Adolescent health in the Eastern Mediterranean Region: findings from the global burden of disease 2015 study

Parenting a High and Growing Population of Youth in the Arab Region: A Scoping Review for an Evidence-Informed Research Agenda

The Arab region is experiencing the largest youth cohort in its history. Parental influence is a clear factor in the well-being of this demographic. This scoping review serves as the first consolidated synthesis of existing research on parenting in the Arab world, aimed at identifying research gaps and informing future research agendas. Searches of 18 databases resulted in 4,758 records (1995-2018) in all languages. Using Arksey and O'Malley's methodological framework, eligible studies (n = 152) underwent duplicate data abstraction. An evidence gap map was developed using 3i.e.'s platform. Studies were mostly published in English (88%), and lead authors' affiliations were mostly from Arab institutions. Included studies were mostly cross-sectional (89%), quantitative (96%), conducted in a school/university (83%), and surveyed children and adolescents (70%). Most studies (79%) examined parenting influences on youth outcomes. Fewer examined parenting measurement (30%) or evaluated interventions (1%). Mental health and school performance were the most commonly investigated outcomes. The evidence gap map allows researchers who study youth in the Arab world to efficiently and visually delineate the gaps and strategically prioritize research needs. Future studies should employ robust mixed methods study designs, focus on evaluation and psychometric research, engage youth in the research process and explore a more diverse set of outcomes.

Emerging burdens of adolescent psychosocial health problems: a population-based study of 202 040 adolescents from 68 countries

BACKGROUND

Psychosocial health problems are major public health burdens for adolescents. Identifying risk factors is essential to containing negative health implications.

AIMS

This study aimed to estimate the burden of psychosocial health problems among adolescents, and identify potential risk and protective factors.

METHOD

We used the Global School-based Student Health Survey data from 68 countries across six World Health Organization regions. We computed the overall, national- and regional-level weighted estimates of the mean number of psychosocial health problems. Adjusted Poisson regression models examined the factors associated with psychosocial health problems.

RESULTS

Our sample totalled 202 040 adolescents aged 11-17 years (mean age 14.6 [s.d. 1.18] years), composed of 95 589 (47.31%) boys and 104 191 (51.57%) girls (2260 (1.12%) missing answers). Samoa had the highest mean number of psychosocial health problems (mean 2.64 [s.d. 1.41]), and Niue had the lowest (mean 0.33 [s.d. 0.72]). In the pooled analysis, the following factors were associated with higher rates of psychosocial health problems in adolescents globally: ≥13 years of age, being female, experiencing food insecurity, experiencing physical violence, having been bullied, engagement in physical altercation, experiencing serious injury, missing school without parental permission, lack of parental support or monitoring, parents who were not understanding of their child's problems and high sedentary behaviour. Being female, food insecurity, bullying, physical attacks or serious injury were all significantly associated with higher rates of psychosocial health problems in each of the six regions separately.

CONCLUSIONS

The prevalence of psychosocial health problems is high among adolescents, although there are country-level variations. Health promotion strategies should consider the identified factors to promote adolescents' health and well-being.

Epidemiology of iron deficiency among adolescents aged 10-19 years old in Qatar: a cross-sectional study

OBJECTIVE

To estimate the magnitude and the determinants of iron deficiency among adolescents aged 10-19 years in the State of Qatar.

DESIGN

A cross-sectional study design was used to conduct the study.

SETTING

Primary healthcare centres covering the three main geographical areas. One health centre was selected randomly from each region catchment areas: Northern, Central and Western.

PARTICIPANTS

Four hundred and fifty adolescents aged 10-19 years of all nationalities were enrolled in the study.

OUTCOME MEASURES

Serum ferritin cut-off level used to diagnose iron deficiency (<15 µg/L), with normal C reactive protein.

RESULTS

The mean age of the participants was 14.00±2.920, and more than half of the participating adolescents were among 10-14 years old age group (56.9%). Fifty-five per cent of the study participants were Non-Qatari, and females consisted of 70.0% of the participants. The prevalence of iron deficiency was 26.4%. Iron deficiency was significantly associated with gender, nationality, attaining menarche and consumption of iron absorption enhancers (citrus fruits and juice).

CONCLUSION

Iron deficiency among adolescents is of moderate public health concern in the country, according to the classification of the WHO. The estimated prevalence of iron deficiency was close to what was found in other low-income and middle-income countries; however, it is still behind the developed countries. Gender, attaining menarche and dietary habits are among the important factors that are associated with iron deficiency. Thus, there is a need to coordinate efforts and resources to address this issue by implementing effective strategies at the community and primary healthcare levels.

Alarming changes in the global burden of mental disorders in children and adolescents from 1990 to 2019: a systematic analysis for the Global Burden of Disease study

Mental disorders account for a large and increasing health burden worldwide, as shown in the Global Burden of Diseases (GBD) Study 2010. Unpacking how this burden in children and adolescents varies with sex, geographical regions, and ethnicities and how it has changed in the last 3 decades are important to improve the existing public health policies and prevention strategies. The study was conducted using GBD 2019 database. The burden of children and adolescents' (< 20 years old) mental disorders was displayed as prevalence, incidence, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability globally between 1990 and 2019. The number of DALYs in children and adolescents diagnosed with mental disorders was 21.5 million (95% CI: 15.2-29.6 million) in 2019. From 1990 to 2019, the age-standardized rates of DALYs of mental disorders increased from 803.8 per 100,000 (95% CI: 567.7-1104.3 per 100,000) to 833.2 per 100,000 (95% CI: 589.0-1146.1 per 100,000) population. Over the past 30 years, there had been a huge increase in the number of individuals suffering from anxiety disorders, major depressive disorders, and conduct disorders including an alarming increase in the rate of eating disorders such as 24.3% in bulimia nervosa and 17.0% in anorexia nervosa. Globally, 8.8% of children and adolescents have been diagnosed with varieties of mental illnesses, accounting for a heavy disease burden on public health. Besides, the worldwide increasing rates of anxiety disorders, major depressive disorders, and eating disorders have brought considerable challenges to public health undertakings, for which further prevention and treatment countermeasures are urgently needed.

Drowning in the Eastern Mediterranean region: a systematic literature review of the epidemiology, risk factors and strategies for prevention

INTRODUCTION

Globally, drowning is a significant cause of preventable mortality and morbidity. The Eastern Mediterranean region (EMR) comprises 22 countries of extreme disparity in income and is a region impacted by conflict and migration. We systematically review literature published on drowning in the EMR.

METHODS

Peer-reviewed literature (limited to original research) was identified using Embase, PubMed, Scopus, SportsDiscus, and Web of Science databases. Literature was independently dual screened at title/abstract and full text stages with dual data extraction (20% of included studies). Studies were included if they reported epidemiology, risk/protective factors and/or prevention strategies for drowning (unintentional and intentional; fatal and non-fatal) of residents, tourists or migrants in the EMR. Literature was assessed against the [Australian] National Health and Medical Research Council's Levels of Evidence.

RESULTS

Seventy-two studies were included in this review (epidemiology 68 studies; risk/protective factor 13 studies; prevention strategies 19 studies). Iran (n = 27), Saudia Arabia (n = 11) and Pakistan (n = 10) recorded the largest number of dedicated studies. Studies predominately focused on unintentional drowning. Ninety-two percent of included studies (n = 66) were ranked as being low evidence (level IV). The majority of studies explored drowning among children and adolescents (0-19 years). All-age fatal drowning rates varied from a low of 0.48 per 100,000 (United Arab Emirates; 2002; Ministry of Health death registry data) to a high of 18.5 per 100,000 (Egypt; 2014-15; WHO mortality database). Commonly identified risk factors included being male, young age, submersion time and resident status. Common prevention strategies public education, lifeguard supervision, and cardiopulmonary resuscitation.

DISCUSSION

Gaps in understanding of drowning burden in some countries within the region, as well as region-wide risk factor identification for adult drowning, intentional and migration-related drowning, impair the ability of nations to advance drowning prevention. There is a need for investment in implementation and evaluation of drowning prevention interventions in the EMR.

CONCLUSION

Drowning is a significant cause of mortality and morbidity in the EMR. The recent UN declaration on global drowning prevention may provide the impetus to invest in drowning prevention research, policy, and advocacy with the aim of reducing drowning-related harms in the EMR.

TRIAL REGISTRATION

Registration number: # CRD42021271215 .

Prevalence of depression and anxiety among school-going adolescents in Indian Kashmir valley during COVID-19 pandemic

Background

The coronavirus disease 2019 pandemic has led to severe disruption in routine activities, significant mortality and morbidity. Adolescents are particularly prone to mental health issues. The present study aims to estimate prevalence of depression and anxiety and its determinants among school-going adolescents in Kashmir valley of India.

Results

The Patient Health Questionnaire for Adolescents and Generalised Anxiety Disorder questionnaire were used to screen for depression and anxiety among school-going adolescents aged between 15 and 19 years during January and February 2021. Out of the 439 adolescents who had responded, 426 (97.03%) were included in final analysis. The adolescents had a mean age of 17.5 + 1.26 years and comprised of 57% males. The overall prevalence of depression was 16% and was associated with a past history of COVID-19 infection. Anxiety was present in 20% of adolescents. The prevalence was 14% for boys and 27.5% for girls. On logistic regression, anxiety was associated with female gender, past history of personal COVID-19 infection, history of COVID-19 diagnosis in family and hospital admission due to COVID-19 in family.

Conclusions

Anxiety and depression are major public health problems among adolescents. The high burden estimated in our study highlights the need for immediate action to support adolescents particularly those with a self/family history of COVID-19.

Matching action to need: an analysis of Global Burden of Disease 2017 and population health data to focus adolescent health policy and actions in Myanmar

Background: Myanmar is a country undergoing rapid transitions in health. Its national strategic policy for young people's health is being revised but there is a paucity of population data to inform local priorities and needs. Objective: In this paper we describe a comprehensive profile of adolescent health in Myanmar to focus policy and health actions. Methods: We used available primary data, and modelled estimates from the GBD 2017, to describe health outcomes (mortality and morbidity), health risks and determinants for adolescents in Myanmar between 1990-2017. A governance group of key stakeholders guided the framing of the study, interpretation of findings, and recommendations. Results: Overall health has improved for adolescents in Myanmar since 1990, however adolescent mortality remains high, particularly so for older adolescent males; all-cause mortality rate for 10-24 years was 70 per 100,000 for females and 149 per 100,000 for males (16,095 adolescent deaths in 2017). Overall, the dominant health problems were injuries for males and non-communicable disease for females in a context of ongoing burden of communicable and nutritional diseases for both sexes, and reproductive health needs for females. Health risks relating to undernutrition (thinness and anaemia) remain prevalent, with other health risks (overweight, binge alcohol use, and substance use) relatively low by global and regional standards but increasing. Gains have been made in social determinants such as adolescent fertility and modern contraception use; however, advances have been more limited in secondary education completion and engagement in employment and post education training. Conclusions: These results highlight the need to focus current efforts on addressing disease and mortality experienced by adolescents in Myanmar, with a specific focus on injury, mental health and non-communicable disease.

Child and adolescent injury burden in the eastern mediterranean region: Findings from the Global Burden of Disease 1990-2017

BACKGROUND

Child and adolescent injury is one of the leading causes of child death globally with a large proportion occurring in Low- and Middle-Income Countries (LMICs). Similarly, the Eastern Mediterranean Region (EMR) countries borne a heavy burden that largely impact child and adolescent safety and health in the region. We aim to assess child and adolescent injury morbidity and mortality and estimate its burden in the Eastern Mediterranean Region based on findings from the Global Burden of Disease (GBD), Injuries and Risk Factors study 2017.

METHODS

Data from the Global Burden of Disease GBD 2017 were used to estimate injury mortality for children aged 0-19, Years of Life Lost (YLLs), Years lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs) by age and sex from 1990 to 2017.

RESULTS

In 2017, an estimated 133,117 (95% UI 122,587-143,361) children died in EMR compared to 707,755 (95% UI 674401.6-738,166.6) globally. The highest rate of injury deaths was reported in Syria at 183.7 (95% UI 181.8-185.7) per 100,000 population. The leading cause of injury deaths was self-harm and interpersonal violence followed by transport injury. The primary cause of injury DALYs in EMR in 2017 was self-harm and interpersonal violence with a rate of 1272.95 (95% UI 1228.9 - 1319.2) almost 3-times the global rate.

CONCLUSION

Almost 19% of global child injury related deaths occur in the EMR. Concerted efforts should be integrated to inform policies and adopt injury preventive strategies to reduce injury burden and promote child and adolescent health and well-being in EMR countries.

Social health needs of Iranian male adolescents

BACKGROUND

Adequate attention to adolescents' health is considered an investment for the future of any country. Adolescents face many social and cultural challenges when they enter a new stage of social life. The advancement of adolescent social health depends on the recognition of their needs. This study aimed to explain the concept of social health needs from the perspectives of male adolescents to improve the health of both adolescents and the society.

METHOD

In this qualitative study with a content analysis approach, 52 male adolescents aged 13-18 years participated in 10 semi-structured individual interviews and seven focus group discussions. They expressed their experiences and opinions regarding social health needs. Purposive sampling was performed to recruit the adolescents in different areas of Tehran in 2017. Collected data was analyzed using the conventional content analysis method.

RESULTS

The findings were divided into four main themes and eight sub-themes including "need to have a healthy family (healthy family relationships and family responsibility)", "need to have a healthy society (favorable social status and favorable economic situation)", "need to have educational facilities (promoting productivity in schools and public education facilities)", "need to have communication with peers (healthy communication with peers and setting up for communication with peers of the opposite gender)".

CONCLUSION

To promote social health in adolescents, it is necessary to plan for the empowerment of community, family, schools and mass media by health authorities and devise appropriate health policies.

Danger ahead: the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region, 1990-2015

OBJECTIVES

The Eastern Mediterranean Region faces several health challenges at a difficult time with wars, unrest, and economic change.

METHODS

We used the Global Burden of Disease 2015 study to present the burden of diseases, injuries, and risk factors in the Eastern Mediterranean Region from 1990 to 2015.

RESULTS

Ischemic heart disease was the leading cause of death in the region in 2015, followed by cerebrovascular disease. Changes in total deaths ranged from a reduction of 25% for diarrheal diseases to an increase of about 42% for diabetes and tracheal, bronchus, and lung cancer. Collective violence and legal intervention increased by 850% during the time period. Diet was the leading risk factor for disability-adjusted life years (DALYs) for men compared to maternal malnutrition for females. Childhood undernutrition was the leading risk factor for DALYs in 1990 and 2005, but the second in 2015 after high blood pressure.

CONCLUSIONS

Our study shows that the region is facing several health challenges and calls for global efforts to stabilise the region and to address the current and future burden of disease.

Burden of disease attributable to vitamin A deficiency in Iranian population aged less than five years: findings from the global burden of disease study 2010

BACKGROUND

Vitamin A deficiency (VAD) is considered as one of the most serious public health concerns in developing countriesand the leading cause of mortality in under-five-year-old children.A large number of young children and pregnant women especially in low-income, non-industrialized communities are more susceptible to VAD. This study aims to report the burden of disease (BOD) attributable to VAD in Iranian population aged less than 5 years by using data of the Global Burden of Disease (GBD) study 2010.

METHODS

The GBD 2010 study calculated the proportion of deaths, years of life lost (YLLs), and years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to VAD by using the comparative risk assessment (CRA). VAD defined as low serum retinol concentrations (plasma retinol concentration < 0.70 umole/L) among children aged less than five. The VAD outcomes consisted of mortality due to diarrhea, measles, malaria, neglected infectious diseases, morbidity due to malaria (children < 5 years), low birth weight and other perinatal conditions. Uncertainty in the estimates is presented as 95% uncertainty interval (UI).

RESULTS

In 1990, there were 371 (95% UI: 166,665) DALYs due to VAD per 100,000 under five-year-old Iranian children in both sexes. The DALYs rate had a downward trend throughout the following years and reached to 76 (95% UI: 33-139)in 2010.The DALYs in children aged under 5 years was 378 (95% UI: 153-747) years for boys and 363 (95% UI: 148-692) years for girls in 1990 which fell to 79 (95% UI: 32-149) and 73 (95% UI: 29-138) in boys and girls in 2010, respectively. The rates of YLDs attributable to VAD changed in both sexes from 87(95% UI: 34-162) in 1990 to 46 (95% UI: 17-69) in 2010. The highest rate of YLDs attributed to VAD was observed in children aged 1-4. On the other hand, the YLLs were mostly in the 0-1-year-oldchildren in all years except 2010.

CONCLUSION

It was found that DALYs attributable to VAD in 1990, followed by a considerable reduction rate after a period of two decades, in 2010. Additional studies on the burden of diseases particularly at sub-national level with more accurate data are recommended.