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Galles NC, Liu PY, Updike RL, Fullman N, Nguyen J, Rolfe S, Sbarra AN, Schipp MF, Marks A, Abady GG, Abbas KM, Abbasi SW, Abbastabar H, Abd-Allah F, Abdoli A, Abolhassani H, Abosetugn AE, Adabi M, Adamu AA, Adetokunboh OO, Adnani QES, Advani SM, Afzal S, Aghamir SMK, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi S, Ahmed H, Ahmed MB, Ahmed Rashid T, Ahmed Salih Y, Akalu Y, Aklilu A, Akunna CJ, Al Hamad H, Alahdab F, Albano L, Alemayehu Y, Alene KA, Al-Eyadhy A, Alhassan RK, Ali L, Aljunid SM, Almustanyir S, Altirkawi KA, Alvis-Guzman N, Amu H, Andrei CL, Andrei T, Ansar A, Ansari-Moghaddam A, Antonazzo IC, Antony B, Arabloo J, Arab-Zozani M, Artanti KD, Arulappan J, Awan AT, Awoke MA, Ayza MA, Azarian G, Azzam AY, B DB, Babar ZUD, Balakrishnan S, Banach M, Bante SA, Bärnighausen TW, Barqawi HJ, Barrow A, Bassat Q, Bayarmagnai N, Bejarano Ramirez DF, Bekuma TT, Belay HG, Belgaumi UI, Bhagavathula AS, Bhandari D, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bibi S, Bijani A, Biondi A, Boloor A, Braithwaite D, Buonsenso D, Butt ZA, Camargos P, Carreras G, Carvalho F, Castañeda-Orjuela CA, Chakinala RC, Charan J, Chatterjee S, Chattu SK, Chattu VK, Chowdhury FR, Christopher DJ, Chu DT, Chung SC, Cortesi PA, Costa VM, Couto RAS, Dadras O, Dagnew AB, Dagnew B, Dai X, Dandona L, Dandona R, De Neve JW, Derbew Molla M, Derseh BT, Desai R, Desta AA, Dhamnetiya D, Dhimal ML, Dhimal M, Dianatinasab M, Diaz D, Djalalinia S, Dorostkar F, Edem B, Edinur HA, Eftekharzadeh S, El Sayed I, El Sayed Zaki M, Elhadi M, El-Jaafary SI, Elsharkawy A, Enany S, Erkhembayar R, Esezobor CI, Eskandarieh S, Ezeonwumelu IJ, Ezzikouri S, Fares J, Faris PS, Feleke BE, Ferede TY, Fernandes E, Fernandes JC, Ferrara P, Filip I, Fischer F, Francis MR, Fukumoto T, Gad MM, Gaidhane S, Gallus S, Garg T, Geberemariyam BS, Gebre T, Gebregiorgis BG, Gebremedhin KB, Gebremichael B, Gessner BD, Ghadiri K, Ghafourifard M, Ghashghaee A, Gilani SA, Glăvan IR, Glushkova EV, Golechha M, Gonfa KB, Gopalani SV, Goudarzi H, Gubari MIM, Guo Y, Gupta VB, Gupta VK, Gutiérrez RA, Haeuser E, Halwani R, Hamidi S, Hanif A, Haque S, Harapan H, Hargono A, Hashi A, Hassan S, Hassanein MH, Hassanipour S, Hassankhani H, Hay SI, Hayat K, Hegazy MI, Heidari G, Hezam K, Holla R, Hoque ME, Hosseini M, Hosseinzadeh M, Hostiuc M, Househ M, Hsieh VCR, Huang J, Humayun A, Hussain R, Hussein NR, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Inamdar S, Iqbal U, Irham LM, Irvani SSN, Islam SMS, Ismail NE, Itumalla R, Jha RP, Joukar F, Kabir A, Kabir Z, Kalhor R, Kamal Z, Kamande SM, Kandel H, Karch A, Kassahun G, Kassebaum NJ, Katoto PDMC, Kelkay B, Kengne AP, Khader YS, Khajuria H, Khalil IA, Khan EA, Khan G, Khan J, Khan M, Khan MAB, Khang YH, Khoja AT, Khubchandani J, Kim GR, Kim MS, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Korshunov VA, Kosen S, Kuate Defo B, Kulkarni V, Kumar A, Kumar GA, Kumar N, Kwarteng A, La Vecchia C, Lami FH, Landires I, Lasrado S, Lassi ZS, Lee H, Lee YY, Levi M, Lewycka S, Li S, Liu X, Lobo SW, Lopukhov PD, Lozano R, Lutzky Saute R, Magdy Abd El Razek M, Makki A, Malik AA, Mansour-Ghanaei F, Mansournia MA, Mantovani LG, Martins-Melo FR, Matthews PC, Medina JRC, Mendoza W, Menezes RG, Mengesha EW, Meretoja TJ, Mersha AG, Mesregah MK, Mestrovic T, Miazgowski B, Milne GJ, Mirica A, Mirrakhimov EM, Mirzaei HR, Misra S, Mithra P, Moghadaszadeh M, Mohamed TA, Mohammad KA, Mohammad Y, Mohammadi M, Mohammadian-Hafshejani A, Mohammed A, Mohammed S, Mohapatra A, Mokdad AH, Molokhia M, Monasta L, Moni MA, Montasir AA, Moore CE, Moradi G, Moradzadeh R, Moraga P, Mueller UO, Munro SB, Naghavi M, Naimzada MD, Naveed M, Nayak BP, Negoi I, Neupane Kandel S, Nguyen TH, Nikbakhsh R, Ningrum DNA, Nixon MR, Nnaji CA, Noubiap JJ, Nuñez-Samudio V, Nwatah VE, Oancea B, Ochir C, Ogbo FA, Olagunju AT, Olakunde BO, Onwujekwe OE, Otstavnov N, Otstavnov SS, Owolabi MO, Padubidri JR, Pakshir K, Park EC, Pashazadeh Kan F, Pathak M, Paudel R, Pawar S, Pereira J, Peres MFP, Perianayagam A, Pinheiro M, Pirestani M, Podder V, Polibin RV, Pollok RCG, Postma MJ, Pottoo FH, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahimi-Movaghar V, Rahman M, Rahmani AM, Rahmawaty S, Rajesh A, Ramshaw RE, Ranasinghe P, Rao CR, Rao SJ, Rathi P, Rawaf DL, Rawaf S, Renzaho AMN, Rezaei N, Rezai MS, Rios-Blancas M, Rogowski ELB, Ronfani L, Rwegerera GM, Saad AM, Sabour S, Saddik B, Saeb MR, Saeed U, Sahebkar A, Sahraian MA, Salam N, Salimzadeh H, Samaei M, Samy AM, Sanabria J, Sanmarchi F, Santric-Milicevic MM, Sartorius B, Sarveazad A, Sathian B, Sawhney M, Saxena D, Saxena S, Seidu AA, Seylani A, Shaikh MA, Shamsizadeh M, Shetty PH, Shigematsu M, Shin JI, Sidemo NB, Singh A, Singh JA, Sinha S, Skryabin VY, Skryabina AA, Soheili A, Tadesse EG, Tamiru AT, Tan KK, Tekalegn Y, Temsah MH, Thakur B, Thapar R, Thavamani A, Tobe-Gai R, Tohidinik HR, Tovani-Palone MR, Traini E, Tran BX, Tripathi M, Tsegaye B, Tsegaye GW, Ullah A, Ullah S, Ullah S, Unim B, Vacante M, Velazquez DZ, Vo B, Vollmer S, Vu GT, Vu LG, Waheed Y, Winkler AS, Wiysonge CS, Yiğit V, Yirdaw BW, Yon DK, Yonemoto N, Yu C, Yuce D, Yunusa I, Zamani M, Zamanian M, Zewdie DT, Zhang ZJ, Zhong C, Zumla A, Murray CJL, Lim SS, Mosser JF. Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1. Lancet 2021; 398:503-521. [PMID: 34273291 PMCID: PMC8358924 DOI: 10.1016/s0140-6736(21)00984-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. METHODS For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. FINDINGS By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4-82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5-42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4-41·3] in 1980 to 83·6% [82·3-84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4-44·1) in 1980 to 79·8% (78·4-81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6-60·9) to 14·5 million (13·4-15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. INTERPRETATION After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. FUNDING Bill & Melinda Gates Foundation.
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Leung VKY, Wong JY, Barnes R, Kelso J, Milne GJ, Blyth CC, Cowling BJ, Moore HC, Sullivan SG. Excess respiratory mortality and hospitalizations associated with influenza in Australia, 2007-2015. Int J Epidemiol 2021; 51:458-467. [PMID: 34333637 DOI: 10.1093/ije/dyab138] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Influenza is the most common vaccine-preventable disease in Australia, causing significant morbidity and mortality. We assessed the burden of influenza across all ages in terms of influenza-associated mortality and hospitalizations using national mortality, hospital-discharge and influenza surveillance data. METHODS Influenza-associated excess respiratory mortality and hospitalization rates from 2007 to 2015 were estimated using generalized additive models with a proxy of influenza activity based on syndromic and laboratory surveillance data. Estimates were made for each age group and year. RESULTS The estimated mean annual influenza-associated excess respiratory mortality was 2.6 per 100 000 population [95% confidence interval (CI): 1.8, 3.4 per 100 000 population]. The excess annual respiratory hospitalization rate was 57.4 per 100 000 population (95% CI: 32.5, 82.2 per 100 000 population). The highest mortality rates were observed among those aged ≥75 years (35.11 per 100 000 population; 95% CI: 19.93, 50.29 per 100 000 population) and hospitalization rates were also highest among older adults aged ≥75 years (302.95 per 100 000 population; 95% CI: 144.71, 461.19 per 100 000 population), as well as children aged <6 months (164.02 per 100 000 population; 95% CI: -34.84, 362.88 per 100 000 population). Annual variation was apparent, ranging from 1.0 to 3.9 per 100 000 population for mortality and 24.2 to 94.28 per 100 000 population for hospitalizations. Influenza A contributed to almost 80% of the average excess respiratory hospitalizations and 60% of the average excess respiratory deaths. CONCLUSIONS Influenza causes considerable burden to all Australians. Expected variation was observed among age groups, years and influenza type, with the greatest burden falling to older adults and young children. Understanding the current burden is useful for understanding the potential impact of mitigation strategies, such as vaccination.
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Affiliation(s)
- Vivian K Y Leung
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Jessica Y Wong
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Roseanne Barnes
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Joel Kelso
- Department of Computer Science, University of Western Australia, Perth, Australia
| | - George J Milne
- Department of Computer Science, University of Western Australia, Perth, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine WA, QE11 Medical Centre, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia.,Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Epidemiology, University of California, Los Angeles, USA
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Wang H, Abbas KM, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abolhassani H, Abreu LG, Abrigo MRM, Abushouk AI, Adabi M, Adair T, Adebayo OM, Adedeji IA, Adekanmbi V, Adeoye AM, Adetokunboh OO, Advani SM, Afshin A, Aghaali M, Agrawal A, Ahmadi K, Ahmadieh H, Ahmed MB, Al-Aly Z, Alam K, Alam T, Alanezi FM, Alanzi TM, Alcalde-Rabanal JE, Ali M, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Alizade H, Aljunid SM, Allebeck P, Almadi MAH, Almasi-Hashiani A, Al-Mekhlafi HM, Altirkawi KA, Alumran AK, Alvis-Guzman N, Amini-Rarani M, Aminorroaya A, Amit AML, Ancuceanu R, Andrei CL, Androudi S, Angus C, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Anvari D, Appiah SCY, Arabloo J, Arab-Zozani M, Aravkin AY, Aremu O, Ärnlöv J, Aryal KK, Asadi-Pooya AA, Asgari S, Asghari Jafarabadi M, Atteraya MS, Ausloos M, Avila-Burgos L, Avokpaho EFGA, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azarian G, Babaee E, Badiye AD, Bagli E, Bahrami MA, Bakhtiari A, Balassyano S, Banach M, Banik PC, Barker-Collo SL, Bärnighausen TW, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Bell ML, Bennett DA, Bensenor IM, Berhe K, Berman AE, Bertolacci GJ, Bhageerathy R, Bhala N, Bhattacharyya K, Bhutta ZA, Bijani A, Biondi A, Bisanzio D, Bisignano C, Biswas RK, Bjørge T, Bohlouli S, Bohluli M, Bolla SRR, Borzì AM, Borzouei S, Brady OJ, Braithwaite D, Brauer M, Briko AN, Briko NI, Bumgarner BR, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cai T, Callender CSKH, Cámera LLAA, Campos-Nonato IR, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castelpietra G, Castro F, Catalá-López F, Cederroth CR, Cerin E, Chattu VK, Chin KL, Chu DT, Ciobanu LG, Cirillo M, Comfort H, Costa VM, Cowden RG, Cromwell EA, Croneberger AJ, Cunningham M, Dahlawi SMA, Damiani G, D'Amico E, Dandona L, Dandona R, Dargan PI, Darwesh AM, Daryani A, Das Gupta R, das Neves J, Davletov K, De Leo D, Denova-Gutiérrez E, Deribe K, Dervenis N, Desai R, Dhungana GP, Dias da Silva D, Diaz D, Dippenaar IN, Djalalinia S, Do HT, Dokova K, Doku DT, Dorostkar F, Doshi CP, Doshmangir L, Doyle KE, Dubljanin E, Duraes AR, Edvardsson D, Effiong A, El Sayed I, El Tantawi M, Elbarazi I, El-Jaafary SI, Emamian MH, Eskandarieh S, Esmaeilzadeh F, Estep K, Farahmand M, Faraj A, Fareed M, Faridnia R, Faro A, Farzadfar F, Fattahi N, Fazaeli AA, Fazlzadeh M, Feigin VL, Fereshtehnejad SM, Fernandes E, Ferreira ML, Filip I, Fischer F, Flohr C, Foigt NA, Folayan MO, Fomenkov AA, Freitas M, Fukumoto T, Fuller JE, Furtado JM, Gad MM, Gakidou E, Gallus S, Gebrehiwot AM, Gebremedhin KB, Gething PW, Ghamari F, Ghashghaee A, Gholamian A, Gilani SA, Gitimoghaddam M, Glushkova EV, Gnedovskaya EV, Gopalani SV, Goulart AC, Gugnani HC, Guo Y, Gupta R, Gupta SS, Haagsma JA, Haj-Mirzaian A, Haj-Mirzaian A, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Han C, Handiso DW, Hankey GJ, Haririan H, Haro JM, Hasaballah AI, Hassanipour S, Hassankhani H, Hay SI, Heibati B, Heidari-Soureshjani R, Henny K, Henry NJ, Herteliu C, Heydarpour F, Hole MK, Hoogar P, Hosgood HD, Hossain N, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hu G, Huda TM, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Imani-Nasab MH, Islam M, Iso H, Iwu CJ, Jaafari J, Jacobsen KH, Jahagirdar D, Jahanmehr N, Jalali A, Jalilian F, James SL, Janjani H, Jenabi E, Jha RP, Jha V, Ji JS, Jonas JB, Joukar F, Jozwiak JJ, Jürisson M, Kabir Z, Kalani H, Kalankesh LR, Kamiab Z, Kanchan T, Kapoor N, Karch A, Karimi SE, Karimi SA, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keiyoro PN, Keller C, Khader YS, Khalid N, Khan EA, Khan M, Khang YH, Khater AM, Khater MM, Khazaei S, Khazaie H, Khodayari MT, Khubchandani J, Kianipour N, Kim CI, Kim YE, Kim YJ, Kinfu Y, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Komaki H, Kopec JA, Kosen S, Koul PA, Koyanagi A, Kravchenko MA, Krishan K, Krohn KJ, Kuate Defo B, Kumar GA, Kumar M, Kumar P, Kumar V, Kusuma D, Kyu HH, La Vecchia C, Lacey B, Lal DK, Lalloo R, Lami FH, Lansky S, Larson SL, Larsson AO, Lasrado S, Lassi ZS, Lazarus JV, Lee PH, Lee SWH, Leever AT, LeGrand KE, Leonardi M, Li S, Lim LL, Lim SS, Linn S, Lodha R, Logroscino G, Lopez AD, Lopukhov PD, Lotufo PA, Lozano R, Lu A, Lunevicius R, Madadin M, Maddison ER, Magdy Abd El Razek H, Magdy Abd El Razek M, Mahasha PW, Mahdavi MM, Malekzadeh R, Mamun AA, Manafi N, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mapoma CC, Martini S, Martins-Melo FR, Masaka A, Mastrogiacomo CI, Mathur MR, May EA, McAlinden C, McGrath JJ, McKee M, Mehndiratta MM, Mehri F, Mehta KM, Meitei WB, Memiah PTN, Mendoza W, Menezes RG, Mengesha EW, Mensah GA, Meretoja A, Meretoja TJ, Mestrovic T, Michalek IM, Mihretie KM, Miller TR, Mills EJ, Milne GJ, Mirrakhimov EM, Mirzaei H, Mirzaei M, Mirzaei-Alavijeh M, Misganaw AT, Moazen B, Moghadaszadeh M, Mohamadi E, Mohammad DK, Mohammad Y, Mohammad Gholi Mezerji N, Mohammadbeigi A, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed H, Mohammed S, Mohebi F, Mohseni Bandpei MA, Mokari A, Mokdad AH, Momen NC, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Joo M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Musa KI, Muthupandian S, Nabavizadeh B, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naik G, Najafi F, Nangia V, Nansseu JR, Ndwandwe DE, Negoi I, Negoi RI, Ngunjiri JW, Nguyen HLT, Nguyen TH, Nigatu YT, Nikbakhsh R, Nikpoor AR, Nixon MR, Nnaji CA, Nomura S, Noubiap JJ, Nouraei Motlagh S, Nowak C, Oţoiu A, Odell CM, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Ong KL, Onwujekwe OE, Ortiz A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Park J, Pasupula DK, Patel JR, Patel SK, Patton GC, Paulson KR, Pazoki Toroudi H, Pease SA, Peden AE, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico 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S, Shahbaz M, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharafi Z, Sharara F, Sharma R, Shaw DH, Sheikh A, Shin JI, Shiri R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Simonetti B, Simpson KE, Singh JA, Skiadaresi E, Skryabin VY, Soheili A, Sokhan A, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stockfelt L, Stokes MA, Stubbs JL, Sudaryanto A, Sufiyan MB, Suliankatchi Abdulkader R, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tang M, Taveira N, Taylor HJ, Teagle WL, Tehrani-Banihashemi A, Teklehaimanot BF, Tessema ZT, Thankappan KR, Thomas N, Thrift AG, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Traini E, Tran BX, Travillian R, Trias-Llimós S, Truelsen TC, Tudor Car L, Unnikrishnan B, Upadhyay E, Vacante M, Vakilian A, Valdez PR, Valli A, Vardavas C, Vasankari TJ, Vasconcelos AMN, Vasseghian Y, 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Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1160-1203. [PMID: 33069325 PMCID: PMC7566045 DOI: 10.1016/s0140-6736(20)30977-6] [Citation(s) in RCA: 701] [Impact Index Per Article: 175.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. METHODS 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. FINDINGS The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. INTERPRETATION Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. FUNDING Bill & Melinda Gates Foundation.
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Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, Marquez N, Abbasalizad-Farhangi M, Abbasi M, Abd-Allah F, Abdoli A, Abdollahi M, Abdollahpour I, Abdulkader RS, Abrigo MRM, Acharya D, Adebayo OM, Adekanmbi V, Adham D, Afshari M, Aghaali M, Ahmadi K, Ahmadi M, Ahmadpour E, Ahmed R, Akal CG, Akinyemi JO, Alahdab F, Alam N, Alamene GM, Alene KA, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Almalki MJ, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Amegah AK, Amini S, Amit AML, Anbari Z, Androudi S, Anjomshoa M, Ansari F, Antonio CAT, Arabloo J, Arefi Z, Aremu O, Armoon B, Arora A, Artaman A, Asadi A, Asadi-Aliabadi M, Ashraf-Ganjouei A, Assadi R, Ataeinia B, Atre SR, Quintanilla BPA, Ayanore MA, Azari S, Babaee E, Babazadeh A, Badawi A, Bagheri S, Bagherzadeh M, Baheiraei N, Balouchi A, Barac A, Bassat Q, Baune BT, Bayati M, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Belay YB, Bell B, Bell ML, Berbada DA, Bernstein RS, Bhattacharjee NV, Bhattarai S, Bhutta ZA, Bijani A, Bohlouli S, Breitborde NJK, Britton G, Browne AJ, Nagaraja SB, Busse R, Butt ZA, Car J, Cárdenas R, Castañeda-Orjuela CA, Cerin E, Chanie WF, Chatterjee P, Chu DT, Cooper C, Costa VM, Dalal K, Dandona L, Dandona R, Daoud F, Daryani A, Das Gupta R, Davis I, Davis Weaver N, Davitoiu DV, De Neve JW, Demeke FM, Demoz GT, Deribe K, Desai R, Deshpande A, Desyibelew HD, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Doshmangir L, Duraes AR, Dwyer-Lindgren L, Earl L, Ebrahimi R, Ebrahimpour S, Effiong A, Eftekhari A, Ehsani-Chimeh E, El Sayed I, El Sayed Zaki M, El Tantawi M, El-Khatib Z, Emamian MH, Enany S, Eskandarieh S, Eyawo O, Ezalarab M, Faramarzi M, Fareed M, Faridnia R, Faro A, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad SM, Fernandes JC, Filip I, Fischer F, Foigt NA, Foroutan M, Francis JM, Fukumoto T, Fullman N, Gallus S, Gebre DG, Gebrehiwot TT, Gebremeskel GG, Gessner BD, Geta B, Gething PW, Ghadimi R, Ghadiri K, Ghajarzadeh M, Ghashghaee A, Gill PS, Gill TK, Golding N, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goulart BNG, Graetz N, Greaves F, Green MS, Guo Y, Haj-Mirzaian A, Haj-Mirzaian A, Hall BJ, Hamidi S, Haririan H, Haro JM, Hasankhani M, Hasanpoor E, Hasanzadeh A, Hassankhani H, Hassen HY, Hegazy MI, Hendrie D, Heydarpour F, Hird TR, Hoang CL, Hollerich G, Rad EH, Hoseini-Ghahfarokhi M, Hossain N, Hosseini M, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsairi M, Ilesanmi OS, Imani-Nasab MH, Iqbal U, Irvani SSN, Islam N, Islam SMS, Jürisson M, Balalami NJ, Jalali A, Javidnia J, Jayatilleke AU, Jenabi E, Ji JS, Jobanputra YB, Johnson K, Jonas JB, Shushtari ZJ, Jozwiak JJ, Kabir A, Kahsay A, Kalani H, Kalhor R, Karami M, Karki S, Kasaeian A, Kassebaum NJ, Keiyoro PN, Kemp GR, Khabiri R, Khader YS, Khafaie MA, Khan EA, Khan J, Khan MS, Khang YH, Khatab K, Khater A, Khater MM, Khatony A, Khazaei M, Khazaei S, Khazaei-Pool M, Khubchandani J, Kianipour N, Kim YJ, Kimokoti RW, Kinyoki DK, Kisa A, Kisa S, Kolola T, Kosen S, Koul PA, Koyanagi A, Kraemer MUG, Krishan K, Krohn KJ, Kugbey N, Kumar GA, Kumar M, Kumar P, Kuupiel D, Lacey B, Lad SD, Lami FH, Larsson AO, Lee PH, Leili M, Levine AJ, Li S, Lim LL, Listl S, Longbottom J, Lopez JCF, Lorkowski S, Magdeldin S, Abd El Razek HM, Abd El Razek MM, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manafi N, Manda AL, Mansourian M, Martins-Melo FR, Masaka A, Massenburg BB, Maulik PK, Mayala BK, Mazidi M, McKee M, Mehrotra R, Mehta KM, Meles GG, Mendoza W, Menezes RG, Meretoja A, Meretoja TJ, Mestrovic T, Miller TR, Miller-Petrie MK, Mills EJ, Milne GJ, Mini GK, Mir SM, Mirjalali H, Mirrakhimov EM, Mohamadi E, Mohammad DK, Darwesh AM, Mezerji NMG, Mohammed AS, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moodley Y, Moosazadeh M, Moradi G, Moradi M, Moradi Y, Moradi-Lakeh M, Moradinazar M, Moraga P, Morawska L, Mosapour A, Mousavi SM, Mueller UO, Muluneh AG, Mustafa G, Nabavizadeh B, Naderi M, Nagarajan AJ, Nahvijou A, Najafi F, Nangia V, Ndwandwe DE, Neamati N, Negoi I, Negoi RI, Ngunjiri JW, Thi Nguyen HL, Nguyen LH, Nguyen SH, Nielsen KR, Ningrum DNA, Nirayo YL, Nixon MR, Nnaji CA, Nojomi M, Noroozi M, Nosratnejad S, Noubiap JJ, Motlagh SN, Ofori-Asenso R, Ogbo FA, Oladimeji KE, Olagunju AT, Olfatifar M, Olum S, Olusanya BO, Oluwasanu MM, Onwujekwe OE, Oren E, Ortega-Altamirano DDV, Ortiz A, Osarenotor O, Osei FB, Osgood-Zimmerman AE, Otstavnov SS, Owolabi MO, P A M, Pagheh AS, Pakhale S, Panda-Jonas S, Pandey A, Park EK, Parsian H, Pashaei T, Patel SK, Pepito VCF, Pereira A, Perkins S, Pickering BV, Pilgrim T, Pirestani M, Piroozi B, Pirsaheb M, Plana-Ripoll O, Pourjafar H, Puri P, Qorbani M, Quintana H, Rabiee M, Rabiee N, Radfar A, Rafiei A, Rahim F, Rahimi Z, Rahimi-Movaghar V, Rahimzadeh S, Rajati F, Raju SB, Ramezankhani A, Ranabhat CL, Rasella D, Rashedi V, Rawal L, Reiner RC, Renzaho AMN, Rezaei S, Rezapour A, Riahi SM, Ribeiro AI, Roever L, Roro EM, Roser M, Roshandel G, Roshani D, Rostami A, Rubagotti E, Rubino S, Sabour S, Sadat N, Sadeghi E, Saeedi R, Safari Y, Safari-Faramani R, Safdarian M, Sahebkar A, Salahshoor MR, Salam N, Salamati P, Salehi F, Zahabi SS, Salimi Y, Salimzadeh H, Salomon JA, Sambala EZ, Samy AM, Santric Milicevic MM, Jose BPS, Saraswathy SYI, Sarmiento-Suárez R, Sartorius B, Sathian B, Saxena S, Sbarra AN, Schaeffer LE, Schwebel DC, Sepanlou SG, Seyedmousavi S, Shaahmadi F, Shaikh MA, Shams-Beyranvand M, Shamshirian A, Shamsizadeh M, Sharafi K, Sharif M, Sharif-Alhoseini M, Sharifi H, Sharma J, Sharma R, Sheikh A, Shields C, Shigematsu M, Shiri R, Shiue I, Shuval K, Siddiqi TJ, Silva JP, Singh JA, Sinha DN, Sisay MM, Sisay S, Sliwa K, Smith DL, Somayaji R, Soofi M, Soriano JB, Sreeramareddy CT, Sudaryanto A, Sufiyan MB, Sykes BL, Sylaja PN, Tabarés-Seisdedos R, Tabb KM, Tabuchi T, Taveira N, Temsah MH, Terkawi AS, Tessema ZT, Thankappan KR, Thirunavukkarasu S, To QG, Tovani-Palone MR, Tran BX, Tran KB, Ullah I, Usman MS, Uthman OA, Vahedian-Azimi A, Valdez PR, van Boven JFM, Vasankari TJ, Vasseghian Y, Veisani Y, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov V, Vos T, Vu GT, Vujcic IS, Waheed Y, Wakefield J, Wang H, Wang Y, Wang YP, Ward JL, Weintraub RG, Weldegwergs KG, Weldesamuel GT, Westerman R, Wiysonge CS, Wondafrash DZ, Woyczynski L, Wu AM, Xu G, Yadegar A, Yamada T, Yazdi-Feyzabadi V, Yilgwan CS, Yip P, Yonemoto N, Lebni JY, Younis MZ, Yousefifard M, Yousof HASA, Yu C, Yusefzadeh H, Zabeh E, Moghadam TZ, Bin Zaman S, Zamani M, Zandian H, Zangeneh A, Zerfu TA, Zhang Y, Ziapour A, Zodpey S, Murray CJL, Hay SI. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. Nature 2019; 574:353-358. [PMID: 31619795 PMCID: PMC6800389 DOI: 10.1038/s41586-019-1545-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022]
Abstract
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
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Affiliation(s)
- Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nathaniel J Henry
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michael L Collison
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Laurie B Marczak
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Amber Sligar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Stefanie Watson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Neal Marquez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | - Amir Abdoli
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Mohammad Abdollahi
- The Institute of Pharmaceutical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ibrahim Abdollahpour
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
| | | | - Michael R M Abrigo
- Research Department, Philippine Institute for Development Studies, Quezon City, The Philippines
| | - Dilaram Acharya
- Department of Preventive Medicine, Dongguk University, Gyeongju, South Korea
- Department of Community Medicine, Kathmandu University, Devdaha, Nepal
| | | | | | - Davoud Adham
- School of Health, Ardabil University of Medical Science, Ardabil, Iran
| | - Mahdi Afshari
- Department of Community Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Aghaali
- Department of Epidemiology and Biostatistics, Qom University of Medical Sciences, Qom, Iran
| | - Keivan Ahmadi
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Mehdi Ahmadi
- Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Ahmadpour
- Department of Parasitology and Mycology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rushdia Ahmed
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Chalachew Genet Akal
- Department of Medical Laboratory Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Joshua O Akinyemi
- Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Fares Alahdab
- Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
| | - Noore Alam
- Prevention Division, Queensland Health, Herston, Queensland, Australia
| | | | - Kefyalew Addis Alene
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Cyrus Alinia
- Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
| | - Vahid Alipour
- Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, Kuwait University, Safat, Kuwait
- International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
| | - Mohammed J Almalki
- Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Jazan University, Jazan, Saudi Arabia
| | - Hesham M Al-Mekhlafi
- Medical Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Medical Parasitology, Sana'a University, Sana'a, Yemen
| | | | - Nelson Alvis-Guzman
- Research Group in Health Economics, Universidad de Cartagena, Cartagena, Colombia
- Research Group in Hospital Management and Health Policies, Universidad de la Costa, Barranquilla, Colombia
| | | | - Saeed Amini
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Arianna Maever Loreche Amit
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
| | - Zohreh Anbari
- Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
| | - Sofia Androudi
- Department of Medicine, University of Thessaly, Volos, Greece
| | - Mina Anjomshoa
- Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fereshteh Ansari
- Research Center for Evidence Based Medicine-Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Carl Abelardo T Antonio
- Department of Health Policy and Administration, University of the Philippines Manila, Manila, The Philippines
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Jalal Arabloo
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zohreh Arefi
- Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Olatunde Aremu
- School of Health Sciences, Birmingham City University, Birmingham, UK
| | - Bahram Armoon
- School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Al Artaman
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anvar Asadi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Asadi-Aliabadi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Assadi
- Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahar Ataeinia
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sachin R Atre
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, MD, USA
- Dr D. Y. Patil Medical College, Pune, India
| | - Beatriz Paulina Ayala Quintanilla
- The Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
- General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
| | - Martin Amogre Ayanore
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Samad Azari
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Babaee
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Alaa Badawi
- Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Soghra Bagheri
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Nafiseh Baheiraei
- Tissue Engineering and Applied Cell Sciences Division, Tarbiat Modares University, Tehran, Iran
- Division of Diseases, Advanced Technologies Research Group, Tehran, Iran
| | - Abbas Balouchi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Quique Bassat
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Bernhard T Baune
- Department of Psychiatry, Melbourne Medical School, Melbourne, Victoria, Australia
| | - Mohsen Bayati
- Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neeraj Bedi
- Jazan University, Jazan, Saudi Arabia
- Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
| | - Ettore Beghi
- Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Meysam Behzadifar
- Hepatitis Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Yared Belete Belay
- Pharmacoepidemiology and Social Pharmacy, Mekelle University, Mekelle, Ethiopia
| | - Brent Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Michelle L Bell
- School of Forestry and Environmental Studies, Yale University, New Haven, CT, USA
| | | | - Robert S Bernstein
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
- Department of Global Health, University of South Florida, Tampa, FL, USA
| | | | - Suraj Bhattarai
- London School of Hygiene & Tropical Medicine, London, UK
- Nepal Academy of Science & Technology, Patan, Nepal
| | - Zulfiqar A Bhutta
- The Centre for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Somayeh Bohlouli
- Department of Veterinary Medicine, Karaj Islamic Azad University, Kermanshah, Iran
| | - Nicholas J K Breitborde
- Department of Psychology, Ohio State University, Columbus, OH, USA
- Psychiatry and Behavioral Health Department, Ohio State University, Columbus, OH, USA
| | - Gabrielle Britton
- Neuroscience Department, Institute for Scientific Research and High Technology Services, City of Knowledge, Panama
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Reinhard Busse
- Department for Health Care Management, Technical University of Berlin, Berlin, Germany
| | - Zahid A Butt
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Josip Car
- Centre for Population Health Sciences, Nanyang Technological University, Singapore, Singapore
- Global Ehealth Unit, Imperial College London, London, UK
| | - Rosario Cárdenas
- Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
| | - Carlos A Castañeda-Orjuela
- Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
- Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
| | - Ester Cerin
- Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- School of Public Health, University of Hong Kong, Hong Kong, China
| | | | - Pranab Chatterjee
- Division of Epidemiology, National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Dinh-Toi Chu
- Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Cyrus Cooper
- Department of Rheumatology, University of Oxford, Oxford, UK
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Vera M Costa
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Koustuv Dalal
- Institute of Public Health Kalyani, Kalyani, India
- School of Health Science, Orebro University, Orebro, Sweden
| | - Lalit Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Rakhi Dandona
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Public Health Foundation of India, Gurugram, India
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rajat Das Gupta
- James P. Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Ian Davis
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Dragos Virgil Davitoiu
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Surgery, Clinical Emergency Hospital St Pantelimon, Bucharest, Romania
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
| | | | - Gebre Teklemariam Demoz
- School of Pharmacy, Aksum University, Aksum, Ethiopia
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Deribe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Rupak Desai
- Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Aniruddha Deshpande
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - Samath Dhamminda Dharmaratne
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Meghnath Dhimal
- Health Research Section, Nepal Health Research Council, Kathmandu, Nepal
| | - Daniel Diaz
- Center of Complexity Sciences, National Autonomous University of Mexico, Mexico City, Mexico
- Facultad de Medicina Veterinaria y Zootecnia, Autonomous University of Sinaloa, Culiacan Rosales, Mexico
| | - Leila Doshmangir
- Department of Health Policy and Economy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Andre R Duraes
- School of Medicine, Federal University of Bahia, Salvador, Brazil
- Diretoria Médica, Roberto Santos General Hospital, Salvador, Brazil
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lucas Earl
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Roya Ebrahimi
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Andem Effiong
- Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Aziz Eftekhari
- Department of Toxicology and Pharmacology, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Basic Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Elham Ehsani-Chimeh
- National Institute for Health Researchers, Tehran University of Medical Sciences, Tehran, Iran
| | - Iman El Sayed
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | | | - Maha El Tantawi
- Pediatric Dentistry and Dental Public Health, Alexandria University, Alexandria, Egypt
- Preventive Dental Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ziad El-Khatib
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mohammad Hassan Emamian
- Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shymaa Enany
- Department of Microbiology and Immunology, Suez Canal University, Ismailia, Egypt
| | - Sharareh Eskandarieh
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Oghenowede Eyawo
- Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maha Ezalarab
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Mohammad Fareed
- College of Medicine, Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Roghiyeh Faridnia
- Department of Parasitology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Andre Faro
- Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Ali Akbar Fazaeli
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mehdi Fazlzadeh
- Environmental Health Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Department of Environmental Health Engineering, Ardabil University of Medical Science, Ardabil, Iran
| | - Netsanet Fentahun
- Department of Public Health Nutrition, Bahir Dar University, Bahir Dar, Ethiopia
| | - Seyed-Mohammad Fereshtehnejad
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - João C Fernandes
- Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
| | - Irina Filip
- Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
- Department of Health Sciences, A.T. Still University, Mesa, AZ, USA
| | - Florian Fischer
- Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany
| | - Nataliya A Foigt
- Institute of Gerontology, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | - Joel Msafiri Francis
- Clinical Medicine and Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Takeshi Fukumoto
- Gene Expression & Regulation Program, Cancer Institute (W.I.A.), Philadelphia, PA, USA
- Department of Dermatology, Kobe University, Kobe, Japan
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Silvano Gallus
- Department of Environmental Health Science, Mario Negri Institute for Pharmacological Research, Milan, Italy
| | | | | | | | - Bradford D Gessner
- Vaccines Department, Pfizer, Collegeville, PA, USA
- Agency of Preventive Medicine, Paris, France
| | - Birhanu Geta
- Department of Pharmacy, Wollo University, Dessie, Ethiopia
| | - Peter W Gething
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Reza Ghadimi
- Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Mahsa Ghajarzadeh
- Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Nick Golding
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nelson G M Gomes
- Department of Chemistry, University of Porto, Porto, Portugal
- REQUIMTE/LAQV, Porto, Portugal
| | - Philimon N Gona
- Nursing and Health Sciences Department, University of Massachusetts Boston, Boston, MA, USA
| | - Sameer Vali Gopalani
- Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, OK, USA
- Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Federated States of Micronesia
| | - Giuseppe Gorini
- Occupational and Environmental Epidemiology Section, Cancer Prevention and Research Institute, Florence, Italy
| | | | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Health Improvement Directorate, Public Health England, London, UK
| | | | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
| | - Arvin Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arya Haj-Mirzaian
- Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Brian James Hall
- Global and Community Mental Health Research Group, University of Macau, Macao, China
| | - Samer Hamidi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
| | | | - Josep Maria Haro
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Milad Hasankhani
- School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Edris Hasanpoor
- Healthcare Management, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Amir Hasanzadeh
- Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Hadi Hassankhani
- School of Nursing and Midwifery Tabriz University of Medical Sciences, Tabriz, Iran
- Independent Consultant, Tabriz, Iran
| | - Hamid Yimam Hassen
- Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
- Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp, Belgium
| | | | - Delia Hendrie
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Fatemeh Heydarpour
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Thomas R Hird
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Population Health, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Chi Linh Hoang
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Gillian Hollerich
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Enayatollah Homaie Rad
- Social Determinants of Health Research Center, Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Naznin Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Pharmacology and Therapeutics, University of Dhaka, Dhaka, Bangladesh
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Hosseinzadeh
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Computer Science Department, University of Human Development, Sulaimaniyah, Iraq
| | - Mihaela Hostiuc
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Internal Medicine, Bucharest Emergency Hospital, Bucharest, Romania
| | - Sorin Hostiuc
- Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Clinical Legal Medicine, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
| | - Mowafa Househ
- Division of Information and Computing Technology, Hamad Bin Khalifa University, Doha, Qatar
- Qatar Foundation for Education, Science and Community Development, Doha, Qatar
| | - Mohamed Hsairi
- Faculty of Medicine Tunis, Medicine School of Tunis, Baab Saadoun, Tunisia
| | | | | | - Usman Iqbal
- Global Health and Development Department, Taipei Medical University, Taipei City, Taiwan
| | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Harvard University, Boston, MA, USA
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mikk Jürisson
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | | | - Amir Jalali
- Psychiatric Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Javad Javidnia
- Department of Medical Mycology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Achala Upendra Jayatilleke
- Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
- Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ensiyeh Jenabi
- School of Midwifery, A.T. Still University, Mesa, AZ, USA
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, Kunshan, China
| | | | - Kimberly Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jost B Jonas
- Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Zahra Jorjoran Shushtari
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jacek Jerzy Jozwiak
- Faculty of Medicine and Health Sciences, University of Opole, Opole, Poland
- Department of Family Medicine and Public Health, University of Opole, Opole, Poland
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amaha Kahsay
- Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
| | - Hamed Kalani
- Mazandaran University of Medical Sciences, Sari, Iran
- Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rohollah Kalhor
- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Manoochehr Karami
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Surendra Karki
- Research and Development, Australian Red Cross Blood Service, Sydney, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amir Kasaeian
- Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Grant Rodgers Kemp
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Michigan State University, East Lansing, MI, USA
| | - Roghayeh Khabiri
- Tabriz Health Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- National Institute for Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Saleh Khader
- Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
| | - Morteza Abdullatif Khafaie
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ejaz Ahmad Khan
- Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
| | - Junaid Khan
- Population Studies, International Institute for Population Sciences, Mumbai, India
| | - Muhammad Shahzeb Khan
- Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL, USA
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University, Seoul, South Korea
- Department of Health Policy and Management, Seoul National University, Seoul, South Korea
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
- Department of Arts and Sciences, Ohio University, Zanesville, OH, USA
| | - Amir Khater
- Internal Medicine and Gastroenterology Department, National Hepatology and Tropical Research Institute, Cairo, Egypt
| | - Mona M Khater
- Department of Medical Parasitology, Cairo University, Cairo, Egypt
| | | | - Mohammad Khazaei
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Khazaei-Pool
- Department of Public Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Jagdish Khubchandani
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Neda Kianipour
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yun Jin Kim
- School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
| | | | - Damaris K Kinyoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Adnan Kisa
- Department of Health Management and Health Economics, Kristiania University College, Oslo, Norway
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, USA
| | - Sezer Kisa
- Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Tufa Kolola
- Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
| | | | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ai Koyanagi
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi De Llobregat, Spain
| | - Moritz U G Kraemer
- Department of Zoology, University of Oxford, Oxford, UK
- Medical School, Harvard University, Boston, MA, USA
| | - Kewal Krishan
- Department of Anthropology, Panjab University, Chandigarh, India
| | - Kris J Krohn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nuworza Kugbey
- Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
- Psychology and Health Promotion, University of Kwazulu-Natal, Durban, South Africa
| | - G Anil Kumar
- Public Health Foundation of India, Gurugram, India
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Psychology, University College London, London, UK
| | | | - Desmond Kuupiel
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Nursing, St John of God Hospital, Duayaw Nkwanta, Ghana
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford Biomedical Research Centre, National Institute for Health Research (NIHR), Oxford, UK
| | - Sheetal D Lad
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faris Hasan Lami
- Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq
| | - Anders O Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Chemistry and Pharmacology, Uppsala University Hospital, Uppsala, Sweden
| | - Paul H Lee
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Mostafa Leili
- Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Aubrey J Levine
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee-Ling Lim
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
| | - Stefan Listl
- Department of Dentistry, Radboud University, Nijmegen, The Netherlands
- Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jaifred Christian F Lopez
- Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, The Philippines
- Alliance for Improving Health Outcomes, Quezon City, The Philippines
| | - Stefan Lorkowski
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (NUTRICARD), Jena, Germany
| | - Sameh Magdeldin
- Physiology Department, Suez Canal University, Ismailia, Egypt
- Proteomics and Metabolomics Unit, Suez Canal University, Ismailia, Egypt
| | | | | | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Afshin Maleki
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Navid Manafi
- Ophthalmology Department, Iran University of Medical Sciences, Tehran, Iran
- Department Ophthalmology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ana-Laura Manda
- Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
| | - Morteza Mansourian
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | | | - Anthony Masaka
- Faculty of Health and Education, Botho University-Botswana, Gaborone, Botswana
| | | | - Pallab K Maulik
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Research Department, The George Institute for Global Health, New Delhi, India
| | - Benjamin K Mayala
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Mazidi
- Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Ravi Mehrotra
- Preventive Oncology Department, National Institute of Cancer Prevention and Research, Noida, India
| | - Kala M Mehta
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | | | - Walter Mendoza
- Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
| | - Ritesh G Menezes
- Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Atte Meretoja
- Neurocenter, Helsinki University Hospital, Helsinki, Finland
- School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Tuomo J Meretoja
- Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Tomislav Mestrovic
- Clinical Microbiology and Parasitology Unit, Dr Zora Profozic Polyclinic, Zagreb, Croatia
- University Centre Varazdin, University North, Varazdin, Croatia
| | - Ted R Miller
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
- Pacific Institute for Research & Evaluation, Calverton, MD, USA
| | - Molly K Miller-Petrie
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Edward J Mills
- Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - George J Milne
- Department of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
| | - G K Mini
- Department of Public Health, Amrita Institute of Medical Sciences, Kochi, India
| | - Seyed Mostafa Mir
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erkin M Mirrakhimov
- Faculty of General Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
- Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
| | - Efat Mohamadi
- Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Dara K Mohammad
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Food Technology, College of Agriculture, Salahaddin University-Erbil, Erbil, Iraq
| | - Aso Mohammad Darwesh
- Information Technology Department, University of Human Development, Sulaimaniyah, Iraq
| | | | | | - Shafiu Mohammed
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mariam Molokhia
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lorenzo Monasta
- Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
| | - Yoshan Moodley
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masoud Moradi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Moradi
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moradinazar
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Paula Moraga
- Department of Mathematical Sciences, University of Bath, Bath, UK
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Abbas Mosapour
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
- Department of Clinical Biochemistry, Tarbiat Modares University, Tehran, Iran
| | - Seyyed Meysam Mousavi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
| | - Ulrich Otto Mueller
- Federal Institute for Population Research, Wiesbaden, Germany
- Center for Population and Health, Wiesbaden, Germany
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Ghulam Mustafa
- Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
- Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
| | - Behnam Nabavizadeh
- Department of Urology, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Naderi
- Operating Room Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ahamarshan Jayaraman Nagarajan
- Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
- Research and Analytics, Bioinsilico Technologies, Chennai, India
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Nahid Neamati
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Ionut Negoi
- Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- General Surgery Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ruxandra Irina Negoi
- Anatomy and Embryology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Cardiology, Cardio-aid, Bucharest, Romania
| | | | | | - Long Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Son Hoang Nguyen
- Center for Excellence in Behavioral Health, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | - Katie R Nielsen
- Global Health Department, University of Washington, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Dina Nur Anggraini Ningrum
- State University of Semarang, Public Health Science Department, Kota Semarang, Indonesia
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
| | | | - Molly R Nixon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Public Health Science Department, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Marzieh Nojomi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Shirin Nosratnejad
- Department of Health Economics, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
- Independent Consultant, Accra, Ghana
| | - Felix Akpojene Ogbo
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Kelechi E Oladimeji
- Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa
- Center for the Aid Program of Research in South Africa (CAPRISA) TB and HIV Pathogenesis Unit, United Nations Programme on HIV/AIDS (UNAIDS), Durban, South Africa
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | - Meysam Olfatifar
- Gastroenterology and Liver Disease Research Center, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Solomon Olum
- Department of Food Science and Postharvest Technology, Gulu University, Gulu, Uganda
- Ghent University, Ghent, Belgium
| | | | | | - Obinna E Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
| | - Eyal Oren
- University of Washington, Seattle, WA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | - Alberto Ortiz
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
- Department of Nephrology and Hypertension, The Institute for Health Research Foundation Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Frank B Osei
- Faculty of Geoinformation Science and Earth Observation, University of Twente, Enschede, The Netherlands
- Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana
| | | | - Stanislav S Otstavnov
- Analytical Center, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Committee for the Comprehensive Assessment of Medical Devices and Information Technology, Health Technology Assessment Association, Moscow, Russia
| | - Mayowa Ojo Owolabi
- Institute for Advanced Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mahesh P A
- Department of Tb & Respiratory Medicine, Jagadguru Sri Shivarathreeswara University, Mysore, India
| | - Abdol Sattar Pagheh
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Smita Pakhale
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Eun-Kee Park
- Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
| | - Hadi Parsian
- Department of Clinical Biochemistry, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Pashaei
- Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sangram Kishor Patel
- Research and Evaluation, Population Council, New Delhi, India
- Indian Institute of Health Management Research University, Jaipur, India
| | | | - Alexandre Pereira
- Department of Genetics, Harvard University, Boston, MA, USA
- Laboratory of Genetics and Molecular Cardiology, University of São Paulo, Sao Paulo, Brazil
| | - Samantha Perkins
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Brandon V Pickering
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
| | - Majid Pirestani
- Parasitology and Entomology Department, Tarbiat Modares University, Tehran, Iran
| | - Bakhtiar Piroozi
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | | | - Hadi Pourjafar
- Department of Nutrition and Food Sciences, Maragheh University of Medical Sciences, Maragheh, Iran
- Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Parul Puri
- International Institute for Population Sciences, Mumbai, India
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hedley Quintana
- Gorgas Memorial Institute for Health Studies, Panama, Panama
| | - Mohammad Rabiee
- Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Navid Rabiee
- Department of Chemistry, Sharif University of Technology, Tehran, Iran
| | - Amir Radfar
- College of Graduate Health Sciences, A.T. Still University, Mesa, AZ, USA
- Medichem, Barcelona, Spain
| | - Alireza Rafiei
- Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fakher Rahim
- Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zohreh Rahimi
- Department of Clinical Biochemistry, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Rahimzadeh
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rajati
- Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Azra Ramezankhani
- Prevention of Metabolic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Critical Care Quality Improvement Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Chhabi Lal Ranabhat
- Policy Research Institute, Kathmandu, Nepal
- Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
| | - Davide Rasella
- Institute of Public Health, Federal University of Bahia, Salvador, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Lal Rawal
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
- Social Science and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Riahi
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Elias Merdassa Roro
- Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Max Roser
- Martin School, University of Oxford, Oxford, UK
| | - Gholamreza Roshandel
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Daem Roshani
- Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Babol University of Medical Sciences, Babol, Iran
| | - Enrico Rubagotti
- School of Biotechnology, Ikiam Amazon Regional University, Tena, Ecuador
- Department of Ocean Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Siamak Sabour
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafis Sadat
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ehsan Sadeghi
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Saeedi
- Department of Health, Safety and Environment (HSE), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yahya Safari
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Safdarian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Nasir Salam
- Department of Pathology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Payman Salamati
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Health and Policy Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Farkhonde Salehi
- Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saleh Salehi Zahabi
- Department of Radiology and Nuclear Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Taleghani Hospital, Kermanshah, Iran
| | - Yahya Salimi
- Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamideh Salimzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Joshua A Salomon
- Center for Health Policy & Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | - Abdallah M Samy
- Department of Entomology, Ain Shams University, Cairo, Egypt
| | | | - Bruno Piassi Sao Jose
- Post-graduate Program in Infectious Diseases and Tropical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sivan Yegnanarayana Iyer Saraswathy
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, India
- PSG-FAIMER South Asia Regional Institute, Coimbatore, India
| | - Rodrigo Sarmiento-Suárez
- Department of Health and Society, Faculty of Medicine, University of Applied and Environmental Sciences, Bogotá, Colombia
| | - Benn Sartorius
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Brijesh Sathian
- Surgery Department, Hamad Medical Corporation, Doha, Qatar
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Alyssa N Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lauren E Schaeffer
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyedmojtaba Seyedmousavi
- Center of Expertise in Microbiology, Tehran University of Medical Sciences, Tehran, Iran
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Faramarz Shaahmadi
- Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mehran Shams-Beyranvand
- Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Amir Shamshirian
- Medical Laboratory Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Shamsizadeh
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Mehdi Sharif
- Department of Laboratory Sciences, Karaj Islamic Azad University, Kermanshah, Iran
- Department of Basic Sciences, Karaj Islamic Azad University, Kermanshah, Iran
| | - Mahdi Sharif-Alhoseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Jayendra Sharma
- Policy and Planning Division, Ministry of Health, Riyadh, Saudi Arabia
| | - Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, New Delhi, India
| | - Aziz Sheikh
- Division of General Internal Medicine and Primary Care, Harvard University, Boston, MA, USA
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Chloe Shields
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Rahman Shiri
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Institute of Medical Epidemiology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Kerem Shuval
- School of Public Health, University of Haifa, Haifa, Israel
| | - Tariq J Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - João Pedro Silva
- Applied Molecular Biosciences Unit (UCIBIO), University of Porto, Porto, Portugal
| | - Jasvinder A Singh
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dhirendra Narain Sinha
- Department of Epidemiology, School of Preventive Oncology, Patna, India
- Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
| | - Malede Mequanent Sisay
- Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Solomon Sisay
- Medical Division, German Leprosy and TB Relief Association Ethiopia, Addis Ababa, Ethiopia
| | - Karen Sliwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ranjani Somayaji
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Joan B Soriano
- Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | | | - Agus Sudaryanto
- Department of Nursing, Muhammadiyah University of Surakarta, Kartasura, Indonesia
| | | | - Bryan L Sykes
- Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
| | - P N Sylaja
- Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Rafael Tabarés-Seisdedos
- Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Karen M Tabb
- School of Social Work, University of Illinois, Urbana, IL, USA
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Nuno Taveira
- University Institute 'Egas Moniz', Monte Da Caparica, Portugal
- Research Institute for Medicines, Faculty of Pharmacy of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Mohamad-Hani Temsah
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Sulieman Terkawi
- Anesthesiology Department, University of Virginia, Charlottesville, VA, USA
- Syrian Expatriate Medical Association (SEMA), Charlottesville, VA, USA
| | | | | | | | - Quyen G To
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Bach Xuan Tran
- Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
| | - Khanh Bao Tran
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
- Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
| | - Irfan Ullah
- Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
- TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
| | - Muhammad Shariq Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Amir Vahedian-Azimi
- Department of Education and Health, Trauma Research Center, Tehran, Iran
- Critical and Intensive Care Department, Trauma Research Center, Tehran, Iran
| | - Pascual R Valdez
- Argentine Society of Medicine, Buenos Aires, Argentina
- Velez Sarsfield Hospital, Buenos Aires, Argentina
| | - Job F M van Boven
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Yasser Vasseghian
- Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Narayanaswamy Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Francesco S Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Occupational Health Unit, Sant'orsola Malpighi Hospital, Bologna, Italy
| | - Sergey Konstantinovitch Vladimirov
- Department of Information Technologies and Management, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Department of Information and Internet Technologies, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasily Vlassov
- Department of Health Care Administration and Economy, National Research University Higher School of Economics, Moscow, Russia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Giang Thu Vu
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh, Vietnam
| | | | - Yasir Waheed
- Foundation University Medical College, Foundation University, Rawalpindi, Pakistan
| | - Jon Wakefield
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Yafeng Wang
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
| | - Yuan-Pang Wang
- Department of Psychiatry, University of São Paulo, Sao Paulo, Brazil
| | - Joseph L Ward
- Institute of Child Health, University College London, London, UK
| | - Robert G Weintraub
- Cardiology Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | | | - Ronny Westerman
- Competence Center of Mortality-Follow-Up, Federal Institute for Population Research, Wiesbaden, Germany
| | - Charles Shey Wiysonge
- Cochrane South Africa, Medical Research Council South Africa, Cape Town, South Africa
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Dawit Zewdu Wondafrash
- Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
- Department of Pharmacology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lauren Woyczynski
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ai-Min Wu
- Zhejiang Spine Research Center, Wenzhou Medical University, Wenzhou, China
| | - Gelin Xu
- School of Medicine, Nanjing University, Nanjing, China
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tomohide Yamada
- Department of Diabetes and Metabolic Diseases, University of Tokyo, Tokyo, Japan
| | - Vahid Yazdi-Feyzabadi
- Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
- Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Christopher Sabo Yilgwan
- Department of Pediatrics, University of Jos, Jos, Nigeria
- Department of Pediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Paul Yip
- Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Naohiro Yonemoto
- Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Javad Yoosefi Lebni
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Mustafa Z Younis
- Health Economics & Finance, Global Health, Jackson State University, Jackson, MS, USA
- Research Center for Public Health, Tsinghua University, Peking, China
| | - Mahmoud Yousefifard
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
- Global Health Institute, Wuhan University, Wuhan, China
| | - Hasan Yusefzadeh
- Department of Health Management and Economics, A.C.S. Medical College and Hospital, Tehran, Iran
| | - Erfan Zabeh
- Department of Electrical Engineering, Sharif University of Technology, Tehran, Iran
- Electrical Engineering, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Telma Zahirian Moghadam
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mohammad Zamani
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
- Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Alireza Zangeneh
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Taddese Alemu Zerfu
- Maternal and Child Wellbeing Unit, African Population Health Research Centre, Nairobi, Kenya
- Public Health Department, Dilla University, Dilla, Ethiopia
| | - Yunquan Zhang
- Department of Preventative Medicine, Wuhan University, Wuhan, China
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Arash Ziapour
- Department of Health Education and Health Promotion, Iran University of Medical Sciences, Tehran, Iran
| | - Sanjay Zodpey
- Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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5
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Lozano R, Fullman N, Abate D, Abay SM, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdel-Rahman O, Abdi A, Abdollahpour I, Abdulkader RS, Abebe ND, Abebe Z, Abejie AN, Abera SF, Abil OZ, Aboyans V, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NM, Abyu GY, Accrombessi MMK, Acharya D, Acharya P, Adamu AA, Adebayo OM, Adedeji IA, Adedoyin RA, Adekanmbi V, Adetokunboh OO, Adhena BM, Adhikari TB, Adib MG, Adou AK, Adsuar JC, Afarideh M, Afshari M, Afshin A, Agarwal G, Aghayan SA, Agius D, Agrawal A, Agrawal S, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmed MB, Ahmed S, Akalu TY, Akanda AS, Akbari ME, Akibu M, Akinyemi RO, Akinyemiju T, Akseer N, Alahdab F, Al-Aly Z, Alam K, Alam T, Albujeer A, Alebel A, Alene KA, Al-Eyadhy A, Alhabib S, Ali R, Alijanzadeh M, Alizadeh-Navaei R, Aljunid SM, Alkerwi A, Alla F, Allebeck P, Allen CA, Almasi A, Al-Maskari F, Al-Mekhlafi HM, Alonso J, Al-Raddadi RM, Alsharif U, Altirkawi K, Alvis-Guzman N, Amare AT, Amenu K, Amini E, Ammar 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Zucker I, Zuhlke LJJ, Lim SS, Murray CJL. Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392:2091-2138. [PMID: 30496107 PMCID: PMC6227911 DOI: 10.1016/s0140-6736(18)32281-5] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. METHODS We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. FINDINGS The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. INTERPRETATION The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. FUNDING Bill & Melinda Gates Foundation.
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de Boer PT, Kelso JK, Halder N, Nguyen TPL, Moyes J, Cohen C, Barr IG, Postma MJ, Milne GJ. The cost-effectiveness of trivalent and quadrivalent influenza vaccination in communities in South Africa, Vietnam and Australia. Vaccine 2018; 36:997-1007. [PMID: 29373192 PMCID: PMC5805858 DOI: 10.1016/j.vaccine.2017.12.073] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND To inform national healthcare authorities whether quadrivalent influenza vaccines (QIVs) provide better value for money than trivalent influenza vaccines (TIVs), we assessed the cost-effectiveness of TIV and QIV in low-and-middle income communities based in South Africa and Vietnam and contrasted these findings with those from a high-income community in Australia. METHODS Individual based dynamic simulation models were interfaced with a health economic analysis model to estimate the cost-effectiveness of vaccinating 15% of the population with QIV or TIV in each community over the period 2003-2013. Vaccination was prioritized for HIV-infected individuals, before elderly aged 65+ years and young children. Country or region-specific data on influenza-strain circulation, clinical outcomes and costs were obtained from published sources. The societal perspective was used and outcomes were expressed in International$ (I$) per quality-adjusted life-year (QALY) gained. RESULTS When compared with TIV, we found that QIV would provide a greater reduction in influenza-related morbidity in communities in South Africa and Vietnam as compared with Australia. The incremental cost-effectiveness ratio of QIV versus TIV was estimated at I$4183/QALY in South Africa, I$1505/QALY in Vietnam and I$80,966/QALY in Australia. CONCLUSIONS The cost-effectiveness of QIV varied between communities due to differences in influenza epidemiology, comorbidities, and unit costs. Whether TIV or QIV is the most cost-effective alternative heavily depends on influenza B burden among subpopulations targeted forvaccination in addition to country-specific willingness-to-pay thresholds and budgetary impact.
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Affiliation(s)
- Pieter T de Boer
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | - Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Australia.
| | - Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Australia.
| | - Thi-Phuong-Lan Nguyen
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands; Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam.
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa; School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
| | - Ian G Barr
- WHO Collaborating Centre for Reference and Research on Influenza, Melbourne, Australia.
| | - Maarten J Postma
- Unit of Pharmacotherapy, Epidemiology & Economics (PTE2), Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands; Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands.
| | - George J Milne
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Australia.
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Karl S, White MT, Milne GJ, Gurarie D, Hay SI, Barry AE, Felger I, Mueller I. Spatial Effects on the Multiplicity of Plasmodium falciparum Infections. PLoS One 2016; 11:e0164054. [PMID: 27711149 PMCID: PMC5053403 DOI: 10.1371/journal.pone.0164054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
As malaria is being pushed back on many frontiers and global case numbers are declining, accurate measurement and prediction of transmission becomes increasingly difficult. Low transmission settings are characterised by high levels of spatial heterogeneity, which stands in stark contrast to the widely used assumption of spatially homogeneous transmission used in mathematical transmission models for malaria. In the present study an individual-based mathematical malaria transmission model that incorporates multiple parasite clones, variable human exposure and duration of infection, limited mosquito flight distance and most importantly geographically heterogeneous human and mosquito population densities was used to illustrate the differences between homogeneous and heterogeneous transmission assumptions when aiming to predict surrogate indicators of transmission intensity such as population parasite prevalence or multiplicity of infection (MOI). In traditionally highly malaria endemic regions where most of the population harbours malaria parasites, humans are often infected with multiple parasite clones. However, studies have shown also in areas with low overall parasite prevalence, infection with multiple parasite clones is a common occurrence. Mathematical models assuming homogeneous transmission between humans and mosquitoes cannot explain these observations. Heterogeneity of transmission can arise from many factors including acquired immunity, body size and occupational exposure. In this study, we show that spatial heterogeneity has a profound effect on predictions of MOI and parasite prevalence. We illustrate, that models assuming homogeneous transmission underestimate average MOI in low transmission settings when compared to field data and that spatially heterogeneous models predict stable transmission at much lower overall parasite prevalence. Therefore it is very important that models used to guide malaria surveillance and control strategies in low transmission and elimination settings take into account the spatial features of the specific target area, including human and mosquito vector distribution.
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Affiliation(s)
- Stephan Karl
- Population-Based Biology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
- Vector-borne Diseases Unit, Papua New Guinea Insititute of Medical Research, Madang, Madang Province, Papua New Guinea
- * E-mail:
| | - Michael T. White
- Population-Based Biology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom
| | - George J. Milne
- School of Computer Science and Software Engineering, The University of Western Australia, Perth, WA, Australia
| | - David Gurarie
- Department of Mathematics, Applied Mathematics and Statistics, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, Seattle, Washington, United States of America
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alyssa E. Barry
- Population-Based Biology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Ingrid Felger
- Department of Medical Parasitology and Infection Biology Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ivo Mueller
- Population-Based Biology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
- Malaria: Parasites and Hosts Unit, Department of Parasites & Insect Vectors, Institut Pasteur, Paris, France
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Milne GJ, Halder N, Kelso JK, Barr IG, Moyes J, Kahn K, Twine R, Cohen C. Trivalent and quadrivalent influenza vaccination effectiveness in Australia and South Africa: results from a modelling study. Influenza Other Respir Viruses 2016; 10:324-32. [PMID: 26663701 PMCID: PMC4910176 DOI: 10.1111/irv.12367] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A modelling study was conducted to determine the effectiveness of trivalent (TIV) and quadrivalent (QIV) vaccination in South Africa and Australia. OBJECTIVES This study aimed to determine the potential benefits of alternative vaccination strategies which may depend on community-specific demographic and health characteristics. METHODS Two influenza A and two influenza B strains were simulated using individual-based simulation models representing specific communities in South Africa and Australia over 11 years. Scenarios using TIV or QIV, with alternative prioritisation strategies and vaccine coverage levels, were evaluated using a country-specific health outcomes process. RESULTS In South Africa, approximately 18% fewer deaths and hospitalisations would be expected to result from the use of QIV compared to TIV over the 11 modelled years (P = 0·031). In Australia, only 2% (P = 0·30) fewer deaths and hospitalisations would result. Vaccinating 2%, 5%, 15% or 20% of the population with TIV using a strategy of prioritising vulnerable age groups, including HIV-positive individuals, resulted in reductions in hospitalisations and mortality of at least 7%, 18%, 57% and 66%, respectively, in both communities. CONCLUSIONS The degree to which QIV can reduce health burden compared to TIV is strongly dependent on the number of years in which the influenza B lineage in the TIV matches the circulating B lineages. Assuming a moderate level of B cross-strain protection, TIV may be as effective as QIV. The choice of vaccination prioritisation has a greater impact than the QIV/TIV choice, with strategies targeting those most responsible for transmission being most effective.
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Affiliation(s)
- George J Milne
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia
| | - Ian G Barr
- World Health Organization (WHO) Collaborating Centre for Reference and Research on Influenza, Melbourne, Vic., Australia
| | - Jocelyn Moyes
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Science, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Karl S, Halder N, Kelso JK, Ritchie SA, Milne GJ. A spatial simulation model for dengue virus infection in urban areas. BMC Infect Dis 2014; 14:447. [PMID: 25139524 PMCID: PMC4152583 DOI: 10.1186/1471-2334-14-447] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/13/2014] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization estimates that the global number of dengue infections range between 80–100 million per year, with some studies estimating approximately three times higher numbers. Furthermore, the geographic range of dengue virus transmission is extending with the disease now occurring more frequently in areas such as southern Europe. Ae. aegypti, one of the most prominent dengue vectors, is endemic to the far north-east of Australia and the city of Cairns frequently experiences dengue outbreaks which sometimes lead to large epidemics. Method A spatially-explicit, individual-based mathematical model that accounts for the spread of dengue infection as a result of human movement and mosquito dispersion is presented. The model closely couples the four key sub-models necessary for representing the overall dynamics of the physical system, namely those describing mosquito population dynamics, human movement, virus transmission and vector control. Important features are the use of high quality outbreak data and mosquito trapping data for calibration and validation and a strategy to derive local mosquito abundance based on vegetation coverage and census data. Results The model has been calibrated using detailed 2003 dengue outbreak data from Cairns, together with census and mosquito trapping data, and is shown to realistically reproduce a further dengue outbreak. The simulation results replicating the 2008/2009 Cairns epidemic support several hypotheses (formulated previously) aimed at explaining the large-scale epidemic which occurred in 2008/2009; specifically, while warmer weather and increased human movement had only a small effect on the spread of the virus, a shorter virus strain-specific extrinsic incubation time can explain the observed explosive outbreak of 2008/2009. Conclusion The proof-of-concept simulation model described in this study has potential as a tool for understanding factors contributing to dengue spread as well as planning and optimizing dengue control, including reducing the Ae. aegypti vector population and for estimating the effectiveness and cost-effectiveness of future vaccination programmes. This model could also be applied to other vector borne viral diseases such as chikungunya, also spread by Ae. aegypti and, by re-parameterisation of the vector sub-model, to dengue and chikungunya viruses spread by Aedes albopictus. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-447) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | - George J Milne
- School of Computer Science and Software Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.
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Kelso JK, Milne GJ. A spatial simulation model for the dispersal of the bluetongue vector Culicoides brevitarsis in Australia. PLoS One 2014; 9:e104646. [PMID: 25105418 PMCID: PMC4126746 DOI: 10.1371/journal.pone.0104646] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 07/15/2014] [Indexed: 11/18/2022] Open
Abstract
Background The spread of Bluetongue virus (BTV) among ruminants is caused by movement of infected host animals or by movement of infected Culicoides midges, the vector of BTV. Biologically plausible models of Culicoides dispersal are necessary for predicting the spread of BTV and are important for planning control and eradication strategies. Methods A spatially-explicit simulation model which captures the two underlying population mechanisms, population dynamics and movement, was developed using extensive data from a trapping program for C. brevitarsis on the east coast of Australia. A realistic midge flight sub-model was developed and the annual incursion and population establishment of C. brevitarsis was simulated. Data from the literature was used to parameterise the model. Results The model was shown to reproduce the spread of C. brevitarsis southwards along the east Australian coastline in spring, from an endemic population to the north. Such incursions were shown to be reliant on wind-dispersal; Culicoides midge active flight on its own was not capable of achieving known rates of southern spread, nor was re-emergence of southern populations due to overwintering larvae. Data from midge trapping programmes were used to qualitatively validate the resulting simulation model. Conclusions The model described in this paper is intended to form the vector component of an extended model that will also include BTV transmission. A model of midge movement and population dynamics has been developed in sufficient detail such that the extended model may be used to evaluate the timing and extent of BTV outbreaks. This extended model could then be used as a platform for addressing the effectiveness of spatially targeted vaccination strategies or animal movement bans as BTV spread mitigation measures, or the impact of climate change on the risk and extent of outbreaks. These questions involving incursive Culicoides spread cannot be simply addressed with non-spatial models.
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Affiliation(s)
- Joel K. Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - George J. Milne
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Western Australia, Australia
- * E-mail:
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Halder N, Kelso JK, Milne GJ. A model-based economic analysis of pre-pandemic influenza vaccination cost-effectiveness. BMC Infect Dis 2014; 14:266. [PMID: 24884470 PMCID: PMC4045999 DOI: 10.1186/1471-2334-14-266] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background A vaccine matched to a newly emerged pandemic influenza virus would require a production time of at least 6 months with current proven techniques, and so could only be used reactively after the peak of the pandemic. A pre-pandemic vaccine, although probably having lower efficacy, could be produced and used pre-emptively. While several previous studies have investigated the cost effectiveness of pre-emptive vaccination strategies, they have not been directly compared to realistic reactive vaccination strategies. Methods An individual-based simulation model of ~30,000 people was used to examine a pre-emptive vaccination strategy, assuming vaccination conducted prior to a pandemic using a low-efficacy vaccine. A reactive vaccination strategy, assuming a 6-month delay between pandemic emergence and availability of a high-efficacy vaccine, was also modelled. Social distancing and antiviral interventions were examined in combination with these alternative vaccination strategies. Moderate and severe pandemics were examined, based on estimates of transmissibility and clinical severity of the 1957 and 1918 pandemics respectively, and the cost effectiveness of each strategy was evaluated. Results Provided that a pre-pandemic vaccine achieved at least 30% efficacy, pre-emptive vaccination strategies were found to be more cost effective when compared to reactive vaccination strategies. Reactive vaccination coupled with sustained social distancing and antiviral interventions was found to be as effective at saving lives as pre-emptive vaccination coupled with limited duration social distancing and antiviral use, with both strategies saving approximately 420 life-years per 10,000 population for a moderate pandemic with a basic reproduction number of 1.9 and case fatality rate of 0.25%. Reactive vaccination was however more costly due to larger productivity losses incurred by sustained social distancing, costing $8 million per 10,000 population ($19,074/LYS) versus $6.8 million per 10,000 population ($15,897/LYS) for a pre-emptive vaccination strategy. Similar trends were observed for severe pandemics. Conclusions Compared to reactive vaccination, pre-emptive strategies would be more effective and more cost effective, conditional on the pre-pandemic vaccine being able to achieve a certain level of coverage and efficacy. Reactive vaccination strategies exist which are as effective at mortality reduction as pre-emptive strategies, though they are less cost effective.
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Affiliation(s)
| | - Joel K Kelso
- School of Computer Science and Software Engineering, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
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Milne GJ, Halder N, Kelso JK. The cost effectiveness of pandemic influenza interventions: a pandemic severity based analysis. PLoS One 2013; 8:e61504. [PMID: 23585906 PMCID: PMC3621766 DOI: 10.1371/journal.pone.0061504] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. METHODS A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. RESULTS Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. CONCLUSIONS The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the infection rate.
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Affiliation(s)
- George J Milne
- Simulation and Modelling Research Unit, University of Western Australia, Perth, Australia.
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Abstract
OBJECTIVES The possible occurrence of a highly pathogenic influenza strain is of concern to health authorities worldwide. It is known that during past influenza pandemics developing countries have experienced considerably higher death rates compared with developed countries. Furthermore, many developing countries lack appropriate pandemic preparedness plans. Mathematical modelling studies to guide the development of such plans are largely focused on predicting pandemic influenza spread in developed nations. However, intervention strategies shown by modelling studies to be highly effective for developed countries give limited guidance as to the impact which an influenza pandemic may have on low-income countries given different demographics and resource constraints. To address this, an individual-based model of a Papua New Guinean (PNG) community was created and used to simulate the spread of a novel influenza strain. The results were compared with those obtained from a comparable Australian model. DESIGN A modelling study. SETTING The towns of Madang in PNG (population ∼35 000) and Albany (population ∼30 000) in Australia. OUTCOME MEASURES Daily and cumulative illness attack rates in both models following introduction of a novel influenza strain into a naive population, for an unmitigated scenario and two social distancing intervention scenarios. RESULTS The unmitigated scenario indicated an approximately 50% higher attack rate in PNG compared with the Australian model. The two social distancing-based interventions strategies were 60-70% less effective in a PNG setting compared with an Australian setting. CONCLUSIONS This study provides further evidence that an influenza pandemic occurring in a low-income country such as PNG may have a greater impact than one occurring in a developed country, and that PNG-feasible interventions may be substantially less effective. The larger average household size in PNG, the larger proportion of the population under 18 and greater community-wide contact all contribute to this feature.
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Affiliation(s)
- George J Milne
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
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Kelso JK, Halder N, Postma MJ, Milne GJ. Economic analysis of pandemic influenza mitigation strategies for five pandemic severity categories. BMC Public Health 2013; 13:211. [PMID: 23496898 PMCID: PMC3606600 DOI: 10.1186/1471-2458-13-211] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/28/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The threat of emergence of a human-to-human transmissible strain of highly pathogenic influenza A(H5N1) is very real, and is reinforced by recent results showing that genetically modified A(H5N1) may be readily transmitted between ferrets. Public health authorities are hesitant in introducing social distancing interventions due to societal disruption and productivity losses. This study estimates the effectiveness and total cost (from a societal perspective, with a lifespan time horizon) of a comprehensive range of social distancing and antiviral drug strategies, under a range of pandemic severity categories. METHODS An economic analysis was conducted using a simulation model of a community of ~30,000 in Australia. Data from the 2009 pandemic was used to derive relationships between the Case Fatality Rate (CFR) and hospitalization rates for each of five pandemic severity categories, with CFR ranging from 0.1% to 2.5%. RESULTS For a pandemic with basic reproduction number R0 = 1.8, adopting no interventions resulted in total costs ranging from $441 per person for a pandemic at category 1 (CFR 0.1%) to $8,550 per person at category 5 (CFR 2.5%). For severe pandemics of category 3 (CFR 0.75%) and greater, a strategy combining antiviral treatment and prophylaxis, extended school closure and community contact reduction resulted in the lowest total cost of any strategy, costing $1,584 per person at category 5. This strategy was highly effective, reducing the attack rate to 5%. With low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, whereas higher severity pandemic costs are dominated by healthcare costs and costs arising from productivity losses due to death. CONCLUSIONS For pandemics in high severity categories the strategies with the lowest total cost to society involve rigorous, sustained social distancing, which are considered unacceptable for low severity pandemics due to societal disruption and cost.
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Affiliation(s)
- Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
| | - Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
| | - Maarten J Postma
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, Netherlands
| | - George J Milne
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Western Australia, Australia
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Kelso JK, Halder N, Milne GJ. Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis. BMC Infect Dis 2013; 13:81. [PMID: 23398722 PMCID: PMC3637125 DOI: 10.1186/1471-2334-13-81] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/07/2013] [Indexed: 12/25/2022] Open
Abstract
Background A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. Methods A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Results Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination further improved effectiveness and cost effectiveness. Conclusions The effectiveness and cost effectiveness consequences of the time-critical interplay of pandemic dynamics, vaccine availability and intervention timing has been quantified. For moderate and extreme pandemics, vaccination combined with rapidly activated antiviral and social distancing interventions of sufficient duration is cost effective from the perspective of life years saved.
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Affiliation(s)
- Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Stirling Highway, Crawley, Western Australia 6009, Australia
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Halder N, Kelso JK, Milne GJ. Cost-effective strategies for mitigating a future influenza pandemic with H1N1 2009 characteristics. PLoS One 2011; 6:e22087. [PMID: 21760957 PMCID: PMC3132288 DOI: 10.1371/journal.pone.0022087] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 06/15/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We performed an analysis of the cost-effectiveness of pandemic intervention strategies using a detailed, individual-based simulation model of a community in Australia together with health outcome data of infected individuals gathered during 2009-2010. The aim was to examine the cost-effectiveness of a range of interventions to determine the most cost-effective strategies suitable for a future pandemic with H1N1 2009 characteristics. METHODOLOGY/PRINCIPAL FINDINGS Using transmissibility, age-stratified attack rates and health outcomes determined from H1N1 2009 data, we determined that the most cost-effective strategies involved treatment and household prophylaxis using antiviral drugs combined with limited duration school closure, with costs ranging from $632 to $777 per case prevented. When school closure was used as a sole intervention we found the use of limited duration school closure to be significantly more cost-effective compared to continuous school closure, a result with applicability to countries with limited access to antiviral drugs. Other social distancing strategies, such as reduced workplace attendance, were found to be costly due to productivity losses. CONCLUSION The mild severity (low hospitalisation and case fatality rates) and low transmissibility of H1N1 2009 meant that health treatment costs were dominated by the higher productivity losses arising from workplace absence due to illness and childcare requirements following school closure. Further analysis for higher transmissibility but with the same, mild severity had no effect on the overall findings.
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Affiliation(s)
- Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - Joel K. Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Western Australia, Australia
| | - George J. Milne
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Western Australia, Australia
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Kelso JK, Halder N, Milne GJ. The impact of case diagnosis coverage and diagnosis delays on the effectiveness of antiviral strategies in mitigating pandemic influenza A/H1N1 2009. PLoS One 2010; 5:e13797. [PMID: 21072188 PMCID: PMC2972206 DOI: 10.1371/journal.pone.0013797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 10/12/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neuraminidase inhibitors were used to reduce the transmission of pandemic influenza A/H1N1 2009 at the early stages of the 2009/2010 pandemic. Policies for diagnosis of influenza for the purposes of antiviral intervention differed markedly between and within countries, leading to differences in the timing and scale of antiviral usage. METHODOLOGY/PRINCIPAL FINDINGS The impact of the percentage of symptomatic infected individuals who were diagnosed, and of delays to diagnosis, for three antiviral intervention strategies (each with and without school closure) were determined using a simulation model of an Australian community. Epidemic characteristics were based on actual data from the A/H1N1 2009 pandemic including reproduction number, serial interval and age-specific infection rate profile. In the absence of intervention an illness attack rate (AR) of 24.5% was determined from an estimated R(0) of 1.5; this was reduced to 21%, 16.5% or 13% by treatment-only, treatment plus household prophylaxis, or treatment plus household plus extended prophylaxis antiviral interventions respectively, assuming that diagnosis occurred 24 hours after symptoms arose and that 50% of symptomatic cases were diagnosed. If diagnosis occurred without delay, ARs decreased to 17%, 12.2% or 8.8% respectively. If 90% of symptomatic cases were diagnosed (with a 24 hour delay), ARs decreased to 17.8%, 11.1% and 7.6%, respectively. CONCLUSION The ability to rapidly diagnose symptomatic cases and to diagnose a high proportion of cases was shown to improve the effectiveness of all three antiviral strategies. For epidemics with R(0)< = 1.5 our results suggest that when the case diagnosis coverage exceeds ∼70% the size of the antiviral stockpile required to implement the extended prophylactic strategy decreases. The addition of at least four weeks of school closure was found to further reduce cumulative and peak attack rates and the size of the required antiviral stockpile.
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Affiliation(s)
- Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Crawley, Australia.
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Halder N, Kelso JK, Milne GJ. Developing guidelines for school closure interventions to be used during a future influenza pandemic. BMC Infect Dis 2010; 10:221. [PMID: 20659348 PMCID: PMC2915996 DOI: 10.1186/1471-2334-10-221] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 07/27/2010] [Indexed: 11/20/2022] Open
Abstract
Background The A/H1N1 2009 influenza pandemic revealed that operational issues of school closure interventions, such as when school closure should be initiated (activation trigger), how long schools should be closed (duration) and what type of school closure should be adopted, varied greatly between and within countries. Computer simulation can be used to examine school closure intervention strategies in order to inform public health authorities as they refine school closure guidelines in light of experience with the A/H1N1 2009 pandemic. Methods An individual-based simulation model was used to investigate the effectiveness of school closure interventions for influenza pandemics with R0 of 1.5, 2.0 and 2.5. The effectiveness of individual school closure and simultaneous school closure were analyzed for 2, 4 and 8 weeks closure duration, with a daily diagnosed case based intervention activation trigger scheme. The effectiveness of combining antiviral drug treatment and household prophyaxis with school closure was also investigated. Results Illness attack rate was reduced from 33% to 19% (14% reduction in overall attack rate) by 8 weeks school closure activating at 30 daily diagnosed cases in the community for an influenza pandemic with R0 = 1.5; when combined with antivirals a 19% (from 33% to 14%) reduction in attack rate was obtained. For R0 >= 2.0, school closure would be less effective. An 8 weeks school closure strategy gives 9% (from 50% to 41%) and 4% (from 59% to 55%) reduction in attack rate for R0 = 2.0 and 2.5 respectively; however, school closure plus antivirals would give a significant reduction (~15%) in over all attack rate. The results also suggest that an individual school closure strategy would be more effective than simultaneous school closure. Conclusions Our results indicate that the particular school closure strategy to be adopted depends both on the disease severity, which will determine the duration of school closure deemed acceptable, and its transmissibility. For epidemics with a low transmissibility (R0 < 2.0) and/or mild severity, individual school closures should begin once a daily community case count is exceeded. For a severe, highly transmissible epidemic (R0 >= 2.0), long duration school closure should begin as soon as possible and be combined with other interventions.
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Affiliation(s)
- Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Australia
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Halder N, Kelso JK, Milne GJ. Analysis of the effectiveness of interventions used during the 2009 A/H1N1 influenza pandemic. BMC Public Health 2010; 10:168. [PMID: 20346187 PMCID: PMC2853510 DOI: 10.1186/1471-2458-10-168] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 03/29/2010] [Indexed: 11/20/2022] Open
Abstract
Background Following the emergence of the A/H1N1 2009 influenza pandemic, public health interventions were activated to lessen its potential impact. Computer modelling and simulation can be used to determine the potential effectiveness of the social distancing and antiviral drug therapy interventions that were used at the early stages of the pandemic, providing guidance to public health policy makers as to intervention strategies in future pandemics involving a highly pathogenic influenza strain. Methods An individual-based model of a real community with a population of approximately 30,000 was used to determine the impact of alternative interventions strategies, including those used in the initial stages of the 2009 pandemic. Different interventions, namely school closure and antiviral strategies, were simulated in isolation and in combination to form different plausible scenarios. We simulated epidemics with reproduction numbers R0of 1.5, which aligns with estimates in the range 1.4-1.6 determined from the initial outbreak in Mexico. Results School closure of 1 week was determined to have minimal effect on reducing overall illness attack rate. Antiviral drug treatment of 50% of symptomatic cases reduced the attack rate by 6.5%, from an unmitigated rate of 32.5% to 26%. Treatment of diagnosed individuals combined with additional household prophylaxis reduced the final attack rate to 19%. Further extension of prophylaxis to close contacts (in schools and workplaces) further reduced the overall attack rate to 13% and reduced the peak daily illness rate from 120 to 22 per 10,000 individuals. We determined the size of antiviral stockpile required; the ratio of the required number of antiviral courses to population was 13% for the treatment-only strategy, 25% for treatment and household prophylaxis and 40% for treatment, household and extended prophylaxis. Additional simulations suggest that coupling school closure with the antiviral strategies further reduces epidemic impact. Conclusions These results suggest that the aggressive use of antiviral drugs together with extended school closure may substantially slow the rate of influenza epidemic development. These strategies are more rigorous than those actually used during the early stages of the relatively mild 2009 pandemic, and are appropriate for future pandemics that have high morbidity and mortality rates.
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Affiliation(s)
- Nilimesh Halder
- School of Computer Science and Software Engineering, University of Western Australia, Perth, Australia
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Kelso JK, Milne GJ, Kelly H. Simulation suggests that rapid activation of social distancing can arrest epidemic development due to a novel strain of influenza. BMC Public Health 2009; 9:117. [PMID: 19400970 PMCID: PMC2680828 DOI: 10.1186/1471-2458-9-117] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 04/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social distancing interventions such as school closure and prohibition of public gatherings are present in pandemic influenza preparedness plans. Predicting the effectiveness of intervention strategies in a pandemic is difficult. In the absence of other evidence, computer simulation can be used to help policy makers plan for a potential future influenza pandemic. We conducted simulations of a small community to determine the magnitude and timing of activation that would be necessary for social distancing interventions to arrest a future pandemic. METHODS We used a detailed, individual-based model of a real community with a population of approximately 30,000. We simulated the effect of four social distancing interventions: school closure, increased isolation of symptomatic individuals in their household, workplace nonattendance, and reduction of contact in the wider community. We simulated each of the intervention measures in isolation and in several combinations; and examined the effect of delays in the activation of interventions on the final and daily attack rates. RESULTS For an epidemic with an R0 value of 1.5, a combination of all four social distancing measures could reduce the final attack rate from 33% to below 10% if introduced within 6 weeks from the introduction of the first case. In contrast, for an R0 of 2.5 these measures must be introduced within 2 weeks of the first case to achieve a similar reduction; delays of 2, 3 and 4 weeks resulted in final attack rates of 7%, 21% and 45% respectively. For an R0 of 3.5 the combination of all four measures could reduce the final attack rate from 73% to 16%, but only if introduced without delay; delays of 1, 2 or 3 weeks resulted in final attack rates of 19%, 35% or 63% respectively. For the higher R0 values no single measure has a significant impact on attack rates. CONCLUSION Our results suggest a critical role of social distancing in the potential control of a future pandemic and indicate that such interventions are capable of arresting influenza epidemic development, but only if they are used in combination, activated without delay and maintained for a relatively long period.
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Affiliation(s)
- Joel K Kelso
- School of Computer Science and Software Engineering, University of Western Australia, Perth, WA, Australia.
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Milne GJ, Kelso JK, Kelly HA, Huband ST, McVernon J. A small community model for the transmission of infectious diseases: comparison of school closure as an intervention in individual-based models of an influenza pandemic. PLoS One 2008; 3:e4005. [PMID: 19104659 PMCID: PMC2602849 DOI: 10.1371/journal.pone.0004005] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 11/20/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the absence of other evidence, modelling has been used extensively to help policy makers plan for a potential future influenza pandemic. METHOD We have constructed an individual based model of a small community in the developed world with detail down to exact household structure obtained from census collection datasets and precise simulation of household demographics, movement within the community and individual contact patterns. We modelled the spread of pandemic influenza in this community and the effect on daily and final attack rates of four social distancing measures: school closure, increased case isolation, workplace non-attendance and community contact reduction. We compared the modelled results of final attack rates in the absence of any interventions and the effect of school closure as a single intervention with other published individual based models of pandemic influenza in the developed world. RESULTS We showed that published individual based models estimate similar final attack rates over a range of values for R(0) in a pandemic where no interventions have been implemented; that multiple social distancing measures applied early and continuously can be very effective in interrupting transmission of the pandemic virus for R(0) values up to 2.5; and that different conclusions reached on the simulated benefit of school closure in published models appear to result from differences in assumptions about the timing and duration of school closure and flow-on effects on other social contacts resulting from school closure. CONCLUSION Models of the spread and control of pandemic influenza have the potential to assist policy makers with decisions about which control strategies to adopt. However, attention needs to be given by policy makers to the assumptions underpinning both the models and the control strategies examined.
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Affiliation(s)
- George J Milne
- School of Computer Science and Software Engineering, The University of Western Australia, Crawley, Western Australia, Australia.
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Ackroyd KS, Campbell JW, Dean CE, Enderby M, Gregory CM, Hayes MA, Hughes EA, Kinder SH, Kirkman IW, Mant GR, Miller MC, Milne GJ, Ramsdale CA, Stephenson PC, Pantos E. Computing for synchrotron radiation experiments. J Synchrotron Radiat 1994; 1:63-8. [PMID: 16728785 DOI: 10.1107/s0909049594006151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Computing provision is of major concern to synchrotron radiation researchers. An overview is presented of the computing facilities for synchrotron radiation work at the Synchrotron Radiation Source, Daresbury Laboratory. Data acquisition, reduction and analysis are seen as an integrated activity essential for full utilization of beam time. We discuss the evolution of data-acquisition systems from stand-alone systems of limited computing power, to a unified project computing village using state-of-the-art equipment for combined-technique, high-data-rate experiments. A brief account of software packages for data reduction and analysis is also given.
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