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1. What does it cost to deliver antenatal care in Papua New Guinea? Results from a health system costing and budget impact analysis using cross-sectional data

Author: William Pomat, Rebecca Guy, Handan Wand, John M Kaldor, Nicola Low, Suzanne M Garland, Christopher Morgan, Angela Kelly-Hanku, Sepehr Tabrizi, Lisa Vallely, Andrew Vallely, Virginia Wiseman, Neha Batura, Stanley Luchters, Steven Badman, Moses Laman, Pamela Toliman, David Whiley, Elizabeth Peach, Glen Mola, Grace Kariwiga, Michaela Riddell, John Bolnga, Jacob Morewaya, Wilfred Peter, Stephen J Rogerson, Olga Phoebe Martinella Saweri, Alice Mengi, Delly Babona, Leanne Robinson, Lucy Au, Irene Pukai Gani, Batura Neha, Kelvin Waukave, Peter Siba, Patricia Sengele, Leah Molok, Tessie Clip, Irene Daniels, Crystal Keiwaga, Daniel Hosea, Augustina Aiarak, Lorraine Mua, Valentine Russiat, Anna Davis, Biru Subey, Misilie Padik, Muria Tangal, Esleen Vovono, Konsetta Malava, Ellen Kavang, Vicky Bayagau Wong, Jermimah Garaen, Laniet Eddie, Johnslyne David, Jermimah Garaaen, Diana Malip, Noel Amada, Elisha Jordan, Mosely Viringa, Cosmos Francis, James Makap, Daniel Amin, Ruth Fidelis, Tony Rave, Rebecca Anian, Romalus Tavui, John Kamit, Benedictor Mission, Charity Stanley, Grace Baining, Everlyn Kavang, Sharon Warel, Janeth Kulimbao, Talitha Manie, Dupain Singirok, Carolyn Wokias Augusto, Eunice Jally, Maggie Taupa, Regina Enman, Judith Demie, Pamela Brea, Aileen Jeffrey, Jonathon Warel, Cornelia Duba, George Kuias, Beromina Jano, Michelyn John, Georgina Sengum, Joyce Soalili, Francesca Buran, Cegatha Tawai, Milda Lasu, Tia Marie Badem, Theresa Tivud, Joseph Yamuna, Mathilda Saki, Kelly Masil, Lennie Mal, Yapi Kepea, Paul Romanus, and Konnie Patrick
Subjects: Medicine
Abstract: Objective In Papua New Guinea (PNG), antenatal clinic attendance averaged 50% for one or more visits, and 30% for four visits in the last decade. In 2016, the WHO revised its focused antenatal care (ANC) model recommending eight rather than four visits. If implemented, this new model would require additional resources. This study estimated provider costs of ANC in PNG, including the expected cost of scaling up to universal ANC coverage as well as recommending eight visits.Design and setting Cross-sectional estimation of ANC costs collected from nine health facilities, which were part of a cluster randomised trial. Costs were estimated using both top-down and bottom-up approaches. The cost of the first and follow-up visits were estimated per woman, at the health facility level. Health system and scale-up costs of four visits were calculated by multiplying the aggregate cost of four visits by ANC utilisation rates. A budget impact analysis estimated the expected costs of delivering eight visits over 5 years. Univariate sensitivity analysis was conducted. Discounted costs are reported in local currency and 2019 international dollars using purchasing power parity data.Results The average cost of the first and follow-up visits were $17.66–$30.58 (K42.94–K74.34) in Madang and $11.26–$35.61 (K27.37–K86.56) in East New Britain. Four visits per woman cost $70.65–$122.33 (K171.76–K297.36) in Madang and $45.02–$142.45 (K109.50–K346.4) in East New Britain; and salaries represented the largest share of costs. The annual health system cost was $6.9 million (K16.9 million), the expected cost of scaling up to the universal coverage of four visits was $22.7 million (K55.2 million), and $45.4 million (K110.3 million) over 5 years for eight visits.Conclusion Costs varied with the number of clinicians, infrastructure and ANC coverage, suggesting scaling up requires increasing the financial investment in ANC services. These results provide a template to strengthen health systems by improving the quality of care.
Published: 2024
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2. Young men's everyday life experiences with contraception and unintended pregnancy in Papua New Guinea.

Author: Stephen Bell, Elke Mitchell, Sophie Ase, Herick Aeno, Richard Naketrumb, Priscilla Selon Ofi, Agnes Mek, William Pomat, Marie Habito, Glen Mola, Elissa Kennedy, and Angela Kelly-Hanku
Subjects: Public aspects of medicine, RA1-1270
Abstract: Unintended adolescent pregnancy is a public health priority in Papua New Guinea (PNG), where national policies specify need for easier access to reliable modern contraceptives. To reduce young people's experiences of unintended pregnancy in PNG, improved understandings of use of modern and other forms of contraception within young people's relationships is required to support the development of new sexual and reproductive health (SRH) programs and policies. The aim of this paper is to understand young men's use of modern and other contraceptives. This qualitative study involved semi-structured interviews with 35 sexually active young men aged 15-24 years, who were sampled purposively from the general population within community-based settings. Data were analysed using inductive thematic analysis techniques. Our analysis of young men's everyday experiences of using condoms and other contraceptives highlights clear drivers of unintended adolescent pregnancies. Across three settings, these included non-use of any modern method at first sex or during early sexual experiences; inconsistent use of condoms, often only after first pregnancy experiences; difficulties accessing condoms from health service providers, pharmacies and stores; a lack of understanding of other modern contraceptive strategies; inconsistent use of the withdrawal method; and inconsistent and incorrect use of calendar approaches due to misunderstandings about women's fertile period. Ten young men had never used any form of contraception. These occurred largely because young men's sexual agency is constrained within sexual and peer relationships, and community, school and health service settings, in ways that inhibit pregnancy prevention. It is important to engage meaningfully with young men to build sexual and reproductive health policies and programs that pay honest, respectful attention to young people's everyday sexual and social lives. Young men's everyday stories provide a unique lens through which we can identify mechanisms of change required to address the health and social inequities associated with unintended pregnancy among young men and young women in PNG and beyond.
Published: 2024
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3. Prevalence of pregnancy termination and associated factors among married women in Papua New Guinea: A nationally representative cross-sectional survey.

Author: McKenzie Maviso, Paula Zebedee Aines, Gracelyn Potjepat, Nancy Geregl, Glen Mola, and John W Bolnga
Subjects: Medicine, Science
Abstract: BackgroundPregnancy termination or induced abortion is not decriminalized, and access to safe abortion services is largely unavailable in Papua New Guinea (PNG). However, the practice is common throughout the country. This study aimed to estimate the prevalence and determine factors associated with pregnancy termination among married women aged 15-49 years in PNG.MethodsSecondary data from the 2016-2018 PNG Demographic and Health Survey (PNGDHS) was used. A total weighted sample of 6,288 married women were included. The Complex Sample Analysis method was used to account for the cluster design and sample weight of the study. Chi-square tests and multivariable logistic regression were used to assess factors associated with pregnancy termination. Adjusted odds ratios (aORs) with 95% Confidence Intervals (CIs) were reported.ResultsThe prevalence of pregnancy termination was 5.3%. Nearly half (45.2%) of all pregnancy terminations occurred in the Highlands region. Women aged 35-44 years (aOR = 8.54; 95% CI: 1.61-45.26), not working (aOR = 6.17; 95% CI: 2.26-16.85), owned a mobile phone (aOR = 3.77; 95% CI: 1.60-8.84), and lived in urban areas (aOR = 5.66; 95% CI: 1.91-16.81) were more likely to terminate a pregnancy. Women who experienced intimate partner violence (IPV) were 2.27 times (aOR = 2.27; 95% CI: 1.17-4.41) more likely to terminate a pregnancy compared to those who did not experience IPV. Women with unplanned pregnancies were 6.23 times (aOR = 6.23; 95% CI: 2.61-14.87) more likely to terminate a pregnancy. Women who knew about modern contraceptive methods and made independent decisions for contraceptive use were 3.38 and 2.54 times (aOR = 3.38; 95% CI: 1.39-8.18 and aOR = 2.54; 95% CI: 1.18-5.45, respectively) more likely to terminate a pregnancy.ConclusionThe findings highlight the role of sociodemographic and maternal factors in pregnancy termination among married women in PNG. Efforts aimed at reducing unplanned pregnancies and terminations should focus on comprehensive sexual and reproductive health education and improving easy access to contraceptives for married couples. Post-abortion care should also be integrated into the country's legal framework and added as an important component of existing sexual and reproductive health services.
Published: 2024
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4. Women’s acceptability of a self-collect HPV same-day screen-and-treat program in a high burden setting in the Pacific

Author: Hawa Camara, Somu Nosi, Gloria Munnull, Steven G. Badman, John Bolgna, Joseph Kuk, Glen Mola, Rebecca Guy, Andrew J. Vallely, and Angela Kelly-Hanku
Subjects: Acceptability, Self-collect, Screen-and-treat, Cervical cancer, HPV testing, Early detection, Public aspects of medicine, RA1-1270
Abstract: Abstract Background A field trial to evaluate a self-collect point-of-care HPV screen-and-treat (HPV S&T) program was implemented in two Well Women Clinics in Papua New Guinea (Papua New Guinea). Assessing the acceptability of a health intervention is a core element of evaluation. In this study, we examined women’s acceptability of both self-collection and HPV S&T intervention in Papua New Guinea. Methods Sixty-two semi-structured interviews were conducted with women who had undergone cervical screening in the same-day self-collected HPV screen-and-treat program in Madang and Western Highlands Provinces, Papua New Guinea. Data were thematically analysed using the Theoretical Framework of Acceptability (TFA) and managed using NVivo 12.5. Results Most women agreed that self-collection was transformative: it helped circumvent the culturally embarrassing pelvic examination and increased their self-efficacy, especially due to the provision of health education, instructions, and pictorial aids. The availability of same-day results, and treatment if indicated, was particularly valued by the women because it reduced the financial and temporal burden to return to the clinic for results. It also meant they did not need to wait anxiously for long periods of time for their results. Women also appreciated the support from, and expertise of, health care workers throughout the process and spoke of trust in the HPV-DNA testing technology. Most women were willing to pay for the service to ensure its sustainability and timely scale-up throughout Papua New Guinea to support access for women in harder to reach areas. Conclusion This study reported very high levels of acceptability from a field trial of self-collection and HPV same-day screen-and-treat. The program was deemed culturally congruent and time efficient. This innovative cervical screening modality could be the ‘solution’ needed to see wider and more immediate impact and improved outcomes for women in Papua New Guinea and other high-burden, low-resource settings.
Published: 2022
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5. Maternal and newborn health indicators in Papua New Guinea – 2008–2018

Author: Gianna Robbers, Joshua P. Vogel, Glen Mola, John Bolgna, and Caroline S. E. Homer
Subjects: maternal and neonatal health, newborns, postpartum, prenatal, antenatal, Diseases of the genitourinary system. Urology, RC870-923, The family. Marriage. Woman, HQ1-2044
Abstract: Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health care – especially in rural areas, where most people live – is challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.
Published: 2019
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6. Legal Transplants: A conflict of statutory law and customary Law in Papua New Guinea

Author: Glen Mola Pumuye
Subjects: Law in general. Comparative and uniform law. Jurisprudence, K1-7720
Abstract: The state of Papua New Guinea adopted the common law system of government in 1975 during independence. The genesis of most if not all its legislation can be traced back to the United Kingdom, Australia, New Zealand and other commonwealth countries. The tendency for legal transplants of legislative texts from these common law jurisdictions to sections of Papua New Guinean laws has been a constant reoccurrence. With huge texts of laws transplanted it begs the question whether these laws are coherent with existing laws and appropriate for Papua New Guinea. This paper analyses the existing Mining Act 1992 and Oil and Gas Act 1998 vesting ownership of minerals and petroleum in the State although these resources are located on customary land. I will use the said acts to establish the hypothesis that, in the rush to transplant legislation from Australia, this transplanted provision fails the functionality test and is not effective in Papua New Guinea. I will also try and point out the effects and solutions to redress this situation. Keywords: Customary law, alienated land, legal transplants, functionality test
Published: 2017
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7. Mobile Phone–based Syndromic Surveillance System, Papua New Guinea

Author: Alexander Rosewell, Berry Ropa, Heather Randall, Rosheila Dagina, Samuel Hurim, Sibauk Bieb, Siddhartha Datta, Sundar Ramamurthy, Glen Mola, Anthony B. Zwi, Pradeep Ray, and C. Raina MacIntyre
Subjects: syndromic surveillance, mobile phone, m-health, information and communication technology, ICT, early warning, Medicine, Infectious and parasitic diseases, RC109-216
Abstract: The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.
Published: 2013
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8. Preterm or not--an evaluation of estimates of gestational age in a cohort of women from Rural Papua New Guinea.

Author: Stephan Karl, Connie S N Li Wai Suen, Holger W Unger, Maria Ome-Kaius, Glen Mola, Lisa White, Regina A Wangnapi, Stephen J Rogerson, and Ivo Mueller
Subjects: Medicine, Science
Abstract: BackgroundKnowledge of accurate gestational age is required for comprehensive pregnancy care and is an essential component of research evaluating causes of preterm birth. In industrialised countries gestational age is determined with the help of fetal biometry in early pregnancy. Lack of ultrasound and late presentation to antenatal clinic limits this practice in low-resource settings. Instead, clinical estimators of gestational age are used, but their accuracy remains a matter of debate.MethodsIn a cohort of 688 singleton pregnancies from rural Papua New Guinea, delivery gestational age was calculated from Ballard score, last menstrual period, symphysis-pubis fundal height at first visit and quickening as well as mid- and late pregnancy fetal biometry. Published models using sequential fundal height measurements and corrected last menstrual period to estimate gestational age were also tested. Novel linear models that combined clinical measurements for gestational age estimation were developed. Predictions were compared with the reference early pregnancy ultrasound (ResultsAverage bias between reference ultrasound and clinical methods ranged from 0-11 days (95% confidence levels: 14-42 days). Preterm birth was best predicted by mid-pregnancy ultrasound (F-measure: 0.72), and neuromuscular Ballard score provided the least reliable preterm birth prediction (F-measure: 0.17). The best clinical methods to predict gestational age and preterm birth were last menstrual period and fundal height (F-measures 0.35). A linear model combining both measures improved prediction of preterm birth (F-measure: 0.58).ConclusionsEstimation of gestational age without ultrasound is prone to significant error. In the absence of ultrasound facilities, last menstrual period and fundal height are among the more reliable clinical measures. This study underlines the importance of strengthening ultrasound facilities and developing novel ways to estimate gestational age.
Published: 2015
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9. Concurrent Influenza and Shigellosis Outbreaks, Papua New Guinea, 2009

Author: Alexander Rosewell, Rosheila Dagina, Manoj V. Murhekar, Berry Ropa, Enoch Posanai, Samir Dutta, Ian Barr, Glen Mola, Anthony Zwi, and C. Raina MacIntyre
Subjects: Influenza, Shigella, shigellosis, viruses, bacteria, outbreak, Medicine, Infectious and parasitic diseases, RC109-216
Published: 2011
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10. Vibrio cholerae O1 in 2 Coastal Villages, Papua New Guinea

Author: Alexander Rosewell, Rosheila Dagina, Manoj V. Murhekar, Berry Ropa, Enoch Posanai, Samir R. Dutta, Amy V. Jennison, Helen V. Smith, Glen Mola, Anthony Zwi, and C. Raina MacIntyre
Subjects: cholera, emergence, outbreak, bacteria, Vibrio cholerae O1, New Guinea, Medicine, Infectious and parasitic diseases, RC109-216
Published: 2011
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11. Shigella spp. Antimicrobial Drug Resistance, Papua New Guinea, 2000–2009

Author: Alexander Rosewell, Berry Ropa, Enoch Posanai, Samir R. Dutta, Glen Mola, Anthony Zwi, and C. Raina MacIntyre
Subjects: Antimicrobial drug resistance, Shigella, resistance, surveillance, bacteria, letter, Medicine, Infectious and parasitic diseases, RC109-216
Published: 2010
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12. Concurrent outbreaks of cholera and peripheral neuropathy associated with high mortality among persons internally displaced by a volcanic eruption.

Author: Alexander Rosewell, Geoff Clark, Paul Mabong, Berry Ropa, Enoch Posanai, Nicola W Y Man, Samir R Dutta, Wasa Wickramasinghe, Lixia Qi, Jack C Ng, Glen Mola, Anthony B Zwi, and C Raina MacIntyre
Subjects: Medicine, Science
Abstract: BACKGROUND: In October 2004, Manam Island volcano in Papua New Guinea erupted, causing over 10 000 villagers to flee to internally displaced person (IDP) camps, including 550 from Dugulaba village. Following violence over land access in March 2010, the IDPs fled the camps, and four months later concurrent outbreaks of acute watery diarrhea and unusual neurological complaints were reported in this population. MATERIALS AND METHODS: A retrospective case-control study was conducted to identify the risk factors for peripheral neuropathy. Rectal swabs were collected from cases of acute watery diarrhea. Hair and serum metals and metalloids were analyzed by Inductively Coupled Plasma-Mass Spectrometry (ICP-MS). RESULTS: There were 17 deaths among the 550 village inhabitants during the outbreak period at a crude mortality rate 21-fold that of a humanitarian crisis. Vibrio cholerae O1 El Tor Ogawa was confirmed among the population. Access to community-level rehydration was crucial to mortality. Peripheral neuropathy was diagnosed among cases with neurological symptoms. A balanced diet was significantly protective against neuropathy. A dose-response relationship was seen between peripheral neuropathy and a decreasing number of micronutrient- rich foods in the diet. Deficiencies in copper, iron, selenium and zinc were identified among the cases of peripheral neuropathy. CONCLUSIONS: Cholera likely caused the mostly preventable excess mortality. Peripheral neuropathy was not caused by cholera, but cholera may worsen existing nutritional deficiencies. The peripheral neuropathy was likely caused by complex micronutrient deficiencies linked to non-diversified diets that potentially increased the vulnerability of this population, however a new zinc-associated neuropathy could not be ruled out. Reoccurrence can be prevented by addressing the root cause of displacement and ensuring access to arable land and timely resettlement.
Published: 2013
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13. Papua New Guinea's experiments with sovereign wealth funds

Author: Farrar, John H and Pumuye, Glen Mola
Published: 2021

14. Induced abortion in Papua‐New Guinea: Experience and opinions of health professionals

Author: Glen Mola, Caroline de Costa, Cindy Woods, and Francisca Kopunye
Subjects: medicine.medical_specialty, Abortion, Pregnancy, Unsafe abortion, parasitic diseases, medicine, Humans, reproductive and urinary physiology, New Guinea, Primary Health Care, Health professionals, business.industry, Mortality rate, Public health, Obstetrics and Gynecology, New guinea, Abortion, Induced, General Medicine, Service provider, Maternal Mortality, Attitude, Family planning, Family medicine, embryonic structures, Female, business
Abstract: Background: Papua-New Guinea (PNG) has one of the highest maternal mortality rates in the world; complications due to unsafe abortion are an important cause. Abortion laws are restrictive, and safe, induced abortions are unavailable to the majority of women, while unsafe abortions are known to be practised throughout the country. The topic of abortion is stigmatised, for women and health professionals. Aim: To conduct a study of PNG health professionals’ experience of induced abortion and their views on the provision of safe, accessible abortion services for PNG women. Materials and Methods: A questionnaire developed from similar surveys conducted in Australia and New Zealand was distributed in 2017 to doctors working in provincial hospitals of the public health system; in 2020, the questionnaire was distributed to doctors and nursing staff in Port Moresby General Hospital, and to medical, nursing and health sciences students in the University of Papua-New Guinea. Results: Significant numbers of senior medical officers and nurses reported experience of women presenting following unsafe induced abortion. There was wide variation across all respondents with regard to accurate knowledge of PNG’s abortion laws, and to views on the provision of safe accessible abortion services in the country’s public health system. Conclusions: Abortion training for service providers and provision of primary care services are necessary to ensure that PNG women have equitable access to abortion care instead of seeking out untrained providers or attempting self-abortion. Innovative approaches also need to be adopted to complement family planning efforts in PNG.
Published: 2021
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15. Improving the governance of Papua New Guinea’s State Owned Enterprise in the Mining and Petroleum Sector

Author: Glen Mola Pumuye
Abstract: State-Owned Enterprises (SOEs) play a pivotal role in the economic development of Papua New Guinea (PNG). The country’s economy is heavily dependent on the mining and petroleum sector for revenue generation. Successive governments have relied on SOEs to manage the state’s equity interests in collaboration with resource developers. In 2015, the Kumul Minerals Holding Limited Authorization Act 2015 (KMHLAA) and the Kumul Petroleum Holdings Limited Authorization Act 2015 (KPHLAA) were passed by the Papua New Guinean Parliament, to consolidate all State interests in resource projects and to appoint the incumbent Prime Minister to be the sole trustee. This paper examines these legislative provisions and argues that the above legislative provision contradicts proven corporate governance best practices. The paper also suggests possible reforms in conjunction with practice from benchmarking countries and developing countries that have elevated their corporate governance structures through reforms.
Published: 2022
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16. Improving the governance of Papua New Guinea’s State Owned Enterprise in the Mining and Petroleum Sector

Author: Pumuye, Glen Mola, primary
Published: 2022
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17. A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea

Author: Kirsten I Black, Willie Trane, Edwina Dorney, and Glen Mola
Subjects: Papua New Guinea, Cross-Sectional Studies, Contraception, Reproductive Medicine, Contraceptive Agents, Pregnancy, Postpartum Period, Obstetrics and Gynecology, Humans, Female
Abstract: In 2016 the Port Moresby General Hospital in Papua New Guinea introduced a midwife led postpartum contraception service to educate patients and provide contraceptive implants. This study examines the factors that were associated with immediate postpartum uptake of the implants.We conducted a cross-sectional study of patients on the hospital postnatal ward who gave birth between March 2017 and January 2018. Patients aged 16-45 who had a vaginal birth with a singleton, live baby not requiring admission to the special care nursery were eligible for inclusion and invited to complete a survey prior to discharge.Of 2082 patients approached, all consented to participate in the survey. Of those completing the survey, 531 (25.5%) chose to have the contraceptive implant provided immediately postpartum. Excluding patients who chose tubal ligation (n = 330), in multivariable analysis, higher odds of implant uptake was associated with no prior contraception use compared to prior use (aOR 1.38; 95% CI 1.07 -1.77), unplanned pregnancy compared to planned (aOR 1.37, 95% CI 1.07-1.79), and having received antenatal education about the implant compared to no information (AOR 1.65, 95% CI 1.23-2.10).Antenatal education about the contraceptive implant impacted on likelihood of immediate postpartum method uptake. Patients who had no prior use of contraception and those with unplanned pregnancies were also more likely to request the implants, suggesting that the midwife-led postpartum service is successfully reaching patients with a previous unmet need for contraception.This study demonstrates successful delivery of a postpartum implant program in a setting where community access to contraception is limited. Antenatal information and education can support implant uptake and that the program provides the opportunity for birth spacing and limiting in patients with a previous unmet need.
Published: 2022

18. Corrigendum to 'A cross-sectional study of factors associated with immediate postpartum uptake of contraceptive implants in Papua New Guinea' [Contraception 117 Pages 25-29]

Author: Kirsten Isla Black, Willie Trane, Edwina Dorney, and Glen Mola
Subjects: Reproductive Medicine, Obstetrics and Gynecology
Published: 2023
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19. The Need for Law Reform in Papua New Guinea: Part 1

Author: Pumuye, Glen Mola, Kuman, Jennivive, Pumuye, Glen Mola, and Kuman, Jennivive
Abstract: This In Brief is the first in a two-part series on law reform in Papua New Guinea (PNG). Part 1 highlights the importance of law reform and law reform bodies as well as the existing barriers to the implementation of adequate law reform. Part 2 deals with the difficulties of criminalising drugs new to PNG.
Published: 2022

20. The Need for Law Reform in Papua New Guinea: Part 2 — Updating Drug Laws

Author: Pumuye, Glen Mola, Kuman, Jennivive, Pumuye, Glen Mola, and Kuman, Jennivive
Abstract: This paper is the second part in a two-part series on the need for law reform in Papua New Guinea (PNG). Part 1 outlined some challenges for law reform and suggested that with more attention and political will, progress can be made. This second part highlights how some drugs entering into PNG, such as methamphetamine, were not captured by the Dangerous Drugs Act 1952, and in response, the PNG parliament recently passed the Controlled Substance Act 2021.
Published: 2022

21. Separation of Powers in Papua New Guinea as interpreted by the Supreme Court

Author: Pumuye, Glen Mola
Published: 2022
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22. Restricting Party Hopping in Papua New Guinea��s Parliament

Author: Pumuye, Glen Mola
Subjects: Legislations, Papua New Guinea, governance, Politics, Party politics, Pacific
Abstract: This paper argues that legislative initiative is needed to control party hopping by members of parliament (MPs), especially during the constitutional period for the moving of a motion of no confidence in Papua New Guinea (PNG). The Organic Law on the Integrity of Political Parties and Candidates (OLIPPAC) governs political parties in PNG. In 2003, certain amendments were made to OLIPPAC to control party hopping. However, the provisions were challenged in the Supreme Court. The Supreme Court nullified those amendments on the basis that they restricted and infringed the constitutional rights of MPs and were unconstitutional. The political conditions following the court��s decision contributed to the constitutional crisis/impasse of 2011��12 and, later, the constitutional confusion of 2020. The Supreme Court��s expectations for MPs to act in an orderly way through education have not been achieved. The challenge is to construct the OLIPPAC legislation in conformity with the court��s deliberation. Rather than infringing and restricting MPs�� rights, the balance should be to regulate those rights for a certain amount of time. The current crisis and confusion being faced should prompt the relevant law reform institutions to tailor a possible legislative solution.
Published: 2021
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23. Cancer management in the Pacific region: a report on innovation and good practice

Author: Glen Mola, Toakase Fakakovikaetau, Rachel Dyer, Neal A Palafox, Martina Reichhardt, James Fong, Sunia Foliaki, Alec Ekeroma, Jane Skeen, Livinston Taulung, Kiki Maoate, Pamela J Toliman, David A. K. Watters, Andrew Vallely, Merilyn Hibma, Lee E Buenconsejo-Lum, Diana Sarfati, and George Aho
Subjects: Economic growth, West Indies, Uterine Cervical Neoplasms, Surgical workforce, Pacific Islands, Article, Essential medicines, Papua New Guinea, 03 medical and health sciences, 0302 clinical medicine, Humans, Medicine, 030212 general & internal medicine, Child, Good practice, Caribbean island, business.industry, Regionalisation, New guinea, Oncology, 030220 oncology & carcinogenesis, Cancer management, Female, Small Island Developing States, business, Delivery of Health Care
Abstract: Pacific island countries and territories (PICTs) face the challenge of a growing cancer burden. In response to these challenges, examples of innovative practice in cancer planning, prevention, and treatment in the region are emerging, including regionalisation and coalition building in the US-affiliated Pacific nations, a point-of-care test and treat programme for cervical cancer control in Papua New Guinea, improving the management of children with cancer in the Pacific, and surgical workforce development in the region. For each innovation, key factors leading to its success have been identified that could allow the implementation of these new developments in other PICTs or regions outside of the Pacific islands. These factors include the strengthening of partnerships within and between countries, regional collaboration within the Pacific islands (eg, the US-affiliated Pacific nations) and with other regional groupings of small island nations (eg, the Caribbean islands), a local commitment to the idea of change, and the development of PICT-specific programmes.
Published: 2019
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24. Impact of the contraceptive implant on maternal and neonatal morbidity and mortality in rural Papua New Guinea: a retrospective observational cohort study

Author: Kevin McGeechan, John W. Bolnga, Angela Kelly-Hanku, Kirsten I. Black, Sarika Gupta, Glen Mola, and Philippa Ramsay
Subjects: Adult, Rural Population, medicine.medical_specialty, Adolescent, Pregnancy, High-Risk, Population, Levonorgestrel, Birth rate, Papua New Guinea, Young Adult, Pregnancy, Infant Mortality, Contraceptive Agents, Female, medicine, Humans, education, Retrospective Studies, Reproductive health, education.field_of_study, business.industry, Obstetrics, Postpartum Hemorrhage, Infant, Newborn, Pregnancy Outcome, Infant, Obstetrics and Gynecology, Prenatal Care, Retrospective cohort study, Middle Aged, Parity, Contraception, Maternal Mortality, Reproductive Medicine, Female, Implant, Morbidity, business, Contraceptive implant, Cohort study, medicine.drug
Abstract: Using routinely collected birth data, this study sought to measure changes in maternal and neonatal morbidity and mortality after introduction of the levonorgestrel contraceptive implant into a large, rural island population in Papua New Guinea (PNG).We conducted a retrospective observational study of birth records from 4251 births that occurred between January 2010 and December 2016 on Karkar Island, PNG. The primary outcome was the change in crude birth rate (CBR) before (2010-2012) and after (2014-2016) introduction of the implant. Secondary outcomes were the change in rates (per year/1000 births) of severe postpartum hemorrhage, postpartum infection, hospital readmission, prematurity (37 weeks), low birth weight (2500 g) and maternal and neonatal mortality. We also studied changes in the number of pregnancies affected by grand multiparity (≥4) and short interpregnancy interval (12 months) for the same time periods. Data were analyzed using interrupted time series and Poisson regression.CBR was stable until 2012 and then declined from 2014 (p.0001). Following introduction of the implant, the annual rate/1000 births of selected adverse birth outcomes decreased between 56% and 74% (p.0001). The number of women with parity ≥4 who gave birth decreased by 59% (p.0001), and the number with interpregnancy interval12 months decreased by 64% (p.0001).Introduction of the contraceptive implant was associated with reductions in CBR, maternal and neonatal morbidity, and the number of women with high-risk pregnancies giving birth.These results encourage efforts to increase knowledge and availability of the contraceptive implant in low- and middle-income countries such as PNG. In cases where it reduces the CBR and the number of women with high-risk pregnancies birthing, the implant may have a beneficial impact on maternal and neonatal morbidity.
Published: 2019
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25. Point-of-care testing and treatment of sexually transmitted and genital infections during pregnancy in Papua New Guinea (WANTAIM trial): protocol for an economic evaluation alongside a cluster-randomised trial

Author: Moses Laman, Nicola Low, Neha Batura, Michaela A Riddell, Pamela J Toliman, Caroline S.E. Homer, Olga P. M. Saweri, Elizabeth Peach, Stephen J. Rogerson, Christopher Morgan, David M. Whiley, Grace Kariwiga, John M. Kaldor, Glen Mola, Sepehr N. Tabrizi, Lisa M Vallely, Wilfred Peter, Angela Kelly-Hanku, Stanley Luchters, Jacob Morewaya, Peter Siba, Handan Wand, Virginia Wiseman, Steven G Badman, William Pomat, John Bolnga, Rosanna W. Peeling, Andrew Vallely, Suzanne M. Garland, Rebecca Guy, and Leanne J. Robinson
Subjects: medicine.medical_specialty, protocols & guidelines, Cost-Benefit Analysis, Sexually Transmitted Diseases, 610 Medicine & health, 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences, Papua New Guinea, Health Economics, 360 Social problems & social services, Pregnancy, Humans, Medicine, Genitalia, Child, Randomized Controlled Trials as Topic, Research ethics, Health economics, Cost–benefit analysis, business.industry, Public health, public health, Infant, Newborn, General Medicine, Cost-effectiveness analysis, Institutional review board, Health equity, Point-of-Care Testing, Family medicine, Economic evaluation, Premature Birth, Female, business
Abstract: IntroductionLeft untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs with standard antenatal care in two provinces in PNG.Methods and analysisCost-effectiveness of the PoC intervention compared with standard antenatal care will be assessed prospectively over the trial period (2017–2021) from societal and provider perspectives. Incremental cost-effectiveness ratios will be calculated for the primary health outcome, a composite measure of the proportion of either preterm birth and/or low birth weight; for life years saved; for disability-adjusted life years averted; and for non-health benefits (financial risk protection and improved health equity). Scenario analyses will be conducted to identify scale-up options, and budget impact analysis will be undertaken to understand short-term financial impacts of intervention adoption on the national budget. Deterministic and probabilistic sensitivity analysis will be conducted to account for uncertainty in key model inputs.Ethics and disseminationThis study has ethical approval from the Institutional Review Board of the PNG Institute of Medical Research; the Medical Research Advisory Committee of the PNG National Department of Health; the Human Research Ethics Committee of the University of New South Wales; and the Research Ethics Committee of the London School of Hygiene and Tropical Medicine. Findings will be disseminated through national stakeholder meetings, conferences, peer-reviewed publications and policy briefs.Trial registration numberISRCTN37134032.
Published: 2021
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26. Fertility Preferences, Contraceptive Use, and the Unmet Need for Contraception in Papua New Guinea: Key Findings From 1996 to 2016

Author: Sarika Gupta, Kirsten I. Black, Kevin McGeechan, Sarah Bernays, Angela Kelly-Hanku, Glen Mola, and John W. Bolnga
Subjects: Health Services Needs and Demand, business.industry, Public Health, Environmental and Occupational Health, Fertility Preferences, New guinea, Maternal morbidity, Population health, Unmet needs, Papua New Guinea, Contraceptive use, Contraception, Fertility, Contraceptive Agents, Environmental health, Family Planning Services, parasitic diseases, Key (cryptography), Global health, Medicine, Humans, business, Contraception Behavior
Abstract: Expanding access to reliable contraception is a global priority in the fight to lower maternal morbidity and mortality. Papua New Guinea (PNG) continues to face significant challenges in enhancing ...
Published: 2021

27. Towards the elimination of cervical cancer in low-income and lower-middle-income countries: modelled evaluation of the effectiveness and cost-effectiveness of point-of-care HPV self-collected screening and treatment in Papua New Guinea

Author: Diep Thi Ngoc Nguyen, Kate T Simms, Adam Keane, Glen Mola, John Walpe Bolnga, Joseph Kuk, Pamela J Toliman, Steven G Badman, Marion Saville, John Kaldor, Andrew Vallely, and Karen Canfell
Subjects: Papua New Guinea, Cost-Benefit Analysis, Point-of-Care Systems, Health Policy, Papillomavirus Infections, Public Health, Environmental and Occupational Health, Humans, Uterine Cervical Neoplasms, Female, Developing Countries, Early Detection of Cancer
Abstract: IntroductionWHO has launched updated cervical screening guidelines, including provisions for primary HPV screen-and-treat. Papua New Guinea (PNG) has a high burden of cervical cancer, but no national cervical screening programme. We recently completed the first field trials of a screen-and-treat algorithm using point-of-care self-collected HPV and same-day treatment (hereafter self-collected HPV S&T) and showed this had superior clinical performance and acceptability to visual inspection of the cervix with acetic acid (VIA). We, therefore, evaluated the effectiveness, cost-effectiveness and resource implications of a national cervical screening programme using self-collected HPV S&T compared with VIA in PNG.MethodsAn extensively validated platform (‘Policy1-Cervix’) was calibrated to PNG. A total of 38 strategies were selected for investigation, and these incorporated variations in age ranges and screening frequencies and allowed for the identification of the optimal strategy across a wide range of possibilities. A selection of strategies that were identified as being the most effective and cost-effective were then selected for further investigation for longer-term outcomes and budget impact estimation. In the base case, we assumed primary HPV testing has a sensitivity to cervical intraepithelial neoplasia 2 (CIN2+) + of 91.8% and primary VIA of 51.5% based on our earlier field evaluation combined with evidence from the literature. We conservatively assumed HPV sampling and testing would cost US$18. Costs were estimated from a service provider perspective based on data from local field trials and local consultation.ResultsSelf-collected HPV S&T was more effective and more cost-effective than VIA. Either twice or thrice lifetime self-collected HPV S&T would be cost-effective at 0.5× gross domestic product (GDP) per capita (incremental cost-effectiveness ratio: US$460–US$656/life-years saved; 1GDPper-capita: US$2829 or PGK9446 (year 2019)) and could prevent 33 000–42 000 cases and 23 000–29 000 deaths in PNG over the next 50 years, if scale-up reached 70% coverage from 2023.ConclusionSelf-collected HPV S&T was effective and cost-effective in the high-burden, low-resource setting of PNG, and, if scaled-up rapidly, could prevent over 20 000 deaths over the next 50 years. VIA screening was not effective or cost-effective. These findings support, at a country level, WHO updated cervical screening guidelines and indicate that similar approaches could be appropriate for other low-resource settings.
Published: 2022
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28. Short-term and long-term effects of caesarean section on the health of women and children

Author: Glen Mola, Rachel M. Tribe, Hussein Kidanto, Paul D. Taylor, Marleen Temmerman, Lisa Avery, Niamh M. Kelly, Deena L. Gibbons, Caroline S.E. Homer, Holly Powell Kennedy, Jane Sandall, and Gerard H. A. Visser
Subjects: medicine.medical_specialty, medicine.medical_treatment, Global Health, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Global health, Humans, Medicine, Caesarean section, 030212 general & internal medicine, Microbiome, Poverty, Asthma, 030219 obstetrics & reproductive medicine, Cesarean Section, business.industry, Obstetrics, Incidence (epidemiology), Infant, Newborn, Pregnancy Outcome, General Medicine, medicine.disease, Obesity, Uterine rupture, Female, business
Abstract: Summary A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose–response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.
Published: 2018
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29. Research Handbook on Corporate Bankruptcy, Edited by BarryAdler (ed) (2020, Edward Elgar, Cheltenham), 456 pp., USD 225, ISBN 978‐1‐78100‐787‐7

Author: Pumuye, Glen Mola, primary and Watters, Casey, additional
Published: 2020
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30. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Author: Haleema Shakur, Ian Roberts, Bukola Fawole, Rizwana Chaudhri, Mohamed El-Sheikh, Adesina Akintan, Zahida Qureshi, Hussein Kidanto, Bellington Vwalika, Abdulfetah Abdulkadir, Saturday Etuk, Shehla Noor, Etienne Asonganyi, Zarko Alfirevic, Danielle Beaumont, Carine Ronsmans, Sabaratnam Arulkumaran, Adrian Grant, Kaosar Afsana, Metin Gülmezoglu, Beverley Hunt, Oladapo Olayemi, Iain Chalmers, Pisake Lumbiganon, Gilda Piaggio, Tony Brady, Diana Elbourne, Eni Balogun, Tracey Pepple, Danielle Prowse, Nigel Quashi, Lin Barneston, Collette Barrow, Lisa Cook, Lauren Frimley, Daniel Gilbert, Catherine Gilliam, Rob Jackson, Taemi Kawahara, Hakim Miah, Sergey Kostrov, Maria Ramos, Phil Edwards, Tom Godec, Sumaya Huque, Olujide Okunade, Olusade Adetayo, Aasia Kayani, Kiran Javaid, Chrstine Biryabarema, Robert Tchounzou, Mohan Regmi, Kastriot Dallaku, Mateus Sahani, Sayeba Akhter, Nicolas Meda, Anthony Kwame Dah, Olufemi Odekunle, Oluwabusola Monehin, Austin Ojo, Grace Akinbinu, Ifeoma Offiah, Ubong Akpan, Uduak Udofia, Useneno Okon, Ezukwa Omoronyia, Okpe James, Nike Bello, Blessed Adeyemi, Chris Aimakhu, Olufemi Akinsanya, Bamidele Adeleye, Oluwaseun Adeyemi, Kayode Oluwatosin, Abiodun Aboyeji, Abiodun Adeniran, Adebayo Adewale, Noah Olaomo, Lawrence Omo-Aghoja, Emmanuel Okpako, Lucky Oyeye, Francis Alu, John Ogudu, Ezekiel Ladan, Ibrahim Habib, Babasola Okusanya, Olatunde Onafowokan, David Isah, Abalaka Aye, Felix Okogbo, Egbaname Aigere, Mark Ogbiti, Temitope Onile, Olaide Salau, Yinka Amode, Kamil Shoretire, Adebola Owodunni, Kehinde Ologunde, Akintunde Ayinde, Moses Alao, Olalekan Awonuga, Babatunde Awolaja, Omololu Adegbola, Fatimah Habeebu-Adeyemi, Adeyemi Okunowo, Hadiza Idris, Ola Okike, Nneka Madueke, Josiah Mutihir, Nankat Joseph, Babatunde Adebudo, Adeniyi Fasanu, Olugbenga Akintunde, Olufemi Abidoye, Owigho Opreh, Sophia Udonwa, Gladys Dibia, Simeon Bazuaye, Arafat Ifemeje, Aniefiok Umoiyoho, Emmanuel Inyang-Etoh, Sununu Yusuf, Kayode Olayinka, Babalola Adeyemi, Olusegun Ajenifuja, Umar Ibrahim, Yusuf Baffah Adamu, Oluwarotimi Akinola, Grace Adekola-Oni, Paul Kua, Roseline Iheagwam, Audu Idrisa, Ado Geidam, Andrea Jogo, Joseph Agulebe, Joseph Ikechebelu, Onyebuchi Udegbunam, Jacob Awoleke, Oluseyi Adelekan, Hajaratu Sulayman, Nkeiruka Ameh, Nurudeen Onaolapo, Affiss Adelodun, William Golit, Dachollom Audu, Adetunji Adeniji, Folasade Oyelade, Lamaran Dattijo, Palmer Henry, Olabisi Loto, Odidika Umeora, Abraham Onwe, Emily Nzeribe, Bartthy Okorochukwu, Augustine Adeniyi, Emmanuel Gbejegbe, Akpojaro Ikpen, Ikemefuna Nwosu, Abdulrasaq Sambo, Olubunmi Ladipo, Sola Abubakar, Ola Nene Okike, Enyinnaya Chikwendu Nduka, Eziamaka Pauline Ezenkwele, Daniel Onwusulu, Theresa Azonima Irinyenikan, Swati Singh, Amaitari Bariweni, Hadiza Galadanci, Peter Achara, Osagie Osayande, Mohammed Gana, Kiran Jabeen, Ayesha Mobeen, Sadaf Mufti, Maliha Zafar, Basharat Ahmad, Maimoona Munawar, Jeharat Gul, Naseema Usman, Fehmida Shaheen, Mariam Tariq, Nadia Sadiq, Rabia Batool, Habiba Sharaf Ali, Manahil Jaffer, Asma Baloch, Noonari Mukhtiar, Tasneem Ashraf, Raheela Asmat, Salma Khudaidad, Ghazala Taj, Roshan Qazi, Saira Dars, Faryal Sardar, Sanobar Ashfaq, Saeeda Majeed, Sadaqat Jabeen, Rukhsana Karim, Farzana Burki, Syeda Rabia Bukhari, Fouzia Gul, Musarrat Jabeen, Akhtar Sherin, Qurratul Ain, Shahid Rao, Uzma Shaheen, Samina Manzoor, Shabween Masood, Shabana Rizvi, Anita Ali, Abida Sajid, Aisha Iftikhar, Shazia Batool, Lubna Dar, Shahenzad Sohail, Shazia Rasul, Shamsa Humayun, Rashida Sultana, Sofia Manzoor, Syeda Mazhar, Afshan Batool, Asia Nazir, Nasira Tasnim, Hajira Masood, Razia Khero, Neelam Surhio, Samana Aleem, Naila Israr, Saba Javed, Lubna Bashir, Samina Iqbal, Faiza Aleem, Rubina Sohail, Saima Iqbal, Samina Dojki, Alia Bano, Naseem Saba, Maimoona Hafeez, Nishat Akram, Riffat Shaheen, Haleema Hashmi, Sharmeen Arshad, Rubina Hussain, Sadia Khan, Nighat Shaheen, Safia Khalil, Pushpa Sachdev, Gulfareen Arain, Amtullah Zarreen, Sara Saeed, Shamayela Hanif, Nabia Tariq, Mahwish Jamil, Shama Chaudhry, Hina Rajani, Tayyiba Wasim, Summera Aslam, Nilofar Mustafa, Huma Quddusi, Sajila Karim, Shazia Sultana, Misbah Harim, Mohd Chohan, Nabila Salman, Fareesa Waqar, Shamsunnisa Sadia, Lubna Kahloon, Shehla Manzoor, Samar Amin, Umbreen Akram, Ambreen Ikram, Samina Kausar, Tahira Batool, Brigadier Naila, Tahir Kyani, Christine Biryabarema, Ruth Bulime, Regina Akello, Bernadette Nakawooya Lwasa, Joselyn Ayikoru, Christine Namulwasira, Patrick Komagum, Isabirye Rebecca, Nayiga Annet, Nakirigya Nuulu, Elizabeth Nionzima, Rose Bwotya, Margret Nankya, Sarah Babirye, Joseph Ngonzi, Cesar Sanchez, Nkonwa Innocent, Kusasira Anitah, Ayiko Jackson, Elizabeth Ndagire, Christine Nanyongo, Dominic Drametu, Grace Meregurwa, Francis Banya, Rita Atim, Emmanuel Byaruhanga, Lema Felix, Hussein Iman, Vincent Oyiengo, Peninah Waigi, Rose Wangui, Faiza Nassir, Musimbi Soita, Rophina Msengeti, Zeinab Zubier, Hillary Mabeya, Antony Wanjala, Henry Mwangi, Brian Liyayi, Evelyn Muthoka, Alfred Osoti, Amos Otara, Veronicah Ongwae, Victor Wanjohi, Bonface Musila, Kubasu Wekesa, Alex Nyakundi Bosire, Alice Ntem, Angeline Njoache, Alice Ashu, André Simo, Dorothy Keka, Kenfack Bruno, Amadou Ndouoya, Martin Saadio, Mesack Tchana, Odel Gwan, Pauline Assomo, Venantius Mutsu, Nji Eric, Pascal Foumane, Philemon Nsem, Jeanne Fouedjio, Ymele Fouelifack, Pierre Marie Tebeu, Georges Nko'ayissi, Eta Ngole Mbong, Wisal Nabag, Riham Desougi, Hadia Mustafa, Huida Eltaib, Taha Umbeli, Khalid Elfadl, Murwan Ibrahim, Abdalla Mohammed, Awadia Ali, Somia Abdelrahiem, Mohammed Musa, Khidir Awadalla, Samirra Ahmed, Mahdi Bushra, Omer Babiker, Hala Abdullahi, Mohamed Ahmed, Elhassan Safa, Huida Almardi, Duria Rayis, Saeed Abdelrahman Abdelgabar, Gillian Houghton, Andrew Sharpe, Jim Thornton, Nick Grace, Carys Smith, Kim Hinshaw, Dawn Edmundson, Paul Ayuk, Alison Bates, George Bugg, Joanne Wilkins, Clare Tower, Alysha Allibone, Eugene Oteng-Ntim, Ahmad Kazumari, Anna Danford, Matilda Ngarina, Muzdalifat Abeid, Khadija Mayumba, Magreth Zacharia, George Mtove, Leonard Madame, Anthony Massinde, Berno Mwambe, Rwakyendela Onesmo, Sebastian Kitengile Ganyaka, Shyam Gupta, Rabindra Bhatt, Ajay Agrawal, Pramila Pradhan, Nikita Dhakal, Punita Yadav, Gyanendra Karki, Bhola Ram Shrestha, Mwansa Lubeya, Jane Mumba, Willies Silwimba, Isaiah Hansingo, Noojiri Bopili, Ziche Makukula, Alexander Kawimbe, Mwansa Ketty Lubeya, Willard Mtambo, Mathew Ng'ambi, Saimir Cenameri, Ilir Tasha, Aferdita Kruja, Besnik Brahimaj, Armida Tola, Leon Kaza, Desire Tshombe, Elizabeth Buligho, Roger Paluku-Hamuli, Charles Kacha, Kato Faida, Badibanga Musau, Herman Kalyana, Phanny Simisi, Serge Mulyumba, Nzanzu Kikuhe Jason, Jean Robert Lubamba, Willis Missumba, Ferdousi Islam, Nazneen Begum, Ferdousi Chowdhury, Rokeya Begum, Farjana Basher, Nazlima Nargis, Abu Kholdun, Shahela Jesmin, Shrodha Paul, Hailemariam Segni, Getachew Ayana, William Haleke, Hassen Hussien, Fikre Geremew, Moussa Bambara, Adolphe Somé, Amadou Ly, Roamba Pabakba, Horace Fletcher, Leslie Samuels, Henry Opare-Addo, Roderick Larsen-Reindorf, Kwadwo Nyarko-Jectey, Glen Mola, Malts Wai, Magdy El Rahman, Wafaa Basta, Hussein Khamis, Maria Fernanda Escobar, Liliana Vallecilla, and Gabriel Essetchi Faye
Subjects: medicine.medical_specialty, Hysterectomy, business.industry, medicine.medical_treatment, Placebo-controlled study, General Medicine, 030204 cardiovascular system & hematology, Placebo, medicine.disease, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Relative risk, Anesthesia, Clinical endpoint, medicine, Caesarean section, Maternal death, 030212 general & internal medicine, business, Tranexamic acid, medicine.drug
Abstract: Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.
Published: 2017
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31. Twelve month follow-up of a contraceptive implant outreach service in rural Papua New Guinea

Author: John W. Bolnga, Sarika Gupta, Kirsten I. Black, Greg J. Jenkins, Wendy Stein, Philippa Ramsay, and Glen Mola
Subjects: Adult, Rural Population, Metrorrhagia, Adolescent, Pregnancy Rate, Dentistry, Levonorgestrel, Papua New Guinea, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Surveys and Questionnaires, Contraceptive Agents, Female, medicine, Humans, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, business.industry, Mortality rate, Obstetrics and Gynecology, New guinea, General Medicine, Middle Aged, Patient Acceptance of Health Care, medicine.disease, Outreach, Contraception, Cross-Sectional Studies, Patient Satisfaction, Delayed-Action Preparations, Female, Implant, Rural area, business, Contraceptive implant, Follow-Up Studies, Demography, Month follow up
Abstract: Background Poor access to contraception contributes to persistently high maternal mortality rates in Papua New Guinea (PNG). Since 2012 contraceptive implants have been provided to women in rural areas of PNG through outreach services but follow-up data in these communities on continuation and acceptability is lacking. Objective To gain insight into women's experience with contraceptive implants by assessing the acceptability, satisfaction, 12 month continuation rates and efficacy of contraceptive implants among women in rural PNG. Material and methods We undertook a cross-sectional survey of women in two rural provinces who had received a contraceptive implant at least 12 months prior using a structured questionnaire. We sought information on device continuation rates, satisfaction scores, side effects and failure rates. Results Of the 860 women surveyed, 97% (n = 836) still had the device in situ after 12 months and 92% (n = 793) were very happy with it. Seventy-six percent of women (n = 654) reported no side effects. Irregular bleeding was the most commonly reported side effect (n = 178, 20.6%) but only 7% (n = 13) said the bleeding was bothersome. Documented failure rates were 0.8% although pregnancy at the time of insertion could not be excluded in any of these cases. Conclusion Twelve month implant follow-up data in this study showed high continuation rates and high levels of satisfaction among a rural population in PNG. Implants have the potential to lower maternal morbidity and mortality and simultaneously address the unmet need for contraception in these communities.
Published: 2017
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32. Cancer of the cervix - The view from Australia's nearest neighbour

Author: Caroline de Costa and Glen Mola
Subjects: Oncology, medicine.medical_specialty, business.industry, Australia, Obstetrics and Gynecology, Nearest neighbour, Cancer, Uterine Cervical Neoplasms, General Medicine, medicine.disease, Papua New Guinea, medicine.anatomical_structure, Internal medicine, medicine, Humans, Female, business, Cervix
Published: 2020

33. Cancer control in the Pacific: big challenges facing small island states

Author: Diana Sarfati, Filipina Amosa-Lei Sam, Wendy Snowdon, Paula Vivili, Freddie Bray, Jane Skeen, Ineke Meredith, Kiki Maoate, Alec Ekeroma, James Fong, Neal A Palafox, Malama Tafuna'i, Viliami Puloka, Josephine Herman, Andrea Teng, Rachel Dyer, Michael Barton, Eka Buadromo, David A. K. Watters, Linda Huggins, Glen Mola, Hai Rim Shin, and Sunia Foliaki
Subjects: Commercial policy, Economic growth, Palliative care, business.industry, Palliative Care, Cancer, medicine.disease, Pacific Islands, Article, 03 medical and health sciences, Health services, 0302 clinical medicine, Oncology, Cancer control, 030220 oncology & carcinogenesis, Neoplasms, Cancer screening, medicine, Humans, 030212 general & internal medicine, Small Island Developing States, Natural disaster, business, Early Detection of Cancer
Abstract: This Series paper describes the current state of cancer control in Pacific island countries and territories (PICTs). PICTs are diverse but face common challenges of having small, geographically dispersed, isolated populations, with restricted resources, fragile ecological and economic systems, and overburdened health services. PICTs face a triple burden of infection-related cancers, rapid transition to lifestyle-related diseases, and ageing populations; additionally, PICTs are increasingly having to respond to natural disasters associated with climate change. In the Pacific region, cancer surveillance systems are generally weaker than those in high-income countries, and patients often present at advanced cancer stage. Many PICTs are unable to provide comprehensive cancer services, with some patients receiving cancer care in other countries where resources allow. Many PICTs do not have, or have poorly developed, cancer screening, pathology, oncology, surgical, and palliative care services, although some examples of innovative cancer planning, prevention, and treatment approaches have been developed in the region. To improve cancer outcomes, we recommend prioritising regional collaborative approaches, enhancing cervical cancer prevention, improving cancer surveillance and palliative care services, and developing targeted treatment capacity in the region.
Published: 2019

34. Outcomes of the novel Odon Device in indicated operative vaginal birth

Author: Emily J. Hotton, Erik Lenguerrand, Mary Alvarez, Stephen O’Brien, Tim J. Draycott, Joanna F. Crofts, Sabaratnam Arulkumaran, Nichola Bale, Natalie S. Blencowe, Timothy J. Draycott, Lily Exell, Anne Glover, Sally Hall, Helen Lewis-White, Naomi Mallinson, Michelle Mayer, Sadie McKeown-Keegan, Glen Mola, Alison Pike, Iona Smith, Claire Rose, Sherrie Villis, Julia Wade, Paul White, and Cathy Winter
Subjects: vacuum, Obstetrical Forceps, assisted vaginal birth, 0302 clinical medicine, Pregnancy, fetal compromise, management of second stage of labor, Fetal head, 030212 general & internal medicine, Original Research, 030219 obstetrics & reproductive medicine, medical device, Obstetrics, Obstetrics and Gynecology, Extraction, Obstetrical, Treatment Outcome, obstetric forceps, medicine.anatomical_structure, obstetrical forceps, Patient Satisfaction, Cuff, Equipment Failure, Female, Adult, safety, medicine.medical_specialty, Adolescent, prolonged second stage, Forceps, Ischial spine, prolonged second stage of labor, Young Adult, 03 medical and health sciences, medicine, Humans, Adverse effect, business.industry, Occiput, ventouse, Odon device, Obstetric Labor Complications, non-reassuring fetal heart tracing, Feasibility Studies, nonreassuring fetal heart tracing, business, intrapartum research, Follow-Up Studies, feasibility
Abstract: Background No new method of assisting vaginal birth has been introduced into clinical practice since the development of the vacuum extractor in the 1950s. The Odon Device is a new device that employs a circumferential air cuff over the fetal head to assist birth. In this study, the Odon Device has been used to assist vaginal birth for standard clinical indications. Objective This study aimed to investigate the clinical impact, safety, and acceptability of the Odon Device to women, their babies, and clinicians and to assess the feasibility of recruiting women to an interventional intrapartum research study. Study Design This is a nonrandomized, single-arm interventional feasibility study of the Odon Device for operative vaginal birth undertaken in a single maternity unit: Southmead Hospital, Bristol, United Kingdom. The Odon Device was used to assist birth in 40 women who required the birth to be assisted for suspected fetal compromise and/or prolonged second stage of labor. The primary clinical outcome was the proportion of births successfully assisted with the Odon Device, and the primary feasibility outcome was the proportion of eligible women who were approached and who agreed to participate. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Results Between October 2018 and January 2019, 298 of 384 approached, eligible women (77.6%) consented to participate. Of these women, 40 received the intervention—the use of the Odon Device. Birth was assisted in all cephalic (occiput anterior, occiput transverse, and occiput posterior) fetal positions, at all stations at or below the ischial spine and with or without regional analgesia. The Odon Device was effective in 19 of 40 cases (48%). Of the 40 births, 21 (52.5%) required additional assistance: 18 of 40 births (45%) were completed using nonrotational forceps, 1 of 40 births (3%) required rotational forceps, and 2 of 40 births (5%) required an emergency cesarean delivery. There was no serious maternal or neonatal adverse event related to the use of the device, and there was no serious adverse device effect. There were 4 devices (10%) that were ineffective because of a manufacturing fault. Furthermore, 39 of 40 women (98%) reported a high birth perception score. All practitioners were able to use the device as intended, although some steps in using the device were reported to be easier to perform (setup and deflation of air chamber) than others (application of the device and withdrawal of the applicator). Conclusion Recruitment to an interventional study of a new device for operative vaginal birth was feasible; 78% of eligible women were willing to participate, often expressing an aspiration for an alternative to forceps and vacuum. The success rate of the Odon Device was lower than reported success rates of vacuum and forceps; however, in this study, the device had been used to assist birth for standard clinical indications. There was no significant maternal or neonatal safety concern associated with the use of the device, although the number of births studied was small. Further feasibility study to establish iterative changes to the device, technique, and clinical indications is necessary.
Published: 2021
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35. Maternal and newborn health indicators in Papua New Guinea–2008–2018

Author: John Bolgna, Gianna Robbers, Joshua P. Vogel, Glen Mola, and Caroline S.E. Homer
Subjects: Adult, Male, Postnatal Care, newborns, prenatal, Maternal Health, Sexually Transmitted Diseases, Breastfeeding, Review Article, antenatal, Birth rate, Papua New Guinea, Young Adult, Pregnancy, Environmental health, Infant Mortality, Health care, parasitic diseases, Humans, Medicine, Infant Health, postpartum, Review Articles, HQ1-2044, maternal and neonatal health, business.industry, Infant, Newborn, Infant, Obstetrics and Gynecology, medicine.disease, Health indicator, Diseases of the genitourinary system. Urology, Infectious Disease Transmission, Vertical, Malaria, Low birth weight, Maternal Mortality, Standardized mortality ratio, Reproductive Medicine, The family. Marriage. Woman, Female, RC870-923, medicine.symptom, business
Abstract: © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Papua New Guinea (PNG) is the most populous country in the Pacific with more than 9 million people. Difficult terrain, poor roads and limited infrastructure mean providing effective health care–especially in rural areas, where most people live–is challenging. Women and newborns in PNG experience high rates of preventable morbidity and mortality; however, reliable data are often limited or unavailable. The aim of this paper is to provide an overview of research on key maternal and neonatal health (MNH) indicators conducted approximately over the past 11 years in PNG comparing research findings to global MNH estimates of the indicators. There was considerable variation in mortality indicators (maternal mortality ratio, neonatal mortality rate and stillbirth) reported across studies in PNG. Mortality was generally higher in rural areas. Rates of sexually transmitted infections (STIs) in pregnancy were consistently high, while anaemia in pregnancy, preterm birth and low birth weight varied widely between studies and settings. Breastfeeding seems to have been under-researched. There was a lack of data available on other indicators such as the adolescent birth rate, postnatal care provided to women and newborns, intermittent preventative treatment to prevent malaria in pregnancy and treatment to prevent mother-to-child transmission of HIV. Studies demonstrate the high burden of preventable maternal and newborn morbidity and mortality across PNG. Efforts to improve MNH outcomes need to be escalated.
Published: 2019

36. Use of assisted vaginal birth to reduce unnecessary caesarean sections and improve maternal and perinatal outcomes

Author: Arfang Faye, Josaphat Byamugisha, John Lule, Manuela Capelle, Jos van Roosmalen, Barbara Nolens, Thomas van den Akker, Glen Mola, APH - Quality of Care, APH - Global Health, and Athena Institute
Subjects: medicine.medical_specialty, Vacuum Extraction, Obstetrical, Vaginal birth, Perinatal care, MEDLINE, Developing country, Global Health, Pregnancy, medicine, Global health, Humans, Developing Countries, Perinatal Mortality, Obstetrics, Perinatal mortality, business.industry, Cesarean Section, Vacuum extraction, Infant, Newborn, Pregnancy Outcome, General Medicine, medicine.disease, Perinatal Care, Africa, Female, business, Risk Reduction Behavior
Published: 2018
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37. Youth-centred research to help prevent and mitigate the adverse health and social impacts of pregnancy amongst young Papua New Guineans

Author: Elissa Kennedy, John M. Kaldor, Stephen Bell, Lisa M Vallely, Kirsten I. Black, Caroline Ninnes, Angela Kelly-Hanku, Mary Bagita, Glen Mola, Andrew Vallely, and William Pomat
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Sexual Behavior, sexual health, Qualitative property, Health Promotion, Abortion, lcsh:RC870-923, maternal health, young people, 03 medical and health sciences, Papua New Guinea, Young Adult, 0302 clinical medicine, Pregnancy, Environmental health, health inequities, medicine, Humans, Maternal Health Services, 030212 general & internal medicine, reproductive health, Developing Countries, Reproductive health, youth, 030219 obstetrics & reproductive medicine, Adolescent pregnancy, lcsh:HQ1-2044, business.industry, Public health, Obstetrics and Gynecology, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Outreach, Maternal Mortality, Reproductive Medicine, Adolescent Behavior, lcsh:The family. Marriage. Woman, Pregnancy in Adolescence, Female, business, Psychology, qualitative research, Unintended pregnancy, Qualitative research
Abstract: Despite persistent international attention, adolescent pregnancy remains a major public health concern in low- and middle-income countries, like Papua New Guinea (PNG), where health inequities related to social and cultural norms, gender power imbalance, education and socio-economic deprivation affect young and unmarried women in particular. In PNG – where there is high adolescent fertility, high early childbearing and high maternal mortality ratio, and evidence of high rates of unintended pregnancy and abortion among young women – adolescent pregnancy is a policy priority. Yet there are no youth-specific sexual, reproductive and maternal health services or community-based outreach programmes. There is limited in-depth qualitative data on young women's and young men's experiences of pregnancy, the social contexts within which these pregnancies occur, young people's contraception practices and experiences with existing sexual, reproductive and maternal health services. These issues inhibit the design and delivery of youth-friendly health services and outreach support programmes that could prevent or mitigate adverse health and social outcomes associated with adolescent pregnancy. In this commentary article, we propose the need for novel youth-centred research to inform the development of policies, health services and outreach programmes that pay honest and respectful attention to young people's lived experiences of pregnancy. Whilst we focus on the situation in PNG, these ideas are relevant to diverse low resource settings where the harmful impacts of health inequities among young people persist and are particularly detrimental.
Published: 2018

38. Near-misses at the Port Moresby General Hospital: a descriptive study

Author: Glen Mola, Caroline de Costa, Apeawusu B. Amoa, Hilda Tanimia, and Skandarupan Jayaratnam
Subjects: Adult, Pediatrics, medicine.medical_specialty, Adolescent, Near Miss, Healthcare, Developing country, Audit, Near miss, Hospitals, General, Papua New Guinea, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Risk Factors, Humans, Medicine, Childbirth, Prospective Studies, 030212 general & internal medicine, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics, Attendance, Obstetrics and Gynecology, Prenatal Care, General Medicine, Stillbirth, medicine.disease, Pregnancy Complications, Maternal Mortality, Standardized mortality ratio, Female, business, Live Birth, Developed country
Abstract: Background The World Health Organization (WHO) defines ‘maternal near-miss’ as ‘a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of her pregnancy’. With declining rates of maternal mortality, near-miss analysis is being examined in both developed and developing country settings for the assessment of obstetric care. Aims Over a 15-month period, details of cases that could be classified as ‘near-misses’ were collected at Port Moresby General Hospital (PMGH), to assess the practicality of collecting such data routinely and determine near-miss rates for the hospital. Materials and Methods Information about all cases that fitted the WHO definition of ‘near-miss’ was collected prospectively. Results During the audit period, there were 13 338 live births at PMGH; 131 women presented with a life-threatening condition of whom 122 met WHO criteria for ‘maternal near-miss’; there were nine maternal deaths. The maternal mortality ratio was 67.5/100 000 live births, the maternal near-miss index ratio 9.1/1000 live births and the combination of maternal deaths and near-misses gave a severe maternal outcome ratio of 9.8/1000 live births. Main causes of the ‘near-misses’ were obstetric haemorrhage, hypertensive disorders and infections. Grandmultiparity, nulliparity, no antenatal attendance and age beyond 30 years were associated with maternal near-misses. Conclusion Assessment of near-misses equivalent to that provided in developed countries is possible in less well-resourced settings such as PMGH. Knowledge of causes of near-misses will assist health professionals to anticipate or prevent devastating maternal morbidities and thereby improve maternal and perinatal outcomes.
Published: 2016
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39. 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

Author: Yong Zhao, Hadi Danawi, Bach Xuan Tran, Gene Bukhman, Vasiliki Stathopoulou, Taavi Tillmann, Nelson Alvis-Guzman, Yongmei Li, Jerry Puthenpurakal Abraham, Sudan Prasad Neupane, Jack Caravanos, Ben Schöttker, Rafael Lozano, Damian G Hoy, Yoshihiro Kokubo, Nicholas J K Breitborde, Sergey Soshnikov, Yukito Shinohara, Randall V. Martin, Michael Brainin, Fernando Perez-Ruiz, Yingfeng Zheng, Santosh Mishra, Julio Cesar Montañez Hernandez, Michael Phillips, Belinda J. Gabbe, Hebe N. Gouda, Ziad A. Memish, Rupert R A Bourne, Guoqing Hu, Emmanuel A. Ameh, Abigail McLain, Michelle L. Bell, Christopher Margono, Marissa Iannarone, Wilkister N. Moturi, Donald H. Silberberg, Carl Abelardo T. Antonio, Nataliya Foigt, Anand Dayama, Yanping Wang, Amanda J. Mason-Jones, Bolajoko O. Olusanya, Monica S. Vavilala, Katherine B Gibney, David Tanne, Sidibe S Kany Roseline, Marcella Montico, Abhishek Singh, Sarah Derrett, Alireza Esteghamati, Seok Jun Yoon, Corine Karema, Rakhi Dandona, David M. Pereira, Kazem Rahimi, Gitanjali M. Singh, Vivekanand Jha, John Hornberger, Anne M. Riederer, Kathryn H. Jacobsen, Andrea Pedroza, Lily Alexander, Fiona M. Blyth, Tommi Vasankari, Kyle J Foreman, Rana J. Asghar, Tilahun Nigatu Haregu, Yousef Khader, Rafael Alfonso-Cristancho, Suzanne Barker-Collo, Lydia S. Atkins, Simerjot K. Jassal, Mohammad Ali Sahraian, Peter Scarborough, Hans W. Hoek, E. Ray Dorsey, Muluken Dessalegn, David C. Schwebel, Gavin Shaddick, Thomas D. Fleming, Mohammad Tavakkoli, Dorairaj Prabhakaran, Mohammad H. Forouzanfar, Christopher C. Mapoma, Jost B. Jonas, Erin C Mullany, Gene F. Kwan, Johanna M. Geleijnse, Antonio Luiz Pinho Ribeiro, Roberto Tchio Talongwa, Tolesa Bekele, Jed D. Blore, Gunn Marit Aasvang, Philimon Gona, Miguel Angel Alegretti, Babak Eshrati, Mitsuru Mukaigawara, Richard F. Gillum, Odgerel Chimed-Ochir, Ubai Alsharif, Richard C. Franklin, Felix Masiye, Richard T. Burnett, Sanjay Krishnaswami, Martin McKee, John J Huang, Lucía Cuevas-Nasu, Wagner Marcenes, Walid Ammar, Knud Juel, Joseph R. Zunt, Martha M Téllez Rojo, Mamta Swaroop, Noela M Prasad, Azmeraw T. Amare, Tim Driscoll, Michael Kravchenko, Heresh Amini, Amir Sapkota, Theo Vos, Charlotte Watts, Dennis Odai Laryea, D. Alex Quistberg, Justin Beardsley, Cheng Huang, Adnan M. Durrani, Sarah V Thackway, Rita Van Dingenen, Manami Inoue, Martha Híjar, Honglei Chen, Amany H. Refaat, Yichong Li, Vineet K. Chadha, Wenzhi Wang, Louisa Degenhardt, Kingsley N. Ukwaja, Nayu Ikeda, James D. Wilkinson, Linh N Bui, Maria Hagströmer, Gonghuan Yang, Ann Kristin Knudsen, David J. Margolis, Soewarta Kosen, Hans Kromhout, Atsushi Goto, Man Mohan Mehndiratta, Thomas N. Williams, Michael Soljak, Yun Jin Kim, Hideaki Toyoshima, Jeyaraj D Pandian, Borja del Pozo-Cruz, Soufiane Boufous, Ivy Shiue, Anders Larsson, Guilherme V. Polanczyk, John Powles, Yara A. Halasa, Robin Room, Ratilal Lalloo, Carolina Batis Ruvalcaba, Panniyammakal Jeemon, Elisabete Weiderpass, Jürgen Rehm, Ejaz Ahmad Khan, Alicia Aleman, Zacharie Tsala Dimbuene, Elena Alvarez, Rachelle Buchbinder, Randah R. Hamadeh, Bryan Hubbell, Sadaf G. Sepanlou, Farhad Islami, Costas A. Christophi, Heidi Stöckl, Ismael R. Campos-Nonato, Nigel Bruce, Edward J Mills, Samuel A L Perry, Taavi Lai, Baffour Awuah, Mete Saylan, Karen J. Courville, Arindam Basu, Vanessa De la Cruz-Góngora, Teresita González de Cosío, Naohiro Yonemoto, Frida Namnyak Ngalesoni, Muluken Azage Yenesew, Atte Meretoja, Michael Brauer, Cyrus Cooper, Giorgia Giussani, Valentina S. Arsic Arsenijevic, Vasiliy Victorovich Vlassov, André Karch, Leilei Duan, Matthew M Coates, Omid Ameli, Gelin Xu, Matthias Endres, Ganesan Karthikeyan, Ione Jayce Ceola Schneider, Mohamed Hsairi, Palwasha Anwari, Mazin J. Al Khabouri, Dariush Mozaffarian, Juan R. Sanabria, Pablo M. Lavados, Sumeet S. Chugh, Johan Ärnlöv, Ivo Rakovac, Maurice Giroud, Haidong Kan, Ibrahim Abdelmageem Mohamed Ginawi, José Luis Texcalac-Sangrador, Luigi Naldi, Erica Leigh Slepak, Deena Alasfoor, James E. Saunders, Richard Matzopoulos, Talal Bakfalouni, Stein Emil Vollset, Andrea Werdecker, Lennert J. Veerman, Lorenzo Monasta, Henrica A. F. M. Jansen, Reyna A Gutiérrez, Brittany Wurtz, Luz Maria Sanchez, Lijing L. Yan, M. Patrice Lindsay, Michele Meltzer, Sanjay Basu, Steven van de Vijver, Alaa Badawi, Thomas Claßen, Young-Ho Khang, Brett M. Kissela, Jun Zhu, In-Hwan Oh, Fiona J Charlson, Maria Cecilia Bahit, Dinorah González-Castell, Rosario Cárdenas, Dan Poenaru, Sayed Saidul Alam, Mitchell T. Wallin, Harish Chander Gugnani, James Leigh, Ferrán Catalá-López, Lidia Morawska, Jim van Os, Stephanie J. London, Kaire Innos, Isabelle Romieu, Fiorella Cavalleri, Adrian Davis, Hwee Pin Phua, Chakib Nejjari, Héctor Gómez Dantés, Boris I. Pavlin, Karen Sliwa, Lynne Gaffikin, Constance D. Pond, Michael F. MacIntyre, Blake Thomson, Norberto Perico, Ronny Westerman, Samantha M. Colquhoun, Michael H. Criqui, Ana Maria Nogales Vasconcelos, Wubegzier Mekonnen, Bulat Idrisov, Ana Basto-Abreu, Andrew G. M. Bulloch, Jasvinder A. Singh, Vinod K. Paul, Emin Murat Tuzcu, Svetlana Popova, Hmwe H Kyu, Richard L. Guerrant, Mohammed I. Albittar, Srikanth Mangalam, Steven E. Lipshultz, Lela Sturua, Semaw Ferede Abera, Eduardo Bernabé, George D. Thurston, Bruno F. Sunguya, Tiffany Ku, Alejandra G. Contreras, Abdullah Sulieman Terkawi, Charles Atkinson, Ashkan Afshin, Heidi J. Larson, Abdullatif Husseini, Jose C. Adsuar, Reza Assadi, Ademola Lukman Adelekan, Joshua A. Salomon, Yousef M. Elshrek, Gokalp Kadri Yentur, Devina Nand, Narayanaswamy Venketasubramanian, Graça Maria Ferreira De Lima, Maheswar Satpathy, Fotis Topouzis, Traolach S. Brugha, Hywel C Williams, Coen H. Van Gool, Andrew H. Kemp, Awoke Misganaw, Amado D Quezada, Norito Kawakami, Bert Brunekreef, Peter Burney, Tati S. 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Ding, Mukesh Dherani, Ljiljana Pejin Stokic, Vinay Nangia, Sukanta Saha, Juan Liang, Elisabeth Cardis, Zourkaleini Younoussi, José R Nogueira, Braden Te Ao, Vasco Manuel Pedro Machado, Lionel Racapé, Ting Wu Chuang, Shahab Khatibzadeh, E Filipa de Castro, Barthelemy Kuate Defo, Ulises Trujillo, Alan D. Lopez, Soraya Seedat, Lope H Barrero, Linhong Wang, Daniel Pope, Alexandra Brazinova, Faris Lami, Valentina Colistro, G Anil Kumar, Derek F J Fay, Haidong Wang, Hwashin H. Shin, Raimundas Lunevicius, Suzanne Polinder, Dietrich Plass, David Rojas-Rueda, Stephen S Lim, Tania G Sánchez-Pimienta, K.M. Venkat Narayan, Yuantao Hao, Jung-Chen Chang, Corina Benjet, Seyed-Mohammad Fereshtehnejad, Luciano A. Sposato, Stan Biryukov, Kunihiro Matsushita, Beth E. Ebel, Cleusa P. Ferri, Soumya Swaminathan, K. Ryan Wessells, Gustavo Velasquez-Melendez, Leslie T. Cooper, David O. Carpenter, Nancy Lopez, Bryan L. Sykes, Sandra Nolte, Murray B. Stein, Paul N. 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Erskine, Shireen Sindi, Arjun Lakshmana Balaji, Francesco Saverio Violante, Monika Sawhney, Alejandra Cantoral, Ketevan Goginashvili, Raghib Ali, Fan Jiang, Robert G. Weintraub, Homie Razavi, Myriam Tobollik, Howard Hu, Emerito Jose A. Faraon, Irma Khonelidze, Patricia M. Riccio, Eun-Kee Park, Julio Cesar Campuzano, Ibrahim Abubakar, Jürgen C Schmidt, Konstantinos Stroumpoulis, Aref A. Bin Abdulhak, Graeme J. Hankey, Natan M. Bornstein, Mouhanad Hammami, Lee Richardson, Rintaro Mori, Alanur Çavlin, Ruth W Kimokoti, Samir Soneji, Mark J. Nieuwenhuijsen, John Q. Wong, Joseph Frostad, Tom Achoki, Rahman Shiri, Ashish Bhalla, Kurt Straif, Simon I. Hay, Scott B. Patten, Kalpana Balakrishnan, Awoke Misganaw Temesgen, Chandrashekhar T Sreeramareddy, Ryan M Barber, Rosana E. Norman, JianLi Wang, Siyi Shangguan, Luke Nyakarahuka, Kovin Naidoo, Charles D. H. Parry, Mercedes Colomar, H. Ross Anderson, Carlos Magis-Rodriguez, Joan M. Nolla, Muhammad Imran Nisar, Karen Devries, Andrew L. Thorne-Lyman, Denis Nash, Marape Marape, Rajiv Chowdhury, Dima M. Qato, Luca Ronfani, Nobhojit Roy, Daniel Kim, Yuichiro Yano, Luke D. Knibbs, Margaret Robinson, Hilda L Harb, Rogelio Pérez-Padilla, Janet L Leasher, Jonathan L. Wright, Peter Brooks, Cristiana Abbafati, Belinda K Lloyd, Victor Aboyans, Nikhil Tandon, Charles R. Newton, Simón Barquera, Ted R. Miller, Kinnari S. Murthy, Habib Benzian, Glen Mola, Paulo A. Lotufo, Burcu Kucuk Bicer, Peggy Pei-Chia Chiang, Alexander Kraemer, Solomon Meseret Woldeyohannes, Saman Fahimi, Lesley Rushton, Kim Moesgaard Iburg, Vafa Rahimi-Movaghar, Logan Sandar, Bruce Neal, Teresa Shamah Levy, Karen M. Tabb, Jeffrey A. Towbin, Christopher J L Murray, Ramesh Sahathevan, Aaron Cohen, Chanda Kulkarni, Van C. Lansingh, François Alla, Tasara T. Mazorodze, Murugesan Raju, Saeid Shahraz, Uchechukwu K.A. Sampson, Rajeev Gupta, Neil Pearce, Mustafa Z. Younis, Veena S. Kulkarni, Francisco A García-Guerra, Amanda G. Thrift, Stefan Ma, Samaya Ismayilova, Evariste Gasana, Amitava Banerjee, Aslam Pervaiz, Emilie Agardh, Abraham D. Flaxman, Farshad Farzadfar, Peter W. Gething, Ileana Heredia-Pi, Boris Bikbov, Wanqing Chen, Saad B. Omer, Ruben Castro, Neeraj Bhala, Sara Sheikhbahaei, Hilton Lam, Urbano Fra Paleo, Lidia Sanchez-Riera, Alicia Elena Beatriz Lawrynowicz, Kristen Delwiche, Richard G. Ellenbogen, Max Petzold, Yuri Y Varakin, Guilherme Borges, Guohong Jiang, Francis Guillemin, Kyle R. Heuton, Yohannes Kinfu, Victoria F Bachman, Joseph A Wagner, Carlos A Castañeda-Orjuela, Leonardo Trasande, Abbas Ali Mahdi, Josef Coresh, Chuanhua Yu, Kenji Shibuya, Berrin Serdar, Laetitia Huiart, Xiaofeng Liang, Jean de Dieu Ngirabega, Takayoshi Ohkubo, Natalie Stephens, Francis Apolinary Mhimbira, Jefferson Traebert, Amiran Gamkrelidze, Kjetil Søreide, Samath D Dharmaratne, Robert P. Dellavalle, George Mugambage Ruhago, Lakshmi Vijayakumar, Joannie Lortet-Tieulent, Dipan Bose, Tania C Aburto, Saleem M Rana, Miriam Levi, Mohammad Taghi Hedayati, Rodolfo S Pagcatipunan, Ron T. Gansevoort, H. D. Hosgood, Michael Burch, Mohsen Naghavi, Vegard Skirbekk, Ayfer Pekericli, Walter Mendoza, Pengpeng Ye, Gabrielle deVeber, Ali H. Mokdad, David M. Broday, Koranteng Adofo, Zewdie Aderaw Alemu, Shifalika Goenka, Carrie Beth Peterson, Nicolas J. C. Stapelberg, Edson Serván-Mori, Anil Kaul, Foad Abd-Allah, Marek Majdan, Rahul Gupta, Giancarlo Logroscino, Kardiyoloji, Peterson, Carrie B., Laboratoire de Physique des Solides (LPS), Université Paris-Sud - Paris 11 (UP11)-Centre National de la Recherche Scientifique (CNRS), Wisconsin Division of Public Health, Laboratoire de psychologie sociale et de psychologie cognitive (LAPSCO), Centre National de la Recherche Scientifique (CNRS)-Université Blaise Pascal - Clermont-Ferrand 2 (UBP), Erosion torrentielle neige et avalanches (UR ETGR (ETNA)), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA), London South Bank University, Metropolitan Police Service, Hong Kong Baptist University (HKBU), Institut für Informatik [München/Munich] (LMU), Ludwig-Maximilians-Universität München (LMU), Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Insight Centre for Data Analytics [Galway] (INSIGHT), National University of Ireland [Galway] (NUI Galway), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Karolinska Institute, karolinska institute, Department of Molecular Biosciences, Department of Molecular Biosciences [Oslo], Faculty of Mathematics and Natural Sciences [Oslo], University of Oslo (UiO)-University of Oslo (UiO)-Faculty of Mathematics and Natural Sciences [Oslo], University of Oslo (UiO)-University of Oslo (UiO), Centro de Estudios Avanzados en Zonas Aridas (CEAZA), Ecole Polytechnique Fédérale de Lausanne (EPFL), Regional Genetic Service, St Mary's Hospital, Manchester, Laboratoire d'Ingénierie des Matériaux (LIM), Centre National de la Recherche Scientifique (CNRS), Computer Science Department [Bristol], University of Bristol [Bristol], Universität Mannheim [Mannheim], Lawrence Berkeley National Laboratory [Berkeley] (LBNL), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) (SRI-B), Computational Science and Engineering Department [Daresbury] (STFC), Science & Technologie Facilities Council, Multimedia Research Center (MRC), University of Alberta, Division of Biostatistics (Biostat - MINNEAPOLIS), University of Minnesota [Twin Cities], University of Minnesota System-University of Minnesota System, University of Southampton, Imperial College London, Neurology Department, Ichilov Medical Center, Interactions, transferts, ruptures artistiques et culturels - EA 6301 (InTRu), Université de Tours, Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Julius Center for Health Sciences and Primary Care, University Medical Center [Utrecht], Risk Assessment Sciences Institute, Utrecht University [Utrecht], Unité de Biologie Fonctionnelle et Adaptative (BFA (UMR_8251 / U1133)), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Respiratory Epidemiology and Public Health, Imperial College London-Royal Brompton Hospital-National Heart and Lung Institute [UK], CIBER de Epidemiología y Salud Pública (CIBERESP), STAR laboratory, Stanford University [Stanford], Unité de recherche Virologie et Immunologie Moléculaires (VIM), Institut National de la Recherche Agronomique (INRA), Tennent Institute of Ophthalmology, National University of Singapore (NUS), Centre de Robotique (CAOR), MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL), Multidisciplinary Nanotechnology Centre, Swansea University, Cyprus International Institute for the Environment and Public Health, Harvard School of Public Health, Genomics Research Center, Academia Sinica, Neuro Rehab Services LLP [New Delhi], Department of Signal Theory and Communications (TSC), Univ. Politec. de Catalunya, King‘s College London, Dept. Mat. Engn. De Ma, Sao Carlos, Fed. Univ. Sao Carlos UFSCar, RESPEC (RESPEC), RESPEC, Advanced Laboratories on Embedded Systems [Roma] (ALES), Department of Biology [Miami], University of Miami [Coral Gables], Health Care, Minister Of Labour-Ministry of Labor, Health and Social Affairs, Department of Nephrology, University Medical Center, University of Groningen, Division of Human Nutrition, Wageningen University and Research Centre [Wageningen] (WUR), Spatial Ecology and Epidemiology Group, University of Oxford [Oxford], College of Medicine, University of Hail, Saudi Arabia, Laboratory of Neurologic Diseases, Mario Negri Institute, Milan, Department of Civil Engineering [Hamirpur], National Institute of Technology [Hamirpur], GEMMA — Environmental Engineering and Microbiology Research Group, Department of Hydraulic, Maritime and Environmental Engineering, Universitat Politècnica de Catalunya [Barcelona] (UPC), Department of Biosciences and Nutrition, Karolinska Institutet [Stockholm], Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), Institut National de Recherche et d'Analyse Physico-chimique (Ariana, Tunisie) (INRAP), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences [Tehran] (SBUMS), Shahid Beheshti University-Shahid Beheshti University, Center for Applied Medical Research (CIMA), University of Tehran, Secretariat of the Pacific Community, Public Health Division, Sociétés, Acteurs, Gouvernement en Europe (SAGE), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), College of Precision Instrument and Optoelectronics Engineering, Tianjin University, George Washington University (GW), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Universiteit Gent [Ghent], Washington State University (WSU), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse 1 Capitole (UT1)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, School of Computer Science - China University of Geosciences (China University of Geosciences (East Area)), Centre de Recherche en Automatique de Nancy (CRAN), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Université Catholique de Louvain (UCL), Fachbereich Physik [Berlin], Freie Universität Berlin, Div Cyclotron & Radiopharmaceut Sci (DRDO, INMAS), Univ New Delhi, School of Physics and Astronomy, University of St Andrews [Scotland], University of Cape Town, Department of Neuroscience, Department of Computer Science and Engineering [Daejeon] (Chungnam National University), Lawrence University, Gastroenterology & Hepatology, Tata Research Development and Design Center (TRDDC), TCS Innovation Labs, University of Helsinki, Google Inc [Mountain View], Research at Google, Swedish Defense Research Agency (FOI), Servicio de Neurologia (SANTIAGO - Neurologie), Universidad del Desarrollo, Novartis Pharmaceutical Corporation, Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble [1985-2015] (OSUG [1985-2015]), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology [2007-2019] (Grenoble INP [2007-2019])-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology [2007-2019] (Grenoble INP [2007-2019])-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Department of Mechanical and Automation Engineering (CAD Laboratory), The Chinese University of Hong Kong [Hong Kong], Università degli studi di Bari, Department of Health and Human Services, National Institutes of Health [Bethesda] (NIH), Centre d'études et de recherche en informatique et communications (CEDRIC), Ecole Nationale Supérieure d'Informatique pour l'Industrie et l'Entreprise (ENSIIE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] (Heudiasyc), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), College of Information and Electrical Engineering [Beijing] (CIEE), China Agricultural University (CAU), Thales Research and Technology [Palaiseau], THALES, Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), Centre d'économie de la Sorbonne (CES), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), École supérieure du professorat et de l'éducation - Académie de Grenoble [2013-2019] (ESPE Grenoble [2013-2019]), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Department of Mathematics, University of Iowa [Iowa City], College of Medicine, Alfaisal University, Saudi Ministry of Health, Institut national des recherches agricoles du Bénin, Centre de Recherches agricoles du Sud, Departments of Epidemiology and Nutrition, Unit of Human Nutrition, Agricultural University of Athens, Department of Animal Science, Pennsylvania State University (Penn State), Penn State System-Penn State System, University of Virginia, University of Virginia [Charlottesville], Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS ‘‘Burlo Garofolo', Jet Propulsion Laboratory (JPL), NASA-California Institute of Technology (CALTECH), Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital [Boston], American University of Beirut [Beyrouth] (AUB), Department of Chemistry, Scientific Computing Research Unit, Department of dermatology, Milano University-Azienda Ospedaleria Ospedali Riuniti di Bergamo, Mailman School of Public Health, Columbia University [New York], The Georges Institute for International Health, The University of Sydney, Department of epidemiology and Public Health, Faculty of Medicine, Département Optique (OPT), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT), Laboratoire des signaux et systèmes (L2S), Université Paris-Sud - Paris 11 (UP11)-CentraleSupélec-Centre National de la Recherche Scientifique (CNRS), Universitat Pompeu Fabra [Barcelona], Center for Research in Environmental Epidemiology (CREAL), Universitat Pompeu Fabra [Barcelona]-Catalunya ministerio de salud, Nutriments Lipidiques et Prévention des Maladies Métaboliques, Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université de la Méditerranée - Aix-Marseille 2, Department of Neurology Lunds University Hospital Lund, Unit of Functional Bionanomaterials, School of Biosciences, University of Birmingham [Birmingham], Electrical Engineering and Computer Science Department - Case Western Reserve University, Case Western Reserve University [Cleveland], World Health Organization, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Nordic School of Public Health, The James Hutton Institute, Horia Hulubei National Institute for Physics and Nuclear Engineering, Department of Pediatrics, University of Washington [Seattle], Institute of Public Health, Department of Physics, Clarendon Laboratory, Center for TeleInFrastruktur (CTIF), Aalborg University [Denmark] (AAU), Physikalisches Institut [Freiburg], Albert-Ludwigs-Universität Freiburg, Savoirs, Textes, Langage (STL) - UMR 8163 (STL), Centre National de la Recherche Scientifique (CNRS)-Université de Lille, Dept.of Computer Science, Indian Institute of Technology Madras (IIT Madras), Istituto Mario Negri Bergamo, Centro Ricerche e Trapianti Villa Camozzi, Universidade Estadual Paulista Júlio de Mesquita Filho [São José do Rio Preto] (UNESP), Laboratoire de Génie Informatique et Ingénierie de Production (LGI2P), IMT - MINES ALES (IMT - MINES ALES), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Institut geològic de Catalunya (IGC), Institut Geològic de Catalunya-IGC, Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Physiologie et Génomique des Poissons (LPGP), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Recherche Agronomique (INRA), Politecnico di Milano [Milan] (POLIMI), Symantec, University of Oviedo, European Microsoft Innovation Center (EMIC), Microsoft Corporation [Redmond, Wash.], Technion - Israel Institute of Technology [Haifa], Laboratoire de Mécanique, Physique et Géosciences (LMPG), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU), Department of Physics, Cavendish Laboratory, University of Cambridge [UK] (CAM), Laboratoire de Probabilités et Modèles Aléatoires (LPMA), Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), Departments of Applied Physics [New Haven], Yale University [New Haven], Center for Mathematical Modeling (CMM), Department of Global Health and Development, London School of Hygiene and Tropical Medicine (LSHTM), University of Occupational and Environmental Health [Kitakyushu] (UEOH), Department of Computer Science and Engineering [New Delhi], Indian Institute of Technology Delhi (IIT Delhi), Institut de Recherche sur les Phénomènes Hors Equilibre (IRPHE), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), GlaxoSmithKline, Imperial College London-Clinical Imaging Center, Universidade Federal de Pernambuco [Recife] (UFPE), Maclean Building, Benson Lane, Crowmarsh Gifford, Centre for Ecology and Hydrology, Nanoscience Institute (NEST), Dipartimento di Fisica, Università di Pisa, Aristotle University of Thessaloniki, Laboratory Of Immune Cell Biology (LICB), JRC Institute for Environment and Sustainability (IES), European Commission - Joint Research Centre [Ispra] (JRC), Institute of Human Genetics, Rheinische Friedrich-Wilhelms-Universität Bonn, Laboratorio Nacional de Computação Cientifica [Rio de Janeiro] (LNCC / MCT), Occupational Health Unit, Bologna University Hospital-Sant'Orsola-Malpighi Polyclinic, Royal Institute of Technology [Stockholm] (KTH ), NICTA [Eveleigh], National ICT Australia [Sydney] (NICTA), Division of Solid Mechanics, Lund University [Lund], University of Calgary, BioWare Corp, Manchester Academic Health Sciences Centre, Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Ghent University [Belgium] (UGENT), Imaging Sciences and Biomedical Engineering Division [London], Guy's and St Thomas' Hospital [London]-King‘s College London, Children’s Hospital of Philadelphia (CHOP ), Perelman School of Medicine, University of Pennsylvania [Philadelphia], Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Génie Civil et Mécanique (GeM), Université de Nantes - Faculté des Sciences et des Techniques, Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Department of Physiology, Augusta University - Medical College of Georgia, University System of Georgia (USG)-University System of Georgia (USG), Neurorestoration Group, Wolfson Centre for Age-related Diseases-King‘s College London, Electronic Navigation Research Institute (ENRI), Ministry of Land, Infrastructure, Transport and Tourism, Department of Computer Science [KAIST] (CS), Korea Advanced Institute of Science and Technology (KAIST), Centre for Undergraduate Studies, University of the Punjab, Siemens Corporate Research, Siemens AG [Munich], University of Massachusetts [Boston] (UMass Boston), University of Massachusetts System (UMASS), Department of Materials Science, Sichuan University [Chengdu] (SCU), Natl Engn Res Ctr Vegetables, Key Lab Biol & Genet Improvement Hort Crops N Chi, Beijing Acad Agr & Forestry Sci, University Hospital Puerta de Hierro, Madrid, Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), MINES ParisTech - École nationale supérieure des mines de Paris-PSL Research University (PSL), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), Shahid Beheshti University of Medical Sciences, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), MOLTECH-ANJOU (MOLTECH-ANJOU), Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), Universidad de Santiago de Chile [Santiago] (USACH)-Universidad del Desarrollo, Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), École supérieure du professorat et de l'éducation - Académie de Grenoble (ESPE Grenoble), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Université Grenoble Alpes (UGA), California Institute of Technology (CALTECH)-NASA, Centre National de la Recherche Scientifique (CNRS)-CentraleSupélec-Université Paris-Sud - Paris 11 (UP11), Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique (INRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Institut National de la Recherche Agronomique (INRA)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Universidad de Santiago de Chile [Santiago] (USACH), École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), King‘s College London-Wolfson Centre for Age-related Diseases, Sichuan University, Universitat de Barcelona, Interne Geneeskunde, Medische Sociologie, MUMC+: MA Psychiatrie (3), MUMC+: Hersen en Zenuw Centrum (3), Psychiatrie & Neuropsychologie, CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology [2007-2019] (Grenoble INP [2007-2019])-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology [2007-2019] (Grenoble INP [2007-2019])-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Institut Mines-Télécom [Paris] (IMT)-Télécom Bretagne-Université européenne de Bretagne - European University of Brittany (UEB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), RS: MHeNs - R2 - Mental Health, Laboratoire de Physique des Solides ( LPS ), Université Paris-Sud - Paris 11 ( UP11 ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire de psychologie sociale et de psychologie cognitive ( LAPSCO ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Centre National de la Recherche Scientifique ( CNRS ), Erosion torrentielle neige et avalanches ( UR ETGR ), Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture ( IRSTEA ), Hong Kong Baptist University ( HKBU ), Institut für Informatik [München/Munich] ( LMU ), Ludwig-Maximilians-Universität München, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Insight Centre for Data Analytics (National University of Ireland Galway (NUIG)) ( INSIGHT ), Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), University of Oslo ( UiO ) -University of Oslo ( UiO ), Centro de Estudios Avanzados en Zonas Aridas ( CEAZA ), Ecole Polytechnique Fédérale de Lausanne ( EPFL ), Laboratoire d'Ingénierie des Matériaux ( LIM ), Centre National de la Recherche Scientifique ( CNRS ), Lawrence Berkeley National Laboratory [Berkeley] ( LBNL ), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) ( SRI-B ), Computational Science and Engineering Department [Daresbury] ( STFC ), Multimedia Research Center ( MRC ), University of Alberta [Edmonton], Division of Biostatistics ( Biostat - MINNEAPOLIS ), University of Minnesota [Minneapolis], University of Southampton [Southampton], Interactions, transferts, ruptures artistiques et culturels - EA 6301 ( InTRu ), Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), University Medical Center Utrecht, Biologie Fonctionnelle et Adaptative ( BFA ), Imperial College London-Royal Brompton Hospital-National Heart and Lung Institute, Unité de recherche Virologie et Immunologie Moléculaires ( VIM ), Institut National de la Recherche Agronomique ( INRA ), National University of Singapore ( NUS ), Centre de Robotique ( CAOR ), MINES ParisTech - École nationale supérieure des mines de Paris-PSL Research University ( PSL ), Department of Signal Theory and Communications ( TSC ), RESPEC ( RESPEC ), Advanced Laboratories on Embedded Systems [Roma] ( ALES ), Wageningen University and Research Centre [Wageningen] ( WUR ), Universitat Politècnica de Catalunya [Barcelona] ( UPC ), Institut National de Recherche et d'Analyse Physico-Chimique ( INRAP ), Institut National de Recherche et d'Analyse Physico-chimique (INRAP-Tunisie), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) ( FEMTO-ST ), Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Ecole Nationale Supérieure de Mécanique et des Microtechniques ( ENSMM ) -Université de Technologie de Belfort-Montbeliard ( UTBM ), Tehran University, Sociétés, Acteurs, Gouvernement en Europe ( SAGE ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM - U912 INSERM - AMU - IRD ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Washington State University ( WSU ), Laboratoire de Physique de l'ENS Lyon ( Phys-ENS ), École normale supérieure - Lyon ( ENS Lyon ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Institut des Sciences Chimiques de Rennes ( ISCR ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Ecole Nationale Supérieure de Chimie de Rennes-Institut National des Sciences Appliquées ( INSA ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en informatique de Toulouse ( IRIT ), Institut National Polytechnique [Toulouse] ( INP ) -Université Toulouse 1 Capitole ( UT1 ) -Université Toulouse - Jean Jaurès ( UT2J ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique ( CNRS ), Centre de Recherche en Automatique de Nancy ( CRAN ), Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Université Catholique de Louvain ( UCL ), Freie Universität Berlin [Berlin], Div Cyclotron & Radiopharmaceut Sci ( DRDO, INMAS ), Institut de Physique Nucléaire d'Orsay ( IPNO ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Tata Research Development and Design Center ( TRDDC ), Laboratoire MOLTECH-Anjou [Angers] ( MOLTECH ANJOU ), Université d'Angers ( UA ) -Centre National de la Recherche Scientifique ( CNRS ), University of Helsinki [Helsinki], Swedish Defense Research Agency ( FOI ), Servicio de Neurologia ( SANTIAGO - Neurologie ), Universidad de Santiago de Chile [Santiago] ( USACH ) -Universidad del Desarrollo, Novartis Pharmaceutical Corp., East Hanover NJ 07936, USA, Laboratoire de glaciologie et géophysique de l'environnement ( LGGE ), Observatoire des Sciences de l'Univers de Grenoble ( OSUG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ), Department of Mechanical and Automation Engineering ( CAD Laboratory ), National Institutes of Health ( NIH ), Centre d'étude et de recherche en informatique et communications ( CEDRIC ), Ecole Nationale Supérieure d'Informatique pour l'Industrie et l'Entreprise ( ENSIIE ) -Conservatoire National des Arts et Métiers [CNAM] ( CNAM ), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] ( Heudiasyc ), Université de Technologie de Compiègne ( UTC ) -Centre National de la Recherche Scientifique ( CNRS ), College of Information and Electrical Engineering [Beijing] ( CIEE ), China Agricultural University ( CAU ), Queen Mary University of London ( QMUL ), Centre d'économie de la Sorbonne ( CES ), Université Panthéon-Sorbonne ( UP1 ) -Centre National de la Recherche Scientifique ( CNRS ), Paris School of Economics ( PSE ), École supérieure du professorat et de l'éducation - Académie de Grenoble ( ESPE Grenoble ), Université Savoie Mont Blanc ( USMB [Université de Savoie] [Université de Chambéry] ) -Université Grenoble Alpes ( UGA ), PennState University [Pennsylvania] ( PSU ), Jet Propulsion Laboratory ( JPL ), NASA-California Institute of Technology ( CALTECH ), American University of Beirut [Beyrouth], The University of Sydney [Sydney], Département Optique ( OPT ), Université européenne de Bretagne ( UEB ) -Télécom Bretagne-Institut Mines-Télécom [Paris], Laboratoire des signaux et systèmes ( L2S ), Université Paris-Sud - Paris 11 ( UP11 ) -CentraleSupélec-Centre National de la Recherche Scientifique ( CNRS ), Center for Research in Environmental Epidemiology ( CREAL ), Université de la Méditerranée - Aix-Marseille 2-Institut National de la Recherche Agronomique ( INRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Center for TeleInFrastruktur ( CTIF ), Aalborg University [Denmark] ( AAU ), Savoirs, Textes, Langage (STL) - UMR 8163 ( STL ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Indian Institute of Technology Madras ( IIT Madras ), Universidade Estadual Paulista Júlio de Mesquita ( UNESP ), Laboratoire de Génie Informatique et Ingénierie de Production ( LGI2P ), IMT - Mines Alès Ecole Mines - Télécom ( IMT - MINES ALES ), Institut geològic de Catalunya ( IGC ), Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Laboratoire de Physiologie et Génomique des Poissons ( LPGP ), Institut National de la Recherche Agronomique ( INRA ) -Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Politecnico di Milano [Milan], European Microsoft Innovation Center ( EMIC ), Laboratoire de Mécanique, Physique et Géosciences ( LMPG ), Université Le Havre Normandie ( ULH ), Normandie Université ( NU ) -Normandie Université ( NU ), University of Cambridge [UK] ( CAM ), Laboratoire de Probabilités et Modèles Aléatoires ( LPMA ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Génétique et de Biologie Moléculaire et Cellulaire ( IGBMC ), Université de Strasbourg ( UNISTRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Center for Mathematical Modeling ( CMM ), Universidad de Santiago de Chile [Santiago] ( USACH ), London School of Hygiene and Tropical Medicine ( LSHTM ), University of Occupational and Environmental Health [Kitakyushu] ( UEOH ), Indian Institute of Technology Delhi ( IIT Delhi ), Institut de Recherche sur les Phénomènes Hors Equilibre ( IRPHE ), Aix Marseille Université ( AMU ) -Ecole Centrale de Marseille ( ECM ) -Centre National de la Recherche Scientifique ( CNRS ), Universidade Federal de Pernambuco [Recife] ( UFPE ), Nanoscience Institute ( NEST ), Laboratory Of Immune Cell Biology ( LICB ), JRC Institute for Environment and Sustainability ( IES ), European Commission - Joint Research Centre [Ispra] ( JRC ), Bonn Universität [Bonn], Laboratorio Nacional de Computação Cientifica [Rio de Janeiro] ( LNCC / MCT ), Royal Institute of Technology [Stockholm] ( KTH ), National ICT Australia [Sydney] ( NICTA ), Institut d'Histoire et de Philosophie des Sciences et des Techniques ( IHPST ), Université Panthéon-Sorbonne ( UP1 ) -Département d'Etudes Cognitives - ENS Paris ( DEC ), École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ), Ghent University [Belgium] ( UGENT ), Children’s Hospital of Philadelphia ( CHOP ), Univeristy of Pennsylvania Medical School, Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique ( LHEEA ), École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Génie Civil et Mécanique ( GeM ), Université de Nantes ( UN ) -École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Medical College of Georgia, Electronic Navigation Research Institute ( ENRI ), Department of Computer Science [KAIST] ( CS ), Korea Advanced Institute of Science and Technology ( KAIST ), Laboratoire de l'Accélérateur Linéaire ( LAL ), University of Massachusetts [Boston] ( UMass Boston ), Forouzanfar, Mohammad H, Alexander, Lily, Anderson, H. Ro, Bachman, Victoria F, Biryukov, Stan, Brauer, Michael, Burnett, Richard, Casey, Daniel, Coates, Matthew M, Cohen, Aaron, Delwiche, Kristen, Estep, Kara, Frostad, Joseph J, Kc, Astha, Kyu, Hmwe H, Moradi Lakeh, Maziar, Ng, Marie, Slepak, Erica Leigh, Thomas, Bernadette A, Wagner, Joseph, Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd Allah, Foad, Abera, Semaw F, Aboyans, Victor, Abraham, Biju, Abraham, Jerry Puthenpurakal, Abubakar, Ibrahim, Abu Rmeileh, Niveen M. E, Aburto, Tania C, Achoki, Tom, Adelekan, Ademola, Adofo, Koranteng, Adou, Arsène K, Adsuar, José C, Afshin, Ashkan, Agardh, Emilie E, Al Khabouri, Mazin J, Al Lami, Faris H, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Aleman, Alicia V, Alemu, Zewdie A, Alfonso Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Ali, Mohammed K, Alla, Françoi, Allebeck, Peter, Allen, Peter J, Alsharif, Ubai, Alvarez, Elena, Alvis Guzman, Nelson, Amankwaa, Adansi A, Amare, Azmeraw T, Ameh, Emmanuel A, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O, Antonio, Carl Abelardo T, Anwari, Palwasha, Cunningham, Solveig Argeseanu, Arnlöv, Johan, Arsenijevic, Valentina S. Arsic, Artaman, Al, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S, Atkinson, Charle, Avila, Marco A, Awuah, Baffour, Badawi, Alaa, Bahit, Maria C, Bakfalouni, Talal, Balakrishnan, Kalpana, Balalla, Shivanthi, Balu, Ravi Kumar, Banerjee, Amitava, Barber, Ryan M, Barker Collo, Suzanne L, Barquera, Simon, Barregard, Lar, Barrero, Lope H, Barrientos Gutierrez, Tonatiuh, Basto Abreu, Ana C, Basu, Arindam, Basu, Sanjay, Basulaiman, Mohammed O, Ruvalcaba, Carolina Bati, Beardsley, Justin, Bedi, Neeraj, Bekele, Tolesa, Bell, Michelle L, Benjet, Corina, Bennett, Derrick A, Benzian, Habib, Bernabé, Eduardo, Beyene, Tariku J, Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar A, Bikbov, Bori, Abdulhak, Aref A. Bin, Blore, Jed D, Blyth, Fiona M, Bohensky, Megan A, Başara, Berrak Bora, Borges, Guilherme, Bornstein, Natan M, Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J, Brenner, Hermann, Briggs, Adam D. M, Broday, David M, Brooks, Peter M, Bruce, Nigel G, Brugha, Traolach S, Brunekreef, Bert, Buchbinder, Rachelle, Bui, Linh N, Bukhman, Gene, Bulloch, Andrew G, Burch, Michael, Burney, Peter G. J, Campos Nonato, Ismael R, Campuzano, Julio C, Cantoral, Alejandra J, Caravanos, Jack, Cárdenas, Rosario, Cardis, Elisabeth, Carpenter, David O, Caso, Valeria, Castañeda Orjuela, Carlos A, Castro, Ruben E, Catalá López, Ferrán, Cavalleri, Fiorella, Çavlin, Alanur, Chadha, Vineet K, Chang, Jung Chen, Charlson, Fiona J, Chen, Honglei, Chen, Wanqing, Chen, Zhengming, Chiang, Peggy P, Chimed Ochir, Odgerel, Chowdhury, Rajiv, Christophi, Costas A, Chuang, Ting Wu, Chugh, Sumeet S, Cirillo, Massimo, Claßen, Thomas Kd, Colistro, Valentina, Colomar, Mercede, Colquhoun, Samantha M, Contreras, Alejandra G, Cooper, Cyru, Cooperrider, Kimberly, Cooper, Leslie T, Coresh, Josef, Courville, Karen J, Criqui, Michael H, Cuevas Nasu, Lucia, Damsere Derry, Jame, Danawi, Hadi, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I, Davis, Adrian, Davitoiu, Dragos V, Dayama, Anand, de Castro, E. Filipa, De la Cruz Góngora, Vanessa, De Leo, Diego, de Lima, Graça, Degenhardt, Louisa, Del Pozo Cruz, Borja, Dellavalle, Robert P, Deribe, Kebede, Derrett, Sarah, Jarlais, Don C. De, Dessalegn, Muluken, Deveber, Gabrielle A, Devries, Karen M, Dharmaratne, Samath D, Dherani, Mukesh K, Dicker, Daniel, Ding, Eric L, Dokova, Klara, Dorsey, E. Ray, Driscoll, Tim R, Duan, Leilei, Durrani, Adnan M, Ebel, Beth E, Ellenbogen, Richard G, Elshrek, Yousef M, Endres, Matthia, Ermakov, Sergey P, Erskine, Holly E, Eshrati, Babak, Esteghamati, Alireza, Fahimi, Saman, Faraon, Emerito Jose A, Farzadfar, Farshad, Fay, Derek F. J, Feigin, Valery L, Feigl, Andrea B, Fereshtehnejad, Seyed Mohammad, Ferrari, Alize J, Ferri, Cleusa P, Flaxman, Abraham D, Fleming, Thomas D, Foigt, Nataliya, Foreman, Kyle J, Paleo, Urbano Fra, Franklin, Richard C, Gabbe, Belinda, Gaffikin, Lynne, Gakidou, Emmanuela, Gamkrelidze, Amiran, Gankpé, Fortuné G, Gansevoort, Ron T, García Guerra, Francisco A, Gasana, Evariste, Geleijnse, Johanna M, Gessner, Bradford D, Gething, Pete, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim A. M, Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goginashvili, Ketevan, Dantes, Hector Gomez, Gona, Philimon, de Cosio, Teresita Gonzalez, González Castell, Dinorah, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Guerrant, Richard L, Gugnani, Harish C, Guillemin, Franci, Gunnell, David, Gupta, Rahul, Gupta, Rajeev, Gutiérrez, Reyna A, Hafezi Nejad, Nima, Hagan, Holly, Hagstromer, Maria, Halasa, Yara A, Hamadeh, Randah R, Hammami, Mouhanad, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Haregu, Tilahun Nigatu, Haro, Josep Maria, Havmoeller, Rasmu, Hay, Simon I, Hedayati, Mohammad T, Heredia Pi, Ileana B, Hernandez, Lucia, Heuton, Kyle R, Heydarpour, Pouria, Hijar, Martha, Hoek, Hans W, Hoffman, Howard J, Hornberger, John C, Hosgood, H. Dean, Hoy, Damian G, Hsairi, Mohamed, Hu, Guoqing, Hu, Howard, Huang, Cheng, Huang, John J, Hubbell, Bryan J, Huiart, Laetitia, Husseini, Abdullatif, Iannarone, Marissa L, Iburg, Kim M, Idrisov, Bulat T, Ikeda, Nayu, Innos, Kaire, Inoue, Manami, Islami, Farhad, Ismayilova, Samaya, Jacobsen, Kathryn H, Jansen, Henrica A, Jarvis, Deborah L, Jassal, Simerjot K, Jauregui, Alejandra, Jayaraman, Sudha, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Fan, Jiang, Guohong, Jiang, Ying, Jonas, Jost B, Juel, Knud, Kan, Haidong, Roseline, Sidibe S. Kany, Karam, Nadim E, Karch, André, Karema, Corine K, Karthikeyan, Ganesan, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S, Kemp, Andrew H, Kengne, Andre P, Keren, Andre, Khader, Yousef S, Khalifa, Shams Eldin Ali Hassan, Khan, Ejaz A, Khang, Young Ho, Khatibzadeh, Shahab, Khonelidze, Irma, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kim, Yunjin, Kimokoti, Ruth W, Kinfu, Yohanne, Kinge, Jonas M, Kissela, Brett M, Kivipelto, Miia, Knibbs, Luke D, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kose, M. Rifat, Kosen, Soewarta, Kraemer, Alexander, Kravchenko, Michael, Krishnaswami, Sanjay, Kromhout, Han, Ku, Tiffany, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kulkarni, Chanda, Kulkarni, Veena S, Kumar, G. Anil, Kwan, Gene F, Lai, Taavi, Balaji, Arjun Lakshmana, Lalloo, Ratilal, Lallukka, Tea, Lam, Hilton, Lan, Qing, Lansingh, Van C, Larson, Heidi J, Larsson, Ander, Laryea, Dennis O, Lavados, Pablo M, Lawrynowicz, Alicia E, Leasher, Janet L, Lee, Jong Tae, Leigh, Jame, Leung, Ricky, Levi, Miriam, Li, Yichong, Li, Yongmei, Liang, Juan, Liang, Xiaofeng, Lim, Stephen S, Lindsay, M. Patrice, Lipshultz, Steven E, Liu, Shiwei, Liu, Yang, Lloyd, Belinda K, Logroscino, Giancarlo, London, Stephanie J, Lopez, Nancy, Lortet Tieulent, Joannie, Lotufo, Paulo A, Lozano, Rafael, Lunevicius, Raimunda, Ma, Jixiang, Ma, Stefan, Machado, Vasco M. P, Macintyre, Michael F, Magis Rodriguez, Carlo, Mahdi, Abbas A, Majdan, Marek, Malekzadeh, Reza, Mangalam, Srikanth, Mapoma, Christopher C, Marape, Marape, Marcenes, Wagner, Margolis, David J, Margono, Christopher, Marks, Guy B, Martin, Randall V, Marzan, Melvin B, Mashal, Mohammad T, Masiye, Felix, Mason Jones, Amanda J, Matsushita, Kunihiro, Matzopoulos, Richard, Mayosi, Bongani M, Mazorodze, Tasara T, Mckay, Abigail C, Mckee, Martin, Mclain, Abigail, Meaney, Peter A, Medina, Catalina, Mehndiratta, Man Mohan, Mejia Rodriguez, Fabiola, Mekonnen, Wubegzier, Melaku, Yohannes A, Meltzer, Michele, Memish, Ziad A, Mendoza, Walter, Mensah, George A, Meretoja, Atte, Mhimbira, Francis Apolinary, Micha, Renata, Miller, Ted R, Mills, Edward J, Misganaw, Awoke, Mishra, Santosh, Ibrahim, Norlinah Mohamed, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L, Monasta, Lorenzo, Hernandez, Julio C. Montañez, Montico, Marcella, Moore, Ami R, Morawska, Lidia, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N, Mozaffarian, Dariush, Mueller, Ulrich O, Mukaigawara, Mitsuru, Mullany, Erin C, Murthy, Kinnari S, Naghavi, Mohsen, Nahas, Ziad, Naheed, Aliya, Naidoo, Kovin S, Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, Km Venkat, Nash, Deni, Neal, Bruce, Nejjari, Chakib, Neupane, Sudan P, Newton, Charles R, Ngalesoni, Frida N, de Dieu Ngirabega, Jean, Nguyen, Grant, Nguyen, Nhung T, Nieuwenhuijsen, Mark J, Nisar, Muhammad I, Nogueira, José R, Nolla, Joan M, Nolte, Sandra, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nyakarahuka, Luke, Oh, In Hwan, Ohkubo, Takayoshi, Olusanya, Bolajoko O, Omer, Saad B, Opio, John Nelson, Orozco, Ricardo, Pagcatipunan, Rodolfo S, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Papachristou, Christina, Park, Eun Kee, Parry, Charles D, Caicedo, Angel J. Paternina, Patten, Scott B, Paul, Vinod K, Pavlin, Boris I, Pearce, Neil, Pedraza, Lilia S, Pedroza, Andrea, Stokic, Ljiljana Pejin, Pekericli, Ayfer, Pereira, David M, Perez Padilla, Rogelio, Perez Ruiz, Fernando, Perico, Norberto, Perry, Samuel A. L, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B, Petzold, Max, Phillips, Michael R, Phua, Hwee Pin, Plass, Dietrich, Poenaru, Dan, Polanczyk, Guilherme V, Polinder, Suzanne, Pond, Constance D, Pope, C. Arden, Pope, Daniel, Popova, Svetlana, Pourmalek, Farshad, Powles, John, Prabhakaran, Dorairaj, Prasad, Noela M, Qato, Dima M, Quezada, Amado D, Quistberg, D. Alex A, Racapé, Lionel, Rafay, Anwar, Rahimi, Kazem, Rahimi Movaghar, Vafa, Rahman, Sajjad Ur, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Rao, Mayuree, Razavi, Homie, Reddy, K. Srinath, Refaat, Amany H, Rehm, Jürgen, Remuzzi, Giuseppe, Ribeiro, Antonio L, Riccio, Patricia M, Richardson, Lee, Riederer, Anne, Robinson, Margaret, Roca, Anna, Rodriguez, Alina, Rojas Rueda, David, Romieu, Isabelle, Ronfani, Luca, Room, Robin, Roy, Nobhojit, Ruhago, George M, Rushton, Lesley, Sabin, Nsanzimana, Sacco, Ralph L, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Salomon, Joshua A, Salvo, Deborah, Sampson, Uchechukwu K, Sanabria, Juan R, Sanchez, Luz Maria, Sánchez Pimienta, Tania G, Sanchez Riera, Lidia, Sandar, Logan, Santos, Itamar S, Sapkota, Amir, Satpathy, Maheswar, Saunders, James E, Sawhney, Monika, Saylan, Mete I, Scarborough, Peter, Schmidt, Jürgen C, Schneider, Ione J. C, Schöttker, Ben, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Serdar, Berrin, Servan Mori, Edson E, Shaddick, Gavin, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shibuya, Kenji, Shin, Hwashin H, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stapelberg, Nicolas J. 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Subjects: Male, Fine particulate matter, Nutrition and Disease, MESH : Sanitation, Health Behavior, Diseases, MESH: Metabolic Diseases, MESH: Global Health, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Global Health, MESH : Nutritional Status, MESH: Occupational Exposure, 0302 clinical medicine, Unsafe Sex, MESH: Risk Factors, Risk Factors, Voeding en Ziekte, Medicine, Air-pollution, MESH : Female, 030212 general & internal medicine, MESH : Risk Assessment, Sanitation, Wasting, 2. Zero hunger, Factors de risc en les malalties, Medicine (all), [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, MESH : Occupational Diseases, MESH: Nutritional Status, All-cause mortality, MESH : Risk Factors, humanities, Environmental Exposure, Female, Humans, Metabolic Diseases, Nutritional Status, Occupational Diseases, Occupational Exposure, Risk Assessment, Tobacco smoking, 3. Good health, Nutritional Statu, MESH : Occupational Exposure, MESH : Metabolic Diseases, Cohort, medicine.symptom, Risk assessment, Blood-pressure, Human, MESH: Occupational Diseases, Risk factors in diseases, Coronary-heart-disease, MESH : Male, MESH: Health Behavior, MESH: Environmental Exposure, Population health, Body-mass index, 03 medical and health sciences, Household cooking, Cardiovascular-disease, Environmental health, General & Internal Medicine, parasitic diseases, Life Science, MESH: Sanitation, Risk factor, MESH : Health Behavior, VLAG, GBD2013, MESH: Humans, business.industry, Risk Factor, Global Burden of Disease Study, 79 behavioural, environmental and occupational, and metabolic risks, Long-term exposure, MESH : Humans, CAUSE-SPECIFIC MORTALITY, MESH: Male, Metabolic Disease, Occupational Disease, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, MALE BRITISH DOCTORS, Years of potential life lost, Relative risk, Malalties, MESH : Global Health, OUTDOOR AIR-POLLUTION, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH : Environmental Exposure, MESH: Female
Abstract: Summary 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 metaregression 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. Background The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the fi rst of a series of annual updates of the GBD. Risk factor quantifi cation, particularly of modifi able 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 fi rst 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 fi ltration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression 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.
Published: 2015
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40. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013

Author: Meghan D. Mooney, Ken Takahashi, Andrea Stewart, Jonathan C Brown, Shireen Sindi, Amany H Refaat, Ruben Castro, Sara Sheikhbahaei, Kyle R. Heuton, Gillian M. Hansen, Chante Karimkhani, Bryan K. Phillips, Ibrahim Abubakar, Yohannes Kinfu, Victoria F Bachman, Konstantinos Stroumpoulis, Megan Coggeshall, Lucía Cuevas-Nasu, Yichong Li, Vineet K. Chadha, Andrew G. M. Bulloch, Takayoshi Ohkubo, Don C. Des Jarlais, Giancarlo Logroscino, Francis Apolinary Mhimbira, Jefferson G Fernandes, Cheng Huang, Ejaz Ahmad Khan, Fortuné Gbètoho Gankpé, Roderick J Hay, Itamar S. Santos, Zanfina Ademi, Fiona J Charlson, Norlinah Mohamed Ibrahim, Anwar Rafay, Andrew L. Thorne-Lyman, Juanita A. Haagsma, Emmanuel A. Ameh, John J. McGrath, Massimo Cirillo, Wubegzier Mekonnen, Holly Hagan, Naohiro Yonemoto, Frida Namnyak Ngalesoni, Dietrich Plass, Matias Trillini, David Phillips, Braden Te Ao, Wanqing Chen, Yun Jin Kim, David Rojas-Rueda, Christina Papachristou, Andrew E. Moran, Richard A. Gosselin, Maziar Moradi-Lakeh, Soraya Seedat, Janet L Leasher, Belinda K Lloyd, Lorenzo Monasta, Bruno F. Sunguya, Eun-Kee Park, Eduardo A. Undurraga, Mohammad A. AlMazroa, Mohammad H. Forouzanfar, Young-Ho Khang, Vasiliki Stathopoulou, Dima M. Qato, James Scott, Ileana Heredia-Pi, Luca Ronfani, Haidong Kan, Tasara T. Mazorodze, Murugesan Raju, Saeid Shahraz, Taavi Tillmann, Wang Wenzhi, Neil Pearce, Eric Y. Tenkorang, Aliya Naheed, Ferrán Catalá-López, Sudan Prasad Neupane, Emily Dansereau, Michael McKee, Derrick A Bennett, Mazeda Hossain, Paul S. F. Yip, Grant Nguyen, Norberto Perico, Miguel Angel Alegretti, Babak Eshrati, Boris Bikbov, Palwasha Anwari, Guoqing Hu, Amelia Bertozzi-Villa, Peter A. Meaney, Farshad Farzadfar, Svetlana Popova, Tara Templin, Hmwe H Kyu, Uche S. Uchendu, Kebede Deribe, Sergey Soshnikov, Nobhojit Roy, Daniel Kim, Ilana N. Ackerman, Homie Razavi, Leslie T. Cooper, Sandra Nolte, David T. Felson, John J Huang, Yang Liu, Fiorella Cavalleri, Adrian Davis, Héctor Gómez Dantés, Klara Dokova, Yuantao Hao, Catalina Medina, Austin E Schumacher, Stan Biryukov, Jane Rowley, Arindam Basu, Jose C. Adsuar, Rosana E. Norman, Yousef Khader, Rafael Alfonso-Cristancho, Sukanta Saha, Simón Barquera, Diego Gonzalez-Medina, Philip B. Mitchell, Lars Barregard, Haidong Wang, Yongmei Li, Ami R. Moore, Marie Ng, Raghib Ali, Peter T. Serina, Lijing L Yan, Ayse Abbasoglu Ozgoren, Ricky Leung, Michelle L. Bell, Tim Driscoll, Azmeraw T. Amare, Farshad Pourmalek, Tea Lallukka, Benjamin O Anderson, Raimundas Lunevicius, Corine Karema, Robert G. Weintraub, Erin C Mullany, Anders Larsson, Glen Mola, Paulo A. Lotufo, Luke Nyakarahuka, Sayed Saidul Alam, Louisa Degenhardt, Hugh R. Taylor, E. 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A, Boyers, Lindsay N, Brayne, Carol E, Breitborde, Nicholas J. K, Briggs, Adam D, Brooks, Peter M, Brown, Jonathan C, Brugha, Traolach S, Buckle, Geoffrey C, Budke, Christine M, Bulloch, Andrew G, Campos Nonato, Ismael R, Carapetis, Jonathan R, Carpenter, David O, Castañeda Orjuela, Carlos A, Castro, Ruben E, Catalá López, Ferrán, Chadha, Vineet K, Chang, Jung Chen, Charlson, Fiona J, Chiang, Peggy P, Chimed Ochir, Odgerel, Christophi, Costas A, Coates, Matthew M, Coffeng, Luc E, Coggeshall, Megan S, Colquhoun, Samantha M, Cooke, Graham S, Cooper, Leslie T, Coppola, Luis M, Criqui, Michael H, Crump, John A, Cuevas Nasu, Lucia, Dargan, Paul I, Davitoiu, Dragos V, Del Pozo Cruz, Borja, Dellavalle, Robert P, Jarlais, Don C. De, Dharmaratne, Samath D, Dherani, Mukesh K, Diaz Torné, Cesar, Ding, Eric L, Dorsey, E. Ray, Driscoll, Tim R, Duber, Herbert C, Ebel, Beth E, Edmond, Karen M, Elshrek, Yousef M, Ermakov, Sergey P, Erskine, Holly E, Faraon, Emerito Jose A, Fay, Derek F, Feigin, Valery L, Felson, David T, Fereshtehnejad, Seyed Mohammad, Fernandes, Jefferson G, Ferrari, Alize J, Flaxman, Abraham D, Fleming, Thomas D, Forouzanfar, Mohammad H, Fowkes, F. Gerry R, Paleo, Urbano Fra, Franklin, Richard C, Gankpé, Fortuné G, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, González Medina, Diego, Gosselin, Richard A, Gotay, Carolyn C, Gouda, Hebe N, Gugnani, Harish C, Gutiérrez, Reyna A, Hafezi Nejad, Nima, Halasa, Yara A, Hamadeh, Randah R, Hankey, Graeme J, Hansen, Gillian M, Harb, Hilda L, Hay, Simon I, Hay, Roderick J, Heredia Pi, Ileana B, Heuton, Kyle R, Hoek, Hans W, Hoffman, Howard J, Hosgood, H. Dean, Hotez, Peter J, Hoy, Damian G, Huang, John J, Iannarone, Marissa L, Iburg, Kim M, Jacobsen, Kathryn H, Jarvis, Deborah L, Jassal, Simerjot K, Jensen, Paul N, Jonas, Jost B, Karema, Corine K, Kassebaum, Nicholas J, Kemp, Andrew H, Kengne, Andre P, Khader, Yousef S, Khalifa, Shams Eldin A, Khan, Ejaz A, Khang, Young Ho, Kinge, Jonas M, Knibbs, Luke D, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, G. Anil, Kyu, Hmwe H, Lansingh, Van C, Lawrynowicz, Alicia E. B, Leasher, Janet L, Levitz, Carly E, Lim, Stephen S, Lipshultz, Steven E, Lloyd, Belinda K, Lofgren, Katherine T, Looker, Katharine J, Lortet Tieulent, Joannie, Lotufo, Paulo A, Lucas, Robyn M, Lyons, Ronan A, Macintyre, Michael F, Mackay, Mark T, Margolis, David J, Marzan, Melvin B, Masci, Joseph R, Mashal, Mohammad T, Mayosi, Bongani M, Mazorodze, Tasara T, Mcgill, Neil W, Mcgrath, John J, Meaney, Peter A, Melaku, Yohannes A, Memish, Ziad A, Mensah, George A, Mhimbira, Francis A, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L. D, Montine, Thomas J, Mooney, Meghan D, Moore, Ami R, Moradi Lakeh, Maziar, Moran, Andrew E, Moturi, Wilkister N, Moyer, Madeline L, Msemburi, William T, Mueller, Ulrich O, Mullany, Erin C, Murdoch, Michele E, Murthy, Kinnari S, Naidoo, Kovin S, Narayan, K. M. Venkat, Neupane, Sudan P, Newton, Charles R, Ngalesoni, Frida N, Nisar, Muhammad I, Norheim, Ole F, Norman, Rosana E, Oh, In Hwan, Ohno, Summer L, Olusanya, Bolajoko O, Pain, Amanda W, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Park, Eun Kee, Park, Jae Hyun, Patten, Scott B, Patton, George C, Paul, Vinod K, Pavlin, Boris I, Pereira, David M, Perez Padilla, Rogelio, Perez Ruiz, Fernando, Peterson, Carrie B, Phillips, Michael R, Phillips, Bryan K, Phillips, David E, Piel, Frédéric B, Poulton, Richie G, Prasad, Noela M, Pullan, Rachel L, Qato, Dima M, Quistberg, D. Alex, Rahman, Sajjad U, Rana, Saleem M, Reddy, K. Srinath, Ribeiro, Antonio L, Roberts, D. Allen, Rojas Rueda, David, Roth, Gregory A, Rothstein, David H, Rowley, Jane T, Ruhago, George M, Saeedi, Mohammad Y, Sampson, Uchechukwu K. A, Sanabria, Juan R, Santos, Itamar S, Schneider, Ione J, Schumacher, Austin E, Schwebel, David C, Scott, James G, Sepanlou, Sadaf G, Serina, Peter T, Servan Mori, Edson E, Shackelford, Katya A, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Singh, Jasvinder A, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stanaway, Jeffrey D, Stein, Dan J, Stein, Murray B, Steiner, Timothy J, Stovner, Lars J, Sunguya, Bruno F, Sykes, Bryan L, Tabb, Karen M, Taylor, Hugh R, Ao, Braden J. Te, Temesgen, Awoke M, Tenkorang, Eric Y, Terkawi, Abdullah S, Thorne Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tran, Bach X, Tuzcu, Emin M, Uchendu, Uche S, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, Van Brakel, Wim H, van Gool, Coen H, Vasankari, Tommi J, Violante, Francesco S, Vlassov, Vasiliy V, Wagner, Gregory R, Waller, Stephen G, Warouw, Tati S, Weintraub, Robert G, Whiteford, Harvey A, Wilkinson, James D, Williams, Thomas N, Wolfe, Charles D, Wolock, Timothy M, Woolf, Anthony D, Yan, Lijing L, Yentür, Gökalp K, Yoon, Seok Jun, Younis, Mustafa Z, Zaki, Maysaa E, Salomon, Joshua A, Lopez, Alan D, Computational Science and Engineering Department [Daresbury] ( STFC ), Science & Technologie Facilities Council, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Weill Cornell Medical College - Qatar, Qatar Foundation - Education City, Doha, Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Karolinska Institute, karolinska institute, Centro de Estudios Avanzados en Zonas Aridas ( CEAZA ), Ecole Polytechnique Fédérale de Lausanne ( EPFL ), Wisconsin Division of Public Health, Regional Genetic Service, St Mary's Hospital, Manchester, Laboratoire d'Ingénierie des Matériaux ( LIM ), Centre National de la Recherche Scientifique ( CNRS ), Computer Science Department [Bristol], University of Bristol [Bristol], Lawrence Berkeley National Laboratory [Berkeley] ( LBNL ), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) ( SRI-B ), Multimedia Research Center ( MRC ), University of Alberta [Edmonton], Division of Biostatistics ( Biostat - MINNEAPOLIS ), University of Minnesota [Minneapolis], Laboratory of Neurologic Diseases, Mario Negri Institute, Milan, University of Southampton [Southampton], Imperial College London, Neurology Department, Ichilov Medical Center, Department of Public Health and Primary Care, Cambridge University, Interactions, transferts, ruptures artistiques et culturels - EA 6301 ( InTRu ), Université de Tours, Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Institute of Parasitology, STAR laboratory, Stanford University [Stanford], Unité de recherche Virologie et Immunologie Moléculaires ( VIM ), Institut National de la Recherche Agronomique ( INRA ), Tennent Institute of Ophthalmology, National University of Singapore ( NUS ), Multidisciplinary Nanotechnology Centre, Swansea University, Department of Computer Sciences [Scheffield], University of Sheffield [Sheffield], Cyprus International Institute for the Environment and Public Health, Harvard School of Public Health, Glasgow Centre for Physical Organic Chemistry, University of Glasgow, King‘s College London, Université Panthéon-Sorbonne - UFR Science Politique ( UP1 UFR11 ), Université Panthéon-Sorbonne ( UP1 ), National Diagnostics Centre ( NDC ), National University of Ireland [Galway] ( NUI Galway ), Arthritis Research UK Epidemiology Unit ( MANCHESTER - Arthritis Research ), University of Manchester [Manchester], CEGOT - Porto, Universidade do Porto [Porto], Advanced Laboratories on Embedded Systems [Roma] ( ALES ), Department of Biology [Miami], University of Miami [Coral Gables], Division of Human Nutrition, Wageningen University and Research Centre [Wageningen] ( WUR ), Spatial Ecology and Epidemiology Group, University of Oxford [Oxford], Department of Civil Engineering [Hamirpur], National Institute of Technology [Hamirpur], GEMMA — Environmental Engineering and Microbiology Research Group, Department of Hydraulic, Maritime and Environmental Engineering, Universitat Politècnica de Catalunya [Barcelona] ( UPC ), Institut National de Recherche et d'Analyse Physico-Chimique ( INRAP ), Institut National de Recherche et d'Analyse Physico-chimique (INRAP-Tunisie), University of Connecticut ( UCONN ), Norwegian Institute for Air Research ( NILU ), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) ( FEMTO-ST ), Université de Franche-Comté ( UFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Ecole Nationale Supérieure de Mécanique et des Microtechniques ( ENSMM ) -Université de Technologie de Belfort-Montbeliard ( UTBM ), Tehran University, Friedrich-Alexander Universität Erlangen-Nürnberg ( FAU ), Secretariat of the Pacific Community, Public Health Division, Sociétés, Acteurs, Gouvernement en Europe ( SAGE ), Université de Strasbourg ( UNISTRA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Physics and Astronomy, Washington State University ( WSU ), Laboratoire de Physique de l'ENS Lyon ( Phys-ENS ), École normale supérieure - Lyon ( ENS Lyon ) -Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en informatique de Toulouse ( IRIT ), Institut National Polytechnique [Toulouse] ( INP ) -Université Toulouse 1 Capitole ( UT1 ) -Université Toulouse - Jean Jaurès ( UT2J ) -Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique ( CNRS ), School of Computer Science - China University of Geosciences (China University of Geosciences (East Area)), Université Catholique de Louvain ( UCL ), Div Cyclotron & Radiopharmaceut Sci ( DRDO, INMAS ), Univ New Delhi, University of St Andrews [Scotland], University of Cape Town, Department of Neuroscience, Karolinska Institutet [Stockholm], Institut de Physique Nucléaire d'Orsay ( IPNO ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Department of Computer Science and Engineering [Daejeon] (Chungnam National University), Lawrence University, Gastroenterology & Hepatology, Tata Research Development and Design Center ( TRDDC ), TCS Innovation Labs, Laboratoire MOLTECH-Anjou [Angers] ( MOLTECH ANJOU ), Université d'Angers ( UA ) -Centre National de la Recherche Scientifique ( CNRS ), University of Helsinki [Helsinki], Google Inc [Mountain View], Research at Google, Swedish Defense Research Agency ( FOI ), Centre de Recherche en Information Biomédicale sino-français ( CRIBS ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Laboratory of Image Science and Technology [Nanjing] ( LIST ), Southeast University [Jiangsu]-School of Computer Science and Engineering, Laboratoire de glaciologie et géophysique de l'environnement ( LGGE ), Observatoire des Sciences de l'Univers de Grenoble ( OSUG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ), School of Business and Informatics, University of Boras, Department of Mechanical and Automation Engineering ( CAD Laboratory ), The Chinese University of Hong Kong [Hong Kong], Università degli studi di Bari, Heuristique et Diagnostic des Systèmes Complexes [Compiègne] ( Heudiasyc ), Université de Technologie de Compiègne ( UTC ) -Centre National de la Recherche Scientifique ( CNRS ), Department of plant pathology and microbiology - centre for sustainable pest and disease management, Rothamsted Research, RGU, Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Barts and The London School of Medicine and Dentistry, Queen Mary University of London ( QMUL ), Centre d'économie de la Sorbonne ( CES ), Université Panthéon-Sorbonne ( UP1 ) -Centre National de la Recherche Scientifique ( CNRS ), Paris School of Economics ( PSE ), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale ( IDSIA ), Università della Svizzera italiana ( USI ) -Scuola universitaria professionale della Svizzera italiana [Manno] ( SUPSI ), Anaesthetics, Southampton University Hospital, Department of Mathematics, University of Iowa [Iowa City], College of Medicine, Alfaisal University, Saudi Ministry of Health, Institut national des recherches agricoles du Bénin, Centre de Recherches agricoles du Sud, Departments of Epidemiology and Nutrition, Unit of Human Nutrition, Agricultural University of Athens, Department of Animal Science, PennState University [Pennsylvania] ( PSU ), University of Virginia, University of Virginia [Charlottesville], Epidemiology and Biostatistics Unit, Institute for Maternal and Child Health - IRCCS ‘‘Burlo Garofolo', Jet Propulsion Laboratory ( JPL ), NASA-California Institute of Technology ( CALTECH ), Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women's Hospital [Boston], Division of Gastroenterology and Hepatology, Department of Immunology, Mayo Clinic, Department of Chemistry, Scientific Computing Research Unit, Department of dermatology, Milano University-Azienda Ospedaleria Ospedali Riuniti di Bergamo, Department of epidemiology and Public Health, Faculty of Medicine, Hong Kong Baptist University ( HKBU ), Département Optique ( OPT ), Université européenne de Bretagne ( UEB ) -Télécom Bretagne-Institut Mines-Télécom [Paris], Department of Neurology Lunds University Hospital Lund, Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux ( SAMOVAR ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ) -Centre National de la Recherche Scientifique ( CNRS ), Département Réseaux et Services Multimédia Mobiles ( RS2M ), Institut Mines-Télécom [Paris]-Télécom SudParis ( TSP ), Electrical Engineering and Computer Science Department - Case Western Reserve University, Case Western Reserve University [Cleveland], Institut Lumière Matière [Villeurbanne] ( ILM ), Université Claude Bernard Lyon 1 ( UCBL ), World Health Organization, Nordic School of Public Health, The James Hutton Institute, Sero, Sero consulting, Evolutionary Ecology of Infectious Disease Group, Department of Zoology, Horia Hulubei National Institute for Physics and Nuclear Engineering, Dunedin School of Medicine, University of Otago, Department of Physics, Clarendon Laboratory, Center for TeleInFrastruktur ( CTIF ), Aalborg University [Denmark] ( AAU ), Physikalisches Institut [Freiburg], Albert-Ludwigs-Universität Freiburg, Savoirs, Textes, Langage (STL) - UMR 8163 ( STL ), Université de Lille-Centre National de la Recherche Scientifique ( CNRS ), Dept.of Computer Science, Indian Institute of Technology Madras ( IIT Madras ), Istituto Mario Negri Bergamo, Centro Ricerche e Trapianti Villa Camozzi, Universidade Estadual Paulista Júlio de Mesquita ( UNESP ), Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Université Grenoble Alpes - UFR Médecine ( UGA UFRM ), Université Grenoble Alpes ( UGA ), Clinical Epidemiology and Aging Research, German Cancer Research Center, Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Symantec, European Microsoft Innovation Center ( EMIC ), Microsoft Corporation [Redmond, Wash.], Laboratoire de Mécanique, Physique et Géosciences ( LMPG ), Université Le Havre Normandie ( ULH ), Normandie Université ( NU ) -Normandie Université ( NU ), Novartis institute for tropical diseases, Institut de Génétique et de Biologie Moléculaire et Cellulaire ( IGBMC ), Université de Strasbourg ( UNISTRA ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Departments of Anatomy and Cell Biology, Wayne State University School of Medicine, Departments of Ophthalmology, Departments of Applied Physics [New Haven], Yale University [New Haven], Center for Mathematical Modeling ( CMM ), Universidad de Santiago de Chile [Santiago] ( USACH ), Laboratory for Atmospheric and Space Physics [Boulder] ( LASP ), University of Colorado Boulder [Boulder], University of Occupational and Environmental Health [Kitakyushu] ( UEOH ), Department of Computer Science and Engineering [New Delhi], Indian Institute of Technology Delhi ( IIT Delhi ), Institut de Recherche sur les Phénomènes Hors Equilibre ( IRPHE ), Aix Marseille Université ( AMU ) -Ecole Centrale de Marseille ( ECM ) -Centre National de la Recherche Scientifique ( CNRS ), GlaxoSmithKline, Imperial College London-Clinical Imaging Center, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, Yale School of Medicine-Yale School of Medicine-Yale Stem Cell Center, Maclean Building, Benson Lane, Crowmarsh Gifford, Centre for Ecology and Hydrology, Nanoscience Institute ( NEST ), Dipartimento di Fisica, Università di Pisa, Aristotle University of Thessaloniki, Laboratory Of Immune Cell Biology ( LICB ), National Institutes of Health ( NIH ), Institute of Human Genetics, Bonn Universität [Bonn], Occupational Health Unit, Bologna University Hospital-Sant'Orsola-Malpighi Polyclinic, Royal Institute of Technology [Stockholm] ( KTH ), Institut für Informatik [München/Munich] ( LMU ), Ludwig-Maximilians-Universität München, NICTA [Eveleigh], National ICT Australia [Sydney] ( NICTA ), Manchester Academic Health Sciences Centre, Institut d'Histoire et de Philosophie des Sciences et des Techniques ( IHPST ), Université Panthéon-Sorbonne ( UP1 ) -Département d'Etudes Cognitives - ENS Paris ( DEC ), École normale supérieure - Paris ( ENS Paris ) -École normale supérieure - Paris ( ENS Paris ) -Centre National de la Recherche Scientifique ( CNRS ), Ghent University [Belgium] ( UGENT ), German Research Centre for Geosciences - Helmholtz-Centre Potsdam ( GFZ ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique ( LHEEA ), École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Institut de Recherche en Génie Civil et Mécanique ( GeM ), Université de Nantes ( UN ) -École Centrale de Nantes ( ECN ) -Centre National de la Recherche Scientifique ( CNRS ), Neurorestoration Group, King‘s College London-Wolfson Centre for Age-related Diseases, Department of Computer Science [KAIST] ( CS ), Korea Advanced Institute of Science and Technology ( KAIST ), Laboratoire de l'Accélérateur Linéaire ( LAL ), Natl Engn Res Ctr Vegetables, Key Lab Biol & Genet Improvement Hort Crops N Chi, Beijing Acad Agr & Forestry Sci, University Hospital Puerta de Hierro, Madrid, Computational Science and Engineering Department [Daresbury] (STFC), Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Weill Cornell Medicine [Qatar], Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Centro de Estudios Avanzados en Zonas Aridas (CEAZA), Ecole Polytechnique Fédérale de Lausanne (EPFL), Laboratoire d'Ingénierie des Matériaux (LIM), Centre National de la Recherche Scientifique (CNRS), Lawrence Berkeley National Laboratory [Berkeley] (LBNL), Samsung Research &Development Institute India - Bangalore (Groupe Samsung) (SRI-B), Multimedia Research Center (MRC), University of Alberta, Division of Biostatistics (Biostat - MINNEAPOLIS), University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System, University of Southampton, University of Cambridge [UK] (CAM), Interactions, transferts, ruptures artistiques et culturels - EA 6301 (InTRu), Université de Tours (UT), Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Stanford University, Unité de recherche Virologie et Immunologie Moléculaires (VIM (UR 0892)), Institut National de la Recherche Agronomique (INRA), National University of Singapore (NUS), Université Paris 1 Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Paris 1 Panthéon-Sorbonne (UP1), National Diagnostics Centre (NDC), National University of Ireland [Galway] (NUI Galway), Arthritis Research UK Epidemiology Unit (MANCHESTER - Arthritis Research), Universidade do Porto = University of Porto, Advanced Laboratories on Embedded Systems [Roma] (ALES), Wageningen University and Research [Wageningen] (WUR), University of Oxford, Universitat Politècnica de Catalunya [Barcelona] (UPC), Institut National de Recherche et d'Analyse Physico-Chimique (INRAP), University of Connecticut (UCONN), Norwegian Institute for Air Research (NILU), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), University of Tehran, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Sociétés, Acteurs, Gouvernement en Europe (SAGE), Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), The George Washington University (GW), Washington State University (WSU), Laboratoire de Physique de l'ENS Lyon (Phys-ENS), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), Institut de recherche en informatique de Toulouse (IRIT), Université Toulouse Capitole (UT Capitole), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université Catholique de Louvain = Catholic University of Louvain (UCL), Div Cyclotron & Radiopharmaceut Sci (DRDO, INMAS), School of Physics and Astronomy [St Andrews], Tata Research Development and Design Center (TRDDC), MOLTECH-Anjou, Université d'Angers (UA)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Swedish Defense Research Agency (FOI), Centre de Recherche en Information Biomédicale sino-français (CRIBS), Université de Rennes (UR)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratory of Image Science and Technology [Nanjing] (LIST), Laboratoire de glaciologie et géophysique de l'environnement (LGGE), Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Department of Mechanical and Automation Engineering (CAD Laboratory), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Heuristique et Diagnostic des Systèmes Complexes [Compiègne] (Heudiasyc), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), Biotechnology and Biological Sciences Research Council (BBSRC)-Biotechnology and Biological Sciences Research Council (BBSRC), Queen Mary University of London (QMUL), Centre d'économie de la Sorbonne (CES), Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Paris School of Economics (PSE), Université Paris 1 Panthéon-Sorbonne (UP1)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École des hautes études en sciences sociales (EHESS)-École des Ponts ParisTech (ENPC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Istituto Dalle Molle di Studi sull'Intelligenza Artificiale (IDSIA), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana = University of Applied Sciences and Arts of Southern Switzerland [Manno] (SUPSI), Pennsylvania State University (Penn State), Penn State System-Penn State System, Jet Propulsion Laboratory (JPL), NASA-California Institute of Technology (CALTECH), Hong Kong Baptist University (HKBU), Département Optique (OPT), Université européenne de Bretagne - European University of Brittany (UEB)-Télécom Bretagne-Institut Mines-Télécom [Paris] (IMT), Services répartis, Architectures, MOdélisation, Validation, Administration des Réseaux (SAMOVAR), Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP), Département Réseaux et Services Multimédia Mobiles (TSP - RS2M), University of Melbourne, Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), University of Otago [Dunedin, Nouvelle-Zélande], Center for TeleInFrastruktur (CTIF), Aalborg University [Denmark] (AAU), Savoirs, Textes, Langage (STL) - UMR 8163 (STL), Université de Lille-Centre National de la Recherche Scientifique (CNRS), Indian Institute of Technology Madras (IIT Madras), Universidade Estadual Paulista Júlio de Mesquita Filho = São Paulo State University (UNESP), Erasmus University Medical Center [Rotterdam] (Erasmus MC), Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg] (DKFZ), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), European Microsoft Innovation Center (EMIC), Laboratoire de Mécanique, Physique et Géosciences (LMPG), Université Le Havre Normandie (ULH), Normandie Université (NU)-Normandie Université (NU), Novartis Institute for Tropical Diseases (NITD), Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Center for Mathematical Modeling (CMM), Universidad de Chile = University of Chile [Santiago] (UCHILE), Laboratory for Atmospheric and Space Physics [Boulder] (LASP), University of Colorado [Boulder], University of Occupational and Environmental Health [Kitakyushu] (UEOH), Indian Institute of Technology Delhi (IIT Delhi), Institut de Recherche sur les Phénomènes Hors Equilibre (IRPHE), Aix Marseille Université (AMU)-École Centrale de Marseille (ECM)-Centre National de la Recherche Scientifique (CNRS), Yale University [New Haven]-Yale School of Medicine [New Haven, Connecticut] (YSM), Nanoscience Institute (NEST), University of Pisa - Università di Pisa, Laboratory Of Immune Cell Biology (LICB), National Institutes of Health [Bethesda] (NIH), Rheinische Friedrich-Wilhelms-Universität Bonn, Royal Institute of Technology [Stockholm] (KTH ), Institut für Informatik [München/Munich] (LMU), Ludwig-Maximilians-Universität München (LMU), National ICT Australia [Sydney] (NICTA), Institut d'Histoire et de Philosophie des Sciences et des Techniques (IHPST), Université Paris 1 Panthéon-Sorbonne (UP1)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS-PSL), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS), Universiteit Gent = Ghent University (UGENT), German Research Centre for Geosciences - Helmholtz-Centre Potsdam (GFZ), Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche en Génie Civil et Mécanique (GeM), Université de Nantes - UFR des Sciences et des Techniques (UN UFR ST), Université de Nantes (UN)-Université de Nantes (UN)-École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Department of Computer Science [KAIST] (CS), Korea Advanced Institute of Science and Technology (KAIST), Kardiyoloji, Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Minnesota [Twin Cities], Centre National de la Recherche Scientifique (CNRS)-Université Paris Diderot - Paris 7 (UPD7), Unité de recherche Virologie et Immunologie Moléculaires (VIM), Université Panthéon-Sorbonne - UFR Science Politique (UP1 UFR11), Université Panthéon-Sorbonne (UP1), Wageningen University and Research Centre [Wageningen] (WUR), Institut National de Recherche et d'Analyse Physico-chimique (Ariana, Tunisie) (INRAP), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), George Washington University (GW), École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université Toulouse 1 Capitole (UT1)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées, Université Catholique de Louvain (UCL), MOLTECH-ANJOU (MOLTECH-ANJOU), Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), University of Helsinki, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Southeast University [Jiangsu]-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National de la Recherche Scientifique (CNRS), Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS), Università della Svizzera italiana (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), California Institute of Technology (CALTECH)-NASA, Institut Mines-Télécom [Paris] (IMT)-Télécom SudParis (TSP)-Centre National de la Recherche Scientifique (CNRS), Département Réseaux et Services Multimédia Mobiles (RS2M), Universidade Estadual Paulista Júlio de Mesquita Filho [São José do Rio Preto] (UNESP), Université Grenoble Alpes (UGA), Universidad de Santiago de Chile [Santiago] (USACH), Yale University [New Haven]-Yale University School of Medicine, Université Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-Département d'Etudes Cognitives - ENS Paris (DEC), École normale supérieure - Paris (ENS Paris)-École normale supérieure - Paris (ENS Paris), Ghent University [Belgium] (UGENT), Université de Nantes - Faculté des Sciences et des Techniques, Grelier, Elisabeth, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse III - Paul Sabatier (UT3), Universidade do Porto, Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), École normale supérieure - Lyon (ENS Lyon)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon, Université Toulouse 1 Capitole (UT1), Centre National de la Recherche Scientifique (CNRS)-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire des Sciences de l'Univers de Grenoble (OSUG), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Institut national des sciences de l'Univers (INSU - CNRS)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Università degli studi di Bari Aldo Moro (UNIBA), École des Ponts ParisTech (ENPC)-École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université Paris 1 Panthéon-Sorbonne (UP1)-Centre National de la Recherche Scientifique (CNRS)-École des hautes études en sciences sociales (EHESS)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università della Svizzera italiana = University of Italian Switzerland (USI)-Scuola universitaria professionale della Svizzera italiana [Manno] (SUPSI), Institut Mines-Télécom [Paris] (IMT)-Télécom Bretagne-Université européenne de Bretagne - European University of Brittany (UEB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), École normale supérieure - Paris (ENS Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-École normale supérieure - Paris (ENS Paris), Universiteit Gent = Ghent University [Belgium] (UGENT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-CHU Limoges-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Technologie de Belfort-Montbeliard (UTBM), Institut de Chimie du CNRS (INC)-Université d'Angers (UA)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS)-École Centrale de Nantes (ECN), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS), Wolfson Centre for Age-related Diseases-King‘s College London, Cell biology, Public Health, Epidemiology, Health Technology Assessment (HTA), Erasmus MC other, Pathology, and Cardiothoracic Surgery
Subjects: Gerontology, Male, CHANGING RELATION, Nutrition and Disease, MESH : Life Expectancy, MESH : Aged, ECONOMIC-DEVELOPMENT, Poison control, MESH: Global Health, Global Health, Socioeconomic Factor, Communicable Disease, MESH : Chronic Disease, Health Transition, Voeding en Ziekte, Quality-Adjusted Life Year, SELF-RATED HEALTH, MESH : Socioeconomic Factors, Medicine, MESH : Female, MESH: Mortality, Premature, 2. Zero hunger, MESH: Aged, education.field_of_study, MESH: Middle Aged, Mortality rate, Medicine (all), GBD2013 diseases, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, General Medicine, Middle Aged, 3. Good health, MESH : Wounds and Injuries, Epidemiological transition, MESH: Quality-Adjusted Life Years, MESH: Communicable Diseases, NONCOMMUNICABLE DISEASES, Female, Quality-Adjusted Life Years, MESH: Life Expectancy, MESH: Health Transition, Human, MESH: Socioeconomic Factors, ACUTE MYOCARDIAL-INFARCTION, MESH : Male, MORTALITY TRENDS, Population, MESH : Health Transition, Communicable Diseases, Article, Life Expectancy, EUROPEAN-UNION, SDG 3 - Good Health and Well-being, General & Internal Medicine, SYSTEMATIC ANALYSIS, Disability-adjusted life year, Humans, Life Science, MESH : Middle Aged, Mortality, education, Premature, MESH : Mortality, Premature, VLAG, Aged, MESH: Humans, business.industry, Mortality, Premature, MESH: Chronic Disease, MESH : Communicable Diseases, Wounds and Injurie, MESH : Humans, MESH : Quality-Adjusted Life Years, Non-communicable disease, Chronic Disease, Socioeconomic Factors, Wounds and Injuries, medicine.disease, MESH: Male, LOW SOCIOECONOMIC-STATUS, Years of potential life lost, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Wounds and Injuries, Life expectancy, RISK-FACTORS, MESH : Global Health, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female, Demography
Abstract: Summary Background The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age–sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. Methods We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Findings Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6–6·6), from 65·3 years (65·0–65·6) in 1990 to 71·5 years (71·0–71·9) in 2013, HALE at birth rose by 5·4 years (4·9–5·8), from 56·9 years (54·5–59·1) to 62·3 years (59·7–64·8), total DALYs fell by 3·6% (0·3–7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6–29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non–communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Interpretation Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition—in which increasing sociodemographic status brings structured change in disease burden—is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Funding Bill & Melinda Gates Foundation. BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition-in which increasing sociodemographic status brings structured change in disease burden-is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
Published: 2015
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41. Maternal Health Phone Line: Saving Women in Papua New Guinea

Author: Gaius Sabumei, Glen Mola, Amanda H. A. Watson, and Rick Iedema
Subjects: mobile phone, communication, business.industry, Rural health, lcsh:R, lcsh:Medicine, Medicine (miscellaneous), childbirth, medicine.disease, maternal health, Focus group, Article, Pacific, mHealth, Nursing, Phone, parasitic diseases, Health care, medicine, health communication, Maternal death, Landline, business, Health communication
Abstract: This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the “ICTs for healthcare development” model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The “three stages of delay” typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The “three stages of delay” typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG, potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges.
Published: 2015
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42. Assisted vaginal delivery in low and middle income countries:an overview

Author: Glen Mola, C Evans, L de Bernis, J. van Roosmalen, Patricia E. Bailey, and Blami Dao
Subjects: medicine.medical_specialty, Caesarean delivery, Population, Global Health, 03 medical and health sciences, 0302 clinical medicine, Health facility, SDG 3 - Good Health and Well-being, Pregnancy, vacuum extraction, medicine, Humans, 030212 general & internal medicine, Practice Patterns, Physicians', education, Developing Countries, Gynecology, education.field_of_study, 030219 obstetrics & reproductive medicine, business.industry, Vacuum extraction, Obstetrics and Gynecology, Secondary data, Extraction, Obstetrical, forceps, Private sector, Assisted Vaginal Delivery, Cross-Sectional Studies, Low and middle income countries, Family medicine, Female, caesarean delivery, business, Assisted vaginal delivery
Abstract: Objective To assess the use of assisted vaginal delivery (AVD) in low- and middle-income countries (LMICs), highlighting what level of care procedures were performed and identifying systemic barriers to its use. Design Cross-sectional health facility assessments. Setting Up to 40 countries in Latin America, sub-Saharan Africa and Asia. Population Assessments tended to be national in scope and included all hospitals and samples of midlevel facilities in public and private sectors. Methods Descriptive secondary data analysis. Main outcome measures Percentage of facilities where health workers performed AVD in the 3 months prior to the assessment, instrument preference, which health workers performed the procedure, and reasons AVD was not practiced. Results Fewer than 20% of facilities in Latin America reported performing AVD in the last 3 months. In sub-Saharan Africa, 53% of 1728 hospitals had performed AVD but only 6% of nearly 10 000 health centres had done so. It was not uncommon to find
Published: 2017
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43. Cholera risk factors, Papua New Guinea, 2010

Author: Freda Makenda, Alexander Roswell, Lucas Komnapi, C. Raina MacIntyre, Berry Ropa, Glen Mola, Enoch Posanai, Benita Addy, Samir R. Dutta, Anthony B. Zwi, and W. Y. Nicola Man
Subjects: Geography, medicine, New guinea, medicine.disease, Socioeconomics, Cholera, Pathology and Forensic Medicine
Published: 2020
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44. Unintended pregnancy amongst women attending antenatal clinics at the Port Moresby General Hospital

Author: Glen Mola, Kirsten I. Black, Karen Sanga, Aafke Justesen, and Jeany Wattimena
Subjects: Adult, Postnatal Care, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, media_common.quotation_subject, Health Behavior, Population, Fertility, Hospitals, General, Papua New Guinea, Young Adult, Birth Intervals, Pregnancy, Surveys and Questionnaires, Prevalence, Humans, Medicine, education, Contraception Behavior, Socioeconomic status, media_common, education.field_of_study, Marital Status, business.industry, Obstetrics, Age Factors, Coitus, Pregnancy, Unplanned, Obstetrics and Gynecology, Prenatal Care, General Medicine, medicine.disease, Parity, Family planning, Educational Status, Marital status, Female, business, Unintended pregnancy, Demography
Abstract: BACKGROUND: National survey data from Papua New Guinea (PNG) suggest that women are having almost 1.5 times the number of children they desire. Womens ability to space and limit the number of children could have a significant impact on the countrys high infant and maternal mortality rates. AIM: To determine the prevalence and demographic associations of unintended pregnancy in women presenting for antenatal care to Port Moresby General Hospital. METHODS: From November 2011 to February 2012 we administered a structured questionnaire to women attending antenatal clinics covering pregnancy intention contraceptive use and demographic information. RESULTS: Amongst the 1198 respondents 49.4% of the pregnancies were reported as unintended with significantly higher proportions amongst women with no education or education only to primary school level (OR:1.46 CI: 1.10-1.92) unmarried women (OR:7.16 CI: 4.08-12.58) women whose first sexual encounter was under the age of 20 (OR 1.55 CI: 1.20-1.99) and women with three or more children compared to those having their first child (OR: 2.70 CI:1.86-3.93). Amongst multiparous women a short birth interval of less than two years was significantly associated with unintended pregnancy (P < 0.001). CONCLUSIONS: Unintended pregnancy was common and occurred more frequently amongst women who already had three or more children often leading to birth spacing of under two years. There is a need for effective programs and strategies to increase access to contraceptive information and services. Immediate provision of long-acting reversible contraceptive methods in the postnatal period could facilitate such access and reduce unplanned pregnancy amongst multiparous women.
Published: 2014
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45. The use of ‘mother and baby gifts’ (MBGs) to increase uptake of supervised births in the Milne Bay Province of Papua New Guinea

Author: Colin Case, Glen Mola, Stephen J. Robson, and Barry Kirby
Subjects: Adult, Adolescent, Developing country, behavioral disciplines and activities, Papua New Guinea, Young Adult, Pregnancy, parasitic diseases, Humans, Medicine, Poverty, business.industry, Obstetrics and Gynecology, New guinea, Community Health Centers, General Medicine, Gift Giving, Patient Acceptance of Health Care, Delivery, Obstetric, humanities, Obstetric Labor Complications, Maternal Mortality, embryonic structures, Female, business, Bay, Program Evaluation, Demography
Abstract: Improving access to supervised birth reduces mortality in developing countries. In the Milne Bay Province of Papua New Guinea, many women do not deliver at local health centres (HCs) because they feel 'shy' at presenting in an impoverished state and not having baby's clothes, and the state of facilities associated with HCs was poor. To overcome this, women were offered 'mother and baby gifts' (MBGs) at the time of delivery. We found subsequent increases in the rate of supervised birth in all HCs surveyed.
Published: 2015
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46. Effects of Plasmodium falciparum infection on umbilical artery resistance and intrafetal blood flow distribution: a Doppler ultrasound study from Papua New Guinea

Author: Maria Ome-Kaius, Glen Mola, Jane Walker, Regina Wangnapi, Holger W. Unger, Stephen J. Rogerson, John W. Bolnga, Ivo Mueller, and Stephan Karl
Subjects: Adult, Middle Cerebral Artery, medicine.medical_specialty, Adolescent, Plasmodium falciparum, 030231 tropical medicine, Plasmodium vivax, Cerebroplacental ratio, Fetal growth, Biology, Ultrasonography, Prenatal, Umbilical Arteries, Cohort Studies, Papua New Guinea, Young Adult, 03 medical and health sciences, Fetus, 0302 clinical medicine, Umbilical artery resistance, medicine.artery, Internal medicine, parasitic diseases, medicine, Humans, 030212 general & internal medicine, Malaria, Falciparum, Fetal Growth Retardation, Research, Doppler, Ultrasonography, Doppler, Umbilical artery, Middle Aged, Laser Doppler velocimetry, biology.organism_classification, 3. Good health, Sub-microscopic, Low birth weight, Infectious Diseases, Middle cerebral artery pulsatility, Middle cerebral artery, Immunology, Cardiology, Gestation, Parasitology, medicine.symptom
Abstract: Background Doppler velocimetry studies of umbilical artery (UA) and middle cerebral artery (MCA) flow help to determine the presence and severity of fetal growth restriction. Increased UA resistance and reduced MCA pulsatility may indicate increased placental resistance and intrafetal blood flow redistribution. Malaria causes low birth weight and fetal growth restriction, but few studies have assessed its effects on uteroplacental and fetoplacental blood flow. Methods Colour-pulsed Doppler ultrasound was used to assess UA and MCA flow in 396 Papua New Guinean singleton fetuses. Abnormal flow was defined as an UA resistance index above the 90th centile, and/or a MCA pulsatility index and cerebroplacental ratio (ratio of MCA and UA pulsatility index) below the 10th centile of population-specific models fitted to the data. Associations between malaria (peripheral infection prior to and at ultrasound examination, and any gestational infection, i.e., ‘exposure’) and abnormal flow, and between abnormal flow and birth outcomes, were estimated. Results Of 78 malaria infection episodes detected before or at the ultrasound visit, 62 (79.5%) were Plasmodium falciparum (34 sub-microscopic infections), and 16 were Plasmodium vivax. Plasmodium falciparum infection before or at Doppler measurement was associated with increased UA resistance (adjusted odds ratio (aOR) 2.3 95% CI 1.0–5.2, P = 0.047). When assessed by ‘exposure’, P. falciparum infection was significantly associated with increased UA resistance (all infections: 2.4, 1.1–4.9, P = 0.024; sub-microscopic infections 2.6, 1.0–6.6, P = 0.051) and a reduced MCA pulsatility index (all infections: 2.6, 1.2–5.3, P = 0.012; sub-microscopic infections: 2.8, 1.1–7.5, P = 0.035). Sub-microscopic P. falciparum infections were additionally associated with a reduced cerebroplacental ratio (3.64, 1.22–10.88, P = 0.021). There were too few P. vivax infections to draw robust conclusions. An increased UA resistance index was associated with histological evidence of placental malaria (5.1, 2.3–10.9, P Discussion/conclusion Both microscopic and sub-microscopic P. falciparum infections impair fetoplacental and intrafetal flow, at least temporarily. Increased UA resistance has high specificity but low sensitivity for the detection of placental infection. These findings suggest that interventions to protect the fetus should clear and prevent both microscopic and sub-microscopic malarial infections. Trial Registration ClinicalTrials.gov NCT01136850. Registered 06 April 2010
Published: 2017
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47. Mobile Phone–based Syndromic Surveillance System, Papua New Guinea

Author: Sibauk Bieb, Samuel Hurim, Alexander Rosewell, Berry Ropa, Siddhartha Sankar Datta, Pradeep Ray, C. Raina MacIntyre, Heather Randall, Rosheila Dagina, Anthony B. Zwi, Glen Mola, and Sundar Ramamurthy
Subjects: Microbiology (medical), Quality Control, Epidemiology, Cost-Benefit Analysis, lcsh:Medicine, Poison control, Occupational safety and health, lcsh:Infectious and parasitic diseases, Papua New Guinea, Public health surveillance, Health care, medicine, Humans, lcsh:RC109-216, syndromic surveillance, Public Health Surveillance, Data reporting, information and communication technology, Disease Notification, Qualitative Research, early warning, mobile phone, evaluation, Warning system, business.industry, Research, lcsh:R, Reproducibility of Results, medicine.disease, Infectious Diseases, Mobile phone, ICT, fragile state, Medical emergency, m-health, business, Cell Phone
Abstract: The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.
Published: 2013

48. Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Author: Carl Abelardo T. Antonio, Rob E. Dorrington, Belinda K Lloyd, Elisabete Weiderpass, Kovin Naidoo, Leslie T. Cooper, Sandra Nolte, Eduardo A. Undurraga, Mohammad A. AlMazroa, R. Kumar, Xiaofeng Liang, Amanda J. Mason-Jones, Kazem Rahimi, Sanjay Basu, Vasiliy Victorovich Vlassov, André Karch, Dipan Bose, Vivekanand Jha, Adansi A. Amankwaa, Kaire Innos, Ione Jayce Ceola Schneider, Itamar S. Santos, Anwar Rafay, Bolajoko O. Olusanya, Tommi Vasankari, Nana Kwaku Mainoo, Saleem M Rana, Wagner Marcenes, Fortuné Gbètoho Gankpé, Rana J. Asghar, Lela Sturua, Nicholas J K Breitborde, Corine Karema, Charles R. Newton, Uche S. Uchendu, Jongmin Lee, Inga Dora Sigfusdottir, Harish Chander Gugnani, Kaushalendra Kumar, Reza Assadi, Ibrahim Abubakar, Konstantinos Stroumpoulis, Megan Coggeshall, Timothy M. Wolock, Ronny Westerman, Samath D Dharmaratne, Katya Anne Shackelford, Anders Larsson, Jeffrey A. Towbin, Jixiang Ma, Lynne Gaffikin, Konstantin Kazanjan, Mohammad Ali Sahraian, Mohammad H. Forouzanfar, Yichong Li, Felix Sayinzoga, Daniel Dicker, Philimon Gona, Maurice Giroud, Maysaa El Sayed Zaki, Shiwei Liu, Lorenzo Monasta, Chantal Huynh, Abdullatif Husseini, Ted R. Miller, Solomon Meseret Woldeyohannes, D. Alex Quistberg, Justin Beardsley, Majed Asad, Uʇur Dilmen, Alaa Badawi, Hsien-Ho Lin, Haidong Kan, Vinod K. Paul, Mitsuru Mukaigawara, James Leigh, Xiao Nong Zou, Sajjad Ur Rahman, Valentina Arsić Arsenijević, Gokalp Kadri Yentur, Man Mohan Mehndiratta, Murugesan Raju, Stephanie J. London, Kingsley N. Ukwaja, Young-Ho Khang, Knud Juel, Mohsen Naghavi, Rasmus Havmoeller, Gelin Xu, Semaw Ferede Abera, Devina Nand, Norito Kawakami, Neil Pearce, Elisabeth Barboza França, Ferrán Catalá-López, Ketevan Goginashvili, Vegard Skirbekk, Neeraj Bedi, Barthelemy Kuate Defo, Andrew H. Kemp, H. Dean Hosgood, Vafa Rahimi-Movaghar, Konrad Pesudovs, Linhong Wang, Xiao Rong Wang, Alan D. Lopez, Ademola Lukman Adelekan, Joshua A. Salomon, Walter Mendoza, Aref A. Bin Abdulhak, Ivy Shiue, G Anil Kumar, Yuichiro Yano, Luke D. Knibbs, Jung-Chen Chang, Yousef Khader, Caitlyn Steiner, Selen Begüm Uzun, Luciano A. Sposato, Gabrielle deVeber, Raghib Ali, Andre Pascal Kengne, Chakib Nejjari, Rafael Alfonso-Cristancho, Tania Georgina Sánchez Pimienta, Roberto Tchio Talongwa, Hilda L Harb, Ali H. Mokdad, Edward J Mills, Angel J Paternina Caicedo, Xiaohong Li, Luke Nyakarahuka, Diego De Leo, Rashmi Gupta, Robert G. Weintraub, Tim Driscoll, Sun Ha Jee, Carolina Maria Teixeira, Ole Frithjof Norheim, Zulfiqar A Bhutta, Hwashin Hyun Shin, Palwasha Anwari, Daniel Pope, Hassan Amini, Jae-Hyun Park, Saad B. Omer, Eric L. Ding, Narayanaswamy Venketasubramanian, Juan Liang, Tara Templin, Arindam Basu, Farshad Farzadfar, Yang Yang, Xuan Che, Scott Weichenthal, Jeyaraj D Pandian, David L. Tirschwell, Adrian Davis, Hilton Lam, Feng Tan, Stephen S Lim, Soewarta Kosen, Atsushi Goto, Ratilal Lalloo, Yanping Wang, Glen Mola, Paulo A. Lotufo, Dhruv S. Kazi, Jose C. Adsuar, Amany H Refaat, Ruben Castro, Gene F. Kwan, Johanna M. Geleijnse, Emerito Jose A. Faraon, Costas A. Christophi, Theo Vos, Sara Sheikhbahaei, Guilherme V. Polanczyk, Jed D. Blore, Azmeraw T. Amare, Kyle R. Heuton, Walid Ammar, Louisa Degenhardt, Andrew Vallely, Guohong Jiang, Ricky Leung, Jasvinder A. Singh, Zewdie Aderaw Alemu, A Artaman, Steven E. Lipshultz, Carlos A Castañeda-Orjuela, Seyed-Mohammad Fereshtehnejad, Sadaf G. Sepanlou, Mark J. Nieuwenhuijsen, John Q. Wong, Manami Inoue, Coen H. Van Gool, James D. Wilkinson, Ejaz Ahmad Khan, Yoshihiro Kokubo, Manuela Mendonca Felicio, Farshad Pourmalek, Boris I. Pavlin, Karen Sliwa, Robert G. Nelson, Tom Achoki, Edmond K. Kabagambe, Orish Ebere Orisakwe, Christopher J L Murray, In-Hwan Oh, Uchechukwu K.A. Sampson, Ulrich O Mueller, Austin E Schumacher, Edson Serván-Mori, Berrak Bora Basara, Simon I. Hay, Anil Kaul, Foad Abd-Allah, Takayoshi Ohkubo, Kim Yun Jin, Abdullah Sulieman Terkawi, Mall Leinsalu, Sergei Petrovich Ermakov, Marek Majdan, Ileana B. Heredia Pi, Christina Papachristou, Scott B. Patten, Rajeev Gupta, Kalpana Balakrishnan, Mustafa Z. Younis, Kenji Shibuya, Graça Maria Ferreira De Lima, Andrea P. Silva, Maziar Moradi-Lakeh, Anand Dayama, Eiman Jahangir, Stefan Ma, Karen M. Tabb, Nicholas J Kassebaum, Shams Eldin Ali Hassan Khalifa, Mazin J. Al Kahbouri, Nadim E. Karam, Jun Zhu, Chandrashekhar T Sreeramareddy, Dinorah González-Castell, Diego Gonzalez-Medina, Aliya Naheed, Ryan M Barber, Salvador Villalpando, Yang Liu, Chanda Kulkarni, Vinay Nangia, Haidong Wang, Yongmei Li, Rosario Cárdenas, Randah R. Hamadeh, Suzanne Polinder, Van C. Lansingh, François Alla, Max Petzold, Bryan L. Sykes, Ubai Alsharif, Chuanhua Yu, Francesco Saverio Violante, Monika Sawhney, Ayse Abbasoglu Ozgoren, Graeme J. Hankey, Mouhanad Hammami, Iuri da Costa Leite, Dickens Akena, Rintaro Mori, Alanur Çavlin, Maia Kereselidze, Jonathan de la Cruz Monis, Deena Alasfoor, Taavi Lai, Eric Y. Tenkorang, Cyrus Cooper, Sudan Prasad Neupane, Dan Poenaru, Veena S. Kulkarni, Naohiro Yonemoto, Elizabeth Glaser, Sergey Soshnikov, Ziad A. Memish, Paul N. Jensen, Fabiola Mejía-Rodríguez, Ana C. Garcia, Rakhi Dandona, Emilie Agardh, Katherine B Gibney, Vasco Manuel Pedro Machado, Michelle L. Bell, David M. Pereira, Muluemebet Abera Wordofa, Samantha M. Colquhoun, Elena Alvarez, Stephen G. Waller, Ketevan Gambashidze, Eduardo Bernabé, Rafael Lozano, Damian G Hoy, Miltiadis K. Tsilimbaris, Hebe N. Gouda, Muhammad Imran Nisar, Zanfina Ademi, Andrew L. Thorne-Lyman, Denis Nash, Dima M. Qato, Luca Ronfani, Nobhojit Roy, Donald H. Silberberg, Monica S. Vavilala, Lydia S. Atkins, Hans W. Hoek, Muluken Dessalegn, David C. Schwebel, Christopher C. Mapoma, Jost B. Jonas, Tolesa Bekele, Lalit Dandona, Borja del Pozo-Cruz, Sumeet S. Chugh, Johan Ärnlöv, Tariku Jibat Beyene, Melvin Barrientos Marzan, Ami R. Moore, Marie Ng, Maigeng Zhou, Samia Alhabib, Massimo Cirillo, Soraya Seedat, Paul S. F. Yip, Nima Hafezi-Nejad, Amelia Bertozzi-Villa, Kebede Deribe, John Nelson Opio, Peter J. Allen, Marina Shakh-Nazarova, Bach Xuan Tran, Arsène Kouablan Adou, Yingfeng Zheng, Julio Cesar Montañez Hernandez, Yong Zhao, Nelson Alvis-Guzman, Bulat Idrisov, Alireza Esteghamati, Seok Jun Yoon, Kathryn H. Jacobsen, Kassebaum, Nicholas J., Bertozzi-Villa, Amelia, Coggeshall, Megan S., Shackelford, Katya A., Steiner, Caitlyn, Heuton, Kyle R., Gonzalez-Medina, Diego, Barber, Ryan, Huynh, Chantal, Dicker, Daniel, Templin, Tara, Wolock, Timothy M., Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw Ferede, Abubakar, Ibrahim, Achoki, Tom, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C., Agardh, Emilie E., Akena, Dicken, Alasfoor, Deena, Alemu, Zewdie Aderaw, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Al Kahbouri, Mazin J., Alla, Françoi, Allen, Peter J., Almazroa, Mohammad A., Alsharif, Ubai, Alvarez, Elena, Alvis-Guzmán, Nelson, Amankwaa, Adansi A., Amare, Azmeraw T., Amini, Hassan, Ammar, Walid, Antonio, Carl A.T., Anwari, Palwasha, Ärnlöv, Johan, Arsenijevic, Valentina S. Arsic, Artaman, Ali, Asad, Majed Masoud, Asghar, Rana J., Assadi, Reza, Atkins, Lydia S., Badawi, Alaa, Balakrishnan, Kalpana, Basu, Arindam, Basu, Sanjay, Beardsley, Justin, Bedi, Neeraj, Bekele, Tolesa, Bell, Michelle L., Bernabe, Eduardo, Beyene, Tariku J., Bhutta, Zulfiqar, Abdulhak, Aref Bin, Blore, Jed D., Basara, Berrak Bora, Bose, Dipan, Breitborde, Nichola, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A., Castro, Ruben Estanislao, Catalá-López, Ferrán, Cavlin, Alanur, Chang, Jung-Chen, Che, Xuan, Christophi, Costas A., Chugh, Sumeet S., Cirillo, Massimo, Colquhoun, Samantha M., Cooper, Leslie Trumbull, Cooper, Cyru, Da Costa Leite, Iuri, Dandona, Lalit, Dandona, Rakhi, Davis, Adrian, Dayama, Anand, Degenhardt, Louisa, De Leo, Diego, Del Pozo-Cruz, Borja, Deribe, Kebede, Dessalegn, Muluken, Deveber, Gabrielle A., Dharmaratne, Samath D., Dilmen, Uʇur, Ding, Eric L., Dorrington, Rob E., Driscoll, Tim R., Ermakov, Sergei Petrovich, Esteghamati, Alireza, Faraon, Emerito Jose A., Farzadfar, Farshad, Felicio, Manuela Mendonca, Fereshtehnejad, Seyed-Mohammad, De Lima, Graça Maria Ferreira, Forouzanfar, Mohammad H., França, Elisabeth B., Gaffikin, Lynne, Gambashidze, Ketevan, Gankpé, Fortuné Gbètoho, Garcia, Ana C., Geleijnse, Johanna M., Gibney, Katherine B., Giroud, Maurice, Glaser, Elizabeth L., Goginashvili, Ketevan, Gona, Philimon, González-Castell, Dinorah, Goto, Atsushi, Gouda, Hebe N., Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hammami, Mouhanad, Hankey, Graeme J., Harb, Hilda L., Havmoeller, Rasmu, Hay, Simon I., Pi, Ileana B. Heredia, Hoek, Hans W., Hosgood, H Dean, Hoy, Damian G., Husseini, Abdullatif, Idrisov, Bulat T., Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H., Jahangir, Eiman, Jee, Sun Ha, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Jonas, Jost B., Juel, Knud, Kabagambe, Edmond Kato, Kan, Haidong, Karam, Nadim E., Karch, André, Karema, Corine Kakizi, Kaul, Anil, Kawakami, Norito, Kazanjan, Konstantin, Kazi, Dhruv S., Kemp, Andrew H., Kengne, Andre Pascal, Kereselidze, Maia, Khader, Yousef Saleh, Khalifa, Shams Eldin Ali Hassan, Khan, Ejaz Ahmed, Khang, Young-Ho, Knibbs, Luke, Kokubo, Yoshihiro, Kosen, Soewarta, Defo, Barthelemy Kuate, Kulkarni, Chanda, Kulkarni, Veena S., Kumar, G. Anil, Kumar, Kaushalendra, Kumar, Ravi B., Kwan, Gene, Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lansingh, Van C., Larsson, Ander, Lee, Jong-Tae, Leigh, Jame, Leinsalu, Mall, Leung, Ricky, Li, Xiaohong, Li, Yichong, Li, Yongmei, Liang, Juan, Liang, Xiaofeng, Lim, Stephen S., Lin, Hsien-Ho, Lipshultz, Steven E., Liu, Shiwei, Liu, Yang, Lloyd, Belinda K., London, Stephanie J., Lotufo, Paulo A., Ma, Jixiang, Ma, Stefan, Machado, Vasco Manuel Pedro, Mainoo, Nana Kwaku, Majdan, Marek, Mapoma, Christopher Chabila, Marcenes, Wagner, Marzan, Melvin Barriento, Mason-Jones, Amanda J., Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Memish, Ziad A., Mendoza, Walter, Miller, Ted R., Mills, Edward J., Mokdad, Ali H., Mola, Glen Liddell, Monasta, Lorenzo, De La Cruz Monis, Jonathan, Hernandez, Julio Cesar Montañez, Moore, Ami R., Moradi-Lakeh, Maziar, Mori, Rintaro, Mueller, Ulrich O., Mukaigawara, Mitsuru, Naheed, Aliya, Naidoo, Kovin S., Nand, Devina, Nangia, Vinay, Nash, Deni, Nejjari, Chakib, Nelson, Robert G., Neupane, Sudan Prasad, Newton, Charles R., Ng, Marie, Nieuwenhuijsen, Mark J., Nisar, Muhammad Imran, Nolte, Sandra, Norheim, Ole F., Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Olusanya, Bolajoko O., Omer, Saad B., Opio, John Nelson, Orisakwe, Orish Ebere, Pandian, Jeyaraj D., Papachristou, Christina, Park, Jae-Hyun, Paternina Caicedo, Angel J., Patten, Scott B., Paul, Vinod K., Pavlin, Boris Igor, Pearce, Neil, Pereira, David M., Pesudovs, Konrad, Petzold, Max, Poenaru, Dan, Polanczyk, Guilherme V., Polinder, Suzanne, Pope, Dan, Pourmalek, Farshad, Qato, Dima, Quistberg, D. Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Ur Rahman, Sajjad, Raju, Murugesan, Rana, Saleem M., Refaat, Amany, Ronfani, Luca, Roy, Nobhojit, Pimienta, Tania Georgina Sánchez, Sahraian, Mohammad Ali, Salomon, Joshua A., Sampson, Uchechukwu, Santos, Itamar S., Sawhney, Monika, Sayinzoga, Felix, Schneider, Ione J.C., Schumacher, Austin, Schwebel, David C., Seedat, Soraya, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shakh-Nazarova, Marina, Sheikhbahaei, Sara, Shibuya, Kenji, Shin, Hwashin Hyun, Shiue, Ivy, Sigfusdottir, Inga Dora, Silberberg, Donald H., Silva, Andrea P., Singh, Jasvinder A., Skirbekk, Vegard, Sliwa, Karen, Soshnikov, Sergey S., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stroumpoulis, Konstantino, Sturua, Lela, Sykes, Bryan L., Tabb, Karen M., Talongwa, Roberto Tchio, Tan, Feng, Teixeira, Carolina Maria, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Thorne-Lyman, Andrew L., Tirschwell, David L., Towbin, Jeffrey A., Tran, Bach X., Tsilimbaris, Miltiadi, Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen Begüm, Vallely, Andrew J., Van Gool, Coen H., Vasankari, Tommi J., Vavilala, Monica S., Venketasubramanian, N., Villalpando, Salvador, Violante, Francesco S., Vlassov, Vasiliy Victorovich, Vos, Theo, Waller, Stephen, Wang, Haidong, Wang, Linhong, Wang, Xiao Rong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Westerman, Ronny, Wilkinson, James D., Woldeyohannes, Solomon Meseret, Wong, John Q., Wordofa, Muluemebet Abera, Xu, Gelin, Yang, Yang C., Yano, Yuichiro, Yentur, Gokalp Kadri, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Jin, Kim Yun, El Sayed Zaki, Maysaa, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zhu, Jun, Zou, Xiao Nong, Lopez, Alan D., Naghavi, Mohsen, Murray, Christopher J.L., Lozano, Rafael, Kassebaum, Nj, Bertozzi-Villa, A, Coggeshall, M, Shackelford, Ka, Steiner, C, Heuton, Kr, Gonzalez-Medina, D, Barber, R, Huynh, C, Dicker, D, Templin, T, Wolock, Tm, Ozgoren, Aa, Abd-Allah, F, Abera, Sf, Achoki, T, Adelekan, A, Ademi, Z, Adou, Ak, Adsuar, Jc, Agardh, Ee, Akena, D, Alasfoor, D, Alemu, Za, Alfonso-Cristancho, R, Alhabib, S, Ali, R, Al Kahbouri, Mj, Alla, F, Allen, Pj, Almazroa, Ma, Alsharif, U, Alvarez, E, Alvis-Guzmán, N, Amankwaa, Aa, Amare, At, Amini, H, Ammar, W, Antonio, Ca, Anwari, P, Arnlöv, J, Arsenijevic, V, Artaman, A, Asad, Mm, Asghar, Rj, Assadi, R, Atkins, L, Badawi, A, Balakrishnan, K, Basu, A, Basu, S, Beardsley, J, Bedi, N, Bekele, T, Bell, Ml, Bernabe, E, Beyene, Tj, Bhutta, Z, Bin Abdulhak, A, Blore, J, Basara, Bb, Bose, D, Breitborde, N, Cárdenas, R, Castañeda-Orjuela, Ca, Castro, Re, Catalá-López, F, Cavlin, A, Chang, Jc, Che, X, Christophi, Ca, Chugh, S, Cirillo, M, Colquhoun, Sm, Cooper, Lt, Cooper, C, da Costa Leite, I, Dandona, L, Dandona, R, Davis, A, Dayama, A, Degenhardt, L, De Leo, D, Del Pozo-Cruz, B, Deribe, K, Dessalegn, M, Deveber, Ga, Dharmaratne, Sd, Dilmen, U, Ding, El, Dorrington, Re, Driscoll, Tr, Ermakov, Sp, Esteghamati, A, Faraon, Ej, Farzadfar, F, Felicio, Mm, Fereshtehnejad, Sm, de Lima, Gm, Forouzanfar, Mh, França, Eb, Gaffikin, L, Gambashidze, K, Gankpé, Fg, Garcia, Ac, Geleijnse, Jm, Gibney, Kb, Giroud, M, Glaser, El, Goginashvili, K, Gona, P, González-Castell, D, Goto, A, Gouda, Hn, Gugnani, Hc, Gupta, R, Hafezi-Nejad, N, Hamadeh, Rr, Hammami, M, Hankey, Gj, Harb, Hl, Havmoeller, R, Hay, S, Pi, Ib, Hoek, Hw, Hosgood, Hd, Hoy, Dg, Husseini, A, Idrisov, Bt, Innos, K, Inoue, M, Jacobsen, Kh, Jahangir, E, Jee, Sh, Jensen, Pn, Jha, V, Jiang, G, Juel, K, Kabagambe, Ek, Kan, H, Karam, Ne, Karch, A, Karema, Ck, Kaul, A, Kawakami, N, Kazanjan, K, Kazi, D, Kemp, Ag, Kengne, Ap, Kereselidze, M, Khader, Y, Khalifa, Se, Khan, Ea, Khang, Yh, Knibbs, L, Kokubo, Y, Kosen, S, Defo, Bk, Kulkarni, C, Kulkarni, V, Kumar, Ga, Kumar, K, Kumar, Rb, Kwan, G, Lai, T, Lalloo, R, Lam, H, Lansingh, Vc, Larsson, A, Lee, Jt, Leigh, J, Leinsalu, M, Leung, R, Li, X, Li, Y, Liang, J, Liang, X, Lim, S, Lin, Hh, Lipshultz, Se, Liu, S, Liu, Y, Lloyd, Bk, London, Sj, Lotufo, Pa, Ma, J, Ma, S, Machado, Vm, Mainoo, Nk, Majdan, M, Mapoma, Cc, Marcenes, W, Marzan, Mb, Mason-Jones, Aj, Mehndiratta, Mm, Mejia-Rodriguez, F, Memish, Za, Mendoza, W, Miller, Tr, Mills, Ej, Mokdad, Ah, Mola, Gl, Monasta, L, de la Cruz Monis, J, Hernandez, Jc, Moore, Ar, Mori, R, Mueller, Uo, Mukaigawara, M, Naheed, A, Naidoo, K, Nand, D, Nangia, V, Nash, D, Nejjari, C, Nelson, Rg, Neupane, Sp, Newton, Cr, Ng, M, Nieuwenhuijsen, Mj, Nisar, Mi, Nolte, S, Norheim, Of, Nyakarahuka, L, Oh, Ih, Ohkubo, T, Olusanya, Bo, Omer, Sb, Opio, Jn, Orisakwe, Oe, Pandian, Jd, Papachristou, C, Park, Jh, Caicedo, Aj, Patten, Sb, Paul, Vk, Pavlin, Bi, Pearce, N, Pereira, Dm, Pesudovs, K, Petzold, M, Poenaru, D, Polanczyk, Gv, Polinder, S, Pope, D, Pourmalek, F, Qato, D, Quistberg, Da, Rafay, A, Rahimi, K, Rahimi-Movaghar, V, Ur Rahman, S, Raju, M, Rana, Sm, Refaat, A, Ronfani, L, Roy, N, Pimienta, Tg, Sahraian, Ma, Salomon, J, Sampson, U, Santos, I, Sawhney, M, Sayinzoga, F, Schneider, Ij, Schumacher, A, Schwebel, Dc, Seedat, S, Sepanlou, Sg, Servan-Mori, Ee, Shakh-Nazarova, M, Sheikhbahaei, S, Shibuya, K, Shin, Hh, Shiue, I, Sigfusdottir, Id, Silberberg, Dh, Silva, Ap, Singh, Ja, Skirbekk, V, Sliwa, K, Soshnikov, S, Sposato, La, Sreeramareddy, Ct, Stroumpoulis, K, Sturua, L, Sykes, Bl, Tabb, Km, Talongwa, Rt, Tan, F, Teixeira, Cm, Tenkorang, Ey, Terkawi, A, Thorne-Lyman, Al, Tirschwell, Dl, Towbin, Ja, Tran, Bx, Tsilimbaris, M, Uchendu, U, Ukwaja, Kn, Undurraga, Ea, Uzun, Sb, Vallely, Aj, van Gool, Ch, Vasankari, Tj, Vavilala, M, Venketasubramanian, N, Villalpando, S, Violante, F, Vlassov, Vv, Vos, T, Waller, S, Wang, H, Wang, L, Wang, Sx, Wang, Y, Weichenthal, S, Weiderpass, E, Weintraub, Rg, Westerman, R, Wilkinson, Jd, Woldeyohannes, Sm, Wong, Jq, Wordofa, Ma, Xu, G, Yang, Yc, Yano, Y, Yentur, Gk, Yip, P, Yonemoto, N, Yoon, Sj, Younis, Mz, Yu, C, Jin, Ky, El Sayed Zaki, M, Zhao, Y, Zheng, Y, Zhou, M, Zhu, J, Zou, Xn, Lopez, Ad, Naghavi, M, Murray, Cj, Lozano, R, Cell biology, Epidemiology, Public Health, Erasmus MC other, Cardiothoracic Surgery, and Pathology
Subjects: Pediatrics, Time Factors, Nutrition and Disease, hiv-infection, immunodeficiency virus-1 infection, peripartum cardiomyopathy, Poison control, HIV Infections, IMMUNODEFICIENCY VIRUS-1 INFECTION, Socioeconomic Factor, Global Health, 0302 clinical medicine, PERIPARTUM CARDIOMYOPATHY, pregnancy-related mortality, Risk Factors, Pregnancy, Voeding en Ziekte, Cause of Death, Global health, HIV Infection, 030212 general & internal medicine, Pregnancy Complications, Infectious, 10. No inequality, Cause of death, 030219 obstetrics & reproductive medicine, south-africa, Medicine (all), 1. No poverty, WOMEN, PREGNANCY-RELATED MORTALITY, health initiatives, General Medicine, SOUTH-AFRICA, 3. Good health, Maternal Mortality, World Health, CHILD SURVIVAL, Female, Maternal death, women, Human, medicine.medical_specialty, Time Factor, DEATHS, child survival, Article, adult mortality, 03 medical and health sciences, Age Distribution, HEALTH INITIATIVES, SDG 3 - Good Health and Well-being, HIV-INFECTION, ADULT MORTALITY, Injury prevention, medicine, Organizational Objectives, Organizational Objective, Humans, VLAG, Models, Statistical, business.industry, Risk Factor, medicine.disease, deaths, Standardized mortality ratio, Socioeconomic Factors, Relative risk, Pregnancy Complications, Infectiou, business, Demography
Abstract: BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.FUNDING: Bill & Melinda Gates Foundation.
Published: 2016
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49. Midwifery capacity building in Papua New Guinea: Key achievements and ways forward

Author: Lahui Geita, Michele Rumsey, Felicity Copeland, Glen Mola, Angela Dawson, Mary Kililo, Pat Brodie, Amanda Neill, and Caroline S.E. Homer
Subjects: medicine.medical_specialty, Capacity Building, education, Midwifery, Interviews as Topic, 03 medical and health sciences, Papua New Guinea, 0302 clinical medicine, Nursing, Pregnancy, Maternity and Midwifery, Medicine, Humans, 030212 general & internal medicine, Staff Development, Obstetrics & Reproductive Medicine, Curriculum, Health policy, Qualitative Research, Accreditation, business.industry, Obstetrics, 030503 health policy & services, Professional development, Obstetrics and Gynecology, Capacity building, Focus Groups, Achievement, Focus group, Workforce, Female, 0305 other medical science, business, Qualitative research
Abstract: © 2015 Australian College of Midwives. Background: Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. Aim: This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. Method: A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. Findings: Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. Conclusion: The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates.
Published: 2016

50. A novel point-of-care testing strategy for sexually transmitted infections among pregnant women in high-burden settings: Results of a feasibility study in Papua New Guinea

Author: Glen Mola, David M. Whiley, Suzanne M. Garland, Andrew Vallely, Stephen J. Rogerson, Pamela J Toliman, Lisa M Vallely, Stanley Luchters, Basil Donovan, Rebecca Guy, Louise M. Causer, John M. Kaldor, Christopher Morgan, Steven G Badman, Sepehr N. Tabrizi, William Pomat, Caroline Holmer, Handan Wand, Grace Kariwiga, and Bomesina Lote
Subjects: 0301 basic medicine, Gonorrhea, Chlamydia trachomatis, HIV Infections, medicine.disease_cause, Ambulatory Care Facilities, 0302 clinical medicine, Syndromic management, Pregnancy, Prevalence, Odds Ratio, 030212 general & internal medicine, Pregnancy Complications, Infectious, Asymptomatic Infections, Obstetrics, Age Factors, Prenatal Care, Genexpert, Vaginosis, Bacterial, Infectious Diseases, Point-of-Care Testing, Female, Bacterial vaginosis, medicine.symptom, Research Article, Adult, medicine.medical_specialty, Adolescent, 030106 microbiology, Sexually Transmitted Diseases, Trichomonas Infections, Prenatal care, STIs, Microbiology, Pregnancy outcome, Molecular testing, 03 medical and health sciences, Papua New Guinea, Young Adult, medicine, Trichomonas vaginalis, Antenatal, Humans, Low-middle-income country, Syphilis, Gynecology, business.industry, Chlamydia Infections, medicine.disease, Infant mortality, Neisseria gonorrhoeae, Low birth weight, Point-of-care, Feasibility Studies, business
Abstract: © 2016 The Author(s). Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is feasible in the high-burden, low-income setting of Papua New Guinea. Methods: Women attending their first antenatal clinic visit were invited to participate. CT/NG and TV were tested using the GeneXpert platform (Cepheid, USA), and BV tested using BVBlue (Gryphus Diagnostics, USA). Participants received same-day test results and antibiotic treatment as indicated. Routine antenatal care including HIV and syphilis screening were provided. Results: Point-of-care testing was provided to 125/222 (56 %) of women attending routine antenatal care during the three-month study period. Among the 125 women enrolled, the prevalence of CT was 20.0 %; NG, 11.2 %; TV, 37.6 %; and BV, 17.6 %. Over half (67/125, 53.6 %) of women had one or more of these infections. Most women were asymptomatic (71.6 %; 47/67). Women aged 24 years and under were more likely to have one or more STI compared with older women (odds ratio 2.38; 95 % CI: 1.09, 5.21). Most women with an STI received treatment on the same day (83.6 %; 56/67). HIV prevalence was 1.6 % and active syphilis 4.0 %. Conclusion: Point-of-care STI testing and treatment using a combination of novel, newly-available assays was feasible during routine antenatal care in this setting. This strategy has not previously been evaluated in any setting and offers the potential to transform STI management in pregnancy and to prevent their associated adverse health outcomes.
Published: 2016

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