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1. Mapping the incidence rate of typhoid fever in sub-Saharan Africa.

Author

Jong-Hoon Kim, Jungsoon Choi, Chaelin Kim, Gi Deok Pak, Prerana Parajulee, Andrea Haselbeck, Se Eun Park, Vittal Mogasale, Hyon Jin Jeon, Annie J Browne, Ellis Owusu-Dabo, Raphaël Rakotozandrindrainy, Abdramane Soura Bassiahi, Mekonnen Teferi, Octavie Lunguya-Metila, Christiane Dolecek, Virginia E Pitzer, John A Crump, Simon I Hay, and Florian Marks

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundWith more than 1.2 million illnesses and 29,000 deaths in sub-Saharan Africa in 2017, typhoid fever continues to be a major public health problem. Effective control of the disease would benefit from an understanding of the subnational geospatial distribution of the disease incidence.MethodWe collated records of the incidence rate of typhoid fever confirmed by culture of blood in Africa from 2000 to 2022. We estimated the typhoid incidence rate for sub-Saharan Africa on 20 km × 20 km grids by exploring the association with geospatial covariates representing access to improved water and sanitation, health conditions of the population, and environmental conditions.ResultsWe identified six published articles and one pre-print representing incidence rate estimates in 22 sites in 2000-2022. Estimated incidence rates showed geospatial variation at sub-national, national, and regional levels. The incidence rate was high in Western and Eastern African subregions followed by Southern and Middle African subregions. By age, the incidence rate was highest among 5-14 yo followed by 2-4 yo, > 14 yo, and 0-1 yo. When aggregated across all age classes and grids that comprise each country, predicted incidence rates ranged from 43.7 (95% confidence interval: 0.6 to 591.2) in Zimbabwe to 2,957.8 (95% CI: 20.8 to 4,245.2) in South Sudan per 100,000 person-years. Sub-national heterogeneity was evident with the coefficient of variation at the 20 km × 20 km grid-level ranging from 0.7 to 3.3 and was generally lower in high-incidence countries and widely varying in low-incidence countries.ConclusionOur study provides estimates of 20 km × 20 km incidence rate of typhoid fever across sub-Saharan Africa based on data collected from 2000 through 2020. Increased understanding of the subnational geospatial variation of typhoid fever in Africa may inform more effective intervention programs by better targeting resources to heterogeneously disturbed disease risk.

Published
2024
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2. Evaluating COVID-19-Related Disruptions to Effective Malaria Case Management in 2020–2021 and Its Potential Effects on Malaria Burden in Sub-Saharan Africa

Author

Paulina A. Dzianach, Susan F. Rumisha, Jailos Lubinda, Adam Saddler, Mauricio van den Berg, Yalemzewod A. Gelaw, Joseph R. Harris, Annie J. Browne, Francesca Sanna, Jennifer A. Rozier, Beatriz Galatas, Laura F. Anderson, Camilo A. Vargas-Ruiz, Ewan Cameron, Peter W. Gething, and Daniel J. Weiss

Subjects
malaria, COVID-19, effective treatment, Medicine
Abstract

The COVID-19 pandemic has led to far-reaching disruptions to health systems, including preventative and curative services for malaria. The aim of this study was to estimate the magnitude of disruptions in malaria case management in sub-Saharan Africa and their impact on malaria burden during the COVID-19 pandemic. We used survey data collected by the World Health Organization, in which individual country stakeholders reported on the extent of disruptions to malaria diagnosis and treatment. The relative disruption values were then applied to estimates of antimalarial treatment rates and used as inputs to an established spatiotemporal Bayesian geostatistical framework to generate annual malaria burden estimates with case management disruptions. This enabled an estimation of the additional malaria burden attributable to pandemic-related impacts on treatment rates in 2020 and 2021. Our analysis found that disruptions in access to antimalarial treatment in sub-Saharan Africa likely resulted in approximately 5.9 (4.4–7.2 95% CI) million more malaria cases and 76 (20–132) thousand additional deaths in the 2020–2021 period within the study region, equivalent to approximately 1.2% (0.3–2.1 95% CI) greater clinical incidence of malaria and 8.1% (2.1–14.1 95% CI) greater malaria mortality than expected in the absence of the disruptions to malaria case management. The available evidence suggests that access to antimalarials was disrupted to a significant degree and should be considered an area of focus to avoid further escalations in malaria morbidity and mortality. The results from this analysis were used to estimate cases and deaths in the World Malaria Report 2022 during the pandemic years.

Published
2023
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3. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study

Author

Annie J Browne, DPhil, Michael G Chipeta, PhD, Georgina Haines-Woodhouse, MSc, Emmanuelle P A Kumaran, MPH, Bahar H Kashef Hamadani, MPH, Sabra Zaraa, MPH, Nathaniel J Henry, BSc, Aniruddha Deshpande, MPH, Robert C Reiner, Jr, PhD, Nicholas P J Day, ProfFMedSci, Alan D Lopez, ProfPhD, Susanna Dunachie, ProfPhD, Catrin E Moore, DPhil, Andy Stergachis, ProfPhD, Simon I Hay, ProfDSc, and Christiane Dolecek, PhD

Subjects
Environmental sciences, GE1-350
Abstract

Summary: Background: Antimicrobial resistance (AMR) is a serious threat to global public health. WHO emphasises the need for countries to monitor antibiotic consumption to combat AMR. Many low-income and middle-income countries (LMICs) lack surveillance capacity; we aimed to use multiple data sources and statistical models to estimate global antibiotic consumption. Methods: In this spatial modelling study, we used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children (aged

Published
2021
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4. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis

Author

Annie J. Browne, Bahar H. Kashef Hamadani, Emmanuelle A. P. Kumaran, Puja Rao, Joshua Longbottom, Eli Harriss, Catrin E. Moore, Susanna Dunachie, Buddha Basnyat, Stephen Baker, Alan D. Lopez, Nicholas P. J. Day, Simon I. Hay, and Christiane Dolecek

Subjects
Enteric fever, Typhoid fever, Paratyphoid fever, Salmonella Typhi, Salmonella Paratyphi A, Antimicrobial drug resistance, Medicine
Abstract

Abstract Background Antimicrobial resistance (AMR) is an increasing threat to global health. There are > 14 million cases of enteric fever every year and > 135,000 deaths. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention. Methods We performed a systematic review of the literature by searching seven databases for studies published between 1990 and 2018. We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period. The prevalence of multidrug resistance (MDR) and fluoroquinolone non-susceptibility (FQNS) in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease (GBD) region and 5-year time period. Heterogeneity was assessed using the I 2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. Findings We identified 4557 articles, of which 384, comprising 124,347 isolates (94,616 S. Typhi and 29,731 S. Paratyphi A) met the pre-specified inclusion criteria. The majority (276/384; 72%) of studies were from South Asia; 40 (10%) articles were identified from Sub-Saharan Africa. With the exception of MDR S. Typhi in South Asia, which declined between 1990 and 2018, and MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing (AST) and lack of quality assurance were identified. Interpretation Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening. It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice. Trial registration PROSPERO CRD42018029432.

Published
2020
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5. Mapping local variation in educational attainment across Africa.

Author

Nicholas Graetz, Joseph Friedman, Aaron Osgood-Zimmerman, Roy Burstein, Molly H. Biehl, Chloe Shields, Jonathan F. Mosser, Daniel C. Casey, Aniruddha Deshpande, Lucas Earl, Robert C. Reiner, Sarah E. Ray, Nancy Fullman, Aubrey J. Levine, Rebecca W. Stubbs, Benjamin K. Mayala, Joshua Longbottom, Annie J. Browne, Samir Bhatt, Daniel J. Weiss, Peter W. Gething, Ali H. Mokdad, Stephen S. Lim, Christopher J. L. Murray, Emmanuela Gakidou, and Simon I. Hay

Published
2018
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6. Mapping local variation in household overcrowding across Africa from 2000 to 2018: a modelling study

Author

Michael G, Chipeta, Emmanuelle P A, Kumaran, Annie J, Browne, Bahar H Kashef, Hamadani, Georgina, Haines-Woodhouse, Benn, Sartorius, Robert C, Reiner, Christiane, Dolecek, Simon I, Hay, and Catrin E, Moore

Subjects
History, Health (social science), Polymers and Plastics, Health Policy, Public Health, Environmental and Occupational Health, COVID-19, Nigeria, Medicine (miscellaneous), Bayes Theorem, Industrial and Manufacturing Engineering, Risk Factors, Humans, Sanitation, Business and International Management
Abstract

BACKGROUND: Household overcrowding is a serious public health threat associated with high morbidity and mortality. Rapid population growth and urbanisation contribute to overcrowding and poor sanitation in low-income and middle- income countries, and are risk factors for the spread of infectious diseases, including COVID-19, and antimicrobial resistance. Many countries do not have adequate surveillance capacity to monitor household overcrowding. Geostatistical models are therefore useful tools for estimating household overcrowding. In this study, we aimed to estimate household overcrowding in Africa between 2000 and 2018 by combining available household survey data, population censuses, and other country-specific household surveys within a geostatistical framework. METHODS: We used data from household surveys and population censuses to generate a Bayesian geostatistical model of household overcrowding in Africa for the 19-year period between 2000 and 2018. Additional sociodemographic and health-related covariates informed the model, which covered 54 African countries. FINDINGS: We analysed 287 surveys and population censuses, covering 78 695 991 households. Spatial and temporal variability arose in household overcrowding estimates over time. In 2018, the highest overcrowding estimates were observed in the Horn of Africa region (median proportion 62% [IQR 57-63]); the lowest regional median proportion was estimated for the north of Africa region (16% [14-19]). Overall, 474·4 million (95% uncertainty interval [UI] 250·1 million-740·7 million) people were estimated to be living in overcrowded conditions in Africa in 2018, a 62·7% increase from the estimated 291·5 million (180·8 million-417·3 million) people who lived in overcrowded conditions in the year 2000. 48·5% (229·9 million) of people living in overcrowded conditions came from six African countries (Nigeria, Ethiopia, Democratic Republic of the Congo, Sudan, Uganda, and Kenya), with a combined population of 538·3 million people. INTERPRETATION: This study incorporated survey and population censuses data and used geostatistical modelling to estimate continent-wide overcrowding over a 19-year period. Our analysis identified countries and areas with high numbers of people living in overcrowded conditions, thereby providing a benchmark for policy planning and the implementation of interventions such as in infectious disease control. FUNDING: UK Department of Health and Social Care, Wellcome Trust, Bill & Melinda Gates Foundation.

Published
2022
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7. Mapping the Incidence Rate of Typhoid Fever in Sub-Saharan Africa

Author

Jong-Hoon Kim, Jungsoon Choi, Chaelin Kim, Gi Deok Pak, Prerana Parajulee, Andrea Haselbeck, Se Eun Park, Vittal Mogasale, Hyonjin Jeon, Annie J. Browne, Ellis Owusu-Dabo, Raphaël Rakotozandrindrainy, Abdramane Soura Bassiahi, Mekonnen Teferi, Octavie Lunguya-Metila, Christiane Dolecek, Virginia E. Pitzer, John A. Crump, Simon I. Hay, and Florian Marks

Published
2023
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8. Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis

Author

Freya M Shearer, BSc, Joshua Longbottom, MSc, Annie J Browne, MPH, David M Pigott, DPhil, Oliver J Brady, DPhil, Moritz U G Kraemer, DPhil, Fatima Marinho, PhD, Sergio Yactayo, MD, Valdelaine E M de Araújo, PhD, Aglaêr A da Nóbrega, PhD, Nancy Fullman, MPH, Sarah E Ray, BS, Jonathan F Mosser, MD, Jeffrey D Stanaway, PhD, Stephen S Lim, ProfPhD, Robert C Reiner, Jr, PhD, Catherine L Moyes, PhD, Simon I Hay, ProfFMedSci, and Nick Golding, DPhil

Subjects
Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity to spread further internationally. The aim of this study was to estimate the disease's contemporary distribution and potential for spread into new areas to help inform optimal control and prevention strategies. Methods: We assembled 1155 geographical records of yellow fever virus infection in people from 1970 to 2016. We used a Poisson point process boosted regression tree model that explicitly incorporated environmental and biological explanatory covariates, vaccination coverage, and spatial variability in disease reporting rates to predict the relative risk of apparent yellow fever virus infection at a 5 × 5 km resolution across all risk zones (47 countries across the Americas and Africa). We also used the fitted model to predict the receptivity of areas outside at-risk zones to the introduction or reintroduction of yellow fever transmission. By use of previously published estimates of annual national case numbers, we used the model to map subnational variation in incidence of yellow fever across at-risk countries and to estimate the number of cases averted by vaccination worldwide. Findings: Substantial international and subnational spatial variation exists in relative risk and incidence of yellow fever as well as varied success of vaccination in reducing incidence in several high-risk regions, including Brazil, Cameroon, and Togo. Areas with the highest predicted average annual case numbers include large parts of Nigeria, the Democratic Republic of the Congo, and South Sudan, where vaccination coverage in 2016 was estimated to be substantially less than the recommended threshold to prevent outbreaks. Overall, we estimated that vaccination coverage levels achieved by 2016 avert between 94 336 and 118 500 cases of yellow fever annually within risk zones, on the basis of conservative and optimistic vaccination scenarios. The areas outside at-risk regions with predicted high receptivity to yellow fever transmission (eg, parts of Malaysia, Indonesia, and Thailand) were less extensive than the distribution of the main urban vector, A aegypti, with low receptivity to yellow fever transmission in southern China, where A aegypti is known to occur. Interpretation: Our results provide the evidence base for targeting vaccination campaigns within risk zones, as well as emphasising their high effectiveness. Our study highlights areas where public health authorities should be most vigilant for potential spread or importation events. Funding: Bill & Melinda Gates Foundation.

Published
2018
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9. Global antibiotic consumption and usage in humans, 2000–18: a spatial modelling study

Author

Andy Stergachis, Nathaniel J. Henry, Annie J. Browne, Simon I. Hay, Emmanuelle P. A. Kumaran, Georgina Haines-Woodhouse, Michael G. Chipeta, Catrin E. Moore, Alan D. Lopez, Susanna Dunachie, Aniruddha Deshpande, Robert C. Reiner, Bahar H. Kashef Hamadani, Nicholas P. J. Day, Christiane Dolecek, and Sabra Zaraa

Subjects
medicine.medical_specialty, Health (social science), medicine.drug_class, Antibiotics, Population, Psychological intervention, Medicine (miscellaneous), Global Health, Antibiotic resistance, Africa, Northern, Environmental health, Drug Resistance, Bacterial, medicine, Humans, GE1-350, Child, education, Consumption (economics), education.field_of_study, Models, Statistical, Respiratory tract infections, Health Policy, Public health, Public Health, Environmental and Occupational Health, Bayes Theorem, Articles, Anti-Bacterial Agents, Environmental sciences, Multiple data, Geography, Child, Preschool
Abstract

Background Antimicrobial resistance (AMR) is a serious threat to global public health. WHO emphasises the need for countries to monitor antibiotic consumption to combat AMR. Many low-income and middle-income countries (LMICs) lack surveillance capacity; we aimed to use multiple data sources and statistical models to estimate global antibiotic consumption. Methods In this spatial modelling study, we used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children (aged Findings We analysed 209 surveys done between 2000 and 2018, covering 284 045 children with lower respiratory tract infections. We identified large national and subnational variations of antibiotic usage in LMICs, with the lowest levels estimated in sub-Saharan Africa and the highest in eastern Europe and central Asia. We estimated a global antibiotic consumption rate of 14·3 (95% uncertainty interval 13·2–15·6) defined daily doses (DDD) per 1000 population per day in 2018 (40·2 [37·2–43·7] billion DDD), an increase of 46% from 9·8 (9·2–10·5) DDD per 1000 per day in 2000. We identified large spatial disparities, with antibiotic consumption rates varying from 5·0 (4·8–5·3) DDD per 1000 per day in the Philippines to 45·9 DDD per 1000 per day in Greece in 2018. Additionally, we present trends in consumption of different classes of antibiotics for selected Global Burden of Disease study regions using the IQVIA, WHO, and ESAC-net input data. We identified large increases in the consumption of fluoroquinolones and third-generation cephalosporins in North Africa and Middle East, and south Asia. Interpretation To our knowledge, this is the first study that incorporates antibiotic usage and consumption data and uses geostatistical modelling techniques to estimate antibiotic consumption for 204 countries from 2000 to 2018. Our analysis identifies both high rates of antibiotic consumption and a lack of access to antibiotics, providing a benchmark for future interventions. Funding Fleming Fund, UK Department of Health and Social Care; Wellcome Trust; and Bill & Melinda Gates Foundation.

Published
2022

10. Global burden of bacterial antimicrobial resistance in 2019 : a systematic analysis

Author

Christopher J L Murray, Kevin Shunji Ikuta, Fablina Sharara, Lucien Swetschinski, Gisela Robles Aguilar, Authia Gray, Chieh Han, Catherine Bisignano, Puja Rao, Eve Wool, Sarah C Johnson, Annie J Browne, Michael Give Chipeta, Frederick Fell, Sean Hackett, Georgina Haines-Woodhouse, Bahar H Kashef Hamadani, Emmanuelle A P Kumaran, Barney McManigal, Sureeruk Achalapong, Ramesh Agarwal, Samuel Akech, Samuel Albertson, John Amuasi, Jason Andrews, Aleskandr Aravkin, Elizabeth Ashley, François-Xavier Babin, Freddie Bailey, Stephen Baker, Buddha Basnyat, Adrie Bekker, Rose Bender, James A Berkley, Adhisivam Bethou, Julia Bielicki, Suppawat Boonkasidecha, James Bukosia, Cristina Carvalheiro, Carlos Castañeda-Orjuela, Vilada Chansamouth, Suman Chaurasia, Sara Chiurchiù, Fazle Chowdhury, Rafai Clotaire Donatien, Aislinn J Cook, Ben Cooper, Tim R Cressey, Elia Criollo-Mora, Matthew Cunningham, Saffiatou Darboe, Nicholas P J Day, Maia De Luca, Klara Dokova, Angela Dramowski, Susanna J Dunachie, Thuy Duong Bich, Tim Eckmanns, Daniel Eibach, Amir Emami, Nicholas Feasey, Natasha Fisher-Pearson, Karen Forrest, Coralith Garcia, Denise Garrett, Petra Gastmeier, Ababi Zergaw Giref, Rachel Claire Greer, Vikas Gupta, Sebastian Haller, Andrea Haselbeck, Simon I Hay, Marianne Holm, Susan Hopkins, Yingfen Hsia, Kenneth C Iregbu, Jan Jacobs, Daniel Jarovsky, Fatemeh Javanmardi, Adam W J Jenney, Meera Khorana, Suwimon Khusuwan, Niranjan Kissoon, Elsa Kobeissi, Tomislav Kostyanev, Fiorella Krapp, Ralf Krumkamp, Ajay Kumar, Hmwe Hmwe Kyu, Cherry Lim, Kruy Lim, Direk Limmathurotsakul, Michael James Loftus, Miles Lunn, Jianing Ma, Anand Manoharan, Florian Marks, Jürgen May, Mayfong Mayxay, Neema Mturi, Tatiana Munera-Huertas, Patrick Musicha, Lilian A Musila, Marisa Marcia Mussi-Pinhata, Ravi Narayan Naidu, Tomoka Nakamura, Ruchi Nanavati, Sushma Nangia, Paul Newton, Chanpheaktra Ngoun, Amanda Novotney, Davis Nwakanma, Christina W Obiero, Theresa J Ochoa, Antonio Olivas-Martinez, Piero Olliaro, Ednah Ooko, Edgar Ortiz-Brizuela, Pradthana Ounchanum, Gideok D Pak, Jose Luis Paredes, Anton Yariv Peleg, Carlo Perrone, Thong Phe, Koukeo Phommasone, Nishad Plakkal, Alfredo Ponce-de-Leon, Mathieu Raad, Tanusha Ramdin, Sayaphet Rattanavong, Amy Riddell, Tamalee Roberts, Julie Victoria Robotham, Anna Roca, Victor Daniel Rosenthal, Kristina E Rudd, Neal Russell, Helio S Sader, Weerawut Saengchan, Jesse Schnall, John Anthony Gerard Scott, Samroeng Seekaew, Mike Sharland, Madhusudhan Shivamallappa, Jose Sifuentes-Osornio, Andrew J Simpson, Nicolas Steenkeste, Andrew James Stewardson, Temenuga Stoeva, Nidanuch Tasak, Areerat Thaiprakong, Guy Thwaites, Caroline Tigoi, Claudia Turner, Paul Turner, H Rogier van Doorn, Sithembiso Velaphi, Avina Vongpradith, Manivanh Vongsouvath, Huong Vu, Timothy Walsh, Judd L Walson, Seymour Waner, Tri Wangrangsimakul, Prapass Wannapinij, Teresa Wozniak, Tracey E M W Young Sharma, Kalvin C Yu, Peng Zheng, Benn Sartorius, Alan D Lopez, Andy Stergachis, Catrin Moore, Christiane Dolecek, Mohsen Naghavi, Antimicrobial Resistance Collaborators, and Collaborators, Antimicrobial Resistance

Subjects
METHICILLIN-RESISTANT, Models, Statistical, Science & Technology, SEPSIS, UNITED-STATES, ANTIBIOTIC-RESISTANCE, General Medicine, Bacterial Infections, systematic analysis, Global Health, Anti-Bacterial Agents, Global Burden of Disease, DEFINITIONS, Medicine, General & Internal, INFECTIONS, General & Internal Medicine, VACCINES, Drug Resistance, Bacterial, bacterial antimicrobial resistance, Humans, Human medicine, Life Sciences & Biomedicine, STAPHYLOCOCCUS-AUREUS
Abstract

Background Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen–drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date. Methods We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 23 pathogens and 88 pathogen–drug combinations in 204 countries and territories in 2019. We obtained data from systematic literature reviews, hospital systems, surveillance systems, and other sources, covering 471 million individual records or isolates and 7585 study-location-years. We used predictive statistical modelling to produce estimates of AMR burden for all locations, including for locations with no data. Our approach can be divided into five broad components: number of deaths where infection played a role, proportion of infectious deaths attributable to a given infectious syndrome, proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of a given pathogen resistant to an antibiotic of interest, and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden based on two counterfactuals: deaths attributable to AMR (based on an alternative scenario in which all drug-resistant infections were replaced by drug-susceptible infections), and deaths associated with AMR (based on an alternative scenario in which all drug-resistant infections were replaced by no infection). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. We present final estimates aggregated to the global and regional level. Findings On the basis of our predictive statistical models, there were an estimated 4·95 million (3·62–6·57) deaths associated with bacterial AMR in 2019, including 1·27 million (95% UI 0·911–1·71) deaths attributable to bacterial AMR. At the regional level, we estimated the all-age death rate attributable to resistance to be highest in western sub-Saharan Africa, at 27·3 deaths per 100 000 (20·9–35·3), and lowest in Australasia, at 6·5 deaths (4·3–9·4) per 100 000. Lower respiratory infections accounted for more than 1·5 million deaths associated with resistance in 2019, making it the most burdensome infectious syndrome. The six leading pathogens for deaths associated with resistance (Escherichia coli, followed by Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa) were responsible for 929 000 (660 000–1 270 000) deaths attributable to AMR and 3·57 million (2·62–4·78) deaths associated with AMR in 2019. One pathogen–drug combination, meticillin-resistant S aureus, caused more than 100 000 deaths attributable to AMR in 2019, while six more each caused 50 000–100 000 deaths: multidrug-resistant excluding extensively drug-resistant tuberculosis, third-generation cephalosporin-resistant E coli, carbapenem-resistant A baumannii, fluoroquinolone-resistant E coli, carbapenem-resistant K pneumoniae, and third-generation cephalosporin-resistant K pneumoniae. Interpretation To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen–drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat. Funding Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

Published
2022

11. Global antibiotic consumption: A modelling study

Author

M. Chipeta, Christiane Dolecek, Annie J. Browne, Robert Reiner, S. Zaraa, Susanna Dunachie, G. Haines-Woodhouse, Aniruddha Deshpande, Andy Stergachis, Simon I. Hay, Emmanuelle A. P. Kumaran, and Catrin E. Moore

Subjects
Microbiology (medical), Consumption (economics), Infectious Diseases, medicine.drug_class, Environmental health, Antibiotics, medicine, Economics, lcsh:RC109-216, General Medicine, lcsh:Infectious and parasitic diseases
Published
2020

12. Geospatial mapping of the global prevalence of antimicrobial resistant Salmonella Typhi and Paratyphi A isolates

Author

Simon I. Hay, Annie J. Browne, B. Kashef Hamadani, Emmanuelle P. A. Kumaran, Christiane Dolecek, Michael G. Chipeta, and Catrin E. Moore

Subjects
Microbiology (medical), Infectious Diseases, Geospatial analysis, lcsh:RC109-216, General Medicine, Biology, Antimicrobial, computer.software_genre, Salmonella typhi, computer, Microbiology, lcsh:Infectious and parasitic diseases
Published
2020

13. Determining the global burden of antimicrobial resistance – The GRAM project

Author

G. Haines-Woodhouse, B Kashef, G R Aguilar, Christiane Dolecek, Kevin S Ikuta, S Dunnachie, Mohsen Naghavi, M. Chipeta, Catrin E. Moore, A Stergachis, P Rao, Annie J. Browne, Christopher J L Murray, Alan D. Lopez, and E Kumaran

Subjects
Microbiology (medical), Infectious Diseases, Antibiotic resistance, lcsh:RC109-216, General Medicine, Biology, Microbiology, Gram, lcsh:Infectious and parasitic diseases
Published
2020

14. Global Antibiotic Consumption in Humans, 2000 to 2018: A Spatial Modelling Study

Author

Alan D. Lopez, Emmanuelle P. A. Kumaran, Simon I. Hay, Susanna Dunachie, Nicholas P. J. Day, Robert C. Reiner Jnr, Sabra Zaraa, Aniruddha Deshpande, Michael G. Chipeta, Christiane Dolecek, Georgina Haines-Woodhouse, Andy Stergachis, Bahar H. Kashef Hamadani, Catrin E. Moore, Annie J. Browne, and Nathaniel J. Henry

Subjects
Consumption (economics), education.field_of_study, medicine.medical_specialty, Under-five, medicine.drug_class, Public health, Population, Antibiotics, Psychological intervention, Declaration, Antibiotic resistance, Geography, Environmental health, medicine, education
Abstract

Background: Antimicrobial resistance (AMR) is a serious threat to global public health. The World Health Organization emphasizes the need for countries to monitor antibiotic consumption in order to combat AMR. Many low- and middle-income countries (LMICs) lack surveillance capacity; geostatistical models can be used to estimate antibiotic consumption. Methods: We used individual-level data from household surveys to inform a Bayesian geostatistical model of antibiotic usage in children under five years with lower respiratory tract infections (LRI) in LMICs, from 2000 to 2018. Antibiotic consumption data were obtained from multiple sources, including IQVIA, WHO and ESAC-Net. The estimates of the antibiotic usage model were used alongside socio-demographic and health covariates to inform a model of total antibiotic consumption covering 204 countries from 2000 to 2018.FindingsWe analysed 209 surveys conducted between 2000 and 2018, covering 284,045 children with LRI. We identified large national and subnational variations of antibiotic usage in LMICs, with the lowest levels estimated in sub-Saharan Africa and the highest in Eastern Europe and Central Asia. We estimated a global antibiotic consumption rate of 14·3 [95% uncertainty interval 13·2-15·6] defined daily doses (DDD) per 1000 population per day in 2018 (40·2 [37·2-43·7] billion DDDs), an increase of 46% from 9·8 [9·2-10·5] DDD per 1000 per day in 2000. We identified large spatial disparities, with antibiotic consumption rates varying from 5·0 [4·8-5·3] DDD per 1000 per day in the Philippines to 45·9 DDD per 1000 per day in Greece in 2018. In addition, we present trends in consumption of different classes of antibiotics for selected GBD regions using the IQVIA, WHO and ESAC-net input data. Interpretation: This is the first study that incorporates antibiotic usage and consumption data and utilises geostatistical modelling techniques to estimate antibiotic consumption for 204 countries from 2000 to 2018. Our analysis identifies both high rates of antibiotic consumption and a lack of access to antibiotics, and provides a benchmark for future interventions. Funding Statement: This work was funded by a grant from the Fleming Fund, UK Department of Health and Social Care; the Wellcome Trust (209142/Z/17/Z) and the Bill and Melinda Gates Foundation (OPP1176062). Declaration of Interests: All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. None of the authors reports any relevant financial or other conflicts of interests. AS has been the recipient of research grants from the Bill and Melinda Gates Foundation. Ethics Approval Statement: This research was exempted from ethics approval as all analyses were performed on publicly accessible de-identified data.

Published
2020
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15. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Author

Mohsen Bayati, Arvin Haj-Mirzaian, Mehran Asadi-Aliabadi, Maziar Moradi-Lakeh, Nasir Salam, Mohamad-Hani Temsah, Fatemeh Heydarpour, Davide Rasella, Kavumpurathu Raman Thankappan, Ghulam Mustafa, Sergey Konstantinovitch Vladimirov, Fereshteh Ansari, Dina Nur Anggraini Ningrum, Leonardo Roever, Oghenowede Eyawo, Koustuv Dalal, Ana-Laura Manda, Ritesh G. Menezes, Molly K. Miller-Petrie, Javad Yoosefi Lebni, Gebreamlak Gebremedhn Gebremeskel, Aziz Eftekhari, Oleguer Plana-Ripoll, Jon Wakefield, Sanjay Zodpey, Birhanu Geta, Amaha Kahsay, Edris Hasanpoor, Brijesh Sathian, Kala M. Mehta, Moritz U. G. Kraemer, Saeed Amini, Hesham M. Al-Mekhlafi, Abbas Yadegar, João Pedro Silva, Desmond Kuupiel, Anvar Asadi, Hamid Sharifi, Ebrahim Babaee, Dessalegn Ajema Berbada, Taddese Alemu Zerfu, Ian Davis, Mostafa Qorbani, Fatemeh Rajati, Samer Hamidi, Parvaiz A Koul, Foad Abd-Allah, Mojisola Oluwasanu, Syed Mohamed Aljunid, Elias Merdassa Roro, Mihaela Hostiuc, Robert S. Bernstein, Vahid Yazdi-Feyzabadi, Gebre Teklemariam Demoz, Irina Filip, Mu'awiyyah Babale Sufiyan, Amir Khater, Lidia Morawska, Sangram Kishor Patel, Robert C. Reiner, Joshua O. Akinyemi, Telma Zahirian Moghadam, Ali Akbar Fazaeli, Reza Malekzadeh, Olatunde Aremu, Mohammad Reza Salahshoor, Irfan Ullah, Gabrielle B. Britton, Gelin Xu, Nathaniel J Henry, Thomas R. Hird, Ronny Westerman, Vera Marisa Costa, Reza Assadi, Tiffany K. Gill, Chhabi Lal Ranabhat, Meysam Olfatifar, Sezer Kisa, Grant Rodgers Kemp, Mahmoud Yousefifard, Aleksandra Barac, Simon I. Hay, Walter Mendoza, Mohammad Zamani, Nader Jafari Balalami, Mahdi Safdarian, Manfred S. Green, Mahesh P A, Nahid Neamati, Pallab K. Maulik, Ali H. Mokdad, Joshua Longbottom, Somayeh Bohlouli, Ahmad Daryani, Ibrahim Abdollahpour, Mostafa Hosseini, Deborah Carvalho Malta, Nick Golding, Sheikh Mohammed Shariful Islam, Shirin Nosratnejad, Haidong Wang, Shadi Rahimzadeh, Pushpendra Kumar, Mehdi Noroozi, Andre M. N. Renzaho, Brent Bell, Huong Lan Thi Nguyen, Khaled Khatab, Meghdad Pirsaheb, Yousef Veisani, Katie R Nielsen, Ionut Negoi, Seyyed Meysam Mousavi, Amir Ashraf-Ganjouei, Mohammad Hassan Emamian, Joseph L Ward, Sharath Burugina Nagaraja, Songhomitra Panda-Jonas, Ettore Beghi, Azeem Majeed, Ivy Shiue, Delia Hendrie, Roghiyeh Faridnia, Seyed Mostafa Mir, Moslem Soofi, Ghobad Moradi, Mahsa Ghajarzadeh, Chandrashekhar T Sreeramareddy, Milad Hasankhani, Mohamed I Hegazy, Mika Shigematsu, Bryan L. Sykes, Vahid Alipour, Ruth W Kimokoti, Afshin Maleki, Nafiseh Baheiraei, Noore Alam, Jalal Arabloo, Mariam Molokhia, Kimberly B. Johnson, Amber Sligar, Nicole Davis Weaver, Kerem Shuval, Malede Mequanent Sisay, Paul H. Lee, Reza Ghadimi, Mahbobeh Faramarzi, Natalia V. Bhattacharjee, Ehsan Sadeghi, Brandon V. Pickering, Animika Pandey, Ana Isabel Ribeiro, Felix Greaves, Sameer Vali Gopalani, Joel M. Francis, Alyssa N. Sbarra, Yun Jin Kim, Agus Sudaryanto, Hebat Allah Salah A. Yousof, Hadi Pourjafar, Tomohide Yamada, Alireza Rafiei, Rosario Cárdenas, Mohammad Khazaei, Hasan Yusefzadeh, Rahman Shiri, Girmay Teklay Weldesamuel, Zahra Jorjoran Shushtari, Michael Collison, Stanislav S. Otstavnov, Narayanaswamy Venketasubramanian, Yahya Salimi, Naohiro Yonemoto, Ahmad Ghashghaee, Soewarta Kosen, Al Artaman, Surendra Karki, Tariq Jamal Siddiqi, Lorenzo Monasta, Amit Arora, Christopher S Yilgwan, Ahamarshan Jayaraman Nagarajan, Adnan Kisa, Gholamreza Roshandel, Vahid Rashedi, Daniel Diaz, Amir Vahedian-Azimi, Erkin M. Mirrakhimov, Nuworza Kugbey, Zohreh Arefi, Benjamin B. Massenburg, Robert G. Weintraub, Lauren E. Schaeffer, Alexandre C. Pereira, Mehdi Hosseinzadeh, Milena M Santric Milicevic, Ai Koyanagi, Mehran Shams-Beyranvand, Salman Khazaei, Olalekan A. Uthman, Mohamed Hsairi, Nuno Taveira, Masoud Foroutan, Jayendra Sharma, Hanna Demelash Desyibelew, Max Roser, Keivan Ahmadi, Yousef Khader, Hamideh Salimzadeh, Ali Bijani, Shanshan Li, Mehran Alijanzadeh, Florian Fischer, Aziz Sheikh, Eun-Kee Park, Stefan Listl, Smita Pakhale, Brian J. Hall, Alireza Zangeneh, Ravi Mehrotra, Kidu Gidey Weldegwergs, Mahdi Afshari, Son Hoang Nguyen, Francisco Rogerlândio Martins-Melo, Rupak Desai, Aziz Rezapour, Hassan Magdy Abd El Razek, Gillian I. Hollerich, Reza Saeedi, Iman El Sayed, Olayinka Stephen Ilesanmi, Ben Lacey, Soheil Ebrahimpour, Laura Dwyer-Lindgren, Roya Ebrahimi, Bolajoko O. Olusanya, Tommi Vasankari, Siamak Sabour, Theo Vos, Tuomo J. Meretoja, Job F M van Boven, Nataliya Foigt, Mojtaba Hoseini-Ghahfarokhi, Saleh Salehi Zahabi, Mehdi Fazlzadeh, Neeraj Bedi, Hamed Mirjalali, Payman Salamati, P N Sylaja, Ted R. Miller, George J. Milne, Alaa Badawi, Muhammad Usman, Amir Hasanzadeh, Michelle L. Bell, Giang Thu Vu, Masoud Behzadifar, Manasi Kumar, Mona M. Khater, Josip Car, Nafis Sadat, Mostafa Leili, Mehdi Sharif, Hadi Hassankhani, Mowafa Househ, Joshua A. Salomon, Morteza Mansourian, G Anil Kumar, João C. Fernandes, Tufa Kolola, Arya Haj-Mirzaian, Masood Ali Shaikh, Keyghobad Ghadiri, Andrew T Olagunju, Bahram Armoon, Beatriz Paulina Ayala Quintanilla, Samantha Perkins, Mohsen Mazidi, Stefan Lorkowski, Sagnik Dey, Edward J Mills, Ali Kabir, Maryam Khazaei-Pool, Mohammad Rabiee, Arianna Maever L. Amit, John S. Ji, Sivan Yegnanarayana Iyer Saraswathy, Fares Alahdab, Vafa Rahimi-Movaghar, Martin McKee, Hadi Parsian, Ejaz Ahmad Khan, Amirhossein Sahebkar, Paramjit Gill, Dara K. Mohammad, Naznin Hossain, Karen M. Tabb, Annie J. Browne, Abdallah M. Samy, Elham Ehsani-Chimeh, Nelson G.M. Gomes, Destallem Gebremedhin Gebre, Fakher Rahim, Sheetal D. Lad, Rajat Das Gupta, Yash Jobanputra, Rajesh Sharma, Davoud Adham, Richard Ofori-Asenso, Farah Daoud, Aso Mohammad Darwesh, Meghnath Dhimal, Pranab Chatterjee, Javad Javidnia, Shafiu Mohammed, Amir Abdoli, Josep Maria Haro, Stefanie Watson, Behnam Nabavizadeh, Masoumeh Abbasi, Kefyalew Addis Alene, Marzieh Nojomi, G. K. Mini, Abbas Mosapour, Cyrus Cooper, Yirga Legesse Nirayo, Jagdish Khubchandani, Muhammed Magdy Abd El Razek, Faramarz Shaahmadi, Satar Rezaei, Mahdi Sharif-Alhoseini, Francesco Saverio Violante, Eyal Oren, Erfan Zabeh, Atte Meretoja, Nicholas Graetz, Kris J. Krohn, Anthony Masaka, Oladimeji Adebayo, Mikk Jürisson, Faris Lami, Marcos Roberto Tovani-Palone, Chloe Shields, Yahya Safari, Yasir Waheed, Dilaram Acharya, Seyed Mohammad Riahi, Jan-Walter De Neve, Carlos A Castañeda-Orjuela, Alberto Ortiz, Samad Azari, Shymaa Enany, Maha Ezalarab, Salvatore Rubino, Enayatollah Homaie Rad, Roghayeh Khabiri, Seyed-Mohammad Fereshtehnejad, Yuming Guo, Sonia Saxena, Nicholas J K Breitborde, Takeshi Fukumoto, Hamid Yimam Hassen, Thomas Pilgrim, Yasser Vasseghian, Dragos Virgil Davitoiu, Farid Najafi, Sathish Thirunavukkarasu, Ali Rostami, Efat Mohamadi, Sameh Magdeldin, Hedley Quintana, Cyrus Alinia, Rodrigo Sarmiento-Suarez, Roya Safari-Faramani, Leila Doshmangir, Kewal Krishan, Karen Sliwa, Nazrul Islam, Neal Marquez, Genet Melak Alamene, Andem Effiong, Khanh Bao Tran, Amir Kasaeian, Adeladza Kofi Amegah, Hamidreza Haririan, Maha El Tantawi, Anders Larsson, André Faro, Rushdia Ahmed, Amir Shamshirian, Josephine W. Ngunjiri, Yousef Moradi, Sharareh Eskandarieh, Evanson Z. Sambala, Nelson Alvis-Guzman, Mehdi Moradinazar, Lauren Woyczynski, Parul Puri, Yunquan Zhang, Navid Manafi, Vinay Nangia, Joan B. Soriano, Victor Adekanmbi, Sofia Androudi, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Netsanet Fentahun, Achala Upendra Jayatilleke, David L. Smith, Solomon Sisay, Giuseppe Gorini, Meysam Behzadifar, Charles Shey Wiysonge, Bach Xuan Tran, Lal B. Rawal, Arefeh Babazadeh, Damaris K. Kinyoki, Morteza Shamsizadeh, Ziad El-Khatib, Zohreh Anbari, Abdol Sattar Pagheh, Ranjani Somayaji, Frank B. Osei, Nancy Fullman, Zahid A Butt, Ai-Min Wu, Tahereh Pashaei, Benn Sartorius, Aaron Osgood-Zimmerman, Sachin R Atre, Mehdi Ahmadi, Chalachew Genet Akal, Aubrey J. Levine, Mohammad Fareed, Quique Bassat, Khalid A Altirkawi, Ensiyeh Jenabi, Daem Roshani, Mina Anjomshoa, Jasvinder A. Singh, Yafeng Wang, Samath D Dharmaratne, Enrico Rubagotti, Ruxandra Irina Negoi, Reinhard Busse, Abdullah Al Mamun, Yoshan Moodley, Mohammed Almalki, Peter W. Gething, Alireza Khatony, Usman Iqbal, Soraya Nouraei Motlagh, Roy Burstein, Hamed Zandian, Rakhi Dandona, Mojtaba Bagherzadeh, Majid Pirestani, Jaifred Christian F. Lopez, Chuanhua Yu, Arash Ziapour, Seyed Sina Naghibi Irvani, Bárbara Niegia Garcia Goulart, Pascual R. Valdez, Amir Jalali, Chukwudi A Nnaji, Kelechi Elizabeth Oladimeji, Tomislav Mestrovic, Isidora S. Vujcic, Osayomwanbo Osarenotor, Azin Nahvijou, Chi Linh Hoang, Christopher J L Murray, Mustafa Z. Younis, Veincent Christian Filipino Pepito, Andre Rodrigues Duraes, Yuan-Pang Wang, Felix Akpojene Ogbo, Aniruddha Deshpande, Nicholas J Kassebaum, Jacek Jerzy Jozwiak, Soghra Bagheri, Paul S. F. Yip, Sree Bhushan Raju, Sadaf G. Sepanlou, Kebede Deribe, Junaid Khan, Mohammad Aghaali, Lalit Dandona, Masoud Moradi, Molly R Nixon, Bruno Piassi Sao Jose, Atalay Goshu Muluneh, Mohammad Hasan Imani-Nasab, Naser Mohammad Gholi Mezerji, Abdullah Sulieman Terkawi, Sojib Bin Zaman, Muhammad Shahzeb Khan, Maysaa El Sayed Zaki, Gebrekiros Gebremichael Meles, Suraj Bhattarai, Yared Belete Belay, Ammas Siraj Mohammed, Dawit Zewdu Wondafrash, Abbas Balouchi, Silvano Gallus, Mohammad Abdollahi, Long Hoang Nguyen, Zulfiqar A Bhutta, Jean Jacques Noubiap, Mehdi Naderi, Bernhard T. Baune, Lucas Earl, Doris D. V. Ortega-Altamirano, Michael R.M. Abrigo, Farkhonde Salehi, Hamed Kalani, Mayowa O. Owolabi, Feleke Mekonnen Demeke, Lee Ling Lim, Ulrich O Mueller, Laurie B. Marczak, Peter Njenga Keiyoro, Ehsan Ahmadpour, Navid Rabiee, Dinh-Toi Chu, Vasily Vlassov, Bradford D Gessner, Tsegaye Tewelde Gebrehiwot, Sorin Hostiuc, Bakhtiar Piroozi, Mahdieh Abbasalizad-Farhangi, Takahiro Tabuchi, Philimon Gona, Bahar Ataeinia, Azra Ramezankhani, Duduzile Ndwandwe, Obinna Onwujekwe, Zohreh Rahimi, Seyedmojtaba Seyedmousavi, Wagaye Fentahun Chanie, Neda Kianipour, Rizwan Suliankatchi Abdulkader, Dhirendra N Sinha, Young-Ho Khang, Paula Moraga, Manoochehr Karami, Solomon Olum, Rafael Tabarés-Seisdedos, Zemenu Tadesse Tessema, Amir Radfar, Kiomars Sharafi, Rohollah Kalhor, Benjamin K. Mayala, Mahmood Moosazadeh, David C. Schwebel, Jost B. Jonas, Quyen G. To, Ester Cerin, Martin Amogre Ayanore, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Research Institute for Asthma and COPD (GRIAC), Veritati - Repositório Institucional da Universidade Católica Portuguesa, Department of Earth Observation Science, Faculty of Geo-Information Science and Earth Observation, UT-I-ITC-ACQUAL, GeoHealth, HUS Neurocenter, Department of Neurosciences, Neurologian yksikkö, Clinicum, HUS Comprehensive Cancer Center, Staff Services, Department of Surgery, University of Helsinki, Islam, Nazrul [0000-0003-3982-4325], Apollo - University of Cambridge Repository, Burstein R., Henry N.J., Collison M.L., Marczak L.B., Sligar A., Watson S., Marquez N., Abbasalizad-Farhangi M., Abbasi M., Abd-Allah F., Abdoli A., Abdollahi M., Abdollahpour I., Abdulkader R.S., Abrigo M.R.M., Acharya D., Adebayo O.M., Adekanmbi V., Adham D., Afshari M., Aghaali M., Ahmadi K., Ahmadi M., Ahmadpour E., Ahmed R., Akal C.G., Akinyemi J.O., Alahdab F., Alam N., Alamene G.M., Alene K.A., Alijanzadeh M., Alinia C., Alipour V., Aljunid S.M., Almalki M.J., Al-Mekhlafi H.M., Altirkawi K., Alvis-Guzman N., Amegah A.K., Amini S., Amit A.M.L., Anbari Z., Androudi S., Anjomshoa M., Ansari F., Antonio C.A.T., Arabloo J., Arefi Z., Aremu O., Armoon B., Arora A., Artaman A., Asadi A., Asadi-Aliabadi M., Ashraf-Ganjouei A., Assadi R., Ataeinia B., Atre S.R., Quintanilla B.P.A., Ayanore M.A., Azari S., Babaee E., Babazadeh A., Badawi A., Bagheri S., Bagherzadeh M., Baheiraei N., Balouchi A., Barac A., Bassat Q., Baune B.T., Bayati M., Bedi N., Beghi E., Behzadifar M., Belay Y.B., Bell B., Bell M.L., Berbada D.A., Bernstein R.S., Bhattacharjee N.V., Bhattarai S., Bhutta Z.A., Bijani A., Bohlouli S., Breitborde N.J.K., Britton G., Browne A.J., Nagaraja S.B., Busse R., Butt Z.A., Car J., Cardenas R., Castaneda-Orjuela C.A., Cerin E., Chanie W.F., Chatterjee P., Chu D.-T., Cooper C., Costa V.M., Dalal K., Dandona L., Dandona R., Daoud F., Daryani A., Das Gupta R., Davis I., Davis Weaver N., Davitoiu D.V., De Neve J.-W., Demeke F.M., Demoz G.T., Deribe K., Desai R., Deshpande A., Desyibelew H.D., Dey S., Dharmaratne S.D., Dhimal M., Diaz D., Doshmangir L., Duraes A.R., Dwyer-Lindgren L., Earl L., Ebrahimi R., Ebrahimpour S., Effiong A., Eftekhari A., Ehsani-Chimeh E., El Sayed I., El Sayed Zaki M., El Tantawi M., El-Khatib Z., Emamian M.H., Enany S., Eskandarieh S., Eyawo O., Ezalarab M., Faramarzi M., Fareed M., Faridnia R., Faro A., Fazaeli A.A., Fazlzadeh M., Fentahun N., Fereshtehnejad S.-M., Fernandes J.C., Filip I., Fischer F., Foigt N.A., Foroutan M., Francis J.M., Fukumoto T., Fullman N., Gallus S., Gebre D.G., Gebrehiwot T.T., Gebremeskel G.G., Gessner B.D., Geta B., Gething P.W., Ghadimi R., Ghadiri K., Ghajarzadeh M., Ghashghaee A., Gill P.S., Gill T.K., Golding N., Gomes N.G.M., Gona P.N., Gopalani S.V., Gorini G., Goulart B.N.G., Graetz N., Greaves F., Green 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C.J.L., and Hay S.I.

Subjects
Survival, RJ101, Mortalidad Infantil, HB, UNDER-5 MORTALITY, Global Health, Pediatrics, 0302 clinical medicine, 3123 Gynaecology and paediatrics, Child death, Infant Mortality, Epidemiology, Global health, Middle income country, Nacimiento vivo, 030212 general & internal medicine, 10. No inequality, Child, POPULATION, Developing world, education.field_of_study, Public health, Multidisciplinary, Geography, Mortality rate, wa_900, 1. No poverty, SUCCESS, Pediatrik, A900 Others in Medicine and Dentistry, 3142 Public health care science, environmental and occupational health, 3. Good health, Child Mortality, Death children, VACCINATION, HEALTH, ws_100, INTERVENTIONS, AFRICA, medicine.medical_specialty, United Nations, General Science & Technology, 030231 tropical medicine, Population, Developing country, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], ITC-HYBRID, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Social Justice, Recién nacido, Neonatal deaths, medicine, SYSTEMATIC ANALYSIS, Organizational Objectives, Humans, education, Developing Countries, business.industry, Infant, Newborn, Infant, CIVIL REGISTRATION, Paediatrics, Child survival, Newborn, PREVENTION, Infant mortality, wa_320, ws_200, Child mortality, Socioeconomic Factors, ITC-ISI-JOURNAL-ARTICLE, Human medicine, Paediatrics, Public health, Developing world, business, Demography
Abstract

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations., A high-resolution, global atlas of mortality of children under five years of age between 2000 and 2017 highlights subnational geographical inequalities in the distribution, rates and absolute counts of child deaths by age.

Published
2019
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16. Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis

Author

Freya M, Shearer, Catherine L, Moyes, David M, Pigott, Oliver J, Brady, Fatima, Marinho, Aniruddha, Deshpande, Joshua, Longbottom, Annie J, Browne, Moritz U G, Kraemer, Kathleen M, O'Reilly, Joachim, Hombach, Sergio, Yactayo, Valdelaine E M, de Araújo, Aglaêr A, da Nóbrega, Jonathan F, Mosser, Jeffrey D, Stanaway, Stephen S, Lim, Simon I, Hay, Nick, Golding, and Robert C, Reiner

Subjects
Vaccination, Yellow Fever, Yellow Fever Vaccine, Humans, Global Health, Article, Retrospective Studies, Disease Outbreaks
Abstract

Summary Background Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. Methods For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Findings Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Interpretation Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. Funding The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Union's Horizon 2020 research and innovation programme.

Published
2017

17. Mapping local variation in educational attainment across Africa

Author

Aniruddha Deshpande, Joseph Friedman, Peter W. Gething, Lucas Earl, Samir Bhatt, Joshua Longbottom, Roy Burstein, Daniel J. Weiss, Daniel C Casey, Stephen S Lim, Nancy Fullman, Aubrey J. Levine, Emmanuela Gakidou, Sarah E Ray, Nicholas Graetz, Ali H. Mokdad, Jonathan F. Mosser, Christopher J L Murray, Annie J. Browne, Robert Reiner, Molly H Biehl, Simon I. Hay, Aaron Osgood-Zimmerman, Chloe Shields, Rebecca W. Stubbs, and Benjamin K. Mayala

Subjects
0301 basic medicine, Male, Internationality, SUSTAINABLE DEVELOPMENT GOALS, ECONOMIC-DEVELOPMENT, 0302 clinical medicine, 030212 general & internal medicine, Young adult, Reproductive health, media_common, Multidisciplinary, PLASMODIUM-FALCIPARUM, Middle Aged, Multidisciplinary Sciences, GENDER INEQUALITY, Geography, Science & Technology - Other Topics, MATERNAL EDUCATION, GROWTH, Educational Status, Female, CHILD-MORTALITY, HEALTH, Goals, COUNTRIES, Adult, Inequality, Adolescent, General Science & Technology, media_common.quotation_subject, Fertility, World Health Organization, Article, 03 medical and health sciences, Young Adult, Sex Factors, Kilometer, MD Multidisciplinary, SYSTEMATIC ANALYSIS, Humans, Probability, Sustainable development, Science & Technology, business.industry, Local variation, Educational attainment, 030104 developmental biology, Africa, Demographic economics, business
Abstract

Educational attainment for women of reproductive age is linked to reduced child and maternal mortality, lower fertility and improved reproductive health. Comparable analyses of attainment exist only at the national level, potentially obscuring patterns in subnational inequality. Evidence suggests that wide disparities between urban and rural populations exist, raising questions about where the majority of progress towards the education targets of the Sustainable Development Goals is occurring in African countries. Here we explore within-country inequalities by predicting years of schooling across five by five kilometre grids, generating estimates of average educational attainment by age and sex at subnational levels. Despite marked progress in attainment from 2000 to 2015 across Africa, substantial differences persist between locations and sexes. These differences have widened in many countries, particularly across the Sahel. These high-resolution, comparable estimates improve the ability of decision-makers to plan the precisely targeted interventions that will be necessary to deliver progress during the era of the Sustainable Development Goals., Local-level analyses show that, despite marked progress in educational attainment from 2000 to 2015 across Africa, substantial differences persist between locations and sexes that have widened in many countries.

Published
2018

18. Mapping child growth failure in Africa between 2000 and 2015

Author

Aaron Osgood-Zimmerman, Puja Rao, David M. Pigott, Chloe Shields, Nancy Fullman, Rebecca W. Stubbs, Nathaniel J Henry, Abdisalan M. Noor, Jonathan F. Mosser, Peter W. Gething, Roy Burstein, Ewan Cameron, Daniel C Casey, Annie J. Browne, Mario Herrero, Nicholas Graetz, Lutz Krause, Stephen S Lim, Sarah E Ray, Robert Reiner, Daniel J. Weiss, Damaris K. Kinyoki, Ian D. Letourneau, Aubrey J. Levine, Rahul Rawat, Samir Bhatt, Harry S. Gibson, Ali H. Mokdad, Joshua Longbottom, Anoushka Millear, Brandon V. Pickering, Kirsten E. Wiens, Simon I. Hay, Benjamin K. Mayala, Murray Cjl., P. Liu, Aniruddha Deshpande, Nicholas J Kassebaum, Lucas Earl, Ellen Piwoz, David L. Smith, and Medical Research Council (MRC)

Subjects
medicine.medical_specialty, General Science & Technology, 030231 tropical medicine, SUSTAINABLE DEVELOPMENT GOALS, MODELS, Psychological intervention, GLOBAL HEALTH, Article, 03 medical and health sciences, 0302 clinical medicine, Environmental health, HEALTH SYSTEM PERFORMANCE, MD Multidisciplinary, Medicine, 030212 general & internal medicine, NIGERIA, Wasting, 2. Zero hunger, Sustainable development, Multidisciplinary, Science & Technology, PLASMODIUM-FALCIPARUM, business.industry, Public health, 1. No poverty, MALNUTRITION, medicine.disease, Child development, Health equity, 3. Good health, Multidisciplinary Sciences, Malnutrition, PUBLIC-HEALTH, SURVIVAL, Science & Technology - Other Topics, Public Health, Underweight, medicine.symptom, business, INTERVENTIONS
Abstract

Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal target—to end malnutrition by 2030. Geospatial estimates of child growth failure provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress., Geospatial estimates of child growth failure in Africa provide a baseline for measuring progress and a precision public health platform to target interventions to those populations with the greatest need.

Published
2018

19. Mapping under-5 and neonatal mortality in Africa, 2000-15: a baseline analysis for the Sustainable Development Goals

Author

Nick, Golding, Roy, Burstein, Joshua, Longbottom, Annie J, Browne, Nancy, Fullman, Aaron, Osgood-Zimmerman, Lucas, Earl, Samir, Bhatt, Ewan, Cameron, Daniel C, Casey, Laura, Dwyer-Lindgren, Tamer H, Farag, Abraham D, Flaxman, Maya S, Fraser, Peter W, Gething, Harry S, Gibson, Nicholas, Graetz, L Kendall, Krause, Xie Rachel, Kulikoff, Stephen S, Lim, Bonnie, Mappin, Chloe, Morozoff, Robert C, Reiner, Amber, Sligar, David L, Smith, Haidong, Wang, Daniel J, Weiss, Christopher J L, Murray, Catherine L, Moyes, Simon I, Hay, and Medical Research Council (MRC)

Subjects
Male, Conservation of Natural Resources, Age Factors, Infant, Newborn, Infant, Bayes Theorem, 11 Medical And Health Sciences, Risk Assessment, Article, Africa, Western, Sex Factors, Predictive Value of Tests, Cause of Death, Child, Preschool, Population Surveillance, General & Internal Medicine, Child Mortality, Infant Mortality, Humans, Female, Developing Countries, Goals
Abstract

Summary Background During the Millennium Development Goal (MDG) era, many countries in Africa achieved marked reductions in under-5 and neonatal mortality. Yet the pace of progress toward these goals substantially varied at the national level, demonstrating an essential need for tracking even more local trends in child mortality. With the adoption of the Sustainable Development Goals (SDGs) in 2015, which established ambitious targets for improving child survival by 2030, optimal intervention planning and targeting will require understanding of trends and rates of progress at a higher spatial resolution. In this study, we aimed to generate high-resolution estimates of under-5 and neonatal all-cause mortality across 46 countries in Africa. Methods We assembled 235 geographically resolved household survey and census data sources on child deaths to produce estimates of under-5 and neonatal mortality at a resolution of 5 × 5 km grid cells across 46 African countries for 2000, 2005, 2010, and 2015. We used a Bayesian geostatistical analytical framework to generate these estimates, and implemented predictive validity tests. In addition to reporting 5 × 5 km estimates, we also aggregated results obtained from these estimates into three different levels—national, and subnational administrative levels 1 and 2—to provide the full range of geospatial resolution that local, national, and global decision makers might require. Findings Amid improving child survival in Africa, there was substantial heterogeneity in absolute levels of under-5 and neonatal mortality in 2015, as well as the annualised rates of decline achieved from 2000 to 2015. Subnational areas in countries such as Botswana, Rwanda, and Ethiopia recorded some of the largest decreases in child mortality rates since 2000, positioning them well to achieve SDG targets by 2030 or earlier. Yet these places were the exception for Africa, since many areas, particularly in central and western Africa, must reduce under-5 mortality rates by at least 8·8% per year, between 2015 and 2030, to achieve the SDG 3.2 target for under-5 mortality by 2030. Interpretation In the absence of unprecedented political commitment, financial support, and medical advances, the viability of SDG 3.2 achievement in Africa is precarious at best. By producing under-5 and neonatal mortality rates at multiple levels of geospatial resolution over time, this study provides key information for decision makers to target interventions at populations in the greatest need. In an era when precision public health increasingly has the potential to transform the design, implementation, and impact of health programmes, our 5 × 5 km estimates of child mortality in Africa provide a baseline against which local, national, and global stakeholders can map the pathways for ending preventable child deaths by 2030. Funding Bill & Melinda Gates Foundation.

Published
2017

20. Correction: Corrigendum: The contemporary distribution of Trypanosoma cruzi infection in humans, alternative hosts and vectors

Author

Annie J. Browne, Carlos A. Guerra, Renato Vieira Alves, Veruska Maia da Costa, Anne L. Wilson, David M. Pigott, Simon I. Hay, Steve W. Lindsay, Nick Golding, and Catherine L. Moyes

Subjects
0106 biological sciences, Statistics and Probability, 010602 entomology, 0303 health sciences, 03 medical and health sciences, Library and Information Sciences, Statistics, Probability and Uncertainty, 01 natural sciences, 030304 developmental biology, Computer Science Applications, Education, Information Systems
Abstract

Scientific Data 4:170050 doi: 10.1038/sdata.2017.50 (2017); Published 11 April 2017; Updated 30 May 2017 The financial support for this Data Descriptor was not fully acknowledged. The Acknowledgements should have included the following: S.I.H. is funded by a Senior Research Fellowship from the Wellcome Trust [095066].

Published
2017
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22. High Spatial Resolution Mapping of Changing Inequalities in Child Mortality Across Africa between 2000 and 2015

Author

Aaron Osgood-Zimmerman, Haidong Wang, Lucas Earl, Chloe Morozoff, Laura Dwyer-Lindgren, Tamer H. Farag, Samir Bhatt, Catherine L. Moyes, Scott F. Dowell, Nick Golding, Simon I. Hay, Abraham D. Flaxman, Joshua Longbottom, Lutz Krause, Stephen S Lim, Roy Burstein, D. Weiss, Christopher J L Murray, P. Gething, and Annie J. Browne

Subjects
Child mortality, Geography, Inequality, media_common.quotation_subject, High spatial resolution, Infectious and parasitic diseases, RC109-216, General Medicine, Public aspects of medicine, RA1-1270, Cartography, media_common
Published
2017
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