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1. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Wang, H, Liddell, CA, Coates, MM, Mooney, MD, Levitz, CE, Schumacher, AE, Apfel, H, Iannarone, M, Phillips, B, Lofgren, KT, Sandar, L, Dorrington, RE, Rakovac, I, Jacobs, TA, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, AA, Abera, SF, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, ZA, Allen, PJ, AlMazroa, MA, Alvarez, E, Amankwaa, AA, Amare, AT, Ammar, W, Anwari, P, Cunningham, SA, Asad, MM, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, ML, Bhutta, Z, Blore, JD, Basara, BB, Boufous, S, Breitborde, N, Bruce, NG, Bui, LN, Carapetis, JR, Cárdenas, R, Carpenter, DO, Caso, V, Castro, RE, Catalá-Lopéz, F, Cavlin, A, Che, X, Chiang, PP, Chowdhury, R, Christophi, CA, Chuang, TW, Cirillo, M, da Costa Leite, I, Courville, KJ, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, SD, Dherani, MK, Dilmen, U, Ding, EL, Edmond, KM, Ermakov, SP, Farzadfar, F, Fereshtehnejad, SM, Fijabi, DO, Foigt, N, Forouzanfar, MH, Garcia, AC, Geleijnse, JM, Gessner, BD, Goginashvili, K, Gona, P, Goto, A, Gouda, HN, Green, MA, Greenwell, KF, Gugnani, HC, Gupta, R, Hamadeh, RR, Hammami, M, Harb, HL, Hay, Simon, Hedayati, MT, Hosgood, HD, Hoy, DG, Idrisov, BT, Islami, F, Ismayilova, S, Jha, Vivekanand, Jiang, G, Jonas, JB, Juel, K, Kabagambe, EK, Kazi, DS, Kengne, AP, Kereselidze, M, Khader, YS, Khalifa, SE, Khang, YH, Kim, D, Kinfu, Y, Kinge, JM, Kokubo, Y, Kosen, S, Defo, BK, Kumar, GA, Kumar, K, Kumar, RB, Lai, T, Lan, Q, Larsson, A, Lee, JT, Leinsalu, M, Lim, SS, Lipshultz, SE, Logroscino, G, Lotufo, PA, Lunevicius, R, Lyons, RA, Ma, S, Mahdi, AA, Marzan, MB, Mashal, MT, Mazorodze, TT, McGrath, JJ, Memish, ZA, Mendoza, W, Mensah, GA, Meretoja, A, Miller, TR, Mills, EJ, Mohammad, KA, Mokdad, AH, Monasta, L, Montico, M, Moore, AR, Moschandreas, Joanna, Msemburi, WT, Mueller, UO, Muszynska, MM, Naghavi, M, Naidoo, KS, Narayan, KM, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, MJ, Nyakarahuka, L, Ohkubo, T, Omer, SB, Caicedo, AJ, Pillay-van Wyk, V, Pope, D, Pourmalek, F, Prabhakaran, D, Rahman, SU, Rana, SM, Reilly, RQ, Rojas-Rueda, D, Ronfani, L, Rushton, L, Saeedi, MY, Salomon, JA, Sampson, U, Santos, IS, Sawhney, M, Schmidt, JC, Shakh-Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, HH, Shishani, K, Shiue, I, Sigfusdottir, ID, Singh, JA, Skirbekk, V, Sliwa, K, Soshnikov, SS, Sposato, LA, Stathopoulou, VK, Stroumpoulis, K, Tabb, KM, Talongwa, RT, Teixeira, CM, Terkawi, AS, Thomson, AJ, Thorne-Lyman, AL, Toyoshima, H, Dimbuene, ZT, Uwaliraye, P, Uzun, SB, Vasankari, TJ, Vasconcelos, AM, Vlassov, VV, Vollset, SE, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, RG, Westerman, R, Wilkinson, JD, Williams, HC, Yang, YC, Yentur, GK, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, KY, El Sayed Zaki, M, Zhu, S, Vos, T, Lopez, AD, and Murray, CJ

Abstract

Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030.We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone.Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030.Bill & Melinda Gates Foundation, US Agency for International Development.

Published
2018

2. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015 : the Global Burden of Disease Study 2015

Author

GBD 2015 HIV Collaborators, Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NM, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, Akseer, N, Lami, FH, Al-Aly, Z, Alam, K, Alam, NK, Alasfoor, D, Aldhahri, SF, Aldridge, RW, Alegretti, MA, Aleman, AV, Alemu, ZA, Alfonso-Cristancho, R, Ali, R, Alkerwi, A, Alla, F, Mohammad, R, Al-Raddadi, S, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, AT, Amberbir, A, Amegah, AK, Ammar, W, Amrock, SM, Antonio, CA, Anwari, P, Ärnlöv, J, Artaman, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Atkins, LS, Avokpaho, EF, Awasthi, A, Quintanilla, BP, Bacha, U, Badawi, A, Barac, A, Bärnighausen, T, Basu, A, Bayou, TA, Bayou, YT, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Bennett, DA, Bensenor, IM, Betsu, BD, Beyene, AS, Bhatia, E, Bhutta, ZA, Biadgilign, S, Bikbov, B, Birlik, SM, Bisanzio, D, Brainin, M, Brazinova, A, Breitborde, NJ, Brown, A, Burch, M, Butt, ZA, Campuzano, JC, Cárdenas, R, Carrero, JJ, Castañeda-Orjuela, CA, Rivas, JC, Catalá-López, F, Chang, HY, Chang, JC, Chavan, L, Chen, W, Chiang, PP, Chibalabala, M, Chisumpa, VH, Choi, JY, Christopher, DJ, Ciobanu, LG, Cooper, C, Dahiru, T, Damtew, SA, Dandona, L, Dandona, R, Das Neves, J, De Jager, P, De Leo, D, Degenhardt, L, Dellavalle, RP, Deribe, K, Deribew, A, Des Jarlais, DC, Dharmaratne, SD, Ding, EL, Doshi, PP, Driscoll, TR, Dubey, M, Elshrek, YM, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Esteghamati, A, Faghmous, ID, Farinha, CS, Faro, A, Farvid, MS, Farzadfar, F, Fereshtehnejad, SM, Fernandes, JC, Fischer, F, Fitchett, JR, Foigt, N, Fullman, N, Fürst, T, Gankpé, FG, Gebre, T, Gebremedhin, AT, Gebru, AA, Geleijnse, JM, Gessner, BD, Gething, PW, Ghiwot, TT, Giroud, M, Gishu, MD, Glaser, E, Goenka, S, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Guimaraes, MD, Gupta, R, Gupta, V, Haagsma, J, Hafezi-Nejad, N, Hagan, H, Hailu, GB, Hamadeh, RR, Hamidi, S, Hammami, M, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Harun, KM, Havmoeller, R, Hedayati, MT, Heredia-Pi, IB, Hoek, HW, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Huang, H, Huang, JJ, Iburg, KM, Idrisov, BT, Innos, K, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jeemon, P, Jha, V, Jiang, G, Jiang, Y, Jibat, T, Jonas, JB, Kabir, Z, Kamal, R, Kan, H, Karch, A, Karema, CK, Karletsos, D, Kasaeian, A, Kaul, A, Kawakami, N, Kayibanda, JF, Keiyoro, PN, Kemp, AH, Kengne, AP, Kesavachandran, CN, Khader, YS, Khalil, I, Khan, AR, Khan, EA, Khang, YH, Khubchandani, J, Kim, YJ, Kinfu, Y, Kivipelto, M, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Defo, BK, Bicer, BK, Kulkarni, VS, Kumar, GA, Lal, DK, Lam, H, Lam, JO, Langan, SM, Lansingh, VC, Larsson, A, Leigh, J, Leung, R, Li, Y, Lim, SS, Lipshultz, SE, Liu, S, Lloyd, BK, Logroscino, G, Lotufo, PA, Lunevicius, R, Razek, HM, Mahdavi, M, Majdan, M, Majeed, A, Makhlouf, C, Malekzadeh, R, Mapoma, CC, Marcenes, W, Martinez-Raga, J, Marzan, MB, Masiye, F, Mason-Jones, AJ, Mayosi, BM, McKee, M, Meaney, PA, Mehndiratta, MM, Mekonnen, AB, Melaku, YA, Memiah, P, Memish, ZA, Mendoza, W, Meretoja, A, Meretoja, TJ, Mhimbira, FA, Miller, TR, Mikesell, J, Mirarefin, M, Mohammad, KA, Mohammed, S, Mokdad, AH, Monasta, L, Moradi-Lakeh, M, Mori, R, Mueller, UO, Murimira, B, Murthy, GV, Naheed, A, Naldi, L, Nangia, V, Nash, D, Nawaz, H, Nejjari, C, Ngalesoni, FN, De Dieu Ngirabega, J, Nguyen, QL, Nisar, MI, Norheim, OF, Norman, RE, Nyakarahuka, L, Ogbo, FA, Oh, IH, Ojelabi, FA, Olusanya, BO, Olusanya, JO, Opio, JN, Oren, E, Ota, E, Padukudru, MA, Park, HY, Park, JH, Patil, ST, Patten, SB, Paul, VK, Pearson, K, Peprah, EK, Pereira, CC, Perico, N, Pesudovs, K, Petzold, M, Phillips, MR, Pillay, JD, Plass, D, Polinder, S, Pourmalek, F, Prokop, DM, Qorbani, M, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Rahman, M, Rahman, MH, Rahman, SU, Rai, RK, Rajsic, S, Ram, U, Rana, SM, Rao, PV, Remuzzi, G, Rojas-Rueda, D, Ronfani, L, Roshandel, G, Roy, A, Ruhago, GM, Saeedi, MY, Sagar, R, Saleh, MM, Sanabria, JR, Santos, IS, Sarmiento-Suarez, R, Sartorius, B, Sawhney, M, Schutte, AE, Schwebel, DC, Seedat, S, Sepanlou, SG, Servan-Mori, EE, Shaikh, MA, Sharma, R, She, J, Sheikhbahaei, S, Shen, J, Shibuya, K, Shin, HH, Sigfusdottir, ID, Silpakit, N, Silva, DA, Silveira, DG, Simard, EP, Sindi, S, Singh, JA, Singh, OP, Singh, PK, Skirbekk, V, Sliwa, K, Soneji, S, Sorensen, RJ, Soriano, JB, Soti, DO, Sreeramareddy, CT, Stathopoulou, V, Steel, N, Sunguya, BF, Swaminathan, S, Sykes, BL, Tabarés-Seisdedos, R, Talongwa, RT, Tavakkoli, M, Taye, B, Tedla, BA, Tekle, T, Shifa, GT, Temesgen, AM, Terkawi, AS, Tesfay, FH, Tessema, GA, Thapa, K, Thomson, AJ, Thorne-Lyman, AL, Tobe-Gai, R, Topor-Madry, R, Towbin, JA, Tran, BX, Dimbuene, ZT, Tsilimparis, N, Tura, AK, Ukwaja, KN, Uneke, CJ, Uthman, OA, Venketasubramanian, N, Vladimirov, SK, Vlassov, VV, Vollset, SE, Wang, L, Weiderpass, E, Weintraub, RG, Werdecker, A, Westerman, R, Wijeratne, T, Wilkinson, JD, Wiysonge, CS, Wolfe, CD, Won, S, Wong, JQ, Xu, G, Yadav, AK, Yakob, B, Yalew, AZ, Yano, Y, Yaseri, M, Yebyo, HG, Yip, P, Yonemoto, N, Yoon, SJ, Younis, MZ, Yu, C, Yu, S, Zaidi, Z, Zaki, MELS, Zeeb, H, Zhang, H, Zhao, Y, Zodpey, S, Zoeckler, L, Zuhlke, LJ, Lopez, AD, and Murray, CJ

Subjects
GBD 2015 HIV Collaborators
Abstract

BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6-40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7-1·9 million) in 2005, to 1·2 million deaths (1·1-1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. INTERPRETATION: Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding: We thank the countless individuals who have contributed to the Global Burden of Disease (GBD) Study 2015 in various capacities. We specifically thank Jeffrey Eaton and John Stover. HW and CJLM received funding for this study from the Bill & Melinda Gates Foundation; the National Institute of Mental Health, National Institutes of Health (NIH; R01MH110163); and the National Institute on Aging, NIH (P30AG047845). LJAR acknowledges the support of Qatar National Research Fund (NPRP 04-924-3-251) who provided the main funding for generating the data provided to the GBD-Institute for Health Metrics and Evaluation effort. BPAQ acknowledges institutional support from PRONABEC (National Program of Scholarship and Educational Loan), provided by the Peruvian government. DB is supported by the Bill & Melinda Gates Foundation (grant number OPP1068048). JDN was supported in his contribution to this work by a Fellowship from Fundacao para a Ciencia e a Tecnologia, Portugal (SFRH/BPD/92934/2013). KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine (grant number 099876). TF received financial support from the Swiss National Science Foundation (SNSF; project number P300P3-154634). AG acknowledges funding from Sistema Nacional de Investigadores de Panama-SNI. PJ is supported by Wellcome Trust-DBT India Alliance Clinical and Public Health Intermediate Fellowship. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimerfonden, Alzheimer's Research & Prevention Foundation, Center for Innovative Medicine (CIMED) at Karolinska Institutet South Campus, AXA Research Fund, Wallenberg Clinical Scholars Award from the Knut och Alice Wallenbergs Foundation, and the Sheika Salama Bint Hamdan Al Nahyan Foundation. AK's work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R&D&I and funded by the ISCIII (General Branch Evaluation and Promotion of Health Research), and the European Regional Development Fund (ERDF-FEDER). SML is funded by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (grant number NIHR/CS/010/014). HJL reports grants from the NIHR, EU Innovative Medicines Initiative, Centre for Strategic & International Studies, and WHO. WM is Program analyst, Population and Development, in the Peru Country Office of the United Nations Population Fund, which does not necessarily endorse this study. For UOM, funding from the German National Cohort Consortium (O1ER1511D) is gratefully acknowledged. KR reports grants from NIHR Oxford Biomedical Research Centre, NIHR Career Development Fellowship, and Oxford Martin School during the conduct of the study. GR acknowledges that work related to this paper has been done on the behalf of the GBD Genitourinary Disease Expert Group supported by the International Society of Nephrology (ISN). ISS reports grants from FAPESP (Brazilian public agency). RSS receives institutional support from Universidad de Ciencias Aplicadas y Ambientales, UDCA, Bogota Colombia. SS receives postdoctoral funding from the Fonds de la recherche en sante du Quebec (FRSQ), including its renewal. RTS was supported in part by grant number PROMETEOII/2015/021 from Generalitat Valenciana and the national grant PI14/00894 from ISCIII-FEDER. PY acknowledges support from Strategic Public Policy Research (HKU7003-SPPR-12).

Published
2016

3. Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015

Author

Wang, H, Wolock, TM, Carter, A, Nguyen, G, Kyu, HH, Gakidou, E, Hay, SI, Mills, EJ, Trickey, A, Msemburi, W, Coates, MM, Mooney, MD, Fraser, MS, Sligar, A, Salomon, J, Larson, HJ, Friedman, J, Abajobir, AA, Abate, KH, Abbas, KM, Abd El Razek, MM, Abd-Allah, F, Abdulle, AM, Abera, SF, Abubakar, I, Abu-Raddad, LJ, Abu-Rmeileh, NME, Abyu, GY, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adofo, K, Adou, AK, Ajala, ON, Akinyemiju, TF, Akseer, N, Al Lami, FH, Al-Aly, Z, Alam, K, Alam, NKM, Alasfoor, D, Aldhahri, SFS, Aldridge, RW, Alegretti, MA, Aleman, AV, Alemu, ZA, Alfonso-Cristancho, R, Ali, R, Alkerwi, A, Alla, F, Al-Raddadi, RMS, Alsharif, U, Alvarez, E, Alvis-Guzman, N, Amare, AT, Amberbir, A, Amegah, AK, Ammar, W, Amrock, SM, Antonio, CAT, Anwari, P, Arnlov, J, Al, A, Asayesh, H, Asghar, RJ, Assadi, R, Atique, S, Atkins, LS, Avokpaho, EFGA, Awasthi, A, Quintanilla, BPA, Bacha, U, Badawi, A, Barac, A, Barnighausen, T, Basu, A, Bayou, TA, Bayou, YT, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Bennett, DA, Bensenor, IM, Betsu, BD, Beyene, AS, Bhatia, E, Bhutta, ZA, Biadgilign, S, Bikbov, B, Birlik, SM, Bisanzio, D, Brainin, M, Brazinova, A, Breitborde, NJK, Brown, A, Burch, M, Butt, ZA, Campuzano, JC, Cardenas, R, Carrero, JJ, Castaneda-Orjuela, CA, Rivas, JC, Catala-Lopez, F, Chang, H-Y, Chang, J-C, Chavan, L, Chen, W, Chiang, PP-C, Chibalabala, M, Chisumpa, VH, Choi, J-YJ, Christopher, DJ, Ciobanu, LG, Cooper, C, Dahiru, T, Damtew, SA, Dandona, L, Dandona, R, das Neves, J, de Jager, P, De Leo, D, Degenhardt, L, Dellavalle, RP, Deribe, K, Deribew, A, Jarlais, DCD, Dharmaratne, SD, Ding, EL, Doshi, PP, Driscoll, TR, Dubey, M, Elshrek, YM, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Esteghamati, A, Faghmous, IDA, Sofia e Sa Farinha, C, Faro, A, Farvid, MS, Farzadfar, F, Fereshtehnejad, S-M, Fernandes, JC, Fischer, F, Fitchett, JRA, Foigt, N, Fullman, N, Furst, T, Gankpe, FG, Gebre, T, Gebremedhin, AT, Gebru, AA, Geleijnse, JM, Gessner, BD, Gething, PW, Ghiwot, TT, Giroud, M, Gishu, MD, Glaser, E, Goenka, S, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Guimaraes, MDC, Gupta, R, Gupta, V, Haagsma, J, Hafezi-Nejad, N, Hagan, H, Hailu, GB, Hamadeh, RR, Hamidi, S, Hammami, M, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Harun, KM, Havmoeller, R, Hedayati, MT, Heredia-Pi, IB, Hoek, HW, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Huang, H, Huang, JJ, Iburg, KM, Idrisov, BT, Innos, K, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jeemon, P, Jha, V, Jiang, G, Jiang, Y, Jibat, T, Jonas, JB, Kabir, Z, Kamal, R, Kan, H, Karch, A, Karema, CK, Karletsos, D, Kasaeian, A, Kaul, A, Kawakami, N, Kayibanda, JF, Keiyoro, PN, Kemp, AH, Kengne, AP, Kesavachandran, CN, Khader, YS, Khalil, I, Khan, AR, Khan, EA, Khang, Y-H, Khubchandani, J, Kim, YJ, Kinfu, Y, Kivipelto, M, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Defo, BK, Bicer, BK, Kulkarni, VS, Kumar, GA, Lal, DK, Lam, H, Lam, JO, Langan, 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C, Dahiru, T, Damtew, SA, Dandona, L, Dandona, R, das Neves, J, de Jager, P, De Leo, D, Degenhardt, L, Dellavalle, RP, Deribe, K, Deribew, A, Jarlais, DCD, Dharmaratne, SD, Ding, EL, Doshi, PP, Driscoll, TR, Dubey, M, Elshrek, YM, Elyazar, I, Endries, AY, Ermakov, SP, Eshrati, B, Esteghamati, A, Faghmous, IDA, Sofia e Sa Farinha, C, Faro, A, Farvid, MS, Farzadfar, F, Fereshtehnejad, S-M, Fernandes, JC, Fischer, F, Fitchett, JRA, Foigt, N, Fullman, N, Furst, T, Gankpe, FG, Gebre, T, Gebremedhin, AT, Gebru, AA, Geleijnse, JM, Gessner, BD, Gething, PW, Ghiwot, TT, Giroud, M, Gishu, MD, Glaser, E, Goenka, S, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Guimaraes, MDC, Gupta, R, Gupta, V, Haagsma, J, Hafezi-Nejad, N, Hagan, H, Hailu, GB, Hamadeh, RR, Hamidi, S, Hammami, M, Hankey, GJ, Hao, Y, Harb, HL, Harikrishnan, S, Haro, JM, Harun, KM, Havmoeller, R, Hedayati, MT, Heredia-Pi, IB, Hoek, HW, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Hsairi, M, Hu, G, Huang, H, Huang, JJ, Iburg, KM, Idrisov, BT, Innos, K, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jeemon, P, Jha, V, Jiang, G, Jiang, Y, Jibat, T, Jonas, JB, Kabir, Z, Kamal, R, Kan, H, Karch, A, Karema, CK, Karletsos, D, Kasaeian, A, Kaul, A, Kawakami, N, Kayibanda, JF, Keiyoro, PN, Kemp, AH, Kengne, AP, Kesavachandran, CN, Khader, YS, Khalil, I, Khan, AR, Khan, EA, Khang, Y-H, Khubchandani, J, Kim, YJ, Kinfu, Y, Kivipelto, M, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Defo, BK, Bicer, BK, Kulkarni, VS, Kumar, GA, Lal, DK, Lam, H, Lam, JO, Langan, SM, Lansingh, VC, Larsson, A, Leigh, J, Leung, R, Li, Y, Lim, SS, Lipshultz, SE, Liu, S, Lloyd, BK, Logroscino, G, Lotufo, PA, Lunevicius, R, Abd El Razek, HM, Mahdavi, M, Majdan, M, Majeed, A, Makhlouf, C, Malekzadeh, R, Mapoma, CC, Marcenes, W, Martinez-Raga, J, Marzan, MB, Masiye, F, Mason-Jones, AJ, Mayosi, BM, Mckee, M, Meaney, PA, Mehndiratta, MM, Mekonnen, AB, Melaku, YA, Memiah, P, Memish, ZA, Mendoza, W, Meretoja, A, 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Sepanlou, SG, Servan-Mori, EE, Shaikh, MA, Sharma, R, She, J, Sheikhbahaei, S, Shen, J, Shibuya, K, Shin, HH, Sigfusdottir, ID, Silpakit, N, Santos Silva, DA, Alves Silveira, DG, Simard, EP, Sindi, S, Singh, JA, Singh, OP, Singh, PK, Skirbekk, V, Sliwa, K, Soneji, S, Sorensen, RJD, Soriano, JB, Soti, DO, Sreeramareddy, CT, Stathopoulou, V, Steel, N, Sunguya, BF, Swaminathan, S, Sykes, BL, Tabares-Seisdedos, R, Talongwa, RT, Tavakkoli, M, Taye, B, Tedla, BA, Tekle, T, Shifa, GT, Temesgen, AM, Terkawi, AS, Tesfay, FH, Tessema, GA, Thapa, K, Thomson, AJ, Thorne-Lyman, AL, Tobe-Gai, R, Topor-Madry, R, Towbin, JA, Bach, XT, Dimbuene, ZT, Tsilimparis, N, Tura, AK, Ukwaja, KN, Uneke, CJ, Uthman, OA, Venketasubramanian, N, Vladimirov, SK, Vlassov, VV, Vollset, SE, Wang, L, Weiderpass, E, Weintraub, RG, Werdecker, A, Westerman, R, Wijeratne, T, Wilkinson, JD, Wiysonge, CS, Wolfe, CDA, Won, S, Wong, JQ, Xu, G, Yadav, AK, Yakob, B, Yalew, AZ, Yano, Y, Yaseri, M, Yebyo, HG, Yip, P, Yonemoto, N, Yoon, S-J, Younis, MZ, Yu, C, Yu, S, Zaidi, Z, Zaki, MES, Zeeb, H, Zhang, H, Zhao, Y, Zodpey, S, Zoeckler, L, Zuhlke, LJ, Lopez, AD, and Murray, CJL

Abstract

BACKGROUND: Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. METHODS: For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. FINDINGS: Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95% uncertainty interval [UI] 3·1-3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5-2·8 mi

Published
2016

4. Dietary diversity, socioeconomic status and maternal body mass index (BMI): quantile regression analysis of nationally representative data from Ghana, Namibia and Sao Tome and Principe

Author

Amugsi, DA, Dimbuene, ZT, Bakibinga, P, Kimani-Murage, EW, Haregu, TN, Mberu, B, Amugsi, DA, Dimbuene, ZT, Bakibinga, P, Kimani-Murage, EW, Haregu, TN, and Mberu, B

Abstract

OBJECTIVES: To (a) assess the association between dietary diversity (DD) score, socioeconomic status (SES) and maternal body mass index (BMI), and (b) the variation of the effects of DD and SES at different points of the conditional distribution of the BMI. METHODS: The study used Demographic and Health Surveys round 5 data sets from Ghana, Namibia and Sao Tome and Principe. The outcome variable for the analysis was maternal BMI. The DD score was computed using 24-hour dietary recall data. Quantile regression (QR) was used to examine the relationship between DD and SES, and maternal BMI, adjusting for other covariates. The QR allows the covariate effects to vary across the entire distribution of maternal BMI. RESULTS: Women who consumed an additional unit of DD achieved an increase of 0.245 in BMI for those in the 90th quantile in Ghana. The effect of household wealth increases for individuals across all quantiles of the BMI distribution and in all the 3 countries. A unit change in the household wealth score was associated with an increase of 0.038, 0.052 and 0.065 units increase in BMI for individuals in the 5th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Also, 0.237, 0.301 and 0.174 units increased for those in the 90th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Education had a significant positive effect on maternal BMI across all quantiles in Namibia and negative effect at the 5th, 10th and 90th quantiles in Sao Tome and Principe. CONCLUSIONS: There is heterogeneity in the effects of DD and SES on maternal BMI. Studies focusing on the effects of diet and socioeconomic determinants on maternal BMI should examine patterns of effects at different points of the conditional distribution of the BMI and not just the average effect.

Published
2016

6. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Karen Sliwa, Xiaofeng Liang, Vivekanand Jha, Dorairaj Prabhakaran, Rakhi Dandona, Gonghuan Yang, Xuan Che, Soewarta Kosen, Sergei Petrovich Ermakov, Ted R. Miller, Samath D Dharmaratne, Philimon Gona, Sergey Soshnikov, Atsushi Goto, Costas A. Christophi, Zacharie Tsala Dimbuene, Elena Alvarez, Yanping Wang, Peggy Pei-Chia Chiang, Mohammad H. Forouzanfar, Giancarlo Logroscino, Massimo Cirillo, Knud Juel, Johanna M. Geleijnse, Stefan Ma, Samaya Ismayilova, Karen Fern Greenwell, Michelle L. Bell, Saad B. Omer, Ademola Lukman Adelekan, Joshua A. Salomon, Dhruv S. Kazi, Jed D. Blore, Walid Ammar, Carly E Levitz, Kovin Naidoo, Solveig A. Cunningham, Stephen G. Waller, Anand Dayama, James D. Wilkinson, Vasiliki Stathopoulou, Meghan D. Mooney, Mall Leinsalu, Jonathan R. Carapetis, Paul S. F. Yip, Anders Larsson, Abbas Ali Mahdi, Hideaki Toyoshima, Guohong Jiang, Xia Wan, Chuanhua Yu, Soufiane Boufous, Ivy Shiue, Bulat Idrisov, Qing Lan, Chelsea A. Liddell, Austin E Schumacher, Valeria Caso, Nigel Bruce, Paulo A. Lotufo, Ibrahim Abubakar, Roberto Tchio Talongwa, Luke Nyakarahuka, Edward J Mills, Iuri da Costa Leite, Semaw Ferede Abera, Ana C. Garcia, Ayse Abbasoglu Ozgoren, Matthew M Coates, Konstantinos Stroumpoulis, Bradford D. Gessner, Kebede Deribe, Tommi Vasankari, Logan Sandar, Kenji Shibuya, Karen M. Tabb, Troy Jacobs, Christopher J L Murray, Chakib Nejjari, Katherine T. Lofgren, Melvin Barrientos Marzan, Haidong Wang, Joanna Moschandreas, Raimundas Lunevicius, Nataliya Foigt, Rashmi Gupta, Ziad A. Memish, Victoria Pillay-van Wyk, Randah R. Hamadeh, Azmeraw T. Amare, Lalit Dandona, Uchechukwu K.A. Sampson, Monika Sawhney, Vasiliy Victorovich Vlassov, Farhad Islami, Palwasha Anwari, Mustafa Z. Younis, Amitava Banerjee, Ruben Castro, David O. Carpenter, Karzan Abdulmuhsin Mohammad, Taavi Lai, Yousef Khader, Sara Sheikhbahaei, Atte Meretoja, Zanfina Ademi, Ivo Rakovac, Yang Yang, Hilda L Harb, Daniel Pope, Jun She, Yichong Li, Andrew L. Thorne-Lyman, Adrian Davis, Stein Emil Vollset, Andre Pascal Kengne, Henry Apfel, Mark J. Nieuwenhuijsen, John J. McGrath, Yoshihiro Kokubo, Jonas Minet Kinge, Elisabete Weiderpass, Rajiv Chowdhury, Damian G Hoy, Jürgen C Schmidt, Seyed-Mohammad Fereshtehnejad, Harish Chander Gugnani, Hywel C Williams, Karen Edmond, Peter J. Allen, Marina Shakh-Nazarova, Tom Achoki, Edmond K. Kabagambe, Naohiro Yonemoto, Jun Zhu, Simon I. Hay, Karen J. Courville, Ketevan Goginashvili, Theo Vos, Kim Yun Jin, Kawkab Shishani, Lorenzo Monasta, H. Dean Hosgood, Uʇur Dilmen, Marcella Montico, Shankuan Zhu, Ami R. Moore, Marie Ng, Maigeng Zhou, Hebe N. Gouda, Linh N Bui, Sanjay Basu, Mouhanad Hammami, Mohammad T Mashal, Bryan K. Phillips, Marissa Iannarone, Ronan A Lyons, Young-Ho Khang, Robert G. Weintraub, Luca Ronfani, Daniel Kim, Alanur Çavlin, Ferrán Catalá-López, Ronny Westerman, Maia Kereselidze, Itamar S. Santos, Reza Assadi, Hwashin Hyun Shin, Carolina Maria Teixeira, Berrak Bora Basara, David Rojas-Rueda, Abdullah Sulieman Terkawi, Adansi A. Amankwaa, Nicholas J K Breitborde, Gokalp Kadri Yentur, Kaushalendra Kumar, Daniel Obadare Fijabi, Neeraj Bedi, Robert Quentin Reilly, Ana Maria Nogales Vasconcelos, Scott Weichenthal, Mark A. Green, Selen Begüm Uzun, Mukesh Dherani, Shams Eldin Ali Hassan Khalifa, Majed Asad, Jasvinder A. Singh, Angel J Paternina Caicedo, Eric L. Ding, Jost B. Jonas, Tolesa Bekele, Alan J Thomson, Steven E. Lipshultz, Rosario Cárdenas, Sajjad Ur Rahman, George A. Mensah, Jongmin Lee, Inga Dora Sigfusdottir, Mohammad Yahya Saeedi, Magdalena M. Muszyńska, Ulrich O Mueller, Stephen S Lim, Barthelemy Kuate Defo, Alan D. Lopez, Luciano A. Sposato, G Anil Kumar, Farshad Pourmalek, Zulfiqar A Bhutta, Maysaa El Sayed Zaki, Shiwei Liu, K.M. Venkat Narayan, William Msemburi, Ting Wu Chuang, Zewdie Aderaw Alemu, Saleem M Rana, Mohammad Taghi Hedayati, Mohsen Naghavi, Vegard Skirbekk, Walter Mendoza, Ali H. Mokdad, Yohannes Kinfu, Jean de Dieu Ngirabega, Takayoshi Ohkubo, Parfait Uwaliraye, Tasara T. Mazorodze, Farshad Farzadfar, Rob E. Dorrington, Mohammad A. AlMazroa, R. Kumar, Lesley Rushton, Wang, H, Liddell, Ca, Coates, Mm, Mooney, Md, Levitz, Ce, Schumacher, Ae, Apfel, H, Iannarone, M, Phillips, B, Lofgren, Kt, Sandar, L, Dorrington, Re, Rakovac, I, Jacobs, Ta, Liang, X, Zhou, M, Zhu, J, Yang, G, Wang, Y, Liu, S, Li, Y, Ozgoren, Aa, Abera, Sf, Abubakar, I, Achoki, T, Adelekan, A, Ademi, Z, Alemu, Za, Allen, Pj, Almazroa, Ma, Alvarez, E, Amankwaa, Aa, Amare, At, Ammar, W, Anwari, P, Cunningham, Sa, Asad, Mm, Assadi, R, Banerjee, A, Basu, S, Bedi, N, Bekele, T, Bell, Ml, Bhutta, Z, Blore, J, Basara, Bb, Boufous, S, Breitborde, N, Bruce, Ng, Bui, Ln, Carapetis, Jr, Cárdenas, R, Carpenter, Do, Caso, V, Castro, Re, Catalá Lopéz, F, Cavlin, A, Che, X, Chiang, Pp, Chowdhury, R, Christophi, Ca, Chuang, Tw, Cirillo, Massimo, da Costa Leite, I, Courville, Kj, Dandona, L, Dandona, R, Davis, A, Dayama, A, Deribe, K, Dharmaratne, Sd, Dherani, Mk, Dilmen, U, Ding, El, Edmond, Km, Ermakov, Sp, Farzadfar, F, Fereshtehnejad, Sm, Fijabi, Do, Foigt, N, Forouzanfar, Mh, Garcia, Ac, Geleijnse, Jm, Gessner, Bd, Goginashvili, K, Gona, P, Goto, A, Gouda, Hn, Green, Ma, Greenwell, Kf, Gugnani, Hc, Gupta, R, Hamadeh, Rr, Hammami, M, Harb, Hl, Hay, S, Hedayati, Mt, Hosgood, Hd, Hoy, Dg, Idrisov, Bt, Islami, F, Ismayilova, S, Jha, V, Jiang, G, Jonas, Jb, Juel, K, Kabagambe, Ek, Kazi, D, Kengne, Ap, Kereselidze, M, Khader, Y, Khalifa, Se, Khang, Yh, Kim, D, Kinfu, Y, Kinge, Jm, Kokubo, Y, Kosen, S, Defo, Bk, Kumar, Ga, Kumar, K, Kumar, Rb, Lai, T, Lan, Q, Larsson, A, Lee, Jt, Leinsalu, M, Lim, S, Lipshultz, Se, Logroscino, G, Lotufo, Pa, Lunevicius, R, Lyons, Ra, Ma, S, Mahdi, Aa, Marzan, Mb, Mashal, Mt, Mazorodze, Tt, Mcgrath, Jj, Memish, Za, Mendoza, W, Mensah, Ga, Meretoja, A, Miller, Tr, Mills, Ej, Mohammad, Ka, Mokdad, Ah, Monasta, L, Montico, M, Moore, Ar, Moschandreas, J, Msemburi, Wt, Mueller, Uo, Muszynska, Mm, Naghavi, M, Naidoo, K, Narayan, Kv, Nejjari, C, Ng, M, de Dieu Ngirabega, J, Nieuwenhuijsen, Mj, Nyakarahuka, L, Ohkubo, T, Omer, Sb, Caicedo, Aj, Wyk, Vp, Pope, D, Prabhakaran, D, Rahman, Su, Rana, Sm, Reilly, Rq, Rojas Rueda, D, Ronfani, L, Rushton, L, Saeedi, My, Salomon, J, Sampson, U, Santos, I, Sawhney, M, Schmidt, Jc, Shakh Nazarova, M, She, J, Sheikhbahaei, S, Shibuya, K, Shin, Hh, Shishani, K, Shiue, I, Sigfusdottir, Id, Singh, Ja, Skirbekk, V, Sliwa, K, Soshnikov, S, Sposato, La, Stathopoulou, Vk, Stroumpoulis, K, Tabb, Km, Talongwa, Rt, Teixeira, Cm, Terkawi, A, Thomson, Aj, Thorne Lyman, Al, Toyoshima, H, Dimbuene, Zt, Uwaliraye, P, Uzun, Sb, Vasankari, Tj, Vasconcelos, Am, Vlassov, Vv, Vollset, Se, Vos, T, Waller, S, Wan, X, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Westerman, R, Wilkinson, Jd, Williams, Hc, Yang, Yc, Yentur, Gk, Yip, P, Yonemoto, N, Younis, M, Yu, C, Jin, Ky, El Sayed Zaki, M, Zhu, S, Lopez, Ad, and Murray, C. J.

Subjects
trends, Pediatrics, medicine.medical_specialty, Nutrition and Disease, democracy, Developing country, coverage, VDP::Medisinske fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803, millennium development goals, Global Health, survival, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, 030225 pediatrics, Voeding en Ziekte, Infant Mortality, Global health, Humans, Organizational Objectives, Medicine, 030212 general & internal medicine, 10. No inequality, VLAG, business.industry, Mortality rate, Infant, Newborn, 1. No poverty, Infant, health, General Medicine, Millennium Development Goals, Infant mortality, maternal education, 3. Good health, Secular variation, Child mortality, Socioeconomic Factors, income countries, Child, Preschool, Child Mortality, developing-countries, VDP::Midical sciences: 700::Health sciences: 800::Epidemiology, medical and dental statistics: 803, International development, business, Demography, child-mortality
Abstract

Summary Background Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. Methods We generated updated estimates of child mortality in early neonatal (age 0–6 days), late neonatal (7–28 days), postneonatal (29–364 days), childhood (1–4 years), and under-5 (0–4 years) age groups for 188 countries from 1970 to 2013, with more than 29 000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. Findings We estimated that 6·3 million (95% UI 6·0–6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1–18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6–177·4) in Guinea-Bissau to 2·3 (1·8–2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from −6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000–13 than during 1990–2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only −1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. Interpretation Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. Funding Bill & Melinda Gates Foundation, US Agency for International Development.

Published
2014

7. Effects of social determinants of health on obesity among urban women of reproductive age.

Author

Amugsi DA and Dimbuene ZT

Abstract

Obesity is a major global public health problem. It is spreading very fast in low- and middle-income countries and has reached world record levels in some of them. In Ghana, it has increased by over 65% among urban women in the past three decades. This study investigated the effects of social determinants of health on obesity among women in urban Ghana. The study analyzed the Ghana demographic and health survey data. These are nationally representative data collective every five years across low- and middle-income countries. A total of 1,204 urban women were included in the analysis. Body mass index was the outcome variable of interest. We used logistic regression to model the effects of the various social determinants of health on obesity. The results showed that 40% (95% confidence interval (CI) = 25.4, 57.0) and 36.7% (95% CI = 25.6, 49.3) of women who had higher education and those whose partners had higher education suffered from obesity, respectively. Women living in rich households had a five times higher prevalence of obesity than those in poor households (28.8% vs 5.7%). Further, 33.4% (95% CI = 18.5, 19.3) of women who occupied managerial positions were obese. The results from the multivariable logistic regression analysis suggested that compared to women in poor households, those in rich households were 3.4 times (95% CI = 1.31, 8.97) more likely to suffer from obesity. Women whose main occupation was agriculture were 81% (aOR = 0.19; 95% CI = 0.034, 0.99) less likely to suffer from obesity compared to those with no occupation. The results suggest that the various social determinants of health (SDH) included in the analysis significantly influence obesity outcomes. Women and partner education levels, occupying a managerial position, and living in rich households increase the risk of obesity. Interventions to address the rising obesity in urban Ghana should have specific packages targeted at these sub-groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Amugsi, Dimbuene. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Published
2023
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8. Basic determinants of child linear growth outcomes in sub-Saharan Africa: a cross-sectional survey analysis of positive deviants in poor households.

Author

Amugsi DA and Dimbuene ZT

Subjects
Child, Cross-Sectional Studies, Female, Ghana epidemiology, Health Surveys, Humans, Infant, Pregnancy, Family Characteristics, Malnutrition
Abstract

Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0-59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child's height-for-age Z-scores (HAZ), categorised into HAZ > - 2 standard deviations (SD) (not stunted) and HAZ < - 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive effect on better linear growth, while in Nigeria, healthy maternal body mass index (kg/m 2 ) had a positive effect on child's linear growth. The putative socio-demographic determinants investigated in our study can promote the linear growth of children living in poor households. Interventions aimed at fostering linear growth among children living in poverty should focus on enhancing these factors., (© 2022. The Author(s).)

Published
2022
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9. Differential effects of socio-demographic factors on maternal haemoglobin concentration in three sub-Saharan African Countries.

Author

Amugsi DA, Dimbuene ZT, and Kyobutungi C

Subjects
Adolescent, Adult, Africa South of the Sahara, Cross-Sectional Studies, Female, Humans, Middle Aged, Public Health, Risk Factors, Socioeconomic Factors, Young Adult, Hemoglobins metabolism
Abstract

Low Haemoglobin concentration (Hb) among women of reproductive age is a severe public health problem in sub-Saharan Africa. This study investigated the effects of putative socio-demographic factors on maternal Hb at different points of the conditional distribution of Hb concentration. We utilised quantile regression to analyse the Demographic and Health Surveys data from Ghana, Democratic Republic of the Congo (DRC) and Mozambique. In Ghana, maternal schooling had a positive effect on Hb of mothers in the 5th and 10th quantiles. A one-year increase in education was associated with an increase in Hb across all quantiles in Mozambique. Conversely, a year increase in schooling was associated with a decrease in Hb of mothers in the three upper quantiles in DRC. A unit change in body mass index had a positive effect on Hb of mothers in the 5th, 10th, 50th and 90th, and 5th to 50th quantiles in Ghana and Mozambique, respectively. We observed differential effects of breastfeeding on maternal Hb across all quantiles in the three countries. The effects of socio-demographic factors on maternal Hb vary at the various points of its distribution. Interventions to address maternal anaemia should take these variations into account to identify the most vulnerable groups.

Published
2020
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10. Socio-demographic factors associated with normal linear growth among pre-school children living in better-off households: A multi-country analysis of nationally representative data.

Author

Amugsi DA, Dimbuene ZT, and Kimani-Murage EW

Subjects
Africa, Child, Preschool, Demography, Female, Humans, Infant, Infant, Newborn, Male, Sex Factors, Socioeconomic Factors, Body Mass Index, Body Weight, Breast Feeding, Child Development, Parity
Abstract

This study examined the socio-demographic factors associated with normal linear growth among pre-school children living in better-off households, using survey data from Ghana, Kenya, Nigeria, Mozambique and Democratic Republic of Congo (DRC). The primary outcome variable was child height-for-age z-scores (HAZ), categorised into HAZ≥-2SD (normal growth/not stunted) and HAZ<-2 (stunted). Using logistic regression, we estimated adjusted odds ratios (aORs) of the factors associated with normal growth. Higher maternal weight (measured by body mass index) was associated with increased odds of normal growth in Mozambique, DRC, Kenya and Nigeria. A unit increase in maternal years of education was associated with increased odds in normal growth in DRC (aOR = 1.06, 95% CI = 1.03, 1.09), Ghana (aOR = 1.08, 95% CI = 1.04, 1.12), Mozambique (aOR = 1.08, 95% CI = 1.05, 1.11) and Nigeria (aOR = 1.07, 95% CI = 1.06, 1.08). A year increase in maternal age was positively associated with normal growth in all the five countries. Breastfeeding was associated with increased odds of normal growth in Nigeria (aOR = 1.30, 95% CI = 1.16, 1.46) and Kenya (aOR = 1.37, 95% CI = 1.05, 1.79). Children of working mothers had 25% (aOR = 0.75, 95% CI = 0.60, 0.93) reduced odds of normal growth in DRC. A unit change in maternal parity was associated with 10% (aOR = 0.90, 95% CI = 0.84, 0.97), 23% (aOR = 0.77, 95% CI = 0.63, 0.93), 25% (aOR = 0.75, 95% CI = 0.69, 0.82), 6% (aOR = 0.94, 95% CI = 0.89, 0.99) and 5% (aOR = 0.95, 95% CI = 0.92, 0.99) reduced odds of normal growth in DRC, Ghana, Kenya, Mozambique and Nigeria, respectively. A child being a male was associated with 18% (aOR = 0.82, 95% CI = 0.68, 0.98), 40% (aOR = 0.60, 95% CI = 0.40, 0.89), 37% (aOR = 0.63, 95% CI = 0.51, 0.77) and 21% (aOR = 0.79, 95% CI = 0.71, 0.87) reduced odds of normal child growth in DRC, Ghana, Kenya and Nigeria, respectively. In conclusion, maternal education, weight, age, breastfeeding and antenatal care are positively associated with normal child growth. In contrast, maternal parity, employment, and child sex and age are associated negatively with normal growth. Interventions to improve child growth should take into account these differential effects., Competing Interests: The authors have declared that no competing interests exist

Published
2020
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11. Burden of disease in francophone Africa, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

Author

El Bcheraoui C, Mimche H, Miangotar Y, Krish VS, Ziegeweid F, Krohn KJ, Ekat MH, Nansseu JR, Dimbuene ZT, Olsen HE, Tine RCK, Odell CM, Troeger CE, Kassebaum NJ, Farag T, Hay SI, and Mokdad AH

Subjects
Africa epidemiology, Global Burden of Disease, Humans, Cost of Illness
Abstract

Background: Peer-reviewed literature on health is almost exclusively published in English, limiting the uptake of research for decision making in francophone African countries. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to assess the burden of disease in francophone Africa and inform health professionals and their partners in the region., Methods: We assessed the burden of disease in the 21 francophone African countries and compared the results with those for their non-francophone counterparts in three economic communities: the Economic Community of West African States, the Economic Community of Central African States, and the Southern African Development Community. GBD 2017 employed a variety of statistical models to determine the number of deaths from each cause, through the Cause of Death Ensemble model algorithm, using CoDCorrect to ensure that the number of deaths per cause did not exceed the total number of estimated deaths. After producing estimates for the number of deaths from each of the 282 fatal outcomes included in the GBD 2017 list of causes, the years of life lost (YLLs) due to premature death were calculated. Years lived with disability (YLDs) were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. All calculations are presented with 95% uncertainty intervals (UIs). A sample of 1000 draws was taken from the posterior distribution of each estimation step; aggregation of uncertainty across age, sex, and location was done on each draw, assuming independence of uncertainty. The lower and upper UIs represent the ordinal 25th and 975th draws of each quantity and attempt to describe modelling as well as sampling error., Findings: In 2017, 779 deaths (95% UI 750-809) per 100 000 population occurred in francophone Africa, a decrease of 45·3% since 1990. Malaria, lower respiratory infections, neonatal disorders, diarrhoeal diseases, and tuberculosis were the top five Level 3 causes of death. These five causes were found among the six leading causes of death in most francophone countries. In 2017, francophone Africa experienced 53 570 DALYs (50 164-57 361) per 100 000 population, distributed between 43 708 YLLs (41 673-45 742) and 9862 YLDs (7331-12 749) per 100 000 population. In 2017, YLLs constituted the majority of DALYs in the 21 countries of francophone Africa. Age-specific and cause-specific mortality and population ageing were responsible for most of the reductions in disease burden, whereas population growth was responsible for most of the increases., Interpretation: Francophone Africa still carries a high burden of communicable and neonatal diseases, probably due to the weakness of health-care systems and services, as evidenced by the almost complete attribution of DALYs to YLLs. To cope with this burden of disease, francophone Africa should define its priorities and invest more resources in health-system strengthening and in the quality and quantity of health-care services, especially in rural and remote areas. The region could also be prioritised in terms of technical and financial assistance focused on achieving these goals, as much as on demographic investments including education and family planning., Funding: Bill & Melinda Gates Foundation., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Published
2020
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12. Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa.

Author

Amugsi DA, Dimbuene ZT, and Kyobutungi C

Subjects
Adolescent, Adult, Africa South of the Sahara epidemiology, Body Mass Index, Cross-Sectional Studies, Demography, Female, Humans, Logistic Models, Middle Aged, Prevalence, Risk Factors, Socioeconomic Factors, Young Adult, Health Surveys, Malnutrition epidemiology, Obesity epidemiology, Overweight epidemiology, Thinness epidemiology
Abstract

Objective: To investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries., Design: Secondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m 2 ), normal weight (18.50-24.99 kg/m 2 ), overweight (25.0-29.9 kg/m 2 ) and obesity (≥30.0 kg/m 2 )., Settings: Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC)., Subjects: Women aged 15-49 years (n=64698)., Results: Compared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight., Conclusions: Our analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2019
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13. Factors associated with the utilization of antenatal care and prevention of mother-to-child HIV transmission services in Ethiopia: applying a count regression model.

Author

Zegeye EA, Mbonigaba J, and Dimbuene ZT

Subjects
Adult, Ethiopia epidemiology, Female, HIV Infections epidemiology, Humans, Infant, Newborn, Pregnancy, Rural Population statistics & numerical data, Urban Population statistics & numerical data, HIV Infections prevention & control, HIV Infections transmission, Infectious Disease Transmission, Vertical statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data, Pregnancy Complications, Infectious prevention & control, Prenatal Care methods, Prenatal Care statistics & numerical data
Abstract

Background: Prevention of Mother-to-Child HIV Transmission (PMTCT) coverage has been low in Ethiopia and the service has been implemented in a fragmented manner. Solutions to this problem have mainly been sought on the supply-side in the form of improved management and allocation of limited resources. However, this approach largely ignores the demand-side factors associated with low PMTCT coverage in the country. The study assesses the factors associated with the utilization of PMTCT services taking into consideration counts of visits to antenatal care (ANC) services in urban high-HIV prevalence and rural low-HIV prevalence settings in Ethiopia., Methods: A multivariate regression model was employed to identify significant factors associated with PMTCT service utilization. Poisson and negative binomial regression models were applied, considering the number of ANC visits as a dependent variable. The explanatory variables were age; educational status; type of occupation; decision-making power in the household; living in proximity to educated people; a neighborhood with good welfare services; location (urban high-HIV prevalence and rural low-HIV prevalence); transportation accessibility; walking distance (in minutes); and household income status. The alpha dispersion test (a) was performed to measure the goodness-of-fit of the model. Significant results were reported at p-values of < 0.05 and < 0.001., Results: Household income, socio-economic setting (urban high-HIV prevalence and rural low-HIV prevalence) and walking distance (in minutes) had a statistically significant relationship with the number of ANC visits by pregnant women (p < 0.05). A pregnant woman from an urban high-HIV prevalence setting would be expected to make 34% more ANC visits (counts) than her rural low-HIV prevalence counterparts (p < 0.05). Holding other variables constant, a unit increase in household income would increase the expected ANC visits by 0.004%. An increase in walking distance by a unit (a minute) would decrease the number of ANC visits by 0.001(p < 0.001)., Conclusion: Long walking distance, low household income and living in a rural setting are the significant factors associated with low PMTCT service utilization. The primary strategies for a holistic policy to improve ANC/PMTCT utilization should thus include improving the geographical accessibility of ANC/PMTCT services, expanding household welfare and paying more attention to remote rural areas.

Published
2018
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14. Quantile regression analysis of modifiable and non-modifiable drivers' of blood pressure among urban and rural women in Ghana.

Author

Amugsi DA, Dimbuene ZT, Asiki G, and Kyobutungi C

Subjects
Adolescent, Adult, Female, Ghana, Humans, Middle Aged, Pregnancy, Blood Pressure, Body Mass Index, Rural Population, Urban Population
Abstract

High blood pressure is an increasingly problematic public health concern in many developing countries due to the associated cardiovascular and renal complications. This study set out to investigate the drivers of blood pressure among urban and rural women using the 2014 Ghana Demographic and Health Survey data. Diastolic blood pressure (DBP) and systolic blood pressure (SBP) were the outcomes of interest. Our findings showed that body mass index (BMI) had a significant positive effect on DBP and SBP in both urban and rural settings, with the largest effect occurring among women in the 75 th quantile. Arm circumference also had a positive effect on DBP and SBP across all quantiles in both settings. Age had an increasing positive effect along the entire conditional DBP and SBP distribution in both settings. Women who were pregnant had lower DBP and SBP relative to those who were not pregnant in both settings. These results highlight the important drivers of DBP and SBP, and the differential effects of these drivers on blood pressure (BP) among women in urban and rural settings. To increase their effectiveness, interventions to address high BP should take into account these differential effects.

Published
2018
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15. "It takes more than a fellowship program": reflections on capacity strengthening for health systems research in sub-Saharan Africa.

Author

Izugbara CO, Kabiru CW, Amendah D, Dimbuene ZT, Donfouet HPP, Atake EH, Ingabire MG, Maluka S, Mumah JN, Mwau M, Ndinya M, Ngure K, Sidze EM, Sossa C, Soura A, and Ezeh AC

Subjects
Africa South of the Sahara, Government Programs, Humans, Leadership, Research Design, Research Personnel education, Universities standards, Capacity Building, Education, Medical, Graduate, Fellowships and Scholarships, Health Services Research standards
Abstract

Sub-Saharan Africa (SSA) experiences an acute dearth of well-trained and skilled researchers. This dearth constrains the region's capacity to identify and address the root causes of its poor social, health, development, and other outcomes. Building sustainable research capacity in SSA requires, among other things, locally led and run initiatives that draw on existing regional capacities as well as mutually beneficial global collaborations. This paper describes a regional research capacity strengthening initiative-the African Doctoral Dissertation Research Fellowship (ADDRF) program. This Africa-based and African-led initiative has emerged as a practical and tested platform for producing and nurturing research leaders, strengthening university-wide systems for quality research training and productivity, and building a critical mass of highly-trained African scholars and researchers. The program deploys different interventions to ensure the success of fellows. These interventions include research methods and scientific writing workshops, research and reentry support grants, post-doctoral research support and placements, as well as grants for networking and scholarly conferences attendance. Across the region, ADDRF graduates are emerging as research leaders, showing signs of becoming the next generation of world-class researchers, and supporting the transformations of their home-institutions. While the contributions of the ADDRF program to research capacity strengthening in the region are significant, the sustainability of the initiative and other research and training fellowship programs on the continent requires significant investments from local sources and, especially, governments and the private sector in Africa. The ADDRF experience demonstrates that research capacity building in Africa is possible through innovative, multifaceted interventions that support graduate students to develop different critical capacities and transferable skills and build, expand, and maintain networks that can sustain them as scholars and researchers.

Published
2017
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16. Prevalence and time trends in overweight and obesity among urban women: an analysis of demographic and health surveys data from 24 African countries, 1991 - 2014.

Author

Amugsi DA, Dimbuene ZT, Mberu B, Muthuri S, and Ezeh AC

Subjects
Adolescent, Adult, Africa epidemiology, Cross-Sectional Studies, Female, Health Surveys, Humans, Middle Aged, Overweight epidemiology, Prevalence, Young Adult, Developing Countries, Obesity epidemiology, Urban Population
Abstract

Objective: To examine the prevalence and trends in overweight and obesity among non-pregnant urban women in Africa over the past two and a half decades., Design: Cross-sectional surveys conducted between 1991 and 2014., Settings: Demographic and Health Surveys (DHS), repeated cross-sectional data collected in 24 African countries., Participants: Adult non-pregnant women aged 15-49 years. The earlier DHS collected anthropometric data on only those women who had children aged 0-5 years. The main analyses were limited to this subgroup. The participants were classified as overweight (25.0-29.9 kg/m 2 ) and obese (≥30.0 kg/m 2 )., Results: The prevalence of overweight and obesity among women increased in all the 24 countries. Trends were statistically significant in 17 of the 24 countries in the case of obesity and 13 of the 24 for overweight. In Ghana, overweight almost doubled (p=0.001) while obesity tripled (p=0.001) between 1993 and 2014. Egypt has the highest levels of overweight and obesity at 44% (95% CI 42%, 46.5%) and 39% (95% CI 36.6%, 41.8%), respectively, in 2014 and the trend showed significant increase (p=0.005) from 1995 levels. Also, obesity doubled in Kenya, Benin, Niger, Rwanda, Ivory Coast and Uganda, while tripled in Zambia, Burkina Faso, Mali, Malawi and Tanzania. Ethiopia and Madagascar had the lowest prevalence of both obesity and overweight, with overweight ranging from 7% to 12% and obesity from 1% to 4%., Conclusions: Overweight and obesity are increasing among women of reproductive age in urban Africa, with obesity among this age group having more than doubled or tripled in 12 of the 24 countries. There is an urgent need for deliberate policies and interventions to encourage active lifestyles and healthy eating behaviour to curb this trend in urban Africa., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2017
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17. Differential effects of dietary diversity and maternal characteristics on linear growth of children aged 6-59 months in sub-Saharan Africa: a multi-country analysis.

Author

Amugsi DA, Dimbuene ZT, Kimani-Murage EW, Mberu B, and Ezeh AC

Subjects
Adolescent, Adult, Africa South of the Sahara epidemiology, Body Mass Index, Child, Preschool, Cross-Sectional Studies, Family Characteristics, Female, Growth Disorders prevention & control, Health Surveys, Humans, Infant, Infant Nutritional Physiological Phenomena, Male, Middle Aged, Mothers, Nutritional Status, Socioeconomic Factors, Young Adult, Child Development, Diet, Growth Disorders epidemiology
Abstract

Objective: To investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-age Z-score (HAZ) in sub-Saharan Africa., Design: Secondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0-59 months, born to mothers aged 15-49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis., Setting: The most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC)., Subjects: The present analysis was restricted to children aged 6-59 months (n 31 604)., Results: DD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD was significantly and positively associated with HAZ in the two lower quantiles (5th, 10th). The largest effects of maternal education occurred at the lower end of the conditional HAZ distribution in Ghana, Nigeria and DRC. Maternal BMI and height also had positive effects on HAZ at different points of the conditional distribution of HAZ., Conclusions: Our analysis shows that the association between DD and maternal factors and HAZ differs along the conditional HAZ distribution. Intervention measures need to take into account the heterogeneous effect of the determinants of child nutritional status along the different percentiles of the HAZ distribution.

Published
2017
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18. Dietary diversity, socioeconomic status and maternal body mass index (BMI): quantile regression analysis of nationally representative data from Ghana, Namibia and Sao Tome and Principe.

Author

Amugsi DA, Dimbuene ZT, Bakibinga P, Kimani-Murage EW, Haregu TN, and Mberu B

Abstract

Objectives: To (a) assess the association between dietary diversity (DD) score, socioeconomic status (SES) and maternal body mass index (BMI), and (b) the variation of the effects of DD and SES at different points of the conditional distribution of the BMI., Methods: The study used Demographic and Health Surveys round 5 data sets from Ghana, Namibia and Sao Tome and Principe. The outcome variable for the analysis was maternal BMI. The DD score was computed using 24-hour dietary recall data. Quantile regression (QR) was used to examine the relationship between DD and SES, and maternal BMI, adjusting for other covariates. The QR allows the covariate effects to vary across the entire distribution of maternal BMI., Results: Women who consumed an additional unit of DD achieved an increase of 0.245 in BMI for those in the 90th quantile in Ghana. The effect of household wealth increases for individuals across all quantiles of the BMI distribution and in all the 3 countries. A unit change in the household wealth score was associated with an increase of 0.038, 0.052 and 0.065 units increase in BMI for individuals in the 5th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Also, 0.237, 0.301 and 0.174 units increased for those in the 90th quantile in Ghana, Namibia and Sao Tome and Principe, respectively. Education had a significant positive effect on maternal BMI across all quantiles in Namibia and negative effect at the 5th, 10th and 90th quantiles in Sao Tome and Principe., Conclusions: There is heterogeneity in the effects of DD and SES on maternal BMI. Studies focusing on the effects of diet and socioeconomic determinants on maternal BMI should examine patterns of effects at different points of the conditional distribution of the BMI and not just the average effect., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Published
2016
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19. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NM, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CA, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs AD, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PG, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TK, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJ, Farzadfar F, Fay DF, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IA, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SE, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VM, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KM, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega Jde D, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS Jr, Pain AW, Pandian JD, Panelo CI, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SA, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJ, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJ, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AM, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CD, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, and Murray CJ

Subjects
Female, Global Health statistics & numerical data, Health Behavior, Humans, Male, Nutritional Status, Occupational Exposure adverse effects, Risk Assessment methods, Risk Factors, Sanitation trends, Environmental Exposure adverse effects, Global Health trends, Metabolic Diseases epidemiology, Occupational Diseases epidemiology
Abstract

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution., Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol., Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa., Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks., Funding: Bill & Melinda Gates Foundation., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Published
2015
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20. FAMILIES' RESPONSE TO AIDS: NEW INSIGHTS INTO PARENTAL ROLES IN FOSTERING HIV/AIDS KNOWLEDGE.

Author

Dimbuene ZT

Subjects
Acquired Immunodeficiency Syndrome epidemiology, Adolescent, Adolescent Behavior ethnology, Adolescent Behavior psychology, Africa South of the Sahara epidemiology, Cameroon epidemiology, Child, Condoms, Family Relations psychology, Female, Gender Identity, HIV Infections epidemiology, HIV Infections ethnology, Health Surveys, Humans, Male, Parent-Child Relations ethnology, Sex Education statistics & numerical data, Sexual Behavior ethnology, Sexual Behavior psychology, Sexual Behavior statistics & numerical data, Young Adult, Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome psychology, Communication, HIV Infections prevention & control, Health Education, Health Knowledge, Attitudes, Practice ethnology, Parents psychology
Abstract

Worldwide, there is a consensus that parents must be involved in children's HIV/AIDS education. However, there is little evidence that speaks to this advocacy for improving adolescent health. This study developed and tested four hypotheses about (i) the relationship between parents' and adolescents' knowledge of HIV/AIDS transmission routes and prevention strategies conditional upon (ii) parents' gender, (iii) communication about sexuality, and (iv) the parent-adolescent education gap. The sample consisted of 306 parent-adolescent dyads from the 2002 Cameroon Family and Health Survey. Adolescents were aged 12-19 years. Overall, fifteen items about HIV/AIDS transmission routes and prevention strategies were analysed. Descriptive results showed that parents fared better than adolescents regardless of the AIDS fact considered. An exception was the correct use of condoms (parents 57% vs adolescents 61%). The generation gap probably explains this result: parents are more conservative, reluctant and distant from condoms compared with adolescents, who are more receptive and open to discussing sex with peers. Multivariate ordered logistic regressions showed a significant positive effect of parents' HIV/AIDS knowledge on adolescents' HIV/AIDS knowledge, thus supporting the main hypothesis of direct parental influences. Parent-adolescent communication about sexuality showed positive and significant effects on adolescents' HIV/AIDS knowledge, suggesting an 'enhancing effect' when combined with the effect of parents' HIV/AIDS knowledge. Against the background that parents in sub-Saharan Africa do not teach their children about sexuality, the study demonstrated that families can play an important role in HIV/AIDS education. These findings have major implications for HIV/AIDS interventions involving adolescents, parents or both, in fostering accurate HIV/AIDS knowledge among adolescents, which could lead to protective sexual behaviours.

Published
2015
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21. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA, Dansereau EA, Graetz N, Barber RM, Brown JC, Wang H, Duber HC, Naghavi M, Dicker D, Dandona L, Salomon JA, Heuton KR, Foreman K, Phillips DE, Fleming TD, Flaxman AD, Phillips BK, Johnson EK, Coggeshall MS, Abd-Allah F, Abera SF, Abraham JP, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NM, Achoki T, Adeyemo AO, Adou AK, Adsuar JC, Agardh EE, Akena D, Al Kahbouri MJ, Alasfoor D, Albittar MI, Alcalá-Cerra G, Alegretti MA, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Amini H, Ammar W, Anderson BO, Antonio CA, Anwari P, Arnlöv J, Arsenijevic VS, Artaman A, Asghar RJ, Assadi R, Atkins LS, Badawi A, Balakrishnan K, Banerjee A, Basu S, Beardsley J, Bekele T, Bell ML, Bernabe E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Abdulhak AB, Binagwaho A, Blore JD, Basara BB, Bose D, Brainin M, Breitborde N, Castañeda-Orjuela CA, Catalá-López F, Chadha VK, Chang JC, Chiang PP, Chuang TW, Colomar M, Cooper LT, Cooper C, Courville KJ, Cowie BC, Criqui MH, Dandona R, Dayama A, De Leo D, Degenhardt L, Del Pozo-Cruz B, Deribe K, Des Jarlais DC, Dessalegn M, Dharmaratne SD, Dilmen U, Ding EL, Driscoll TR, Durrani AM, Ellenbogen RG, Ermakov SP, Esteghamati A, Faraon EJ, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Forouzanfar MH, Fra Paleo U, Gaffikin L, Gamkrelidze A, Gankpé FG, Geleijnse JM, Gessner BD, Gibney KB, Ginawi IA, Glaser EL, Gona P, Goto A, Gouda HN, Gugnani HC, Gupta R, Gupta R, Hafezi-Nejad N, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Pi IB, Hoek HW, Hornberger JC, Hosgood HD, Hotez PJ, Hoy DG, Huang JJ, Iburg KM, Idrisov BT, Innos K, Jacobsen KH, Jeemon P, Jensen PN, Jha V, Jiang G, Jonas JB, Juel K, Kan H, Kankindi I, Karam NE, Karch A, Karema CK, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Kereselidze M, Khader YS, Khalifa SE, Khan EA, Khang YH, Khonelidze I, Kinfu Y, Kinge JM, Knibbs L, Kokubo Y, Kosen S, Defo BK, Kulkarni VS, Kulkarni C, Kumar K, Kumar RB, Kumar GA, Kwan GF, Lai T, Balaji AL, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Lee JT, Leigh J, Leinsalu M, Leung R, Li Y, Li Y, De Lima GM, Lin HH, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Lotufo PA, Machado VM, Maclachlan JH, Magis-Rodriguez C, Majdan M, Mapoma CC, Marcenes W, Marzan MB, Masci JR, Mashal MT, Mason-Jones AJ, Mayosi BM, Mazorodze TT, Mckay AC, Meaney PA, Mehndiratta MM, Mejia-Rodriguez F, Melaku YA, Memish ZA, Mendoza W, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montico M, Moore AR, Mori R, Moturi WN, Mukaigawara M, Murthy KS, Naheed A, Naidoo KS, Naldi L, Nangia V, Narayan KM, Nash D, Nejjari C, Nelson RG, Neupane SP, Newton CR, Ng M, Nisar MI, Nolte S, Norheim OF, Nowaseb V, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orisakwe OE, Pandian JD, Papachristou C, Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pereira DM, Pervaiz A, Pesudovs K, Petzold M, Pourmalek F, Qato D, Quezada AD, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Ur Rahman S, Raju M, Rana SM, Razavi H, Reilly RQ, Remuzzi G, Richardus JH, Ronfani L, Roy N, Sabin N, Saeedi MY, Sahraian MA, Samonte GM, Sawhney M, Schneider IJ, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Sheikhbahaei S, Shibuya K, Shin HH, Shiue I, Shivakoti R, Sigfusdottir ID, Silberberg DH, Silva AP, Simard EP, Singh JA, Skirbekk V, Sliwa K, Soneji S, Soshnikov SS, Sreeramareddy CT, Stathopoulou VK, Stroumpoulis K, Swaminathan S, Sykes BL, Tabb KM, Talongwa RT, Tenkorang EY, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Towbin JA, Traebert J, Tran BX, Dimbuene ZT, Tsilimbaris M, Uchendu US, Ukwaja KN, Uzun SB, Vallely AJ, Vasankari TJ, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Waller S, Wallin MT, Wang L, Wang X, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, White RA, Wilkinson JD, Williams TN, Woldeyohannes SM, Wong JQ, Xu G, Yang YC, Yano Y, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhao Y, Zheng Y, Zhou M, Zhu J, Zou XN, Lopez AD, and Vos T

Subjects
Age Distribution, Epidemics statistics & numerical data, Female, Humans, Incidence, Male, Mortality trends, Organizational Objectives, Sex Distribution, Global Health trends, HIV Infections epidemiology, Malaria epidemiology, Tuberculosis epidemiology
Abstract

Background: The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration., Methods: To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010-13) of incidence, drug resistance, and coverage of insecticide-treated bednets., Findings: Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990., Interpretation: Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. The number of people living with HIV, tuberculosis, or malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action., Funding: Bill & Melinda Gates Foundation., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Published
2014
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22. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Author

Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE, Apfel H, Iannarone M, Phillips B, Lofgren KT, Sandar L, Dorrington RE, Rakovac I, Jacobs TA, Liang X, Zhou M, Zhu J, Yang G, Wang Y, Liu S, Li Y, Ozgoren AA, Abera SF, Abubakar I, Achoki T, Adelekan A, Ademi Z, Alemu ZA, Allen PJ, AlMazroa MA, Alvarez E, Amankwaa AA, Amare AT, Ammar W, Anwari P, Cunningham SA, Asad MM, Assadi R, Banerjee A, Basu S, Bedi N, Bekele T, Bell ML, Bhutta Z, Blore JD, Basara BB, Boufous S, Breitborde N, Bruce NG, Bui LN, Carapetis JR, Cárdenas R, Carpenter DO, Caso V, Castro RE, Catalá-Lopéz F, Cavlin A, Che X, Chiang PP, Chowdhury R, Christophi CA, Chuang TW, Cirillo M, da Costa Leite I, Courville KJ, Dandona L, Dandona R, Davis A, Dayama A, Deribe K, Dharmaratne SD, Dherani MK, Dilmen U, Ding EL, Edmond KM, Ermakov SP, Farzadfar F, Fereshtehnejad SM, Fijabi DO, Foigt N, Forouzanfar MH, Garcia AC, Geleijnse JM, Gessner BD, Goginashvili K, Gona P, Goto A, Gouda HN, Green MA, Greenwell KF, Gugnani HC, Gupta R, Hamadeh RR, Hammami M, Harb HL, Hay S, Hedayati MT, Hosgood HD, Hoy DG, Idrisov BT, Islami F, Ismayilova S, Jha V, Jiang G, Jonas JB, Juel K, Kabagambe EK, Kazi DS, Kengne AP, Kereselidze M, Khader YS, Khalifa SE, Khang YH, Kim D, Kinfu Y, Kinge JM, Kokubo Y, Kosen S, Defo BK, Kumar GA, Kumar K, Kumar RB, Lai T, Lan Q, Larsson A, Lee JT, Leinsalu M, Lim SS, Lipshultz SE, Logroscino G, Lotufo PA, Lunevicius R, Lyons RA, Ma S, Mahdi AA, Marzan MB, Mashal MT, Mazorodze TT, McGrath JJ, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Miller TR, Mills EJ, Mohammad KA, Mokdad AH, Monasta L, Montico M, Moore AR, Moschandreas J, Msemburi WT, Mueller UO, Muszynska MM, Naghavi M, Naidoo KS, Narayan KM, Nejjari C, Ng M, de Dieu Ngirabega J, Nieuwenhuijsen MJ, Nyakarahuka L, Ohkubo T, Omer SB, Caicedo AJ, Pillay-van Wyk V, Pope D, Pourmalek F, Prabhakaran D, Rahman SU, Rana SM, Reilly RQ, Rojas-Rueda D, Ronfani L, Rushton L, Saeedi MY, Salomon JA, Sampson U, Santos IS, Sawhney M, Schmidt JC, Shakh-Nazarova M, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shishani K, Shiue I, Sigfusdottir ID, Singh JA, Skirbekk V, Sliwa K, Soshnikov SS, Sposato LA, Stathopoulou VK, Stroumpoulis K, Tabb KM, Talongwa RT, Teixeira CM, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Toyoshima H, Dimbuene ZT, Uwaliraye P, Uzun SB, Vasankari TJ, Vasconcelos AM, Vlassov VV, Vollset SE, Waller S, Wan X, Weichenthal S, Weiderpass E, Weintraub RG, Westerman R, Wilkinson JD, Williams HC, Yang YC, Yentur GK, Yip P, Yonemoto N, Younis M, Yu C, Jin KY, El Sayed Zaki M, Zhu S, Vos T, Lopez AD, and Murray CJ

Subjects
Child, Preschool, Global Health statistics & numerical data, Humans, Infant, Infant, Newborn, Organizational Objectives, Risk Factors, Socioeconomic Factors, Child Mortality trends, Global Health trends, Infant Mortality trends
Abstract

Background: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success., Methods: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030., Findings: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone., Interpretation: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030., Funding: Bill & Melinda Gates Foundation, US Agency for International Development., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Published
2014
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23. UNAIDS 'multiple sexual partners' core indicator: promoting sexual networks to reduce potential biases.

Author

Dimbuene ZT, Emina JB, and Sankoh O

Subjects
Bayes Theorem, Bias, Female, HIV Infections epidemiology, Humans, Male, Population Surveillance methods, Risk Factors, Sexual Behavior statistics & numerical data, Sexual Partners
Abstract

UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the 'multiple sexual partners' core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS's 'multiple sexual partners' core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents' sexual behaviors. First, the indicator assumes that a person's risk of contracting HIV/AIDS/STIs is merely a function of his/her own sexual behavior. Second, the indicator does not account for a partner's sexual history, which is very important in assessing an individual's risk level. Finally, the 12-month period used to define a person's risks can be misleading, especially because HIV/AIDS theoretically has a period of latency longer than a year. The paper concludes that, programmatically, improvements in data collection are a top priority for reducing the observed bias in the 'multiple sexual partners' core indicator.

Published
2014
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24. Influences of family structure dynamics on sexual debut in Africa: implications for research, practice and policies in reproductive health and social development.

Author

Defo BK and Dimbuene ZT

Subjects
Africa, Cameroon, Child, Family, Female, Health Policy, Humans, Male, Reproductive Health, Social Change, Socialization, Young Adult, Coitus
Abstract

There is no research on the timing, sequencing and number of changes in family environment and their influences on sexual and reproductive health outcomes in Africa. Using a population-based survey with data on family structure at three points in the life course, this paper examines the influences of these family structure dynamics on the timing of first sex among unmarried males and females aged 12-24 years in Cameroon. The number and timing of family transitions significantly impacted the timing of sexual debut for both males and females. The median age at first sex (18.7 years) is higher among young people without family transition than among those with one transition (18.2 years) or two transitions (17.7 years). Family transitions occurring during childhood were significantly associated with premature sexual initiation for females but not for males. Reproductive health and social development interventions for young people in Africa should integrate the changing contexts and transitions in family structure.

Published
2012

25. Risky sexual behaviour among unmarried young people in Cameroon: another look at family environment.

Author

Dimbuene ZT and Defo BK

Subjects
Adolescent, Adult, Age Factors, Cameroon epidemiology, Child, Female, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Resilience, Psychological, Risk Factors, Sex Factors, Single Person psychology, Single Person statistics & numerical data, Single-Parent Family psychology, Single-Parent Family statistics & numerical data, Unsafe Sex psychology, Young Adult, Family psychology, Unsafe Sex statistics & numerical data
Abstract

Most studies of the association between family structure and risky sexual behaviour among adolescents and young adults have employed a risk perspective which assumes that, compared with other types, two-parent families are protective. Drawing from a positive-oriented approach in this study, it is hypothesized that within each family type some influential factors may mitigate such anticipated deleterious effects of non-intact families and decrease sexual risk-taking. The paper examines specifically the effects of risk and protective factors with an emphasis on family processes associated with resilience, using data from a pooled sample of 1025 females and males aged 12-24 years from Bandjoun (West Cameroon). Findings show that the quality of parent/guardian-youth relationships significantly decreases the odds of risky sexual behaviour by 36%, 65% and 50% in neither-, one- and two-parent families, respectively. For two-parent families only, parental control acts as a significant protective factor; it decreased by 41% the odds of risky sexual behaviour. Programmatically, protective family factors such as parent/guardian-youth interactions need to be promoted to improve the efficiency of reproductive health and HIV interventions in sub-Saharan Africa.

Published
2011
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