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1. Challenges and enablers for scaling up interventions targeting non-communicable diseases: a qualitative study applying the Consolidated Framework for Implementation Research to 19 research projects worldwide

Author

Josefien van Olmen, Peter Delobelle, Meena Daivadanam, Hassan Haghparast-Bidgoli, Maria Lazo-Porras, J Jaime Miranda, Yuan Li, Rohina Joshi, Amanda G Thrift, Rajesh Vedanthan, Gina Agarwal, Mark D Huffman, Kerstin Klipstein-Grobusch, Naomi Levitt, Dike Ojji, Feng J He, Kamran Siddiqi, Pascal Geldsetzer, Puhong Zhang, Milena Soriano Marcolino, Lal B Rawal, Brian Oldenburg, Helena Teede, Josephine Birungi, Edwin Wouters, Abha Shrestha, Ari Probandari, Mayowa Owolabi, Vilma Irazola, Andrea Beratarrechea, Keiko Nakamura, Gindo Tampubolon, Zulma Ortiz, Violet Naanyu, Jaap Koot, Anusha Ramani-Chander, Stephen Sherwood, Monika Martens, Gade Waqa, Maria Eugenia Esandi, Sujarwoto Sujarwoto, Laura Antonietti, Jan-Walter De Neve, Sayoki G Mfinanga, and Antonio Luiz Pinho Ribeiro

Subjects
Public aspects of medicine, RA1-1270
Abstract

Introduction Scaling up interventions targeting non-communicable diseases (NCDs) is a global health priority, and implementation research can contribute to that effort. In 2019, the Global Alliance for Chronic Diseases funded 27 implementation research studies to improve evidence for scaling up interventions targeting prevention and/or control of hypertension and/or diabetes in low-resource settings. We examined these studies to improve the understanding of the implementation factors, including challenges and facilitators, that influence the early implementation phase of scale-up research projects targeting NCDs.Methods This qualitative study was undertaken between August 2020 and July 2021. 43 semi-structured interviews were conducted with project investigators, implementers and policymakers, across 19 diverse scale-up projects, being implemented in 20 countries. The transcripts were inductively, open-coded using thematic analysis. Generated themes were mapped systematically to four out of five domain categorisations of the Consolidated Framework for Implementation Research (CFIR); the innovation domain fell outside the scope of this study.Results Highlighted findings using CFIR are: (i) outer setting: influence of politics, lack of coordination between government departments and differing agendas towards NCDs hindered implementation while reliable and trustworthy government connections proved useful; (ii) inner setting: commitment of resources for implementation was a challenge while research capacity, work culture and trustworthy networks facilitated implementation; (iii) individuals: high-level stakeholder support and leadership was essential; (iv) process: extensive time and efforts required for stakeholder engagement towards local contextualisation was challenging, while collaborating, joint reflection, effective communication and adaptation facilitated. COVID-19 provided both challenges and opportunities and these varied depending on the intervention characteristics and study objectives.Conclusion Researchers supporting the scale-up of complex interventions targeting NCDs need to leverage on existing trusting relationships and foster equitable stakeholder partnerships through research. Interpersonal skills and good communication are essential complements to research expertise and must be considered during capacity building.

Published
2024
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2. The effect of health behavior interventions to manage Type 2 diabetes on the quality of life in low-and middle-income countries: A systematic review and meta-analysis.

Author

Ashmita Karki, Corneel Vandelanotte, Saman Khalesi, Padam Dahal, and Lal B Rawal

Subjects
Medicine, Science
Abstract

BackgroundBehavioral interventions targeted at managing Type 2 diabetes mellitus (T2DM) may have a positive effect on quality of life (QOL). Limited reviews have synthesized this effect in low- and middle-income countries (LMICs). This review and meta-analysis synthesised available evidence on the effect of behavioral interventions to manage T2DM on the QOL of people with T2DM in LMICs.MethodsElectronic databases PUBMED/MEDLINE, SCOPUS, CINAHL, Embase, Web of Science and PsycINFO were searched from May to June 2022. Studies published between January 2000 and May 2022, conducted in LMICs using randomized controlled trial design, using a health behavior intervention for T2DM management, and reporting QOL outcomes were included. Difference in QOL change scores between the intervention and control group was calculated as the standardized mean difference (SMD) of QOL scores observed between the intervention and control groups. Random-effects model was used for meta-analysis.ResultsOf 6122 studies identified initially, 45 studies met the inclusion criteria (n = 8336). Of them, 31 involved diabetes self-management education and 14 included dietary and/or physical activity intervention. There was moderate quality evidence from the meta-analysis of mean QOL (n = 25) that health behavior intervention improved the QOL of people with T2DM (SMD = 1.62, 95%CI = 0.65-2.60 I2 = 0.96, p = 0.001). However, no significant improvements were found for studies (n = 7) separately assessing the physical component summary (SMD = 0.76, 95%CI = -0.03-1.56 I2 = 0.94, p = 0.060) and mental component summary (SMD = 0.43, 95%CI = -0.30-1.16 I2 = 0.94, p = 0.249) scores. High heterogeneity and imprecise results across studies resulted in low to moderate quality of evidence.ConclusionThe findings suggest that health behavior interventions to manage T2DM may substantially improve the QOL of individuals with T2DM over short term. However, due to low to moderate quality of evidence, further research is required to corroborate our findings. Results of this review may guide future research and have policy implications for T2DM management in LMICs.

Published
2023
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4. Effectiveness of an educational intervention in improving healthcare workers’ knowledge of early recognition, diagnosis and management of rheumatic fever and rheumatic heart disease in rural far-western Nepal: a pre/post-intervention study

Author

Sanjib Kumar Sharma, Lal B Rawal, Navin Bhatt, Biplav Shrestha, Ashmita Karki, and Amul Singh

Subjects
Medicine
Abstract

Objectives Rheumatic fever (RF) and rheumatic heart disease (RHD) remain among the major heart problems among children in Nepal. Although these conditions are preventable and treatable, the lack of proper knowledge and resources to diagnose and manage these conditions in rural health centres is a key concern. This study assessed the impact of educational sessions to improve the knowledge of healthcare workers in the early recognition, diagnosis, and management of RF and RHD in rural far-western Nepal.Design, setting and participants This study used a pretest and post-test interventional design and was conducted among 64 healthcare workers in two primary healthcare centres and a peripheral district-level hospital in Achham district in the far-western region of Nepal. A self-administered questionnaire was used before and after the educational sessions. Data were analysed using SPSS V.21.Results The overall test scores increased from 10 (SD=2.4) pre-intervention to 13.8 (SD=1.9) post-intervention (p

Published
2022
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5. Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study

Author

Josefien van Olmen, Peter Delobelle, Meena Daivadanam, Hassan Haghparast-Bidgoli, Maria Lazo-Porras, J Jaime Miranda, Anushka Patel, David Peiris, Yuan Li, Rohina Joshi, Amanda G Thrift, Rajesh Vedanthan, Maoyi Tian, Gina Agarwal, Mark D Huffman, Kerstin Klipstein-Grobusch, Naomi Levitt, Dike Ojji, Feng J He, Maarten Postma, Kamran Siddiqi, Pascal Geldsetzer, Puhong Zhang, Milena Soriano Marcolino, Lal B Rawal, Hueiming Liu, Brian Oldenburg, Mayowa O Owolabi, Jan-Walter De Neve, Antonio Luiz Pinho Ribeiro, Josephine Birungi, Edwin Wouters, Abha Shrestha, Ari Probandari, Sayoki Godfrey Mfinanga, Robert James Mash, Andrea Beratarrechea, Keiko Nakamura, Gindo Tampubolon, Jacqui Webster, Vilma Edith Irazola, Zulma Ortiz, Violet Naanyu, Jaap Koot, Anusha Ramani-Chander, Stephen Sherwood, Monika Martens, Gade Waqa, Maria Eugenia Esandi, Francisco González-Salazar, Sujarwoto Sujarwoto, Myriam Paredes, Tomohiko Sugishita, Malek Batal, Laura Antonietti, and Darcelle Schouw

Subjects
Medicine
Abstract

Introduction There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions.Methods and analysis We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.Ethics and dissemination The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Published
2022
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7. Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal.

Author

Lal B Rawal, Yuewen Sun, Padam K Dahal, Sushil C Baral, Sudeepa Khanal, Abriti Arjyal, Shraddha Manandhar, and Abu S Abdullah

Subjects
Medicine, Science
Abstract

IntroductionNon-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal.MethodsWe used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts.ResultsThe mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, PConclusionWe conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Published
2022
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8. Poor glycemic control, cardiovascular disease risk factors and their clustering among patients with type 2 diabetes mellitus: A cross-sectional study from Nepal.

Author

Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Yadav Gurung, Lal B Rawal, Gyanendra Pandey, Madan Bhandari, Surya Devkota, Maximilian de Courten, and Barbora de Courten

Subjects
Medicine, Science
Abstract

BackgroundCardiovascular disease (CVD) is the most common complication of diabetes mellitus (DM). To prevent morbidity and mortality among patients with type 2 diabetes mellitus (T2DM), optimization of glycemic status and minimizing CVD risk factors is essential. As Nepal has limited data on these CVD risk parameters, we assessed the prevalence of poor glycemic control, CVD risk factors, and their clustering among patients with T2DM.MethodsUsing a cross-sectional study design, we collected data of 366 patients with T2DM. We applied a multistage cluster sampling technique and used the WHO STEPS tools. Binary logistic and Poisson regression was applied to calculate odds and prevalence ratio of clustering of risk factors, considering PResultsThe mean age of participants was 54.5±10.7 years and 208 (57%) were male. The prevalence of poor glycemic control was 66.4% (95% C.I: 61.5-71.2). The prevalence of smoking, alcohol users, inadequate fruit and vegetables intake and physical inactivity were 18% (95% C.I:14 to 21.9), 14.8% (95% C.I:11.1 to 18.4), 98.1% (95% C.I: 96.7-99.4), and 9.8% (95% C.I:6.7-12.8), respectively. Overall, 47.3% (95% C.I: 42.1-52.4) were overweight and obese, 59% (95% C.I: 52.9-63) were hypertensive, and 68% (95% C.I: 63.2-72.7) had dyslipidemia. Clustering of two, three, four, five and more than five risk factors was 12.6%, 30%, 30%,19%, and 8.7%, respectively. Four or more risk factors clustering was significantly associated with gender, age, level of education, T2DM duration, and use of medication. Risk factors clustering was significantly higher among males and users of anti-diabetic medications with prevalence ratio of 1.14 (95% C.I:1.05-1.23) and 1.09 (95% C.I: 1.09-1.18)], respectively.ConclusionsThe majority of the patients with T2DM had poor glycemic control and CVD risk factors. Policies and programs focused on the prevention and better management of T2DM and CVD risk factors should be implemented to reduce mortality in Nepal.

Published
2022
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9. Factors associated with low medication adherence in patients with Type 2 diabetes mellitus attending a tertiary hospital in Bangladesh

Author

Sheikh Mohammed Shariful Islam, Md. Tauhidul Islam, Riaz Uddin, Tania Tansi, Shamim Talukder, Farhana Sarker, Khondaker Abdullah Al Mamun, Sasan Adibi, and Lal B Rawal

Subjects
Bangladesh, hypertension, medication adherence, tertiary hospital, Type 2 diabetes, Public aspects of medicine, RA1-1270
Abstract

Abstract Background Adherence to prescribed medication is essential for glycemic control and to delay the onset of complications. However, information on medication adherence among patients with Type 2 diabetes mellitus is sparse in Bangladesh. This study aimed to determine medication adherence and factors associated with low adherence in patients with Type 2 diabetes in Bangladesh. Methods A cross‐sectional study was conducted among 500 consecutive patients with Type 2 diabetes attending a tertiary hospital in Bangladesh between September 2013 and July 2014. Data were collected on sociodemographic and clinical characteristics, medication use and adherence, and blood tests for glycated hemoglobin. Medication adherence was assessed using the 8‐item Morisky Medication Adherence Scale (score range 0–8), and a score

Published
2021
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10. Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal: a cross-sectional study

Author

Mark Harris, Lal B Rawal, Sabuj Kanti Mistry, Uday Narayan Yadav, Saruna Ghimire, and Selvanaayagam Shanmuganathan

Subjects
Medicine
Abstract

Objectives This study’s objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors.Design This was a community-based cross-sectional study conducted between January and April 2018.Setting Rural municipalities of Sunsari and Morang districts in eastern Nepal.Participants 794 older Nepalese adults, 60 years and older, were recruited using a multistage cluster sampling approach.Primary outcome measure(s) Prevalence of four major non-communicable chronic conditions (osteoarthritis, cardiovascular disease, diabetes and chronic obstructive pulmonary disease (COPD) and multimorbidity.Results Almost half (48.9%: men 45.3%; women 52.4%) of the participants had at least one of four non-communicable chronic conditions, and 14.6% (men 12.5%; women 16.8%) had two or more conditions. The prevalence of individual conditions included: osteoarthritis—41.7% (men 37.5%; women 45.9%), cardiovascular disease—2.4% (men 2.8%; women 2.0%), diabetes—5.3% (men 6.0%; women 4.6%) and COPD—15.4% (men 13.3%; women 17.5%). In the adjusted model, older adults aged 70–79 years (adjusted OR (AOR): 1.62; 95% CI: 1.04 to 2.54), those from Madhesi and other ethnic groups (AOR: 1.08; 95% CI: 1.02 to 1.72), without a history of alcohol drinking (AOR: 1.53; 95% CI: 1.18 to 2.01) and those physically inactive (AOR: 5.02; 95% CI: 1.47 to 17.17) had significantly higher odds of multimorbidity.Conclusions This study found one in seven study participants had multimorbidity. The prevalence of multimorbidity and associated socioeconomic and behavioural correlates need to be addressed by integrating social programmes with health prevention and management at multiple levels. Moreover, a longitudinal study is suggested to understand the temporal relationship between lifestyle predictors and multimorbidity among older Nepalese adults.

Published
2021
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11. Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial.

Author

Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Pratik Bhandari, Lal B Rawal, Yadav Gurung, K N Paudel, Amit Singh, Surya Devkota, and Barbora de Courten

Subjects
Medicine, Science
Abstract

BackgroundHypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal.MethodsWe conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months.Results125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01-4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63-2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (pConclusionsMultiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal.Trial registrationClinicalTrial.gov: NCT02981251.

Published
2021
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12. A qualitative study to understand drivers of psychoactive substance use among Nepalese youth.

Author

Tulsi Ram Bhandari, Bhushan Khatiwada, Bibika Rajbhandari, Amy Bestman, Sabuj Kanti Mistry, Binod Rayamajhee, Lal B Rawal, and Uday Narayan Yadav

Subjects
Medicine, Science
Abstract

BackgroundPsychoactive substance use among youth is an emerging public health issue in Nepal. This exploratory study aimed to better understand the drivers of psychoactive substance use among Nepalese youth in Rupandehi district of Nepal.Materials and methodsThis study used a qualitative approach for data collection. Both in-depth interviews (IDI, seven participants) and focus group discussions (FGD, 13 participants) were conducted among study participants who self-reported as psychoactive substance users or had history of psychoactive substance use. Participants for IDI were aged between 11 and 24 years and between 18 and 35 years old for FGDs. Semi-structured interview guides were prepared separately for IDIs and FDGs. Interviews were conducted in Nepali language and were audio recorded, which were there transcribed and translated into English for coding and analyses. In addition, interviews notes were taken by two research assistants. An inductive thematic analysis was used to analyze the data.ResultsThis study identified a range of drivers of psychoactive substances use among Nepalese youths. Themes included (i) socio-cultural factors, (ii) individual factors, (iii) academic environment, (iv) physical environment and the (v) influence of media. The socio-cultural factors were categorized into sub-themes of family relationships, ethnic identity and psychoactive substance use and lack of social acceptance. Individual factors included peer pressure, stress relief and coping with financial challenges. Accessibility and availability of psychoactive substances in the surrounding environment and lack of monitoring and reinforcement of rules/ law and regulations were other drivers to psychoactive substance use among this Nepalese youth cohort.ConclusionOur study identified several important drivers of psychoactive substance use among youth in the Rupandehi district of Nepal. Future works are anticipated to further explore youth initiation and use of psychoactive substances and support the design of interventions that address these risk factors to reduce and prevent subsequent harms.

Published
2021
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13. Factors influencing place of delivery: Evidence from three south-Asian countries.

Author

Md Ashfikur Rahman, Muhammad Aziz Rahman, Lal B Rawal, Mohan Paudel, Md Hasan Howlader, Bayezid Khan, Tanjim Siddiquee, Abdur Rahman, Apurbo Sarkar, Md Sazedur Rahman, Roslin Botlero, and Sheikh Mohammed Shariful Islam

Subjects
Medicine, Science
Abstract

BackgroundHigh maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women's preferences for such in three selected South-Asian countries.MethodsWe extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017-18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted.ResultsOverall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09-1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20-1.67, PConclusionOur findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.

Published
2021
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14. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study

Author

Sushil Baral, Corneel Vandelanotte, Tuhin Biswas, Chandani Kharel, Lal B Rawal, Kie Kanda, Abu S Abdullah, and Uday Narayan Yadav

Subjects
Medicine
Abstract

Background/objective The increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.Design We used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.Setting Data were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.Participants We conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).Results The CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.Conclusion Engaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.

Published
2020
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15. Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level

Author

Syed Masud Ahmed, Tuhin Biswas, Sheikh Mohammed Shariful Islam, Lal B Rawal, Kie Kanda, Md. Imtiaz Tanim, Prakash Poudel, Andre M N Renzaho, and Abu S Abdullah

Subjects
Medicine
Abstract

Objective To explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level.Design We used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners’ service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted.Setting Twelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions.Participants Participants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters.Results Participants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments’ initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems.Conclusion The initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.

Published
2019
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16. ‘Connecting the dots’ for generating a momentum for Universal Health Coverage in Bangladesh: findings from a cross-sectional descriptive study

Author

Nahitun Naher, Syed Masud Ahmed, Lal B Rawal, and Tarek Hossain

Subjects
Medicine
Abstract

Objective This study was conducted to explore how and whether, the strategic grants made by the Rockefeller Foundation (RF) in different sectors of health systems in the inception phase were able to ‘connect the dots’ for ‘generating a momentum for Universal Health Coverage (UHC)’ in the country.Design Cross-sectional descriptive study, using document review and qualitative methods.Setting Bangladesh, 17 UHC-related projects funded by the RF Transforming Health Systems (THS) initiative during 2010–2013.Data Available reports of the completed and on-going UHC projects, policy documents of the government relevant to UHC, key-informant interviews and feedback from grant recipients and relevant stakeholders in the policy and practice.Outcome measures Key policy initiatives undertaken for implementing UHC activities by the government post grants disbursement.Results The RF THS grants simultaneously targeted and connected the academia, the public and non-profit development sectors and news media for awareness-building and advocacy on UHC, develop relevant policies and capacity for implementation including evidence generation. This strategy helped relevant stakeholders to come together to discuss and debate the core concepts, scopes and modalities of UHC in an attempt to reach a consensus. Additionally, experiences gained from implementation of the pilot projects helped in identifying possible entry points for initiating UHC activities in a low resource setting like Bangladesh.Conclusions During early years of UHC-related activities in Bangladesh, strategic investments of the RF THS initiative played a catalytic role in sensitising and mobilising different constituencies for concerted activities and undertaking necessary first steps. Learnings from this strategy may be of help to countries under similar conditions of ‘low resource, apparent commitment, but poor governance,’ on their journey towards UHC.

Published
2019
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17. Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis.

Author

Rashidul Alam Mahumud, Khorshed Alam, Andre M N Renzaho, Abdur Razzaque Sarker, Marufa Sultana, Nurnabi Sheikh, Lal B Rawal, and Jeff Gow

Subjects
Medicine, Science
Abstract

IntroductionChild health remains an important public health concern at the global level, with preventable diseases such as diarrheal disease, acute respiratory infection (ARI) and fever posing a large public health burden in low- and middle-income countries including Bangladesh. Improvements in socio-economic conditions have tended to benefit advantaged groups in societies, which has resulted in widespread inequalities in health outcomes. This study examined how socioeconomic inequality is associated with childhood morbidity in Bangladesh, and identified the factors affecting three illnesses: diarrhea, ARI and fever.Materials and methodsA total of 43,860 sample observations from the Bangladesh Demographic and Health Survey, spanning a 22-year period (1993-2014), were analysed. Concentration curve and concentration index methods were used to evaluate changes in the degree of household wealth-related inequalities and related trends in childhood morbidity. Regression-based decomposition analyses were used to attribute the inequality disparities to individual determinants for the three selected causes of childhood morbidity.ResultsThe overall magnitude of inequality in relation to childhood morbidity has been declining slowly over the 22-year period. The magnitude of socio-economic inequality as a cause of childhood morbidity varied during the period. Decomposition analyses attributed the inequalities to poor maternal education attainment, inadequate pre-delivery care, adverse chronic undernutrition status and low immunisation coverage.ConclusionsHigh rates of childhood morbidity were observed, although these have declined over time. Socio-economic inequality is strongly associated with childhood morbidity. Socio-economically disadvantaged communities need to be assisted and interventions should emphasise improvements of, and easier access to, health care services. These will be key to improving the health status of children in Bangladesh and should reduce economic inequality through improved health over time.

Published
2019
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18. Prevalence of underweight, overweight and obesity and their associated risk factors in Nepalese adults: Data from a Nationwide Survey, 2016.

Author

Lal B Rawal, Kie Kanda, Rashidul Alam Mahumud, Deepak Joshi, Suresh Mehata, Nipun Shrestha, Prakash Poudel, Surendra Karki, and Andre Renzaho

Subjects
Medicine, Science
Abstract

INTRODUCTION:Over the past few decades, the total population of Nepal has increased substantially with rapid urbanization, changing lifestyle and disease patterns. There is anecdotal evidence that non-communicable diseases (NCDs) and associated risk factors are becoming key public health challenges. Using nationally representative survey data, we estimated the prevalence of underweight, overweight and obesity among Nepalese adults and explored socio-demographic factors associated with these conditions. MATERIALS AND METHODS:We used the Nepal Demographic Health Survey 2016 data. Sample selection was based on stratified two-stage cluster sampling in rural areas and three stages in urban areas. Weight and height were measured in all adult women and men. Body mass index (BMI) was calculated using Asian specific BMI cut-points. RESULTS:A total of 13,542 adults aged 18 years and above (women 58.19%) had their weight and height measured. The mean (±SD) age was 40.63±16.82 years (men 42.75±17.27, women 39.15±16.34); 41.13% had no formal education and 60.97% lived in urban areas. Overall, 17.27% (95% CI: 16.64-17.91) were underweight; 31.16% (95% CI: 30.38-31.94) overweight/obese. The prevalence of both underweight (women 18.30% and men 15.83%, p

Published
2018
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19. Clinical profile of patients with diabetic nephropathy in a tertiary level hospital in Dhaka, Bangladesh

Author

Sheikh MohammedShariful Islam, Md Serajul Islam, Lal B Rawal, AKM Mainuddin, Mohammad Wahiduzzaman, and Louis W Niessen

Subjects
Bangladesh, diabetes, diabetic nephropathy, hypertension, Medicine
Abstract

Background: Diabetic nephropathy (DN) is one of the major causes of morbidity and mortality among patients with diabetes worldwide. Data on DN patients in Bangladesh are scarce. Objectives: The aim of this study was to determine the clinical status of patients with DN and its associated factors in Bangladesh. Materials and Methods: A cross-sectional study was conducted among 130 DN patients admitted in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital in Dhaka from May to July 2010. We collected data using structured questionnaires, anthropometric, biochemical, and clinical measurements. Multiple regression analyses were performed to examine the relationships between independent variables and factors associated with DN. Results: The mean age of the patients was 56.50 ± 14.2 years. The mean duration of hypertension, diabetes, and DN was 7.32 ± 5.42, 10.08 ± 6.8, and 3.24 ± 3.67 years, respectively. The mean HbA1c was 10.07 ± 3.27%, and mean serum creatinine 2.91 ± 1.98 mg/dl. The correlation coefficient matrix suggests relationships between many of the patients′ characteristics and clinical outcomes. Multiple logistic regression analysis shows that the duration of DN (>3 years) is associated with female sex (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.97-2.12), systolic blood pressure (OR 1.04, 95% CI 0.78-1.53), serum creatinine (OR 1.04, 95% CI 0.96-1.87), HbA1c (OR 1.12, 95% CI 0.89-2.01), and duration of hypertension (OR 1.06, 95% CI 0.83-2.37). Conclusion: The results show that among the study participants DN develops earlier with a shorter duration of hypertension and diabetes, providing a strong case for promoting effective strategies for optimum management of diabetes and hypertension in the clinics.

Published
2015
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20. Socio-demographic characteristics and tobacco use among the adults in urban slums of Dhaka, Bangladesh

Author

Nusrat Nausheen Khandker, Tuhin Biswas, Abdullah Nurus Salam Khan, Enamul Hasib, and Lal B Rawal

Subjects
tobacco use, urban slum, Dhaka, Bangladesh, Diseases of the respiratory system, RC705-779, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Introduction Use of tobacco has become one of the major causes of premature deaths in most developing countries, including Bangladesh. The poorest and most disadvantaged populations, such as those living in slums, are considered to be extremely vulnerable to non-communicable diseases and their risk factors, especially tobacco use. The objective of this study was to assess the current status of tobacco consumption among slum dwellers and its association with socio-demographic factors. Material and Methods A cross-sectional study was conducted in three slums of Dhaka city. Information about tobacco use as well as socio-demographic characteristics was collected from adult slum dwellers via face to face interviews using WHO STEPS questionnaire. Results Overall proportion of smoking, smokeless tobacco consumption and dual use of tobacco was 35% [95% CI: 31.6-39.8], 40.6% [95% CI: 36.5–45.2] and 12% [95% CI: 9.3–15.0] respectively. Elderly people (55–64 years) were more likely to smoke (OR: 2.34, 95% CI: 1.21–4.49) than younger people (aged 25–34 years). On the other hand, those who had no schooling history (OR: 2.95, 95% CI: 1.66–5.25) were more likely to consume smokeless tobacco than those who had higher education (secondary or above). At the same time, manual workers were more likely to indulge in dual use of tobacco (OR: 5.17, 95% CI: 2.82–9.48) as compared to non-manual workers. Conclusions The urban slum population of Dhaka city has a high prevalence of tobacco use, which increases their likelihood of developing non-communicable diseases. Proper attention needs to be directed towards addressing the risk factors related to non-communicable diseases within this vulnerable population.

Published
2017
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21. Non-communicable disease (NCD) risk factors and diabetes among adults living in slum areas of Dhaka, Bangladesh.

Author

Lal B Rawal, Tuhin Biswas, Nusrat Nausheen Khandker, Shekhar Ranjan Saha, Mohammed Mahiul Bidat Chowdhury, Abdullah Nurus Salam Khan, Enamul Hasib Chowdhury, and Andre Renzaho

Subjects
Medicine, Science
Abstract

BACKGROUND:Despite one-third of the urban population in Bangladesh living in urban slums and at increased risk of non-communicable diseases (NCDs), little is known about the NCD risk profile of this at-risk population. The aim of the study was to identify the prevalence of the NCD risk factors and the association of NCD risk factors with socio-demographic factors among the adults of urban slums in Dhaka, Bangladesh. METHOD:A cross-sectional study was conducted among adult slum dwellers (aged 25 and above) residing in three purposively selected urban slums of Dhaka for at least six months preceding the survey. The risk factors assessed were- currently smoking, fruit and vegetable intake, physical activity, hypertension and body mass index (BMI). Information on self-reported diabetes was also taken. A total of 507 participants (252 females; 49.7%) were interviewed and their physical measures were taken using the WHO NCD STEPS instrument. RESULT:The overall prevalence of NCD risk factors was: 36.0% (95% CI: 31.82-40.41) for smoking; 95.60% (95% CI: 93.60-97.40) for insufficient fruit and vegetable intake; 15.30% (95% CI:12.12-18.71) for low physical activity;13.70% (95% CI: 10.71-16.92) for hypertension; 22.70% (95% CI: 19.31-26.02) for overweight or obesity; and 5.00% (95%: 3.20-7.00) for self-reported diabetes. In the logistic regression model, the clustering of three or more NCD risk factors was positively associated with younger age groups (p = 0.02), no formal education (p

Published
2017
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22. The prevalence of underweight, overweight and obesity in Bangladeshi adults: Data from a national survey.

Author

Tuhin Biswas, Sarah P Garnett, Sonia Pervin, and Lal B Rawal

Subjects
Medicine, Science
Abstract

BackgroundOver the two last decades Bangladesh, a low-income country, has experienced a rapid demographic and epidemiological transition. The population has increased substantially with rapid urbanization and changing pattern of disease, which at least in part, can be explained by nutritional changes. However, the nutritional status of the adult population has not been previously described. Hence, the objective of this study was to estimate the prevalence and explore socio-demographic determinants of underweight, overweight and obesity among the Bangladeshi adult population.MethodsThis study is a secondary data analysis of the national 2011 Bangladesh Demographic and Health Survey. We determined the nutritional status of adults aged ≥35 years of age, who had a measured weight and height, using the Asian body mass index (BMI) cut-offs for underweight (BMI ResultOf total sample (n = 5495), 30.4% were underweight, 18.9% were overweight and 4.6% were obese. Underweight was associated with age, education and wealth. The adjusted odd ratios for underweight were higher for older people (≥70 years) compared to younger, the least educated compared to the most educated and the poorest compared to the wealthiest were 2.51 (95%CI: 1.95-3.23, pConclusionUnderweight and overweight/obesity are prevalent in Bangladeshi adults. Both conditions are associated with increased morbidity and mortality and increase the risk of developing non-communicable diseases. Effective public health intervention approaches are necessary to address both these conditions.

Published
2017
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23. Socio-Economic Inequality of Chronic Non-Communicable Diseases in Bangladesh.

Author

Tuhin Biswas, Md Saimul Islam, Natalie Linton, and Lal B Rawal

Subjects
Medicine, Science
Abstract

Chronic non-communicable diseases (NCDs) are a major public health challenge, and undermine social and economic development in much of the developing world, including Bangladesh. Epidemiologic evidence on the socioeconomic status (SES)-related pattern of NCDs remains limited in Bangladesh. This study assessed the relationship between three chronic NCDs and SES among the Bangladeshi population, paying particular attention to the differences between urban and rural areas.Data from the 2011 Bangladesh Demographic and Health Survey were used for this study. Using a concentration index (CI), we measured relative inequality across pre-diabetes, diabetes, pre-hypertension, hypertension, and BMI (underweight, normal weight, and overweight/obese) in urban and rural areas in Bangladesh. A CI and its associated curve can be used to identify whether socioeconomic inequality exists for a given health variable. In addition, we estimated the health achievement index, integrating mean coverage and the distribution of coverage by rural and urban populations.Socioeconomic inequalities were observed across diseases and risk factors. Using CI, significant inequalities observed for pre-hypertension (CI = 0.09, p = 0.001), hypertension (CI = 0.10, p = 0.001), pre-diabetes (CI = -0.01, p = 0.005), diabetes (CI = 0.19, p

Published
2016
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24. Women Empowerment and Its Relation with Health Seeking Behavior in Bangladesh.

Author

Akm Mainuddin, Housne Ara Begum, Lal B Rawal, Anwar Islam, and S M Shariful Islam

Subjects
Women empowerment, decision making, health seeking behavior, mobility, Gynecology and obstetrics, RG1-991
Abstract

Objective:Over the last few decades, Bangladesh has made significant progress towards achieving targets for the Millennium Development Goals (MDGs) and women empowerment. This study is aimed at identifying the levels and patterns of women empowerment in relation to health seeking behavior in Bangladesh. Materials and methods:We conducted a cross-sectional study among 200 rural married women in Cox's Bazar district in Bangladesh using multi stage sampling technique and face-to-face interview. Data was collected on socio-economic characteristics, proxy indicators for women empowerment in mobility and health seeking behavior related decision making. Bivariate and multivariate regression analyses were performed to identify associations between women empowerment in relation to health seeking behavior on mobility and decision making, controlling the effect of other independent variables. Results:The results showed that only 12% women were empowered to decide on their own about seeking healthcare and 8.5% in healthcare seeking for their children. In multivariate analysis women empowerment in health seeking behavior was higher among age group 25-34 years (OR 1.76, [CI = 0.82-3.21]), women's education, husband's education, age at marriage > 18 years (OR 6.38, [CI = 0.98-4.21]) and women's working status (OR 16.44, [CI = 0.79-2.71]). Conclusion:Women empowerment enhances their decision-making authority regarding health seeking behavior. Acknowledging and adopting the implications of these findings are essential for an integrated health and development strategy for Bangladesh and achieving the MDGs.

Published
2015

26. Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: A healthcare facilities‐based cross‐sectional study in Dang district of Nepal

Author

Mahesh Kumar Khanal, Pratiksha Bhandari, Raja Ram Dhungana, Yadav Gurung, Lal B. Rawal, Gyanendra Pandey, Madan Bhandari, Rijwan Bhuiyan, Surya Devkota, Maximilian de Courten, and Barbora de Courten

Subjects
Endocrinology, Diabetes and Metabolism, Internal Medicine, General Medicine
Published
2023
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27. Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

Author

Lal B. Rawal, Kodjo Senah, Christabel Enweronu-Laryea, Matilda Aberese-Ako, Gifty Sunkwa-Mills, and Britt Pinkowski Tersbøl

Subjects
Neonatal intensive care unit, Health Personnel, Supplement Articles, Participant observation, Healthcare-associated infections, 030501 epidemiology, Ghana, Grounded theory, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Nursing, Intensive Care Units, Neonatal, Intensive care, parasitic diseases, Humans, health communication, Medicine, AcademicSubjects/MED00860, infection prevention and control, cardiovascular diseases, 030212 general & internal medicine, Health communication, Infection Control, business.industry, Health Policy, Infant, Newborn, Capacity building, neonatal intensive care unit, Focus group, Hospitals, Caregivers, Hardware_CONTROLSTRUCTURESANDMICROPROGRAMMING, 0305 other medical science, business, Delivery of Health Care
Abstract

Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers’ roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

Published
2020
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28. Effectiveness of an educational intervention in improving healthcare workers' knowledge of early recognition, diagnosis and management of rheumatic fever and rheumatic heart disease in rural far-western Nepal: a pre/post-intervention study

Author

Navin Bhatt, Ashmita Karki, Biplav Shrestha, Amul Singh, Lal B Rawal, and Sanjib Kumar Sharma

Subjects
Nepal, Health Personnel, Rheumatic Heart Disease, Humans, Pharyngitis, General Medicine, Rheumatic Fever, Child
Abstract

ObjectivesRheumatic fever (RF) and rheumatic heart disease (RHD) remain among the major heart problems among children in Nepal. Although these conditions are preventable and treatable, the lack of proper knowledge and resources to diagnose and manage these conditions in rural health centres is a key concern. This study assessed the impact of educational sessions to improve the knowledge of healthcare workers in the early recognition, diagnosis, and management of RF and RHD in rural far-western Nepal.Design, setting and participantsThis study used a pretest and post-test interventional design and was conducted among 64 healthcare workers in two primary healthcare centres and a peripheral district-level hospital in Achham district in the far-western region of Nepal. A self-administered questionnaire was used before and after the educational sessions. Data were analysed using SPSS V.21.ResultsThe overall test scores increased from 10 (SD=2.4) pre-intervention to 13.8 (SD=1.9) post-intervention (pConclusionThe findings suggest that the investigated educational sessions are promising with respect to improving the knowledge and confidence of healthcare workers in the early recognition, diagnosis, and management of RF and RHD at the primary healthcare level. Further studies with a larger sample size and conducted in different parts of the country are warranted to assess the effectiveness and impact of scaling up such educational interventions in Nepal.

Published
2022

29. Machine Learning Approaches for Predicting Hypertension and Its Associated Factors Using Population-Level Data From Three South Asian Countries

Author

Sheikh Mohammed Shariful Islam, Ashis Talukder, Md. Abdul Awal, Md. Muhammad Umer Siddiqui, Md. Martuza Ahamad, Benojir Ahammed, Lal B. Rawal, Roohallah Alizadehsani, Jemal Abawajy, Liliana Laranjo, Clara K. Chow, and Ralph Maddison

Subjects
Cardiology and Cardiovascular Medicine
Abstract

BackgroundHypertension is the most common modifiable risk factor for cardiovascular diseases in South Asia. Machine learning (ML) models have been shown to outperform clinical risk predictions compared to statistical methods, but studies using ML to predict hypertension at the population level are lacking. This study used ML approaches in a dataset of three South Asian countries to predict hypertension and its associated factors and compared the model's performances.MethodsWe conducted a retrospective study using ML analyses to detect hypertension using population-based surveys. We created a single dataset by harmonizing individual-level data from the most recent nationally representative Demographic and Health Survey in Bangladesh, Nepal, and India. The variables included blood pressure (BP), sociodemographic and economic factors, height, weight, hemoglobin, and random blood glucose. Hypertension was defined based on JNC-7 criteria. We applied six common ML-based classifiers: decision tree (DT), random forest (RF), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), logistic regression (LR), and linear discriminant analysis (LDA) to predict hypertension and its risk factors.ResultsOf the 8,18,603 participants, 82,748 (10.11%) had hypertension. ML models showed that significant factors for hypertension were age and BMI. Ever measured BP, education, taking medicine to lower BP, and doctor's perception of high BP was also significant but comparatively lower than age and BMI. XGBoost, GBM, LR, and LDA showed the highest accuracy score of 90%, RF and DT achieved 89 and 83%, respectively, to predict hypertension. DT achieved the precision value of 91%, and the rest performed with 90%. XGBoost, GBM, LR, and LDA achieved a recall value of 100%, RF scored 99%, and DT scored 90%. In F1-score, XGBoost, GBM, LR, and LDA scored 95%, while RF scored 94%, and DT scored 90%. All the algorithms performed with good and small log loss values ConclusionML models performed well to predict hypertension and its associated factors in South Asians. When employed on an open-source platform, these models are scalable to millions of people and might help individuals self-screen for hypertension at an early stage. Future studies incorporating biochemical markers are needed to improve the ML algorithms and evaluate them in real life.

Published
2022
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30. Prevalence of multiple non-communicable diseases risk factors among adolescents in 140 countries: A population-based study

Author

Tuhin Biswas, Nick Townsend, M. Mamun Huda, Joemer Maravilla, Tahmina Begum, Sonia Pervin, Arpita Ghosh, Rashidul Alam Mahumud, Shariful Islam, Novera Anwar, Rukaiya Rifhat, Kerim Munir, Rajat Das Gupta, Andre M.N. Renzaho, Helda Khusun, Luh Ade Ari Wiradnyani, Tim Radel, Janeen Baxter, Lal B. Rawal, David McIntyre, Kjersti Mørkrid, and Abdullah Mamun

Subjects
Risk factors, Burden, General Medicine, SPS Exercise, Nutrition and Health Sciences, Adolescents, Non-communicable disease
Abstract

Background: Modifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents. Methods: We used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex. Findings: Over 487,565 adolescents, aged 11–17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003–2007 and increased to 44% in 2013–2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions. Interpretation: Our results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions. Funding: None.

Published
2022
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31. Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries : protocol for a longitudinal mixed-methods study

Author

Anusha Ramani-Chander, Rohina Joshi, Josefien van Olmen, Edwin Wouters, Peter Delobelle, Rajesh Vedanthan, J Jaime Miranda, Brian Oldenburg, Stephen Sherwood, Lal B Rawal, Robert James Mash, Vilma Edith Irazola, Monika Martens, Maria Lazo-Porras, Hueiming Liu, Gina Agarwal, Gade Waqa, Milena Soriano Marcolino, Maria Eugenia Esandi, Antonio Luiz Pinho Ribeiro, Ari Probandari, Francisco González-Salazar, Abha Shrestha, Sujarwoto Sujarwoto, Naomi Levitt, Myriam Paredes, Tomohiko Sugishita, Malek Batal, Yuan Li, Hassan Haghparast-Bidgoli, Violet Naanyu, Feng J He, Puhong Zhang, Sayoki Godfrey Mfinanga, Jan-Walter De Neve, Meena Daivadanam, Kamran Siddiqi, Pascal Geldsetzer, Kerstin Klipstein-Grobusch, Mark D Huffman, Jacqui Webster, Dike Ojji, Andrea Beratarrechea, Maoyi Tian, Maarten Postma, Mayowa O Owolabi, Josephine Birungi, Laura Antonietti, Zulma Ortiz, Anushka Patel, David Peiris, Darcelle Schouw, Jaap Koot, Keiko Nakamura, Gindo Tampubolon, Amanda G Thrift, Value, Affordability and Sustainability (VALUE), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Microbes in Health and Disease (MHD), Mental Health and Wellbeing research group, and Public Health Sciences

Subjects
Enablers, hypertension, Systems Analysis, protocols & guidelines, health services administration & management, 111799 Public Health and Health Services not elsewhere classified, longitudinal mixed-methods study, FOS: Health sciences, Diabetes Mellitus/therapy, low-income countries, Noncommunicable Diseases/therapy, Internal Medicine, Diabetes Mellitus, Humans, Noncommunicable Diseases, Developing Countries, Medicine(all), diabetes, public health, Public Health, Environmental and Occupational Health, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, middle-income countries, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Nephrology, Technologie and Innovatie, Hypertension/diagnosis, Hypertension, Knowledge Technology and Innovation, Kennis, Human medicine, Kennis, Technologie and Innovatie
Abstract

IntroductionThere is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions.Methods and analysisWe will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TPand conduct multistakeholder qualitative interviews to gather data at T0and T1.We will undertake descriptive statistical analysis of TPdata and analyse T0and T1data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks.Ethics and disseminationThe current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.

Published
2022

32. Health problems and utilization of health services among Forcibly Displaced Myanmar Nationals in Bangladesh

Author

Md. Imtiaz Tanim, Tahmina Begum, Lal B. Rawal, Md. Rajibul Islam, Berhe W. Sahle, Kie Kanda, Padam Kanta Dahal, Tarique Md. Nurul Huda, Tuhin Biswas, Andre M. N. Renzaho, and Iqbal Anwar

Subjects
Male, medicine.medical_specialty, Health (social science), Epidemiology, Refugee, media_common.quotation_subject, Myanmar, Grounded theory, Acquired immunodeficiency syndrome (AIDS), Pregnancy, Environmental health, Political science, Health care, medicine, Humans, Family planning, Child, Empowerment, media_common, Refugees, Bangladesh, business.industry, Research, Health Policy, Public health, Public Health, Environmental and Occupational Health, Men, Prenatal Care, medicine.disease, Focus group, Health services, HIV/AIDS, Female, Rohingya refugees, Public aspects of medicine, RA1-1270, business
Abstract

Background Access to and utilization of health services have remained major challenges for people living in low- and middle-income countries, especially for those living in impaired public health environment such as refugee camps and temporary settlements. This study presents health problems and utilization of health services among Forcibly Displaced Myanmar Nationals (FDMNs) living in the southern part of Bangladesh. Methods A mixed-method (quantitative and qualitative) approach was used. Altogether 999 household surveys were conducted among the FDMNs living in makeshift/temporary settlements and host communities. We used a grounded theory approach involving in-depth interviews (IDIs), focus group discussions (FGDs), and key informant interviews (KIIs) including 24 IDIs, 10 FGDs, and 9 KIIs. The quantitative data were analysed with STATA. Results The common health problems among the women were pregnancy and childbirth-related complications and violence against women. Among the children, fever, diarrhoea, common cold and malaria were frequently observed health problems. Poor general health, HIV/AIDS, insecurity, discrimination, and lack of employment opportunity were common problems for men. Further, 61.2% women received two or more antenatal care (ANC) visits during their last pregnancy, while 28.9% did not receive any ANC visit. The majority of the last births took place at home (85.2%) assisted by traditional birth attendants (78.9%), a third (29.3%) of whom suffered pregnancy- and childbirth-related complications. The clinics run by the non-governmental organizations (NGOs) (76.9%) and private health facilities (86.0%) were the most accessible places for seeking healthcare for the FDMNs living in the makeshift settlements. All participants heard about HIV/AIDS. 78.0% of them were unaware about the means of HIV transmission, and family planning methods were poorly used (45.2%). Conclusions Overall, the health of FDMNs living in the southern part of Bangladesh is poor and they have inadequate access to and utilization of health services to address the health problems and associated factors. Existing essential health and nutrition support programs need to be culturally appropriate and adopt an integrated approach to encourage men’s participation to improve utilization of health and family planning services, address issues of gender inequity, gender-based violence, and improve women empowerment and overall health outcomes.

Published
2021
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33. Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis

Author

Syed Afroz Keramat, Rashidul Alam Mahumud, Gail M. Ormsby, Jeff Gow, Andre M. N. Renzaho, Marufa Sultana, Khorshed Alam, and Lal B. Rawal

Subjects
Adult, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Inequality, media_common.quotation_subject, Uterine Cervical Neoplasms, Cervical cancer screening services, 03 medical and health sciences, 0302 clinical medicine, Decomposition analyses, Surveys and Questionnaires, Medicine, Humans, 030212 general & internal medicine, Developing Countries, Health policy, Early Detection of Cancer, media_common, Cervical cancer, Service (business), 030505 public health, biology, business.industry, Health Policy, Public health, Research, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, Middle Aged, biology.organism_classification, medicine.disease, Tanzania, Resource-constrained countries, Knowledge, Socioeconomic Factors, Utilisation, Income, Residence, Female, 0305 other medical science, business, Demography
Abstract

Introduction Resource-constrained countries (RCCs) have the highest burden of cervical cancer (CC) in the world. Nonetheless, although CC can be prevented through screening for precancerous lesions, only a small proportion of women utilise screening services in RCCs. The objective of this study was to examine the magnitude of inequalities of women’s knowledge and utilisation of cervical cancer screening (CCS) services in RCCs. Methods A total of 1,802,413 sample observations from 18 RCC’s latest national-level Demographic and Health Surveys (2008 to 2017–18) were analysed to assess wealth-related inequalities in terms of women’s knowledge and utilisation of CCS services. Regression-based decomposition analyses were applied in order to compute the contribution to the inequality disparities of the explanatory variables for women’s knowledge and utilisation of CCS services. Results Overall, approximately 37% of women had knowledge regarding CCS services, of which, 25% belonged to the poorest quintile and approximately 49% from the richest. Twenty-nine percent of women utilised CCS services, ranging from 11% in Tajikistan, 15% in Cote d’Ivoire, 17% in Tanzania, 19% in Zimbabwe and 20% in Kenya to 96% in Colombia. Decomposition analyses determined that factors that reduced inequalities in women’s knowledge of CCS services were male-headed households (− 2.24%; 95% CI: − 3.10%, − 1.59%; P ), currently experiencing amenorrhea (− 1.37%; 95% CI: − 2.37%, − 1.05%; P ), having no problems accessing medical assistance (− 10.00%; 95% CI: − 12.65%, − 4.89%; P ), being insured (− 6.94%; 95% CI: − 9.58%, − 4.29%; P ) and having an urban place of residence (− 9.76%; 95% CI: − 12.59%, − 5.69%; P ). Similarly, factors that diminished inequality in the utilisation of CCS services were being married (− 8.23%;95% CI: − 12.46%, − 5.80%; P ), being unemployed (− 14.16%; 95% CI: − 19.23%, − 8.47%; P ) and living in urban communities (− 9.76%; 95% CI: − 15.62%, − 5.80%; P ). Conclusions Women’s knowledge and utilisation of CCS services in RCCs are unequally distributed. Significant inequalities were identified among socioeconomically deprived women in the majority of countries. There is an urgent need for culturally appropriate community-based awareness and access programs to improve the uptake of CCS services in RCCs.

Published
2020
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34. Estimating global injuries morbidity and mortality

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Zohreh Arefi, Rasmus Havmoeller, Pietro Ferrara, Vijay Kumar Chattu, Payman Salamati, Agegnehu Bante Getenet, Seyedeh Zahra Masoumi, Alexander C. Tsai, Andrew T Olagunju, Carl Abelardo T. Antonio, Morteza Abdullatif Khafaie, Tim Driscoll, Reza Rawassizadeh, Vishnu Renjith, Taras Kavetskyy, Ejaz Ahmad Khan, Gebreamlak Gebremedhn Gebremeskel, Richard C. Franklin, Naznin Hossain, Bhaskaran Unnikrishnan, Fariborz Mansour-Ghanaei, Arash Tehrani-Banihashemi, Morteza Naserbakht, Sangram Kishor Patel, Vera Marisa Costa, Suzanne Polinder, Ziad El-Khatib, Ashish Pathak, Mika Shigematsu, Bryan L. Sykes, David M. Pigott, Zeleke Aschalew Melketsedik, Hadi Hassankhani, Nuworza Kugbey, Lal B. Rawal, Masoud Foroutan, Dejana Braithwaite, Muluken Bekele Sorrie, Grant M. A. Wyper, Joht Singh Chandan, Akbar Barzegar, Hamid Safarpour, Kate E. LeGrand, Giulio Castelpietra, Dina Nur Anggraini Ningrum, Seth Christopher Yaw Appiah, Amin Soheili, Azeem Majeed, Akshaya Srikanth Bhagavathula, Nikolay Ivanovich Briko, Vahid Yazdi-Feyzabadi, Walter Mendoza, Ghulam Mustafa, Cuong Tat Nguyen, Pengpeng Ye, Mahesh P A, Carlos Miguel Rios González, Ahmad Daryani, Ibrahim Abdollahpour, Masoud Moradi, Haileab Fekadu Wolde, Mohammad Rabiee, Jaya Prasad Tripathy, Jack T Fox, Diep Ngoc Nguyen, Pallab K. Maulik, Ai-Min Wu, Félix Carvalho, Yun Jin Kim, Fatemeh Rajati, Nathaniel J Henry, David C. Schwebel, Ali H. Mokdad, Akine Eshete Abosetugn, Leonardo Roever, Ketema Bizuwork Gebremedhin, Khalid A Altirkawi, Hayimro Edemealem Merie, Farhad Ghamari, Ramesh Holla, Arash Sarveazad, Devasahayam J. Christopher, Kedir Hussein Abegaz, Suresh Jungari, Rohan Borschmann, Irfan Ullah, Nitin Joseph, Catalina Liliana Andrei, Abdallah M. Samy, Roman Topor-Madry, Michal Grivna, Ivo Rakovac, Mohammad Zamani, Antonio Maria Borzì, Atif Amin Baig, Mohsen Bayati, Mohammad Ali Mansournia, Fatemeh Heydarpour, Juanita A. Haagsma, Segun Emmanuel Ibitoye, Mehdi Sayyah, Teshome Abegaz Kamil, Fakher Rahim, Dillon O Sylte, Feng Sha, Palash Chandra Banik, Mohan Bairwa, Mariya Vladimirovna Titova, Yong Yu, Delia Hendrie, Spencer L. James, Anusha Ganapati Bhat, Seok Jun Yoon, Siavash Rahimi, Jost B. Jonas, Michael R. Phillips, Diana Silva, Amir Hossein Goudarzian, Samath D Dharmaratne, Roba Khundkar, Jemal Abdu Mohammed, Joemer C. Maravilla, Eleonora Dubljanin, Arun Balachandran, Arman Latifi, Randah R. Hamadeh, G. K. Mini, Alessandra C. Goulart, Andreea Mirica, Fatemeh Zarei, Habte Belete, Telma Zahirian Moghadam, Maseer Khan, Morenike Oluwatoyin Folayan, Atte Meretoja, Jasvinder A. 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Otstavnov, Ahmed Omar Bali, Farshad Farzadfar, Vivek Kumar, Sanghamitra Pati, Gholamreza Roshandel, Daiane Borges Machado, Yuan-Pang Wang, Rafael Alves Guimarães, Aziz Sheikh, Jeevan Pereira, Ahamarshan Jayaraman Nagarajan, Soraya Siabani, Kamarul Imran Musa, Farshad Pourmalek, Janet L Leasher, Shafiu Mohammed, Shyam Sundar Budhathoki, Mehdi Naderi, Mehdi Hosseinzadeh, Eun-Kee Park, Marwa Rashad Salem, Alireza Ansari-Moghaddam, Achala Upendra Jayatilleke, Paolo Lauriola, Amir Kasaeian, Adam Belay Wondmieneh, Tilahun Belete Mossie, Rovshan Khalilov, Milena M Santric Milicevic, Ai Koyanagi, Shailesh Advani, Felix Akpojene Ogbo, Nihad A. Almasri, Abdur Razzaque Sarker, Salman Khazaei, Narayanaswamy Venketasubramanian, Josephine W. Ngunjiri, Mihajlo Jakovljevic, Matthew Cunningham, Shaimaa I. El-Jaafary, Hosni Salem, Sharareh Eskandarieh, Muktar Beshir Ahmed, Amy E. 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Mohseni Bandpei, Ali Kabir, Jee-Young Jasmine Choi, Gebretsadkan Hintsa Tekulu, Kidanemaryam Berhe, Bill & Melinda Gates Foundation, Sanofi, HUS Comprehensive Cancer Center, Clinicum, University of Helsinki, Helsinki University Hospital Area, HUS Neurocenter, James, S. L., Castle, C. D., Dingels, Z. V., Fox, J. T., Hamilton, E. B., Liu, Z., Roberts, N. L. S., Sylte, D. O., Bertolacci, G. J., Cunningham, M., Henry, N. J., Legrand, K. E., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abedi, A., Abegaz, K. H., Abosetugn, A. E., Abushouk, A. I., Adebayo, O. M., Adsuar, J. C., Advani, S. M., Agudelo-Botero, M., Ahmad, T., Ahmed, M. B., Ahmed, R., Aichour, M. T. E., Alahdab, F., Alanezi, F. M., Alema, N. M., Alemu, B. W., Alghnam, S. A., Ali, B. A., Ali, S., Alinia, C., Alipour, V., Aljunid, S. M., Almasi-Hashiani, A., Almasri, N. A., Altirkawi, K., Amer, Y. S. A., Andrei, C. L., Ansari-Moghaddam, A., Antonio, C. A. T., Anvari, D., Appiah, S. C. 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J., Chu, D. -T., Cicuttini, F. M., Coelho, J. M., Costa, V. M., Dahlawi, S. M. A., Daryani, A., Davila-Cervantes, C. A., De Leo, D., Demeke, F. M., Demoz, G. T., Demsie, D. G., Deribe, K., Desai, R., Nasab, M. D., Da Silva, D. D., Forooshani, Z. S. D., Do, H. T., Doyle, K. E., Driscoll, T. R., Dubljanin, E., Adema, B. D., Eagan, A. W., Elemineh, D. A., El-Jaafary, S. I., El-Khatib, Z., Ellingsen, C. L., El Sayedzaki, M., Eskandarieh, S., Eyawo, O., Faris, P. S., Faro, A., Farzadfar, F., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, P., Fischer, F., Folayan, M. O., Fomenkov, A. A., Foroutan, M., Francis, J. M., Franklin, R. C., Fukumoto, T., Geberemariyam, B. S., Gebremariam, H., Gebremedhin, K. B., Gebremeskel, L. G., Gebremeskel, G. G., Gebremichael, B., Gedefaw, G. A., Geta, B., Getenet, A. B., Ghafourifard, M., Ghamari, F., Gheshlagh, R. G., Gholamian, A., Gilani, S. A., Gill, T. K., Goudarzian, A. H., Goulart, A. C., Grada, A., Grivna, M., Guimaraes, R. A., Guo, Y., Gupta, G., Haagsma, J. A., Hall, B. J., Hamadeh, R. R., Hamidi, S., Handiso, D. W., Haro, J. M., Hasanzadeh, A., Hassan, S., Hassanipour, S., Hassankhani, H., Hassen, H. Y., Havmoeller, R., Hendrie, D., Heydarpour, F., Hijar, M., Ho, H. C., Hoang, C. L., Hole, M. K., Holla, R., Hossain, N., Hosseinzadeh, M., Hostiuc, S., Hu, G., Ibitoye, S. E., Ilesanmi, O. S., Inbaraj, L. R., Irvani, S. S. N., Islam, M. M., Islam, S. M. S., Ivers, R. Q., Jahani, M. A., Jakovljevic, M., Jalilian, F., Jayaraman, S., Jayatilleke, A. U., Jha, R. P., John-Akinola, Y. O., Jonas, J. B., Jones, K. M., Joseph, N., Joukar, F., Jozwiak, J. J., Jungari, S. B., Jurisson, M., Kabir, A., Kahsay, A., Kalankesh, L. R., Kalhor, R., Kamil, T. A., Kanchan, T., Kapoor, N., Karami, M., Kasaeian, A., Kassaye, H. G., Kavetskyy, T., Kayode, G. A., Keiyoro, P. N., Kelbore, A. G., Khader, Y. S., Khafaie, M. A., Khalid, N., Khalil, I. A., Khalilov, R., Khan, M., Khan, E. 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Z.A., Memiah, P.T.N., Mendoza, W., Menezes, R.G., Mengesha, M.M., Meretoja, T.J., Meretoja, A., Merie, H.E., Mestrovic, T., Miazgowski, B., Miazgowski, T., Miller, T.R., Mini, G.K., Mirica, A., Mirrakhimov, E.M., Mirzaei-Alavijeh, M., Mithra, P., Moazen, B., Moghadaszadeh, M., Mohamadi, E., Mohammad, Y., Darwesh, A.M., Mohammadian-Hafshejani, A., Mohammadpourhodki, R., Mohammed, S., Mohammed, J.A., Mohebi, F., Bandpei, M.A.M., Molokhia, M., Monasta, L., Moodley, Y., Moradi, M., Moradi, G., Moradi-Lakeh, M., Moradzadeh, R., Morawska, L., Velásquez, I.M., Morrison, S.D., Mossie, T.B., Muluneh, A.G., Musa, K.I., Mustafa, G., Naderi, M., Nagarajan, A.J., Naik, G., Naimzada, M.D., Najaf, F., Nangia, V., Nascimento, B.R., Naserbakht, M., Nayak, V., Nazari, J., Ndwandwe, D.E., Negoi, I., Ngunjiri, J.W., Nguyen, T.H., Nguyen, C.T., Nguyen, D.N., Nguyen, H.L.T., Nikbakhsh, R., Ningrum, D.N.A., Nnaji, C.A., Ofori-Asenso, R., Ogbo, F.A., Oghenetega, O.B., Oh, I.-H., Olagunju, A.T., Olagunju, T.O., Bali, A.O., Onwujekwe, O.E., Orpana, H.M., Ota, E., Otstavnov, N., Otstavnov, S.S., Mahesh, A.P., Padubidri, J.R., Pakhale, S., Pakshir, K., Panda-Jonas, S., Park, E.-K., Patel, S.K., Pathak, A., Pati, S., Paulos, K., Peden, A.E., Pepito, V.C.F., Pereira, J., Phillips, M.R., Polibin, R.V., Polinder, S., Pourmalek, F., Pourshams, A., Poustchi, H., Prakash, S., Pribadi, D.R.A., Puri, P., Syed, Z.Q., Rabiee, N., Rabiee, M., Radfar, A., Rafay, A., Rafee, A., Rafei, A., Rahim, F., Rahimi, S., Rahman, M.A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Rao, S.J., Rashedi, V., Rastogi, P., Rathi, P., Rawaf, S., Rawal, L., Rawassizadeh, R., Renjith, V., Resnikoff, S., Rezapour, A., Ribeiro, A.I., Rickard, J., González, C.M.R., Roever, L., Ronfani, L., Roshandel, G., Saddik, B., Safarpour, H., Safdarian, M., Sajadi, S.M., Salamati, P., Salem, M.R.R., Salem, H., Salz, I., Samy, A.M., Sanabria, J., Riera, L.S., Milicevic, M.M.S., Sarker, A.R., Sarveazad, A., Sathian, B., Sawhney, M., Sayyah, M., Schwebel, D.C., Seedat, S., Senthilkumaran, S., Seyedmousavi, S., Sha, F., Shaahmadi, F., Shahabi, S., Shaikh, M.A., Shams-Beyranvand, M., Sheikh, A., Shigematsu, M., Shin, J.I., Shiri, R., Siabani, S., Sigfusdottir, I.D., Singh, J.A., Singh, P.K., Sinha, D.N., Soheili, A., Soriano, J.B., Sorrie, M.B., Soyiri, I.N., Stokes, M.A., Sufiyan, M.B., Sykes, B.L., Tabarés-Seisdedos, R., Tabb, K.M., Taddele, B.W., Tefera, Y.M., Tehrani-Banihashemi, A., Tekulu, G.H., Tesema, A.K.T., Tesfay, B.E., Thapar, R., Titova, M.V., Tlaye, K.G., Tohidinik, H.R., Topor-Madry, R., Tran, K.B., Tran, B.X., Tripathy, J.P., Tsai, A.C., Tsatsakis, A., Car, L.T., Ullah, I., Ullah, S., Unnikrishnan, B., Upadhyay, E., Uthman, O.A., Valdez, P.R., Vasankari, T.J., Veisani, Y., Venketasubramanian, N., Violante, F.S., Vlassov, V., Waheed, Y., Wang, Y.-P., Wiangkham, T., Wolde, H.F., Woldeyes, D.H., Wondmeneh, T.G., Wondmieneh, A.B., Wu, A.-M., Wyper, G.M.A., Yadav, R., Yadollahpour, A., Yano, Y., Yaya, S., Yazdi-Feyzabadi, V., Ye, P., Yip, P., Yisma, E., Yonemoto, N., Yoon, S.-J., Youm, Y., Younis, M.Z., Yousef, Z., Yu, C., Yu, Y., Moghadam, T.Z., Zaidi, Z., Zaman, S.B., Zamani, M., Zandian, H., Zarei, F., Zhang, Z.-J., Zhang, Y., Ziapour, A., Zodpey, S., Dandona, R., Dharmaratne, S.D., Hay, S.I., Mokdad, A.H., Pigott, D.M., Reiner, R.C., Vos, T., Instituto de Saúde Pública da Universidade do Porto, James, Spencer L, Castle, Chris D, Dingels, Zachary V, Fox, Jack T, Adema, Bereket Duko, Yisma, Engida, Vos, Theo, and Public Health

Subjects
Male, Populations/contexts, 1106 Human Movement and Sports Sciences, Global injuries, population, 030204 cardiovascular system & hematology, Global Health, contexts, context, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, 030212 general & internal medicine, Original Research, Data, populations/contexts, Incidence (epidemiology), Incidence, methodology, 3142 Public health care science, environmental and occupational health, Female, Public Health, TERRITORIES, Quality-Adjusted Life Years, descriptive epidemiology, Human, Disabilities, 195 COUNTRIES, statistical issue, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, Life Expectancy, Environmental health, Injury prevention, SYSTEMATIC ANALYSIS, statistical issues, Humans, Mortality, Estimation, SEX-SPECIFIC MORTALITY, DISABILITY, Public Health, Environmental and Occupational Health, populations, Morbidity, Wounds and Injuries, 1106 Human Movement and Sports Sciences, 1117 Public Health and Health Services, 1701 Psychology, Quality-adjusted life year, Years of potential life lost, 1701 Psychology, Life expectancy, Estimates, Human medicine, populations/context
Abstract

Background. While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. Methods. In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. Results. GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. Conclusions. GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future. Seyed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia for the approval and support to participate in this research project. Alaa Badawi acknowledges support by the Public Health Agency of Canada. Till Bärnighausen acknowledges support by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Traolach Brugha received support from NatCen Social Research (http://natcen.ac.uk/) via NHS Digital and Department of Health and Social Care London, for the Adult Psychiatric Morbidity Survey (APMS) programme. Felix Carvalho received support from UID/MULTI/04378/2019 with funding from FCT/MCTES through national funds. Vera M Costa acknowledges support from grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe is supported by a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges that work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges support from UID/QUI/50006/2019 with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam is funded by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI) and DOD grant W81XWH-16-2-0040 (Co-I), during the period of this study. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan is supported by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Mansai Kumar acknowledges support from FIC/ NIH K43 1K43MH114320-01. Amanda Mason-Jones acknowledges support by the University of York. Mariam Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’s National Health Service Foundation Trust and King’s College London. Ilais Moreno Velasquez is supported by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Duduzile Ndwandwe acknowledges support from Cochrane South Africa, South African Medical Research Council. Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Natural Science Foundation of China (No.81761128031). Abdallah M. Samy received a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi was supported by the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos was supported in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship.

Published
2020
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35. Engaging village health workers in non-communicable disease (NCD) prevention and control in Vietnam: A qualitative study

Author

Hoang Van Minh, Zhenyu Ma, Tran Thi Duc Hanh, Hongfei Long, Tazeen H. Jafar, Shenglan Tang, Lal B. Rawal, Abu S. Abdullah, and Dilshat S. Urmi

Subjects
Community Health Workers, 030505 public health, Control (management), Perspective (graphical), Public Health, Environmental and Occupational Health, Focus Groups, Non-communicable disease, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Vietnam, Environmental health, Political science, medicine, Humans, Community health workers, 030212 general & internal medicine, Noncommunicable Diseases, 0305 other medical science, Qualitative Research, Qualitative research
Abstract

The burden of non-communicable diseases (NCDs) continues to grow in Vietnam, and reducing the burden of NCDs is a national priority. This study explored perspective of community health workers (CHWs), known as Village Health Workers (VHWs) in Vietnam, and public health leaders towards potential of expanding VHWs' role to deliver NCDs prevention and control services, and determined barriers and facilitators. We conducted focus group discussions (FGDs) with VHWs (

Published
2019
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36. Oral Health Knowledge, Attitudes and Practices of People Living with Diabetes in South Asia: A Scoping Review

Author

Prakash Poudel, Lal B. Rawal, Ariana Kong, Uday N. Yadav, Mariana S. Sousa, Biraj Karmacharya, Shaili Pradhan, and Ajesh George

Subjects
Health Knowledge, Attitudes, Practice, Asia, Health, Toxicology and Mutagenesis, Diabetes Mellitus, Public Health, Environmental and Occupational Health, Humans, Oral Health, Toxicology
Abstract

Diabetes increases the risk of oral health complications. This review aimed to synthesise the current evidence on the oral health knowledge, attitudes and practices of people living with diabetes in South Asian countries and provide recommendations on possible strategies for addressing the gaps in oral health care in this population, including the role of non-dental professionals. Using a scoping review framework, six electronic databases (Ovid Medline, CINAHL, ProQuest Central, Scopus, Web of Science and Embase) were searched to identify the relevant literature published between January 2000 and December 2021. The data were extracted into three main categories based on the review’s aims, and further refined into sub-categories. A total of 23 studies were included. The review identified that while people with diabetes living in South Asian countries had some level of awareness about oral health and limited care practices to maintain good oral health, there were gaps in knowledge, and there were areas where their oral health practices and attitudes could be improved. The findings suggest a need for developing targeted oral health policies as well as implementing integrated oral health care interventions involving non-dental professionals to improve the oral health outcomes of people with diabetes.

Published
2022
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37. Assuring Bangladesh's future: non-communicable disease risk factors among the adolescents and the existing policy responses

Author

Tuhin Biswas, Peter Azzopardi, Syeda Novera Anwar, Tim David de Vries, Luis Manuel Encarnacion-Cruz, Md. Mehedi Hasan, M. Mamun Huda, Sonia Pervin, Rajat Das Gupta, Dipak Kumar Mitra, Lal B. Rawal, and Abdullah Al Mamun

Subjects
Bangladesh, Adolescent, Risk Factors, Health, Toxicology and Mutagenesis, Health Policy, Public Health, Environmental and Occupational Health, Humans, Noncommunicable Diseases, Policy Making, Food Science
Abstract

Background The aim of this study is to assess the current status of non-communicable disease (NCD) risk factors amongst adolescents in Bangladesh. We also critically reviewed the existing policy responses to NCD risk among adolescents in Bangladesh. Methods This study used a mixed method approach. To quantify the NCD risk burden, we used data from the Global School-based Student Health Survey conducted in Bangladesh. To understand policy response, we reviewed NCD-related policy documents introduced by the Government of Bangladesh between 1971 and 2018 using the WHO recommended NCD Action Plan 2013–2020as study framework. Information from the policy documents was extracted using a matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan. Results Almost all adolescents in Bangladesh had at least one NCD risk factor, and there was a high prevalence of concurrent multiple NCD risk factors; 14% had one NCD risk factor while 22% had two, 29% had three, 34% had four or more NCD risk factors. Out of 38 policy documents, eight (21.1%) were related to research and/or surveys, eight (21.1%) were on established policies, and eleven (29%) were on legislation acts. Three policy documents (7.9%) were related to NCD guidelines and eight (21.1%) were strategic planning which were introduced by the government and non-government agencies/institutes in Bangladesh. Conclusions The findings emphasize the needs for strengthening NCD risk factors surveillance and introducing appropriate intervention strategies targeted to adolescents. Despite the Government of Bangladesh introducing several NCD-related policies and programs, the government also needs more focus on clear planning, implementation and monitoring and evaluation approaches to preventing NCD risk factors among the adolescents in Bangladesh.

Published
2021

38. Effectiveness of community-based health education and home support program to reduce blood pressure among patients with uncontrolled hypertension in Nepal: A cluster-randomized trial

Author

Surya Devkota, Lal B. Rawal, Yadav Gurung, Pratiksha Bhandari, Pratik Bhandari, Amit Kumar Singh, Mahesh Kumar Khanal, Raja Ram Dhungana, K. N. Paudel, and Barbora de Courten

Subjects
Male, Blood Pressure, Vascular Medicine, law.invention, Body Mass Index, Geographical Locations, Randomized controlled trial, law, Odds Ratio, Medicine and Health Sciences, Public and Occupational Health, Cluster randomised controlled trial, Health Education, Community based, Multidisciplinary, Alcohol Consumption, Middle Aged, Knowledge, Health Education and Awareness, Hypertension, Medicine, Health education, Female, Behavioral and Social Aspects of Health, Research Article, Adult, medicine.medical_specialty, Asia, Patients, Science, Nepal, Intervention (counseling), medicine, Humans, Nutrition, business.industry, Public health, Biology and Life Sciences, Odds ratio, Physical Activity, Diet, Health Care, Blood pressure, People and Places, Physical therapy, Health Facilities, business, Follow-Up Studies, Program Evaluation
Abstract

Background Hypertension is a major global public health problem. Elevated blood pressure can cause cardiovascular and kidney diseases. We assessed the effectiveness of health education sessions and home support programs in reducing blood pressure among patients with uncontrolled hypertension in a suburban community of Nepal. Methods We conducted a community-based, open-level, parallel-group, cluster randomized controlled trial in Birendranagar municipality of Surkhet, Nepal. We randomly assigned four clusters (wards) into intervention and control arms. We provided four health education sessions, frequent home and usual care for intervention groups over six months. The participants of the control arm received only usual care from health facilities. The primary outcome of this study was the proportion of controlled systolic blood pressure (SBP). The analysis included all participants who completed follow-up at six months. Results 125 participants were assigned to either the intervention (n = 63) or the control (n = 62) group. Of them, 60 participants in each group completed six months follow-up. The proportion of controlled SBP was significantly higher among the intervention participants compared to the control (58.3% vs. 40%). Odds ratio of this was 2.1 with 95% CI: 1.01–4.35 (p = 0.046) and that of controlled diastolic blood pressure (DBP) was 1.31 (0.63–2.72) (p = 0.600). The mean change (follow-up minus baseline) in SBP was significantly higher in the intervention than in the usual care (-18.7 mmHg vs. -11.2 mmHg, p = 0.041). Such mean change of DBP was also higher in the intervention (-10.95 mmHg vs. -5.53 mmHg, p = 0.065). The knowledge score on hypertension improved by 2.38 (SD 2.4) in the intervention arm, which was significantly different from that of the control group, 0.13 (1.8) (p Conclusions Multiple health education sessions complemented by frequent household visits by health volunteers can effectively improve knowledge on hypertension and reduce blood pressure among uncontrolled hypertensive patients at the community level in Nepal. Trial registration ClinicalTrial.gov: NCT02981251

Published
2021

39. Economic Evaluation of Health Behavior Interventions to Prevent and Manage Type 2 Diabetes Mellitus in Asia: A Systematic Review of Randomized Controlled Trials

Author

Padam Kanta Dahal, Lal B. Rawal, Rashidul Alam Mahumud, Grish Paudel, Tomohiko Sugishita, and Corneel Vandelanotte

Subjects
Asia, Diabetes Mellitus, Type 2, Cost-Benefit Analysis, Health, Toxicology and Mutagenesis, Health Behavior, Public Health, Environmental and Occupational Health, Humans, Randomized Controlled Trials as Topic
Abstract

Health behavior interventions implemented in Asian countries often lack economic evaluations that effectively address the problems of type 2 diabetes mellitus. This review systematically assessed the existing literature on economic evaluation of health behavior interventions to prevent and manage type 2 diabetes mellitus for people living in Asian countries. Eligible studies were identified through a search of six bibliographic databases, namely, PubMed, Scopus, Public Health Database by ProQuest, Cumulative Index to Nursing and Allied Health Literature Complete, Web of Science, and Google Scholar. Randomized controlled trials of health behavior interventions and studies published in the English language from January 2000 to May 2022 were included in the review. The search yielded 3867 records, of which 11 studies were included in the review. All included studies concluded that health behavior interventions were cost-effective. Eight of these studies undertook an evaluation from a health system perspective, two studies used both societal and health system perspectives, and one study utilized a societal and multi-payer perspective. This review identified the time horizon, direct and indirect medical costs, and discount rates as the most important considerations in determining cost effectiveness. These findings have implications in extending health behavior interventions to prevent and manage type 2 diabetes mellitus in low-resource settings, and are likely to yield the most promising outcomes for people with type 2 diabetes mellitus.

Published
2022
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40. Prevalence of non-communicable chronic conditions, multimorbidity and its correlates among older adults in rural Nepal: a cross-sectional study

Author

Selvanaayagam Shanmuganathan, Saruna Ghimire, Lal B. Rawal, Uday Narayan Yadav, Sabuj Kanti Mistry, and Mark Harris

Subjects
Male, medicine.medical_specialty, Longitudinal study, Cross-sectional study, Ethnic group, Disease, Global Health, Nepal, Epidemiology, medicine, Prevalence, Humans, Longitudinal Studies, Socioeconomic status, Aged, Geriatrics, business.industry, geriatric medicine, Public health, public health, Multimorbidity, General Medicine, Cross-Sectional Studies, Medicine, epidemiology, Female, business, Demography
Abstract

ObjectivesThis study’s objectives were to estimate the prevalence of major non-communicable conditions and multimorbidity among older adults in rural Nepal and examine the associated socioeconomic and behavioural risk factors.DesignThis was a community-based cross-sectional study conducted between January and April 2018.SettingRural municipalities of Sunsari and Morang districts in eastern Nepal.Participants794 older Nepalese adults, 60 years and older, were recruited using a multistage cluster sampling approach.Primary outcome measure(s)Prevalence of four major non-communicable chronic conditions (osteoarthritis, cardiovascular disease, diabetes and chronic obstructive pulmonary disease (COPD) and multimorbidity.ResultsAlmost half (48.9%: men 45.3%; women 52.4%) of the participants had at least one of four non-communicable chronic conditions, and 14.6% (men 12.5%; women 16.8%) had two or more conditions. The prevalence of individual conditions included: osteoarthritis—41.7% (men 37.5%; women 45.9%), cardiovascular disease—2.4% (men 2.8%; women 2.0%), diabetes—5.3% (men 6.0%; women 4.6%) and COPD—15.4% (men 13.3%; women 17.5%). In the adjusted model, older adults aged 70–79 years (adjusted OR (AOR): 1.62; 95% CI: 1.04 to 2.54), those from Madhesi and other ethnic groups (AOR: 1.08; 95% CI: 1.02 to 1.72), without a history of alcohol drinking (AOR: 1.53; 95% CI: 1.18 to 2.01) and those physically inactive (AOR: 5.02; 95% CI: 1.47 to 17.17) had significantly higher odds of multimorbidity.ConclusionsThis study found one in seven study participants had multimorbidity. The prevalence of multimorbidity and associated socioeconomic and behavioural correlates need to be addressed by integrating social programmes with health prevention and management at multiple levels. Moreover, a longitudinal study is suggested to understand the temporal relationship between lifestyle predictors and multimorbidity among older Nepalese adults.

Published
2021

41. A Policy Analysis Regarding Education, Career, and Governance of the Nurses in Bangladesh: A Qualitative Exploration

Author

Taufique Joarder, Md. Aslam Parvage, Syed Masud Ahmed, and Lal B. Rawal

Subjects
Male, Government, Economic growth, Bangladesh, Leadership and Management, business.industry, Corporate governance, Distribution (economics), Nurses, General Medicine, Policy analysis, Issues, ethics and legal aspects, Leadership, Political science, Production (economics), Humans, Female, Nurse education, business, Education, Nursing, Policy Making
Abstract

Nurses, short in production and inequitable in the distribution in Bangladesh, require the government’s efforts to increase enrolment in nursing education and a smooth career progression. Given the importance of an assessment of the current nursing scenario to inform the decision makers and practitioners to implement the new policies successfully, we analyzed relevant policies on education, career, and governance of nurses in Bangladesh. We used documents review and qualitative methods such as key informant interviews ( n = 13) and stakeholder analysis. We found that nursing education faced several backlashes: resistance from diploma nurses while attempting to establish a graduate (bachelor) course in 1977, and the reluctance of politicians and entrepreneurs to establish nursing institutions. Many challenges with the implementation of nursing policies are attributable to social, cultural, religious, and historical factors. For example, Hindus considered touching the bodily excretions as the task of the lower castes, while Muslims considered women touching the body of the men immoral. Nurses also face governance challenges linked with their performance and reward. For example, nurses have little voice over the decisions related to their profession, and they are not allowed to perform clinical duties unsupervised. To improve the situation, the government has made new policies, including upliftment of nurses’ position in public service, the creation of an independent Directorate General, and improvement of nursing education and service. New policies often come with new apprehensions. Therefore, nurses should be included in the policy processes, and their capacity should be developed in nursing leadership and health system governance.

Published
2021

42. Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study

Author

Om Prakash Yadav, Lal B. Rawal, Arm Mehrab Ali, Uday Narayan Yadav, Sabuj Kanti Mistry, Devendra Raj Singh, Man Kumar Tamang, Binod Rayamajhee, Suresh Mehta, and Saruna Ghimire

Subjects
Male, Viral Diseases, Cross-sectional study, Epidemiology, Emotions, Ethnic group, Social Sciences, Logistic regression, Health Services Accessibility, Geographical Locations, 0302 clinical medicine, Medical Conditions, Elderly, Health facility, Pandemic, Medicine and Health Sciences, Medicine, Psychology, 030212 general & internal medicine, Aged, 80 and over, Multidisciplinary, Fear, Middle Aged, Infectious Diseases, Scale (social sciences), Preparedness, Acute Disease, Female, Research Article, Asia, Science, Ethnic Epidemiology, 03 medical and health sciences, Nepal, Mental Health and Psychiatry, Humans, Adults, Pandemics, Aged, business.industry, SARS-CoV-2, COVID-19, Biology and Life Sciences, Covid 19, Mental health, 030227 psychiatry, Health Care, Cross-Sectional Studies, Logistic Models, Age Groups, Health Care Facilities, People and Places, Population Groupings, business, Stress, Psychological, Demography
Abstract

Background Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal. Methods A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear. Results The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear. Conclusion Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.

Published
2021

43. Factors associated with low adherence to medication among patients with type 2 diabetes at different healthcare facilities in southern Bangladesh

Author

Md. Mashud Rana, Nowshad Asgar Chowdhury, Lal B. Rawal, Farhana Akter, Md. Mahbub Hasan, Tuhin Biswas, and Adnan Mannan

Subjects
Male, medicine.medical_specialty, Type 2 diabetes, Family income, Logistic regression, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Health care, medicine, Humans, 030212 general & internal medicine, diabetic ulcer, Medication adherence, Bangladesh, jennifer stewart williams, umeå university, sweden, business.industry, 030503 health policy & services, Health Policy, Public health, Public Health, Environmental and Occupational Health, medicine.disease, Obesity, Chittagong, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Population study, Original Article, type 2 diabetes, Health Facilities, Public aspects of medicine, RA1-1270, 0305 other medical science, business, Research Article, Retinopathy
Abstract

Background: Diabetic individuals must adhere to their medications to control their glucose levels and prevent diabetes-related complications. However, there is limited evidence of medication adherence in patients with type 2 diabetes in Bangladesh. Objectives: We assessed the level of adherence and factors associated with low adherence to anti-diabetic medication among patients with type 2 diabetes at different health facilities in southern Bangladesh. Methods: This cross-sectional study included 2,070 patients with type 2 diabetes who presented at five health facilities in the Chittagong Division between November 2018 and June 2019. We assessed medication adherence using a self-reported, structured, eight-item questionnaire and performed multiple logistic regression to investigate the factors associated with low medication adherence. Results: The overall prevalence of low medication adherence was 46.3% (95% CI: 41.4–55.8%) of our study population. Multiple logistic regression analysis revealed that males (OR: 1.37; 95% CI: 1.13–1.67), those with a family income of < 233 USD (OR: 1.54, 95% CI: 1.17–2.03), and those with a diabetic ulcer (OR: 1.42, 95% CI: 1.04–1.94) showed low adherence. Diabetic ulcers, retinopathy, and obesity were relatively more elevated among diabetic patients with low medication adherence. Conclusion: Low medication adherence among patients with type 2 diabetes in southern Bangladesh is a key public health challenge. Factors such as male sex, low annual family income, and diabetic ulcers were associated with low medication adherence. Patient counseling and awareness programs may enhance medication adherence among people with type 2 diabetes. Our findings will help physicians and public health workers to develop targeted strategies to increase awareness of the same among their patients.

Published
2021
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44. Recognizing the roles of primary health care in addressing non-communicable diseases in low- and middle-income countries: Lesson from COVID-19, implications for the future

Author

Mark Harris, Lal B. Rawal, Uday Narayan Yadav, Ben Harris-Roxas, Carmen Huckel Schneider, Saruna Ghimire, Shambhu Acharya, and Sabuj Kanti Mistry

Subjects
Primary Health Care, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, Health Policy, Public Health, Environmental and Occupational Health, Primary health care, COVID-19, Viewpoints, Coronavirus, Low and middle income countries, Environmental health, Humans, Business, Noncommunicable Diseases, Developing Countries
Published
2021

45. Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990–2050

Author

Junaid Khan, Blake Angell, Marcel Ausloos, Catherine M. Antony, Elham Ehsani-Chimeh, Edgar Denova-Gutiérrez, Kewal Krishan, Mohamed Kamal Mesregah, Arrigo Francesco Giuseppe Cicero, Simona Cătălina Ştefan, Tanuj Kanchan, Maysaa El Sayed Zaki, Mohamed I Hegazy, Richard James Maude, Salman Rawaf, Viktória Szerencsés, Milena Santric-Milicevic, Martin McKee, Reza Rawassizadeh, Anton C Harle, Neda Milevska Kostova, Hamidreza Pazoki Toroudi, Saravanan Muthupandian, Mohammad Hifz Ur Rahman, Hassan Abolhassani, Christine Mpundu-Kaambwa, Atta Abbas Naqvi, John Dube, Habib Benzian, Cristiano Piccinelli, Kedir Hussein Abegaz, Mohammad Khammarnia, Carlo Eduardo Medina-Solís, Tanvir M. Huda, Fakher Rahim, Modhurima Moitra, Valentin Yurievich Skryabin, Emily Joy Callander, David Laith Rawaf, Saeed Shahabi, Mohsen Bayati, Raffaele Palladino, Shahin Soltani, Mohammad Ali Mansournia, Rafael Lozano, Himal Kandel, João Vasco Santos, MA Garcia-Gordillo, Savita Lasrado, Alexey V Breusov, Nicola Luigi Bragazzi, Deepak Dhamnetiya, Mohammad Amin Bahrami, Teroj Abdulrahman Mohamed, Reinhard Busse, Veer Bala Gupta, Ionut Negoi, Xiaochen Dai, Eun-Cheol Park, Trang Huyen Nguyen, Gulrez Shah Azhar, Annie Haakenstad, Asadollah Gholamian, Vafa Rahimi-Movaghar, Subramanian Senthilkumaran, Ismaeel Yunusa, Hubert Amu, G. K. Mini, Francesco Saverio Violante, Michael Abdelmasseh, Yun Jin Kim, Yousef Moradi, Nataliya Foigt, Afshin Maleki, Pavanchand H Shetty, Mesfin Agachew Woldekidan, Ramesh Holla, Mina Anjomshoa, Seyyed Meysam Mousavi, Azeem Majeed, Bright Opoku Ahinkorah, Hassan Magdy Abd El Razek, Avirup Guha, Telma Zahirian Moghadam, Olayinka Stephen Ilesanmi, Alessandro Arrigo, Neda Kianipour, Marcos Roberto Tovani-Palone, Mosiur Rahman, Tomas Y Ferede, Catalina Liliana Andrei, Alaa Makki, Joseph L Dieleman, Shuhei Nomura, Kanwar Hamza Shuja, Ileana Heredia-Pi, Mukhammad David Naimzada, Ali Kazemi Karyani, Chisom Joyqueenet Akunna, Souranshu Chatterjee, Yonas Akalu, Hanadi Al Hamad, Abdollah Mohammadian-Hafshejani, Hayley N Stutzman, Getinet Ayano, Atte Meretoja, Fahad Alanezi, Aravind Thavamani, Sonu Bhaskar, Claudiu Herteliu, Andreea Mirica, Masood Ali Shaikh, Soewarta Kosen, Nelson J. Alvis-Zakzuk, Emma Elizabeth Spurlock, Ferrán Catalá-López, Samath D Dharmaratne, Stany W. Lobo, Alemayehu Hailu, Sebastian Vollmer, Tarik Ahmed Rashid, Sheikh Mohammed Shariful Islam, Lalit Dandona, Farahnaz Joukar, Jacob Olusegun Olusanya, Befikadu Legesse Wubishet, Sezer Kisa, Songhomitra Panda-Jonas, Nasir Umar, Adrian Otoiu, Yonas Getaye Tefera, Harapan Harapan, Ivo Iavicoli, Jakub Morze, Mihajlo Jakovljevic, Nicholas J K Breitborde, Ian E Cogswell, Mehdi Hosseinzadeh, Sadia Bibi, Stefan Kohler, Florian Fischer, Jagdish Khubchandani, Justice Nonvignon, Salah Eddin Karimi, Yousef Khader, Jan-Walter De Neve, Stanislav S. Otstavnov, Ruoyan Tobe-Gai, Tommi Vasankari, Carlos A Castañeda-Orjuela, Nahlah Elkudssiah Ismail, Khezar Hayat, Chythra R Rao, Priya Rathi, Asma Tahir Awan, Jean Jacques Noubiap, Salime Goharinezhad, Ai Koyanagi, Rafael Tabarés-Seisdedos, Angela E Micah, Rakhi Dandona, Jaykaran Charan, Lorainne Tudor Car, Michael R.M. Abrigo, Kenji Shibuya, Aziz Sheikh, B Reshmi, Rovshan Khalilov, Haroon Ahmed, Andrea Werdecker, Alberto Freitas, Tara Ballav Adhikari, Vasily Vlassov, Risky Kusuma Hartono, Leila Keikavoosi-Arani, Gyu Ri Kim, Ana Laura Manda, Carlos Alberto Marrugo Arnedo, Obinna Onwujekwe, Van C. Lansingh, Miklós Szócska, Gelin Xu, Ted R. Miller, Saad M.A. Dahlawi, Till Bärnighausen, Jagadish Rao Padubidri, Bernhard T. Baune, Fatemeh Pashazadeh Kan, Juan Sanabria, Bruno Ramos Nascimento, Stefano Olgiati, Navid Rabiee, Mark G. Shrime, Mayowa O. Owolabi, V. E. Nwatah, Tesleem Kayode Babalola, Ranil Jayawardena, Robert Kaba Alhassan, Takeshi Fukumoto, Lucero Cahuana-Hurtado, Aparna Ichalangod Narayana, Mohammad Ali Sahraian, Atif Amin Baig, Carl Abelardo T. Antonio, Jost B. Jonas, Dian Kusuma, Priyanga Ranasinghe, Mikhail Sergeevich Zastrozhin, Ali Bijani, Arash Ziapour, Seyed Behzad Jazayeri, Francesco Sanmarchi, Seyed Sina Naghibi Irvani, Allen Seylani, Theo Vos, Tuomo J. Meretoja, Delia Hendrie, Mostafa Amini-Rarani, Manthan D Janodia, Sathish Kumar Jayapal, Sorin Hostiuc, Marjan Ajami, Ali Gholamrezanezhad, Muhammad Aqeel, Muhammed Magdy Abd El Razek, Shaun Wen Huey Lee, Rawlance Ndejjo, Maarten J. Postma, Luis Camera, Chhabi Lal Ranabhat, Sadaf G. Sepanlou, Adnan Kisa, Tahira Ashraf, Tudorel Andrei, Mohammad Ali Jahani, Virginia Bodolica, Chuanhua Yu, Moses K. Muriithi, Pascual R. Valdez, Paul S. F. Yip, Demetris Lamnisos, Amir Masoud Rahmani, Hamed Zandian, Anna Aleksandrovna Skryabina, Yeong Yeh Lee, Sana Salehi, Syed Mohamed Aljunid, Kyle E. Simpson, Sami Almustanyir Almustanyir, Bogdan Oancea, Biswa Prakash Nayak, Omid Dadras, Fariborz Mansour-Ghanaei, Turki Alanzi, Mahaveer Golechha, Bach Xuan Tran, Lal B. Rawal, Shoaib Hassan, Rahul R. Zende, Sandhya Neupane Kandel, Martin Amogre Ayanore, Adam E. Berman, Long Khanh Dao Le, Dragos Virgil Davitoiu, Adithi Shetty, Getinet Kassahun, Birhanu Wubale Yirdaw, Usha Ram, Linh Gia Vu, Emilie R Maddison, Yosef Alemayehu, Ali H. Mokdad, Tomislav Mestrovic, Mavra A Riaz, Muhammad Naveed, Koustuv Dalal, Syed Amir Gilani, Reza Malekzadeh, Nikha Bhardwaj, Desta Debalkie Atnafu, Rohollah Kalhor, Naohiro Yonemoto, Ahmad Ghashghaee, Andre M. N. Renzaho, Amadou Barrow, Christopher J L Murray, Budi Aji, Maitreyi Sahu, Sara D Friedman, Konrad Pesudovs, Robert Reiner, Mohammad Rifat Haider, Mustafa Z. Younis, Aidin Abedi, Sanjay Basu, Nancy Fullman, Darrah McCracken, Rajasekaran Koteeswaran, Falk Schwendicke, Ionela-Roxana Glavan, Mohamed H Hassanein, Sindhura Lakshmi Koulmane Laxminarayana, Javad Nazari, Khurshid Alam, Bulat Idrisov, Nelson Alvis-Guzman, Mokhtar Mohammadi, Golnaz Heidari, Asif Hanif, Ghozali Ghozali, Vijay Kumar Chattu, Leila Doshmangir, Simiao Chen, Maha El Tantawi, Stephen S Lim, Bay Vo, Deepak Saxena, Jasvinder A. Singh, Robert Ancuceanu, Yves Miel H Zuniga, Kamal Hezam, Andrew T Olagunju, Sheikh Jamal Hossain, Lindsey E Wallace, Dejana Braithwaite, Sergio I. Prada, Adolfo Martinez-Valle, Brandon Cunningham, Vivek Gupta, Joseph Salama, Rezaul Karim Ripon, Bing-Fang Hwang, Mokhtar Mahdavi, Tamás Joó, Cristiana Abbafati, Behzad Karami Matin, Tushar Garg, Cyrus Alinia, Yingxi Zhao, Richard G. Wamai, Satoshi Ezoe, Anders Larsson, Seyedeh Zahra Masoumi, Arokiasamy Perianayagam, Sharareh Eskandarieh, Maciej Banach, Billingsley Kaambwa, Nader Jahanmehr, Saeed Amini, Foluke Adetola Ojelabi, Nikolay Ivanovich Briko, Samer Hamidi, Gaetano Isola, Tahereh Javaheri, Gbenga A. Kayode, Nikita Otstavnov, Vahid Yazdi-Feyzabadi, David M. Pereira, Mansour Ghafourifard, Saira Afzal, Ravi Prakash Jha, Erkin M. Mirrakhimov, Ahamarshan Jayaraman Nagarajan, Giang Thu Vu, G Anil Kumar, Vahit Yigit, Farshad Farzadfar, Anasthasia Zastrozhina, Shafiu Mohammed, Leticia Avila-Burgos, Nastaran Barati, Morteza Arab-Zozani, Eduardo A. Undurraga, Muktar Beshir Ahmed, Mohamed M. Gad, Mikk Jürisson, Himanshu Khajuria, Anas M. Saad, Mohammad Rabiee, Abdallah M. Samy, Srinivas Goli, Roman Topor-Madry, Golsum Tsakalos, Mariam Molokhia, Biruk Wogayehu Taddele, Mohammad Ali Moni, E S Abhilash, Timur Aripov, Sepideh Ahmadi, Mehdi Sayyah, Jorge Hugo Villafañe, Peter Andras Gaal, Babayemi O Olakunde, Brijesh Sathian, Anayat Ullah, Ritesh G. Menezes, Samad Azari, Ahmed I. Hasaballah, Soosanna Kumary Chattu, Pankaj Bhardwaj, Sanni Yaya, Zhi-Jiang Zhang, Jalal Arabloo, Saif Ullah, Akshaya Srikanth Bhagavathula, Bahram Mohajer, Ekaterina Vladimirovna Glushkova, Vinay Nangia, Shrikant Pawar, Moslem Soofi, Antonio Reis de Sá-Junior, Simon I. Hay, Miloje Savic, 2. Global Burden of Disease 2020 Health Financing Collaborator Network, Cicero AFG, Network, Global Burden of Disease 2020 Health Financing Collaborator, Bill & Melinda Gates Foundation, Micah, A. E., Cogswell, I. E., Cunningham, B., Ezoe, S., Harle, A. C., Maddison, E. R., Mccracken, D., Nomura, S., Simpson, K. E., Stutzman, H. N., Tsakalos, G., Wallace, L. E., Zhao, Y., Zende, R. R., Abbafati, C., Abdelmasseh, M., Abedi, A., Abegaz, K. H., Abhilash, E. S., Abolhassani, H., Abrigo, M. R. M., Adhikari, T. B., Afzal, S., Ahinkorah, B. O., Ahmadi, S., Ahmed, H., Ahmed, M. B., Ahmed Rashid, T., Ajami, M., Aji, B., Akalu, Y., Akunna, C. J., Al Hamad, H., Alam, K., Alanezi, F. M., Alanzi, T. M., Alemayehu, Y., Alhassan, R. K., Alinia, C., Aljunid, S. M., Almustanyir, S. A., Alvis-Guzman, N., Alvis-Zakzuk, N. J., Amini, S., Amini-Rarani, M., Amu, H., Ancuceanu, R., Andrei, C. L., Andrei, T., Angell, B., Anjomshoa, M., Antonio, C. A. T., Antony, C. M., Aqeel, M., Arabloo, J., Arab-Zozani, M., Aripov, T., Arrigo, A., Ashraf, T., Atnafu, D. D., Ausloos, M., Avila-Burgos, L., Awan, A. T., Ayano, G., Ayanore, M. A., Azari, S., Azhar, G. S., Babalola, T. K., Bahrami, M. A., Baig, A. A., Banach, M., Barati, N., Barnighausen, T. W., Barrow, A., Basu, S., Baune, B. T., Bayati, M., Benzian, H., Berman, A. E., Bhagavathula, A. S., Bhardwaj, N., Bhardwaj, P., Bhaskar, S., Bibi, S., Bijani, A., Bodolica, V., Bragazzi, N. L., Braithwaite, D., Breitborde, N. J. K., Breusov, A. V., Briko, N. I., Busse, R., Cahuana-Hurtado, L., Callander, E. J., Camera, L. A., Castaneda-Orjuela, C. A., Catala-Lopez, F., Charan, J., Chatterjee, S., Chattu, S. K., Chattu, V. K., Chen, S., Cicero, A. F. G., Dadras, O., Dahlawi, S. M. A., Dai, X., Dalal, K., Dandona, L., Dandona, R., Davitoiu, D. V., De Neve, J. -W., de Sa-Junior, A. R., Denova-Gutierrez, E., Dhamnetiya, D., Dharmaratne, S. D., Doshmangir, L., Dube, J., Ehsani-Chimeh, E., El Sayed Zaki, M., El Tantawi, M., Eskandarieh, S., Farzadfar, F., Ferede, T. Y., Fischer, F., Foigt, N. A., Freitas, A., Friedman, S. D., Fukumoto, T., Fullman, N., Gaal, P. A., Gad, M. M., Garcia-Gordillo, M. A., Garg, T., Ghafourifard, M., Ghashghaee, A., Gholamian, A., Gholamrezanezhad, A., Ghozali, G., Gilani, S. A., Glavan, I. -R., Glushkova, E. V., Goharinezhad, S., Golechha, M., Goli, S., Guha, A., Gupta, V. B., Gupta, V. K., Haakenstad, A., Haider, M. R., Hailu, A., Hamidi, S., Hanif, A., Harapan, H., Hartono, R. K., Hasaballah, A. I., Hassan, S., Hassanein, M. H., Hayat, K., Hegazy, M. I., Heidari, G., Hendrie, D., Heredia-Pi, I., Herteliu, C., Hezam, K., Holla, R., Hossain, S. J., Hosseinzadeh, M., Hostiuc, S., Huda, T. M., Hwang, B. -F., Iavicoli, I., Idrisov, B., Ilesanmi, O. S., Irvani, S. S. N., Islam, S. M. S., Ismail, N. E., Isola, G., Jahani, M. A., Jahanmehr, N., Jakovljevic, M., Janodia, M. D., Javaheri, T., Jayapal, S. K., Jayawardena, R., Jazayeri, S. B., Jha, R. P., Jonas, J. B., Joo, T., Joukar, F., Jurisson, M., Kaambwa, B., Kalhor, R., Kanchan, T., Kandel, H., Karami Matin, B., Karimi, S. E., Kassahun, G., Kayode, G. A., Kazemi Karyani, A., Keikavoosi-Arani, L., Khader, Y. S., Khajuria, H., Khalilov, R., Khammarnia, M., Khan, J., Khubchandani, J., Kianipour, N., Kim, G. R., Kim, Y. J., Kisa, A., Kisa, S., Kohler, S., Kosen, S., Koteeswaran, R., Koulmane Laxminarayana, S. L., Koyanagi, A., Krishan, K., Kumar, G. A., Kusuma, D., Lamnisos, D., Lansingh, V. C., Larsson, A. O., Lasrado, S., Le, L. K. D., Lee, S. W. H., Lee, Y. Y., Lim, S. S., Lobo, S. W., Lozano, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Mahdavi, M. M., Majeed, A., Makki, A., Maleki, A., Malekzadeh, R., Manda, A. L., Mansour-Ghanaei, F., Mansournia, M. A., Marrugo Arnedo, C. A., Martinez-Valle, A., Masoumi, S. Z., Maude, R. J., Mckee, M., Medina-Solis, C. E., Menezes, R. G., Meretoja, A., Meretoja, T. J., Mesregah, M. K., Mestrovic, T., Milevska Kostova, N., Miller, T. R., Mini, G. K., Mirica, A., Mirrakhimov, E. M., Mohajer, B., Mohamed, T. A., Mohammadi, M., Mohammadian-Hafshejani, A., Mohammed, S., Moitra, M., Mokdad, A. H., Molokhia, M., Moni, M. A., Moradi, Y., Morze, J., Mousavi, S. M., Mpundu-Kaambwa, C., Muriithi, M. K., Muthupandian, S., Nagarajan, A. J., Naimzada, M. D., Nangia, V., Naqvi, A. A., Narayana, A. I., Nascimento, B. R., Naveed, M., Nayak, B. P., Nazari, J., Ndejjo, R., Negoi, I., Neupane Kandel, S., Nguyen, T. H., Nonvignon, J., Noubiap, J. J., Nwatah, V. E., Oancea, B., Ojelabi, F. A. O., Olagunju, A. T., Olakunde, B. O., Olgiati, S., Olusanya, J. O., Onwujekwe, O. E., Otoiu, A., Otstavnov, N., Otstavnov, S. S., Owolabi, M. O., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Park, E. -C., Pashazadeh Kan, F., Pawar, S., Pazoki Toroudi, H., Pereira, D. M., Perianayagam, A., Pesudovs, K., Piccinelli, C., Postma, M. J., Prada, S. I., Rabiee, M., Rabiee, N., Rahim, F., Rahimi-Movaghar, V., Rahman, M. H. U., Rahman, M., Rahmani, A. M., Ram, U., Ranabhat, C. L., Ranasinghe, P., Rao, C. R., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Reiner Jr, R. C., Renzaho, A. M. N., Reshmi, B., Riaz, M. A., Ripon, R. K., Saad, A. M., Sahraian, M. A., Sahu, M., Salama, J. S., Salehi, S., Samy, A. M., Sanabria, J., Sanmarchi, F., Santos, J. V., Santric-Milicevic, M. M., Sathian, B., Savic, M., Saxena, D., Sayyah, M., Schwendicke, F., Senthilkumaran, S., Sepanlou, S. G., Seylani, A., Shahabi, S., Shaikh, M. A., Sheikh, A., Shetty, A., Shetty, P. H., Shibuya, K., Shrime, M. G., Shuja, K. H., Singh, J. A., Skryabin, V. Y., Skryabina, A. A., Soltani, S., Soofi, M., Spurlock, E. E., Stefan, S. C., Szerencses, V., Szocska, M., Tabares-Seisdedos, R., Taddele, B. W., Tefera, Y. G., Thavamani, A., Tobe-Gai, R., Topor-Madry, R., Tovani-Palone, M. R., Tran, B. X., Tudor Car, L., Ullah, A., Ullah, S., Umar, N., Undurraga, E. A., Valdez, P. R., Vasankari, T. J., Villafane, J. H., Violante, F. S., Vlassov, V., Vo, B., Vollmer, S., Vos, T., Vu, G. T., Vu, L. G., Wamai, R. G., Werdecker, A., Woldekidan, M. A., Wubishet, B. L., Xu, G., Yaya, S., Yazdi-Feyzabadi, V., Yigit, V., Yip, P., Yirdaw, B. W., Yonemoto, N., Younis, M. Z., Yu, C., Yunusa, I., Zahirian Moghadam, T., Zandian, H., Zastrozhin, M. S., Zastrozhina, A., Zhang, Z. -J., Ziapour, A., Zuniga, Y. M. H., Hay, S. I., Murray, C. J. L., and Dieleman, J. L.

Subjects
Economic growth, Financing, Government, International Cooperation, HN, HM, Global Health, Gross domestic product, International Agencies/economics, 0302 clinical medicine, RA0421, Per capita, Global health, Healthcare Financing, 11 Medical and Health Sciences, 2. Zero hunger, COVID 19, develompment assistance, health financing, projection 1995-250, INCOME, COVID-19, Development assistance, Health financing, COVID-19/economics, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, Articles, General Medicine, 3. Good health, Government Programs, Health Expenditures/statistics & numerical data, 030220 oncology & carcinogenesis, Transparency (graphic), QR180, Economic Development, International development, Life Sciences & Biomedicine, medicine.medical_specialty, Government Programs/economics, Gross Domestic Product, Context (language use), 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, medicine, Humans, Developing Countries/economics, Developing Countries, Government, Science & Technology, Public health, COVID-19, development assistance, global health, Global Burden of Disease 2020 Health Financing Collaborator Network, International Agencies, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Business, Global Health/economics, Health Expenditures, 030217 neurology & neurosurgery, RC, Financing, Government/economics
Abstract

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(21)01258-7

Published
2021
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46. Factors influencing place of delivery: Evidence from three south-Asian countries

Author

Abdur Rahman, Mohan Paudel, Md. Sazedur Rahman, Lal B. Rawal, Apurbo Sarkar, Md. Ashfikur Rahman, Sheikh Mohammed Shariful Islam, Tanjim Siddiquee, Muhammad Aziz Rahman, Md. Hasan Howlader, Bayezid Khan, and Roslin Botlero

Subjects
Rural Population, Urban Population, Maternal Health, Social Sciences, Health Services Accessibility, Geographical Locations, Labor and Delivery, Cognition, Health facility, Sociology, Pregnancy, Health care, Medicine and Health Sciences, Economic Status, Psychology, Pakistan, Geographic Areas, Uncategorized, Bangladesh, Multidisciplinary, Geography, Obstetrics and Gynecology, Prenatal Care, Professions, Maternal Mortality, Educational Status, Medicine, Female, Research Article, Adult, medicine.medical_specialty, Asia, Science, Decision Making, Education, Nepal, Antenatal Care, Environmental health, medicine, Humans, Socioeconomic status, Educational Attainment, business.industry, Public health, Cognitive Psychology, Biology and Life Sciences, medicine.disease, Delivery, Obstetric, Educational attainment, Rural Areas, Local community, Health Care, Socioeconomic Factors, Health Care Facilities, People and Places, Maternal Death, Birth, Earth Sciences, Women's Health, Cognitive Science, Population Groupings, Health Facilities, Rural area, business, Neuroscience
Abstract

Background High maternal mortality is still a significant public health challenge in many countries of the South-Asian region. The majority of maternal deaths occur due to pregnancy and delivery-related complications, which can mostly be prevented by safe facility delivery. Due to the paucity of existing evidence, our study aimed to examine the factors associated with place of delivery, including women’s preferences for such in three selected South-Asian countries. Methods We extracted data from the most recent demographic and health surveys (DHS) conducted in Bangladesh (2014), Nepal (2016), and Pakistan (2017–18) and analyzed to identify the association between the outcome variable and socio-demographic characteristics. A total of 16,429 women from Bangladesh (4278; mean age 24.57 years), Nepal (3962; mean age 26.35 years), and Pakistan (8189; mean age 29.57 years) were included in this study. Following descriptive analyses, bivariate and multivariate logistic regressions were conducted. Results Overall, the prevalence of facility-based delivery was 40%, 62%, and 69% in Bangladesh, Nepal, and Pakistan, respectively. Inequity in utilizing facility-based delivery was observed for women in the highest wealth quintile. Participants from Urban areas, educated, middle and upper household economic status, and with high antenatal care (ANC) visits were significantly associated with facility-based delivery in all three countries. Interestingly, watching TV was also found as a strong determinant for facility-based delivery in Bangladesh (aOR = 1.31, 95% CI:1.09–1.56, P = 0.003), Nepal (aOR = 1.42, 95% CI:1.20–1.67, P Conclusion Our findings suggest that the educational status of both women and their husbands, household economic situation, and the number of ANC visits influenced the place of delivery. There is an urgent need to promote facility delivery by building more birthing facilities, training and deployment of skilled birth attendants in rural and hard-to-reach areas, ensuring compulsory female education for all women, encouraging more ANC visits, and providing financial incentives for facility deliveries. There is a need to promote facility delivery by encouraging health facility visits through utilizing social networks and continuing mass media campaigns. Ensuring adequate Government funding for free maternal and newborn health care and local community involvement is crucial for reducing maternal and neonatal mortality and achieving sustainable development goals in this region.

Published
2021

47. Perceived Fear of COVID-19 and its Associated Factors Among Nepalese Older Adults in Eastern Nepal: Findings From a Cross-Sectional Study

Author

Lal B. Rawal, Arm Mehrab Ali, Sabuj Kanti Mistry, Saruna Ghimire, Suresh Mehta, Uday Narayan Yadav, Devendra Raj Singh, Man Kumar Tamang, Binod Rayamajhee, and Om Prakash Yadav

Subjects
Coronavirus disease 2019 (COVID-19), business.industry, Cross-sectional study, Environmental health, Medicine, business
Abstract

BackgroundCoronavirus disease 2019 (COVID-19) has impacted all age groups, but older adults may have greater distress given their increased risk for severe illness and mortality. In Nepal, most stories of older adults are untold ̶ both in pre-COVID-19 and the COVID-19 era. In this study, we aimed to assess the perceived fear of COVID-19, and associated factors, among older adults in eastern Nepal.MethodsA cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). In order to examine the factors associated with the COVID 19 fear, a generalized estimating equation, adjusting the sampling design was used. STATA 15 and JASP 0.13.1 were used for data analyses.ResultsThe mean score of the FCV-19S was 18.1±5.2, and a sizeable proportion of participants, ranging between 12%-34%, agreed to the seven items of the fear scale. Increasing age, Dalit ethnicity remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. Surprisingly, pre-existing health conditions were inversely associated with fear of COVID-19.ConclusionGreater fear of the COVID-19 pandemic among the older population suggests that during unprecedented times such as the current pandemic, the psychological needs of most vulnerable groups should be prioritized. Fear among the most vulnerable groups could be reduced with the flow of adequate genuine information as well as better preparedness and psychosocial interventions.

Published
2020
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48. Community health workers for non-communicable disease prevention and control in Nepal: a qualitative study

Author

Abu S. Abdullah, Tuhin Biswas, Lal B. Rawal, Sushil Baral, Corneel Vandelanotte, Kie Kanda, Uday Narayan Yadav, and Chandani Kharel

Subjects
medicine.medical_specialty, Referral, health services administration & management, Global Health, Grounded theory, Nursing, Nepal, Medicine, Humans, Noncommunicable Diseases, Health policy, Qualitative Research, Community Health Workers, Primary Health Care, business.industry, Public health, public health, health policy, General Medicine, Non-communicable disease, medicine.disease, Focus group, Health education, business, Qualitative research
Abstract

Background/objectiveThe increasing burden of non-communicable diseases (NCDs) in Nepal underscores the importance of strengthening primary healthcare systems to deliver efficient care. In this study, we examined the barriers and facilitators to engaging community health workers (CHWs) for NCDs prevention and control in Nepal.DesignWe used multiple approaches including (a) review of relevant literature, (b) key personnel and stakeholders’ consultation meetings and (c) qualitative data collection using semistructured interviews. A grounded theory approach was used for qualitative data collection and the data were analysed thematically.SettingData were collected from health facilities across four districts in Nepal and two stakeholder consultative meetings were conducted at central level.ParticipantsWe conducted in-depth interviews with CHWs (Health Assistants, Auxiliary Health Workers, Auxiliary Nurse Midwife) (n=5); key informant interviews with health policymakers/managers (n=3) and focus group discussions (FGDs) with CHWs (four FGDs; total n=27). Participants in two stakeholder consultative meetings included members from the government (n=8), non-government organisations (n=7), private sector (n=3) and universities (n=6).ResultsThe CHWs were engaged in a wide range of public health programmes and they also deliver NCDs specific programmes such as common NCDs screening, provisional diagnosis, primary care, health education and counselling, basic medication and referral and so on. These NCD prevention and control services are concentrated in those districts, where the WHO, Package for prevention and control of NCDs) program is being implemented. Some challenges and barriers were identified, including inadequate NCD training, high workload, poor system-level support, inadequate remuneration, inadequate supply of logistics and drugs. The facilitating factors included government priority, formation of NCD-related policies, community support systems, social prestige and staff motivation.ConclusionEngaging CHWs has been considered as key driver to delivering NCDs related services in Nepal. Effective integration of CHWs within the primary care system is essential for CHW’s capacity buildings, necessary supervisory arrangements, supply of logistics and medications and setting up effective recording and reporting systems for prevention and control of NCDs in Nepal.

Published
2020

49. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Author

Soufiane Boufous, Yousef Veisani, Mehran Asadi-Aliabadi, Sharath Burugina Nagaraja, Maziar Moradi-Lakeh, Getachew Mullu Kassa, Edward J Mills, Dimas Ria Angga Pribadi, William James Dangel, Mohamad-Hani Temsah, Catherine O. Johnson, Gregory A. Roth, Giuseppe Gorini, Fariborz Mansour-Ghanaei, Alberto Ortiz, Samad Azari, Assefa Ayalew Ayalew Ayalew Gebreslassie, Salime Goharinezhad, Stephanie R. M. Zimsen, Peng Zheng, Michael Assmus, Elisabetta Pupillo, Bach Xuan Tran, Lal B. Rawal, Narayanaswamy Venketasubramanian, Noushin Mohammadifard, Stephen S Lim, Ata Rafiee, Maria Inês Schmidt, Vincent C. Iannucci, Suzanne Lyn Barker-Collo, Leah E. Cahill, Tauseef Ahmad, Platon D. Lopukhov, Kazumasa Yamagishi, Abdullah Al Mamun, Iqbal R. F. Elyazar, Giovanni Damiani, Mohammad Hossein Bakhshaei, Mehdi Fazlzadeh, Virginia Núñez-Samudio, Alyssa Pennini, Dietrich Plass, Atkilt Esaiyas Etisso, Gebre Teklemariam Demoz, Alexandrea Watson, Arvin Haj-Mirzaian, Paul S Briant, Frank B. Osei, Blair R. Bumgarner, Maciej Banach, Ravensara S. Travillian, Kai-Lan Chang, Shirin Djalalinia, Hasan Yusefzadeh, Silvano Gallus, Seyyed Meysam Mousavi, Bernhard T. Baune, Aaron van Donkelaar, Azeem Majeed, Hans Kromhout, Robert Ancuceanu, Blessing J. Akombi, Pushpendra Singh, Nayu Ikeda, William M. Gardner, Zahid A Butt, Mohammad Abdollahi, Temesgen Yihunie Akalu, Rahman Shiri, Benn Sartorius, Ai-Min Wu, Bing Fang Hwang, Flavia M. Cicuttini, Hiroyasu Iso, Luis Camera, Amin Soheili, Félix Carvalho, Yun Jin Kim, Caleb Mackay Salpeter Irvine, Mehdi Mirzaei-Alavijeh, Iman Halvaei, Saqib Ali, Giulio Castelpietra, Catalina Liliana Andrei, Ali Kazemi Karyani, Parkes J Kendrick, Hamidreza Haririan, Lucas Guimarães Abreu, Mukhammad David Naimzada, Jeff T. Zhao, Samiah Alam, Sorin Hostiuc, Shaun Wen Huey Lee, João Mauricio Castaldelli-Maia, Behzad Karami Matin, Cyrus Alinia, Takahiro Tabuchi, Manu Raj Mathur, Søren Thorgaard Skou, Thomas Khaled Dwayne Classen, Reza Heidari-Soureshjani, Massimo Cirillo, Nikita Otstavnov, Mehdi Bohluli, Ruth W. Kimokoti, Animut Tagele Tamiru, Masoumeh Sadeghi, Mohammad Ali Jahani, Itamar S. Santos, Mekdes Tigistu Yilma, Lars Johansson, Arielle Wilder Eagan, Nevine El Nahas, Silvia Schiavolin, Kevin D. Shield, Dinh-Toi Chu, Shiva Borzouei, Paul S. F. Yip, Beatrix Haddock, Gianfranco Alicandro, Vasily Vlassov, Deanna Anderlini, Giuseppe Remuzzi, Khalid A Altirkawi, Farahnaz Joukar, Aso Mohammad Darwesh, Ratilal Lalloo, Panniyammakal Jeemon, Rohollah Kalhor, Daniel Youngwhan Cho, Weijia Fu, João Pedro Silva, Rodrigo Sarmiento-Suarez, Seth Christopher Yaw Appiah, Mehdi Ahmadi, Jacob Olusegun Olusanya, José Neves, Gaorui Guo, Tomas Y. Yeheyis, John S. Ji, Charles D. H. 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Gad, Kelly Compton, Leila R Kalankesh, Abdelrahman Ibrahim Abushouk, Mikk Jürisson, Catherine M. Antony, Ali A. Asadi-Pooya, Daniel Diaz, Salman Rawaf, Gina Agarwal, Ted R. Miller, Rebecca Ivers, João Vasco Santos, Savita Lasrado, Abdul Moiz Hafiz, Amir Almasi-Hashiani, Praveen Hoogar, Fares Alahdab, Om P Kurmi, Anbissa Muleta Senbeta, Tomi Akinyemiju, Boris Bikbov, Muhammad Aziz Rahman, Amin Mousavi Khaneghah, Yahya Safari, Guilherme Borges, Carlos A Castañeda-Orjuela, Kenji Shibuya, Bahman Yousefi, Berrin Serdar, Karen M. Tabb, Sonali Kochhar, Till Bärnighausen, Kala M. Mehta, Mostafa Dianatinasab, Arash Etemadi, Melissa Y. Wei, Kiana Ramezanzadeh, Lingkan Barua, Zubair Kabir, Rade Vukovic, Hesham M. Al-Mekhlafi, Shoshana H. Ballew, Miriam Levi, Zainab Samad, Florentino Luciano Caetano dos Santos, Juan Sanabria, Ramu Rawat, Chinwe Juliana Iwu, Gabrielle B. Britton, Colm McAlinden, Mohsen Naghavi, Maarten J. Postma, Chhabi Lal Ranabhat, Jalil Jaafari, Walter Mendoza, Mahesh P A, Pallab K. Maulik, Ali H. Mokdad, Andre M. N. Renzaho, Milena Santric-Milicevic, Parvaiz A Koul, Foad Abd-Allah, Mihaela Hostiuc, Richard G. Cowden, Ronny Westerman, Meghdad Pirsaheb, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), Microbes in Health and Disease (MHD), Tampere University, Tays Research Services, Health Sciences, Murray, C. J. L., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., Abd-Allah, F., Abdelalim, A., Abdollahi, M., Abdollahpour, I., Abegaz, K. H., Abolhassani, H., Aboyans, V., Abreu, L. G., Abrigo, M. R. M., Abualhasan, A., Abu-Raddad, L. J., Abushouk, A. I., Adabi, M., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Adham, D., Advani, S. M., Agarwal, G., Aghamir, S. M. K., Agrawal, A., Ahmad, T., Ahmadi, K., Ahmadi, M., Ahmadieh, H., Ahmed, M. B., Akalu, T. Y., Akinyemi, R. O., Akinyemiju, T., Akombi, B., Akunna, C. J., Alahdab, F., Al-Aly, Z., Alam, K., Alam, S., Alam, T., Alanezi, F. M., Alanzi, T. M., Alemu, B. W., Alhabib, K. F., Ali, M., Ali, S., Alicandro, G., Alinia, C., Alipour, V., Alizade, H., Aljunid, S. M., Alla, F., Allebeck, P., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Alonso, J., Altirkawi, K. A., Amini-Rarani, M., Amiri, F., Amugsi, D. A., Ancuceanu, R., Anderlini, D., Anderson, J. A., Andrei, C. L., Andrei, T., Angus, C., Anjomshoa, M., Ansari, F., Ansari-Moghaddam, A., Antonazzo, I. C., Antonio, C. A. T., Antony, C. M., Antriyandarti, E., Anvari, D., Anwer, R., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Ariani, F., Armoon, B., Arnlov, J., Arzani, A., Asadi-Aliabadi, M., Asadi-Pooya, A. A., Ashbaugh, C., Assmus, M., Atafar, Z., Atnafu, D. D., Atout, M. M. W., Ausloos, F., Ausloos, M., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azari, S., Azarian, G., Azene, Z. N., Badawi, A., Badiye, A. D., Bahrami, M. A., Bakhshaei, M. H., Bakhtiari, A., Bakkannavar, S. M., Baldasseroni, A., Ball, K., Ballew, S. H., Balzi, D., Banach, M., Banerjee, S. K., Bante, A. B., Baraki, A. G., Barker-Collo, S. L., Barnighausen, T. W., Barrero, L. H., Barthelemy, C. M., Barua, L., Basu, S., Baune, B. T., Bayati, M., Becker, J. S., Bedi, N., Beghi, E., Bejot, Y., Bell, M. L., Bennitt, F. B., Bensenor, I. M., Berhe, K., Berman, A. E., Bhagavathula, A. S., Bhageerathy, R., Bhala, N., Bhandari, D., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Bikbov, B., Bin Sayeed, M. S., Biondi, A., Birihane, B. M., Bisignano, C., Biswas, R. K., Bitew, H., Bohlouli, S., Bohluli, M., Boon-Dooley, A. S., Borges, G., Borzi, A. M., Borzouei, S., Bosetti, C., Boufous, S., Braithwaite, D., Breitborde, N. J. K., Breitner, S., Brenner, H., Briant, P. S., Briko, A. N., Briko, N. I., Britton, G. B., Bryazka, D., Bumgarner, B. R., Burkart, K., Burnett, R. T., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cahill, L. E., Camera, L. L. A., Campos-Nonato, I. R., Cardenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castaneda-Orjuela, C. A., Castelpietra, G., Castro, F., Causey, K., Cederroth, C. R., Cercy, K. M., Cerin, E., Chandan, J. S., Chang, K. -L., Charlson, F. J., Chattu, V. K., Chaturvedi, S., Cherbuin, N., Chimed-Ochir, O., Cho, D. Y., Choi, J. -Y. J., Christensen, H., Chu, D. -T., Chung, M. T., Chung, S. -C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Classen, T. K. D., Cohen, A. J., Compton, K., Cooper, O. R., Costa, V. M., Cousin, E., Cowden, R. G., Cross, D. H., Cruz, J. A., Dahlawi, S. M. A., Damasceno, A. A. M., Damiani, G., Dandona, L., Dandona, R., Dangel, W. J., Danielsson, A. -K., Dargan, P. I., Darwesh, A. M., Daryani, A., Das, J. K., Das Gupta, R., das Neves, J., Davila-Cervantes, C. A., Davitoiu, D. V., De Leo, D., Degenhardt, L., Delang, M., Dellavalle, R. P., Demeke, F. M., Demoz, G. T., Demsie, D. G., Denova-Gutierrez, E., Dervenis, N., Dhungana, G. P., Dianatinasab, M., Dias da Silva, D., Diaz, D., Dibaji Forooshani, Z. S., Djalalinia, S., Do, H. T., Dokova, K., Dorostkar, F., Doshmangir, L., Driscoll, T. R., Duncan, B. B., Duraes, A. R., Eagan, A. W., Edvardsson, D., El Nahas, N., El Sayed, I., El Tantawi, M., Elbarazi, I., Elgendy, I. Y., El-Jaafary, S. I., Elyazar, I. R., Emmons-Bell, S., Erskine, H. E., Eskandarieh, S., Esmaeilnejad, S., Esteghamati, A., Estep, K., Etemadi, A., Etisso, A. E., Fanzo, J., Farahmand, M., Fareed, M., Faridnia, R., Farioli, A., Faro, A., Faruque, M., Farzadfar, F., Fattahi, N., Fazlzadeh, M., Feigin, V. L., Feldman, R., Fereshtehnejad, S. -M., Fernandes, E., Ferrara, G., Ferrari, A. J., Ferreira, M. L., Filip, I., Fischer, F., Fisher, J. L., Flor, L. S., Foigt, N. A., Folayan, M. O., Fomenkov, A. A., Force, L. M., Foroutan, M., Franklin, R. C., Freitas, M., Fu, W., Fukumoto, T., Furtado, J. M., Gad, M. M., Gakidou, E., Gallus, S., Garcia-Basteiro, A. L., Gardner, W. M., Geberemariyam, B. S., Gebreslassie, A. A. A. A., Geremew, A., Gershberg Hayoon, A., Gething, P. W., Ghadimi, M., Ghadiri, K., Ghaffarifar, F., Ghafourifard, M., Ghamari, F., Ghashghaee, A., Ghiasvand, H., Ghith, N., Gholamian, A., Ghosh, R., Gill, P. S., Ginindza, T. G. G., Giussani, G., Gnedovskaya, E. V., Goharinezhad, S., Gopalani, S. V., Gorini, G., Goudarzi, H., Goulart, A. C., Greaves, F., Grivna, M., Grosso, G., Gubari, M. I. M., Gugnani, H. C., Guimaraes, R. A., Guled, R. A., Guo, G., Guo, Y., Gupta, R., Gupta, T., Haddock, B., Hafezi-Nejad, N., Hafiz, A., Haj-Mirzaian, A., Hall, B. J., Halvaei, I., Hamadeh, R. R., Hamidi, S., Hammer, M. S., Hankey, G. J., Haririan, H., Haro, J. M., Hasaballah, A. I., Hasan, M. M., Hasanpoor, E., Hashi, A., Hassanipour, S., Hassankhani, H., Havmoeller, R. J., Hay, S. I., Hayat, K., Heidari, G., Heidari-Soureshjani, R., Henrikson, H. J., Herbert, M. E., Herteliu, C., Heydarpour, F., Hird, T. R., Hoek, H. W., Holla, R., Hoogar, P., Hosgood, H. D., Hossain, N., Hosseini, M., Hosseinzadeh, M., Hostiuc, M., Hostiuc, S., Househ, M., Hsairi, M., Hsieh, V. C. -R., Hu, G., Hu, K., Huda, T. M., Humayun, A., Huynh, C. K., Hwang, B. -F., Iannucci, V. C., Ibitoye, S. E., Ikeda, N., Ikuta, K. S., Ilesanmi, O. S., Ilic, I. M., Ilic, M. D., Inbaraj, L. R., Ippolito, H., Iqbal, U., Irvani, S. S. N., Irvine, C. M. S., Islam, M. M., Islam, S. M. S., Iso, H., Ivers, R. Q., Iwu, C. C. D., Iwu, C. J., Iyamu, I. O., Jaafari, J., Jacobsen, K. H., Jafari, H., Jafarinia, M., Jahani, M. A., Jakovljevic, M., Jalilian, F., James, S. L., Janjani, H., Javaheri, T., Javidnia, J., Jeemon, P., Jenabi, E., Jha, R. P., Jha, V., Ji, J. S., Johansson, L., John, O., John-Akinola, Y. O., Johnson, C. O., Jonas, J. B., Joukar, F., Jozwiak, J. J., Jurisson, M., Kabir, A., Kabir, Z., Kalani, H., Kalani, R., Kalankesh, L. R., Kalhor, R., Kanchan, T., Kapoor, N., Karami Matin, B., Karch, A., Karim, M. A., Kassa, G. M., Katikireddi, S. V., Kayode, G. A., Kazemi Karyani, A., Keiyoro, P. N., Keller, C., Kemmer, L., Kendrick, P. J., Khalid, N., Khammarnia, M., Khan, E. A., Khan, M., Khatab, K., Khater, M. M., Khatib, M. N., Khayamzadeh, M., Khazaei, S., Kieling, C., Kim, Y. J., Kimokoti, R. W., Kisa, A., Kisa, S., Kivimaki, M., Knibbs, L. D., Knudsen, A. K. S., Kocarnik, J. M., Kochhar, S., Kopec, J. A., Korshunov, V. A., Koul, P. A., Koyanagi, A., Kraemer, M. U. G., Krishan, K., Krohn, K. J., Kromhout, H., Kuate Defo, B., Kumar, G. A., Kumar, V., Kurmi, O. P., Kusuma, D., La Vecchia, C., Lacey, B., Lal, D. K., Lalloo, R., Lallukka, T., Lami, F. H., Landires, I., Lang, J. J., Langan, S. M., Larsson, A. O., Lasrado, S., Lauriola, P., Lazarus, J. V., Lee, P. H., Lee, S. W. H., Legrand, K. E., Leigh, J., Leonardi, M., Lescinsky, H., Leung, J., Levi, M., Li, S., Lim, L. -L., Linn, S., Liu, S., Liu, Y., Lo, J., Lopez, A. D., Lopez, J. C. F., Lopukhov, P. D., Lorkowski, S., Lotufo, P. A., Lu, A., Lugo, A., Maddison, E. R., Mahasha, P. W., Mahdavi, M. M., Mahmoudi, M., Majeed, A., Maleki, A., Maleki, S., Malekzadeh, R., Malta, D. C., Mamun, A. A., Manda, A. L., Manguerra, H., Mansour-Ghanaei, F., Mansouri, B., Mansournia, M. A., Mantilla Herrera, A. M., Maravilla, J. C., Marks, A., Martin, R. V., Martini, S., Martins-Melo, F. R., Masaka, A., Masoumi, S. Z., Mathur, M. R., Matsushita, K., Maulik, P. K., Mcalinden, C., Mcgrath, J. J., Mckee, M., Mehndiratta, M. M., Mehri, F., Mehta, K. M., Memish, Z. A., Mendoza, W., Menezes, R. G., Mengesha, E. W., Mereke, A., Mereta, S. T., Meretoja, A., Meretoja, T. J., Mestrovic, T., Miazgowski, B., Miazgowski, T., Michalek, I. M., Miller, T. R., Mills, E. J., Mini, G. K., Miri, M., Mirica, A., Mirrakhimov, E. M., Mirzaei, H., Mirzaei, M., Mirzaei, R., Mirzaei-Alavijeh, M., Misganaw, A. T., Mithra, P., Moazen, B., Mohammad, D. K., Mohammad, Y., Mohammad Gholi Mezerji, N., Mohammadian-Hafshejani, A., Mohammadifard, N., Mohammadpourhodki, R., Mohammed, A. S., Mohammed, H., Mohammed, J. A., Mohammed, S., Mokdad, A. H., Molokhia, M., Monasta, L., Mooney, M. D., Moradi, G., Moradi, M., Moradi-Lakeh, M., Moradzadeh, R., Moraga, P., Morawska, L., Morgado-da-Costa, J., Morrison, S. D., Mosapour, A., Mosser, J. F., Mouodi, S., Mousavi, S. M., Mousavi Khaneghah, A., Mueller, U. O., Mukhopadhyay, S., Mullany, E. C., Musa, K. I., Muthupandian, S., Nabhan, A. F., Naderi, M., Nagarajan, A. J., Nagel, G., Naghavi, M., Naghshtabrizi, B., Naimzada, M. D., Najafi, F., Nangia, V., Nansseu, J. R., Naserbakht, M., Nayak, V. C., Negoi, I., Ngunjiri, J. W., Nguyen, C. T., Nguyen, H. L. T., Nguyen, M., Nigatu, Y. T., Nikbakhsh, R., Nixon, M. R., Nnaji, C. A., Nomura, S., Norrving, B., Noubiap, J. J., Nowak, C., Nunez-Samudio, V., Otoiu, A., Oancea, B., Odell, C. M., Ogbo, F. A., Oh, I. -H., Okunga, E. W., Oladnabi, M., Olagunju, A. T., Olusanya, B. O., Olusanya, J. O., Omer, M. O., Ong, K. L., Onwujekwe, O. E., Orpana, H. M., Ortiz, A., Osarenotor, O., Osei, F. B., Ostroff, S. M., Otstavnov, N., Otstavnov, S. S., Overland, S., Owolabi, M. O., P A, M., Padubidri, J. R., Palladino, R., Panda-Jonas, S., Pandey, A., Parry, C. D. H., Pasovic, M., Pasupula, D. K., Patel, S. K., Pathak, M., Patten, S. B., Patton, G. C., Pazoki Toroudi, H., Peden, A. E., Pennini, A., Pepito, V. C. F., Peprah, E. K., Pereira, D. M., Pesudovs, K., Pham, H. Q., Phillips, M. R., Piccinelli, C., Pilz, T. M., Piradov, M. A., Pirsaheb, M., Plass, D., Polinder, S., Polkinghorne, K. R., Pond, C. D., Postma, M. J., Pourjafar, H., Pourmalek, F., Poznanska, A., Prada, S. I., Prakash, V., Pribadi, D. R. A., Pupillo, E., Quazi Syed, Z., Rabiee, M., Rabiee, N., Radfar, A., Rafiee, A., Raggi, A., Rahman, M. A., Rajabpour-Sanati, A., Rajati, F., Rakovac, I., Ram, P., Ramezanzadeh, K., Ranabhat, C. L., Rao, P. C., Rao, S. J., Rashedi, V., Rathi, P., Rawaf, D. L., Rawaf, S., Rawal, L., Rawassizadeh, R., Rawat, R., Razo, C., Redford, S. B., Reiner, R. C., Reitsma, M. B., Remuzzi, G., Renjith, V., Renzaho, A. M. N., Resnikoff, S., Rezaei, N., Rezapour, A., Rhinehart, P. -A., Riahi, S. M., Ribeiro, D. C., Ribeiro, D., Rickard, J., Rivera, J. A., Roberts, N. L. S., Rodriguez-Ramirez, S., Roever, L., Ronfani, L., Room, R., Roshandel, G., Roth, G. A., Rothenbacher, D., Rubagotti, E., Rwegerera, G. M., Sabour, S., Sachdev, P. S., Saddik, B., Sadeghi, E., Sadeghi, M., Saeedi, R., Saeedi Moghaddam, S., Safari, Y., Safi, S., Safiri, S., Sagar, R., Sahebkar, A., Sajadi, S. M., Salam, N., Salamati, P., Salem, H., Salem, M. R. R., Salimzadeh, H., Salman, O. M., Salomon, J. A., Samad, Z., Samadi Kafil, H., Sambala, E. Z., Samy, A. M., Sanabria, J., Sanchez-Pimienta, T. G., Santomauro, D. F., Santos, I. S., Santos, J. V., Santric-Milicevic, M. M., Saraswathy, S. Y. I., Sarmiento-Suarez, R., Sarrafzadegan, N., Sartorius, B., Sarveazad, A., Sathian, B., Sathish, T., Sattin, D., Saxena, S., Schaeffer, L. E., Schiavolin, S., Schlaich, M. P., Schmidt, M. I., Schutte, A. E., Schwebel, D. C., Schwendicke, F., Senbeta, A. M., Senthilkumaran, S., Sepanlou, S. G., Serdar, B., Serre, M. L., Shadid, J., Shafaat, O., Shahabi, S., Shaheen, A. A., Shaikh, M. A., Shalash, A. S., Shams-Beyranvand, M., Shamsizadeh, M., Sharafi, K., Sheikh, A., Sheikhtaheri, A., Shibuya, K., Shield, K. D., Shigematsu, M., Shin, J. I., Shin, M. -J., Shiri, R., Shirkoohi, R., Shuval, K., Siabani, S., Sierpinski, R., Sigfusdottir, I. D., Sigurvinsdottir, R., Silva, J. P., Simpson, K. E., Singh, J. A., Singh, P., Skiadaresi, E., Skou, S. T. S., Skryabin, V. Y., Smith, E. U. R., Soheili, A., Soltani, S., Soofi, M., Sorensen, R. J. D., Soriano, J. B., Sorrie, M. B., Soshnikov, S., Soyiri, I. N., Spencer, C. N., Spotin, A., Sreeramareddy, C. T., Srinivasan, V., Stanaway, J. D., Stein, C., Stein, D. J., Steiner, C., Stockfelt, L., Stokes, M. A., Straif, K., Stubbs, J. L., Sufiyan, M. B., Suleria, H. A. R., Suliankatchi Abdulkader, R., Sulo, G., Sultan, I., Szumowski, Tabares-Seisdedos, R., Tabb, K. M., Tabuchi, T., Taherkhani, A., Tajdini, M., Takahashi, K., Takala, J. S., Tamiru, A. T., Taveira, N., Tehrani-Banihashemi, A., Temsah, M. -H., Tesema, G. A., Tessema, Z. T., Thurston, G. D., Titova, M. V., Tohidinik, H. R., Tonelli, M., Topor-Madry, R., Topouzis, F., Torre, A. E., Touvier, M., Tovani-Palone, M. R. R., Tran, B. X., Travillian, R., Tsatsakis, A., Tudor Car, L., Tyrovolas, S., Uddin, R., Umeokonkwo, C. D., Unnikrishnan, B., Upadhyay, E., Vacante, M., Valdez, P. R., van Donkelaar, A., Vasankari, T. J., Vasseghian, Y., Veisani, Y., Venketasubramanian, N., Violante, F. S., Vlassov, V., Vollset, S. E., Vos, T., Vukovic, R., Waheed, Y., Wallin, M. 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Subjects
Male, Nutritional Sciences, Specific risk, Contaminación del Aire Interior, 030204 cardiovascular system & hematology, Socioeconomic Factor, systematic analysis, Global Health, Body Mass Index, Global Burden of Disease, Health Risk Behavior, Health Risk Behaviors, Disease studies, 0302 clinical medicine, Risk Factors, METABOLIC RISKS, 030212 general & internal medicine, 11 Medical and Health Sciences, Factores de Riesgo, 2. Zero hunger, education.field_of_study, Public health, Injuries, Public Health, Global Health, Social Medicine and Epidemiology, General Medicine, GBD, risck factors, attributable burden of disease, 3142 Public health care science, environmental and occupational health, 3. Good health, Relative risk, Environmental health, Health, Hypertension, Global Burden of Diseases, Injuries, Risk Factors, A990 Medicine and Dentistry not elsewhere classified, Female, Leading risk factors, Global Health Metrics, Cohort study, Human, medicine.medical_specialty, Substance-Related Disorders, Population, UNITED-STATES, Risk Assessment, DIET, ITC-HYBRID, 03 medical and health sciences, Life Expectancy, MORTALITY, DISABILITY, POLLUTION, CLUSTERS, SDG 3 - Good Health and Well-being, General & Internal Medicine, medicine, Humans, Global Burden of Disease Study, Risk factor, education, Global burden, business.industry, Risk Factor, Malnutrition, Klinisk medicin, Global Burden of Diseases, Environmental Exposure, medicine.disease, Enfermedades, purl.org/pe-repo/ocde/ford#3.02.00 [https], Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Years of potential life lost, Socioeconomic Factors, Risk factors, Disease study, Hyperglycemia, ITC-ISI-JOURNAL-ARTICLE, NA, Clinical Medicine, business, RA
Abstract

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Published
2020
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50. Global injury morbidity and mortality from 1990 to 2017 : results from the Global Burden of Disease Study 2017

Author

Giulio Castelpietra, Feng Sha, Khalid A Altirkawi, Seyedeh Zahra Masoumi, Gebreamlak Gebremedhn Gebremeskel, Ahmad Daryani, Ibrahim Abdollahpour, Simon I. Hay, Deborah Carvalho Malta, Erin B Hamilton, Kate E. LeGrand, Nikolay Ivanovich Briko, Ana-Laura Manda, Aziz Eftekhari, Irfan Ullah, Seth Christopher Yaw Appiah, Zichen Liu, Maida Umar, Shaimaa I. El-Jaafary, Marina Pinheiro, Farhad Ghamari, Milad Mohammadoo-Khorasani, Rajaram Yadav, Syed Mohamed Aljunid, Ramesh Holla, Farzad Jalilian, Jacek Jerzy Jozwiak, Omar Mukhtar Salman, Bayew Kelkay, Tanuj Kanchan, Irina Filip, Michael R. Phillips, Hamid Reza Tohidinik, Demelash Abewa Elemineh, Reza Malekzadeh, Tomasz Miazgowski, Diana Silva, Samath D Dharmaratne, Eleonora Dubljanin, Fatemeh Zare, Jasvinder A. Singh, Hagazi Gebremedhin Kassaye, Nathaniel J Henry, Venkatesh Maled, Girikumar Kumaresh, Alireza Rafiei, Zhi-Jiang Zhang, Arielle Wilder Eagan, Merhawi Gebremedhin Tekle, Gholamreza Roshandel, Jeevan Pereira, Tinuke O Olagunju, Olatunde Aremu, Mohammad Zamani, Mu'awiyyah Babale Sufiyan, Lidia Morawska, Bayisa Abdissa Baye, Eduarda Fernandes, Feleke Mekonnen Demeke, Beriwan Abdulqadir Ali, Ibrahim A Khalil, Hafte Kahsay Kebede, Songhomitra Panda-Jonas, Yuichiro Yano, Haileab Fekadu Wolde, Antonio Maria Borzì, Delia Hendrie, Azeem Majeed, Vahid Rashedi, Mehran Shams-Beyranvand, Ilais Moreno Velásquez, Derrick A Bennett, Roba Khundkar, Mohammed Madadin, Biniyam Sahiledengle Geberemariyam, Parul Puri, Lidia Sanchez Riera, Yetunde O. John-Akinola, Jennifer Rickard, Saeed Shahabi, Tiffany K. Gill, Jemal Abdu Mohammed, Alessandra C. Goulart, Mohiuddin Ahsanul Kabir Chowdhury, Roya Safari-Faramani, Pawan Faris, Farhad Moradpour, Guilherme Borges, Sadia Bibi, Bartosz Miazgowski, Wubalem Fekadu, Rakhi Dandona, Ali Reza Soltanian, Alaa Badawi, Amir Hasanzadeh, Hassan Haghparast Bidgoli, Carlos A Castañeda-Orjuela, Morteza Arab-Zozani, Vinay Nangia, Gaurav Gupta, Farkhonde Salehi, Isabela M. Benseñor, Rekha Thapar, Yasser S. Amer, Naohiro Yonemoto, Ahmad Ghashghaee, Amanda J. Mason-Jones, Marcela Agudelo-Botero, Ashraf Nabhan, Saeed Safari, Lorainne Tudor Car, Ayman Grada, Stanislav S. 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Subjects
Dánarmein, Fötlun, Dánartíðni, Lífslíkur, Life expectancy, 1106 Human Movement and Sports Sciences, burden of disease, Global Health, Global Burden of Disease, 0302 clinical medicine, Quality-Adjusted Life Year, Global health, Medicine, LIFE EXPECTANCY, 030212 general & internal medicine, POPULATION, Cause of death, Original Research, RISK, education.field_of_study, Global disease burdens, Injuries, Sjúkdómar, Incidence (epidemiology), Incidence, Population health, Burden of disease, Global, global, 3142 Public health care science, environmental and occupational health, 3. Good health, Descriptive epidemiology, Lýðheilsa, Quality-Adjusted Life Years, Public Health, TERRITORIES, descriptive epidemiology, Human, Population, 195 COUNTRIES, Humans, Life Expectancy, Morbidity, Wounds and Injuries, 1117 Public Health and Health Services, 03 medical and health sciences, AGE, SYSTEMATIC ANALYSIS, Mortality, education, Disability, SEX-SPECIFIC MORTALITY, business.industry, Faraldsfræði, DISABILITY, Public Health, Environmental and Occupational Health, Quality-adjusted life year, Years of potential life lost, Áverkar, 1701 Psychology, Human medicine, business, 030217 neurology & neurosurgery, Demography
Abstract

Publisher's version (útgefin grein), Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries. Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs). Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505). Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care., Bill and Melinda Gates Foundation OPP1152504, "Peer Reviewed"

Published
2020
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