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Deribe K, Beng AA, Cano J, Njouendo AJ, Fru-Cho J, Awah AR, Eyong ME, Chounna Ndongmo PW, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Brooker SJ, Hay SI, Enyong P, Newport MJ, Wanji S, Davey G. Mapping the geographical distribution of podoconiosis in Cameroon using parasitological, serological, and clinical evidence to exclude other causes of lymphedema. PLoS Negl Trop Dis 2018; 12:e0006126. [PMID: 29324858 PMCID: PMC5764238 DOI: 10.1371/journal.pntd.0006126] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background Podoconiosis is a non-filarial elephantiasis, which causes massive swelling of the lower legs. It was identified as a neglected tropical disease by WHO in 2011. Understanding of the geographical distribution of the disease is incomplete. As part of a global mapping of podoconiosis, this study was conducted in Cameroon to map the distribution of the disease. This mapping work will help to generate data on the geographical distribution of podoconiosis in Cameroon and contribute to the global atlas of podoconiosis. Methods We used a multi‐stage sampling design with stratification of the country by environmental risk of podoconiosis. We sampled 76 villages from 40 health districts from the ten Regions of Cameroon. All individuals of 15-years old or older in the village were surveyed house-to-house and screened for lymphedema. A clinical algorithm was used to reliably diagnose podoconiosis, excluding filarial-associated lymphedema. Individuals with lymphoedema were tested for circulating Wuchereria bancrofti antigen and specific IgG4 using the Alere Filariasis Test Strips (FTS) test and the Standard Diagnostics (SD) BIOLINE lymphatic filariasis IgG4 test (Wb123) respectively, in addition to thick blood films. Presence of DNA specific to W. bancrofti was checked on night blood using a qPCR technique. Principal findings Overall, 10,178 individuals from 4,603 households participated in the study. In total, 83 individuals with lymphedema were identified. Of the 83 individuals with lymphedema, two were found to be FTS positive and all were negative using the Wb123 test. No microfilaria of W. bancrofti were found in the night blood of any individual with clinical lymphedema. None were found to be positive for W. bancrofti using qPCR. Of the two FTS positive cases, one was positive for Mansonella perstans DNA, while the other harbored Loa loa microfilaria. Overall, 52 people with podoconiosis were identified after applying the clinical algorithm. The overall prevalence of podoconiosis was found to be 0.5% (95% [confidence interval] CI; 0.4–0.7). At least one case of podoconiosis was found in every region of Cameroon except the two surveyed villages in Adamawa. Of the 40 health districts surveyed, 17 districts had no cases of podoconiosis; in 15 districts, mean prevalence was between 0.2% and 1.0%; and in the remaining eight, mean prevalence was between 1.2% and 2.7%. Conclusions Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services. Podoconiosis is a geochemical neglected tropical disease, which causes massive swelling of the lower legs and feet. Although podoconiosis is one of the major causes of lower leg swelling worldwide, understanding of the geographical distribution of the disease is incomplete. In Cameroon, few studies have been conducted, and these have indicated varied and localized distribution of the disease. We conducted this countrywide mapping survey to determine the prevalence and spatial distribution of podoconiosis in Cameroon. We undertook nationwide mapping of podoconiosis in Cameroon by surveying 10,178 individuals from 4,603 households, in 76 communities. During the survey, individuals with lymphedema underwent a rapid-format antigen antibody test, and a thick blood film (TBF) for microscopic examination, as a confirmatory tool for detecting W. bancrofti micro filarial. Peripheral night blood and parasite DNA detection was used to exclude lymphatic filariasis, and a clinical history and physical examination was conducted to diagnosis podoconiosis. The overall prevalence of podoconiosis was found to be 0.5%. At least one case of podoconiosis was found in every region of Cameroon except Adamawa, where in the two surveyed villages no cases of podoconiosis were identified. Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services.
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Yared S, Gebresilassie A, Akililu E, Deribe K, Balkew M, Warburg A, Hailu A, Gebre-Michael T. Diversity and altitudinal distribution of phlebotomine sand flies (Diptera: Psychodidae) in visceral leishmaniasis endemic areas of northwest Ethiopia. Acta Trop 2017; 176:1-10. [PMID: 28712974 PMCID: PMC5590723 DOI: 10.1016/j.actatropica.2017.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/29/2017] [Accepted: 07/09/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Leishmaniases are caused by the protozoan parasites of the genus Leishmania and are transmitted to humans by the bite of infected female phlebotomine sand flies. Both visceral and cutaneous leishmaniases are widely distributed in different parts of Ethiopia. The aim of this study was to determine the diversity and altitudinal distribution of phlebotomine sand flies from Kafta Humera to Gondar town in northwest Ethiopia. METHODS Seven localities were selected with distinct altitudinal variations between 550m above sea level (m a.s.l) and 2300m a.s.l. In each locality, sand flies were collected using standard CDC light traps and sticky traps during the active sand fly season from December 2012 to May 2013. Shannon-Weiner species diversity index and Jaccard's coefficient were used to estimate species diversity and similarity between altitudes and localities, respectively. RESULTS A total of 89,044 sand flies (41,798 males and 47, 246 females) were collected from the seven localities/towns throughout the study period. Twenty-two species belonging to 11 species in the genus Phlebotomus and 11 species in the genus Sergentomyia were documented. Of these, Sergentomyia clydei (25.87%), S. schwetzi (25.21%), S. africana (24.65%), S. bedfordi (8.89%), Phlebotomus orientalis (6.43%), and S. antennata (4.8%) were the most prevalent species. The remaining 10 Phlebotomus species and six Sergentomyia were less frequent catches. In CDC light trap and sticky trap, higher species diversity and richness for both male and female sand flies was observed at low altitude ranging from 550 to 699m a.s.l in Adebay village in Kafta Humera district whereas low species richness and high evenness of both sexes were also observed in an altitude 1950-2300m a.s.l. CONCLUSION The results revealed that the presence of leishmaniasis vectors such as P. orientalis, P. longipes, P. papatasi, and P. duboscqi in different altitudes in northwest Ethiopia. P. orientalis a vector of L. donovani, occurred between altitude 500-1100m a.s.l, the area could be at high risk of VL. P. longipes a vector of L. aethiopica, was recorded in the highland area in Tikil-Dingay and Gondar town, implicating the possibility of CL transmission. Hence, further investigation into vector competence in relation to leishmaniasis (VL and CL) in the region is very vital.
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Deribe K, Cano J, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Cromwell EA, Osgood-Zimmerman A, Enquselassie F, Hailu A, Murray CJL, Newport MJ, Brooker SJ, Hay SI, Davey G. Estimating the number of cases of podoconiosis in Ethiopia using geostatistical methods. Wellcome Open Res 2017. [PMID: 29152596 DOI: 10.12688/wellcomeopenres.12483.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2011, the World Health Organization recognized podoconiosis as one of the neglected tropical diseases. Nonetheless, the number of people with podoconiosis and the geographical distribution of the disease is poorly understood. Based on a nationwide mapping survey and geostatistical modelling, we predict the prevalence of podoconiosis and estimate the number of cases across Ethiopia. METHODS We used nationwide data collected in Ethiopia between 2008 and 2013. Data were available for 141,238 individuals from 1,442 villages in 775 districts from all nine regional states and two city administrations. We developed a geostatistical model of podoconiosis prevalence among adults (individuals aged 15 years or above), by combining environmental factors. The number of people with podoconiosis was then estimated using a gridded map of adult population density for 2015. RESULTS Podoconiosis is endemic in 345 districts in Ethiopia: 144 in Oromia, 128 in Southern Nations, Nationalities and People's [SNNP], 64 in Amhara, 4 in Benishangul Gumuz, 4 in Tigray and 1 in Somali Regional State. Nationally, our estimates suggest that 1,537,963 adults (95% confidence intervals, 290,923-4,577,031 adults) were living with podoconiosis in 2015. Three regions (SNNP, Oromia and Amhara) contributed 99% of the cases. The highest proportion of individuals with podoconiosis resided in the SNNP (39%), while 32% and 29% of people with podoconiosis resided in Oromia and Amhara Regional States, respectively. Tigray and Benishangul Gumuz Regional States bore lower burdens, and in the remaining regions, podoconiosis was almost non-existent. Discussion: The estimates of podoconiosis cases presented here based upon the combination of currently available epidemiological data and a robust modelling approach clearly show that podoconiosis is highly endemic in Ethiopia. Given the presence of low cost prevention, and morbidity management and disability prevention services, it is our collective responsibility to scale-up interventions rapidly.
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Davey G, Deribe K. Precision public health: mapping child mortality in Africa. Lancet 2017; 390:2126-2128. [PMID: 28958466 PMCID: PMC5694343 DOI: 10.1016/s0140-6736(17)32280-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/01/2017] [Indexed: 11/23/2022]
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Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abebo TA, Abera SF, Aboyans V, Abu-Raddad LJ, Ackerman IN, Adamu AA, Adetokunboh O, Afarideh M, Afshin A, Agarwal SK, Aggarwal R, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al Lami FH, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali R, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Maskari F, Al-Raddadi R, Alsharif U, Alsowaidi S, Altirkawi KA, Amare AT, Amini E, Ammar W, Amoako YA, Andersen HH, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atnafu NT, Atre SR, Avila-Burgos L, Avokphako EFGA, Awasthi A, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Bannick MS, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Battista B, Battle KE, Baune BT, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bennett DA, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Biadgilign S, Bicer BK, Bienhoff K, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Brugha TS, Buchbinder R, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Car M, Carabin H, Carapetis JR, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Carvalho F, Casey DC, Caso V, Castañeda-Orjuela CA, Castle CD, Catalá-López F, Chang HY, Chang JC, Charlson FJ, Chen H, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Christopher DJ, Ciobanu LG, Cirillo M, Colombara D, Cooper C, Cortesi PA, Criqui MH, Crump JA, Dadi AF, Dalal K, Dandona L, Dandona R, das Neves J, Davitoiu DV, de Courten B, De Leo DD, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Des Jarlais DC, Dey S, Dharmaratne SD, Dhillon PK, Dicker D, Ding EL, Djalalinia S, Do HP, Dorsey ER, dos Santos KPB, Douwes-Schultz D, Doyle KE, Driscoll TR, Dubey M, Duncan BB, El-Khatib ZZ, Ellerstrand J, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Flor LS, Foigt N, Foreman KJ, Franklin RC, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Ganji M, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Ginawi IAM, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold AL, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Goulart AC, Griswold M, Gugnani HC, Gupta R, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hailu AD, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hanson SW, Hao Y, Harb HL, Hareri HA, Haro JM, Harvey J, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hay RJ, Henry NJ, Heredia-Pi IB, Hernandez JM, Heydarpour P, Hoek HW, Hoffman HJ, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Htet AS, Hu G, Huang H, Huynh C, Iburg KM, Igumbor EU, Ikeda C, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jassal SK, Javanbakht M, Jayaraman SP, Jeemon P, Jensen PN, Jha V, Jiang G, John D, Johnson SC, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Kan H, Karam NE, Karch A, Karema CK, Kasaeian A, Kassa GM, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Keiyoro PN, Kengne AP, Keren A, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim YJ, Kim D, Kim P, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Kumar GA, Kumar P, Kumar S, Kyu HH, Lal DK, Lalloo R, Lambert N, Lan Q, Larsson A, Lavados PM, Leasher JL, Lee PH, Lee JT, Leigh J, Leshargie CT, Leung J, Leung R, Levi M, Li Y, Li Y, Li Kappe D, Liang X, Liben ML, Lim SS, Linn S, Liu PY, Liu A, Liu S, Liu Y, Lodha R, Logroscino G, London SJ, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Low N, Lozano R, Lucas TCD, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Manhertz T, Mantilla A, Mantovani LG, Mapoma CC, Marczak LB, Martinez-Raga J, Martins-Melo FR, Martopullo I, März W, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, McNellan C, Mehata S, Mehndiratta MM, Mekonnen TC, Memiah P, Memish ZA, Mendoza W, Mengistie MA, Mengistu DT, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohanty SK, Mokdad AH, Mollenkopf SK, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Mori R, Morozoff C, Morrison SD, Moses M, Mountjoy-Venning C, Mruts KB, Mueller UO, Muller K, Murdoch ME, Murthy GVS, Musa KI, Nachega JB, Nagel G, Naghavi M, Naheed A, Naidoo KS, Naldi L, Nangia V, Natarajan G, Negasa DE, Negoi RI, Negoi I, Newton CR, Ngunjiri JW, Nguyen TH, Nguyen QL, Nguyen CT, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nolte S, Nong VM, Norrving B, Noubiap JJN, O'Donnell MJ, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju TO, Olagunju AT, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osgood-Zimmerman A, Osman M, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Papachristou C, Park EK, Parry CD, Parsaeian M, Patten SB, Patton GC, Paulson K, Pearce N, Pereira DM, Perico N, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Plass D, Pletcher MA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Prasad N, Purcell C, Qorbani M, Quansah R, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rankin Z, Rao PC, Rao PV, Rawaf S, Ray SE, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Ribeiro AL, Ronfani L, Roshandel G, Roth GA, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Salama J, Saleem HOB, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shaikh MA, Shamsipour M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shields C, Shifa GT, Shigematsu M, Shinohara Y, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shrime MG, Sibai AM, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh NP, Sinha DN, Skiadaresi E, Skirbekk V, Slepak EL, Sligar A, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Sorensen RJD, Sousa TCM, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein MB, Stein DJ, Steiner TJ, Steiner C, Steinke S, Stokes MA, Stovner LJ, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Tabarés-Seisdedos R, Taffere GR, Takala JS, Tandon N, Tavakkoli M, Taveira N, Taylor HR, Tehrani-Banihashemi A, Tekelab T, Terkawi AS, Tesfaye DJ, Tesssema B, Thamsuwan O, Thomas KE, Thrift AG, Tiruye TY, Tobe-Gai R, Tollanes MC, Tonelli M, Topor-Madry R, Tortajada M, Touvier M, Tran BX, Tripathi S, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Varughese S, Vasankari T, Venkatesh S, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Wadilo F, Wakayo T, Wang YP, Weaver M, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Woodbrook R, Woolf AD, Workicho A, Xavier D, Xu G, Yadgir S, Yaghoubi M, Yakob B, Yan LL, Yano Y, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zhang X, Zhou M, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1211-1259. [PMID: 28919117 PMCID: PMC5605509 DOI: 10.1016/s0140-6736(17)32154-2] [Citation(s) in RCA: 4400] [Impact Index Per Article: 628.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/22/2017] [Accepted: 07/26/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. METHODS We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). FINDINGS Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). INTERPRETATION The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Abraha HN, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adedoyin RA, Adetifa IMO, Adetokunboh O, Afshin A, Aggarwal R, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akanda AS, Akinyemiju TF, Akseer N, Al Lami FH, Alabed S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alasfoor D, Aldridge RW, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alizadeh-Navaei R, Aljunid SM, Alkaabi JM, Alkerwi A, Alla F, Allam SD, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Ameh EA, Amini E, Ammar W, Amoako YA, Anber N, Andrei CL, Androudi S, Ansari H, Ansha MG, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Asghar RJ, Assadi R, Assaye AM, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Babalola TK, Bacha U, Badawi A, Balakrishnan K, Balalla S, Barac A, Barber RM, Barboza MA, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Baune BT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bello AK, Bennett DA, Bennett JR, Bensenor IM, Benson J, Berhane A, Berhe DF, Bernabé E, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhaumik S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bjerregaard P, Blosser CD, Boneya DJ, Boufous S, Bourne RRA, Brazinova A, Breitborde NJK, Brenner H, Brugha TS, Bukhman G, Bulto LNB, Bumgarner BR, Burch M, Butt ZA, Cahill LE, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Car M, Cárdenas R, Carpenter DO, Carrero JJ, Carter A, Castañeda-Orjuela CA, Castro FF, Castro RE, Catalá-López F, Chen H, Chiang PPC, Chibalabala M, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colquhoun SM, Coresh J, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, De Leo D, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dherani MK, Diaz-Torné C, Ding EL, Dixit P, Djalalinia S, Do HP, Doku DT, Donnelly CA, dos Santos KPB, Douwes-Schultz D, Driscoll TR, Duan L, Dubey M, Duncan BB, Dwivedi LK, Ebrahimi H, El Bcheraoui C, Ellingsen CL, Enayati A, Endries AY, Ermakov SP, Eshetie S, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Fanuel FBB, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Filip I, Fischer F, Foigt N, Foreman KJ, Frank T, Franklin RC, Fraser M, Friedman J, Frostad JJ, Fullman N, Fürst T, Furtado JM, Futran ND, Gakidou E, Gambashidze K, Gamkrelidze A, Gankpé FG, Garcia-Basteiro AL, Gebregergs GB, Gebrehiwot TT, Gebrekidan KG, Gebremichael MW, Gelaye AA, Geleijnse JM, Gemechu BL, Gemechu KS, Genova-Maleras R, Gesesew HA, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Girma BW, Giussani G, Goenka S, Gomez B, Gona PN, Gopalani SV, Goulart AC, Graetz N, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Haagsma JA, Hafezi-Nejad N, Hakuzimana A, Halasa YA, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Harikrishnan S, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, He F, Heredia-Pi IB, Herteliu C, Hilawe EH, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Huang H, Iburg KM, Igumbor EU, Ileanu BV, Inoue M, Irenso AA, Irvine CMS, Islam SMS, Islam N, Jacobsen KH, Jaenisch T, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jeemon P, Jensen PN, Jha V, Jin Y, John D, John O, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Karthikeyan G, Kasaeian A, Kassaw NA, Kassebaum NJ, Kastor A, Katikireddi SV, Kaul A, Kawakami N, Kazanjan K, Keiyoro PN, Kelbore SG, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Ketema EB, Khader YS, Khalil IA, Khan EA, Khan G, Khang YH, Khera S, Khoja ATA, Khosravi MH, Kibret GD, Kieling C, Kim YJ, Kim CI, Kim D, Kim P, Kim S, Kimokoti RW, Kinfu Y, Kishawi S, Kissoon N, Kivimaki M, Knudsen AK, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kuate Defo B, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kumar P, Kumsa FA, Kutz M, Lachat C, Lagat AK, Lager ACJ, Lal DK, Lalloo R, Lambert N, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Laxmaiah A, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liao Y, Liben ML, Lim SS, Linn S, Lipshultz SE, Liu S, Lodha R, Logroscino G, Lorch SA, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Ma S, Macarayan ER, Machado IE, Mackay MT, Magdy Abd El Razek M, Magis-Rodriguez C, Mahdavi M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marczak LB, Marks GB, Martin EA, Martinez-Raga J, Martins-Melo FR, Massano J, Maulik PK, Mayosi BM, Mazidi M, McAlinden C, McGarvey ST, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Mehta KM, Meier T, Mekonnen TC, Meles KG, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mengistu DT, Menon GR, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Mikesell J, Miller TR, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammadi A, Mohammed KE, Mohammed S, Mohan MBV, Mohanty SK, Mokdad AH, Mollenkopf SK, Molokhia M, Monasta L, Montañez Hernandez JC, Montico M, Mooney MD, Moore AR, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Morrison SD, Mruts KB, Mueller UO, Mullany E, Muller K, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naidoo KS, Nanda L, Nangia V, Nascimento BR, Natarajan G, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Ningrum DNA, Nisar MI, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Nyakarahuka L, O'Donnell MJ, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Osgood-Zimmerman A, Ota E, Owolabi MO, Oyekale AS, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Park EK, Parsaeian M, Patel T, Patten SB, Patton GC, Paudel D, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petri WA, Petzold M, Phillips MR, Piel FB, Pigott DM, Pishgar F, Plass D, Polinder S, Popova S, Postma MJ, Poulton RG, Pourmalek F, Prasad N, Purwar M, Qorbani M, Quintanilla BPA, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman SU, Rahman M, Rai RK, Rajsic S, Ram U, Rana SM, Ranabhat CL, Rao PV, Rawaf S, Ray SE, Rego MAS, Rehm J, Reiner RC, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Rivas JC, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Rubagotti E, Ruhago GM, Saadat S, Sabde YD, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Sahebkar A, Sahraian MA, Salama J, Salamati P, Salomon JA, Salvi SS, Samy AM, Sanabria JR, Sanchez-Niño MD, Santos IS, Santric Milicevic MM, Sarmiento-Suarez R, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Seid AM, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Shen J, Shetty BP, Shi P, Shibuya K, Shifa GT, Shigematsu M, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Silpakit N, Silva DAS, Silva JP, Silveira DGA, Sindi S, Singh JA, Singh PK, Singh A, Singh V, Sinha DN, Skarbek KAK, Skiadaresi E, Sligar A, Smith DL, Sobaih BHA, Sobngwi E, Soneji S, Soriano JB, Sreeramareddy CT, Srinivasan V, Stathopoulou V, Steel N, Stein DJ, Steiner C, Stöckl H, Stokes MA, Strong M, Sufiyan MB, Suliankatchi RA, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tadese F, Tandon N, Tanne D, Tarajia M, Tavakkoli M, Taveira N, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Temsah MH, Terkawi AS, Tesema CL, Tesssema B, Theis A, Thomas N, Thompson AH, Thomson AJ, Thrift AG, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tortajada M, Tran BX, Truelsen T, Trujillo U, Tsilimparis N, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uthman OA, Uzochukwu BSC, van Boven JFM, Varakin YY, Varughese S, Vasankari T, Vasconcelos AMN, Velasquez IM, Venketasubramanian N, Vidavalur R, Violante FS, Vishnu A, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Waid JL, Wakayo T, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wesana J, Wijeratne T, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Workicho A, Workie SB, Xavier D, Xu G, Yaghoubi M, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yirsaw BD, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zeeb H, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zodpey S, Zuhlke LJ, Lopez AD, Murray CJL. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1084-1150. [PMID: 28919115 PMCID: PMC5605514 DOI: 10.1016/s0140-6736(17)31833-0] [Citation(s) in RCA: 488] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/21/2017] [Accepted: 06/07/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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Gakidou E, Afshin A, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Adedeji IA, Adetokunboh O, Afarideh M, Agrawal A, Agrawal S, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Akinyemi RO, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alasfoor D, Alene KA, Ali K, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Ansari H, Antó JM, Antonio CAT, Anwari P, Arian N, Ärnlöv J, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Atey TM, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Ballew SH, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Batis C, Battle KE, Baumgarner BR, Baune BT, Beardsley J, Bedi N, Beghi E, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhansali A, Bhutta ZA, Bicer BK, Bikbov B, Birungi C, Biryukov S, Blosser CD, Boneya DJ, Bou-Orm IR, Brauer M, Breitborde NJK, Brenner H, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Catalá-López F, Cercy K, Chang HY, Charlson FJ, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cohen AJ, Comfort H, Cooper C, Coresh J, Cornaby L, Cortesi PA, Criqui MH, Crump JA, Dandona L, Dandona R, das Neves J, Davey G, Davitoiu DV, Davletov K, de Courten B, Defo BK, Degenhardt L, Deiparine S, Dellavalle RP, Deribe K, Deshpande A, Dharmaratne SD, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Duncan S, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fay K, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frostad JJ, Fullman N, Fürst T, Furtado JM, Ganji M, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gesesew HA, Gething PW, Ghajar A, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Goulart AC, Graetz N, Gugnani HC, Guo J, Gupta R, Gupta T, Gupta V, Gutiérrez RA, Hachinski V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Hanson SW, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, Hedayati MT, Hendrie D, Heredia-Pi IB, Hernandez JCM, Hoek HW, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Hu G, Huang JJ, Huang H, Ibrahim NM, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jackson MD, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Johansson LRK, Johnson CO, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Knibbs LD, Knudsen AK, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kromhout H, Kumar GA, Kutz M, Kyu HH, Lal DK, Lalloo R, Lallukka T, Lan Q, Lansingh VC, Larsson A, Lee PH, Lee A, Leigh J, Leung J, Levi M, Levy TS, Li Y, Li Y, Liang X, Liben ML, Linn S, Liu P, Lodha R, Logroscino G, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lunevicius R, Macarayan ERK, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Mapoma CC, Martin RV, Martinez-Raga J, Martins-Melo FR, Mathur MR, Matsushita K, Matzopoulos R, Mazidi M, McAlinden C, McGrath JJ, Mehata S, Mehndiratta MM, Meier T, Melaku YA, Memiah P, Memish ZA, Mendoza W, Mengesha MM, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Mountjoy-Venning C, Mueller UO, Mullany EC, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Ota E, Owolabi MO, PA M, Pacella RE, Pana A, Panda BK, Panda-Jonas S, Pandian JD, Papachristou C, Park EK, Parry CD, Patten SB, Patton GC, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Pillay JD, Piradov MA, Pishgar F, Plass D, Pletcher MA, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad N, Purcell C, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Rawaf S, Rehm CD, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Reynales-Shigematsu LM, Rezaei S, Ribeiro AL, Rivera JA, Roba KT, Rojas-Rueda D, Roman Y, Room R, Roshandel G, Roth GA, Rothenbacher D, Rubagotti E, Rushton L, Sadat N, Safdarian M, Safi S, Safiri S, Sahathevan R, Salama J, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sánchez-Pimienta TG, Santomauro D, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shen J, Shi P, Shibuya K, Shields C, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shishani K, Shoman H, Shrime MG, Sigfusdottir ID, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Smith DL, Smith M, Sobaih BHA, Sobngwi E, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Subart M, Sufiyan MB, Suliankatchi RA, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Takahashi K, Takala JS, Tandon N, Tanner M, Tarekegn YL, Tavakkoli M, Tegegne TK, Tehrani-Banihashemi A, Terkawi AS, Tesssema B, Thakur JS, Thamsuwan O, Thankappan KR, Theis AM, Thomas ML, Thomson AJ, Thrift AG, Tillmann T, Tobe-Gai R, Tobollik M, Tollanes MC, Tonelli M, Topor-Madry R, Torre A, Tortajada M, Touvier M, Tran BX, Truelsen T, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Veerman LJ, Venkateswaran V, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Workicho A, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zimsen SRM, Zipkin B, Zodpey S, Lim SS, Murray CJL. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1345-1422. [PMID: 28919119 PMCID: PMC5614451 DOI: 10.1016/s0140-6736(17)32366-8] [Citation(s) in RCA: 1582] [Impact Index Per Article: 226.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of risk factor exposure and attributable burden of disease. By providing estimates over a long time series, this study can monitor risk exposure trends critical to health surveillance and inform policy debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2016. This study included 481 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk (RR) and exposure estimates from 22 717 randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources, according to the GBD 2016 source counting methods. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. Finally, we explored four drivers of trends in attributable burden: population growth, population ageing, trends in risk exposure, and all other factors combined. FINDINGS Since 1990, exposure increased significantly for 30 risks, did not change significantly for four risks, and decreased significantly for 31 risks. Among risks that are leading causes of burden of disease, child growth failure and household air pollution showed the most significant declines, while metabolic risks, such as body-mass index and high fasting plasma glucose, showed significant increases. In 2016, at Level 3 of the hierarchy, the three leading risk factors in terms of attributable DALYs at the global level for men were smoking (124·1 million DALYs [95% UI 111·2 million to 137·0 million]), high systolic blood pressure (122·2 million DALYs [110·3 million to 133·3 million], and low birthweight and short gestation (83·0 million DALYs [78·3 million to 87·7 million]), and for women, were high systolic blood pressure (89·9 million DALYs [80·9 million to 98·2 million]), high body-mass index (64·8 million DALYs [44·4 million to 87·6 million]), and high fasting plasma glucose (63·8 million DALYs [53·2 million to 76·3 million]). In 2016 in 113 countries, the leading risk factor in terms of attributable DALYs was a metabolic risk factor. Smoking remained among the leading five risk factors for DALYs for 109 countries, while low birthweight and short gestation was the leading risk factor for DALYs in 38 countries, particularly in sub-Saharan Africa and South Asia. In terms of important drivers of change in trends of burden attributable to risk factors, between 2006 and 2016 exposure to risks explains an 9·3% (6·9-11·6) decline in deaths and a 10·8% (8·3-13·1) decrease in DALYs at the global level, while population ageing accounts for 14·9% (12·7-17·5) of deaths and 6·2% (3·9-8·7) of DALYs, and population growth for 12·4% (10·1-14·9) of deaths and 12·4% (10·1-14·9) of DALYs. The largest contribution of trends in risk exposure to disease burden is seen between ages 1 year and 4 years, where a decline of 27·3% (24·9-29·7) of the change in DALYs between 2006 and 2016 can be attributed to declines in exposure to risks. INTERPRETATION Increasingly detailed understanding of the trends in risk exposure and the RRs for each risk-outcome pair provide insights into both the magnitude of health loss attributable to risks and how modification of risk exposure has contributed to health trends. Metabolic risks warrant particular policy attention, due to their large contribution to global disease burden, increasing trends, and variable patterns across countries at the same level of development. GBD 2016 findings show that, while it has huge potential to improve health, risk modification has played a relatively small part in the past decade. FUNDING The Bill & Melinda Gates Foundation, Bloomberg Philanthropies.
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Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF, Aboyans V, Adetokunboh O, Afshin A, Agrawal A, Ahmadi A, Ahmed MB, Aichour AN, Aichour MTE, Aichour I, Aiyar S, Alahdab F, Al-Aly Z, Alam K, Alam N, Alam T, Alene KA, Al-Eyadhy A, Ali SD, Alizadeh-Navaei R, Alkaabi JM, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amoako YA, Anber N, Andersen HH, Andrei CL, Androudi S, Ansari H, Antonio CAT, Anwari P, Ärnlöv J, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Atey TM, Avila-Burgos L, Avokpaho EFG, Awasthi A, Babalola TK, Bacha U, Balakrishnan K, Barac A, Barboza MA, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Baune BT, Bedi N, Beghi E, Béjot Y, Bekele BB, Bell ML, Bennett JR, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beuran M, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Bisanzio D, Bourne RRA, Breitborde NJK, Bulto LNB, Bumgarner BR, Butt ZA, Cahuana-Hurtado L, Cameron E, Campuzano JC, Car J, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Catalá-López F, Charlson FJ, Chibueze CE, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Christopher DJ, Ciobanu LG, Cirillo M, Cohen AJ, Colombara D, Cooper C, Cowie BC, Criqui MH, Dandona L, Dandona R, Dargan PI, das Neves J, Davitoiu DV, Davletov K, de Courten B, Defo BK, Degenhardt L, Deiparine S, Deribe K, Deribew A, Dey S, Dicker D, Ding EL, Djalalinia S, Do HP, Doku DT, Douwes-Schultz D, Driscoll TR, Dubey M, Duncan BB, Echko M, El-Khatib ZZ, Ellingsen CL, Enayati A, Ermakov SP, Erskine HE, Eskandarieh S, Esteghamati A, Estep K, Farinha CSES, Faro A, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Finegold S, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Frank T, Fraser M, Fullman N, Fürst T, Furtado JM, Gakidou E, Garcia-Basteiro AL, Gebre T, Gebregergs GB, Gebrehiwot TT, Gebremichael DY, Geleijnse JM, Genova-Maleras R, Gesesew HA, Gething PW, Gillum RF, Giref AZ, Giroud M, Giussani G, Godwin WW, Gold AL, Goldberg EM, Gona PN, Gopalani SV, Gouda HN, Goulart AC, Griswold M, Gupta R, Gupta T, Gupta V, Gupta PC, Haagsma JA, Hafezi-Nejad N, Hailu AD, Hailu GB, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hay SI, He F, Hedayati MT, Henry NJ, Heredia-Pi IB, Herteliu C, Hoek HW, Horino M, Horita N, Hosgood HD, Hostiuc S, Hotez PJ, Hoy DG, Huynh C, Iburg KM, Ikeda C, Ileanu BV, Irenso AA, Irvine CMS, Islam SMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayaraman SP, Jeemon P, Jha V, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karimi SM, Karimkhani C, Kasaeian A, Kassaw NA, Kassebaum NJ, Katikireddi SV, Kawakami N, Keiyoro PN, Kemmer L, Kesavachandran CN, Khader YS, Khan EA, Khang YH, Khoja ATA, Khosravi MH, Khosravi A, Khubchandani J, Kiadaliri AA, Kieling C, Kievlan D, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kissoon N, Kivimaki M, Knudsen AK, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kulikoff XR, Kumar GA, Kumar P, Kutz M, Kyu HH, Lal DK, Lalloo R, Lambert TLN, Lan Q, Lansingh VC, Larsson A, Lee PH, Leigh J, Leung J, Levi M, Li Y, Li Kappe D, Liang X, Liben ML, Lim SS, Liu PY, Liu A, Liu Y, Lodha R, Logroscino G, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Ma S, Macarayan ERK, Maddison ER, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Manguerra H, Manyazewal T, Mapoma CC, Marczak LB, Markos D, Martinez-Raga J, Martins-Melo FR, Martopullo I, McAlinden C, McGaughey M, McGrath JJ, Mehata S, Meier T, Meles KG, Memiah P, Memish ZA, Mengesha MM, Mengistu DT, Menota BG, Mensah GA, Meretoja TJ, Meretoja A, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mohamed IA, Mohammad KA, Mohammadi A, Mohammed S, Mokdad AH, Mola GLD, Mollenkopf SK, Molokhia M, Monasta L, Montañez JC, Montico M, Mooney MD, Moradi-Lakeh M, Moraga P, Morawska L, Morozoff C, Morrison SD, Mountjoy-Venning C, Mruts KB, Muller K, Murthy GVS, Musa KI, Nachega JB, Naheed A, Naldi L, Nangia V, Nascimento BR, Nasher JT, Natarajan G, Negoi I, Ngunjiri JW, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nong VM, Noubiap JJN, Ogbo FA, Oh IH, Okoro A, Olagunju AT, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Opio JN, Oren E, Ortiz A, Osman M, Ota E, PA M, Pacella RE, Pakhale S, Pana A, Panda BK, Panda-Jonas S, Papachristou C, Park EK, Patten SB, Patton GC, Paudel D, Paulson K, Pereira DM, Perez-Ruiz F, Perico N, Pervaiz A, Petzold M, Phillips MR, Pigott DM, Pinho C, Plass D, Pletcher MA, Polinder S, Postma MJ, Pourmalek F, Purcell C, Qorbani M, Quintanilla BPA, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman MHU, Rahman M, Rai RK, Ranabhat CL, Rankin Z, Rao PC, Rath GK, Rawaf S, Ray SE, Rehm J, Reiner RC, Reitsma MB, Remuzzi G, Rezaei S, Rezai MS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Ruhago GM, SA R, Saadat S, Sachdev PS, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Sahathevan R, Salama J, Salamati P, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Santomauro D, Santos IS, Santric Milicevic MM, Sartorius B, Satpathy M, Schmidt MI, Schneider IJC, Schulhofer-Wohl S, Schutte AE, Schwebel DC, Schwendicke F, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Sharma J, Sharma R, She J, Sheikhbahaei S, Shey M, Shi P, Shields C, Shigematsu M, Shiri R, Shirude S, Shiue I, Shoman H, Shrime MG, Sigfusdottir ID, Silpakit N, Silva JP, Singh JA, Singh A, Skiadaresi E, Sligar A, Smith DL, Smith A, Smith M, Sobaih BHA, Soneji S, Sorensen RJD, Soriano JB, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stathopoulou V, Steel N, Stein DJ, Steiner C, Steinke S, Stokes MA, Strong M, Strub B, Subart M, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tadakamadla SK, Takahashi K, Takala JS, Talongwa RT, Tarawneh MR, Tavakkoli M, Taveira N, Tegegne TK, Tehrani-Banihashemi A, Temsah MH, Terkawi AS, Thakur JS, Thamsuwan O, Thankappan KR, Thomas KE, Thompson AH, Thomson AJ, Thrift AG, Tobe-Gai R, Topor-Madry R, Torre A, Tortajada M, Towbin JA, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Updike R, Uthman OA, Uzochukwu BSC, van Boven JFM, Vasankari T, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Vos T, Wakayo T, Wallin MT, Wang YP, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whetter B, Whiteford HA, Wijeratne T, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Workicho A, Xavier D, Xiao Q, Xu G, Yaghoubi M, Yakob B, Yano Y, Yaseri M, Yimam HH, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zegeye EA, Zenebe ZM, Zerfu TA, Zhang AL, Zhang X, Zipkin B, Zodpey S, Lopez AD, Murray CJL. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390:1151-1210. [PMID: 28919116 PMCID: PMC5605883 DOI: 10.1016/s0140-6736(17)32152-9] [Citation(s) in RCA: 2992] [Impact Index Per Article: 427.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. METHODS We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. FINDINGS The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2-73·2) of deaths in 2016 with 19·3% (18·5-20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00-8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. INTERPRETATION The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. FUNDING Bill & Melinda Gates Foundation.
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Fullman N, Barber RM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulkader RS, Abdulle AM, Abera SF, Aboyans V, Abu-Raddad LJ, Abu-Rmeileh NME, Adedeji IA, Adetokunboh O, Afshin A, Agrawal A, Agrawal S, Ahmad Kiadaliri A, Ahmadieh H, Ahmed MB, Aichour MTE, Aichour AN, Aichour I, Aiyar S, Akinyemi RO, Akseer N, Al-Aly Z, Alam K, Alam N, Alasfoor D, Alene KA, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Ansari H, Antonio CAT, Anwari P, Arora M, Artaman A, Aryal KK, Asayesh H, Asgedom SW, Assadi R, Atey TM, Atre SR, Avila-Burgos L, Avokpaho EFGA, Awasthi A, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Bannick MS, Barac A, Barker-Collo SL, Bärnighausen T, Barrero LH, Basu S, Battle KE, Baune BT, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bennett DA, Bennett JR, Bensenor IM, Berhane A, Berhe DF, Bernabé E, Betsu BD, Beuran M, Beyene AS, Bhala N, Bhansali A, Bhatt S, Bhutta ZA, Bicer BK, Bidgoli HH, Bikbov B, Bilal AI, Birungi C, Biryukov S, Bizuayehu HM, Blosser CD, Boneya DJ, Bose D, Bou-Orm IR, Brauer M, Breitborde NJK, Brugha TS, Bulto LNB, Butt ZA, Cahuana-Hurtado L, Cameron E, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cercy K, Chang HY, Chang JC, Charlson FJ, Chew A, Chisumpa VH, Chitheer AA, Christensen H, Christopher DJ, Cirillo M, Cooper C, Criqui MH, Cromwell EA, Crump JA, Dandona L, Dandona R, Dargan PI, das Neves J, Davitoiu DV, de Courten B, De Steur H, Defo BK, Degenhardt L, Deiparine S, Deribe K, deVeber GA, Ding EL, Djalalinia S, Do HP, Dokova K, Doku DT, Donkelaar AV, Dorsey ER, Driscoll TR, Dubey M, Duncan BB, Ebel BE, Ebrahimi H, El-Khatib ZZ, Enayati A, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Eskandarieh S, Esteghamati A, Estep K, Faraon EJA, Farinha CSES, Faro A, Farzadfar F, Fazeli MS, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JC, Ferrari AJ, Feyissa TR, Filip I, Fischer F, Fitzmaurice C, Flaxman AD, Foigt N, Foreman KJ, Frank T, Franklin RC, Friedman J, Frostad JJ, Fürst T, Furtado JM, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Geleijnse JM, Geleto A, Gemechu BL, Gething PW, Gibney KB, Gill PS, Gillum RF, Giref AZ, Gishu MD, Giussani G, Glenn SD, Godwin WW, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goryakin Y, Griswold M, Gugnani HC, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Hailu GB, Hamadeh RR, Hammami M, Hankey GJ, Harb HL, Hareri HA, Hassanvand MS, Havmoeller R, Hawley C, Hay SI, He J, Hendrie D, Henry NJ, Heredia-Pi IB, Hoek HW, Holmberg M, Horita N, Hosgood HD, Hostiuc S, Hoy DG, Hsairi M, Htet AS, Huang JJ, Huang H, Huynh C, Iburg KM, Ikeda C, Inoue M, Irvine CMS, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jauregui A, Javanbakht M, Jeemon P, Jha V, John D, Johnson CO, Johnson SC, Jonas JB, Jürisson M, Kabir Z, Kadel R, Kahsay A, Kamal R, Karch A, Karema CK, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kawakami N, Keiyoro PN, Kelbore SG, Kemmer L, Kengne AP, Kesavachandran CN, Khader YS, Khalil IA, Khan EA, Khang YH, Khosravi A, Khubchandani J, Kieling C, Kim JY, Kim YJ, Kim D, Kimokoti RW, Kinfu Y, Kisa A, Kissimova-Skarbek KA, Kivimaki M, Kokubo Y, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krohn KJ, Kulikoff XR, Kumar GA, Kumar Lal D, Kutz MJ, Kyu HH, Lalloo R, Lansingh VC, Larsson A, Lazarus JV, Lee PH, Leigh J, Leung J, Leung R, Levi M, Li Y, Liben ML, Linn S, Liu PY, Liu S, Lodha R, Looker KJ, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Lucas TCD, Lunevicius R, Mackay MT, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Majdan M, Majdzadeh R, Majeed A, Malekzadeh R, Malhotra R, Malta DC, Mamun AA, Manguerra H, Mantovani LG, Manyazewal T, Mapoma CC, Marks GB, Martin RV, Martinez-Raga J, Martins-Melo FR, Martopullo I, Mathur MR, Mazidi M, McAlinden C, McGaughey M, McGrath JJ, McKee M, Mehata S, Mehndiratta MM, Meier T, Meles KG, Memish ZA, Mendoza W, Mengesha MM, Mengistie MA, Mensah GA, Mensink GBM, Mereta ST, Meretoja TJ, Meretoja A, Mezgebe HB, Micha R, Millear A, Miller TR, Minnig S, Mirarefin M, Mirrakhimov EM, Misganaw A, Mishra SR, Mitchell PB, Mohammad KA, Mohammed KE, Mohammed S, Mohan MBV, Mokdad AH, Mollenkopf SK, Monasta L, Montañez Hernandez JC, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Morrison SD, Moses MW, Mountjoy-Venning C, Mueller UO, Muller K, Murthy GVS, Musa KI, Naghavi M, Naheed A, Naidoo KS, Nangia V, Natarajan G, Negoi RI, Negoi I, Nguyen CT, Nguyen QL, Nguyen TH, Nguyen G, Nguyen M, Nichols E, Ningrum DNA, Nomura M, Nong VM, Norheim OF, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olagunju AT, Olagunju TO, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Ong K, Oren E, Ortiz A, Owolabi MO, PA M, Pana A, Panda BK, Panda-Jonas S, Papachristou C, Park EK, Patton GC, Paulson K, Pereira DM, Perico DN, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Piradov MA, Pishgar F, Poulton RG, Pourmalek F, Qorbani M, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahman M, Rai RK, Rajsic S, Ram U, Ranabhat CL, Rao PC, Rawaf S, Reidy P, Reiner RC, Reinig N, Reitsma MB, Remuzzi G, Renzaho AMN, Resnikoff S, Rezaei S, Rios Blancas MJ, Rivas JC, Roba KT, Rojas-Rueda D, Rokni MB, Roshandel G, Roth GA, Roy A, Rubagotti E, Sadat N, Safdarian M, Safi S, Safiri S, Sagar R, Salama J, Salomon JA, Samy AM, Sanabria JR, Santomauro D, Santos IS, Santos JV, Santric Milicevic MM, Sartorius B, Satpathy M, Sawhney M, Saxena S, Saylan MI, Schmidt MI, Schneider IJC, Schneider MT, Schöttker B, Schutte AE, Schwebel DC, Schwendicke F, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shamsipour M, Shamsizadeh M, Shariful Islam SM, Sharma J, Sharma R, She J, Shi P, Shibuya K, Shields C, Shifa GT, Shiferaw MS, Shigematsu M, Shin MJ, Shiri R, Shirkoohi R, Shirude S, Shishani K, Shoman H, Shrime MG, Silberberg DH, Silva DAS, Silva JP, Silveira DGA, Singh JA, Singh V, Sinha DN, Skiadaresi E, Slepak EL, Sligar A, Smith DL, Smith A, Smith M, Sobaih BHA, Sobngwi E, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Srinivasan V, Stanaway JD, Stein DJ, Steiner C, Steinke S, Stokes MA, Strub B, Sufiyan MB, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Sylte DO, Szoeke CEI, Tabarés-Seisdedos R, Tadakamadla SK, Tandon N, Tao T, Tarekegn YL, Tavakkoli M, Taveira N, Tegegne TK, Terkawi AS, Tessema GA, Thakur JS, Thankappan KR, Thrift AG, Tiruye TY, Tobe-Gai R, Topor-Madry R, Torre A, Tortajada M, Tran BX, Troeger C, Truelsen T, Tsoi D, Tuem KB, Tuzcu EM, Tyrovolas S, Ukwaja KN, Uneke CJ, Updike R, Uthman OA, van Boven JFM, Varughese S, Vasankari T, Venketasubramanian N, Vidavalur R, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wadilo F, Wakayo T, Wallin MT, Wang YP, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Woldeyes BG, Wolfe CDA, Woodbrook R, Xavier D, Xu G, Yadgir S, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Yotebieng M, Younis MZ, Zaidi Z, Zaki MES, Zavala-Arciniega L, Zhang X, Zipkin B, Zodpey S, Lim SS, Murray CJL. Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 2017; 390:1423-1459. [PMID: 28916366 PMCID: PMC5603800 DOI: 10.1016/s0140-6736(17)32336-x] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The UN's Sustainable Development Goals (SDGs) are grounded in the global ambition of "leaving no one behind". Understanding today's gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990-2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030. METHODS We used standardised GBD 2016 methods to measure 37 health-related indicators from 1990 to 2016, an increase of four indicators since GBD 2015. We substantially revised the universal health coverage (UHC) measure, which focuses on coverage of essential health services, to also represent personal health-care access and quality for several non-communicable diseases. We transformed each indicator on a scale of 0-100, with 0 as the 2·5th percentile estimated between 1990 and 2030, and 100 as the 97·5th percentile during that time. An index representing all 37 health-related SDG indicators was constructed by taking the geometric mean of scaled indicators by target. On the basis of past trends, we produced projections of indicator values, using a weighted average of the indicator and country-specific annualised rates of change from 1990 to 2016 with weights for each annual rate of change based on out-of-sample validity. 24 of the currently measured health-related SDG indicators have defined SDG targets, against which we assessed attainment. FINDINGS Globally, the median health-related SDG index was 56·7 (IQR 31·9-66·8) in 2016 and country-level performance markedly varied, with Singapore (86·8, 95% uncertainty interval 84·6-88·9), Iceland (86·0, 84·1-87·6), and Sweden (85·6, 81·8-87·8) having the highest levels in 2016 and Afghanistan (10·9, 9·6-11·9), the Central African Republic (11·0, 8·8-13·8), and Somalia (11·3, 9·5-13·1) recording the lowest. Between 2000 and 2016, notable improvements in the UHC index were achieved by several countries, including Cambodia, Rwanda, Equatorial Guinea, Laos, Turkey, and China; however, a number of countries, such as Lesotho and the Central African Republic, but also high-income countries, such as the USA, showed minimal gains. Based on projections of past trends, the median number of SDG targets attained in 2030 was five (IQR 2-8) of the 24 defined targets currently measured. Globally, projected target attainment considerably varied by SDG indicator, ranging from more than 60% of countries projected to reach targets for under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria, to less than 5% of countries projected to achieve targets linked to 11 indicator targets, including those for childhood overweight, tuberculosis, and road injury mortality. For several of the health-related SDGs, meeting defined targets hinges upon substantially faster progress than what most countries have achieved in the past. INTERPRETATION GBD 2016 provides an updated and expanded evidence base on where the world currently stands in terms of the health-related SDGs. Our improved measure of UHC offers a basis to monitor the expansion of health services necessary to meet the SDGs. Based on past rates of progress, many places are facing challenges in meeting defined health-related SDG targets, particularly among countries that are the worst off. In view of the early stages of SDG implementation, however, opportunity remains to take actions to accelerate progress, as shown by the catalytic effects of adopting the Millennium Development Goals after 2000. With the SDGs' broader, bolder development agenda, multisectoral commitments and investments are vital to make the health-related SDGs within reach of all populations. FUNDING Bill & Melinda Gates Foundation.
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Deribe K, Cano J, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Cromwell EA, Osgood-Zimmerman A, Enquselassie F, Hailu A, Murray CJL, Newport MJ, Brooker SJ, Hay SI, Davey G. Estimating the number of cases of podoconiosis in Ethiopia using geostatistical methods. Wellcome Open Res 2017; 2:78. [PMID: 29152596 PMCID: PMC5668927 DOI: 10.12688/wellcomeopenres.12483.2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2011, the World Health Organization recognized podoconiosis as one of the neglected tropical diseases. Nonetheless, the number of people with podoconiosis and the geographical distribution of the disease is poorly understood. Based on a nationwide mapping survey and geostatistical modelling, we predict the prevalence of podoconiosis and estimate the number of cases across Ethiopia. METHODS We used nationwide data collected in Ethiopia between 2008 and 2013. Data were available for 141,238 individuals from 1,442 villages in 775 districts from all nine regional states and two city administrations. We developed a geostatistical model of podoconiosis prevalence among adults (individuals aged 15 years or above), by combining environmental factors. The number of people with podoconiosis was then estimated using a gridded map of adult population density for 2015. RESULTS Podoconiosis is endemic in 345 districts in Ethiopia: 144 in Oromia, 128 in Southern Nations, Nationalities and People's [SNNP], 64 in Amhara, 4 in Benishangul Gumuz, 4 in Tigray and 1 in Somali Regional State. Nationally, our estimates suggest that 1,537,963 adults (95% confidence intervals, 290,923-4,577,031 adults) were living with podoconiosis in 2015. Three regions (SNNP, Oromia and Amhara) contributed 99% of the cases. The highest proportion of individuals with podoconiosis resided in the SNNP (39%), while 32% and 29% of people with podoconiosis resided in Oromia and Amhara Regional States, respectively. Tigray and Benishangul Gumuz Regional States bore lower burdens, and in the remaining regions, podoconiosis was almost non-existent. Discussion: The estimates of podoconiosis cases presented here based upon the combination of currently available epidemiological data and a robust modelling approach clearly show that podoconiosis is highly endemic in Ethiopia. Given the presence of low cost prevention, and morbidity management and disability prevention services, it is our collective responsibility to scale-up interventions rapidly.
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Misganaw A, Haregu TN, Deribe K, Tessema GA, Deribew A, Melaku YA, Amare AT, Abera SF, Gedefaw M, Dessalegn M, Lakew Y, Bekele T, Mohammed M, Yirsaw BD, Damtew SA, Krohn KJ, Achoki T, Blore J, Assefa Y, Naghavi M. National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990-2015: findings from the Global Burden of Disease Study 2015. Popul Health Metr 2017; 15:29. [PMID: 28736507 PMCID: PMC5521057 DOI: 10.1186/s12963-017-0145-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/14/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ethiopia lacks a complete vital registration system that would assist in measuring disease burden and risk factors. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) estimates to describe the mortality burden from communicable, non-communicable, and other diseases in Ethiopia over the last 25 years. METHODS GBD 2015 mainly used cause of death ensemble modeling to measure causes of death by age, sex, and year for 195 countries. We report numbers of deaths and rates of years of life lost (YLL) for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases (NCDs), and injuries with 95% uncertainty intervals (UI) for Ethiopia from 1990 to 2015. RESULTS CMNN causes of death have declined by 65% in the last two-and-a-half decades. Injury-related causes of death have also decreased by 70%. Deaths due to NCDs declined by 37% during the same period. Ethiopia showed a faster decline in the burden of four out of the five leading causes of age-standardized premature mortality rates when compared to the overall sub-Saharan African region and the Eastern sub-Saharan African region: lower respiratory infections, tuberculosis, HIV/AIDS, and diarrheal diseases; however, the same could not be said for ischemic heart disease and other NCDs. Non-communicable diseases, together, were the leading causes of age-standardized mortality rates, whereas CMNN diseases were leading causes of premature mortality in 2015. Although lower respiratory infections, tuberculosis, and diarrheal disease were the leading causes of age-standardized death rates, they showed major declines from 1990 to 2015. Neonatal encephalopathy, iron-deficiency anemia, protein-energy malnutrition, and preterm birth complications also showed more than a 50% reduction in burden. HIV/AIDS-related deaths have also decreased by 70% since 2005. Ischemic heart disease, hemorrhagic stroke, and ischemic stroke were among the top causes of premature mortality and age-standardized death rates in Ethiopia in 2015. CONCLUSIONS Ethiopia has been successful in reducing deaths related to communicable, maternal, neonatal, and nutritional deficiency diseases and injuries by 65%, despite unacceptably high maternal and neonatal mortality rates. However, the country's performance regarding non-communicable diseases, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, was minimal, causing these diseases to join the leading causes of premature mortality and death rates in 2015. While the country is progressing toward universal health coverage, prevention and control strategies in Ethiopia should consider the double burden of common infectious diseases and non-communicable diseases: lower respiratory infections, diarrhea, tuberculosis, HIV/AIDS, cardiovascular disease, cancer, and diabetes. Prevention and control strategies should also pay special attention to the leading causes of premature mortality and death rates caused by non-communicable diseases: cardiovascular disease, cancer, and diabetes. Measuring further progress requires a data revolution in generating, managing, analyzing, and using data for decision-making and the creation of a full vital registration system in the country.
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Misganaw A, Melaku YA, Tessema GA, Deribew A, Deribe K, Abera SF, Dessalegn M, Lakew Y, Bekele T, Haregu TN, Amare AT, Gedefaw M, Mohammed M, Yirsaw BD, Damtew SA, Achoki T, Blore J, Krohn KJ, Assefa Y, Kifle M, Naghavi M. National disability-adjusted life years (DALYs) for 257 diseases and injuries in Ethiopia, 1990-2015: findings from the global burden of disease study 2015. Popul Health Metr 2017; 15:28. [PMID: 28732542 PMCID: PMC5521136 DOI: 10.1186/s12963-017-0146-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/14/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Disability-adjusted life years (DALYs) provide a summary measure of health and can be a critical input to guide health systems, investments, and priority-setting in Ethiopia. We aimed to determine the leading causes of premature mortality and disability using DALYs and describe the relative burden of disease and injuries in Ethiopia. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for non-fatal disease burden, cause-specific mortality, and all-cause mortality to derive age-standardized DALYs by sex for Ethiopia for each year. We calculated DALYs by summing years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) for each age group and sex. Causes of death by age, sex, and year were measured mainly using Causes of Death Ensemble modeling. To estimate YLDs, a Bayesian meta-regression method was used. We reported DALY rates per 100,000 for communicable, maternal, neonatal, and nutritional (CMNN) disorders, non-communicable diseases, and injuries, with 95% uncertainty intervals (UI) for Ethiopia. RESULTS Non-communicable diseases caused 23,118.1 (95% UI, 17,124.4-30,579.6), CMNN disorders resulted in 20,200.7 (95% UI, 16,532.2-24,917.9), and injuries caused 3781 (95% UI, 2642.9-5500.6) age-standardized DALYs per 100,000 in Ethiopia in 2015. Lower respiratory infections, diarrheal diseases, and tuberculosis were the top three leading causes of DALYs in 2015, accounting for 2998 (95% UI, 2173.7-4029), 2592.5 (95% UI, 1850.7-3495.1), and 2562.9 (95% UI, 1466.1-4220.7) DALYs per 100,000, respectively. Ischemic heart disease and cerebrovascular disease were the fourth and fifth leading causes of age-standardized DALYs, with rates of 2535.7 (95% UI, 1603.7-3843.2) and 2159.9 (95% UI, 1369.7-3216.3) per 100,000, respectively. The following causes showed a reduction of 60% or more over the last 25 years: lower respiratory infections, diarrheal diseases, tuberculosis, neonatal encephalopathy, preterm birth complications, meningitis, malaria, protein-energy malnutrition, iron-deficiency anemia, measles, war and legal intervention, and maternal hemorrhage. CONCLUSIONS Ethiopia has been successful in reducing age-standardized DALYs related to most communicable, maternal, neonatal, and nutritional deficiency diseases in the last 25 years, causing a major ranking shift to types of non-communicable disease. Lower respiratory infections, diarrheal disease, and tuberculosis continue to be leading causes of premature death, despite major declines in burden. Non-communicable diseases also showed reductions as premature mortality declined; however, disability outcomes for these causes did not show declines. Recently developed non-communicable disease strategies may need to be amended to focus on cardiovascular diseases, cancer, diabetes, and major depressive disorders. Increasing trends of disabilities due to neonatal encephalopathy, preterm birth complications, and neonatal disorders should be emphasized in the national newborn survival strategy. Generating quality data should be a priority through the development of new initiatives such as vital events registration, surveillance programs, and surveys to address gaps in data. Measuring disease burden at subnational regional state levels and identifying variations with urban and rural population health should be conducted to support health policy in Ethiopia.
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Barber RM, Fullman N, Sorensen RJD, Bollyky T, McKee M, Nolte E, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abdurahman AA, Abera SF, Abraham B, Abreha GF, Adane K, Adelekan AL, Adetifa IMO, Afshin A, Agarwal A, Agarwal SK, Agarwal S, Agrawal A, Kiadaliri AA, Ahmadi A, Ahmed KY, Ahmed MB, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam N, Alam SS, Alemu ZA, Alene KA, Alexander L, Ali R, Ali SD, Alizadeh-Navaei R, Alkerwi A, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amini E, Ammar W, Amo-Adjei J, Amoako YA, Anderson BO, Androudi S, Ansari H, Ansha MG, Antonio CAT, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Astatkie A, Atey TM, Atique S, Atnafu NT, Atre SR, Avila-Burgos L, Avokpaho EFGA, Quintanilla BPA, Awasthi A, Ayele NN, Azzopardi P, Saleem HOB, Bärnighausen T, Bacha U, Badawi A, Banerjee A, Barac A, Barboza MA, Barker-Collo SL, Barrero LH, Basu S, Baune BT, Baye K, Bayou YT, Bazargan-Hejazi S, Bedi N, Beghi E, Béjot Y, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Bernal OA, Beyene AS, Beyene TJ, Bhutta ZA, Biadgilign S, Bikbov B, Birlik SM, Birungi C, Biryukov S, Bisanzio D, Bizuayehu HM, Bose D, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Brenner H, Butt ZA, Cárdenas R, Cahuana-Hurtado L, Campos-Nonato IR, Car J, Carrero JJ, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cecilio P, Cercy K, Charlson FJ, Chen AZ, Chew A, Chibalabala M, Chibueze CE, Chisumpa VH, Chitheer AA, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coggeshall MS, Cooper LT, Cortinovis M, Crump JA, Dalal K, Danawi H, Dandona L, Dandona R, Dargan PI, das Neves J, Davey G, Davitoiu DV, Davletov K, De Leo D, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dey S, Dharmaratne SD, Dicker D, Ding EL, Dokova K, Dorsey ER, Doyle KE, Dubey M, Ehrenkranz R, Ellingsen CL, Elyazar I, Enayati A, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fürst T, Faghmous IDA, Fanuel FBB, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Feigl AB, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Feyissa TR, Fischer F, Fitzmaurice C, Fleming TD, Foigt N, Foreman KJ, Forouzanfar MH, Franklin RC, Frostad J, G/hiwot TT, Gakidou E, Gambashidze K, Gamkrelidze A, Gao W, Garcia-Basteiro AL, Gebre T, Gebremedhin AT, Gebremichael MW, Gebru AA, Gelaye AA, Geleijnse JM, Genova-Maleras R, Gibney KB, Giref AZ, Gishu MD, Giussani G, Godwin WW, Gold A, Goldberg EM, Gona PN, Goodridge A, Gopalani SV, Goto A, Graetz N, Greaves F, Griswold M, Guban PI, Gugnani HC, Gupta PC, Gupta R, Gupta R, Gupta T, Gupta V, Habtewold TD, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Hakuzimana A, Hamadeh RR, Hambisa MT, Hamidi S, Hammami M, Hankey GJ, Hao Y, Harb HL, Hareri HA, Haro JM, Hassanvand MS, Havmoeller R, Hay RJ, Hay SI, Hendrie D, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Htet AS, Hu G, Huang H, Huang JJ, Huntley BM, Huynh C, Iburg KM, Ileanu BV, Innos K, Irenso AA, Jahanmehr N, Jakovljevic MB, James P, James SL, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jeemon P, Jha V, John D, Johnson C, Johnson SC, Jonas JB, Juel K, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimi SM, Kasaeian A, Kassebaum NJ, Kastor A, Katikireddi SV, Kazanjan K, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Kerbo AA, Kereselidze M, Kesavachandran CN, Khader YS, Khalil I, Khan AR, Khan EA, Khan G, Khang YH, Khoja ATA, Khonelidze I, Khubchandani J, Kibret GD, Kim D, Kim P, Kim YJ, Kimokoti RW, Kinfu Y, Kissoon N, Kivipelto M, Kokubo Y, Kolk A, Kolte D, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko M, Krishnaswami S, Krohn KJ, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar GA, Kumsa FA, Kutz M, Kyu HH, Lager ACJ, Lal A, Lal DK, Lalloo R, Lallukka T, Lan Q, Langan SM, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leinsalu M, Leshargie CT, Leung J, Leung R, Levi M, Liang X, Lim SS, Lind M, Linn S, Lipshultz SE, Liu P, Liu Y, Lo LT, Logroscino G, Lopez AD, Lorch SA, Lotufo PA, Lozano R, Lunevicius R, Lyons RA, Macarayan ERK, Mackay MT, El Razek HMA, El Razek MMA, Mahdavi M, Majeed A, Malekzadeh R, Malta DC, Mantovani LG, Manyazewal T, Mapoma CC, Marcenes W, Marks GB, Marquez N, Martinez-Raga J, Marzan MB, Massano J, Mathur MR, Maulik PK, Mazidi M, McAlinden C, McGrath JJ, McNellan C, Meaney PA, Mehari A, Mehndiratta MM, Meier T, Mekonnen AB, Meles KG, Memish ZA, Mengesha MM, Mengiste DT, Mengistie MA, Menota BG, Mensah GA, Mereta ST, Meretoja A, Meretoja TJ, Mezgebe HB, Micha R, Millear A, Mills EJ, Minnig S, Mirarefin M, Mirrakhimov EM, Mock CN, Mohammad KA, Mohammed S, Mohanty SK, Mokdad AH, Mola GLD, Molokhia M, Monasta L, Montico M, Moradi-Lakeh M, Moraga P, Morawska L, Mori R, Moses M, Mueller UO, Murthy S, Musa KI, Nachega JB, Nagata C, Nagel G, Naghavi M, Naheed A, Naldi L, Nangia V, Nascimento BR, Negoi I, Neupane SP, Newton CR, Ng M, Ngalesoni FN, Ngunjiri JW, Nguyen G, Ningrum DNA, Nolte S, Nomura M, Norheim OF, Norrving B, Noubiap JJN, Obermeyer CM, Ogbo FA, Oh IH, Okoro A, Oladimeji O, Olagunju AT, Olivares PR, Olsen HE, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Osman M, Owolabi MO, PA M, Pain AW, Pakhale S, Castillo EP, Pana A, Papachristou C, Parsaeian M, Patel T, Patton GC, Paudel D, Paul VK, Pearce N, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Pesudovs K, Petzold M, Phillips MR, Pigott DM, Pillay JD, Pinho C, Polinder S, Pond CD, Prakash V, Purwar M, Qorbani M, Quistberg DA, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rai RK, Ram U, Rana SM, Rankin Z, Rao PV, Rao PC, Rawaf S, Rego MAS, Reitsma M, Remuzzi G, Renzaho AMNN, Resnikoff S, Rezaei S, Rezai MS, Ribeiro AL, Roba HS, Rokni MB, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy NK, Sachdev PS, Sackey BB, Saeedi MY, Safiri S, Sagar R, Sahraian MA, Saleh MM, Salomon JA, Samy AM, Sanabria JR, Sanchez-Niño MD, Sandar L, Santos IS, Santos JV, Milicevic MMS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schöttker B, Schutte AE, Schwebel DC, Seedat S, Seid AM, Seifu CN, Sepanlou SG, Serdar B, Servan-Mori EE, Setegn T, Shackelford KA, Shaheen A, Shahraz S, Shaikh MA, Shakh-Nazarova M, Shamsipour M, Islam SMS, Sharma J, Sharma R, She J, Sheikhbahaei S, Shen J, Shi P, Shigematsu M, Shin MJ, Shiri R, Shoman H, Shrime MG, Sibamo ELS, Sigfusdottir ID, Silva DAS, Silveira DGA, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Sinke AH, Sinshaw AE, Skirbekk V, Sliwa K, Smith A, Sobngwi E, Soneji S, Soriano JB, Sousa TCM, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Steiner C, Steinke S, Stokes MA, Stranges S, Strong M, Stroumpoulis K, Sturua L, Sufiyan MB, Suliankatchi RA, Sun J, Sur P, Swaminathan S, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Taffere GR, Talongwa RT, Tarajia M, Tavakkoli M, Taveira N, Teeple S, Tegegne TK, Tehrani-Banihashemi A, Tekelab T, Tekle DY, Shifa GT, Terkawi AS, Tesema AG, Thakur JS, Thomson AJ, Tillmann T, Tiruye TY, Tobe-Gai R, Tonelli M, Topor-Madry R, Tortajada M, Troeger C, Truelsen T, Tura AK, Uchendu US, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Boven JFM, Van Dingenen R, Varughese S, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Vos T, Wagner JA, Wakayo T, Waller SG, Walson JL, Wang H, Wang YP, Watkins DA, Weiderpass E, Weintraub RG, Wen CP, Werdecker A, Wesana J, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Woldeyes BG, Wolfe CDA, Won S, Workicho A, Workie SB, Wubshet M, Xavier D, Xu G, Yadav AK, Yaghoubi M, Yakob B, Yan LL, Yano Y, Yaseri M, Yimam HH, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zenebe ZM, Zodpey S, Zoeckler L, Zuhlke LJ, Murray CJL. Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015. Lancet 2017; 390:231-266. [PMID: 28528753 PMCID: PMC5528124 DOI: 10.1016/s0140-6736(17)30818-8] [Citation(s) in RCA: 307] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. METHODS We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. FINDINGS Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. INTERPRETATION This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. FUNDING Bill & Melinda Gates Foundation.
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Deribew A, Dejene T, Kebede B, Tessema GA, Melaku YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Yirsaw BD, Abajobir AA, Shafi O, Abera SF, Negussu N, Mengistu B, Amare AT, Mulugeta A, Mengistu B, Tadesse Z, Sileshi M, Cromwell E, Glenn SD, Deribe K, Stanaway JD. Incidence, prevalence and mortality rates of malaria in Ethiopia from 1990 to 2015: analysis of the global burden of diseases 2015. Malar J 2017; 16:271. [PMID: 28676108 PMCID: PMC5496144 DOI: 10.1186/s12936-017-1919-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/27/2017] [Indexed: 12/21/2022] Open
Abstract
Background In Ethiopia there is no complete registration system to measure disease burden and risk factors accurately. In this study, the 2015 global burden of diseases, injuries and risk factors (GBD) data were used to analyse the incidence, prevalence and mortality rates of malaria in Ethiopia over the last 25 years. Methods GBD 2015 used verbal autopsy surveys, reports, and published scientific articles to estimate the burden of malaria in Ethiopia. Age and gender-specific causes of death for malaria were estimated using cause of death ensemble modelling. Results The number of new cases of malaria declined from 2.8 million [95% uncertainty interval (UI) 1.4–4.5 million] in 1990 to 621,345 (95% UI 462,230–797,442) in 2015. Malaria caused an estimated 30,323 deaths (95% UI 11,533.3–61,215.3) in 1990 and 1561 deaths (95% UI 752.8–2660.5) in 2015, a 94.8% reduction over the 25 years. Age-standardized mortality rate of malaria has declined by 96.5% between 1990 and 2015 with an annual rate of change of 13.4%. Age-standardized malaria incidence rate among all ages and gender declined by 88.7% between 1990 and 2015. The number of disability-adjusted life years lost (DALY) due to malaria decreased from 2.2 million (95% UI 0.76–4.7 million) in 1990 to 0.18 million (95% UI 0.12–0.26 million) in 2015, with a total reduction 91.7%. Similarly, age-standardized DALY rate declined by 94.8% during the same period. Conclusions Ethiopia has achieved a 50% reduction target of malaria of the millennium development goals. The country should strengthen its malaria control and treatment strategies to achieve the sustainable development goals.
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Deribe K, Kebede B, Tamiru M, Mengistu B, Kebede F, Martindale S, Sime H, Mulugeta A, Kebede B, Sileshi M, Mengiste A, McPherson S, Fentaye A. Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia. Bull World Health Organ 2017; 95:652-656. [PMID: 28867846 PMCID: PMC5578380 DOI: 10.2471/blt.16.189399] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. APPROACH To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. LOCAL SETTING In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. RELEVANT CHANGES To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts. LESSONS LEARNT In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic.
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Deribe K, Cano J, Newport MJ, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Hay SI, Brooker SJ, Davey G. The global atlas of podoconiosis. Lancet Glob Health 2017; 5:e477-e479. [PMID: 28395836 PMCID: PMC5390851 DOI: 10.1016/s2214-109x(17)30140-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/22/2022]
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Burn H, Aweke S, Wondie T, Habtamu E, Deribe K, Rajak S, Bremner S, Davey G. Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study. PLoS Negl Trop Dis 2017; 11:e0005388. [PMID: 28187129 PMCID: PMC5322969 DOI: 10.1371/journal.pntd.0005388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/23/2017] [Accepted: 02/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population. METHODS A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract. FINDINGS A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02-2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55-1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08-6.39), P = 0.03. CONCLUSIONS Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.
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Beyene HB, Bekele A, Shifara A, Ebstie YA, Desalegn Z, Kebede Z, Mulugeta A, Deribe K, Tadesse Z, Abebe T, Kebede B, Abrha G, Jima D. Elimination of Guinea Worm Disease in Ethiopia; Current Status of the Disease's, Eradication Strategies and Challenges to the End Game. ETHIOPIAN MEDICAL JOURNAL 2017; 55:15-31. [PMID: 28878428 PMCID: PMC5582630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dracunculiasis, also named Guinea Worm Disease (GWD), is one of the Neglected Tropical Diseases (NTDs) caused by a parasitic nematode known as Dracunculus medinensis and has been known since antiquity as 'fiery serpent' from Israelites. It is transmitted to humans via drinking contaminated water containing infective copepods. Given, its feasibility for eradication, the Guinea Worm Eradication Program (GWEP) was launched in 1980 with the aim of eradicating the disease. Since its inception, GWEP has made an extraordinary progress in interrupting transmission. Globally, the number of reported cases reduced from 3.5 million in 20 countries in 1986 to only 22 cases in 2015 from only four countries namely South Sudan, Mali, Chad and Ethiopia. Since Mali has interrupted transmission of GWD in 2016, currently, the disease remains endemic in only three sub-Saharan African countries namely, South Sudan, Chad and Ethiopia. Each endemic country has its own national Guinea Worm Eradication Program. In Ethiopia, the Ethiopian Dracunculiasis Eradication Program (EDEP) which was established in 1993 has made remarkable move towards interruption of disease transmission and now the endgame is fast approaching. The EDEP with support mainly from The Carter Center, WHO, and UNICEF has reduced GWD by more than 99% from 1994 to 2015. In 2015, only 3 indigenous cases in humans and 14 in animals (13 in dogs and 1 in baboon) were reported. In 2016, 3 human cases, 14 dogs and 2 baboon infections were reported.. Refugee influx from the Republic of South Sudan (RSS), increased animal infections with unknown role in transmission of Dracunculiasis, the presence of hard to reach communities and lack of safe water sources in remote non-village areas remain among important challenges at this final stage of GWD eradication in Ethiopia. This paper reviews progress made towards Guinea Worm Eradication with a focus on the experience of the Ethiopian Dracunculiasis Eradication Program (EDEP), and intervention strategies that need further intensification to realize the endgame. Eradication strategies encompassing community education for behavioral change including raising awareness towards cash reward for reporting Guniea Worm Disease (GWD) and animal infection, case containment, surveillance systems, provision of safe water supply, and ABATE chemical application are discussed. It also summarizes challenges the end game faces and recommendations to strengthen the eradication effort.
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Meribo K, Kebede B, Feleke SM, Mengistu B, Mulugeta A, Sileshi M, Samuel A, Deribe K, Tadesse Z. Review of Ethiopian Onchocerciasis Elimination Programme. ETHIOPIAN MEDICAL JOURNAL 2017; 55:55-63. [PMID: 28878430 PMCID: PMC5582636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Onchocerciasis is a severe parasitic infection which causes disabling skin and subcutaneous tissue changes. The disease is endemic in many African countries including Ethiopia. In 2013, Ethiopia launched Onchocerciasis elimination program with the goal of attaining interruption of onchocerciasis transmission nationwide by 2020. The country has successfully scaled up interventions and achieved 100% geographic coverage in all known endemic districts. The main strategy for interrupting the disease is mass drug administration (MDA) delivered two times per year. The treatment coverage for the last five years has been maintained at more than 80%. Despite many years of ivermectin MDA the transmission of onchocerciasis in many districts remained unabated. To achieve the 2020 goal, sustained high geographic and therapeutic coverage is required which is validated by coverage surveys. The programme should aim to improve the knowledge and attitude of the community towards the programme in order to improve drug compliance. The partnership between the relevant stakeholders should be strengthened to facilitate open discussions regarding the programme implementation and any challenges that may arise in the control and elimination of the disease. It is also important to consider intensified vector control.
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Negussu N, Mengistu B, Kebede B, Deribe K, Ejigu E, Tadesse G, Mekete K, Sileshi M. Ethiopia Schistosomiasis and Soil-Transmitted Helminthes Control Programme: Progress and Prospects. ETHIOPIAN MEDICAL JOURNAL 2017; 55:75-80. [PMID: 28878432 PMCID: PMC5582635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Schistosomiasis and soil-transmitted helminthes are among seventeen WHO prioritized neglected tropical diseases that infect humans. These parasitic infections can be treated using single-dose and safe drugs. Ethiopia successfully mapped the distribution of these infections nationwide. According to the mapping there are an estimated 37.3 million people living in schistosomiasis endemic areas, and 79 million in schistosomiasis and soil-transmitted helminthes endemic areas. The Federal Ministry of Health successfully scaled up Schistosomiasis and schistosomiasis and soil-transmitted helminthes intervention in endemic areas and treated over 19 million individuals in 2015. The Ministry of Health has made a huge effort to establish neglected tropical diseases, including schistosomiasis and soil-transmitted helminthes program in the health system which helped to map majority of the woredas and initiate nationwide intervention. The National control programme is designed to achieve elimination for those diseases as a major public health problem by 2020 and aim to attain transmission break by 2025. The programme focuses on reaching those school-aged children who are not attending school, integration between neglected tropical diseases programme, and further collaboration with the WASH actors.
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Deribe K, Kebede B, Mengistu B, Negussie H, Sileshi M, Tamiru M, Tomczyk S, Tekola-Ayele F, Davey G, Fentaye A. Podoconiosis in Ethiopia: From Neglect to Priority Public Health Problem. ETHIOPIAN MEDICAL JOURNAL 2017; 55:65-74. [PMID: 28878431 PMCID: PMC5582632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.
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Deribew A, Kebede B, Tessema GA, Adama YA, Misganaw A, Gebre T, Hailu A, Biadgilign S, Amberbir A, Desalegn B, Abajobir AA, Shafi O, Abera SF, Negussu N, Mengistu B, Amare AT, Mulugeta A, Kebede Z, Mengistu B, Tadesse Z, Sileshi M, Tamiru M, Chromwel EA, Glenn SD, Stanaway JD, Deribe K. Mortality and Disability-Adjusted Life-Years (Dalys) for Common Neglected Tropical Diseases in Ethiopia, 1990-2015: Evidence from the Global Burden of Disease Study 2015. ETHIOPIAN MEDICAL JOURNAL 2017; 55:3-14. [PMID: 28878427 PMCID: PMC5582634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) are important public health problems in Ethiopia. In 2013, the Federal Ministry of Health (FMOH) has launched a national NTD master plan to eliminate major NTDs of public health importance by 2020. Benchmarking the current status of NTDs in the country is important to monitor and evaluate the progress in the implementation of interventions and their impacts. Therefore, this study aims to assess the trends of mortality and Disability-adjusted Life-Years (DALY) for the priority NTDs over the last 25 years. METHODS We used the Global Burden of Disease (GBD) 2015 estimates for this study. The GBD 2015 data source for cause of death and DALY estimation included verbal autopsy (VA), Demographic and Health Surveys (DHS), and other disease specific surveys, Ministry of Health reports submitted to United Nations (UN) agencies and published scientific articles. Cause of Death Ensemble modeling (CODEm) and/or natural history models were used to estimate NTDs mortality rates. DALY were estimated as the sum of Years of Life Lost (YLL) due to premature mortality and Years Lived with Disability (YLD). RESULTS All NTDs caused an estimated of 6,293 deaths (95% uncertainty interval (UI): 3699-10,080) in 1990 and 3,593 deaths (95% UI: 2051 - 6178) in 2015, a 43% reduction over the 25 years. Age-standardized mortality rates due to schistosomiasis, STH and leshmaniasis have declined by 91.3%, 73.5% and 21.6% respectively between 1990 to 2015. The number of DALYs due to all NTDs has declined from 814.4 thousand (95% UI: 548 thousand-1.2million) in 1990 to 579.5 thousand (95%UI: 309.4 thousand-1.3 million) in 2015. Age-standardized DALY rates due to all NTDs declined by 30.7%, from 17.6 per 1000(95%UI: 12.5-26.5) in 1990 to 12.2 per 1000(95%UI: 6.5 - 27.4) in 2015. Age-standardized DALY rate for trachoma declined from 92.7 per 100,000(95% UI: 63.2 - 128.4) in 1990 to 41.2 per 100,000(95%UI: 27.4-59.2) in 2015, a 55.6% reduction between 1990 and 2015. Age-standardized DALY rates for onchocerciasis, schistosomiasis and lymphiaticfilariasis decreased by 66.2%, 29.4% and 12.5% respectively between 1990 and 2015. DALY rate for ascariasis fell by 56.8% over the past 25 years. CONCLUSIONS Ethiopia has made a remarkable progress in reducing the DALY rates for most of the NTDs over the last 25 years. The rapid scale of interventions and broader system strengthening may have a lasting impact on achieving the 2020 goal of elimination of most of NTDs. Ethiopia should strengthen the coverage of integrated interventions of NTD through proper coordination with other health programs and sectors and community participation to eliminate NTDs by 2020.
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Mengistu B, Deribe K, Kebede F, Martindale S, Hassan M, Sime H, Mackenzie C, Mulugeta A, Tamiru M, Sileshi M, Hailu A, Gebre T, Fentaye A, Kebede B. The National Programme to Eliminate Lymphatic Filariasis from Ethiopia. ETHIOPIAN MEDICAL JOURNAL 2017; 55:45-54. [PMID: 28878429 PMCID: PMC5582637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Lymphatic filariasis (LF) is one of the most debilitating and disfiguring diseases common in Ethiopia and is caused by Wuchereria bancrofti. Mapping for LF has shown that 70 woredas (districts) are endemic and 5.9 million people are estimated to be at risk. The national government's LF elimination programme commenced in 2009 in 5 districts integrated with the onchocerciasis programme. The programme developed gradually and has shown significant progress over the past 6 years, reaching 100% geographical coverage for mass drug administration (MDA) by 2016. To comply with the global LF elimination goals an integrated morbidity management and disability prevention (MMDP) guideline and a burden assessment programme has also been developed; MMDP protocols and a hydrocoele surgical handbook produced for country-wide use. In Ethiopia, almost all LF endemic districts are co-endemic with malaria and vector control aspects of the activities are conducted in the context of malaria programme as the vectors for both diseases are mosquitoes. In order to monitor the elimination, 11 sentinel and spot-check sites have been established and baseline information has been collected. Although significant achievements have been achieved in the scale up of the LF elimination programme, there is still a need to strengthen operational research to generate programme-relevant evidence, to increase access to morbidity management services, and to improve monitoring and evaluation of the LF programme. However, the current status of implementation of the LF national programme indicates that Ethiopia is poised to achieve the 2020 goal of elimination of LF. Nevertheless, to achieve this goal, high and sustained treatment coverage and strong monitoring and evaluation of the programme are essential.
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Melaku YA, Temesgen AM, Deribew A, Tessema GA, Deribe K, Sahle BW, Abera SF, Bekele T, Lemma F, Amare AT, Seid O, Endris K, Hiruye A, Worku A, Adams R, Taylor AW, Gill TK, Shi Z, Afshin A, Forouzanfar MH. The impact of dietary risk factors on the burden of non-communicable diseases in Ethiopia: findings from the Global Burden of Disease study 2013. Int J Behav Nutr Phys Act 2016; 13:122. [PMID: 27978839 PMCID: PMC5159959 DOI: 10.1186/s12966-016-0447-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) has increased in sub-Saharan countries, including Ethiopia. The contribution of dietary behaviours to the NCD burden in Ethiopia has not been evaluated. This study, therefore, aimed to assess diet-related burden of disease in Ethiopia between 1990 and 2013. METHOD We used the 2013 Global Burden of Disease (GBD) data to estimate deaths, years of life lost (YLLs) and disability-adjusted life years (DALYs) related to eight food types, five nutrients and fibre intake. Dietary exposure was estimated using a Bayesian hierarchical meta-regression. The effect size of each diet-disease pair was obtained based on meta-analyses of prospective observational studies and randomized controlled trials. A comparative risk assessment approach was used to quantify the proportion of NCD burden associated with dietary risk factors. RESULTS In 2013, dietary factors were responsible for 60,402 deaths (95% Uncertainty Interval [UI]: 44,943-74,898) in Ethiopia-almost a quarter (23.0%) of all NCD deaths. Nearly nine in every ten diet-related deaths (88.0%) were from cardiovascular diseases (CVD) and 44.0% of all CVD deaths were related to poor diet. Suboptimal diet accounted for 1,353,407 DALYs (95% UI: 1,010,433-1,672,828) and 1,291,703 YLLs (95% UI: 961,915-1,599,985). Low intake of fruits and vegetables and high intake of sodium were the most important dietary factors. The proportion of NCD deaths associated with low fruit consumption slightly increased (11.3% in 1990 and 11.9% in 2013). In these years, the rate of burden of disease related to poor diet slightly decreased; however, their contribution to NCDs remained stable. CONCLUSIONS Dietary behaviour contributes significantly to the NCD burden in Ethiopia. Intakes of diet low in fruits and vegetables and high in sodium are the leading dietary risks. To effectively mitigate the oncoming NCD burden in Ethiopia, multisectoral interventions are required; and nutrition policies and dietary guidelines should be developed.
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Deribew A, Tessema GA, Deribe K, Melaku YA, Lakew Y, Amare AT, Abera SF, Mohammed M, Hiruye A, Teklay E, Misganaw A, Kassebaum N. Trends, causes, and risk factors of mortality among children under 5 in Ethiopia, 1990-2013: findings from the Global Burden of Disease Study 2013. Popul Health Metr 2016; 14:42. [PMID: 27891065 PMCID: PMC5109762 DOI: 10.1186/s12963-016-0112-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 11/08/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ethiopia has made remarkable progress in reducing child mortality over the last two decades. However, the under-5 mortality rate in Ethiopia is still higher than the under-5 mortality rates of several low- and middle-income countries (LMIC). On the other hand, the patterns and causes of child mortality have not been well investigated in Ethiopia. The objective of this study was to investigate the mortality trend, causes of death, and risk factors among children under 5 in Ethiopia during 1990-2013. METHODS We used Global Burden of Disease (GBD) 2013 data. Spatiotemporal Gaussian Process Regression (GPR) was applied to generate best estimates of child mortality with 95% uncertainty intervals (UI). Causes of death by age groups, sex, and year were measured using Cause of Death Ensemble modeling (CODEm). For estimation of HIV/AIDS mortality rate, the modified UNAIDS EPP-SPECTRUM suite model was used. RESULTS Between 1990 and 2013 the under-5 mortality rate declined from 203.9 deaths/1000 live births to 74.4 deaths/1000 live births with an annual rate of change of 4.6%, yielding a total reduction of 64%. Similarly, child (1-4 years), post-neonatal, and neonatal mortality rates declined by 75%, 64%, and 52%, respectively, between 1990 and 2013. Lower respiratory tract infection (LRI), diarrheal diseases, and neonatal syndromes (preterm birth complications, neonatal encephalopathy, neonatal sepsis, and other neonatal disorders) accounted for 54% of the total under-5 deaths in 2013. Under-5 mortality rates due to measles, diarrhea, malaria, protein-energy malnutrition, and iron-deficiency anemia declined by more than two-thirds between 1990 and 2013. Among the causes of under-5 deaths, neonatal syndromes such as sepsis, preterm birth complications, and birth asphyxia ranked third to fifth in 2013. Of all risk-attributable deaths in 1990, 25% of the total under-5 deaths (112,288/435,962) and 48% (112,288/232,199) of the deaths due to diarrhea, LRI, and other common infections were attributable to childhood wasting. Similarly, 19% (43,759/229,333) of the total under-5 deaths and 45% (43,759/97,963) of the deaths due to diarrhea and LRI were attributable to wasting in 2013. Of the total diarrheal disease- and LRI-related deaths (n = 97,963) in 2013, 59% (57,923/97,963) of them were attributable to unsafe water supply, unsafe sanitation, household air pollution, and no handwashing with soap. CONCLUSIONS LRI, diarrheal diseases, and neonatal syndromes remain the major causes of under-5 deaths in Ethiopia. These findings call for better-integrated newborn and child survival interventions focusing on the main risk factors.
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