. The median survival time was 3.5 years. Predictors showed association for time to initial HAART discontinuation were taking > 1 ART pills/day (AHR = 4.1, 95% CI 3.0–6.5), baseline CD4 count < 100 cells/mm3 (AHR = 2.6, 95% CI 1.5–4.7), 100–199 cells/mm3 (AHR = 2.2, 95% CI 1.2–4.0), baseline WHO clinical stage IV (AHR = 2.68, 95% CI 1.6–4.3) and stage III (AHR = 2.6, 95% CI 1.4–4.3) and TB infection (AHR = 2.3, 95% CI 1.6–3.5). Conclusion Most of the discontinuation occurred after 1 year of initiation of HAART. Baseline WHO clinical stage, TB infection, baseline CD4 count, and taking > 1 ART pill/day were found predictors of initial HAART regimen discontinuation. Work on early detection of HIV before the disease is advanced and initiation of one ART regimen daily is vital for survival on the initial regimen.
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Enbiale W, Abdela SG, Seyum M, Bedanie Hundie D, Bogale KA, Tamirat KS, Feleke MB, Azage M, Nigatu D, de Vries HJC. Effect of the COVID-19 Pandemic Preparation and Response on Essential Health Services in Primary and Tertiary Healthcare Settings of Amhara Region, Ethiopia. Am J Trop Med Hyg 2021; 105:1240-1246. [PMID: 34544048 PMCID: PMC8592201 DOI: 10.4269/ajtmh.21-0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/28/2021] [Accepted: 08/12/2021] [Indexed: 11/07/2022] Open
Abstract
Countries like Ethiopia have had to make difficult decisions to balance between the demands of the COVID-19 pandemic and maintaining the essential health service delivery. We assessed the effect of preventive COVID-19 measures on essential healthcare services in selected health facilities of Ethiopia. In a comparative cross-sectional study, we analyzed and compared data from seven health facilities over two periods: the pre-COVID-19 period before the first reported COVID-19 case in the country and during the COVID-19 period. Data were summarized using descriptive statistics and the independent t test. During the COVID-19 period the average number of monthly patient visits in the emergency department, pediatrics outpatient, and adult outpatient dropped by 27%, 30%, and 27%, respectively compared with the pre-COVID-19 period. Family planning; institutional delivery; childhood immunization; antenatal care-, hypertension- and diabetic patient follow-up, did not vary significantly between pre-COVID-19 and during COVID-19. Moreover, the monthly average number of tuberculosis (TB) and HIV patients who visited health facilities for drug refill and clinical evaluation did not vary significantly during the two periods. In conclusion, the study highlights that the effect of public restrictions to mitigate the COVID-19 pandemic on essential care systems should be considered.
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Affiliation(s)
- Wendemagegn Enbiale
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), Location Academic Medical Centre, Amsterdam, The Netherlands
| | - Seid Getahun Abdela
- Department of Internal Medicine, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | | | | | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Muluken Azage
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dabere Nigatu
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Henry J C de Vries
- Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), Location Academic Medical Centre, Amsterdam, The Netherlands
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TeshomeYimer B, Feleke BE, Bogale KA, Tsegaye GW. Factors Associated with Human Brucellosis among patients Attending in Ayu Primary Hospital, North Showa, Ethiopia: ACase Control Study. Ethiop J Health Sci 2021; 31:709-718. [PMID: 34703169 PMCID: PMC8512956 DOI: 10.4314/ejhs.v31i4.4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/26/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Brucellosis is a disease of domestic and wild animals commonly caused by Brucella species and can be transmitted to humans (zoonosis). Susceptibility to Brucellosis in Humans depends on immune status, routes of infection, size of the inoculums, and to some extent, the species of Brucella. Globally more than 500,000 new cases are reported each year. In sub-Saharan Africa, Brucellosis prevalence is unclear and poorly understood with varying reports from country to country, geographical regions as well as animal factors. METHODS Facility-based unmatched case-control study was conducted on 167 patients with human brucellosis and 332 controls from February 27/2019 to May 20/2019 in AYU primary hospital, North Showa Zone, Ethiopia. descriptive statistics such as frequency and percentages were used to describe the profile of case and control and analytical statistics such as bivariate and multivariate logistic regression analysis was performed to identify the determinants of human brucellosis. RESULT A total of 499 participants were included with a response rate of 99.60%. The mean age of participants was 45.46 years with a standard deviation (SD) of ±12.96 years. Human brucellosis had a statistically significant association with raw milk consumptions (AOR 5.75[95%CI 1.97-16.76]), slaughtering of animals at home(AOR 14.81[95%CI 3.63-60.38]), having contact with animal manure(AOR 2.87 [CI 1.08-7.62]), having contact with aborted cattle's fetus (AOR 3.01[95%CI 1.34-9.13]) and knowledge about brucellosis(AOR 0.29 [95%CI 0.08-0.83]. CONCLUSION Generally in this study knowledge about Human Brucellosis, contact with animal manures, practicing animal slaughtering at home, having contact with animal ruminants, and consuming raw milk were identified as determinants for human brucellosis infection.
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Affiliation(s)
- Bahiru TeshomeYimer
- Debreberhan city administration health office, North Showa Zone, Debreberhan, Ethiopia
| | - Berhanu Elfu Feleke
- Department of Epidemiology and Biostatistics College of Medicine Health Sciences, Bahirdar University, Ethiopia
| | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics College of Medicine Health Sciences, Bahirdar University, Ethiopia
| | - Gebiyaw Wudie Tsegaye
- Department of Epidemiology and Biostatistics College of Medicine Health Sciences, Bahirdar University, Ethiopia
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Reiner RC, Wiens KE, Deshpande A, Baumann MM, Lindstedt PA, Blacker BF, Troeger CE, Earl L, Munro SB, Abate D, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahpour I, Abdulkader RS, Abebe G, Abegaz KH, Abreu LG, Abrigo MRM, Accrombessi MMK, Acharya D, Adabi M, Adebayo OM, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Afarideh M, Ahmadi K, Ahmadi M, Ahmed AE, Ahmed MB, Ahmed R, Ajumobi O, Akal CG, Akalu TY, Akanda AS, Alamene GM, Alanzi TM, Albright JR, Alcalde Rabanal JE, Alemnew BT, Alemu ZA, Ali BA, Ali M, Alijanzadeh M, Alipour V, Aljunid SM, Almasi A, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Alvis-Zakzuk NJ, Amare AT, Amini S, Amit AML, Andrei CL, Anegago MT, Anjomshoa M, Ansari F, Antonio CAT, Antriyandarti E, Appiah SCY, Arabloo J, Aremu O, Armoon B, Aryal KK, Arzani A, Asadi-Lari M, Ashagre AF, Atalay HT, Atique S, Atre SR, Ausloos M, Avila-Burgos L, Awasthi A, Awoke N, Ayala Quintanilla BP, Ayano G, Ayanore MA, Ayele AA, Aynalem YAA, Azari S, Babaee E, Badawi A, Bakkannavar SM, Balakrishnan S, Bali AG, Banach M, Barac A, Bärnighausen TW, Basaleem H, Bassat Q, Bayati M, Bedi N, Behzadifar M, Behzadifar M, Bekele YA, Bell ML, Bennett DA, Berbada DA, Beyranvand T, Bhat AG, Bhattacharyya K, Bhattarai S, Bhaumik S, Bijani A, Bikbov B, Biswas RK, Bogale KA, Bohlouli S, Brady OJ, Bragazzi NL, Briko NI, Briko AN, Burugina Nagaraja S, Butt ZA, Campos-Nonato IR, Campuzano Rincon JC, Cárdenas R, Carvalho F, Castro F, Chansa C, Chatterjee P, Chattu VK, Chauhan BG, Chin KL, Christopher DJ, Chu DT, Claro RM, Cormier NM, Costa VM, Damiani G, Daoud F, Dandona L, Dandona R, Darwish AH, Daryani A, Das JK, Das Gupta R, Dasa TT, Davila CA, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demis AB, Demoz GT, Denova-Gutiérrez E, Deribe K, Desalew A, Dessie GA, Dharmaratne SD, Dhillon P, Dhimal M, Dhungana GP, Diaz D, Ding EL, Diro HD, Djalalinia S, Do HP, Doku DT, Dolecek C, Dubey M, Dubljanin E, Duko Adema B, Dunachie SJ, Durães AR, Duraisamy S, Effiong A, Eftekhari A, El Sayed I, El Sayed Zaki M, El Tantawi M, Elemineh DA, El-Jaafary SI, Elkout H, Elsharkawy A, Enany S, Endalamfaw A, Endalew DA, Eskandarieh S, Esteghamati A, Etemadi A, Farag TH, Faraon EJA, Fareed M, Faridnia R, Farioli A, Faro A, Farzam H, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes E, Filip I, Fischer F, Foroutan M, Francis JM, Franklin RC, Frostad JJ, Fukumoto T, Gayesa RT, Gebremariam KT, Gebremedhin KBB, Gebremeskel GG, Gedefaw GA, Geramo YCD, Geta B, Gezae KE, Ghashghaee A, Ghassemi F, Gill PS, Ginawi IA, Goli S, Gomes NGM, Gopalani SV, Goulart BNG, Grada A, Gugnani HC, Guido D, Guimares RA, Guo Y, Gupta R, Gupta R, Hafezi-Nejad N, Haile MT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Handiso DW, Haririan H, Hariyani N, Hasaballah AI, Hasan MM, Hasanzadeh A, Hassankhani H, Hassen HY, Hayelom DH, Heidari B, Henry NJ, Herteliu C, Heydarpour F, Hidru HDD, Hoang CL, Hoogar P, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Househ M, Hu G, Humayun A, Hussain SA, Ibitoye SE, Ilesanmi OS, Ilic MD, Inbaraj LR, Irvani SSN, Islam SMS, Iwu CJ, Jaca A, Jafari Balalami N, Jahanmehr N, Jakovljevic M, Jalali A, Jayatilleke AU, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, Johnson KB, Jonas JB, Jozwiak JJ, Kabir A, Kabir Z, Kahsay A, Kalani H, Kanchan T, Karami Matin B, Karch A, Karki S, Kasaeian A, Kasahun GG, Kayode GA, Kazemi Karyani A, Keiyoro PN, Ketema DB, Khader YS, Khafaie MA, Khalid N, Khalil AT, Khalil I, Khalilov R, Khan MN, Khan EA, Khan G, Khan J, Khatab K, Khater A, Khater MM, Khatony A, Khayamzadeh M, Khazaei M, Khazaei S, Khodamoradi E, Khosravi MH, Khubchandani J, Kiadaliri AA, Kim YJ, Kimokoti RW, Kisa S, Kisa A, Kissoon N, Kondlahalli SKMKMM, Kosek MN, Koyanagi A, Kraemer MUG, Krishan K, Kugbey N, Kumar GA, Kumar M, Kumar P, Kusuma D, La Vecchia C, Lacey B, Lal A, Lal DK, Lami FH, Lansingh VC, Lasrado S, Lee PH, Leili M, Lenjebo TTLL, Levine AJ, Lewycka S, Li S, Linn S, Lodha R, Longbottom J, Lopukhov PD, Magdeldin S, Mahasha PW, Mahotra NB, Malta DC, Mamun AA, Manafi N, Manafi F, Manda AL, Mansournia MA, Mapoma CC, Marami D, Marczak LB, Martins-Melo FR, März W, Masaka A, Mathur MR, Maulik PK, Mayala BK, McAlinden C, Mehndiratta MM, Mehrotra R, Mehta KM, Meles GG, Melese A, Memish ZA, Mena AT, Menezes RG, Mengesha MM, Mengistu DT, Mengistu G, Meretoja TJ, Miazgowski B, Mihretie KMM, Miller-Petrie MK, Mills EJ, Mir SM, Mirabi P, Mirrakhimov EM, Mohamadi-Bolbanabad A, Mohammad KA, Mohammad Y, Mohammad DK, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadifard N, Mohammed AS, Mohammed S, Mohammed JA, Mohebi F, Mokdad AH, Monasta L, Moodley Y, Moradi M, Moradi G, Moradi-Joo M, Moradi-Lakeh M, Moraga P, Mosapour A, Mouodi S, Mousavi SM, Mozaffor MMM, Muluneh AG, Muriithi MK, Murray CJL, Murthy GVS, Musa KI, Mustafa G, Muthupandian S, Naderi M, Nagarajan AJ, Naghavi M, Najafi F, Nangia V, Nazari J, Ndwandwe DE, Negoi I, Ngunjiri JW, Nguyen QP, Nguyen TH, Nguyen CT, Nigatu D, Ningrum DNA, Nnaji CA, Nojomi M, Noubiap JJ, Oh IH, Okpala O, Olagunju AT, Omar Bali A, Onwujekwe OE, Ortega-Altamirano DDV, Osarenotor O, Osei FB, Owolabi MO, P A M, Padubidri JR, Pana A, Pashaei T, Pati S, Patle A, Patton GC, Paulos K, Pepito VCF, Pereira A, Perico N, Pesudovs K, Pigott DM, Piroozi B, Platts-Mills JA, Poljak M, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poustchi H, Prada SI, Preotescu L, Quintana H, Rabiee N, Rabiee M, Radfar A, Rafiei A, Rahim F, Rahimi-Movaghar V, Rahman MA, Rajati F, Ramezanzadeh K, Rana SM, Ranabhat CL, Rasella D, Rawaf S, Rawaf DL, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Reta MA, Rezaei S, Ribeiro AI, Rickard J, Rios González CM, Rios-Blancas MJ, Roever L, Ronfani L, Roro EM, Rostami A, Rothenbacher D, Rubagotti E, Rubino S, Saad AM, Sabour S, Sadeghi E, Safari S, Safdarian M, Sagar R, Sahraian MA, Sajadi SM, Salahshoor MR, Salam N, Salehi F, Salehi Zahabi S, Salem MRR, Salem H, Salimi Y, Salimzadeh H, Sambala EZ, Samy AM, Sanabria J, Santos IS, Saraswathy SYI, Sarker AR, Sartorius B, Sathian B, Satpathy M, Sbarra AN, Schaeffer LE, Schwebel DC, Senbeta AM, Senthilkumaran S, Shabaninejad H, Shaheen AA, Shaikh MA, Shalash AS, Shallo SA, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Sharif M, Shey MS, Shibuya K, Shiferaw WSS, Shigematsu M, Shil A, Shin JI, Shiri R, Shirkoohi R, Si S, Siabani S, Singh JA, Singh NP, Sinha DN, Sisay MM, Skiadaresi E, Smith DL, Sobhiyeh MR, Sokhan A, Soofi M, Soriano JB, Sorrie MB, Soyiri IN, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Suleria HAR, Sykes BL, Tamirat KS, Tassew AA, Taveira N, Taye B, Tehrani-Banihashemi A, Temsah MH, Tesfay BE, Tesfay FH, Tessema ZT, Thankappan KR, Thirunavukkarasu S, Thomas N, Tlaye KG, Tlou B, Tovani-Palone MR, Traini E, Tran KB, Trihandini I, Ullah I, Unnikrishnan B, Valadan Tahbaz S, Valdez PR, Varughese S, Veisani Y, Violante FS, Vollmer S, Vos T, Wada FW, Waheed Y, Wang Y, Wang YP, Weldesamuel GT, Welgan CA, Westerman R, Wiangkham T, Wijeratne T, Wiysonge CSS, Wolde HF, Wondafrash DZ, Wonde TE, Wu AM, Xu G, Yadollahpour A, Yahyazadeh Jabbari SH, Yamada T, Yaseri M, Yenesew MA, Yeshaneh A, Yilma MT, Yimer EM, Yip P, Yirsaw BD, Yisma E, Yonemoto N, Younis MZ, Yousof HASA, Yu C, Yusefzadeh H, Zamani M, Zambrana-Torrelio C, Zandian H, Zeleke AJ, Zepro NB, Zewale TA, Zhang D, Zhang Y, Zhao XJ, Ziapour A, Zodpey S, Hay SI. Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017. Lancet 2020; 395:1779-1801. [PMID: 32513411 PMCID: PMC7314599 DOI: 10.1016/s0140-6736(20)30114-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 06/29/2019] [Revised: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Across low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. METHODS We used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FINDINGS The greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1-65·8), 17·4% (7·7-28·4), and 59·5% (34·2-86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. INTERPRETATION By co-analysing geospatial trends in diarrhoeal burden and its key risk factors, we could assess candidate drivers of subnational death reduction. Further, by doing a counterfactual analysis of the remaining disease burden using key risk factors, we identified potential intervention strategies for vulnerable populations. In view of the demands for limited resources in LMICs, accurately quantifying the burden of diarrhoea and its drivers is important for precision public health. FUNDING Bill & Melinda Gates Foundation.
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Fitzmaurice C, Abate D, Abbasi N, Abbastabar H, Abd-Allah F, Abdel-Rahman O, Abdelalim A, Abdoli A, Abdollahpour I, Abdulle ASM, Abebe ND, Abraha HN, Abu-Raddad LJ, Abualhasan A, Adedeji IA, Advani SM, Afarideh M, Afshari M, Aghaali M, Agius D, Agrawal S, Ahmadi A, Ahmadian E, Ahmadpour E, Ahmed MB, Akbari ME, Akinyemiju T, Al-Aly Z, AlAbdulKader AM, Alahdab F, Alam T, Alamene GM, Alemnew BTT, Alene KA, Alinia C, Alipour V, Aljunid SM, Bakeshei FA, Almadi MAH, Almasi-Hashiani A, Alsharif U, Alsowaidi S, Alvis-Guzman N, Amini E, Amini S, Amoako YA, Anbari Z, Anber NH, Andrei CL, Anjomshoa M, Ansari F, Ansariadi A, Appiah SCY, Arab-Zozani M, Arabloo J, Arefi Z, Aremu O, Areri HA, Artaman A, Asayesh H, Asfaw ET, Ashagre AF, Assadi R, Ataeinia B, Atalay HT, Ataro Z, Atique S, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Awoke N, Ayala Quintanilla BP, Ayanore MA, Ayele HT, Babaee E, Bacha U, Badawi A, Bagherzadeh M, Bagli E, Balakrishnan S, Balouchi A, Bärnighausen TW, Battista RJ, Behzadifar M, Behzadifar M, Bekele BB, Belay YB, Belayneh YM, Berfield KKS, Berhane A, Bernabe E, Beuran M, Bhakta N, Bhattacharyya K, Biadgo B, Bijani A, Bin Sayeed MS, Birungi C, Bisignano C, Bitew H, Bjørge T, Bleyer A, Bogale KA, Bojia HA, Borzì AM, Bosetti C, Bou-Orm IR, Brenner H, Brewer JD, Briko AN, Briko NI, Bustamante-Teixeira MT, Butt ZA, Carreras G, Carrero JJ, Carvalho F, Castro C, Castro F, Catalá-López F, Cerin E, Chaiah Y, Chanie WF, Chattu VK, Chaturvedi P, Chauhan NS, Chehrazi M, Chiang PPC, Chichiabellu TY, Chido-Amajuoyi OG, Chimed-Ochir O, Choi JYJ, Christopher DJ, Chu DT, Constantin MM, Costa VM, Crocetti E, Crowe CS, Curado MP, Dahlawi SMA, Damiani G, Darwish AH, Daryani A, das Neves J, Demeke FM, Demis AB, Demissie BW, Demoz GT, Denova-Gutiérrez E, Derakhshani A, Deribe KS, Desai R, Desalegn BB, Desta M, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Dinberu MTT, Djalalinia S, Doku DT, Drake TM, Dubey M, Dubljanin E, Duken EE, Ebrahimi H, Effiong A, Eftekhari A, El Sayed I, Zaki MES, El-Jaafary SI, El-Khatib Z, Elemineh DA, Elkout H, Ellenbogen RG, Elsharkawy A, Emamian MH, Endalew DA, Endries AY, Eshrati B, Fadhil I, Fallah Omrani V, Faramarzi M, Farhangi MA, Farioli A, Farzadfar F, Fentahun N, Fernandes E, Feyissa GT, Filip I, Fischer F, Fisher JL, Force LM, Foroutan M, Freitas M, Fukumoto T, Futran ND, Gallus S, Gankpe FG, Gayesa RT, Gebrehiwot TT, Gebremeskel GG, Gedefaw GA, Gelaw BK, Geta B, Getachew S, Gezae KE, Ghafourifard M, Ghajar A, Ghashghaee A, Gholamian A, Gill PS, Ginindza TTG, Girmay A, Gizaw M, Gomez RS, Gopalani SV, Gorini G, Goulart BNG, Grada A, Ribeiro Guerra M, Guimaraes ALS, Gupta PC, Gupta R, Hadkhale K, Haj-Mirzaian A, Haj-Mirzaian A, Hamadeh RR, Hamidi S, Hanfore LK, Haro JM, Hasankhani M, Hasanzadeh A, Hassen HY, Hay RJ, Hay SI, Henok A, Henry NJ, Herteliu C, Hidru HD, Hoang CL, Hole MK, Hoogar P, Horita N, Hosgood HD, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hussen MM, Ileanu B, Ilic MD, Innos K, Irvani SSN, Iseh KR, Islam SMS, Islami F, Jafari Balalami N, Jafarinia M, Jahangiry L, Jahani MA, Jahanmehr N, Jakovljevic M, James SL, Javanbakht M, Jayaraman S, Jee SH, Jenabi E, Jha RP, Jonas JB, Jonnagaddala J, Joo T, Jungari SB, Jürisson M, Kabir A, Kamangar F, Karch A, Karimi N, Karimian A, Kasaeian A, Kasahun GG, Kassa B, Kassa TD, Kassaw MW, Kaul A, Keiyoro PN, Kelbore AG, Kerbo AA, Khader YS, Khalilarjmandi M, Khan EA, Khan G, Khang YH, Khatab K, Khater A, Khayamzadeh M, Khazaee-Pool M, Khazaei S, Khoja AT, Khosravi MH, Khubchandani J, Kianipour N, Kim D, Kim YJ, Kisa A, Kisa S, Kissimova-Skarbek K, Komaki H, Koyanagi A, Krohn KJ, Bicer BK, Kugbey N, Kumar V, Kuupiel D, La Vecchia C, Lad DP, Lake EA, Lakew AM, Lal DK, Lami FH, Lan Q, Lasrado S, Lauriola P, Lazarus JV, Leigh J, Leshargie CT, Liao Y, Limenih MA, Listl S, Lopez AD, Lopukhov PD, Lunevicius R, Madadin M, Magdeldin S, El Razek HMA, Majeed A, Maleki A, Malekzadeh R, Manafi A, Manafi N, Manamo WA, Mansourian M, Mansournia MA, Mantovani LG, Maroufizadeh S, Martini SMS, Mashamba-Thompson TP, Massenburg BB, Maswabi MT, Mathur MR, McAlinden C, McKee M, Meheretu HAA, Mehrotra R, Mehta V, Meier T, Melaku YA, Meles GG, Meles HG, Melese A, Melku M, Memiah PTN, Mendoza W, Menezes RG, Merat S, Meretoja TJ, Mestrovic T, Miazgowski B, Miazgowski T, Mihretie KMM, Miller TR, Mills EJ, Mir SM, Mirzaei H, Mirzaei HR, Mishra R, Moazen B, Mohammad DK, Mohammad KA, Mohammad Y, Darwesh AM, Mohammadbeigi A, Mohammadi H, Mohammadi M, Mohammadian M, Mohammadian-Hafshejani A, Mohammadoo-Khorasani M, Mohammadpourhodki R, Mohammed AS, Mohammed JA, Mohammed S, Mohebi F, Mokdad AH, Monasta L, Moodley Y, Moosazadeh M, Moossavi M, Moradi G, Moradi-Joo M, Moradi-Lakeh M, Moradpour F, Morawska L, Morgado-da-Costa J, Morisaki N, Morrison SD, Mosapour A, Mousavi SM, Muche AA, Muhammed OSS, Musa J, Nabhan AF, Naderi M, Nagarajan AJ, Nagel G, Nahvijou A, Naik G, Najafi F, Naldi L, Nam HS, Nasiri N, Nazari J, Negoi I, Neupane S, Newcomb PA, Nggada HA, Ngunjiri JW, Nguyen CT, Nikniaz L, Ningrum DNA, Nirayo YL, Nixon MR, Nnaji CA, Nojomi M, Nosratnejad S, Shiadeh MN, Obsa MS, Ofori-Asenso R, Ogbo FA, Oh IH, Olagunju AT, Olagunju TO, Oluwasanu MM, Omonisi AE, Onwujekwe OE, Oommen AM, Oren E, Ortega-Altamirano DDV, Ota E, Otstavnov SS, Owolabi MO, P A M, Padubidri JR, Pakhale S, Pakpour AH, Pana A, Park EK, Parsian H, Pashaei T, Patel S, Patil ST, Pennini A, Pereira DM, Piccinelli C, Pillay JD, Pirestani M, Pishgar F, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Prakash S, Prasad N, Qorbani M, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi M, Rahman MA, Rajati F, Rana SM, Raoofi S, Rath GK, Rawaf DL, Rawaf S, Reiner RC, Renzaho AMN, Rezaei N, Rezapour A, Ribeiro AI, Ribeiro D, Ronfani L, Roro EM, Roshandel G, Rostami A, Saad RS, Sabbagh P, Sabour S, Saddik B, Safiri S, Sahebkar A, Salahshoor MR, Salehi F, Salem H, Salem MR, Salimzadeh H, Salomon JA, Samy AM, Sanabria J, Santric Milicevic MM, Sartorius B, Sarveazad A, Sathian B, Satpathy M, Savic M, Sawhney M, Sayyah M, Schneider IJC, Schöttker B, Sekerija M, Sepanlou SG, Sepehrimanesh M, Seyedmousavi S, Shaahmadi F, Shabaninejad H, Shahbaz M, Shaikh MA, Shamshirian A, Shamsizadeh M, Sharafi H, Sharafi Z, Sharif M, Sharifi A, Sharifi H, Sharma R, Sheikh A, Shirkoohi R, Shukla SR, Si S, Siabani S, Silva DAS, Silveira DGA, Singh A, Singh JA, Sisay S, Sitas F, Sobngwi E, Soofi M, Soriano JB, Stathopoulou V, Sufiyan MB, Tabarés-Seisdedos R, Tabuchi T, Takahashi K, Tamtaji OR, Tarawneh MR, Tassew SG, Taymoori P, Tehrani-Banihashemi A, Temsah MH, Temsah O, Tesfay BE, Tesfay FH, Teshale MY, Tessema GA, Thapa S, Tlaye KG, Topor-Madry R, Tovani-Palone MR, Traini E, Tran BX, Tran KB, Tsadik AG, Ullah I, Uthman OA, Vacante M, Vaezi M, Varona Pérez P, Veisani Y, Vidale S, Violante FS, Vlassov V, Vollset SE, Vos T, Vosoughi K, Vu GT, Vujcic IS, Wabinga H, Wachamo TM, Wagnew FS, Waheed Y, Weldegebreal F, Weldesamuel GT, Wijeratne T, Wondafrash DZ, Wonde TE, Wondmieneh AB, Workie HM, Yadav R, Yadegar A, Yadollahpour A, Yaseri M, Yazdi-Feyzabadi V, Yeshaneh A, Yimam MA, Yimer EM, Yisma E, Yonemoto N, Younis MZ, Yousefi B, Yousefifard M, Yu C, Zabeh E, Zadnik V, Moghadam TZ, Zaidi Z, Zamani M, Zandian H, Zangeneh A, Zaki L, Zendehdel K, Zenebe ZM, Zewale TA, Ziapour A, Zodpey S, Murray CJL. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol 2019; 5:1749-1768. [PMID: 31560378 PMCID: PMC6777271 DOI: 10.1001/jamaoncol.2019.2996] [Citation(s) in RCA: 1447] [Impact Index Per Article: 289.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). Conclusions and Relevance The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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Affiliation(s)
| | - Christina Fitzmaurice
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Division of Hematology, University of Washington, Seattle
| | | | - Naghmeh Abbasi
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Hedayat Abbastabar
- Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Omar Abdel-Rahman
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Ain Shams University, Cairo, Egypt
| | | | - Amir Abdoli
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
- Research Center for Non-communicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ibrahim Abdollahpour
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
- Multiple Sclerosis Research Center, Tehran, Iran
| | - Abdishakur S M Abdulle
- Public Health Research Center, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Nebiyu Dereje Abebe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Wachemo University, Hossana, Ethiopia
| | | | - Laith Jamal Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College in Qatar, Doha, Qatar
| | | | | | - Shailesh M Advani
- Social Behavioral Research Branch, National Institutes of Health, Bethesda, Maryland
- Cancer Prevention and Control Program, Georgetown University, Washington, DC
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Aghaali
- Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
| | - Dominic Agius
- Department of Health, Directorate for Health Information and Research, Pieta, Malta
| | - Sutapa Agrawal
- Public Health Foundation of India, Gurugram, India
- Vital Strategies, Gurugram, India
| | - Ayat Ahmadi
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Ahmadian
- Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ehsan Ahmadpour
- Department of Parasitology and Mycology, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Ziyad Al-Aly
- John T. Milliken Department of Internal Medicine, Washington University in St. Louis, St Louis, Missouri
- Clinical Epidemiology Center, VA Saint Louis Health Care System, Department of Veterans Affairs, St Louis, Missouri
| | - Assim M AlAbdulKader
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio
| | - Fares Alahdab
- Evidence-Based Practice Research Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, Minnesota
| | - Tahiya Alam
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Birhan Tamene T Alemnew
- Department of Health Sciences, Woldia University, Woldia, Ethiopia
- Department of Microbiology, Immunology, and Parasitology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kefyalew Addis Alene
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Research School of Population Health, Australian National University, Canberra, Australian Capitol Territory, Australia
| | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | | | - Majid Abdulrahman Hamad Almadi
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Gastroenterology and Hepatology, McGill University, Montreal, Québec, Canada
| | | | - Ubai Alsharif
- Department of Oral and Maxillofacial Surgery, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Shirina Alsowaidi
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Nelson Alvis-Guzman
- Research Group in Health Economics, Universidad de Cartagena, Cartagena, Colombia
- Research Group in Hospital Management and Health Policies, Universidad de la Costa, Barranquilla, Colombia
| | - Erfan Amini
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Amini
- Department of Health Services Management, Arak University of Medical Sciences, Arak, Iran
| | - Yaw Ampem Amoako
- Department of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Zohreh Anbari
- Department of Health Services Management, Arak University of Medical Sciences, Arak, Iran
| | | | | | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fereshteh Ansari
- Research Center for Evidence Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Seth Christopher Yaw Appiah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Center for International Health, Ludwig Maximilians University, Munich, Germany
| | - Morteza Arab-Zozani
- Department of Healthcare Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Arefi
- Department of Health Education and Health Promotion, Tehran University of Medical Sciences, Tehran, Iran
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, England, United Kingdom
| | - Habtamu Abera Areri
- School of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Al Artaman
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahar Ataeinia
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zerihun Ataro
- Department of Medical Laboratory Science, Haramaya University, Harar, Ethiopia
| | - Suleman Atique
- University Institute of Public Health, The University of Lahore, Lahore, Pakistan
- College ofPublic Health, University of Hail, Hail, Saudi Arabia
| | - Marcel Ausloos
- School of Business, University of Leicester, Leicester, England, United Kingdom
| | - Leticia Avila-Burgos
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Euripide F G A Avokpaho
- Bénin Clinical Research Institute, Abomey-Calavi, Benin
- Contrôle des Maladies Infectieuses, Laboratory of Studies and Research-Action in Health, Porto Novo, Benin
| | - Ashish Awasthi
- Public Health Foundation of India, Gurugram, India
- Indian Institute of Public Health, Gandhinagar, India
| | - Nefsu Awoke
- Department of Nursing, Wolaita Sodo University, Sodo, Ethiopia
| | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Martin Amogre Ayanore
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | - Henok Tadesse Ayele
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Public Health Department, Dilla University, Dilla, Ethiopia
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Umar Bacha
- School of Health Sciences, University of Management and Technology, Lahore, Pakistan
| | - Alaa Badawi
- Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | | | - Eleni Bagli
- Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
- Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology, Ioannina, Greece
| | | | - Abbas Balouchi
- School of Nursing and Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Till Winfried Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Masoud Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Bayu Begashaw Bekele
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
| | - Yared Belete Belay
- Department of Pharmacoepidemiology and Social Pharmacy, Mekelle University, Mekelle, Ethiopia
- AC Environments Foundation, Cuernavaca, Mexico
| | | | | | - Adugnaw Berhane
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eduardo Bernabe
- Dental Institute, King's College London, London, England, United Kingdom
| | - Mircea Beuran
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Krittika Bhattacharyya
- Department of Biostatistics and Bioinformatics, National Institute of Biomedical Genomics, Kalyani, India
| | - Belete Biadgo
- Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Muhammad Shahdaat Bin Sayeed
- National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Clinical Pharmacy and Pharmacology, University of Dhaka, Ramna, Bangladesh
| | - Charles Birungi
- The UCL Centre for Global Health Economics, University College London, London, England, United Kingdom
- Fast-Track Implementation Department, United Nations Programme on HIV/AIDS, Gaborone, Botswana
| | - Catherine Bisignano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Helen Bitew
- School of Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Tone Bjørge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Archie Bleyer
- Department of Radiation Medicine, Oregon Health and Science University, Portland
- Department of Pediatrics, The University of Texas, Houston
| | | | - Hunduma Amensisa Bojia
- School of Pharmacy, College of Medicine and Health Science, Haramaya University, Harar, Ethiopia
| | - Antonio M Borzì
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | - Cristina Bosetti
- Department of Oncology, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | | | - Nikolay Ivanovich Briko
- Department of Epidemiology and Evidence-Based Medicine, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Juan J Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Félix Carvalho
- Applied Molecular Biosciences Unit, University of Porto, Porto, Portugal
- Institute of Public Health, University of Porto, Porto, Portugal
| | - Clara Castro
- Department of Epidemiology, Portuguese Oncology Institute of Porto, Porto, Portugal
- EpiUnit, Instituto de Saúde Pública, University of Cartagena, Cartagena, Colombia
| | - Franz Castro
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Ferrán Catalá-López
- National School of Public Health, Carlos III Health Institute, Madrid, Spain
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Yazan Chaiah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Vijay Kumar Chattu
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- China Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Neelima Singh Chauhan
- Department of Obstetrics and Gynecology, People's College of Medical Sciences and Research Centre, Bhopal, India
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
- Epidemiology Research Center, Royan Institute, Tehran, Iran
| | | | | | - Onyema Greg Chido-Amajuoyi
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas, Houston
| | - Odgerel Chimed-Ochir
- Institute of Industrial Ecological Science, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jee-Young J Choi
- Departments ofBiochemistry and Biomedical Science, Seoul National University Hospital, Seoul, South Korea
| | | | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
- Department of Cancer Immunology, Oslo University Hospital, Oslo, Norway
| | - Maria-Magdalena Constantin
- Department of Dermatology, 2nd Clinic of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Vera M Costa
- UCIBIO/REQUIMTE, Laboratory of Toxicology, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Emanuele Crocetti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Maria Paula Curado
- Department of Epidemiology, A. C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Saad M A Dahlawi
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | | | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - José das Neves
- Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
- Institute of Biomedical Engineering (INEB), University of Porto, Porto, Portugal
| | - Feleke Mekonnen Demeke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Asmamaw Bizuneh Demis
- Nursing Department, Woldia University, Woldia, Ethiopia
- Department of Nursing, Jimma University, Jimma, Ethiopia
| | | | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Edgar Denova-Gutiérrez
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Afshin Derakhshani
- Department of Immunology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Melaku Desta
- Department of Midwifery, Debre Berhan University, Debre Berhan, Ethiopia
- Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Culiacán Rosales, Mexico
| | | | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Meghnath Dhimal
- Health Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Daniel Diaz
- Faculty of Veterinary Medicine and Zootechnics, Autonomous University of Sinaloa, Culiacán Rosales, Mexico
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico
| | | | - Shirin Djalalinia
- Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
| | - Thomas M Drake
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Manisha Dubey
- United Nations World Food Programme, New Delhi, India
| | | | - Eyasu Ejeta Duken
- College of Health Sciences, Wollega University, Nekemte, Ethiopia
- Mycobacteriology Research Center, Jimma University, Jimma, Ethiopia
| | - Hedyeh Ebrahimi
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Liver and Pancreaticobiliary Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Andem Effiong
- Department of Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aziz Eftekhari
- Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Iman El Sayed
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | | | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Hajer Elkout
- Department of Community Medicine, Tripoli University, Tripoli, Libya
- Department of Health Information, World Health Organization, Tripoli, Libya
| | - Richard G Ellenbogen
- Department of Neurology, University of Washington, Seattle
- Department of Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Aisha Elsharkawy
- Endemic Medicine and Hepatogastroenterology Department, Cairo University, Cairo, Egypt
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Aman Yesuf Endries
- Public Health Department, St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Babak Eshrati
- Center of Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
- School of Public Health, Arak University of Medical Sciences, Arak, Iran
| | - Ibtihal Fadhil
- Department of Non-communicable Diseases, Ministry of Public Health, Dubai, United Arab Emirates
| | | | | | | | - Andrea Farioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Farshad Farzadfar
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Netsanet Fentahun
- Department of Public Health Nutrition, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Garumma Tolu Feyissa
- Department of Health Education and Behavioral Sciences, Jimma University, Jimma, Ethiopia
- Jimma University, Jimma, Ethiopia
| | - Irina Filip
- Department of Psychiatry, Kaiser Permanente, Fontana, California
- School of Health Sciences, A.T. Still University, Mesa, Arizona
| | - Florian Fischer
- School of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - James L Fisher
- James Cancer Hospital, Ohio State University, Columbus, Ohio
| | - Lisa M Force
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Marisa Freitas
- Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Takeshi Fukumoto
- Gene Expression and Regulation Program, Cancer Institute, Philadelphia, Pennsylvania
- Department of Dermatology, Kobe University, Kobe, Japan
| | - Neal D Futran
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle
| | - Silvano Gallus
- Department of Environmental Health Science, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Fortune Gbetoho Gankpe
- Faculty of Medicine and Pharmacy of Fez, University Sidi Mohammed Ben Abdellah, Fez, Morocco
- Non-communicable Disease Department, Laboratory of Studies and Research-Action in Health, Porto Novo, Benin
| | | | | | | | - Getnet Azeze Gedefaw
- Bahir Dar University, Bahir Dar, Ethiopia
- Haramaya University, Dire Dawa, Ethiopia
| | | | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Sefonias Getachew
- Department of Preventive Medicine, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle, Germany
| | | | - Mansour Ghafourifard
- Medical Surgical Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ghajar
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Ahmad Ghashghaee
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Asadollah Gholamian
- Physiology Department, Iran University of Medical Sciences, Tehran, Iran
- Medical Department, Islamic Azad University, Rasht, Iran
| | - Paramjit Singh Gill
- Unit of Academic Primary Care, University of Warwick, Coventry, England, United Kingdom
| | - Themba T G Ginindza
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- University of KwaZulu-Natal, Durban, South Africa
| | - Alem Girmay
- Department of Nursing, A.C.S. Medical College and Hospital, Aksum, Ethiopia
| | - Muluken Gizaw
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia
| | - Giuseppe Gorini
- Occupational and Environmental Epidemiology Section, Cancer Prevention and Research Institute, Florence, Italy
| | | | - Ayman Grada
- School of Medicine, Boston University, Boston, Massachusetts
| | | | | | - Prakash C Gupta
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Rahul Gupta
- West Virginia Bureau for Public Health, Charleston
- Department of Health Policy, Management & Leadership, West Virginia University, Morgantown
| | | | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Randah R Hamadeh
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network, Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
| | - Milad Hasankhani
- School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Hasanzadeh
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Yimam Hassen
- Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
| | - Roderick J Hay
- International Foundation for Dermatology, London, England, United Kingdom
- St John's Institute of Dermatology, King's College London, London, England, United Kingdom
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | | | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Claudiu Herteliu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
| | - Hagos D Hidru
- Department of Epidemiology, Adigrat University, Adigrat, Ethiopia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Praveen Hoogar
- Transdisciplinary Centre for Qualitative Methods, Manipal University, Manipal, India
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University, Kanazawa-ku, Yokohama, Japan
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - H Dean Hosgood
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Department of Computer Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Department of Computer Science, University of Human Development, Sulaimaniyah, Iraq
| | - Mihaela Hostiuc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
| | - Sorin Hostiuc
- Faculty of Dentistry, Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation, Doha, Qatar
| | | | - Bogdan Ileanu
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- Center for Health Outcomes & Evaluation, Bucharest, Romania
| | - Milena D Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Seyed Sina Naghibi Irvani
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kufre Robert Iseh
- Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Farhad Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | | | - Morteza Jafarinia
- ,Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Jahangiry
- Health Education and Health Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nader Jahanmehr
- School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Spencer L James
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University, Richmond
| | - Sun Ha Jee
- Department of Public Health, Yonsei University, Seoul, South Korea
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Ensiyeh Jenabi
- Faculty of Nursing & Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ravi Prakash Jha
- Department of Community Medicine, Banaras Hindu University, Varanasi, India
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Mannheim, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Jitendra Jonnagaddala
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- NSW Health, Sydney, New South Wales, Australia
| | - Tamas Joo
- Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
| | | | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farin Kamangar
- Department of Biology, Morgan State University, Baltimore, Maryland
| | - André Karch
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Narges Karimi
- Immunogenetics Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Neurology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ansar Karimian
- Cellular and Molecular Biology Research Center, Babol University of Medical Sciences, Babol, Iran
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Belete Kassa
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Dessie, Ethiopia
| | | | - Mesfin Wudu Kassaw
- Nursing Department, Woldia University, Woldia, Ethiopia
- Department of Public Health, Amhara Public Health Institute, Bahir Dar, Ethiopia
| | - Anil Kaul
- School of Health Care Administration, Oklahoma State University, Tulsa
- Health Care Delivery Sciences, University of Tulsa, Tulsa, Oklahoma
| | | | | | - Amene Abebe Kerbo
- Department of Public Health, Madda Walabu University, Goba, Ethiopia
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Maryam Khalilarjmandi
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Gulfaraz Khan
- Department of Medical Microbiology & Immunology, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Young-Ho Khang
- Division of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
- College of Arts and Sciences, Ohio University, Zanesville
| | - Amir Khater
- Internal Medicine and Gastroenterology Department, National Hepatology and Tropical Research Institute, Cairo, Egypt
| | - Maryam Khayamzadeh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Academy of Medical Sciences, Tehran, Iran
| | - Maryam Khazaee-Pool
- Department of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Salman Khazaei
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abdullah T Khoja
- Department of Public Health, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Mohammad Hossein Khosravi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
- International Otorhinolaryngology Research Association, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Neda Kianipour
- Department of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | - Adnan Kisa
- Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway
- Department of Health Services Policy & Management, University of South Carolina, Columbia
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | | | - Hamidreza Komaki
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Brain Engineering Research Center, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Ai Koyanagi
- Networking Center for Mental Health Network, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Kristopher J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Burcu Kucuk Bicer
- Department of Public Health, Yüksek Ihtisas University, Ankara, Turkey
- Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana
- Department of Psychology and Health Promotion, University of KwaZulu-Natal, Durban, South Africa
| | - Vivek Kumar
- Department of Medicine Brigham and Women's Hospital, Harvard University, Boston, Massachusetts
| | - Desmond Kuupiel
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, St. John of God Hospital, Duayaw Nkwanta, Ghana
| | - Carlo La Vecchia
- Clinical Medicine and Community Health, A.C.S. Medical College and Hospital, Milan, Italy
| | - Deepesh P Lad
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Eyasu Alem Lake
- Department of Nursing, Wolaita Sodo University, Sodo, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | | | - Faris Hasan Lami
- Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq
| | - Qing Lan
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Savita Lasrado
- Department of Otorhinolaryngology-Head and Neck Surgery, Father Muller Medical College, Mangalore, India
| | - Paolo Lauriola
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | | | - James Leigh
- Asbestos Diseases Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - Yu Liao
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University, Guangzhou, China
- Alliance for Improving Health Outcomes, Inc, Quezon City, Philippines
| | | | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, Netherlands
- Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- University of Melbourne, Melbourne, Queensland, Australia
| | - Platon D Lopukhov
- Department of Epidemiology and Evidence-Based Medicine, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Raimundas Lunevicius
- Department of General Surgery, Aintree University Hospital National Health Service Foundation Trust, Liverpool, England, United Kingdom
- Department of Surgery, University of Liverpool, Liverpool, England, United Kingdom
| | - Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sameh Magdeldin
- Proteomics and Metabolomics Unit, Suez Canal University, Cairo, Egypt
- Department of Physiology, Suez Canal University, Ismailia, Egypt
| | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, England, United Kingdom
| | - Afshin Maleki
- Department of Environmental Health, Tehran University of Medical Sciences, Tehran, Iran
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Manafi
- Department of Plastic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Navid Manafi
- Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Morteza Mansourian
- Department of Health Education and Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saman Maroufizadeh
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Santi Martini S Martini
- Department of Epidemiology, Airlangga University, Surabaya, Indonesia
- Indonesian Public Health Association, Surabaya, Indonesia
| | | | | | | | - Manu Raj Mathur
- Public Health Foundation of India, Gurugram, India
- Department of Epidemiology and Public Health, University College London, London, England, United Kingdom
| | - Colm McAlinden
- Department of Ophthalmology, Hywel Dda University Health Board, Carmarthen, Wales, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Hailemariam Abiy Alemu Meheretu
- Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ravi Mehrotra
- Department of Preventive Oncology, National Institute of Cancer Prevention and Research, Noida, India
| | - Varshil Mehta
- Department of Internal Medicine, SevenHills Hospital, Mumbai, India
| | - Toni Meier
- Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
- Innovation Office, Competence Cluster for Nutrition and Cardiovascular Health, Halle, Germany
| | - Yohannes A Melaku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | | | | | - Addisu Melese
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulugeta Melku
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Peter T N Memiah
- Department of Public Health, University of West Florida, Pensacola, Florida
| | - Walter Mendoza
- Peru Country Office, United Nations Population Fund, Lima, Peru
| | - Ritesh G Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shahin Merat
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr. Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Bartosz Miazgowski
- Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
- Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Miazgowski
- Department of Hypertension, Pomeranian Medical University, Szczecin, Poland
| | | | - Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Edward J Mills
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Seyed Mostafa Mir
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Golestan University of Medical Sciences, Golestan, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamid Reza Mirzaei
- Department of Medical Immunology, Tehran University of Medical Sciences, Tehran, Iran
| | - Rashmi Mishra
- Department of Oral Medicine, University of Washington, Seattle
| | - Babak Moazen
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Dara K Mohammad
- Department of Biology, Salahaddin University, Erbil, Iraq
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | | | - Yousef Mohammad
- Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aso Mohammad Darwesh
- Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
| | - Abolfazl Mohammadbeigi
- Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
| | - Hiwa Mohammadi
- Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Mohammadi
- Department of Physiology and Pharmacology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Mohammadian
- Department of Epidemiology and Biostatistics, Bushehr University of Medical Sciences, Bushehr, Iran
| | | | | | | | - Ammas Siraj Mohammed
- School of Pharmacy, College of Medicine and Health Science, Haramaya University, Harar, Ethiopia
| | | | - Shafiu Mohammed
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Farnam Mohebi
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Yoshan Moodley
- Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Moossavi
- Department of Molecular Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Moradi-Joo
- Department of Economics and Management Sciences for Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan
| | | | - Abbas Mosapour
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Oumer Sada S Muhammed
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jonah Musa
- Department of Obstetrics and Gynecology, University of Jos, Jos, Nigeria
- Center for Global Health, Northwestern University, Chicago, Illinois
| | - Ashraf F Nabhan
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
- Knowledge Translation and Utilization, Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Mehdi Naderi
- School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahamarshan Jayaraman Nagarajan
- Department of Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
- Department of Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Azin Nahvijou
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gurudatta Naik
- O'NealComprehensive Cancer Center, University of Alabama at Birmingham
| | - Farid Najafi
- Department of Epidemiology and Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Luigi Naldi
- Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
- GISED Study Center, Bergamo, Italy
| | - Hae Sung Nam
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, South Korea
- Daejeon Regional Cancer Center, Chungnam National University Hospital, Daejeon, South Korea
| | - Naser Nasiri
- Department of Public Health, School of Public Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Javad Nazari
- Department of Pediatrics, Arak University of Medical Sciences, Arak, Iran
- Ministry of Health and Medical Education, Tehran, Iran
| | - Ionut Negoi
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Subas Neupane
- Faculty of Health Sciences, University of Tampere, Tampere, Finland
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Haruna Asura Nggada
- Department of Histopathology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria
- Department of Human Pathology, University of Maiduguri, Maiduguri, Nigeria
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dina Nur Anggraini Ningrum
- Department of Public Health Sciences, State University of Semarang, Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Nosratnejad
- Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Tinuke O Olagunju
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mojisola Morenike Oluwasanu
- Department of Health Promotion and Education, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abidemi E Omonisi
- Department of Anatomic Pathology, Ekiti State University, Ado- Ekiti, Nigeria
- Department of Anatomic Pathology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Anu Mary Oommen
- Department of Community Health, Christian Medical College, Vellore, India
| | - Eyal Oren
- Department of Epidemiology, University of Washington, Seattle
- Graduate School of Public Health, San Diego State University, San Diego, California
| | | | - Erika Ota
- Department of Global Health Nursing, St. Luke's International University, Chuo-ku, Japan
| | | | - Mayowa Ojo Owolabi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mahesh P A
- Department of TB & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India
| | | | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amir H Pakpour
- Department of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
- Department of Nursing, Jönköping University, Jönköping, Sweden
| | - Adrian Pana
- Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
- Center for Health Outcomes & Evaluation, Bucharest, Romania
| | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Hadi Parsian
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shanti Patel
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Snehal T Patil
- Krishna Institute of Medical Sciences, Deemed University, Karad, India
| | - Alyssa Pennini
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | - David M Pereira
- Requimte/LAQV, University of Porto, Porto, Portugal
- University of Cartagena, Cartagena, Colombia
| | - Cristiano Piccinelli
- ReferenceCenter for Epidemiology and Cancer Prevention, CPO Piedmont, Torino, Italy
| | - Julian David Pillay
- Basic Medical Sciences Department, Durban University of Technology, Durban, South Africa
| | - Majid Pirestani
- Departments of Parasitology and Entomology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farhad Pishgar
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maarten J Postma
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | - Hadi Pourjafar
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Farshad Pourmalek
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Akram Pourshams
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Swayam Prakash
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Rabiee
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
- Divisions of Chemistry and Diseases, Advanced Technologies Research Group, Tehran, Iran
| | | | - Alireza Rafiei
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahdi Rahimi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Muhammad Aziz Rahman
- Austin Health Clinical School of Nursing, La Trobe University, Heidelberg, Victoria, Australia
- National Centre for Farmer Health, Deakin University, Waurn Ponds, Victoria, Australia
| | - Fatemeh Rajati
- Department of Health Education and Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saleem M Rana
- Department of Public Health, Contech School of Public Health, Lahore, Pakistan
- Public Health Department, University of Health Sciences, Lahore, Pakistan
| | - Samira Raoofi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - David Laith Rawaf
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, England, United Kingdom
- University College London Hospitals, London, England, United Kingdom
| | - Salman Rawaf
- Department of Primary Care and Public Health, Imperial College London, London, England, United Kingdom
- Academic Public Health, Public Health England, London, England, United Kingdom
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Network of Immunity in Infection, Malignancy, and Autoimmunity, Universal Scientific Education and Research Network, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ana Isabel Ribeiro
- Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Daniela Ribeiro
- Department of Applied Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luca Ronfani
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Elias Merdassa Roro
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | | | - Parisa Sabbagh
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Siamak Sabour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Basema Saddik
- Medical Department, University of Sharjah, Sharjah, United Arab Emirates
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Farkhonde Salehi
- Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hosni Salem
- Department of Urology, Cairo University, Cairo, Egypt
| | - Marwa Rashad Salem
- Public Health and Community Medicine Department, Cairo University, Giza, Egypt
| | - Hamideh Salimzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Joshua A Salomon
- Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
| | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | - Juan Sanabria
- Department of Surgery, Marshall University, Huntington, West Virginia
- Departments of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Benn Sartorius
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, England, United Kingdom
| | - Maheswar Satpathy
- UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
- Udyam-Global Association for Sustainable Development, Bhubaneswar, India
| | | | - Monika Sawhney
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - Mehdi Sayyah
- Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ione J C Schneider
- School of Health Sciences, Federal University of Santa Catarina, Ararangua, Brazil
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mario Sekerija
- Department of Medical Statistics, Epidemiology and Medical Informatics, University of Zagreb, Zagreb, Croatia
- Division of Epidemiology and Prevention of Chronic Noncommunicable Diseases, Croatian Institute of Public Health, Zagreb, Croatia
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masood Sepehrimanesh
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Seyedmojtaba Seyedmousavi
- Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | - Hosein Shabaninejad
- Department of Health Policy, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shahbaz
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amir Shamshirian
- Department of Medical Laboratory Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Heidar Sharafi
- Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, Iran
| | - Zeinab Sharafi
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mehdi Sharif
- Department of Basic Sciences, Islamic Azad University, Sari, Iran
- Department of Laboratory Sciences, Islamic Azad University, Sari, Iran
| | - Ali Sharifi
- Department of Ophthalmology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, Massachusetts
| | - Reza Shirkoohi
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Biology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharvari Rahul Shukla
- Symbiosis Institute of Health Sciences, Symbiosis International University, Pune, Maharashtra, India
| | - Si Si
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Soraya Siabani
- Imam Ali Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | | | - Dayane Gabriele Alves Silveira
- University of Brasília, Brasília, Brazil
- Department of the Health Industrial Complex and Innovation in Health, Ministry of Health, Brasília, Brazil
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Global Patient Outcome and Real World Evidence, Eli Lilly and Company, Indianapolis, Indiana
| | - Jasvinder A Singh
- Department of Medicine, University of Alabama at Birmingham
- Department of Epidemiology, University of Alabama at Birmingham
| | - Solomon Sisay
- Medical Department, German Leprosy and TB Relief Association, Addis Ababa, Ethiopia
| | - Freddy Sitas
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Eugène Sobngwi
- Department of Internal Medicine and Specialties, University of Yaoundé I, Yaoundé, Cameroon
- Department of Endocrinology and Diabetes, Central Hospital of Yaoundé, Yaoundé, Cameroon
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias, Institute of Health Carlos III, Madrid, Spain
| | - Vasiliki Stathopoulou
- Department of Occupational Therapy, Athens University of Applied Sciences, Athens, Greece
| | | | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia, Valencia, Spain
- Biomedical Research Networking Center for Mental Health Network, Carlos III Health Institute, Madrid, Spain
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Ken Takahashi
- Asbestos Diseases Research Institute, University of Sydney, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Omid Reza Tamtaji
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | - Parvaneh Taymoori
- Department of Public Health, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad-Hani Temsah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Omar Temsah
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Fisaha Haile Tesfay
- Mekelle University, Mekelle, Ethiopia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | | | - Gizachew Assefa Tessema
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Subash Thapa
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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- Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
- The Agency for Health Technology Assessment and Tariff System, Warsaw, Poland
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- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Khanh Bao Tran
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
- Department of Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
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- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
| | - Olalekan A Uthman
- Division of Health Sciences, University of Warwick, Coventry, England, United Kingdom
| | - Marco Vacante
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Maryam Vaezi
- Women's Reproductive Health Research Center, A.C.S. Medical College and Hospital, Tabriz, Iran
- Alzahra Teaching Hospital, Tabriz, Iran
| | - Patricia Varona Pérez
- Department for International Development, Health Network of Cuba, Havana, Cuba
- Centre of Research in Environmental Epidemiology, Barcelona Institute for Global Health, Barcelona, Spain
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Simone Vidale
- Department of Neurology & Stroke Unit, Sant'Anna Hospital, Como, Italy
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Vasily Vlassov
- Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia
| | - Stein Emil Vollset
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
| | - Kia Vosoughi
- Department of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Henry Wabinga
- Department of Pathology, Makerere University, Kampala, Uganda
| | | | | | - Yasir Waheed
- Foundation University Medical College, Foundation University, Rawalpindi, Pakistan
| | - Fitsum Weldegebreal
- Department of Medical Laboratory Science, Haramaya University, Harar, Ethiopia
| | | | - Tissa Wijeratne
- Department of Psychology and Counselling, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Clinical Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
| | | | - Adam Belay Wondmieneh
- Department of Nursing, Wollo University, Dessie, Ethiopia
- Department of Nursing, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Rajaram Yadav
- Department of Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Yadollahpour
- Department of Medical Physics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Yazdi-Feyzabadi
- Department of Health Management, Policy, and Economics, Kerman University of Medical Sciences, Kerman, Iran
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | | | | | | | - Engida Yisma
- School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mustafa Z Younis
- Health Economics & Finance, Global Health, Jackson State University, Jackson, Mississippi
- Department of Public Health, Tsinghua University, Beijing, China
| | - Bahman Yousefi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Biochemistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Erfan Zabeh
- Department of Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran
- Department of Electrical Engineering, Bioelectric Group, Sharif University of Technology, Tehran, Iran
| | - Vesna Zadnik
- Epidemiology and Cancer Registry Sector, Institute of Oncology, Ljubljana, Slovenia
| | - Telma Zahirian Moghadam
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
| | - Zoubida Zaidi
- Department of Epidemiology, University Hospital of Setif, Setif, Algeria
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
| | - Alireza Zangeneh
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Leila Zaki
- Department of Parasitology, Tarbiat Modares University, Tehran, Iran
| | - Kazem Zendehdel
- Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Taye Abuhay Zewale
- Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Arash Ziapour
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle
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Frank TD, Carter A, Jahagirdar D, Biehl MH, Douwes-Schultz D, Larson SL, Arora M, Dwyer-Lindgren L, Steuben KM, Abbastabar H, Abu-Raddad LJ, Abyu DM, Adabi M, Adebayo OM, Adekanmbi V, Adetokunboh OO, Ahmadi A, Ahmadi K, Ahmadian E, Ahmadpour E, Ahmed MB, Akal CG, Alahdab F, Alam N, Albertson SB, Alemnew BTT, Alene KA, Alipour V, Alvis-Guzman N, Amini S, Anbari Z, Anber NH, Anjomshoa M, Antonio CAT, Arabloo J, Aremu O, Areri HA, Asfaw ET, Ashagre AF, Asmelash D, Asrat AA, Avokpaho EFGA, Awasthi A, Awoke N, Ayanore MA, Azari S, Badawi A, Bagherzadeh M, Banach M, Barac A, Bärnighausen TW, Basu S, Bedi N, Behzadifar M, Bekele BB, Belay SA, Belay YB, Belayneh YM, Berhane A, Bhat AG, Bhattacharyya K, Biadgo B, Bijani A, Bin Sayeed MS, Bitew H, Blinov A, Bogale KA, Bojia HA, Burugina Nagaraja SBN, Butt ZA, Cahuana-Hurtado L, Campuzano Rincon JC, Carvalho F, Chattu VK, Christopher DJ, Chu DT, Crider R, Dahiru T, Dandona L, Dandona R, Daryani A, das Neves J, De Neve JW, Degenhardt L, Demeke FM, Demis AB, Demissie DB, Demoz GT, Deribe K, Des Jarlais D, Dhungana GP, Diaz D, Djalalinia S, Do HP, Doan LP, Duber H, Dubey M, Dubljanin E, Duken EE, Duko Adema B, Effiong A, Eftekhari A, El Sayed Zaki M, El-Jaafary SI, El-Khatib Z, Elsharkawy A, Endries AY, Eskandarieh S, Eyawo O, Farzadfar F, Fatima B, Fentahun N, Fernandes E, Filip I, Fischer F, Folayan MO, Foroutan M, Fukumoto T, Fullman N, Garcia-Basteiro AL, Gayesa RT, Gebremedhin KB, Gebremeskel GGG, Gebreyohannes KK, Gedefaw GA, Gelaw BK, Gesesew HA, Geta B, Gezae KE, Ghadiri K, Ghashghaee A, Ginindza TTG, Gugnani HC, Guimarães RA, Haile MT, Hailu GB, Haj-Mirzaian A, Haj-Mirzaian A, Hamidi S, Handanagic S, Handiso DW, Hanfore LK, Hasanzadeh A, Hassankhani H, Hassen HY, Hay SI, Henok A, Hoang CL, Hosgood HD, Hosseinzadeh M, Hsairi M, Ibitoye SE, Idrisov B, Ikuta KS, Ilesanmi OS, Irvani SSN, Iwu CJ, Jacobsen KH, James SL, Jenabi E, Jha RP, Jonas JB, Jorjoran Shushtari Z, Kabir A, Kabir Z, Kadel R, Kasaeian A, Kassa B, Kassa GM, Kassa TD, Kayode GA, Kebede MM, Kefale AT, Kengne AP, Khader YS, Khafaie MA, Khalid N, Khan EA, Khan G, Khan J, Khang YH, Khatab K, Khazaei S, Khoja AT, Kiadaliri AA, Kim YJ, Kisa A, Kisa S, Kochhar S, Komaki H, Koul PA, Koyanagi A, Kuate Defo B, Kumar GA, Kumar M, Kuupiel D, Lal DK, Lee JJH, Lenjebo TL, Leshargie CT, Macarayan ERK, Maddison ER, Magdy Abd El Razek H, Magis-Rodriguez C, Mahasha PW, Majdan M, Majeed A, Malekzadeh R, Manafi N, Mapoma CC, Martins-Melo FR, Masaka A, Mayenga ENL, Mehta V, Meles GG, Meles HG, Melese A, Melku M, Memiah PTN, Memish ZA, Mena AT, Mendoza W, Mengistu DT, Mengistu G, Meretoja TJ, Mestrovic T, Miller TR, Moazen B, Mohajer B, Mohamadi-Bolbanabad A, Mohammad KA, Mohammad Y, Mohammad Darwesh A, Mohammad Gholi Mezerji N, Mohammadi M, Mohammadibakhsh R, Mohammadoo-Khorasani M, Mohammed JA, Mohammed S, Mohebi F, Mokdad AH, Moodley Y, Moossavi M, Moradi G, Moradi-Lakeh M, Moschos MM, Mossie TB, Mousavi SM, Muchie KF, Muluneh AG, Muriithi MK, Mustafa G, Muthupandian S, Nagarajan AJ, Naik G, Najafi F, Nazari J, Ndwandwe DE, Nguyen CT, Nguyen HLT, Nguyen SH, Nguyen TH, Ningrum DNA, Nixon MR, Nnaji CA, Noroozi M, Noubiap JJ, Nourollahpour Shiadeh M, Obsa MS, Odame EA, Ofori-Asenso R, Ogbo FA, Okoro A, Oladimeji O, Olagunju AT, Olagunju TO, Olum S, Oppong Asante KOA, Oren E, Otstavnov SS, PA M, Padubidri JR, Pakhale S, Pakpour AH, Patel SK, Paulos K, Pepito VCF, Peprah EK, Piroozi B, Pourshams A, Qorbani M, Rabiee M, Rabiee N, Radfar A, Rafay A, Rafiei A, Rahim F, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman SU, Ranabhat CL, Rawaf S, Reis C, Renjith V, Reta MA, Rezai MS, Rios González CM, Roro EM, Rostami A, Rubino S, Saeedi Moghaddam S, Safari S, Sagar R, Sahraian MA, Salem MRR, Salimi Y, Salomon JA, Sambala EZ, Samy AM, Sartorius B, Satpathy M, Sawhney M, Sayyah M, Schutte AE, Sepanlou SG, Seyedmousavi S, Shabaninejad H, Shaheen AA, Shaikh MA, Shallo SA, Shamsizadeh M, Sharifi H, Shibuya K, Shin JI, Shirkoohi R, Silva DAS, Silveira DGA, Singh JA, Sisay MMM, Sisay M, Sisay S, Smith AE, Sokhan A, Somayaji R, Soshnikov S, Stein DJ, Sufiyan MB, Sunguya BF, Sykes BL, Tadesse BT, Tadesse DB, Tamirat KS, Taveira N, Tekelemedhin SW, Temesgen HD, Tesfay FH, Teshale MY, Thapa S, Tlaye KG, Topp SM, Tovani-Palone MR, Tran BX, Tran KB, Ullah I, Unnikrishnan B, Uthman OA, Veisani Y, Vladimirov SK, Wada FW, Waheed Y, Weldegwergs KG, Weldesamuel GTT, Westerman R, Wijeratne T, Wolde HF, Wondafrash DZ, Wonde TE, Wondmagegn BY, Yeshanew AG, Yilma MT, Yimer EM, Yonemoto N, Yotebieng M, Youm Y, Yu C, Zaidi Z, Zarghi A, Zenebe ZM, Zewale TA, Ziapour A, Zodpey S, Naghavi M, Vollset SE, Wang H, Lim SS, Kyu HH, Murray CJL. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Lancet HIV 2019; 6:e831-e859. [PMID: 31439534 PMCID: PMC6934077 DOI: 10.1016/s2352-3018(19)30196-1] [Citation(s) in RCA: 286] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. METHODS We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package-a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce age-sex-specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. FINDINGS Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. INTERPRETATION Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. FUNDING Bill & Melinda Gates Foundation, National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH.
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Bogale KA, Zewale TA. Determinant factors of overweight/obesity among federal ministry civil servants in Addis Ababa, Ethiopia: a call for sector-wise occupational health program. BMC Res Notes 2019; 12:449. [PMID: 31331373 PMCID: PMC6647291 DOI: 10.1186/s13104-019-4489-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Civil servants are disposing individuals to sedentary lifestyle and, may lead to overweight and obesity. Thus, the purpose of the study was to identify factors associated with overweight and obesity among employees in Ethiopia ministries. RESULT Respondents who were age 45 years and above [AOR = 11.56, 95% CI 3.75-35.56], 35-44 years [AOR = 11.17, 95% CI 3.89-32.06] and 25-34 [AOR = 3.08 95% CI 1.07-8.83] were more likely to be overweight/obesity as compared to those who were in age category of 18-24 years. The study also found that ever alcohol consumption [AOR = 2.27, 95% CI 1.23, 4.16] was associated with increased risk of overweight and obesity as compared to non-consumers. Another risk factor was adult who did not practice ten minutes' walk per day, more likely to overweight and obesity [AOR = 11.28, 95% CI 5.96-21.36] as compared to the counter parts. Similarly, participants who did not involve physical activity (sport) [AOR = 2.42% 95% CI 1.36-4.30] were 2.42 times more likely to overweight and obesity as compared to those who had physical activity. Sector-wise occupational health program should be developed in work placed to decrease identified risk factors.
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Affiliation(s)
- Kassawmar Angaw Bogale
- Department of Epidemiology and Bio Statistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Taye Abuhay Zewale
- Department of Epidemiology and Bio Statistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Arega WL, Zewale TA, Bogale KA. Premarital sexual practice and associated factors among high school youths in Debretabor town, South Gondar zone, North West Ethiopia, 2017. BMC Res Notes 2019; 12:314. [PMID: 31159838 PMCID: PMC6547544 DOI: 10.1186/s13104-019-4348-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/11/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Premarital sex is voluntary sexual intercourse between unmarried persons. Prevalence and factors associated with premarital sexual practice in the study area are lacking. Thus, the aims of this study were to determine the prevalence and to identify factors associated with premarital sexual practice among Debretabor high school youths. Results The prevalence of premarital sex among Debretabor town high school youths was 22.5% of which 63.9% of them were males. Among those high school youths, the majority (60.2%) had their first sexual intercourse at the age of 15–19 years. The main reason for initiation of sexual intercourse was due to fell in love which accounts 48.1%, followed by sexual desire 22.2%. Predictors that are risk for premarital sex were youths who did not attend religious education [AOR = 7.4, 95% CI (3.32, 16.43)], having boy or girl friends [AOR = 9.66, 95% CI (4.80, 19.43)], drinking alcohol every day [AOR = 9.43, 95% CI (2.86, 31.14)] and less than twice a week [AOR = 2.52, 95% CI (1.22, 5.21)], watching pornography film [AOR = 5.15, 95% CI (2.56, 10.37)] and youths came from rural residing families [AOR = 0.51, 95% CI (0.27, 0.96)].
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Affiliation(s)
- Wondmnew Lakew Arega
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Bahir-Dar University, Bahir Dar, Ethiopia
| | - Taye Abuhay Zewale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir-Dar University, Bahir Dar, Ethiopia.
| | - Kassawmar Angaw Bogale
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir-Dar University, Bahir Dar, Ethiopia
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