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1. QTc interval prolongation and its associated factors among HIV infected patients on ART in Mettu Town.

Author

Befkadu Z and Girma B

Subjects
Humans, Male, Female, Adult, Ethiopia epidemiology, Cross-Sectional Studies, Middle Aged, Antiretroviral Therapy, Highly Active adverse effects, Risk Factors, Anti-HIV Agents adverse effects, Anti-HIV Agents therapeutic use, CD4 Lymphocyte Count, Prevalence, HIV Infections drug therapy, HIV Infections complications, Electrocardiography, Long QT Syndrome chemically induced, Long QT Syndrome epidemiology
Abstract

QTc interval prolongation, which is linked to cardiac arrhythmia and sudden cardiac death, is common in HIV-infected patients. This prolongation can be attributed to the side effects of antiretroviral medications, the direct impact of HIV on the heart, and chronic inflammatory responses that disrupt cardiac electrical activity. This study aimed at assessing QTc interval prolongation and associated factors among HIV-infected adults on ART. A cross-sectional study was conducted among consecutively selected 298 HIV-infected patients at Mettu Karl Specialized Hospital, southwest Ethiopia. A face-to-face interview with a structured and pretested questionnaire was employed to collect socio-demographic and behavioural characteristics data. Electrocardiography was done using a 12-lead electrocardiograph, and interpreted by a cardiologist. Data were entered into Epi-data version 4.6 and analyzed using SPSS version 25. Multivariable logistic regression analyses were done at a significance level of P < 0.05. QTc prolongation was prevalent in 12.4% of participants. Being on PIs containing HAART regimen (AOR = 5.7, 95%CI 2.54-12.8), having recent CD4 count of < 350 cells/mm 3 (AOR = 4.8, 95%CI 2.19-10.5), and recent viral load of ≥ 1000coppies/ml (AOR = 2.8, 95%CI 1.24-6.42) were significantly associated with QTc prolongation. According to this study, one of the ten HIV-infected patients on ART had QTc prolongation. Therefore, we suggest that HIV-positive patients receiving treatment should undergo screening for QTc interval prolongation., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Published
2024
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2. Isoniazid-associated pellagra during mass scale-up of tuberculosis preventive therapy: a case-control study.

Author

Nabity SA, Mponda K, Gutreuter S, Surie D, Zimba SB, Chisuwo L, Moffitt A, Williams AM, Sharma AJ, Marshall RE, Chiwaula MJ, da Silva R, Kumwenda T, Chilikutali L, Mwamale S, Nagoli E, Mwenyeheri G, Ngongonda D, Kaunda E, Mtoto F, Mhango V, Mbewe K, Melgar M, Odo M, Jahn A, Buono N, Maida A, Girma B, Kalua T, Nyirenda R, Sunguti J, Woelk G, Gunde LJ, Mekonnen TF, Maphosa T, Kim EJ, Auld AF, Muula AS, and Oeltmann JE

Subjects
Case-Control Studies, Exanthema chemically induced, Exanthema drug therapy, Female, Humans, Male, Niacin therapeutic use, Vitamin B Complex therapeutic use, Antitubercular Agents adverse effects, HIV Infections complications, HIV Infections drug therapy, HIV Infections prevention & control, Isoniazid adverse effects, Pellagra chemically induced, Pellagra complications, Pellagra drug therapy, Tuberculosis complications, Tuberculosis drug therapy, Tuberculosis epidemiology
Abstract

Background: Pellagra is caused by niacin (vitamin B3) deficiency and patients with pellagra present with a characteristic rash. Isoniazid disrupts intracellular niacin synthesis and might induce niacin deficiency. In 2017, Malawi scaled up continuous isoniazid preventive treatment (IPT) for tuberculosis prevention among people living with HIV. In addition, an under-diversified diet based on subsistence maize, as is commonly the case in Malawi, is a risk factor for pellagra. We aimed to investigate whether large-scale isoniazid exposure in Malawi contributed to the cumulative risk for pellagra in a nutritionally vulnerable population., Methods: We did a matched case-control study to evaluate the association between daily, continuous isoniazid exposure and pellagra. We matched sequentially enrolled patients with pellagra each with four control participants by sex and age from referral dermatology centres in three IPT scale-up districts in Malawi (Lilongwe, Blantyre, and Zomba) to evaluate isoniazid as a risk for pellagra using multivariable conditional logistic regression. We established a community clinic referral system surrounding the dermatology clinic in each district to enhance case-finding and included all patients with pellagra, regardless of referral status. The primary outcome was dermatologist-diagnosed pellagra. We calculated the interval between isoniazid initiation and rash onset and assessed 30-day clinical outcomes after multi-B vitamin treatment containing 300 mg nicotinamide daily., Findings: Between Feb 5 and Aug 9, 2019, we enrolled 197 patients with pellagra and 781 matched controls. Isoniazid exposure was associated with an increased risk of pellagra (adjusted odds ratio 42·6 [95% CI 13·3-136·6]). Significant covariates included HIV infection, referral status, food insecurity, underweight, excess alcohol consumption, and, among women, lactation. The median time from isoniazid initiation to rash onset was shorter during the season of food scarcity (5 months [IQR 3-7]) compared with the harvest season (9 months [8-11]; hazard ratio 7·2 [95% CI 3·2-16·2], log-rank p<0·0001). Those with isoniazid-associated pellagra who discontinued isoniazid and adhered to multi-B vitamin treatment showed 30-day clinical improvement., Interpretation: Continuous IPT scale-up and the annual period of food scarcity both increased the risk of pellagra in Malawi. Use of shorter rifamycin-based regimens for tuberculosis prevention and food fortification in populations with undernutrition might reduce this risk. Niacin-containing multi-B vitamin co-administration with isoniazid as pellagra prevention is worth exploring further., Funding: This study was supported by the President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention under project 7173., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2022
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3. Evaluation of 6-Month Versus Continuous Isoniazid Preventive Therapy for Mycobacterium tuberculosis in Adults Living With HIV/AIDS in Malawi.

Author

Hsieh YL, Jahn A, Menzies NA, Yaesoubi R, Salomon JA, Girma B, Gunde L, Eaton JW, Auld A, Odo M, Kiyiika CN, Kalua T, Chiwandira B, Mpunga JU, Mbendra K, Corbett L, Hosseinipour MC, Cohen T, and Kunkel A

Subjects
Adult, Antitubercular Agents administration & dosage, Drug Administration Schedule, Humans, Incidence, Isoniazid administration & dosage, Malawi epidemiology, Tuberculosis, Pulmonary epidemiology, Antitubercular Agents therapeutic use, HIV Infections complications, Isoniazid therapeutic use, Tuberculosis, Pulmonary prevention & control
Abstract

Background: To assist the Malawi Ministry of Health to evaluate 2 competing strategies for scale-up of isoniazid preventive therapy (IPT) among HIV-positive adults receiving antiretroviral therapy., Setting: Malawi., Methods: We used a multidistrict, compartmental model of the Malawi tuberculosis (TB)/HIV epidemic to compare the anticipated health impacts of 6-month versus continuous IPT programs over a 12-year horizon while respecting a US$10.8 million constraint on drug costs in the first 3 years., Results: The 6-month IPT program could be implemented nationwide, whereas the continuous IPT alternative could be introduced in 14 (of the 27) districts. By the end of year 12, the continuous IPT strategy was predicted to avert more TB cases than the 6-month alternative, although not statistically significant (2368 additional cases averted; 95% projection interval [PI], -1459 to 5023). The 6-month strategy required fewer person-years of IPT to avert a case of TB or death than the continuous strategy. For both programs, the mean reductions in TB incidence among people living with HIV by year 12 were expected to be <10%, and the cumulative numbers of IPT-related hepatotoxicity to exceed the number of all-cause deaths averted in the first 3 years., Conclusions: With the given budgetary constraint, the nationwide implementation of 6-month IPT would be more efficient and yield comparable health benefits than implementing a continuous IPT program in fewer districts. The anticipated health effects associated with both IPT strategies suggested that a combination of different TB intervention strategies would likely be required to yield a greater impact on TB control in settings such as Malawi, where antiretroviral therapycoverage is relatively high.

Published
2020
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4. Predictors of mortality among TB-HIV Co-infected patients being treated for tuberculosis in Northwest Ethiopia: a retrospective cohort study.

Author

Sileshi B, Deyessa N, Girma B, Melese M, and Suarez P

Subjects
Adult, Anti-Retroviral Agents therapeutic use, Antitubercular Agents therapeutic use, Cohort Studies, Coinfection epidemiology, Coinfection microbiology, Coinfection virology, Ethiopia epidemiology, Female, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections microbiology, Humans, Kaplan-Meier Estimate, Male, Prevalence, Retrospective Studies, Tuberculosis drug therapy, Tuberculosis epidemiology, Tuberculosis virology, Coinfection mortality, HIV Infections mortality, Tuberculosis mortality
Abstract

Background: Tuberculosis (TB) is the leading cause of mortality in high HIV-prevalence populations. HIV is driving the TB epidemic in many countries, especially those in sub-Saharan Africa. The aim of this study was to assess predictors of mortality among TB-HIV co-infected patients being treated for TB in Northwest Ethiopia., Methods: An institution-based retrospective cohort study was conducted between April, 2009 and January, 2012. Based on TB, antiretroviral therapy (ART), and pre-ART registration records, TB-HIV co-infected patients were categorized into "On ART" and "Non-ART" cohorts. A Chi-square test and a T-test were used to compare categorical and continuous variables between the two groups, respectively. A Kaplan-Meier test was used to estimate the probability of death after TB diagnosis. A log-rank test was used to compare overall mortality between the two groups. A Cox proportional hazard model was used to determine factors associated with death after TB diagnosis., Results: A total of 422 TB-HIV co-infected patients (i.e., 272 On ART and 150 Non-ART patients) were included for a median of 197 days. The inter-quartile range (IQR) for On ART patients was 140 to 221 days and the IQR for Non-ART patients was 65.5 to 209.5 days. In the Non-ART cohort, more TB-HIV co-infected patients died during TB treatment: 44 (29.3%) Non-ART patients died, as compared to 49 (18%) On ART patients died. Independent predictors of mortality during TB treatment included: receiving ART (Adjusted Hazard Ratio (AHR) =0.35 [0.19-0.64]); not having initiated cotrimoxazole prophylactic therapy (CPT) (AHR = 3.03 [1.58-5.79]); being ambulatory (AHR = 2.10 [1.22-3.62]); CD4 counts category being 0-75 cells/micro liter, 75-150 cells/micro liter, or 150-250 cells/micro liter (AHR = 4.83 [1.98-11.77], 3.57 [1.48-8.61], and 3.07 [1.33-7.07], respectively); and treatment in a hospital (AHR = 2.64 [1.51-4.62])., Conclusions: Despite the availability of free ART from health institutions in Northwest Ethiopia, mortality was high among TB-HIV co-infected patients, and strongly associated with the absence of ART during TB treatment. In addition cotrimoxazol prophylactic therapy remained important factor in reduction of mortality during TB treatment. The study also noted importance of early ART even at higher CD4 counts.

Published
2013
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5. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia.

Author

Amberbir A, Woldemichael K, Getachew S, Girma B, and Deribe K

Subjects
Adolescent, Adult, Depressive Disorder, Diet, Ethiopia, Female, Follow-Up Studies, HIV Infections psychology, Hospitalization statistics & numerical data, Hospitals, University, Humans, Logistic Models, Male, Middle Aged, Patient Compliance statistics & numerical data, Prospective Studies, Social Support, Socioeconomic Factors, Surveys and Questionnaires, Treatment Outcome, Treatment Refusal psychology, Treatment Refusal statistics & numerical data, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Patient Compliance psychology
Abstract

Background: The devastating impact of AIDS in the world especially in sub-Saharan Africa has led to an unprecedented global effort to ensure access to antiretroviral (ARV) drugs. Given that medication-taking behavior can immensely affect an individual's response; ART adherence is now widely recognized as an 'Achilles heel' for the successful outcome. The present study was undertaken to investigate the rate and predictors of adherence to antiretroviral therapy among HIV-infected persons in southwest Ethiopia., Methods: The study was conducted in the antiretroviral therapy unit of Jimma University Specialized Hospital. A prospective study was undertaken on a total of 400 HIV infected person. Data were collected using a pre-tested interviewer-administered structured questionnaire at first month (M0) and third month (M3) follow up visits., Results: A total of 400 and 383 patients at baseline (M0) and at follow up visit (M3) respectively were interviewed. Self-reported dose adherence in the study area was 94.3%. The rate considering the combined indicator (dose, time and food) was 75.7%. Within a three month follow up period, dose adherence decreased by 2% and overall adherence rate decreased by more than 3%. Adherence was common in those patients who have a social support (OR, 1.82, 95%CI, 1.04, 3.21). Patients who were not depressed were two times more likely to be adherent than those who were depressed (OR, 2.13, 95%CI, 1.18, 3.81). However, at the follow up visit, social support (OR, 2.42, 95%CI, 1.29, 4.55) and the use of memory aids (OR, 3.29, 95%CI, 1.44, 7.51) were found to be independent predictors of adherence. The principal reasons reported for skipping doses in this study were simply forgetting, feeling sick or ill, being busy and running out of medication in more than 75% of the cases., Conclusion: The self reported adherence rate was high in the study area. The study showed that adherence is a dynamic process which changes overtime and cannot reliably be predicted by a few patient characteristics that are assumed to vary with time. Adherence is a process, not a single event, and adherence support should be integrated into regular clinical follow up.

Published
2008
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6. National tuberculosis prevalence surveys in Africa, 2008–2016: an overview of results and lessons learned

Author

Law I., Floyd K., Abukaraig E. A. B., Addo K. K., Adetifa I., Alebachew Z., Banda R., Bashorun A., Bloss E., Bonsu F. A., Chanda-Kapata P., Demba E., Elegail A. M. A. S., Eltigany M., Ershova J., Gasana M., Girma B., Glaziou P., Kalisvaart N., Hamadelneel H. K., Kamara D., Kapata N., Kasozi S., Kebede A., Kendall L., Kipruto H., Kirenga B. J., Klinkenberg E., Kobayashi S., Linda C., Masini E., Matambo R., Mfinanga S., Migambi P., Moonan P., Mpunga J., Mugabe F., Munthali A., Mutsvangwa J., Nkhoma W., Obasanya J., Omoleke S., Onozaki I., Patrobas P., Ong'ang'o J. R., Rutebemberwa E., Sandy C., Senkoro M., Sismanidis C., Sitienei J., Tadolini M., Timimi H., Tsegaye F., Uwizeye C. B., Yamada N., Law I., Floyd K., Abukaraig E.A.B., Addo K.K., Adetifa I., Alebachew Z., Banda R., Bashorun A., Bloss E., Bonsu F.A., Chanda-Kapata P., Demba E., Elegail A.M.A.S., Eltigany M., Ershova J., Gasana M., Girma B., Glaziou P., Kalisvaart N., Hamadelneel H.K., Kamara D., Kapata N., Kasozi S., Kebede A., Kendall L., Kipruto H., Kirenga B.J., Klinkenberg E., Kobayashi S., Linda C., Masini E., Matambo R., Mfinanga S., Migambi P., Moonan P., Mpunga J., Mugabe F., Munthali A., Mutsvangwa J., Nkhoma W., Obasanya J., Omoleke S., Onozaki I., Patrobas P., Ong'ang'o J.R., Rutebemberwa E., Sandy C., Senkoro M., Sismanidis C., Sitienei J., Tadolini M., Timimi H., Tsegaye F., Uwizeye C.B., Yamada N., APH - Global Health, and Global Health

Subjects
Adult, Male, Tuberculosis, Adolescent, HIV Infections, Article, Global Burden of Disease, Young Adult, Sex Factors, prevalence survey, Surveys and Questionnaires, medicine, Prevalence, Humans, Mass Screening, Disease Notification, Aged, Aged, 80 and over, public health, Public Health, Environmental and Occupational Health, Prevalence survey, Middle Aged, medicine.disease, Infectious Diseases, Geography, Africa, Parasitology, Female, epidemiology, Humanities
Abstract

Objective and Methods In many countries, national tuberculosis (TB) prevalence surveys are the only way to reliably measure the burden of TB disease and monitor trends. They can also provide evidence about the current performance of TB care and control and how this could be improved. We developed an inventory of Asian surveys from 1953 to 2012 and then compiled and analysed a standard set of data for all national surveys implemented between 1990 (the baseline year for 2015 global TB targets) and 2012. Results There were 21 surveys in 12 countries between 1990 and 2012; published results were available for 18. The participation rate was at least 80% and often much higher except for two surveys in Thailand. The prevalence of bacteriologically-positive TB disease among adults aged ≥15 years varied widely among countries (1.2 per 1000 population in China in 2010 to 15 per 1000 population in Cambodia in 2002), but age and sex distribution patterns were consistent with a progressive increase in rates of disease by age, and men accounting for 66–75% of prevalent cases. A high proportion of cases (40–79% across all surveys) did not report TB symptoms that met screening criteria (generally cough of 2–3 weeks or more, and blood in the sputum) and were only detected due to chest X-ray screening of all survey participants; this proportion increased over time in countries with repeat survey data. The ratio of prevalent cases to cases notified to national TB programmes was typically around two, but was as high as three in Lao PDR and Pakistan even after the internationally recommended TB control strategy had been implemented nationwide for several years. Four countries (China, Cambodia, the Republic of Korea and the Philippines demonstrated declines in smear or culture-positive pulmonary TB prevalence of approximately 50% over 10 years. Conclusions National TB prevalence surveys in Asia show that large reductions in the prevalence of TB disease can be achieved within a decade, that men bear much more of the burden than women and that the epidemic is ageing. Comparisons among countries show that more can be achieved in TB control in some countries with existing strategies and technologies. However, with many prevalent cases not reporting classic TB symptoms, all countries face the challenge of defining and implementing strategies that will result in earlier detection and treatment of cases. Objectifs et methodes Dans de nombreux pays, les enquetes de prevalence nationale de la TB sont le seul moyen de mesurer de maniere fiable la charge de morbidite de la TB et de suivre les tendances. Elles peuvent aussi fournir des donnees sur la performance actuelle des soins et la lutte antituberculeuse et comment cela pourrait etre ameliore. Nous avons etabli un inventaire des enquetes d'Asie de 1953 a 2012 et avons ensuite compile et analyse un ensemble standard de donnees pour toutes les enquetes nationales effectuees entre 1990 (annee de reference pour les objectifs mondiaux 2015 de la TB) et 2012. Resultats Il y a eu 21 enquetes dans 12 pays entre 1990 et 2012; des resultats publies etaient disponibles pour 18 enquetes. Le taux de participation etait d'au moins 80% et souvent beaucoup plus, sauf pour deux enquetes en Thailande. La prevalence de la TB bacteriologiquement positive chez les adultes âges de ≥15 ans variait considerablement entre les pays (de 1,2 pour 1000 habitants en Chine en 2010 a 15 pour 1000 habitants au Cambodge en 2002), mais les profils de distribution selon l’âge et le sexe etaient compatibles avec une augmentation progressive des taux de la maladie selon l’âge, les hommes representant 66 a 75% des cas prevalents. Une forte proportion des cas (40 a 79% dans toutes les enquetes) n'a pas rapporte des symptomes de TB repondant aux criteres de depistage (generalement, de la toux pendant 2 a 3 semaines ou plus et du sang dans les crachats), et ont seulement ete detectes grâce au depistage par la radiographie du thorax de tous les participants a l'enquete; cette proportion a augmente au fil du temps dans les pays avec des donnees repetitives de l'enquete. Le rapport des cas prevalents sur les cas notifies aux programmes nationaux de lutte antituberculeuse etait generalement autour de 2, mais etait aussi eleve que 3 en Republique Democratique Populaire Lao et au Pakistan, meme apres que la strategie de lutte antituberculeuse internationalement recommandee ait ete implementee a l’echelle nationale depuis plusieurs annees. Quatre pays (la Chine, le Cambodge, les Philippines et la Republique de Coree) ont connu une baisse de prevalence de la TB pulmonaire a frottis ou culture positive d'environ 50% sur 10 ans. Conclusions Les enquetes de prevalence nationale de la TB en Asie montrent que de fortes reductions de la prevalence de la TB peuvent etre atteintes en une decennie, que les hommes portent beaucoup plus la charge que les femmes et que l’epidemie est vieillissante. Les comparaisons entre pays montrent que plus d'efforts pourraient etre realises dans certains pays dans la lutte antituberculeuse avec les strategies et les technologies existantes. Cependant, avec les nombreux cas prevalents qui ne rapportent pas les symptomes classiques de la TB, tous les pays sont confrontes au defi de definir et mettre en œuvre des strategies qui resulteront en la detection et au traitement des cas plus tot. Objetivos y Metodos En muchos paises, las encuestas sobre la prevalencia de la TB son la unica forma confiable de medir la carga de enfermedad por TB y monitorizar las tendencias. Tambien pueden proveer evidencia sobre el desempeno actual de los cuidados para y el control de la TB y de como podrian mejorarse. Hemos desarrollado un inventario de las encuestas asiaticas realizadas entre 1953 y el 2012 y despues compilamos y analizamos un set de datos estandar para todas encuestas nacionales implementadas entre 1990 (el ano de base para los objetivos globales de TB del 2015) y el 2012. Resultados Se detectaron 21 encuestas en 12 paises entre 1990 y 2012; 18 de ellas tenian resultados publicados. La tasa de participacion era de al menos el 80% y a menudo mucho mas alta excepto para las dos encuestas de Tailandia. La prevalencia de enfermedad tuberculosa con resultados bacteriologicos positivos entre adultos ≥15 anos variaba ampliamente entre paises (1.2 por 1000 habitantes en China en 2010 a 15 por 1000 habitantes en Camboya en 2002), pero los patrones de distribucion por edad y sexo eran consistentes con un aumento progresivo en las tasas de incidencia por edad, y en que un 66−75% de los casos prevalentes eran en hombres. Una alta proporcion de casos (40−79% a lo largo de todas las encuestas) no reportaban sintomas de TB contemplados como criterios de cribado (generalmente tos de 2−3 semanas o mas, y sangre en el esputo), y solo se detectaron mediante una placa de torax realizada a todos los participantes del estudio; esta proporcion aumentaba a lo largo del tiempo en paises con datos de encuestas repetidas. La proporcion de casos prevalentes frente a casos notificados al programa nacional de TB era tipicamente alrededor de dos, pero llegaba incluso a tres en Lao PDR y Paquistan, incluso varios anos despues de la implementacion de la estrategia de control de la TB recomendada a nivel internacional. Cuatro paises (China, Camboya, Filipinas y la Republica de Corea) mostraron una disminucion en la prevalencia de TB pulmonar con baciloscopia o cultivo positivo de aproximadamente un 50% a lo largo de 10 anos. Conclusiones Las encuestas nacionales de prevalencia de la TB en Asia muestran que se pueden alcanzar grandes reducciones en la prevalencia de la enfermedad tuberculosa a lo largo de una decada, que los hombres tienen una mayor carga de enfermedad que las mujeres y que la epidemia esta envejeciendo. Las comparaciones entre paises muestran que se podria lograr mucho mas en el control de la TB en algunos paises con estrategias y tecnologias existentes. Sin embargo, con muchos casos prevalentes que no presentan los sintomas clasicos de la TB, todos los paises se enfrentan al reto de definir e implementar estrategias que resulten en una deteccion y tratamiento de los casos mas temprano.

Published
2020

7. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Author

Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M., Abd-Allah, Foad, Abera, Semaw Ferede, Abraha, Haftom Niguse, Abu-Raddad, Laith J., Abu-Rmeileh, Niveen M. E., Adedeji, Isaac Akinkunmi, Adedoyin, Rufus Adesoji, Adetifa, Ifedayo Morayo O., Adetokunboh, Olatunji, Afshin, Ashkan, Aggarwal, Rakesh, Agrawal, Anurag, Agrawal, Sutapa, Ahmad Kiadaliri, Aliasghar, Ahmed, Muktar Beshir, Aichour, Miloud Taki Eddine, Aichour, Amani Nidhal, Aichour, Ibthiel, Aiyar, Sneha, Akanda, Ali Shafqat, Akinyemiju, Tomi F., Akseer, Nadia, Al Lami, Faris Hasan, Alabed, Samer, Alahdab, Fares, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore, Alasfoor, Deena, Aldridge, Robert William, Alene, Kefyalew Addis, Al-Eyadhy, Ayman, Alhabib, Samia, Ali, Raghib, Alizadeh-Navaei, Reza, Aljunid, Syed M., Alkaabi, Juma M., Alkerwi, Ala'a, Alla, François, Allam, Shalini D., Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A., Alvis-Guzman, Nelson, Amare, Azmeraw T., Ameh, Emmanuel A., Amini, Erfan, Ammar, Walid, Amoako, Yaw Ampem, Anber, Nahla, Andrei, Catalina Liliana, Androudi, Sofia, Ansari, Hossein, Ansha, Mustafa Geleto, Antonio, Carl Abelardo T., Anwari, Palwasha, Ärnlöv, Johan, Arora, Megha, Artaman, Al, Aryal, Krishna Kumar, Asayesh, Hamid, Asgedom, Solomon Weldegebreal, Asghar, Rana Jawad, Assadi, Reza, Assaye, Ashagre Molla, Atey, Tesfay Mehari, Atre, Sachin R., Avila-Burgos, Leticia, Avokpaho, Euripide Frinel G. Arthur, Awasthi, Ashish, Babalola, Tesleem Kayode, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Balalla, Shivanthi, Barac, Aleksandra, Barber, Ryan M., Barboza, Miguel A., Barker-Collo, Suzanne L., Bärnighausen, Till, Barquera, Simon, Barregard, Lars, Barrero, Lope H., Baune, Bernhard T., Bazargan-Hejazi, Shahrzad, Bedi, Neeraj, Beghi, Ettore, Béjot, Yannick, Bekele, Bayu Begashaw, Bell, Michelle L., Bello, Aminu K., Bennett, Derrick A., Bennett, James R., Bensenor, Isabela M., Benson, Jennifer, Berhane, Adugnaw, Berhe, Derbew Fikadu, Bernabé, Eduardo, Beuran, Mircea, Beyene, Addisu Shunu, Bhala, Neeraj, Bhansali, Anil, Bhaumik, Soumyadeep, Bhutta, Zulfiqar A., Bicer, Burcu Kucuk, Bidgoli, Hassan Haghparast, Bikbov, Boris, Birungi, Charles, Biryukov, Stan, Bisanzio, Donal, Bizuayehu, Habtamu Mellie, Bjerregaard, Peter, Blosser, Christopher D., Boneya, Dube Jara, Boufous, Soufiane, Bourne, Rupert R. A., Brazinova, Alexandra, Breitborde, Nicholas J. 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Subjects
Dánarmein, Heilsufar, Dánartíðni, Lífslíkur, Epidemiology, Aldurshópar, ALCOHOL, Börn, Medicine and Health Sciences, Psychology, DEVELOPING-COUNTRIES, Children, Konur, Ungbörn, Tölfræði, Educational status, Aldraðir, Medicine (all), Global burden of disease/statistics and numerical data, DEATH, Men, Þjóðir, Staðtölur, Stillbirth, Sálfræði, World health, SURVIVAL, Income, CHILD-MORTALITY, HEALTH, Burðarmálsdauði, Infants, Age distribution, HIV infections, Child mortality, Alnæmi, Menntun, GBD, Fæðingartíðni, RUSSIAN MORTALITY, Birth rate, Life Expectancy, SDG 3 - Good Health and Well-being, Women, Mortality, METAANALYSIS, Faraldsfræði, HIV, Frjósemi, Fertility, Socioeconomic Factors, Karlar, Barnadauði, Félagshagfræði, Tekjur, Older people, Cause of death/trends, RA
Abstract

Correction in: Group Author(s): GBD 2016 Mortality Collaborators LANCET Volume: 390 Issue: 10106 Pages: E38-E38 Published: OCT 28 2017, Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0.5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Sociodemographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86.9 years (95% UI 86.7-87.2), and for men in Singapore, at 81.3 years (78.8-83.7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled., Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

Published
2017

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