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3. Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Author

Lara-Castor, Laura, Micha, Renata, Cudhea, Frederick, Miller, Victoria, Shi, Peilin, Zhang, Jianyi, Sharib, Julia R., Erndt-Marino, Josh, Cash, Sean B., Mozaffarian, Dariush, Bas, Murat, Ali, Jemal Haidar, Abumweis, Suhad, Krishnan, Anand, Misra, Puneet, Hwalla, Nahla Chawkat, Janakiram, Chandrashekar, Liputo, Nur Indrawaty, Musaiger, Abdulrahman, Pourfarzi, Farhad, Alam, Iftikhar, DeRidder, Karin, Termote, Celine, Memon, Anjum, Turrini, Aida, Lupotto, Elisabetta, Piccinelli, Raffaela, Sette, Stefania, Anzid, Karim, Vossenaar, Marieke, Mazumdar, Paramita, Rached, Ingrid, Rovirosa, Alicia, Zapata, María Elisa, Asayehu, Tamene Taye, Oduor, Francis, Boedecker, Julia, Aluso, Lilian, Ortiz-Ulloa, Johana, Meenakshi, J.V., Castro, Michelle, Grosso, Giuseppe, Waskiewicz, Anna, Khan, Umber S., Thanopoulou, Anastasia, Malekzadeh, Reza, Calleja, Neville, Ocke, Marga, Etemad, Zohreh, Nsour, Mohannad Al, Waswa, Lydiah M., Nurk, Eha, Arsenault, Joanne, Lopez-Jaramillo, Patricio, Sibai, Abla Mehio, Damasceno, Albertino, Arambepola, Carukshi, Lopes, Carla, Severo, Milton, Lunet, Nuno, Torres, Duarte, Tapanainen, Heli, Lindstrom, Jaana, Virtanen, Suvi, Palacios, Cristina, Roos, Eva, Agdeppa, Imelda Angeles, Desnacido, Josie, Capanzana, Mario, Misra, Anoop, Khouw, Ilse, Ng, Shu Wen, Delgado, Edna Gamboa, Caballero, Mauricio, Otero, Johanna, Lee, Hae Jeung, Koksal, Eda, Guessous, Idris, Lachat, Carl, De Henauw, Stefaan, Rahbar, Ali Reza, Tedstone, Alison, Naska, Androniki, Mathee, Angie, Ling, Annie, Tedla, Bemnet, Hopping, Beth, Ginnela, Brahmam, Leclercq, Catherine, Duante, Charmaine, Haerpfer, Christian, Hotz, Christine, Pitsavos, Christos, Rehm, Colin, van Oosterhout, Coline, Cerdena, Corazon, Bradshaw, Debbie, Trichopoulos, Dimitrios, Gauci, Dorothy, Fernando, Dulitha, Sygnowska, Elzbieta, Vartiainen, Erkki, Farzadfar, Farshad, Zajkas, Gabor, Swan, Gillian, Ma, Guansheng, Pekcan, Gulden, Ibrahim, Hajah Masni, Sinkko, Harri, Barbieri, Helene Enghardt, Sioen, Isabelle, Myhre, Jannicke, Gaspoz, Jean Michel, Odenkirk, Jillian, Bundhamcharoen, Kanitta, Nelis, Keiu, Zarina, Khairul, Biro, Lajos, Johansson, Lars, Steingrimsdottir, Laufey, Riley, Leanne, Yap, Mabel, Inoue, Manami, Szabo, Maria, Ovaskainen, Marja Leena, Lee, Meei Shyuan, Chan, Mei Fen, Cowan, Melanie, Kandiah, Mirnalini, Kally, Ola, Jonsdottir, Olof, Palmer, Pam, Vollenweider, Peter, Orfanos, Philippos, Asciak, Renzo, Templeton, Robert, Don, Rokiah, Yaakub, Roseyati, Selamat, Rusidah, Yusof, Safiah, Al-Zenki, Sameer, Hung, Shu Yi, Beer-Borst, Sigrid, Wu, Suh, Lukito, Widjaja, Hadden, Wilbur, Becker, Wulf, Cao, Xia, Ma, Yi, Lai, Yuen, Hjdaud, Zaiton, Ali, Jennifer, Gravel, Ron, Tao, Tina, Veerman, Jacob Lennert, Chiplonkar, Shashi, Arici, Mustafa, Ngoan, Le Tran, Panagiotakos, Demosthenes, Li, Yanping, Trichopoulou, Antonia, Barengo, Noel, Khadilkar, Anuradha, Ekbote, Veena, Mohammadifard, Noushin, Kovalskys, Irina, Laxmaiah, Avula, Rachakulla, Harikumar, Rajkumar, Hemalatha, Meshram, Indrapal, Avula, Laxmaiah, Arlappa, Nimmathota, Hemalatha, Rajkumar, Iacoviello, Licia, Bonaccio, Marialaura, Costanzo, Simona, Martin-Prevel, Yves, Castetbon, Katia, Jitnarin, Nattinee, Hsieh, Yao Te, Olivares, Sonia, Tejeda, Gabriela, Hadziomeragic, Aida, de Moura Souza, Amanda, Pan, Wen Harn, Huybrechts, Inge, de Brauw, Alan, Moursi, Mourad, Maghroun, Maryam, Zeba, Augustin Nawidimbasba, Sarrafzadegan, Nizal, Keinan-Boker, Lital, Goldsmith, Rebecca, Shimony, Tal, Jordan, Irmgard, Mastiholi, Shivanand C., Mwangi, Moses, Kombe, Yeri, Bukania, Zipporah, Alissa, Eman, Al-Daghri, Nasser, Sabico, Shaun, Gulliford, Martin, Diba, Tshilenge S., Oh, Kyungwon, Kweon, Sanghui, Park, Sihyun, Cho, Yoonsu, Al-Hooti, Suad, Luangphaxay, Chanthaly, Douangvichit, Daovieng, Siengsounthone, Latsamy, Marques-Vidal, Pedro, Rybak, Constance, Luke, Amy, Piaseu, Noppawan, Rojroongwasinkul, Nipa, Sundram, Kalyana, Koster, Jeremy, Baykova, Donka, Abedi, Parvin, Sandjaja, Sandjaja, Fadzil, Fariza, Bukhary, Noriklil Bukhary Ismail, Bovet, Pascal, Chen, Yu, Sawada, Norie, Tsugane, Shoichiro, Rangelova, Lalka, Petrova, Stefka, Duleva, Vesselka, Lindroos, Anna Karin, Sipinen, Jessica Petrelius, Moraeus, Lotta, Bergman, Per, Siamusantu, Ward, Szponar, Lucjan, Chang, Hsing Yi, Sekiyama, Makiko, Le Nguyen Bao, Khanh, Nagalla, Balakrishna, Polasa, Kalpagam, Boindala, Sesikeran, El Ati, Jalila, Silva, Ivonne Ramirez, Dommarco, Juan Rivera, Barquera, Simon, Rodríguez-Ramírez, Sonia, Illescas-Zarate, Daniel, Sanchez-Romero, Luz Maria, Ikeda, Nayu, Zaghloul, Sahar, Houshiar-rad, Anahita, Mohammadi-Nasrabadi, Fatemeh, Abdollahi, Morteza, Chuah, Khun Aik, Mahdy, Zaleha Abdullah, Eldridge, Alison, Ding, Eric L., Kruger, Herculina, Henjum, Sigrun, Fernandez, Anne, Suarez-Ortegon, Milton Fabian, Al-Hamad, Nawal, Janská, Veronika, Tayyem, Reema, Mirmiran, Parvin, Kelishadi, Roya, Lemming, Eva Warensjo, Richter, Almut, Mensink, Gert, Wieler, Lothar, Hoffman, Daniel, Salanave, Benoit, Il Kim, Cho, Kuriyan-Raj, Rebecca, Swaminathan, Sumathi, Garriguet, Didier, Dastgiri, Saeed, Vaask, Sirje, Karupaiah, Tilakavati, Zohoori, Fatemeh Vida, Esteghamati, Alireza, Hashemian, Maryam, Noshad, Sina, Mwaniki, Elizabeth, Yakes-Jimenez, Elizabeth, Chileshe, Justin, Mwanza, Sydney, Marques, Lydia Lera, Preston, Alan Martin, Aguero, Samuel Duran, Oleas, Mariana, Posada, Luz, Ochoa, Angelica, Shamsuddin, Khadijah, Shariff, Zalilah Mohd, Jan Bin Jan Mohamed, Hamid, Manan, Wan, Nicolau, Anca, Tudorie, Cornelia, Poh, Bee Koon, Abbott, Pamela, Pakseresht, Mohammadreza, Sharma, Sangita, Strand, Tor, Alexy, Ute, Nöthlings, Ute, Carmikle, Jan, Brown, Ken, Waidyatilaka, Indu, Lanerolle, Pulani, Jayawardena, Ranil, Long, Julie M., Hambidge, Michael, Krebs, Nancy F., Haque, Aminul, Keding, Gudrun B., Korkalo, Liisa, Erkkola, Maijaliisa, Freese, Riitta, Eleraky, Laila, Stuetz, Wolfgang, Thorsdottir, Inga, Gunnarsdottir, Ingibjorg, Serra-Majem, Lluis, Moy, Foong Ming, Anderson, Simon, Jeewon, Rajesh, Zugravu, Corina Aurelia, Adair, Linda, Skeaff, Sheila, Marchioni, Dirce, Fisberg, Regina, Henry, Carol, Ersino, Getahun, Zello, Gordon, Meyer, Alexa, Elmadfa, Ibrahim, Mitchell, Claudette, Balfour, David, Geleijnse, Johanna M., Manary, Mark, El-kour, Tatyana, Nikiema, Laetitia, Mirzaei, Masoud, Hakeem, Rubina, Lara-Castor, Laura, Micha, Renata, Cudhea, Frederick, Miller, Victoria, Shi, Peilin, Zhang, Jianyi, Sharib, Julia R., Erndt-Marino, Josh, Cash, Sean B., Mozaffarian, Dariush, Bas, Murat, Ali, Jemal Haidar, Abumweis, Suhad, Krishnan, Anand, Misra, Puneet, Hwalla, Nahla Chawkat, Janakiram, Chandrashekar, Liputo, Nur Indrawaty, Musaiger, Abdulrahman, Pourfarzi, Farhad, Alam, Iftikhar, DeRidder, Karin, Termote, Celine, Memon, Anjum, Turrini, Aida, Lupotto, Elisabetta, Piccinelli, Raffaela, Sette, Stefania, Anzid, Karim, Vossenaar, Marieke, Mazumdar, Paramita, Rached, Ingrid, Rovirosa, Alicia, Zapata, María Elisa, Asayehu, Tamene Taye, Oduor, Francis, Boedecker, Julia, Aluso, Lilian, Ortiz-Ulloa, Johana, Meenakshi, J.V., Castro, Michelle, Grosso, Giuseppe, Waskiewicz, Anna, Khan, Umber S., Thanopoulou, Anastasia, Malekzadeh, Reza, Calleja, Neville, Ocke, Marga, Etemad, Zohreh, Nsour, Mohannad Al, Waswa, Lydiah M., Nurk, Eha, Arsenault, Joanne, Lopez-Jaramillo, Patricio, Sibai, Abla Mehio, Damasceno, Albertino, Arambepola, Carukshi, Lopes, Carla, Severo, Milton, Lunet, Nuno, Torres, Duarte, Tapanainen, Heli, Lindstrom, Jaana, Virtanen, Suvi, Palacios, Cristina, Roos, Eva, Agdeppa, Imelda Angeles, Desnacido, Josie, Capanzana, Mario, Misra, Anoop, Khouw, Ilse, Ng, Shu Wen, Delgado, Edna Gamboa, Caballero, Mauricio, Otero, Johanna, Lee, Hae Jeung, Koksal, Eda, Guessous, Idris, Lachat, Carl, De Henauw, Stefaan, Rahbar, Ali Reza, Tedstone, Alison, Naska, Androniki, Mathee, Angie, Ling, Annie, Tedla, Bemnet, Hopping, Beth, Ginnela, Brahmam, Leclercq, Catherine, Duante, Charmaine, Haerpfer, Christian, Hotz, Christine, Pitsavos, Christos, Rehm, Colin, van Oosterhout, Coline, Cerdena, Corazon, Bradshaw, Debbie, Trichopoulos, Dimitrios, Gauci, Dorothy, Fernando, Dulitha, Sygnowska, Elzbieta, Vartiainen, Erkki, Farzadfar, Farshad, Zajkas, Gabor, Swan, Gillian, Ma, Guansheng, Pekcan, Gulden, Ibrahim, Hajah Masni, Sinkko, Harri, Barbieri, Helene Enghardt, Sioen, Isabelle, Myhre, Jannicke, Gaspoz, Jean Michel, Odenkirk, Jillian, Bundhamcharoen, Kanitta, Nelis, Keiu, Zarina, Khairul, Biro, Lajos, Johansson, Lars, Steingrimsdottir, Laufey, Riley, Leanne, Yap, Mabel, Inoue, Manami, Szabo, Maria, Ovaskainen, Marja Leena, Lee, Meei Shyuan, Chan, Mei Fen, Cowan, Melanie, Kandiah, Mirnalini, Kally, Ola, Jonsdottir, Olof, Palmer, Pam, Vollenweider, Peter, Orfanos, Philippos, Asciak, Renzo, Templeton, Robert, Don, Rokiah, Yaakub, Roseyati, Selamat, Rusidah, Yusof, Safiah, Al-Zenki, Sameer, Hung, Shu Yi, Beer-Borst, Sigrid, Wu, Suh, Lukito, Widjaja, Hadden, Wilbur, Becker, Wulf, Cao, Xia, Ma, Yi, Lai, Yuen, Hjdaud, Zaiton, Ali, Jennifer, Gravel, Ron, Tao, Tina, Veerman, Jacob Lennert, Chiplonkar, Shashi, Arici, Mustafa, Ngoan, Le Tran, Panagiotakos, Demosthenes, Li, Yanping, Trichopoulou, Antonia, Barengo, Noel, Khadilkar, Anuradha, Ekbote, Veena, Mohammadifard, Noushin, Kovalskys, Irina, Laxmaiah, Avula, Rachakulla, Harikumar, Rajkumar, Hemalatha, Meshram, Indrapal, Avula, Laxmaiah, Arlappa, Nimmathota, Hemalatha, Rajkumar, Iacoviello, Licia, Bonaccio, Marialaura, Costanzo, Simona, Martin-Prevel, Yves, Castetbon, Katia, Jitnarin, Nattinee, Hsieh, Yao Te, Olivares, Sonia, Tejeda, Gabriela, Hadziomeragic, Aida, de Moura Souza, Amanda, Pan, Wen Harn, Huybrechts, Inge, de Brauw, Alan, Moursi, Mourad, Maghroun, Maryam, Zeba, Augustin Nawidimbasba, Sarrafzadegan, Nizal, Keinan-Boker, Lital, Goldsmith, Rebecca, Shimony, Tal, Jordan, Irmgard, Mastiholi, Shivanand C., Mwangi, Moses, Kombe, Yeri, Bukania, Zipporah, Alissa, Eman, Al-Daghri, Nasser, Sabico, Shaun, Gulliford, Martin, Diba, Tshilenge S., Oh, Kyungwon, Kweon, Sanghui, Park, Sihyun, Cho, Yoonsu, Al-Hooti, Suad, Luangphaxay, Chanthaly, Douangvichit, Daovieng, Siengsounthone, Latsamy, Marques-Vidal, Pedro, Rybak, Constance, Luke, Amy, Piaseu, Noppawan, Rojroongwasinkul, Nipa, Sundram, Kalyana, Koster, Jeremy, Baykova, Donka, Abedi, Parvin, Sandjaja, Sandjaja, Fadzil, Fariza, Bukhary, Noriklil Bukhary Ismail, Bovet, Pascal, Chen, Yu, Sawada, Norie, Tsugane, Shoichiro, Rangelova, Lalka, Petrova, Stefka, Duleva, Vesselka, Lindroos, Anna Karin, Sipinen, Jessica Petrelius, Moraeus, Lotta, Bergman, Per, Siamusantu, Ward, Szponar, Lucjan, Chang, Hsing Yi, Sekiyama, Makiko, Le Nguyen Bao, Khanh, Nagalla, Balakrishna, Polasa, Kalpagam, Boindala, Sesikeran, El Ati, Jalila, Silva, Ivonne Ramirez, Dommarco, Juan Rivera, Barquera, Simon, Rodríguez-Ramírez, Sonia, Illescas-Zarate, Daniel, Sanchez-Romero, Luz Maria, Ikeda, Nayu, Zaghloul, Sahar, Houshiar-rad, Anahita, Mohammadi-Nasrabadi, Fatemeh, Abdollahi, Morteza, Chuah, Khun Aik, Mahdy, Zaleha Abdullah, Eldridge, Alison, Ding, Eric L., Kruger, Herculina, Henjum, Sigrun, Fernandez, Anne, Suarez-Ortegon, Milton Fabian, Al-Hamad, Nawal, Janská, Veronika, Tayyem, Reema, Mirmiran, Parvin, Kelishadi, Roya, Lemming, Eva Warensjo, Richter, Almut, Mensink, Gert, Wieler, Lothar, Hoffman, Daniel, Salanave, Benoit, Il Kim, Cho, Kuriyan-Raj, Rebecca, Swaminathan, Sumathi, Garriguet, Didier, Dastgiri, Saeed, Vaask, Sirje, Karupaiah, Tilakavati, Zohoori, Fatemeh Vida, Esteghamati, Alireza, Hashemian, Maryam, Noshad, Sina, Mwaniki, Elizabeth, Yakes-Jimenez, Elizabeth, Chileshe, Justin, Mwanza, Sydney, Marques, Lydia Lera, Preston, Alan Martin, Aguero, Samuel Duran, Oleas, Mariana, Posada, Luz, Ochoa, Angelica, Shamsuddin, Khadijah, Shariff, Zalilah Mohd, Jan Bin Jan Mohamed, Hamid, Manan, Wan, Nicolau, Anca, Tudorie, Cornelia, Poh, Bee Koon, Abbott, Pamela, Pakseresht, Mohammadreza, Sharma, Sangita, Strand, Tor, Alexy, Ute, Nöthlings, Ute, Carmikle, Jan, Brown, Ken, Waidyatilaka, Indu, Lanerolle, Pulani, Jayawardena, Ranil, Long, Julie M., Hambidge, Michael, Krebs, Nancy F., Haque, Aminul, Keding, Gudrun B., Korkalo, Liisa, Erkkola, Maijaliisa, Freese, Riitta, Eleraky, Laila, Stuetz, Wolfgang, Thorsdottir, Inga, Gunnarsdottir, Ingibjorg, Serra-Majem, Lluis, Moy, Foong Ming, Anderson, Simon, Jeewon, Rajesh, Zugravu, Corina Aurelia, Adair, Linda, Skeaff, Sheila, Marchioni, Dirce, Fisberg, Regina, Henry, Carol, Ersino, Getahun, Zello, Gordon, Meyer, Alexa, Elmadfa, Ibrahim, Mitchell, Claudette, Balfour, David, Geleijnse, Johanna M., Manary, Mark, El-kour, Tatyana, Nikiema, Laetitia, Mirzaei, Masoud, and Hakeem, Rubina

Abstract

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.

Published
2023

4. Children’s and adolescents’ rising animal-source food intakes in 1990–2018 were impacted by age, region, parental education and urbanicity

Author

Miller, Victoria, Webb, Patrick, Cudhea, Frederick, Zhang, Jianyi, Reedy, Julia, Shi, Peilin, Erndt-Marino, Josh, Coates, Jennifer, Micha, Renata, Mozaffarian, Dariush, Bas, Murat, Ali, Jemal Haidar, Abumweis, Suhad, Krishnan, Anand, Misra, Puneet, Hwalla, Nahla Chawkat, Janakiram, Chandrashekar, Liputo, Nur Indrawaty, Musaiger, Abdulrahman, Pourfarzi, Farhad, Alam, Iftikhar, DeRidder, Karin, Termote, Celine, Memon, Anjum, Turrini, Aida, Lupotto, Elisabetta, Piccinelli, Raffaela, Sette, Stefania, Anzid, Karim, Vossenaar, Marieke, Mazumdar, Paramita, Rached, Ingrid, Rovirosa, Alicia, Zapata, María Elisa, Asayehu, Tamene Taye, Oduor, Francis, Boedecker, Julia, Aluso, Lilian, Ortiz-Ulloa, Johana, Meenakshi, J.V., Castro, Michelle, Grosso, Giuseppe, Waskiewicz, Anna, Khan, Umber S., Thanopoulou, Anastasia, Malekzadeh, Reza, Calleja, Neville, Ocke, Marga, Etemad, Zohreh, Nsour, Mohannad Al, Waswa, Lydiah M., Nurk, Eha, Arsenault, Joanne, Lopez-Jaramillo, Patricio, Sibai, Abla Mehio, Damasceno, Albertino, Arambepola, Carukshi, Lopes, Carla, Severo, Milton, Lunet, Nuno, Torres, Duarte, Tapanainen, Heli, Lindstrom, Jaana, Virtanen, Suvi, Palacios, Cristina, Roos, Eva, Agdeppa, Imelda Angeles, Desnacido, Josie, Capanzana, Mario, Misra, Anoop, Khouw, Ilse, Ng, Swee Ai, Delgado, Edna Gamboa, Caballero, Mauricio, Otero, Johanna, Lee, Hae-Jeung, Koksal, Eda, Guessous, Idris, Lachat, Carl, De Henauw, Stefaan, Rahbar, Ali Reza, Tedstone, Alison, Naska, Androniki, Mathee, Angie, Ling, Annie, Tedla, Bemnet, Hopping, Beth, Ginnela, Brahmam, Leclercq, Catherine, Duante, Charmaine, Haerpfer, Christian, Hotz, Christine, Pitsavos, Christos, Rehm, Colin, van Oosterhout, Coline, Cerdena, Corazon, Bradshaw, Debbie, Trichopoulos, Dimitrios, Gauci, Dorothy, Fernando, Dulitha, Sygnowska, Elzbieta, Vartiainen, Erkki, Farzadfar, Farshad, Zajkas, Gabor, Swan, Gillian, Ma, Guansheng, Pekcan, Gulden, Ibrahim, Hajah Masni, Sinkko, Harri, Barbieri, Helene Enghardt, Sioen, Isabelle, Myhre, Jannicke, Gaspoz, Jean-Michel, Odenkirk, Jillian, Bundhamcharoen, Kanitta, Nelis, Keiu, Zarina, Khairul, Biro, Lajos, Johansson, Lars, Steingrimsdottir, Laufey, Riley, Leanne, Yap, Mabel, Inoue, Manami, Szabo, Maria, Ovaskainen, Marja-Leena, Lee, Meei-Shyuan, Chan, Mei Fen, Cowan, Melanie, Kandiah, Mirnalini, Kally, Ola, Jonsdottir, Olof, Palmer, Pam, Vollenweider, Peter, Orfanos, Philippos, Asciak, Renzo, Templeton, Robert, Don, Rokiah, Yaakub, Roseyati, Selamat, Rusidah, Yusof, Safiah, Al-Zenki, Sameer, Hung, Shu-Yi, Beer-Borst, Sigrid, Wu, Suh, Lukito, Widjaja, Hadden, Wilbur, Becker, Wulf, Cao, Xia, Ma, Yi, Lai, Yuen, Hjdaud, Zaiton, Ali, Jennifer, Gravel, Ron, Tao, Tina, Veerman, Jacob Lennert, Chiplonkar, Shashi, Arici, Mustafa, Ngoan, Le Tran, Panagiotakos, Demosthenes, Li, Yanping, Trichopoulou, Antonia, Barengo, Noel, Khadilkar, Anuradha, Ekbote, Veena, Mohammadifard, Noushin, Kovalskys, Irina, Laxmaiah, Avula, Rachakulla, Harikumar, Rajkumar, Hemalatha, Meshram, Indrapal, Avula, Laxmaiah, Arlappa, Nimmathota, Hemalatha, Rajkumar, lacoviello, Licia, Bonaccio, Marialaura, Costanzo, Simona, Martin-Prevel, Yves, Castetbon, Katia, Jitnarin, Nattinee, Hsieh, Yao-Te, Olivares, Sonia, Tejeda, Gabriela, Hadziomeragic, Aida, de Moura Souza, Amanda, Pan, Wen-Harn, Huybrechts, Inge, de Brauw, Alan, Moursi, Mourad, Maghroun, Maryam, Zeba, Augustin Nawidimbasba, Sarrafzadegan, Nizal, Keinan-Boker, Lital, Goldsmith, Rebecca, Shimony, Tal, Jordan, Irmgard, Mastiholi, Shivanand C., Mwangi, Moses, Kombe, Yeri, Bukania, Zipporah, Alissa, Eman, Al-Daghri, Nasser, Sabico, Shaun, Gulliford, Martin, Diba, Tshilenge S., Oh, Kyungwon, Kweon, Sanghui, Park, Sihyun, Cho, Yoonsu, Al-Hooti, Suad, Luangphaxay, Chanthaly, Douangvichit, Daovieng, Siengsounthone, Latsamy, Marques-Vidal, Pedro, Rybak, Constance, Luke, Amy, Piaseu, Noppawan, Rojroongwasinkul, Nipa, Sundram, Kalyana, Baykova, Donka, Abedi, Parvin, Sandjaja, Sandjaja, Fadzil, Fariza, Bukhary, Noriklil Bukhary Ismail, Bovet, Pascal, Chen, Yu, Sawada, Norie, Tsugane, Shoichiro, Rangelova, Lalka, Petrova, Stefka, Duleva, Vesselka, Lindroos, Anna Karin, Sipinen, Jessica Petrelius, Moraeus, Lotta, Bergman, Per, Siamusantu, Ward, Szponar, Lucjan, Chang, Hsing-Yi, Sekiyama, Makiko, Le Nguyen Bao, Khanh, Nagalla, Balakrishna, Polasa, Kalpagam, Boindala, Sesikeran, El Ati, Jalila, Silva, Ivonne Ramirez, Dommarco, Juan Rivera, Barquera, Simon, Ramírez, Sonia Rodríguez, Illescas-Zarate, Daniel, Sanchez-Romero, Luz Maria, Ikeda, Nayu, Zaghloul, Sahar, Houshiar-rad, Anahita, Mohammadi-Nasrabadi, Fatemeh, Abdollahi, Morteza, Chuah, Khun-Aik, Mahdy, Zaleha Abdullah, Eldridge, Alison, Ding, Eric L., Kruger, Herculina, Henjum, Sigrun, Fernandez, Anne, Suarez-Ortegon, Milton Fabian, Hamad, Nawal Al, Janská, Veronika, Tayyem, Reema, Mirmiran, Parvin, Kelishadi, Roya, Lemming, Eva Warensjo, Richter, Almut, Mensink, Gert, Wieler, Lothar, Hoffman, Daniel, Salanave, Benoit, Kim, Cho-il, Kuriyan-Raj, Rebecca, Swaminathan, Sumathi, Garriguet, Didier, Dastgiri, Saeed, Vaask, Sirje, Karupaiah, Tilakavati, Zohoori, Fatemeh Vida, Esteghamati, Alireza, Hashemian, Maryam, Noshad, Sina, Mwaniki, Elizabeth, Yakes-Jimenez, Elizabeth, Chileshe, Justin, Mwanza, Sydney, Marques, Lydia Lera, Preston, Alan Martin, Aguero, Samuel Duran, Oleas, Mariana, Posada, Luz, Ochoa, Angelica, Shamsuddin, Khadijah, Shariff, Zalilah Mohd, Jan Bin Jan Mohamed, Hamid, Manan, Wan, Nicolau, Anca, Tudorie, Cornelia, Poh, Bee Koon, Abbott, Pamela, Pakseresht, Mohammadreza, Sharma, Sangita, Strand, Tor Arne, Alexy, Ute, Nöthlings, Ute, Carmikle, Jan, Brown, Ken, Koster, Jeremy, Waidyatilaka, Indu, Lanerolle, Pulani, Jayawardena, Ranil, Long, Julie M., Hambidge, K. Michael, Krebs, Nancy F., Haque, Aminul, Keding, Gudrun B., Korkalo, Liisa, Erkkola, Maijaliisa, Freese, Riitta, Eleraky, Laila, Stuetz, Wolfgang, Thorsdottir, Inga, Gunnarsdottir, Ingibjorg, Serra-Majem, Lluis, Moy, Foong Ming, Anderson, Simon, Jeewon, Rajesh, Zugravu, Corina Aurelia, Adair, Linda, Ng, Shu Wen, Skeaff, Sheila, Marchioni, Dirce, Fisberg, Regina, Henry, Carol, Ersino, Getahun, Zello, Gordon, Meyer, Alexa, Elmadfa, Ibrahim, Mitchell, Claudette, Balfour, David, Geleijnse, Johanna M., Manary, Mark, El-kour, Tatyana, Nikiema, Laetitia, Mirzaei, Masoud, and Hakeem, Rubina

Abstract

Animal-source foods (ASF) provide nutrition for children and adolescents’ physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world’s child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at

Published
2023

5. Incident type 2 diabetes attributable to suboptimal diet in 184 countries

Author

O’Hearn, Meghan, Lara-Castor, Laura, Cudhea, Frederick, Miller, Victoria, Reedy, Julia, Shi, Peilin, Zhang, Jianyi, Wong, John B., Economos, Christina D., Micha, Renata, Mozaffarian, Dariush, Bas, Murat, Ali, Jemal Haidar, Abumweis, Suhad, Krishnan, Anand, Misra, Puneet, Hwalla, Nahla Chawkat, Janakiram, Chandrashekar, Liputo, Nur Indrawaty, Musaiger, Abdulrahman, Pourfarzi, Farhad, Alam, Iftikhar, DeRidder, Karin, Termote, Celine, Memon, Anjum, Turrini, Aida, Lupotto, Elisabetta, Piccinelli, Raffaela, Sette, Stefania, Anzid, Karim, Vossenaar, Marieke, Mazumdar, Paramita, Rached, Ingrid, Rovirosa, Alicia, Zapata, María Elisa, Asayehu, Tamene Taye, Oduor, Francis, Boedecker, Julia, Aluso, Lilian, Ortiz-Ulloa, Johana, Meenakshi, J.V., Castro, Michelle, Grosso, Giuseppe, Waskiewicz, Anna, Khan, Umber S., Thanopoulou, Anastasia, Malekzadeh, Reza, Calleja, Neville, Ocke, Marga, Etemad, Zohreh, Nsour, Mohannad Al, Waswa, Lydiah M., Nurk, Eha, Arsenault, Joanne, Lopez-Jaramillo, Patricio, Sibai, Abla Mehio, Damasceno, Albertino, Arambepola, Carukshi, Lopes, Carla, Severo, Milton, Lunet, Nuno, Torres, Duarte, Tapanainen, Heli, Lindstrom, Jaana, Virtanen, Suvi, Palacios, Cristina, Roos, Eva, Agdeppa, Imelda Angeles, Desnacido, Josie, Capanzana, Mario, Misra, Anoop, Khouw, Ilse, Ng, Swee Ai, Delgado, Edna Gamboa, Caballero, Mauricio, Otero, Johanna, Lee, Hae-Jeung, Koksal, Eda, Guessous, Idris, Lachat, Carl, De Henauw, Stefaan, Rahbar, Ali Reza, Tedstone, Alison, Naska, Androniki, Mathee, Angie, Ling, Annie, Tedla, Bemnet, Hopping, Beth, Ginnela, Brahmam, Leclercq, Catherine, Duante, Charmaine, Haerpfer, Christian, Hotz, Christine, Pitsavos, Christos, Rehm, Colin, van Oosterhout, Coline, Cerdena, Corazon, Bradshaw, Debbie, Trichopoulos, Dimitrios, Gauci, Dorothy, Fernando, Dulitha, Sygnowska, Elzbieta, Vartiainen, Erkki, Farzadfar, Farshad, Zajkas, Gabor, Swan, Gillian, Ma, Guansheng, Pekcan, Gulden, Ibrahim, Hajah Masni, Sinkko, Harri, Barbieri, Helene Enghardt, Sioen, Isabelle, Myhre, Jannicke, Gaspoz, Jean-Michel, Odenkirk, Jillian, Bundhamcharoen, Kanitta, Nelis, Keiu, Zarina, Khairul, Biro, Lajos, Johansson, Lars, Steingrimsdottir, Laufey, Riley, Leanne, Yap, Mabel, Inoue, Manami, Szabo, Maria, Ovaskainen, Marja-Leena, Lee, Meei-Shyuan, Chan, Mei Fen, Cowan, Melanie, Kandiah, Mirnalini, Kally, Ola, Jonsdottir, Olof, Palmer, Pam, Vollenweider, Peter, Orfanos, Philippos, Asciak, Renzo, Templeton, Robert, Don, Rokiah, Yaakub, Roseyati, Selamat, Rusidah, Yusof, Safiah, Al-Zenki, Sameer, Hung, Shu-Yi, Beer-Borst, Sigrid, Wu, Suh, Lukito, Widjaja, Hadden, Wilbur, Becker, Wulf, Cao, Xia, Ma, Yi, Lai, Yuen, Hjdaud, Zaiton, Ali, Jennifer, Gravel, Ron, Tao, Tina, Veerman, Jacob Lennert, Chiplonkar, Shashi, Arici, Mustafa, Ngoan, Le Tran, Panagiotakos, Demosthenes, Li, Yanping, Trichopoulou, Antonia, Barengo, Noel, Khadilkar, Anuradha, Ekbote, Veena, Mohammadifard, Noushin, Kovalskys, Irina, Laxmaiah, Avula, Rachakulla, Harikumar, Rajkumar, Hemalatha, Meshram, Indrapal, Avula, Laxmaiah, Arlappa, Nimmathota, Hemalatha, Rajkumar, lacoviello, Licia, Bonaccio, Marialaura, Costanzo, Simona, Martin-Prevel, Yves, Castetbon, Katia, Jitnarin, Nattinee, Hsieh, Yao-Te, Olivares, Sonia, Tejeda, Gabriela, Hadziomeragic, Aida, de Moura Souza, Amanda, Pan, Wen-Harn, Huybrechts, Inge, de Brauw, Alan, Moursi, Mourad, Maghroun, Maryam, Zeba, Augustin Nawidimbasba, Sarrafzadegan, Nizal, Keinan-Boker, Lital, Goldsmith, Rebecca, Shimony, Tal, Jordan, Irmgard, Mastiholi, Shivanand C., Mwangi, Moses, Kombe, Yeri, Bukania, Zipporah, Alissa, Eman, Al-Daghri, Nasser, Sabico, Shaun, Gulliford, Martin, Diba, Tshilenge S., Oh, Kyungwon, Kweon, Sanghui, Park, Sihyun, Cho, Yoonsu, Al-Hooti, Suad, Luangphaxay, Chanthaly, Douangvichit, Daovieng, Siengsounthone, Latsamy, Marques-Vidal, Pedro, Rybak, Constance, Luke, Amy, Piaseu, Noppawan, Rojroongwasinkul, Nipa, Sundram, Kalyana, Baykova, Donka, Abedi, Parvin, Sandjaja, Sandjaja, Fadzil, Fariza, Bukhary, Noriklil Bukhary Ismail, Bovet, Pascal, Chen, Yu, Sawada, Norie, Tsugane, Shoichiro, Rangelova, Lalka, Petrova, Stefka, Duleva, Vesselka, Lindroos, Anna Karin, Sipinen, Jessica Petrelius, Moraeus, Lotta, Bergman, Per, Siamusantu, Ward, Szponar, Lucjan, Chang, Hsing-Yi, Sekiyama, Makiko, Le Nguyen Bao, Khanh, Nagalla, Balakrishna, Polasa, Kalpagam, Boindala, Sesikeran, El Ati, Jalila, Silva, Ivonne Ramirez, Dommarco, Juan Rivera, Barquera, Simon, Rodríguez-Ramírez, Sonia, Illescas-Zarate, Daniel, Sanchez-Romero, Luz Maria, Ikeda, Nayu, Zaghloul, Sahar, Houshiar-rad, Anahita, Mohammadi-Nasrabadi, Fatemeh, Abdollahi, Morteza, Chuah, Khun-Aik, Mahdy, Zaleha Abdullah, Eldridge, Alison, Ding, Eric L., Kruger, Herculina, Henjum, Sigrun, Fernandez, Anne, Suarez-Ortegon, Milton Fabian, Al-Hamad, Nawal, Janská, Veronika, Tayyem, Reema, Mirmiran, Parvin, Kelishadi, Roya, Lemming, Eva Warensjo, Richter, Almut, Mensink, Gert, Wieler, Lothar, Hoffman, Daniel, Salanave, Benoit, Kim, Cho-il, Kuriyan-Raj, Rebecca, Swaminathan, Sumathi, Garriguet, Didier, Dastgiri, Saeed, Vaask, Sirje, Karupaiah, Tilakavati, Zohoori, Fatemeh Vida, Esteghamati, Alireza, Hashemian, Maryam, Noshad, Sina, Mwaniki, Elizabeth, Yakes-Jimenez, Elizabeth, Chileshe, Justin, Mwanza, Sydney, Marques, Lydia Lera, Preston, Alan Martin, Aguero, Samuel Duran, Oleas, Mariana, Posada, Luz, Ochoa, Angelica, Shamsuddin, Khadijah, Shariff, Zalilah Mohd, Jan Bin Jan Mohamed, Hamid, Manan, Wan, Nicolau, Anca, Tudorie, Cornelia, Poh, Bee Koon, Abbott, Pamela, Pakseresht, Mohammadreza, Sharma, Sangita, Strand, Tor Arne, Alexy, Ute, Nöthlings, Ute, Carmikle, Jan, Brown, Ken, Koster, Jeremy, Waidyatilaka, Indu, Lanerolle, Pulani, Jayawardena, Ranil, Long, Julie M., Hambidge, K. Michael, Krebs, Nancy F., Haque, Aminul, Keding, Gudrun B., Korkalo, Liisa, Erkkola, Maijaliisa, Freese, Riitta, Eleraky, Laila, Stuetz, Wolfgang, Thorsdottir, Inga, Gunnarsdottir, Ingibjorg, Serra-Majem, Lluis, Moy, Foong Ming, Anderson, Simon, Jeewon, Rajesh, Zugravu, Corina Aurelia, Adair, Linda, Ng, Shu Wen, Skeaff, Sheila, Marchioni, Dirce, Fisberg, Regina, Henry, Carol, Ersino, Getahun, Zello, Gordon, Meyer, Alexa, Elmadfa, Ibrahim, Mitchell, Claudette, Balfour, David, Geleijnse, Johanna M., Manary, Mark, El-kour, Tatyana, Nikiema, Laetitia, Mirzaei, Masoud, and Hakeem, Rubina

Abstract

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally. publishedVersion

Published
2023

9. EVALUATION OF PERCEPTIONS OF CAREGIVERS AND MOTHERS ON EARLY INFANT DIAGNOSIS AND TREATMENT OF HIV IN SELECTED HEALTH FACILITIES IN KENYA.

Author

Barsito, Emily, Magu, Dennis, Kombe, Yeri, and Mbakaya, Charles Fernandes Lumumba

Subjects
HIV infections, CAREGIVER attitudes, ATTITUDES of mothers, FOCUS groups, PSYCHOLOGY of mothers, RESEARCH methodology, RURAL conditions, ATTITUDES of medical personnel, INTERVIEWING, QUALITATIVE research, HEALTH literacy, INTIMATE partner violence, SOUND recordings, METROPOLITAN areas, EARLY diagnosis
Abstract

Introduction: Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is a critical component of the prevention of mother-to-child transmission programs. The Kenya Ministry of Health recently revised their early infant diagnosis (EID) guidelines to include HIV DNA PCR testing at birth (pilot only), six weeks, six months, and 12 months postnatal and a final 18-month antibody test, to be in line with World Health guidelines on Management of HIV and treatment for infants. Despite these interventions to address barriers to IED, Kenya faces challenges in the uptake of EID. This study explored perceptions of caregivers and mothers of HIV positive infants in order to make recommendations to strengthen the provision of EID services in Kenya. Methods: We sought to understand the determinants of caregivers and or mothers of HIV positive infants seeking early infant Diagnosis services and treatment in six public health facilities located in six counties of Kenya. We conducted ten focus group discussions with mothers and caretakers of infants seeking Early Infant Diagnosis services and treatment in level four and level five public health facilities in six counties with high, medium, and low prevalence of HIV in Kenya. All Focus Group Discussions were audiotaped, transcribed, translated, and coded for analysis. Findings: Most respondents reported knowledge and awareness of EID services. However, respondents in rural counties reported less knowledge and awareness of EID compared to those from urban counties. Negative provider attitudes complicated respondents' pathway to seeking care in a stigma-free environment. Linkage by Community Health Volunteers to caregivers and mothers of an infant was noted as a critical component to care. While most respondents were satisfied with how they were treated by health providers while seeking services, most respondents complained about delays and long waiting times to receive services. At the community level, intimate partner violence is a key barrier to caretakers and mothers in seeking EID care. Conclusion & Recommendations: Mothers and caregivers of infants had higher levels of awareness (knowledge and understanding) of EID. Interventions to ensure that caregivers and mothers of infants are not stigmatized as well as addressing delays and long waiting times for the provision of services should be implemented while ensuring interventions to assist mothers and caregivers to address and cope with intimate partner violence initiated at facility and community level. [ABSTRACT FROM AUTHOR]

Published
2023

17. UTILIZATION OF EARLY INFANT DIAGNOSIS SERVICES BY CARETAKERS OF INFANTS IN SELECTED COUNTY HOSPITALS IN KENYA.

Author

Barsito, Emily Chemgetich Rono, Magu, Dennis, Kombe, Yeri, and Mbakaya, Charles

Subjects
INFANT disease diagnosis, HIV, COMMUNICABLE diseases, CAREGIVERS, PREGNANCY
Abstract

Introduction: Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is critical for preventing mother-to-child transmission programs. The Kenya Ministry of Health recently revised their early infant diagnosis (EID) guidelines to align with World Health guidelines on managing HIV and treatment for infants. Despite these interventions to address barriers to EID, Kenya faces challenges in the uptake of EID. This study explored health outcomes of EID on HIV/AIDS and determinants of its utilization in selected level 4 and level 5 public health facilities in Kenya. Methods: A cross-sectional descriptive design was adopted for this study. A structured questionnaire was administered to 351 caregivers of infants presenting in level 4 and 5 hospitals in Baringo, Homa Bay, Kiambu, Machakos and Trans Nzoia counties of Kenya. The study also reviewed medical records for the caregivers and linked the medical records with the caregiver survey. Regression analysis and descriptive statistics were utilized in data analysis. Results: Knowledge of EID services was 86.66 %(n=351), of whom 25 %(n=318) did not know about EID before delivery. 20% of caregivers reported they did not know a facility where EID services are offered during their pregnancy. 12.23% of the infants did not receive HIV prophylaxis after delivery. 78.3% of caregivers reported that they knew the benefits of EID. The main barrier to EID services is stigma and discrimination on HIV. Caregivers' age was associated with poor health outcomes (p= 0.004). Unemployment status, reduced number of times attending HIV counselling at MCH and attendance of ANC visits were associated with more poor health outcomes (p= 0.003, p=0.001 and p= 0.006), respectively. Conclusion and Recommendations: While HIV knowledge among caregivers was high, knowledge of EID services were low in Kiambu and Trans Nzoia counties. The main barriers of EID services were stigma and discrimination and lack of awareness of availability of EID services in facilities. Therefore, interventions to increase awareness and address stigma are critical factors in increasing EID services' uptake and utilisation. [ABSTRACT FROM AUTHOR]

Published
2021

19. Accountable priority setting for trust in health systems - the need for research into a new approach for strengthening sustainable health action in developing countries

Author

Olsen Øystein E, Nyamongo Isaac, Ngulube Thabale J, Ndawi Benedict, Michelo Charles, Martin Douglas K, Marchal Bruno, Kvåle Gunnar, Kombe Yeri, Kamuzora Peter, Fylkesnes Knut, Hurtig Anna-Karin, Blystad Astrid, Bloch Paul, Byskov Jens, Onyango-Ouma Washington, Sandøy Ingvild F, Shayo Elizabeth H, Silwamba Gavin, Songstad Nils, and Tuba Mary

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research framework to examine the potential of AFR to support sustainable improvements to health systems performance. This paper reports on the project design and progress and argues that there is a high need for research into legitimate and fair priority setting to improve the knowledge base for achieving sustainable improvements in health outcomes.

Published
2009
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31. Barriers to emergency obstetric care services:accounts of survivors of life threatening obstetric complications in Malindi District, Kenya

Author

Echoka, Elizabeth, Makokha, Anselimo, Dubourg, Dominique, Kombe, Yeri, Nyandieka, Lillian, Byskov, Jens, Echoka, Elizabeth, Makokha, Anselimo, Dubourg, Dominique, Kombe, Yeri, Nyandieka, Lillian, and Byskov, Jens

Abstract

Introduction: Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. Methods: A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Elizabeth Echoka1,&, Anselimo Makokha2, Dominique Dubourg3, Yeri Kombe1, Lillian Nyandieka1, Jens Byskov4 Results: Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Conclusion: Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

Published
2014

32. Using the unmet obstetric needs indicator to map inequities in life-saving obstetric interventions at the local health care system in Kenya

Author

Echoka, Elizabeth, Dubourg, Dominique, Makokha, Anselimo, Kombe, Yeri, Olsen, Øystein Evjen, Mwangi, Moses, Evjen-Olsen, Bjorg, Byskov, Jens, Echoka, Elizabeth, Dubourg, Dominique, Makokha, Anselimo, Kombe, Yeri, Olsen, Øystein Evjen, Mwangi, Moses, Evjen-Olsen, Bjorg, and Byskov, Jens

Abstract

BackgroundDeveloping countries with high maternal mortality need to invest in indicators that not only provide information about how many women are dying, but also where, and what can be done to prevent these deaths. The unmet Obstetric Needs (UONs) concept provides this information. This concept was applied at district level in Kenya to assess how many women had UONs and where the women with unmet needs were located.MethodsA facility based retrospective study was conducted in 2010 in Malindi District, Kenya. Data on pregnant women who underwent a major obstetric intervention (MOI) or died in facilities that provide comprehensive Emergency Obstetric Care (EmOC) services in 2008 and 2009 were collected. The difference between the number of women who experienced life threatening obstetric complications and those who received care was quantified. The main outcome measures in the study were the magnitude of UONs and their geographical distribution.Results566 women in 2008 and 724 in 2009 underwent MOI. Of these, 185 (32.7%) in 2008 and 204 (28.1%) in 2009 were for Absolute Maternal Indications (AMI). The most common MOI was caesarean section (90%), commonly indicated by Cephalopelvic Disproportion (CPD)¿narrow pelvis (27.6% in 2008; 26.1% in 2009). Based on a reference rate of 1.4%, the overall MOI for AMI rate was 1.25% in 2008 and 1.3% in 2009. In absolute terms, 22 (11%) women in 2008 and 12 (6%) in 2009, who required a life saving intervention failed to get it. Deficits in terms of unmet needs were identified in rural areas only while urban areas had rates higher than the reference rate (0.8% vs. 2.2% in 2008; 0.8% vs. 2.1% in 2009).ConclusionsThe findings, if used as a proxy to maternal mortality, suggest that rural women face higher risks of dying during pregnancy and childbirth. This indicates the need to improve priority setting towards ensuring equity in access to life saving interventions for pregnant women in underserved areas.

Published
2014

33. Response to accountable priority setting for trust in health systems

Author

Kombe, Yeri, Muttunga, James, Nyamongo, Isaac, Onyango-Ouma, Washington, Kamuzora, Peter, Mboera, Leonard G., Shayo, Elisabeth, Ndawi, Benedict T., Silwamba, Gavin, Michelo, Charles, Ngulube, Thabale J., Tuba, Mary, Hurtig, Anna-Karin, Marchal, Bruno, Blystad, Astrid, Fylkesnes, Knut, Byskov, Jens, Bloch, Paul, Olsen, Øystein Evjen, and Martin, Douglas K.

Subjects
fairness, Sundhedssystemer, trust, ansvarlighed, Prioritering, Afrika, rimelighed, equity, Priority Setting, accountability, Africa, tillid, Health Systems, ligelighed, Former LIFE faculty
Published
2008

34. The REACT Project:REsponse to ACcountable priority setting for Trust in health systems

Author

Bloch, Paul, Blystad, Astrid, Byskov, Jens, Hurtig, Anna-Karin, Fylkesnes, Knut, Kamuzora, Peter, Kombe, Yeri, Marchal, Bruno, Martin, Douglas K., Michelo, Charles, Mboera, Leonard, Muttunga, James, Ndawi, Benedict T., Ngulube, Thabale J., Nyamongo, Isaac, Olsen, Øystein Evjen, Onyango-Ouma, Washington, Shayo, Elisabeth, Silwamba, Gavin, and Tuba, Mary

Subjects
Fairness, Sundhedssystemer, ansvarlighed, Prioritering, Afrika, equity, Priority Setting, accountability, Africa, Rimelighed, Health Systems, ligelighed, Former LIFE faculty
Abstract

The objectives of this study are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by an explicit ethical framework Accountability for Reasonableness (AFR) and to measure their effect on quality, equity and trust indicators within selected disease and programme interventions and services, within general care and on health systems management. Efforts to improve health sector performance have not yet been satisfactory, and adequate and sustainable improvements in health outcomes have not been shown. Priority setting in health systems has mainly been based on the burden of disease approach, cost effectiveness and other evidence-based measures. However, these approaches do not equip decision-makers to address a broader range of values - such as compassion, equity, accountability and transparency - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed.AFR is a framework for legitimate and fair priority setting that provides decision-makers with an explicit tool for identifying and considering a wide range of relevant values, and defines priority-setting decisions as necessary compromises between partners. AFR makes continued reference to four conditions: relevance to the local setting, decided by agreed criteria; publicizing priority-setting decisions and the reasons behind them; the establishment of revisions/appeal mechanisms for challenging and revising decisions; and the provision of leadership and the enforcement of conditions. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study, which started in 2006 testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. Qualitative and quantitative methods are applied in an action research framework. The project baseline surveys have already been completed and indicate both a strong need and a high willingness for change in the study districts. REACT has developed active research collaborations with an increasing range of actors, including the communities themselves, into a joint research and development process for priority setting for health. The AFR concept and the analysis of the baseline results will be presented and their broad applicability in terms of making sustainable improvements to health systems performance discussed.

Published
2008

35. Accountable priority setting for trust in health systems - a need for change

Author

Byskov, Jens, Bloch, Paul, Blystad, Astrid, Hurtig, Anna-Karin, Fylkesnes, Knut, Kamuzora, Peter, Kombe, Yeri, Marchal, Bruno, Martin, Douglas K., Michelo, Charles, Ndawi, Benedict T., Ngulube, Thabale J., Nyamongo, Isaac, Olsen, Øystein Evjen, Shayo, Elisabeth, and Silwamba, Gavin

Subjects
Sundhedssystemer, ansvarlighed, priority setting, Trust, Ligelighed, Afrika, prioritering, Tillid, accountability, Equity in health, Africa, Health Systems, Former LIFE faculty
Published
2008

39. Existence and functionality of emergency obstetric care services at district level in Kenya:theoretical coverage versus reality

Author

Echoka, Elizabeth, Kombe, Yeri, Dubourg, Dominique, Makokha, Anselimo, Evjen-Olsen, Bjørg, Mwangi, Moses, Byskov, Jens, Olsen, Øystein Evjen, Mutisya, Richard, Echoka, Elizabeth, Kombe, Yeri, Dubourg, Dominique, Makokha, Anselimo, Evjen-Olsen, Bjørg, Mwangi, Moses, Byskov, Jens, Olsen, Øystein Evjen, and Mutisya, Richard

Abstract

The knowledge on emergency obstetric care (EmOC) is limited in Kenya, where only partial data from sub-national studies exist. The EmOC process indicators have also not been integrated into routine health management information system to monitor progress in safe motherhood interventions both at national and lower levels of the health system. In a country with a high maternal mortality burden, the implication is that decision makers are unaware of the extent of need for life-saving care and, therefore, where to intervene. The objective of the study was to assess the actual existence and functionality of EmOC services at district level.

Published
2013

41. Accountable priority setting for trust in health systems : the need for research into a new approach for strengthening sustainable health action in developing countries

Author

Byskov, Jens, Bloch, Paul, Blystad, Astrid, Hurtig, Anna-Karin, Fylkesnes, Knut, Kamuzora, Peter, Kombe, Yeri, Kvåle, Gunnar, Marchal, Bruno, Martin, Douglas K, Michelo, Charles, Ndawi, Benedict, Ngulube, Thabale J, Nyamongo, Isaac, Olsen, Oystein E, Onyango-Ouma, Washington, Sandøy, Ingvild F, Shayo, Elizabeth H, Silwamba, Gavin, Songstad, Nils Gunnar, Tuba, Mary, Byskov, Jens, Bloch, Paul, Blystad, Astrid, Hurtig, Anna-Karin, Fylkesnes, Knut, Kamuzora, Peter, Kombe, Yeri, Kvåle, Gunnar, Marchal, Bruno, Martin, Douglas K, Michelo, Charles, Ndawi, Benedict, Ngulube, Thabale J, Nyamongo, Isaac, Olsen, Oystein E, Onyango-Ouma, Washington, Sandøy, Ingvild F, Shayo, Elizabeth H, Silwamba, Gavin, Songstad, Nils Gunnar, and Tuba, Mary

Abstract

Despite multiple efforts to strengthen health systems in low and middle income countries, intended sustainable improvements in health outcomes have not been shown. To date most priority setting initiatives in health systems have mainly focused on technical approaches involving information derived from burden of disease statistics, cost effectiveness analysis, and published clinical trials. However, priority setting involves value-laden choices and these technical approaches do not equip decision-makers to address a broader range of relevant values - such as trust, equity, accountability and fairness - that are of concern to other partners and, not least, the populations concerned. A new focus for priority setting is needed. Accountability for Reasonableness (AFR) is an explicit ethical framework for legitimate and fair priority setting that provides guidance for decision-makers who must identify and consider the full range of relevant values. AFR consists of four conditions: i) relevance to the local setting, decided by agreed criteria; ii) publicizing priority-setting decisions and the reasons behind them; iii) the establishment of revisions/appeal mechanisms for challenging and revising decisions; iv) the provision of leadership to ensure that the first three conditions are met. REACT - "REsponse to ACcountable priority setting for Trust in health systems" is an EU-funded five-year intervention study started in 2006, which is testing the application and effects of the AFR approach in one district each in Kenya, Tanzania and Zambia. The objectives of REACT are to describe and evaluate district-level priority setting, to develop and implement improvement strategies guided by AFR and to measure their effect on quality, equity and trust indicators. Effects are monitored within selected disease and programme interventions and services and within human resources and health systems management. Qualitative and quantitative methods are being applied in an action research f

Published
2009
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42. Session 5.3 Equitable priority setting in develping countries: Responses to accountable prioriry setting for trust in health systems

Author

Kombe, Yeri, Muttunga, James, Nyamongo, Isaac, Ouma, Onyango, Kamuzora, Peter, Mboera, Leonard, Shayo, Elisabeth, Ndawi, Benedict, Silwamba, Gavin, Michelo, Charles, Ngulube, Thabale, Tuba, Mary, Hurtig, Anna-Karin, Marchal, Bruno, Blystad, Astrid, Fylkesnes, Knut, Byskov, Jens, Bloch, Paul, Olsen, Oystein, Olsen, Douglas, Kombe, Yeri, Muttunga, James, Nyamongo, Isaac, Ouma, Onyango, Kamuzora, Peter, Mboera, Leonard, Shayo, Elisabeth, Ndawi, Benedict, Silwamba, Gavin, Michelo, Charles, Ngulube, Thabale, Tuba, Mary, Hurtig, Anna-Karin, Marchal, Bruno, Blystad, Astrid, Fylkesnes, Knut, Byskov, Jens, Bloch, Paul, Olsen, Oystein, and Olsen, Douglas

Published
2008

45. Accountable priority setting for trust in health systems - the need for research into a new approach for strengthening sustainable health action in developing countries

Author

Byskov, Jens, primary, Bloch, Paul, additional, Blystad, Astrid, additional, Hurtig, Anna-Karin, additional, Fylkesnes, Knut, additional, Kamuzora, Peter, additional, Kombe, Yeri, additional, Kvåle, Gunnar, additional, Marchal, Bruno, additional, Martin, Douglas K, additional, Michelo, Charles, additional, Ndawi, Benedict, additional, Ngulube, Thabale J, additional, Nyamongo, Isaac, additional, Olsen, Øystein E, additional, Onyango-Ouma, Washington, additional, Sandøy, Ingvild F, additional, Shayo, Elizabeth H, additional, Silwamba, Gavin, additional, Songstad, Nils Gunnar, additional, and Tuba, Mary, additional

Published
2009
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47. Male Involvement in Maternal Health Planning Key to Utilization of Skilled Birth Services in Malindi Subcounty, Kenya

Author

Nyamusi Nyandieka, Lilian, Karimi Njeru, Mercy, Ng’ang’a, Zipporah, Echoka, Elizabeth, and Kombe, Yeri

Abstract

Background. In Malindi, rural populations face challenges in accessing skilled birth services. Consequently, the majority of women deliver at home and only seek help when they have complications. This paper reports part findings from a study conducted to assess health priority setting process and its implication on availability, access, and use of emergency obstetric care services in Malindi. Methods. The study utilized qualitative methods to collect data from health personnel and maternal health stakeholders including community members. Source and method triangulation was used to strengthen the credibility of study findings. Data was categorized manually into themes around issues relating to utilization of skilled birth services discussed in this paper. Findings. Various barriers to utilization of skilled birth services were cited. However, most were linked to mwenye (the husband) who decides on the place of birth for the wife. Conclusion. Husbands are very influential in regard to decisions on skilled birth service utilization in this community. Their lack of involvement in maternal health planning may contribute as a barrier to utilization of skilled care by pregnant women. There is need to address the mwenye factor in an attempt to mitigate some of the barriers cited for nonutilization of skilled birth services.

Published
2016
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48. Epidemiology of Schistosoma haematobioum in Ruruma Location, Kilifi, District, Kenya.

Author

Kombe Y and Southgate B

Abstract

A study of the distribution of S. haematobium in Ruruma Location of Kilifi District, Kenya, was undertaken between December 1988 and June 1990. Schistosomiasis haematobia was found to be highly endemic with prevalence rates of upto 85%. The distribution of prevalences of infection in this location is very varied ranging from 1.6% in the East to 85% in the Southwest. Prevalences of infection were also noted to be lower in those areas closer to the main roads than farther away, a pattern that coincided also with the distribution of piped water in the area. Gross haematuria, observed by naked eye, did not give a similar picture as that of infection prevalences. Certain areas with high infection rates had relatively low levels of haematuria and vice versa. Thus, gross haematuria alone cannot be used (even in a broad sense) to categorize to compare levels of endemicity of S.heaematobium in this area.

Published
1995

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